Monday, September 30, 2013

Framing male lactivism

Given that breastfeeding is by nature a feminine act, some people might wonder how a man can be passionate and committed in this connection. Although I've written for years on the topic - what I describe as appropriate nurturing and nutrition for the young of our species - I have never set out to define in so many words the source of my passion and commitment. I will attempt to do so now.

When I present at conferences, I often begin by emphasizing my three most important credentials, in order of significance:

- I've been a mammal since 1944
- I've been a father since 1974
- I've been a grandfather since 2000

Oh, and before formally retiring in 2004, I also worked for 30 years in the field of international public health nutrition.

Beyond that are elements like my life-long interest in human behavior and motivation; cultural cues and influences governing behavior in distinctly different environments where I have lived and worked for varying periods, for example the USA, Turkey, Cameroon, Haiti and Switzerland; what it means to be a mammal and the implications of acting consistently, or not, with our nature; and how the unique universal biological norm for feeding infants and young children is molded by culture.

Add fascination, since I was an early teen, with the concept of "deviant behavior", how it is defined in a given sociocultural context, how such behavior is punished and who goes to prison and for how long, and the all too rare emphasis on crime prevention in place of, or at least complementary to, criminal confinement. (It is sobering to compare the ever-breastfed rates with the incarceration rates in the same countries around the world. I long ago observed the tendency for many countries with the lowest incarceration rates to have the highest breastfeeding rates and vice versa. I am not saying that breastfeeding keeps people out of jail, although that may well be true in several meaningful ways. What I am saying is that breastfeeding is a useful surrogate measure of how effectively a given society nurtures its members in the widest sense of the term.)

Should only women be interested in how society nurtures its members?

Stir in as well a general neglect, until only recently, of:

- the results of acting, or failing to act, in a manner that is consistent with our nature in terms of the impact on life-long mental, emotional and physical health and the related costs and benefits; and
- the inevitable implications of all this in terms of neurocognitive development.

One doesn't have to be a neuroscientist to observe, with certainty, that we can never hope to achieve our full neurocognitive developmental potential by any other means than by beginning life with ingesting the food that is unique to our species. We are mammals; this is what we do, or at least this is what we should be doing.

Should only women care whether our species achieves its potential?

As a male I spent the first two decades of life in the USA and came of age in a highly confused Puritanical anti-pleasure environment where distrust, even fear, of the human body was - and still is - in constant conflict with a morbid fascination with sexuality divorced from any real understanding or awareness of our status as mammals. I long ago concluded that we can do better, much better, by acting consistently with our nature in place of varying degrees of denial and hypocrisy and the individual and collective disasters that they continue to generate. For the neonate, this begins at the breast.

Thus, I think that being male hardly disqualifies me from having strong feelings about breast milk and breastfeeding any more than it dispenses me from acting consistently on this basis. Yes, I'm a father of three and a grandfather of five; but there's no need for any of that to understand the multiple advantages of surrounding ourselves with healthy, well-adjusted and intelligent people who begin their life journey consistent with Nature's plan. I have never menstruated either, yet I've not had a problem adopting a strong position on iron deficiency, which afflicts differentially according to sex.

I certainly have no regrets in becoming involved in promoting appropriate nurturing and nutrition for all children. Some of the staunchest female breastfeeding advocates I've ever known have never actually breastfed (Alison Blenkinsop springs to mind), just as some of the strongest female critics have, apparently for short periods.

In my version of ho-hum ordinariness, the best place to be is where both women and men - and this irrespective of whether they become parents - because they're genuinely informed, caring and societally supportive, are not only keen on mothers and children breastfeeding generally, they also make all the right moves - defined as the easy and obvious things to do because they're normalized - to ensure that the entire society is totally in on the deal.

Breastfeeding is not a woman's issue. Breastfeeding is not a man's issue. Breastfeeding is a human issue.

James Akre prepared this post for The Alpha Parent. 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).

