Friday, February 26, 2010

Dou-la-la's Top Three Breastfeeding Books

Back from Family Travel 2010, Jaunt #1 and raring to get posting again.

As it happens, the travel provided a perfect segue: while I was visiting some relatives, a new mom-to-be asked me for a breastfeeding book recommendation, and it reminded me that I've been meaning to get to this for awhile. Since I've gotten multiple requests for recommendations in a number of areas (birth, pregnancy, parenting in general, and thusandsuch), I'll make this a series. But today, let's start with la leche.

1. Hands-down, no contest, for my money, the best breastfeeding book out there is . . . "Breastfeeding Made Simple", by Kathleen Kendall-Tackett and Nancy Mohrbacher.

Why do I love it so? First, the information is spot-on, as one would expect from a book written by not one, but TWO IBCLCs (this is the gold standard for lactation consultants). They pull no punches and give the most accurate, thorough advice I have encountered in a single source. Second, I love the way this is organized. Some breastfeeding books I have received have good information and decent advice, but one would never sit down and read it from cover to cover. Rather, the inclination is to skim them initially and then cherry-pick whatever you happen to need at the moment as issues come up. There's nothing wrong with using books as wonderreferences (in fact, choice #2 falls much more into this category), but a lot of essential information can be missed this way.

Here, the authors lay out Seven Natural Laws of Breastfeeding, under which everything ultimately falls, and it flows as a wonderfully readable whole out of this structure. The natural laws are:

1. Babies Are Hardwired to Breastfeed
2. Mother's Body is Baby’s Natural Habitat
3. Better Feel and Flow Happen in the Comfort Zone
4. More Breastfeeding at First Means More Milk Later
5. Every Breastfeeding Couple Has Its Own Rhythm
6. More Milk Out = More Milk Made
7. Children Wean Naturally

I love this, because really, in essence, these laws cover everything. I do think new mothers often suffer from information overload, and this can be particularly true when it comes to breastfeeding. And, as I've often seen struggling moms bemoan, isn't this supposed to come naturally? So how come I have to read all these instructions and learn all these techniques and remember all these facts? This approach, looking at everything through the natural laws, brings it back to nature - and crucially, appeals to the right brain. Information overload is very much a left-brained circumstance, and breastfeeding is very much a right-brained activity. The authors themselves explain this here.

Yes, they then go into detail with how each law applies to real life situations, from the basics through common and not-so-common problems, but if every mom really took each of the laws to heart as-is, she's already setting herself up for success. I'm certainly not saying she might not need and want some more information - I'm a big fan of information, hence, this post, and hence, my overabundant library and praise of lactation support when needed. I do think that when the going gets tough, sometimes keeping things as simple as possible is key, and I absolutely love the simple essence of the Seven Laws.

It's also well-written, period. I found it easy to understand and very warm and relatable. Once complaint I have heard was that they tend to be anti-formula. It's true that they are forthright about the risks of artificial feeding, but I never caught any hint of judgment from them, certainly not when it comes to the minority of women who truly cannot breastfeed. They are also more than aware that inadequate support and bad advice has jeopardized the best intentions of women who really did give it their best effort, and this is expressed compassionately. And honestly, I would be disappointed and frankly perplexed by any breastfeeding book that was pro-formula. I don't expect a vegetarian cookbook to be pro-meat (not an airtight analogy, but you catch my drift).

My sole criticism is a very simple one: the lack of an index! This drove me a tiny bit crazy - I need to be able to look things up quickly and easily, even if a book is more than just a reference. But on that very note, I have good news, thanks to Kendall-Tackett befriending me on Facebook - they are currently at work on a second edition of the book, coming soon, which will indeed feature an index! I guess I wasn't the only curmudgeon dependent on them. Their website has some great resources on it too, including things impossible to include in a book, like latch videos.

In short, if you buy only ONE book about breastfeeding, this would do you very, very well. I always like to have multiple sources (to say the least), but I realize not everyone is a huge nerd on the this and related topics.

