Tuesday, August 27, 2013

Triumphant Tuesday - Exclusive pumping to exclusive nursing

Sometimes occasions arise which prevent a mom from being able to nurse her baby. Many mothers who have a baby who cannot or will not latch, for whatever reason, resign their breastfeeding dreams to failure folder and reach straight for formula. There is a more baby-friendly option however, and one that doesn’t seem to get the support or acknowledgment it deserves: exclusive pumping.

When faced with receiving breast milk, or not, method of delivery often becomes a moot issue. Many exclusively pumping mothers are doing the best they can in the situation they find themselves. However, situations evolve. Lots of pumping moms dream of sacking the pump in favour of exclusive nursing. The following story details one mom’s journey from one end of the spectrum to the other.

“When I was pregnant with my son I wasn't sure I wanted to breastfeed, since I had failed to breastfeed my daughter in the past. But time waits for no mom, at 35 weeks pregnant I woke up to regular contractions ranging from 3 to 10 minutes apart. I waited until after supper and then headed to Labor & Delivery triage to be monitored. It turned out these contractions were only Braxton Hicks however the medical staff found proteins in my urine and my blood pressure was borderline high, so I was admitted for a 24 hour urine analysis.

Induction or c-section?

After the 24 hours were up I was beginning to develop preeclampsia.  Consequently it was decided that I should be induced that night. I had just settled in to watch a movie when my nurse rolled in, announcing the news. Nothing short of "freak out" could describe me at that point. It was 11:30pm and my mom wasn't answering her phone, so I was starting to have a mild panic attack. I couldn't be induced alone!

I finally got in touch with her while I packed up my stuff. She wheeled me into a labour room and the on-call OB came in to talk to me. She did an ultrasound to determine baby's position and talked to me about my options. Since I was only 35 weeks my cervix definitely wasn't primed for delivery, which meant I would have some sort of device inserted into my vagina against my cervix to help ripen it. After a certain amount of time if it wasn't ready I was told I would have to consider a C-Section.

The nurse also told me that because of the C-Section I had with my daughter, the medicine used to help thin the cervix also posed a risk to my previous incision, meaning rupture and potential death for me and my son. Since I had already gone through a C-Section and knew the risks, I decided to just go for it. The OB's bedside manner sucked and I felt pressured into a decision without being able to consider fully my options.

Once that decision was made the nurses started prepping me for the surgery. When time came for the spinal I had another mild panic attack and was given some meds to help me calm down. It made me spacey and by the time my son was born I'd forgotten why I was there in the first place. I didn't get to completely enjoy his moment of birth because of all the drugs I was on.


My son was 4 lbs 2 oz at birth and because he was born at 35.2 weeks gestation he was taken to the NICU. I don't remember looking at him before he was taken away and didn't get to see him until he was almost 8 hours old. I didn't get to hold him until he was 14 hours old. Although I loved him completely I felt disconnected because he was stuck in his plastic box and the only way I could touch him was through a small hole in the side.


My son’s assigned nurse told me I needed to pump every two hours to build and maintain a decent milk supply. I tried hard not to bawl each time I thought about what a wreck my mothering experience was thus far. How did she expect me to attach myself to a pump every two hours? The Lactation Consultant was lovely and tried her best to help me express manually, but I wasn't quite catching on. I still had the drugs in my system and found it hard to stay awake for more than an hour at a time. My milk hadn't come in so when I did pump I would get very little, which made me feel like my body wasn't able to produce anyway, so what was the point?

Day 3 and my milk started coming in. The nurses were very impressed so it boosted my confidence in this pumping nonsense. Day 3 was also when my "baby blues" kicked in full force. I cried almost all day for close to three days straight. I couldn't cope with not being pregnant and not having a baby to show for it. I developed a pumping routine, but nowhere near the 2 hours the nurses asked for.

Day 4 was my discharge day. My hospital's NICU has "parent care" rooms that they offer to the baby's mothers. I had my 5 year old daughter at home so I would be with her during the day and then I stayed at the hospital for the first two nights. I rented a pump from the hospital to keep with me at home and used it when I was able to but my determination left much to be desired. During the day at the hospital I would pump there. I had a decent stash in the NICU's fridge so I didn't see it as a priority to pump as often as I should of.

During my son's 11 day NICU stay the LC tried helping me to get him to latch and nurse on a few occasions. Because of the premature birth and the NICU ins and outs, I was resenting pretty much everything. I didn't want to put forth the work to get him to latch if it wasn't going to magically happen the first time. I figured since I was already pumping anyway, once we went home I would exclusively pump and feed him by bottle.

During the first 3 - 4 weeks I had a major over-supply so I didn't pump as often as needed to maintain a decent milk supply long term. Around the 6 1/2 week mark I noticed the 4 - 6 bottles I had in the fridge started dropping to 2 - 4. By the end of that week I was pumping just for the upcoming feed.

Exclusive bottle feeding to exclusive breastfeeding

Numerous times I wondered briefly about putting my son on the breast just to see what he'd do. Then one day when my daughter was at school and I was home alone, I decided to try. After a full bottle feed I put my son to the breast. To my surprise, he latched and started nursing like a pro! He was a rockstar nurser! It took roughly 3 days to go from 8 weeks of exclusive bottle feeding to exclusive breastfeeding. The process was fairly simple: I would let him nurse as long as he wanted and if he still seemed hungry I would top him off with a bit of a bottle. Gradually he just wouldn't want the bottle after nursing. To say I was proud of myself and my son was a huge understatement. I felt like we could do anything!

Pediatrician pushing formula

Since he had been born, my son had a bit of a stomach issue. His stomach couldn't tolerate big feeds and he would throw it back up, hindering his weight gain. Because of his prematurity we see a pediatrician as well as his regular family doctor. The pediatrician's main job is looking for problems related to being premature. One big concern, for me, was the fact that he would spit up constantly after every feed. The pedi started bugging me to supplement with formula to get his weight up. I was devastated. I did not want to give him formula because of everything he'd gone through in the NICU, his stomach issues, plus finally developing our breastfeeding relationship. It felt like we'd gotten 3 steps ahead then were pushed 6 steps back. The pedi didn't seem concerned about his spitting up at all, just about getting calories into him. I wondered how was he to gain weight when he can't keep anything down. Despite not gaining he was a happy, healthy baby so I opted to try other methods before resorting to formula. 