Tuesday, September 24, 2013

Triumphant Tuesday - How Female Solidarity Affects Breastfeeding

Fathers like to think they wield great influence over the success of their partners’ breastfeeding efforts – and they do. But even daddy can’t hold a candle to the almighty impact of a mother’s female peers. Be they friends, family or medical professionals, women have an ability to engage with one another on an intuitive level that is unique to their gender. The female brain is empathy-inclined and wired to thrive on expressive interaction. Indeed, the intimacy found amongst females often baffles their male contemporaries.

In ignorant or insincere hands however, feminine kinship can lead to unfortunate outcomes. The following story illustrates a potent and timely fact: just as female solidarity can facilitate breastfeeding, it can equally impede it.

“I grew up not really thinking a whole lot about parenting; As a child I played with baby dolls of course, but I never really considered parenting styles or options of parenting. Without even realizing it, somehow the feminist culture of our time had crept into my life and my mother's life and like most around me by the time I reached high school graduation I had no interest in marriage or babies. I planned to go to the local university for a few years and then move to Shreveport and work in broadcast journalism. So imagine my surprise when two years later, at nineteen, I ended up married and going to a small college no longer studying journalism, but instead counselling. Mostly because I cared about women and wanted to do something to help other women.

The influence of friends

That's where I met Kati, she gave me a book "Feminine Appeal" by Carolyn Mahaney. She said that if I didn't absolutely love the book, that she would take me out for ice cream.  I began the book sceptical, and then got annoyed - it goes against everything we are taught today, and ended it a complete convert, so I didn't get any ice cream lol. The book really rocked my world view and made me begin considering homemaking as a profession. I began rejecting my former ideals of self worth. I concluded my degree at the college, I'm not a quitter after all, and went to work for the college to pay the bills. During this time a different friend, Hannah began teaching me about parenting. She had had her first daughter a year prior, while in school, not being able to afford babysitting her daughter came to school with her, where-she-breastfed-her in public.

Hannah is the woman that influenced me the most the year leading up to my - wait for it - home birth! That's right I had jumped off the deep end. She told me that breast feeding was the hardest and best thing she had ever done. I knew I would breast feed too. I saw myself transforming from someone who had once been appalled by breast feeding in public to someone who really hates the whole concept of a nursing cover. I assumed that when my baby was born she would do the breast crawl and then we would all go away, breast feeding into the sunset.

A disappointing reality

Needless to say, when that didn't happen I was pretty surprised. When I put my daughter to the breast for the first time she didn't seem that interested. When she eventually did seem hungry she would get so frustrated at the breast that she would reject it and just cry. So I expressed as much as I could and put it in her mouth.

My mother had only breastfed myself and brothers a short time and then switched to formula. Thought pregnancy she shared many things with me that really could have sabotaged all my plans. She had a belief that since she had three cesareans that I would not be able to deliver naturally, she believed babies would starve if exclusively breastfed, and many other odd things that I can only attribute to lack of information. When the midwife told me to make my daughter eat every two to three hours my mother kept telling me that I shouldn't wake a sleeping baby.

Since my daughter didn't seem interested I would let her go sometimes 5 hours without eating. When I did try to feed her it was hard, toe curling pain, I dreaded each feeding. I can safely say that the first 2 weeks of breastfeeding was way harder than pushing out a baby!  We were having trouble latching, and she would scream and I was in pain from engorgement, I felt like I had the flu, I was tired and I cried. 

Anger towards my baby

One night I was having a particular amount of trouble and I just found myself getting so mad. I was so angry at my baby for crying and not eating right. It was scary, so I called my mom and she came and took Abbie and rocked her for about 2 hours so that I could sleep. When I woke up I had a clearer head, but it really scared me that I was capable of feeling that angry towards my baby. I was able to realize how people get themselves in those bad situations where they end up hurting their child. Prior to that night I always assumed that people who do that are bad people, now I think that maybe they are just people without help, who need sleep, and I am afraid that it could easily have been me. I was lucky to have my mom and my husband to help me, I was not left alone for 5 days, - yet not everyone has that.