2. Second in line is "The Ultimate Breastfeeding Book of Answers" by Dr. Jack Newman.

Unlike the other two on my list, I can't say that this is a great sit-down-and-read-start-to-finish book, but it IS an excellent, thorough, accurate resource. It's also very interesting, for those interested in breastfeeding as a topic as well as an activity, to read about his experience with breastfeeding over the years as a pediatrician. Support from the medical community has come a long way in recent years (though it still has a long way to go), and it's quite something to see what the changes have been like from the 'inside'.

As you would expect, the book is chockablock with solid medical advice and steadfast faith in the power of the breastfeeding dyad. Getting the latch correct solves a multitude of problems for most mothers, and he correspondingly spends a good deal of time on the matter. Dr. Newman also has an excellent website with good videos, by the way. If you're simply a mother looking for one good, solid overview, I would say the other two on the list would be better choices, but pairing this with another book is perfect if you can swing it. And for birth/baby/boob professionals, I think it's a must for your library.

3. Finally, a surprising entry: "So That's What They're For" by Janet Tamaro.

I ignored this book for a long, long time. Years. It just struck me as a book that would be silly or even flip about the topic, and I thought the title and cover way too cutesy for me. I still don't LOVE the cover, but guess what? The book itself is, in fact, very, very good. Of the three favorites here, it is the most purely enjoyable, and contrary to my prejudices, actually delivers excellent information. Tamaro's sense of humor is scattered throughout without overdoing it - it's just the right mix of lighthearted and informative. Best of all, it really lends itself to reading cover to cover - it's as close as a breastfeeding manual can get to a page-turner.

Quibbles: Some of the information is a little out of date: for one thing, HIV recommendations have changed since publication (it's definitely complex, but not necessarily contraindicated in all situations). Food allergies and the connection between mom's diet and baby's reactions gets glossed over - an important issue for some moms. Tamaro is also a bit underinformed about medications and breastfeeding, and takes a relatively conservative approach to the topic, when in fact many medications are compatible with breastfeeding, often unbeknownst to the prescribing physicians themselves, as they're simply untrained in lactation. (The Hale Guide is THE way to go here.)

But the complaints are very much outweighed by the very strong, solid basics, conveyed in an entertaining way - a tough balance to strike for many authors, and it's such an important one. Amusing or revealing anecdotes illustrate key points without overshadowing the core information, which is no easy feat. Tamaro does a good job covering some common challenges as well.

I'm so thankful I finally gave this a try, on a whim. It's a great fit for so many prospective and current breastfeeders out there - I'll be lending and recommending it liberally. What's that saying, you can't judge a something by its something? Yep.

Friday, February 19, 2010

Thursday, February 18, 2010

Like Mother, Like Daughter

I neglected to mention that I'm out of town at the moment, and thus online less copiously. I meant to post this yesterday for Wordless Wednesday - check out how the little pumpkin-headed chip off my old block loves on the babehs.

(The best moment is at about 0:41.)

Incidentally, the adorable wee bairn Lily is so enthusiastically macking on is the homebirthed baby from this post here! Mama promised a birth story soon(ish).

Sunday, February 14, 2010

Weekend Movie: The mixed bag that is the Duggars' home birth

My feelings about the Duggars are mixed, admittedly. There's much to appreciate along with the things I might view more critically, but in the best, most thought-provoking way.

I won't digress into the pros and cons of the Duggar phenomenon here, but, like the Duggars as a whole, the episode of "19 and Counting" which features Anna Duggar's home birth leaves me a little befuddled as to where I stand. I finally got to watch the big event on YouTube (we haz no cable, or any other direct source, so have to download, use DVDs or watch things online; it keeps life simpler while still allowing for marathon Buffy festivals when needed).

Here we get to see Josh (the eldest Duggar child) and his wife, Anna, attending Bradley classes; having a baby shower, at which I was pleased to see they did the melted-candy-in-the-diaper game that I insisted my friends include at mine, which pretty much says it all about me; and eventually giving birth to Mackynzie Renee (breaking out of the J's) at home with a doula. More on that in a moment.