My son's weight gain has been slow, but at his 9 month appointment he weighed over 17 lbs, so I would say he is thriving well. He is almost 12 months old now and is still breastfeeding. He was made to breastfeed.

Single motherhood

Through all of this I've been single so I've been doing it all on my own. My son's father is not supportive and would rather I wean if it means he can have overnight visits sooner. He would rather give his son formula than let him have the best start to his life possible. Needless to say he wasn't impressed when I'd told him our son was exclusively breastfeeding. When our son refused the bottles with the formula, my ex went behind my back and tried to give him a sippy cup,even though I'd specifically told him not to. 

Breastfeeding has been a very empowering experience, especially considering how rocky our start was. My original goal was 12 months but now I'm hoping to exceed that by a long shot. I think it's selfish to not even try. Breastfeeding is so good for the baby and for mom too!”

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Monday, August 26, 2013

Deconstructing infant formula

What follows is not intended as a convince-you text where breastfeeding as such is concerned. If, in the light of the compelling evidence that’s readily available elsewhere, you don’t already fully subscribe to breastfeeding’s universal significance, it’s unlikely that you will be won over by delving here.

On the other hand, if you already accept this fundamental truth, I hope that my reflection will contribute by suggesting what we might do, individually and collectively, to move things forward.

From a commercial standpoint, one of infant formula’s most important comparative advantages is that in most markets – for that is what we’re dealing with here, marketing – it is firmly lodged in the public consciousness as No. 2 in the child-feeding hierarchy, and a very close second to breast milk at that. I compare this strategic result to what the global rental-car company Avis has accomplished since 1962 by making a lemons-into-lemonade virtue out of being second behind the reputed market leader Hertz.

What I would really like more people to know about are the life-long health and developmental implications for millions of babies the world over of the routine corruption of the cellular matrix, including their guts and brains; their eyes and ears; their renal, respiratory and cardiovascular systems; and the very essence of their tissues, organs and organ systems by the everyday non-emergency use of infant formula that’s supposedly flawless in every way – nutritionally “adequate”, “perfectly” clean, correctly mixed, and lovingly fed.

And what I would also really like more people to know about are the short- and longer-term implications of routine artificial feeding for the health of many millions of women, including increased risk of pregnancy, postpartum hemorrhaging, iron-deficiency anemia, hip fractures and osteoporosis, breast, uterine and ovarian cancer, and quite possibly diabetes.

The truly extraordinary thing is this: All this information and considerably more is already out there and readily available in the public domain, some of it for decades; and it is being confirmed and reinforced almost daily by new studies, new evidence and new understanding about this integral part of the reproductive process on which the healthy growth and development of the infants and young children of our species depend. Indeed, you could look it up. But as English philosopher John Locke observed, it is one thing to show people that they are in error. It is quite another to put them in possession of the truth.

I’m reminded here of one of sociology's elementary principles: A situation defined as real, is real in its consequences; and of the hypothesis of delusion, which is applied to psychopathology in some schizophrenic patients. The ordinary dictionary meaning of “delusion” is a false belief that’s maintained despite compelling evidence to the contrary. Given the mass of compelling scientific and epidemiological evidence about the harm caused by routine artificial feeding, it’s hardly farfetched to qualify as collective delusion the unquestioned faith that the general public and health professionals alike in many settings continue to place in infant formula.

Reframing risk

In fact, the perceived relative risk of routine artificial feeding in industrialized countries is extremely low to non-existent despite an avalanche of contrary evidence regularly reported in the popular media. If scientific inquiry demonstrates that "breastfeeding is protective against SIDS", it’s not unreasonable to conclude that artificial feeding increases SIDS risk. If it’s true that "breastfed babies are less likely to die", it’s not unrealistic to assume that artificially fed babies are more likely to die. If we can believe that "breastfeeding decreases infant mortality", it’s hardly outlandish to accept that artificial feeding increases infant mortality. If "Breast-feeding cuts risk of myopia", shouldn’t we be trumpeting the news that "Infant formula raises risk of myopia"? And doesn’t "Breast milk halves gluten intolerance risk" translate into "Artificial feeding doubles gluten intolerance risk"? The backward way these headlines are currently cast accurately mirrors the majority perception. It suggests that even when reporting hopeful news, many journalists, too, can’t quite come to grips with – or even identify – the cultural chasm between normal breastfeeding as the original default child-feeding mode and normalized artificial feeding. They are writing, wittingly or not, in ways that continue to mask artificial feeding’s serious life-long consequences for the health of children (for example higher blood pressure in adolescents and increased risk of obesity in adulthood) and mothers (the link between artificial feeding and increased risk of some cancers surely ranks as one of popular health knowledge’s best kept secrets).

Consider what happens when the national public health authorities in the world’s largest infant formula market get behind a year-long multi-media campaign with the truly inspired title Babies Were Born to Be Breastfed (click here to view some of the TV ads). Well, several things if you bear in mind that the launching of an ad campaign with a commercial-market value of $40 million was delayed for seven months because of intense pressure not only from infant formula manufacturers (which is at least understandable) but also from the American Academy of Pediatrics (which is hardly intuitive to the uninitiated). As a result, and despite convincing research pointing to the importance of focusing on risk, the campaign’s approach was changed from pointing out the risks of formula feeding to highlighting the benefits of breastfeeding. This certainly isn’t the tack taken in most major public health campaigns over the past, say, half-century to promote awareness about reducing health risks through public service advertisements, for example on seat-belt use, not smoking, and preventing underage drinking, drunk-driving and obesity. Why have we made an exception for breastfeeding?

We continue to devote considerable time and other resources to singing the praises of breast milk and breastfeeding. Isn’t it time we also focused on illustrating why normalized artificial feeding is next to the nadir of nutritional mediocrity and what the true – that is complete and permanent – costs are, both to individuals across the entire life course and thus to society as a whole? Completion of the counterrevolution already under way will be deferred for as long as there is lack of a critical mass – an adequate proportion of the general public, health professionals and politicians that has finally grasped what routine infant formula feeding is really all about and what its true implications are in both the short and longer term.