To her credit and despite her ignorance, my mom did want to help me achieve my breast feeding goals and didn't want to see me in pain, so one night she stayed up with me looking up videos on how to breastfeed and then went to the store and bought me a nipple shield.

We had learned that I had flat nipples which explained my baby’s frustration at the breast. Finally with the breast shield she was eating and I wasn't in toe curling pain. Nonetheless, it still hurt, and I had bruises from poor latch. I was applying lanolin like crazy, but didn't seem to find it very helpful. I had friends come and help me, and it seemed like each one brought me one more piece to the breast feeding puzzle and things began to get easier.

Weight loss and hospital admission

Unfortunately however, I was still not feeding my daughter often enough so she was losing weight and what I thought was a nice olive skin tone was actually jaundice. My midwife was concerned and sent us to the hospital. We were only three points from being hospitalized. She chastised me for not following her instructions on feeding more often. I was terrified. Here I was, being told by the most non-interventionalist medical person I knew that I needed to go to the hospital, right then, do not pass go, do not collect $200, pack your bag, and plan to stay overnight. Prior to that point I had been fairly nonchalant, Abbie was eating and I was feeding on demand. I could kick myself for not listening to my midwife better, but it is hard when it is your own mother telling you to let her sleep, and that everything is okay.  I don't lay all the blame on mom though, I am a parent now, I should have studied more, and listened to my gut more, doing what I knew was right instead of allowing others to influence me. It is my responsibility to care for my child, no one else's.

Friendly advice

The next day my slightly bossy and most experienced friend showed up with a meal. She saw the nipple shield and asked "why are you using that??!" She insisted that I get rid of the shield warning that it could hurt supply, cause infections, and just be bad all around. Then she sat and helped me figure out how to establish a good latch and how to hold my gigantic H cup breasts, she insisted on my using a breast feeding pillow and gave me a new mother's salve that was so much more healing than anything else. Finally it seemed like all the pieces had come together.

Not so friendly advice

Not all friends were this helpful however. One friend, who was sabotaged by her own doctors, kept asking me how I knew my daughter was getting enough. It was so annoying! I know she meant well, however her own experience has impeded her ability to support mine. Her doctors had told her that she didn't have any milk and convinced her to formula feed - two days after birth. This friend has tried to force me to pump so that I can make sure I am producing enough. She also tried to persuade me to use a nursing nursing apron... I finally did because I felt like to continue ignoring her would be rude, and decided that it was an acceptable compromise.

Other behaviour I found aggravating from this particular friend, and which made me question her motives, was her actions at a baby shower. I’m not sure she realized how offensive it was at the time. Basically, the mom-to-be really really wanted to breastfeed, so what did my friend do? She gave her formula and bottles and a note saying that when she gives up on the breastfeeding idea, she could help her with the formula....

Becoming a SAHM

But onwards and upwards! A twist in my own breastfeeding journey occured when I got to quit my job and be a full time mom, which was a very exciting evolution for me as a mother. I got flack about it, and ‘advice’ about how it is impossible to live on one income. Yes, things are tight, and my husband isn't making a whole lot of money, but I have come to believe that it is more about priorities than anything. My husband and I decided to make parenting our children well a priority over cars, homes, vacations or gadgets.

With my newfound freedom I began nursing outside and nursing often. I was not going to let hypocritical and wrong dogmas about supposed modesty keep me from nursing publicly. Unsurprisingly my daughter started putting on weight! One day about 3 weeks in my daughter stopped mid feeding, she looked up at me and smiled and then I realized - I was no longer breast feeding because I knew it was best or because it was duty, I was breastfeeding because I liked it.