Check this out. I'm embedding the last of the 6 that comprise this episode - you can get to the other links in the "related videos" sidebar when you pop out the video into its own YouTube window or tab. The first ones includes some backstory about their budding relationship and then young married life, which should fulfill anyone's quota for wholesome viewing for at least a year or so. (The birth nitty gritty starts in part 6, if you prefer to skip the shower footage, and I would hardly blame you.)

So what's your problem, Dou-la-la? Isn't it so nice to see something other than the standard medically-overmanaged affairs of "A Baby Story"/"Maternity Ward" et. al. on TLC? Well, yes, it is. And yet . . . I still have some mixed feelings. Purely from what we are told in the show, the birth was, as I mentioned above, attended by a doula. Note, not a midwife and a doula, but a doula. In the video, Josh clearly says to Jim Bob on the phone the morning Anna went into labor that they were "considering a home birth" , and that they asked their doula if she would be cool with attending them if they stayed at home.

Now, this very well may be poor editing on TLC's part. The woman who attends them may in fact be a trained midwife who had previously been engaged to act as a doula if they were in the hospital, and the fact that she is seen wearing gloves, weighing the baby with the standard midwives' hanging scale, and has cord-clamping tools on hand SEEMS to imply this, but we just don't know. If she is only a doula (and I don't mean "only" in the pejorative, of course), then she is going WAAAAAY beyond the scope of practice. Josh mentions that Anna was "completely dilated" when she started to push. Doesn't that sound to you like somebody was doing internal exams?

AHEM! Note to possibly alarmed readers: this is not part of DONA's training! Even ALACE/toLabor's workshop, which includes the option of both giving and receiving a pelvic exam as a learning experience, in no way endorses ever performing them on clients, and has nothing to do with assessing dilation.

So. One of two things is possible: perhaps the doula actually IS a midwife, and TLC just bungled the information, which should really surprise no one. Or, they essentially had an unassisted birth. I have yet to address "freebirthing" here, and have been stalling on doing so for a while. I won't get into that now, but I do feel the presentation of this birth was confusing, for all its positive aspects (and there are plenty of those too - I love that they showed Josh catching his daughter, I loved her laboring in the tub, I loved the Bradley classes, and just generally loved the emphasis from everyone, including new grandma Michelle, on how peaceful and beautiful the birth was).

Anyway, true to form, another Duggar moment leaves me dazed and confused and unsure of where I stand, seeing both sides, not bearing them any ill will, yet having serious reservations about what is being represented and how.

Thursday, February 11, 2010

Reply turned post on "Why choose home birth?"

The Batsignal went up on Facebook, calling homebirthers (and others) in to this inquisitive post at Majikthise: What Is the Appeal of Home Birth?

She asks, in earnest and without rancor:

I've never understood why anyone would choose to give birth at home, rather than in a birthing center attached to a hospital. a) Why not go somewhere where you don't have to wash the sheets? b) If there's even a remote chance that you need emergency surgery, why not arrange to be seconds away from an operating room rather than minutes, or longer?

I know that childbirth isn't a disease. On the other hand, if I had a non-disease where there was a small chance that I'd need emergency surgery within the next 72 hours, I'd prefer to park myself as close to an OR as possible.

I understand that every woman has the absolute right to make her own decisions about where and how to give birth. I'm not trying to influence anyone else.

By the time I got over there, the topic had been well-covered, safety issues addressed, specifics taken care of. So I just added my $0.02. It occurred to me that although I posted some longwinded spiels, I hadn't ever posted a simple nutshell version on my own darn blog, so here you go.
Why, because Ricki Lake did it, of course!

BUT SERIOUSLY, folks. Everyone else's answers [check out the original post and comments] completely cover my own rationale: the safety of home birth versus fighting the cascade of interventions at the hospitals. The risks of the latter put me over the edge. I won't rehash what others have covered so eloquently. Essentially, for me as an individual:

1. While it is technically possible to battle your way through the hospital for a natural birth, refusing intervention after intervention, protocol after protocol, arguing policy, fending off negative attitudes by way of the crapshoot re: which L&D nurses you get (some are great, some are not, almost all are overworked), I decided that I would rather not spend my whole labor - the birth of my child - fighting with strangers.