Infant formula will sustain life in a pinch, and thank goodness this is so. But as I describe elsewhere [see here], from a nutritional and developmental standpoint, most people do not understand just how hugely inferior it is to breast milk, with negative implications for both children and their mothers – and thus the whole population – across the entire life course. The idealized view of normalized infant formula feeding that manufacturers are so adept at portraying – and, regrettably, so many consumers, health professionals and politicians are inclined to accept – doesn’t allow for even a hint of this disenchanting reality. Finally, routine non-emergency formula feeding ends up being perceived across society and culture as a perfectly legitimate, albeit second-best, source of nourishment for children instead of the vastly inferior ersatz pretender that it is.

Sending formula back to the medicine cabinet

If we wish to move infant formula, once and for all, from the kitchen pantry and permanently relegate it to where it got its start – in the medicine cabinet, for emergency use only – there needs to be a major shift in popular, health-professional and political thinking. In the second decade of the third millennium, deconstructing infant formula may well be our single most important priority in this connection, starting in well-to-do environments in any part of the world. It most assuredly is a pre-condition to moving to breastfeeding’s next plateau – improved awareness followed by the significant behavioral change throughout society that will lead to greater prevalence and duration.  As with seat-belt and tobacco use, based on what we already know about the direct and indirect costs, to individuals and to society as a whole, of more or less breastfeeding, there should be no let up in promoting this health-enhancing behavior as an overall societal good. Breastfeeding is an idea whose time has returned. We quite literally can’t afford to do otherwise.

Clinching the counterrevolution

But let me not appear to be waxing too lyrical too long. I am also keenly conscious of the challenge of change and its differential rate – slower or faster in one part of a culture or in one society compared with another. Public-health revolutions are anything but linear; despite real progress it’s clear that in 2013 too many people still fail to buckle up and too many people still use tobacco in one form or another. But a key difference today is that virtually no one any longer dares to suggest that either approach is somehow beneficial or risk-free. Moreover, consensus about what is desirable, indeed normal, behavior in this regard could not be clearer.

Formula: a pediatric fast-food.
Where breastfeeding is concerned, even if “everyone” supposedly now knows that breast is best, not nearly enough people know just how damaging routine artificial feeding is both for today’s children and tomorrow’s adults and the soaring price that society continues to pay for its collective ignorance. Postpartum child development, for better or for worse, is nutritionally programmed at the base level of still-maturing tissues and organs. It is clear that achieving our genetic potential – including in terms of brain development, visual acuity, even longevity – is just not going to happen by ingesting a pediatric fast-food prepared from the milk of an alien species.

We need to emphasize the steadily expanding evidence about the short- and longer-term risks associated with routine artificial feeding; they should surprise no one given so fundamental a deviation from the biological norm for the young of our species. I propose this be done initially by undertaking major multi-center research projects, in representative low-, medium- and high-income settings, followed by international expert consultations to present results and forge global consensus on two interrelated topics:

Topic one: “Beyond breast is best” – to focus on the multiple risks of artificial feeding and their impact on the health of children and mothers alike, and thus society as a whole, throughout the life course.

Topic two: “We can’t afford not to breastfeed” – to get a firm fix on the multiple, complex and lifelong economic implications of observing or disregarding the hominid blueprint for nourishing the young of our species.

What about formula makers?

So what about the infant-food industry – does it have a place at the table? Yes, I think it does, albeit a narrowly defined ad hoc one [see here], in the same way that manufacturers of emergency equipment – for example air bags, oxygen masks, life vests and inflatable rafts – have places at consortium tables around which also sit hospitals, airlines, aircraft and automobile manufacturers, accident prevention bureaus and consumer organizations. I’m not naively suggesting that the infant-food industry, as presently self-perceived, will voluntarily assume such a narrowly defined and spartan straight-back chair in favor of its currently coveted cushy one; just that, if this is indeed the seat we want the industry to occupy, it’s up to us to effect the downward product-demand shift – through significantly more and longer breastfeeding – that will make industry only too glad to grab it out of sheer enlightened self-interest. But as with gradually shifting society-wide attitudes toward tobacco and seat-belt use in recent decades, we’re not going to see this downward shift in product demand happen overnight, or at all, except by altering the way society as a whole views artificial feeding and its life-long negative consequences.

James Akre prepared this post for The Alpha Parent. It is adapted from his book "The problem with breastfeeding. A personal reflection" (Hale Publishing, 2006). As founder, chairman and CEO of the International Breastfeeding Support Collective, James focuses on the sociocultural dimension of the universal biological norm for feeding infants and young children, and on pathways for returning breastfeeding to the realm of the ho-hum ordinary everywhere. He is a member of the editorial board of the International Breastfeeding Journal and of the Scientific Advisory Committee of La Leche League France, and past member of the board of directors of the International Board of Lactation Consultant Examiners (IBLCE).

Friday, August 23, 2013

A Word About Nazis

If there’s something Defensive Formula Feeders (DFFs) love even more than visiting breastfeeding discussion forums, it’s resorting to Godwin’s Law during said discussions:

“As an online discussion grows longer and more heated, the probability of a comparison involving Nazis or Hitler approaches” (Wikipedia definition of Godwin’s Law).

Otherwise known as “Playing the Hitler card”, it involves trying to refute an opponent's view by comparing it to a view that would be held by Adolf Hitler. “You think mothers should put their babies’ needs first? OMG get lost Breastapo!”

DFFs do not, however, offer very compelling arguments as to why we should see some kind of moral equivalence between Nazism and breastfeeding advocacy. Perhaps they don’t need to. Simply by making some kind of link between National Socialism and the practice that irritates them, they succeed in implying guilt by association: putting two things that have no necessary connection together in the hope that the bad name of one will taint the other. It stems from the DFF’s reluctance to attribute subtlety and humanity to people with whom they strongly disagree.