I love breastfeeding. I love the bond I have with my daughter and I feel awesome. Not only did I birth my baby with no drugs in my bath tub! But I also feed her on my own, with my body! My body is amazing!

Male prudeness

I am still working on breastfeeding in public, but I try to make judgement calls about when and where I do it. Down by the liberal arts school, I can nurse without a cover and no one will bat an eye. I have done so in that district many times. But when I am out with my husband, I usually use a cover because he is uncomfortable and asked me to use one.  He is still is on the fence about the whole modesty thing, and “causing your brother to stumble”, etc, etc.

In front of my middle brother I use a cover because he said before Abbie was born that the idea makes him uncomfortable, he is 19, but my 13 year old brother doesn't seem to think a thing about it. He thought we were cuddling one day, and then he said "oh that's what you are doing" lol.

As much as possible when I am around women only I nurse without a cover because I want to get the message out there that breastfeeding is normal, natural and should be done. I want others to know who they can come to with questions about breastfeeding when it is their turn, if I hideaway and they never see it, how will they know?

I know that there are a small percentage of women who legitimately cannot breastfeed, and I encourage them to look into their options. I have donated milk to a friend who was having supply issues, and honestly, I wouldn't mind being a wet nurse in whatever capacity needed to help keep another from having to use commercial formula.

Of course, I still battle with negative influences: the church who thinks I should not nurse in public, the friend that kept asking me if my daughter is getting enough, the friend who believes teeth are the marker for weaning, and the family who talk about how extended breastfeeding is weird and offensive, not yet knowing that I have no plans of stopping before 2 years. Let's just say my daughter is calling the shots on this one.”

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Monday, September 23, 2013

The devolution of breastfeeding: part three

Welcome to the climax in a trilogy of posts examining the cultural distortion and disintegration of breastfeeding. The stories you are about to read provide a snapshot of the widespread cultural trend to denormalise, and thus warp, our view of lactation. You can find part one here and part two here.

Enticing target
Whitehouse, New Jersey, USA, 11 November 2005.

According to Health Products Research, pediatricians are the second-biggest promotional target (primary-care doctors are first) of top US drug firms, including GlaxoSmithKline, Abbott Laboratories and Pfizer. The study found that antibiotics known as cephalosporins, analeptics to treat Attention Deficit Disorder, and inhaled nasal steroids were the top three drug types being marketed to pediatricians, followed by other allergy medications, asthma therapies and infant formula. According to the research conducted by polling more than 2300 pediatricians, drug-company representatives made 2.9 million sales calls to pediatricians’ offices in the quarter ending August 2005 (compared to 11 million calls for primary-care doctors). Yearly expenditures on promotion, not including samples, total $8.6 billion. Conflict of interest anyone?

Time’s up
St. Petersburg, Florida, 18 November 2005.

The U.S. Food and Drug Administration is unequivocal: A retailer should not offer for sale any infant formula that has passed its “use by” date, and such formula should be pulled off the retail shelf. In a survey of ten stores conducted the same morning by a local TV news team, four were found to have apparently small quantities of infant formula still on their shelves one, two, four and eleven months past their use-by date. Perhaps even more striking are the reported attitudes of two mother-consumers in this regard. “That’s a little disturbing to the public,” Robyn Cullen said. “Breast milk is supposed to be the best. But if you formula feed, you want it to be as close as possible.” Jacqui Nesbitt said that the formula her eight-month old daughter drinks today sets the tone of her future. “What you do now affects them in the long run. Once she gets in school, the way she’ll be able to think, and take in information and everything, the formula, I believe, affects all that.” Sure does. Something else I’m sure of: Clearly, these moms view formula as a snugly fitting close second to Mother Nature’s Own.

Bordering on harassment
San Ysidro, California, USA, 2 December 2005.