Your mileage may vary, and not ALL hospitals are like this. But it's fair to say that in this current state of maternity care, the odds make me wary indeed, even if you choose the perfect open-minded, supportive care provider (who may not even be the one who ends up attending you, due to the nature of group practice).

2. By the time I got pregnant, I had both read and heard firsthand SO MANY crappy hospital experiences for a first birth followed by a wonderful, healing, life-affirming experience with their second birth at home, that I just decided, "Well . . . why don't I just skip the crappy hospital experience?"

And so I did.

Final note on the matter of cleanup - as others have said, it's really nothing. So you stain some secondhand sheets and toss them, and chux pads take care of the rest, if any. It's a cinch. OR - buy/rent a birth pool and have a waterbirth! Issue = moot.

Monday, February 8, 2010

Mothering the mother in ALL circumstances: doulas and cesareans

I recently had the opportunity to do a consultation with a mother who is considering hiring a doula for her medically necessary scheduled C-section. Being me, I fear that I might have barraged her with a garrulous deluge of overinformation, but the interest was definitely there, and a good connection was made. (It would be a new experience for me, too, so my eager enthusiasm may have added to the overload.) Hopefully she'll be able to process what we talked about in her own time, along with the folder full of printouts I gave her.

So, what ARE the advantages of having a doula present at a cesarean, especially a planned one? As I wrote in the previous post on cesareans and birth plans, isn't the whole idea to use them (plans and doulas) to avoid having cesareans in the first place?

Yes and no. It's true that a woman seeking a natural or minimally interventive childbirth is doing herself a great favor by seeking out doula support. But A) There are, of course, rare times when complications can arise, even in a well-supported normal birth, and a cesarean truly is a lifesaving situation. Should the doula pack her bags and take off at that point? Of course not. She probably will not be allowed in the OR if the father is present, but there are other ways she can continue to be of great service, as I'll discuss in a moment.

And B) On a broader note, doulas are there to enhance ALL birth experiences for all women, and priority one is to support mom's own choices, helping her to achieve her own goals. The mission statement for doulas is often summarized as, simply, "mothering the mother". Yes, of course we do everything we can, within reason and within mom's parameters, to help her avoid a cesarean if she doesn't want one (and most women hiring doulas obviously don't), but we are not just vaginal-exit-only cheerleaders. This seems more obviously logical if the need for a c-section arises out of a spontaneous labor, but though it's rarer, there's no reason a doula would not be valuable, in some different ways as well as some very much identical ways.

So, then, what are some of the specific things a doula can provide to a mother having a cesarean? Let's say for the sake of argument that this needs to be a scheduled event (though much of it applies regardless). I would say there are three primary advantages to having a doula in this situation.

First of all, a doula can help the mother develop a birth plan that makes the absolute most out of the situation. The choices will have to be approved by the doctor and hospital, of course, but as I wrote in my post on c-section birth plans, there are actually a multitude of choices to be made. Some of those choices may be brought up by your doctor, but many others may not - they might even be new to him or her, and there are good doctors out there who are willing to try new things and learn and grow in their practice. Check out that post for a detailed discussion of the options available. The same doula can educate the parents about the whole overall process as well, if their doctor isn't able to take as much time explaining things as they'd like.

Secondly, it is a truth that more babies born via cesarean may have to spend some time in the NICU. Should that happen, typically the father will go with the baby - leaving mom alone and unsupported. The delivery of the baby, once everyone is prepped and ready, only takes a few minutes (5-15, depending on circumstances), but putting mom back together again takes significantly longer, generally 45 minutes to an hour, and that's assuming there are no complications. This can be a very difficult time for mom if her baby has been taken away, and having the doula step in for emotional support and companionship can make a huge difference.