The problem with guilt by association is that it fails to show what is actually wrong with the thing that is being criticised. If DFFs think certain brands of breastfeeding advocacy are wrong, they should show why they are wrong instead of resorting to reactionary hyperbolic innuendo to make them appear wrong by association.

Think about it. Not only is the label "Brestapo" an immature overreaction to breastfeeding advocacy, it is also highly illogical - an oxymoron. Breastfeeding is life-giving. At its core, it is all about supporting life. Nazism on the other hand, is about destroying life. Thus breastfeeding advocacy and Nazism are as polar as two opposites can be.

Without a doubt, any moral high ground is lost when an argument descends into such name calling. Yet reverting to Godwin’s Law is a deliberate ploy, a disreputable form of rhetoric which acts as a silencer on debate. As psychologist Lori Day has pointed out:

"Once this gun is unholstered, the thread is finished and whoever shot out the Nazi comment has not only lost his or her own credibility, but has ruined the discussion thread for everyone else because the piling on has begun. Once a thread has devolved into this kind of rhetoric, there is no saving the original topic."

Likening breastfeeding advocates to Nazis involves intense aversion, anger and stereotyping as well as promulgating a hostile 'us and them' mentality, entrenching opponents in their positions. In this sense, Nazification is an aggressive form of hatred. It embodies a host of assumptions (e.g. lactivists are fascists) which would be seen to be false if stated explicitly, but which can have persuasive force when left unstated. When a DFF compares a breastfeeding advocate to Hitler, she does not make a purely logical comparison, but rather appeals to the listener's emotions of disgust, anger, and fear. It is of course, easier to be offensive by making a comparison which is untrue, than to be clever by using elements of truth. It's no surprise that DFFs adopt such a lazy route, given their analogous approach to infant nutrition.

Indeed, the Nazification of breastfeeding advocacy is also an example of a lazy fallacy known commonly as ‘the straw man’. Although their target is lactivism, DFFs do not in fact confront its reality. Instead, they set up as a target a caricature and attack that instead. But their subsequent easy victory over it is seen as a victory over the real McCoy.

Put in general terms, the straw man fallacy occurs when you deal with a distorted version of a group of people as though it were in fact the full and accurate one. The position of the group itself is taken to be flawed even though it has not actually been subject to proper critique at all.

When DFFs tar lactivism with the Nazi brush, they not only demonstrate that they are prone to overreaction with no sense of proportion, they also show how little effort they are willing to understand the lactivist’s points of view. Why should they? If they attribute hopelessly repugnant views to lactivists, the virtues of their own commitments seem obvious.

As a final thought consider, if you will, the moral and ethical repugnance the 'breastfeeding nazi' analogy places on the memory of the millions - Jews and non-Jews alike, and Germans themselves - who suffered at the hand of the Nazis. Brandishing the Nazi label during breastfeeding debates achieves one thing and one thing only: it trivializes evil. In doing so, it dilutes the memories of a particularly dark period in human history. Therefore I call upon you to leave this term of abuse to the history books.

Tuesday, August 20, 2013

Triumphant Tuesday - Breastfeeding through Domestic Abuse

Breastfeeding is seldom a breeze, but what if it becomes yet another stick for your abusive husband to beat you with? That’s precisely what happened to the mother in the following story. Trapped in a controlling relationship, thousands of miles from her home country, this new mom was subjected to incessant emotional terrorism at the hands of her husband and his family, which gradually escalated to physical abuse.

Yet throughout it all, this mom held onto one of her most cherished goals: breastfeeding her baby girl. Despite the challenge of breastfeeding - or perhaps because of it – she found the strength and courage to escape her nightmare. For this mom, breastfeeding was empowering. It solidified the bond between mom and baby, a bond that no amount of bullying could demolish.

“I have been preparing for a long time to share my story on The Alpha Parent. I hesitated because I was not sure whether I wanted to reincarnate these memories or not. But then I realized my story may help others going through similar struggles.

How I met my abuser

I met my (now ex) husband while we were both working in Japan. He is from Mexico and I am from Estonia. Ironically, we met while practicing Aikido in Japan - the art of harmony, of non-violence. The emotional violence started from the very beginning when now I realise that he liked (and provoked) the situations where I started crying. Looking back, it was an ill-match from the start: Catholic-traditional-family-centered-Mexican, and Atheist-scandinavian-modern-individualistic-Estonian. Hindsight is a wonderful thing. 

My first question when I found out I was pregnant was regarding baptizing, whether it was important for him. Myself an atheist, I would have opted out, but since he is Catholic, and said it was very important, I agreed, thinking that the worst disagreement we could possibly have had been evaded. Silly me.

The pregnancy

My pregnancy was quite average, but the morning sickness lasted for the first 7 months, from morning, till next morning. It was also more difficult because all the foods I really craved (Estonian traditional black rye bread among the others) were nowhere to be found in Japan. Without being able to eat much of anything due to the nausea I somehow managed to gain 10 kg by the third month, which, as I was told by my very pleasant doctor in one of the biggest and most modern hospitals of the country, is the maximum allowed weight gain in Japan. Women there, when they find out they are pregnant, actually go on a diet! 

Me in the Japanese delivery room
I was very nervous about giving birth and wanted to know that no matter what, the hospital staff would understand English and would be able to revive me (and the baby) if any emergency should arise.

My Mexican in-laws did not understand my wish for natural birth (c-sections are practically the norm over there), and since my husband was to have a business trip at around the due date, they also did not understand why I did not choose a planned C section with a scheduled delivery date. The hospital in Japan, although very modern, was fortunately all-for natural births without any pain relief. I am glad for that because I am not sure I would have had the strength to not ask for relief when the baby was coming. My baby woke me up a few days before her due date at 3am, and was in my arms by 3pm. We called her Sophie. The first half of the 12 hour labor was a piece of cake, but the last three hours was so horrible that I actually only remember 3 minutes of it. Everything else is wiped out of memory, although I was fully conscious at the time.