The third major advantage is helping to get breastfeeding established. This is more challenging for moms in terms of positioning, even for experienced mothers with existing children, and can be particularly confounding for a first-time mom who is learning to nurse for the first time. Milk can also take a bit longer to come in (remember, though, 3 to 5 days is perfectly normal), and sometimes cesarean babies can be sleepy due to medication. If the baby is having to stay in the NICU, a doula can help mom to get pumping right away, establishing her supply and providing the baby with the best possible nourishment for him or her. All of these extra challenges are much easier to face with doula support.

Now, there are definitely some L&D nurses who are very good with breastfeeding, but, it must be said, there are sadly some who are not. Many a breastfeeding relationship has been sabotaged by hospital practices, even with an uncomplicated vaginal birth. And even the nurses who are good can be in short supply if you happen to be there on a particularly busy day. Same goes for actual lactation consultants. Some hospitals have them, but availability (and quality, too) can be limited.

Those, as I said, are the big ones. There are a lot of other little things that a doula can help with along the way - guiding both mom and dad through the admissions process; helping mom relax during the prep for surgery, including the epidural or spinal (a big fear for a lot of women); taking pictures as much as is desired and possible; keeping communication going between parents if they are separated by a NICU stay, and keeping mom up-to-date on baby's status; establishing skin-to-skin contact as soon as possible, which can be difficult if mom is having trouble with uncontrollable shaking from the anesthesia; running interference with relatives if needed, even running errands for the parents.

But hold on here, are you even allowed to have a doula in the operating room? In some cases, no. If the need for one arises during labor, it's true that it is very unlikely that a second support person will be allowed, though the doula can be standing by should dad have a hard time with the procedure or become ill or pass out - rare, but it does happen. (The other advantages of doula support still remain.) But if it is a scheduled cesarean, it is possible that special arrangements can be made in advance. As doula Rachel Wickersham explains:
Though it is possible your caregiver may initially be resistant to the idea of a doula in surgery with you and your partner, you may be able to convince him or her of the possible benefits to you - especially if you work with a doula who attended at least a few. And this may not be as far fetched as it may seem. I know of at least one practice in which there are doulas who specialize in cesarean.
I came across one mother's story of how invaluable her doula Shelly was for her own cesarean birth at Fort Wayne Doula Network. After attempts to turn Alison's breech baby via external version were unsuccessful, the family reluctantly decided to proceed with a C-section.
Shelly was very sympathetic and reassuring to us both. Mostly without words. Which we appreciated. She and Doug left the room while they prepped me for surgery. When they came back we made sure Shelly had her camera. Although we cried through the c-section a little it was very exciting too.

From the moment they got the baby's little bottom out Shelly started snapping pictures and showing them to me so I felt more a part of what was going on instead of so disconnected. It was great to have Doug and Shelly there so one person could be with me and one with the baby at all times until I joined him in the recovery room. She also unlatched my arm to touch the baby better after my pitiful attempts to stroke his little head while restrained for the surgery.

Shelly was intregal in getting me nursing the baby within 40 minutes of birth (not bad for a c-section!) She continued "nursing" Doug back to health a little bit by getting him what he needed and also helping out so he could get to the post partem room to rest for a bit. I was wheeled to my room with my sweet baby latched on and nursing like a pro!

Once we were settled in our room for a little bit Shelly asked if it would be ok timing for her to slip out for a bite to eat and to develop the pictures. When she returned she had an album of all the pictures she'd taken. I cried as I flipped through them... I would continue flipping through them MANY times over the next few weeks until I had memorized them so it actually felt like my memories instead of the actual memories I had of trying so hard to see everything and be a part of it while my baby was so far away at the little bassinet as they measured and treated him (the whole time he's just wailing for Mama)

I can't describe how much it meant having Shelly there. I am trying to in this email, and I tried to when I wrote her a thank you note after coming home from the hospital. But she was much more than a doula to me that day. She was a mother figure that I so needed. She filled that role when I needed it most. She was concerned for me and excited for me and I felt as if I'd always known her. She was truly the only advocate I really felt I had that day with me. My midwife was not able to be there during the c-section, and Doug was still kind of coming around and trying to get to feeling better himself. It was a very emotional day- but thanks to Shelly and her support the deliriously joyful emotions outweighed the negative. I had a happy, healthy (Big) boy and was well cared for with my medical needs.