Establishing breastfeeding

I had asked for delayed cord clamping but had no strength to fight for it when the moment came, so Sophie was taken out, cut off, put for a few moments next to my face and taken out for measuring and cleaning. It took an hour before I got to feed her, but fortunately everything was alright there. In Japan, everyone stays in hospital for a full week in case of natural birth (and 2 weeks for C-section). I was glad for that, but unable to eat the very traditional Japanese hospital food, so my husband sneaked in some ‘human food’ for me.

Sophie was feeding very well, non-stop on my breast. The first 6 weeks were very painful for me, cracked and bleeding, but then I got a hang of it. I thought she latched on perfectly and the hospital staff said the same, so maybe the pain was only because of her very strong suction and non-stop feeding. (The norm in Japan is to separate mothers and babies but they are also used to the crazy demands of foreigners like us to have the baby in the same room with the mother). 

When we were finally home, my mother came to stay with us to help with the babycare. My friend, an Indian pediatrician, who had breastfed her lovely seven year old daughter for the first 6 years of her life, told me that it should not be so painful. She also helped me to understand the idea behind ‘extended’ breastfeeding.

Sophie and I slowly settled to normal life and my mother went back to Estonia when Sophie was a month old. Then my husband’s parents from Mexico moved in for three months (without anyone discussing this with me beforehand) and the nightmares began… 

Undermining and overtaking

Whether it is due to the position of a wife in Mexican culture or our own relationship problems, the fact that I was only informed about my in-laws arrival after the plane tickets had already been bought shows the level of importance my opinion would have had on the whole decision. After that, without any support from my husband (who sided completely with his parents), I had to start protecting my beliefs and practices and intuition against bullying orders. Examples include:

  • Giving tea, water and porridge to a newborn
  • Being told how harmful exclusive breastfeeding was
  • Being told to feed in intervals
  • How my baby would die if she wasn’t given formula
  • How she would die if the belly button is not forced inside by some special mechanism
  • How it is not normal that her ears are still not pierced (fortunately she wasn’t a boy, with forced circumcision and what not)
  • How she should sleep on stomach or at least side, not back
  • How she should not go outside in Japanese cold 18 degree Celsius weather
  • How the temperature in the room needs to be 30 degrees and she herself in blankets all the time
  • Etc…

I was not allowed to bathe my baby, as it was deemed my husband’s mother had so much more ‘experience’ and know-how, having raised ten children (including relatives), and I was merely getting my information from the internet. My husband and his parents told me that I was going through post-partum depression and turning crazy. They said I was disrespectful, inexperienced and plain ‘blonde’.

Since I was still in shock after my horrific childbirth experience, it was hard for me also to realise how wrong things were going. I was only able to dream how nice it would be if there would be only the three of us, with me taking care of the child based on my own beliefs and without continuous harassment  Only later, from distance, can I see how distorted it all was. Somehow it sneaks up on you, even though an onlooker might understand it quicker than the people involved.

Since I tend to be quite persistent when I know in my heart that I am right, the result was that we had constant daily arguments in the house. However I knew that the most important here was my child’s health and her future so I made no compromises. Having ploughed deeper into the theories and science behind child-raising such as the Virgin Gut concept and other related health positions, I felt compelled to stick to my guns. 

Fortunately my daughter was ‘on my side’. When my in-laws tried to give her a bottle of my expressed breast milk, under the premise of helping them to ‘bond’, she only suckled for a few minutes (nicely captured on the photo below) and then pulled-off and rejected bottles from that moment forth. Same for pacifiers, smart little girl!

Estonians are known for their stubbornness. They consider it good trait. When I my husband would blame me for various ill-deeds, he of course took this trait as one of my worst. We also had a lot of financial arguments, disagreements about friends and basic values. Sadly in our case, as in many others, my husband’s emotional harassment finally, perhaps inevitably, led to physical violence. He often prevented me from exiting rooms, holding me captured while I held the baby, and similar situations.

I could have handled the in-laws and their bullying if only my husband had sided with me, or showed some kind of basic respect to my opinion. Instead he attacked my positions and the psychological harassment intensified so that finally there was no other way out but divorce. It took me some time to realise this, and is only now fully clear when there is some distance between these events. There was really no other way. 

Long story short, I escaped this nonsense when my daughter turned two months, literally took my things and stayed with a friend for a few months until the Japanese court processed the divorce and custody case. Being soft as I was I even considered getting back together, after all court proceedings had finished and things calmed down. Sophie was 10 months and we went to Mexico, but in the end, I ended up on the floor from his violence, at then there was no way back…

Picking up the pieces

My ex now lives in Mexico and I returned to Estonia. I am thankful for this because had our previous plan of moving to Mexico taken place, the results would have been even more damaging and most likely he would have been awarded child custody in the end. In Japan the whole procedure was very complicated and expensive, with threats of child abduction, international laws and embassies involved, but fortunately it is also a country that protects the mother’s and child’s interests and only in very extreme cases is mother separated from the child, therefore I got full custody. 

Winter in Japan

Winter in Estonia

Winter in Mexico

International relationships bring their own difficulties and I have even heard a statistic that as many as 9 in 10 of such marriages end in divorce. For us it was good that it happened so soon, as no child should have to grow up in such environment - an environment that pays so little respect to a woman’s position in the relationship, especially if the child is a girl herself. I am also glad I do not live in Mexico as was our original plan. I do not like the idea of kindergarten children wearing full makeup and false nails (which is what I observed during one of our trips there), or the level of sexualising woman in the culture in general.

My ex now sees us through Skype and when we visit each other (though there is no such legal requirement) and our meetings still tend to end in disagreement. However since he is her father and she is part Mexican, I try not to shut out this part of her life.

Full-term breastfeeding

On a happier note, Sophie contently continues to breastfeed. She will turn three years old very soon. Although so natural, breastfeeding at this age is unusual in Estonia. It will hopefully be easier when Sophie has babies of her own, having had such memories from her own childhood. I will continue to breastfeed her for as long as she wishes (and yes, I am using the joke of ‘until university’ with my own relatives who constantly question this).

My advice to mothers is to look into the actual science and research, and trust your own instincts, even if they clash with the doctors’ recommendations. My Estonian doctor told me to stop at 1 year (and most people here take heed as physicians are the highest authority, especially in a post-soviet culture).  Contrary to some, I also do not hide the fact that I still breastfeed, and then the first question from the doctor is inevitably: does she eat any other foods? Duh. Remember, she is almost three!”

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Monday, August 19, 2013

A formula for ignorance

We all arrive in this world more or less the same way and in the same condition – naked, wet and ready for the breast. After that, nearly all bets are off as culture kicks in and we begin the long differentiating journey to becoming who and what we are based on the rules of the group into which we’re born.

Not surprisingly then, our approach to the only example of a universally common food and feeding system – breast milk and breastfeeding – is conditioned by culture’s stamp. Our identical biological birthright continues to be transformed – even deformed – in multiple ways in society today.

A not so rhetorical question

The world’s second biggest-selling English language daily, The Daily Mail, put it this way: “We know that breast is best for baby – so why do women in the UK continuously ignore the important health benefits of breastfeeding?”

Good question, particularly if you take a look at surveys undertaken to coincide with Breastfeeding Awareness Week. When the Department of Health published results of its 2004 survey of one thousand women, it noted that the UK had one of the lowest breastfeeding rates in Europe. Almost a third of women in England and Wales never even try to breastfeed, and the rate in Wales among those who do falls to 36% by one month. Younger women in particular are less likely to breastfeed with over 40% of mothers under 24 never trying. The survey also showed that:

  • Over a third of women believe that infant formula is very similar to, or the same as, breast milk. 
  • A fifth of young women aged 16–24 years believe that breastfeeding will ruin the shape of their breasts or body (obviously including Gwyneth Paltrow). 
  • Over two-thirds of women believe that people find breastfeeding in public unacceptable. 
  • Nearly all women believe that breastfeeding comes naturally to some and not to others. 
  • Nearly all women believe that some women don’t produce enough milk to be able to breastfeed. 

Unfortunately, according to the National Childbirth Trust results of a survey undertaken for Breastfeeding Awareness Week 2005 were hardly more encouraging:

  • More than 91% of Britons do not know that breastfeeding for just one month has a lasting impact on the first 14 years of life. 
  • Two thirds are unaware that breastfeeding early in life, even if it is not exclusive, provides protection against infections. 
  • Only just over half know that the current recommendation is that babies receive breast milk alone for the first six months. 
  • Almost half do not know that breastfeeding cuts the risk of osteoporosis and ovarian cancer in mothers.

How is it that our common nurturing and nutritional heritage is self-evident in some environments but routinely called into question – or simply ignored – in others? And why is it so obvious for some, yet so poorly understood by others, that initially feeding babies anything but breast milk is a dangerous deviation from the biological norm?

I’ve been considering attitudes toward breastfeeding from various angles for four decades, and my single overriding conclusion is this: Where it remains undervalued and under-practiced, the primary barrier to more and longer breastfeeding is society-wide ignorance both of human milk’s unique, species-specific properties and of the inescapable implications for health throughout the life course. Moreover, this ignorance is as much a sign as it is a source of the disrespect for the biological norm that contributes so effectively to low rates of breastfeeding prevalence and duration.

Every other barrier to breastfeeding – from attitudes and how they are formed, to non-supportive health services, to the multiple unhelpful ways society is structured – can be traced directly to this cross-cutting core ignorance. And thus, to return breastfeeding to the realm of the ho-hum ordinary (which is how I define my goal) we also need a society-wide shift in awareness, attitude and action.

Choice based on ignorance is illusionary

We cherish the role choice plays in our lives, which is understandable given how fond we are of describing our behavior in terms of rational decision-making. But where breastfeeding is concerned my sense is that the impact of choice is roughly equivalent to deciding whether to hold a small child’s hand as we cross a busy street together, which is to say none at all.

“I think I’ll hold my three-year-old granddaughter’s hand as we cross the street today, although frankly I’m getting a little tired of all this responsibility, so perhaps next time I’ll just not bother.”

Of course not. We hold a small child’s hand when crossing the street because we know – as do the vast majority of adults everywhere – that doing otherwise is irredeemably irresponsible, dangerous, culpable, and downright stupid.

So, do we “choose” whether to breastfeed based on carefully worked out criteria? In the main, I think not; we respond the way we have learned to respond. This is why I insist that, where artificial feeding has the upper hand, reverting to breastfeeding means transforming society in its structural complexity. It also requires seeing indisputably related factors in context and not in isolation, notably food manufacturers who tirelessly tout the virtues of routine use of infant formula, which is what I describe as synthetic dream merchants pushing an inert pediatric fast-food based on the milk of an alien species.

It may sound frustratingly circular, but recent history shows this: We are unlikely to see adequate measures widely adopted to protect, promote and support breastfeeding – for example broad-based community support for mothers and babies, health professionals who are knowledgeable about breastfeeding and motivated to promote it energetically, baby-friendly maternity services, maternity protection in the workplace, and appropriate marketing and distribution of breast-milk substitutes – until society and its leaders first embrace the proposition that routinely feeding a breast-milk substitute represents a major deviation from the biological norm with serious life-long consequences for mothers and children alike.

Reframing the breast vs. formula debate

There is a lot of confusion about this defining feature of our shared humanity, whether in the general population or among health professionals and politicians. And it is essential that we take this confusion into account in promoting the shift – in society-wide awareness and attitude – that’s required to return breastfeeding to its place of primacy in human development and health.

Resolving the situation is a complex challenge that depends on considerably more than accumulating and communicating yet more scientific and epidemiological evidence. Education is essential, of course; but education is insufficient, by itself, to turn things around.

It is a serious fallacy to think that, if we just tell people the facts, because they are basically rational beings, they will reach the right conclusions and do the right things. In fact, it is often easier to change ideas than it is to change beliefs and behavior.

We need to do something more. We need to go on the offensive in the ideas marketplace. We need to seize the initiative by establishing a new frame that will permit us to communicate effectively what is really at stake for the health and well-being of all our mothers and children, and thus society as a whole; and what, by working together, we can do to improve the situation.