Shelly helped give me memories by taking pictures of what I otherwise would not have seen. I can't tell you the value of that. It's priceless. I wonder if a doula isn't maybe even more needed w/ a c-section than a normal labor/birth- for the emotional side of it anyway. Even though it's such a shorter period of time. I guess everyone's experience is different. Shelly helped make the overtones of the day very happy. I just don't know how many different ways I can say it.
Two other great pieces I've found online do a great job of explaining the value of doulas with C-sections: Doula for a Cesarean Birth, by Robin Elise Weiss and the aforementioned "Is it worth hiring a doula if I'm going to have a C-section? by Rachel Wickersham.

Did a doula help you during your C-section? Have you been a doula at cesarean births? Please share your stories!

UPDATE: Make sure you check out the video about the "Natural Cesarean", a piece that began circulating after this post was originally published. The demand for this approach definitely seems to be growing!

Saturday, February 6, 2010

"The first thing I'm going to tell you is that your daughter is beautiful and perfect."

In lieu of my usual Weekend Movie offering, today I absolutely must share with you the birth story of Nella Cordelia. Be warned, this is pretty heartwrenching - but also incredibly heartwarming in the end. This mother is amazingly honest, raw, eloquent, and fierce. And anyone reading this can tell that she is the perfect mother for little Nella, with the perfect family and group of friends to come along on the journey.

Make sure you have tissues handy. I was mostly holding it together until she wrote: "Love me. Love me. I'm not what you expected, but oh, please love me."

Welcome to Holland, Kelle. Welcome to Holland.

Monday, February 1, 2010

Ready, Set, Suck: On breastfeeding marketing & Medela's WHO violations

It came to my attention not too long ago that Medela, probably the largest manufacturer of breastfeeding-related products, might be less than squeaky clean in terms of their compliance with the very important WHO Code regarding marketing of formula, bottles, and other breast & breastmilk replacing products. But I managed to coast along in denial for a while longer, having had Medela products play such a huge role in my daughter's long and exhausting road to the breast.

Their high quality, extremely efficient Advanced Pump in Style double electric breast pump was what got Lily fed, period, for the first 5 months of her life, while my LC and I worked at various strategies to get her to latch. Using the SNS was an important step we needed to take along the way (though I ultimately found the Lact-Aid to be superior), as were their nipple shields. And primarily because I became emotionally invested in them, I also purchased accessories like their breastmilk storage bags, breast shells to help draw out flat or inverted nipples (and to air-dry them if sore or healing), their travel wipes for the pump, and the microwave steam cleaning bags. It’s convenient when the pump you’re using fits with the bottles you want to use, when replacement attachments are readily available, and when you feel like there’s a consistent quality there that you can trust. I completely understand that kind of brand loyalty.

Because I was such a loyal customer, it was all the more stinging to read this post by PhD in Parenting last week, full of serious truthiness as it is. I won't rehash the entire thing here, as she has done such a good job already, as did the above much earlier post from Hoyden About Town - do go check them out for yourself. Suffice it to say that not only has Medela flipped the bird at the code, marketing bottles in violation, they're now making matters even worse with this sly, underhanded "Medela Mom Mavens" campaign.

I can understand, to a degree, that it's a tricky line to walk at times. Having some of these products available, like the ones my daughter and I benefited from during our insane nursing saga, is important. They should be available to moms who need them, and easily so. I am thankful that when I needed a different size nipple shield, I was able to run out to the local big box baby store (more on that in a sec) and pick one up. I'm thankful that replacement attachments for the pump were similarly conveniently available. I am thankful that the moment it seemed like my situation might call for an SNS, my LC was able to hand me one immediately. Such breastfeeding support products can make a HUGE difference in breastfeeding success when there are complications. As Annie at PhD in Parenting says:

I don’t want to be overly critical of Medela. I think the company does a great job promoting and facilitating breastfeeding. Most of the information on its website is wonderful. Most of its products are of the highest quality. I have been nothing but happy with my Medela products. However, I do think that some of their current actions to promote their bottles are inappropriate. It would not be difficult for Medela to continue to promote breastfeeding and sell its bottles without promoting them. However, it has chosen to ignore the WHO Code and push more bottle imagery and bottle messaging on moms (more on why bottle imagery and messaging is hurtful here). The result is that Medela is directly pushing bottles on moms and also doing so indirectly via the Medela Mavens and others who might pick up on the message about how breastfeeding ties you down, so you really need a pump and bottles so you can get your hair done.

To be clear, on a sliding scale this is not even close to Enfamil or Nestle or other formula companies. Not even close. But I would argue, and others do argue, that any violation of the WHO Code weakens its potential impact. We cannot say “it’s okay because you are Medela,” but then slap Nestle on the hand for everything it does wrong.
Lines have been crossed, not only in the clearer terms of promoting their "breastmilk bottles", but in the more nebulous grey area of promoting products over breastfeeding. I've been mulling all this over for a few days, and trying to find a way to put that thought into words, and then I went to the big box baby store yesterday, a trip that was disappointing on two levels.

I was there to drop off some flyers for the upcoming doula training I'm sponsoring, as well as some business cards. The last few times I was there (hey, pickin's are slim in this town), probably 2 months ago or so, there was a small table behind the registry area where local birth and baby-related services could leave their materials. There was never a lot, but there was a brochure for an independent childbirth class, cards for a breastfeeding support group, a small calendar of mom's playgroup activities, that kind of thing.

When I walked in yesterday, the table was empty. I asked an employee whether it had moved, or if there was another area to post about things like childbirth classes - a community message board, perhaps. She told me that no, they had decided to not allow outside materials any longer. Disappointment #1, in terms of small businesses and independent agencies. But hey, she said, they have some classes of their own! She pointed out the board below:

Here's a closer look:

A "Breastfeeding 101" workshop, sponsored by You Know Who! A basics of breastfeeding class whose description begins with "Ready, set, pump!"

If that doesn't make their priorities clear, I don't know what will. Believe me, I know firsthand that a pump is sometimes absolutely essential. And certainly it is for mothers who work outside the home. Hallelujah for them, seriously. But a breastfeeding class that focuses first and foremost on pumping? The rest of the description: "Get the scoop on breastfeeding and all the great products sure to make it easy to feed baby naturally." I mean, it's not that I was surprised to see a live, in-person infomercial for Medela products disguised as a breastfeeding "class". Especially not at a big box store (with similar classes in car seats, sponsored by Graco, and the like). I'm not so naive. Just very, very disappointed.

So, like many other lactivist moms out there, I can no longer in good conscience continue to promote Medela products. So what to recommend in its place? Just West of Crunchy has an excellent and thorough post on the matter, which starts out bemoaning the same state of affairs and then goes on to explain the Hygeia and Ameda pumps, both of which sound great - in addition to being WHO compliant, and proudly so, unlike some people, they are also closed system pumps, much preferable to Medela's open systems. She explains it all adeptly here:

If more mothers knew the facts about their beloved Pump in Style pumps, Medela would be selling a lot less of them. And I can speak from experience, I have a PIS sitting in my closet, waiting to die a slow death in a landfill.

Why? Because it can't be given to anyone else. That's right, my $280 breastpump has to be tossed in the trash. It's not FDA approved for more than one user. Even though I only used it maybe 30 times. And I know there's a huge black market for the sale and donation of used single-user pumps, but you know what? Even if I could, I wouldn't give the thing away to another mom. Because once you know the facts on the Medela pumps, you won't want to use them.

There are "closed system" pumps and "open system" pumps. Medela is the latter. Having an "open system" means that milk can contaminate the tubing and the motor to the pump. And while the tubing can be cleaned or replaced, the motor cannot. Which means if my milk makes it into the motor, so could a hypothetical seccond user's, at which a time they'd mix. The motor can't be cleaned or sanitized, and there's no way to know if milk ever contaminated it. So, if you're using a second-hand pump, it might be clean, or it might not. Your guess is as good as mine.