Let’s begin by turning two tired truisms on their head. No, breast is not best. Instead, breastfeeding is normal, routine, commonplace, even ho-hum ordinary. By adopting this attitude we avoid implying that artificial feeding is the norm and that breastfeeding is somehow better than the norm. On the contrary, anything else is a deviation from the norm.

And no, infant formula is not second-best. Obviously the second-best option after breastfeeding is other human milk, whether expressed by a baby’s own mother, or from a healthy wet-nurse, or a human-milk bank. And only as a last resort, when breast milk is unavailable, does formula assume its rightful role as an emergency nutrition intervention and the least-bad nutritional alternative.

Fortunately, in an emergency formula can sustain babies who do not have access to human milk. But no matter how appropriate it is under such circumstances, feeding an inert pediatric fast-food based on the milk of an alien species is no less a deviation from the norm for the young of our species.

In this connection, I invite you to reflect on the following not-so-rhetorical question: At what point should we begin to regard a routine deviation from the biological norm as deviant behavior?

Please bear in mind that infant formula was originally developed for emergency use. Thus, pitching formula as somehow suitable for a routine non-emergency purpose means two things. The product is instantaneously denatured, and it thereby forfeits its only claim to legitimacy as a life-sustaining crisis commodity.

To put this alimentary aberration into perspective, consider routine non-emergency formula use as the feeding equivalent of emergency devices on airplanes – overhead-bin oxygen masks and under-the-sat life jackets – suddenly being transformed into everyday must-have fashion accessories (see here).

It’s not women who breastfeed after all

To conclude, I invite you to focus on a single notion. With only rare exceptions, all mothers love their children and thus, by definition, want what is best for them. However, translating a mother’s love into suitable feeding behavior is invariably a culturally determined act. Therefore, our best hope of seeing more mothers and children breastfeeding longer lies in transforming the society in which they are born, reared, come of age, beget, birth and nurture.

It is indisputable that the processed-food industry is actively engaged in fostering a market that is favorable to its products, for that is what commercial interests do the world over. But let us also recall that the industry does not operate in a vacuum. The purchasing public shares responsibility for creating and sustaining a non-emergency supply of breast-milk substitutes at the expense of Mother Nature’s market share. Don’t forget – it still takes two to tango!

Taking on the synthetic dream merchants implies considerably more than a regulatory frontal assault on supply. We also need to decrease demand for the synthetic dream. The most efficient and effective way to reduce the supply of infant formula is to reduce demand for infant formula; and the most efficient and effective way to reduce demand for infant formula is to increase demand for breast milk.

Please take careful note: None of this is either easy or fast!

James Akre prepared this post for The Alpha Parent. It is adapted from his book "The problem with breastfeeding. A personal reflection" (Hale Publishing, 2006). As founder, chairman and CEO of the International Breastfeeding Support Collective, James focuses on the sociocultural dimension of the universal biological norm for feeding infants and young children, and on pathways for returning breastfeeding to the realm of the ho-hum ordinary everywhere. He is a member of the editorial board of the International Breastfeeding Journal and of the Scientific Advisory Committee of La Leche League France, and past member of the board of directors of the International Board of Lactation Consultant Examiners (IBLCE).

Friday, August 16, 2013

The Eroticism of Child Birth

It is late, later than usual. The lights are low and they are alone at last. Soft music is playing, with a familiar cadence. They have made love to this one before.

A faint but primal scent is in the air. The origin is certain; the fragrance is an unmistakable blend of the two of them. Everything is perfect, the time is right; intimacy is at its peak. Their gaze is unbroken; their union is penetrating, physically and emotionally; a smouldering combination. It is as though they have waited for months for this very moment, the anticipation is vast. They move back and forth in unison. The energy is building, one can feel the pulsation.

She is breathing heavier now; driven by her hormones she is moving to a familiar rhythm, he follows her lead. He caresses her, ever so gently, in all the right places, she lets him know just where. They have been here together before, but never like this. “Oh Yes! Yes please! Yes, thank you, darling. Oh right there, yes, oh baby. You are doing it just right.”

“I know she feels it too. I am certain she can feel our love and how much we want her to join us now. She is so welcome. Soon it will be just the three of us, like we imagined, together at last after all of this time. Just a bit more time and our baby will be here, for both of us to hold and love and care for. Here comes another contraction, move with me honey, that’s it, oh yes, yes, yes, OH YES my baby, yes.”

The miracle of life, it began with a sensual, sexual experience, it has been all along, and now it continues. Now comes the long awaited climax, after nine months of anticipation and building their energy for this perfect moment. Could it get any hotter?

The midwife knocks and asks how they are doing. With permission, she comes into the room and checks on their progress. All is good; and she leaves them to it. As well she should; this is a private affair; they get back into their rhythm. “Here comes another one my love”. They begin moving together, again. It is familiar and easy for them to recreate the ambience. Their love making goes on for hours to their own natural rhythm, it is the longest they have ever gone, I am sure of it. She progresses nicely. She is opening more and more. She is opening; receiving the father and their baby. The expectancy is palpable.

It is getting closer now, I can feel it. They are breathing heavier, almost continuously. She is letting go like never before and she is focused and concentrating and can feel it coming. This is going to be the one, the one she has been waiting for. Only a mother can know these things. The wave is building and she is riding it. It must be a tsunami; it is unlike anything she has ever felt before. Louder and louder comes the YES, OH YES! She could be riding a dragon for all she knows, no matter, she is riding this one all the way, nothing and no one can deprive her of her glorious climax. Her body is trembling all over, from the inside out. She reaches down there to touch; she can not resist the temptation. She discovers her baby’s head and caresses it. Then comes the onset of the most glorious orgasm any woman has ever imagined possible. Her body and mind are transported to another time and place, and she is more present that she has ever been. Ecstasy is hers. In a crescendo of sensation she lets go and receives the gift. She comes and so does their baby. Man, woman and child are all three united in the same moment as she receives her baby and brings her to her breast. Who has given her this gift? They have given it to each other. The miracle of love.