But even if you follow the rules an purchase a new Medela pump, keep it, and never allow it to be used by a second party, you can still have problems. It's important to note that Medela is completely open about their pumps being single-use only, they're very forthright about that. The information that's lacking, though, is that you can actually end up with MOLD in your pump motor and tubing, due to the open system design. The milk that you can't see in the motor - that you have no way of knowing whether it's there or not - can grow mold inside your pump. You can also end up with mold in the tubing (a lesser problem, as that's replaceable).

I don't know about you, but I'd rather have a pump that has ZERO chance of developing mold in its motor. Both Hygeia and Ameda offer pumps that have closed systems. You're not going to get milk in them, because the way they're designed, there's no backflow. Not only are these WHO Code compliant companies, they make superior products!

I took a look at Big Box Baby Store's pumps to see if they had either of the above. Nope. [See update below!] They had one Lansinoh electric pump, and one Evenflo hand pump, and the rest was, of course, all Medela, all the time. So, it's frustrating. Medela is no doubt the most widely available. You can go see them for yourself, talk to a salesperson, and take one home the same day. Ordering things online is less appealing and even prohibitive for some people. But I have to recommend doing so nonetheless, at least until/unless Medela does a serious 180 (and I would be thrilled if they did). If you're lucky enough to live in an area with smaller businesses that might sell alternative pumps directly, then hooray (for that among other reasons).

What about some of the other products, though? Smaller ticket, yes, maybe not as big a deal to the company, but still. I can make a few recommendations. For the best storage bags: I always liked Lansinoh's. And I honestly would recommend the Lact-Aid over the SNS even if Medela was behaving ethically - same basic concept, but the difference in user-friendliness is HUGE, and again I must point out that Lily would NOT be nursing today were it not for the Lact-Aid - along with the brilliance of my LC of course. But I digress: As for nipple shields, that's one where I'm stumped. Breast shells as well - I know that for drawing out inverted nipples, Supple Cups are now available, and reputed to be very good, but for helping to air-dry sore or wounded nipples, I'm not familiar with an alternate brand. Lactation pros, moms with nursing challenge experience, do you have any ideas? Please chime in.

I close with the following from the Hoyden About Town piece, on the insidiousness of Medela's current marketing:
[Medela's commercial states:] “When you choose to breastfeed, you’re doing what’s best for your baby. When you choose Medela breastfeeding products, you’re doing what’s best for you both.”

Medela is saying, directly, that breastfeeding is not best for women. It might be ok for babies, sure, because they get the breastmilk, but Medela is telling us loud and clear that pumping is better for mothers than breastfeeding is. No qualifications, no circumstances; just “pumping and bottle-feeding is best for women”, with a side serve of “and it’s just as good for babies”.

This isn’t just a WHO Code violation; it’s not true. And it’s a lie fed by all of our dysfunctional societal issues around breasts and breastfeeding and public feeding and mother-child attachment and women and the workplace. It’s fed by the huge pile of myths about how easy pumping is, and about how bottled stored breastmilk is just as good, and about how it’s vital to schedule feeds and “see how much babies are taking”, and about how babies don’t know when they’re hungry or thirsty or full or in need of comfort. The problem is, it isn’t just fed by those dysfunctions, it’s feeding back into them, reinforcing them.

These sorts of advertisements are part of the huge coercive societal mechanism denying support for mothers and children, part of the capitalist machine preventing women from being able to afford time with new babies, and keeping them being good little workers and consumers. I think it’s no coincidence that two countries with no moves towards a full legislative implementation of the Code, the USA and Australia, are also the only two industrialised countries in the world without mandatory paid maternity leave.

Words mean stuff. Marketing is powerful. Advertising works.

And it makes a whoooole lot of money.


UPDATE 8/31/10: Ameda pumps are available in Babies R Us nationwide now, and not only that, the Lansinoh double-electric pump for $150 is actually an Ameda pump, rebranded, and at half the price.

*The hospital-grade pump Symphony pump IS a closed system, so this is the one exception in the Medela line, ethical issues notwithstanding. Moms needing to rent these when there's not an alternative brand available should feel safe.