Some women orgasm spontaneously at the delivery of their baby. Many also experience pleasure and heightened ecstatic energy. Certain conditions are typically prerequisite for this to happen. These include a sense of safety, trust, intimacy and the ability to let go and relax. Also there are couples who make love, in various forms, during labour. There is hard science that shows that this can have significant benefits for the labouring woman. The hormone oxytocin is produced when a woman is sexual stimulated. Oxytocin is one of the hormones that encourage and support the onset and progression of labour as well as pain relief. Going even further, sperm contains prostaglandin, a hormone that helps the opening of the cervix.

The science is there, what if the passion, privacy and support were also. What a way to give birth… what a way to be born. What would life be like if it started in pleasure and empowerment, for the whole family?

This post was written for The Alpha Parent by Patrick Houser, author of The Fathers-To-Be Handbook. He is a freelance writer, Keynote Speaker and is co-founder of the Fathers-To-Be (F2B) initiative at www.FathersToBe.org. F2B holds classes for men who are expectant or new fathers to help them understand and integrate birth and early fathering, from a modern perspective. They also hold study days for childbirth professionals/educators on fathers in the pregnancy and birth environment.

Tuesday, August 13, 2013

Triumphant Tuesday - Breastfeeding Twins

In a society where most women fail to breastfeed their newborn, having two newborns to feed simultaneously must surely spell curtains, right? Indeed, many health professionals, upon discovering their client is carrying twins, promptly and without tact suggest that she should expect the worst – and head to the nearest bottle store.

Thankfully, Mother Nature doesn’t take orders from health professionals. Her production line is connected to her line manager – the baby (or babies, in this instance). From womb service to boob service, Mother Nature will satisfy her offspring’s remit – if left to her own devices, as the following story illustrates:

“When I was pregnant my doctor told me to line up donor milk from a milk bank.  I don't think she was confident that I could produce enough milk fast enough or maybe she just wanted to be thorough. Either way, it made me doubt my breastfeeding abilities before my babies were even born.  

Preemie Twins

My twins were born via medically indicated cesarean at 34 weeks due to many factors including IUGR and TTTS.  They weighed 4 lb 15oz and 6 lb 5 oz. They went to the NICU and I was sent to my room to recover from the cesarean. We had made birth plans that we passed out to the doctors and nurses and a copy stayed with each baby at all times. I wanted to breastfeed as soon as possible but was not able to see and hold them until that night. I was adamant that they not be given any formula. They had IVs so that held them over until I could nurse or pump.

Pumping Stations at the Ready

The next day I was given my pump and I started right away. I was excited to get a good sized quantity of colostrum.  Later that day I was able to put them to the breast and see if they could latch. Preemies born before 35 weeks have problems with their suck/swallow coordination and are unable to concentrate on multiple stimuli. We were not sure if they could physically nurse. The first time we tried they were both too sleepy and just wanted to cuddly skin to skin. We could only keep them out of their boxes for 30 minutes at a time to allow them to sleep as much as they could and stay warm. Preemies can easily tire themselves out and expend more calories than they take in just by trying to nurse for too long.

So began our new routine of 30 minutes of nursing/cuddling per twin and then back to the room to pump. Every 2-3 hours my husband and I returned to the NICU to nurse the boys. The second time we tried nursing, the bigger twin latched on and nursed for 30 minutes! The smaller twin took more time but he began nursing shortly afterwards. My milk came in on day three and we brought 3-4 oz of pumped milk with us every time we saw the boys. 

Introducing Bottles

The doctors recommended topping off each nursing session with pumped milk.  Little warning bells went off in my head at this idea! I didn't want to use bottles. The NICU nurse could see my alarm and explained the recommendation to us. The boys were expending so much energy nursing and trying to stay warm that they needed some milk they wouldn't have to work for in order to gain weight. This made sense to me so we started topping them off with tiny amounts (5-10 ml) of pumped milk.  My husband was awesome at bottle feeding while I was utterly incompetent. When I bottle fed the babies they would spit it out, choke, or just hold the bottle in their mouths and not drink. I suspect the babies thought I was holding out on them.  So instead, I would go back to our room and pump while he finished up with the boys.

One day we were held up (talking to doctor) and got to the babies 15 minutes after they were supposed to be fed and discovered that the NICU nurse had already given the babies bottles of pumped milk.  It was our fault for arriving late but it was nonetheless upsetting to me.  We were never late getting to the babies after that!  


Each day brought a new challenge. The boys got jaundiced and needed to be under the billi lights for two days, they were taken out of the warmer to see if they would maintain their temperatures (they didn't) and most of all they needed to gain weight.

I nursed and pumped every 2-3 hours day and night for a week and the boys passed every test. They gained weight, they maintained their temperatures overnight, and they passed the carseat test. On the eighth day we finally got to take them home! I brought a couple of gallons of pumped milk home with me as well.

Nursing and Pumping 24/7

At home we continued to nurse and supplement with pumped milk. I planned to nurse on demand but they were happy to stay on the same 2-3 hr schedule.  It got exhausting to wake up at 2 in the morning to nurse and pump but we did it for an additional 5 weeks until their due date.

They seemed like they were nursing as strong as a normal newborn so we phased out the supplemental bottles over the next two weeks (42 weeks GA) and they breastfed exclusively at the breast from that point onward. They began to nurse on cue more often as well and I nursed them tandem during the day and individually at night. We co-slept with me in the middle and I would nurse whoever woke.

In the meantime I carried on pumping and was able to donate around 500 oz of breast milk to three babies, one of whom was terminally ill and one which had bone disorders.

Nursing in Public

I nursed by babies all the time whether or not people were around. My family seemed to be a little uncomfortable at first and avoided eye contact (lol) but they soon got used to seeing my boobs out!  With my first two kids, nursing in public made me very self conscience, but I feel like a proper lactivist now. I fed them anytime, anywhere - restaurants, parks, stores, cars, visiting friends. I've even tandem nursed at church! There hasn’t been a single negative reaction.

I hope my story can encourage mothers to have faith in their breastfeeding abilities.  If I can feed two preemie babies, surely you can meet your breastfeeding goals! I want you to face booby traps armed with confidence and knowledge. Determine that breastfeeding is your #1 priority and I believe you will succeed!”

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