Zayra Cano, age 18, whose legal residence is in San Ysidro, has filed a complaint against the U.S. Customs and Border Protection Service. Cano told the San Diego Union-Tribune that she was in the back seat of their car breastfeeding when she and her parents, fiancé and baby arrived at the border on their return from Tijuana, Mexico. An agent accused her of child smuggling and told her to produce milk. A service spokeswoman told the newspaper the incident is being investigated. Inspectors who suspect a baby’s identity are supposed to ask for a birth certificate – which Cane said she supplied – and can demand a secondary inspection. And if she had been bottle-feeding?

Whatever the market will bare
Suresens, France & Bremen, Germany, December 2005.

The France-based Epica awards, which are in their 19th year, aim “to encourage the highest standard of creativity in European advertising and to help agencies, production houses and photographers to develop their reputations across the continent”. Awards are judged by a jury composed of representatives of 32 magazines from 23 countries, including Turkey where the awards ceremony was held, for the second time, in January 2006.

The 2005 winner in the “dairy products” category caused quite a stir in the international breastfeeding community. The image included a full-faced view of a fair-haired baby, who can’t be more than 6 to 8 months old, with heavily furrowed brow, squinting eyes, screwed-up nose, pursed lips, jerked-back head, and an evident air of thorough “Oh, yuk!” scorn, even disgust. The baby is shown seated (my assumption is that it’s all a photomontage) directly opposite an equally fair – but bare and disembodied – right female breast and erect nipple that are the antithesis of those of a typically lactating woman.

Oh, yes, and just to the right of the baby is a large glass of presumably cow’s milk with the proprietary legend “AMMERLAND DAIRIES” etched across it, followed by “No other” centered just below. All this is courtesy of the Bremen-based advertising firm of Wächter & Wächter Worldwide Partners, which have been providing “integrated communication since 1948”. Ironically, a quick check of the Ammerland Dairies website appears to confirm that, in fact, the company produces nothing intended for consumption by children under the age of 12 months, whether for direct retail or wholesale marketing purposes. Recalling the standard injunction against whole cow’s milk before a child’s first birthday, and also bearing in mind that breast milk remains the liquid refreshment of choice for a one-year-old child, there is another dimension to this travesty in both the Franco-German and broader European sociocultural context. This is what I have concluded.

First, this is a prime example of the first rule of advertising – at all cost, be noticed! Second, the ad’s creators would doubtless argue that their brainchild was merely being cute; the implied rejection of the human in favor of the bovine shouldn’t be taken literally (Hey, lighten up! We’re just using a figure of speech!). And third, having achieved the approval of their peers by winning a prestigious prize, the creators would no doubt be truly puzzled – even totally clueless – were they to be rebuked for so unceremoniously smacking Mother Nature across the chops this way. Unfortunately, many in the viewing public would be equally clueless. (To see another award winning breastfeeding-related advertising mess, see here).

Shall I compare thee to a … football league?!
Ontario, Canada, 11 January 2006. 

Janet (Wardrobe Malfunction) Jackson, where are you when we need you? In a contact sport – Canadian football – already notorious for its commentators’ overblown rhetoric, what are we to make of sportswriter Mike Camerlengo’s choice of analogy when providing his winning-team forecast for 2006? First, his opening paragraph: “The NFC [Northern Football Conference] is like public breastfeeding to me; I don’t want to watch it, but mainly because there is nothing else going on, I become intrigued. It is ugly and somewhat unnatural, but I want to see what happens in the end.” Mike then proceeds to provide his season picks before closing this way: “Those picks are about as solid as the contents of infants (sic) diaper [especially those who are breastfed?] but as of now, that’s all I got for you. Maybe these NFC games will be filled with high-placed play and become an offensive shootout. If that’s the case, that breastfeeding mother just might turn out to be Pamela Anderson instead of the usual Star Jones [a lawyer and former prosecutor, and currently an American television personality, who some describe euphemistically as a “person of size”].” Is the sportswriter’s copy an example of art imitating life imitating art – or the reverse?

Pump brake
McMinnville, Tennessee, USA, 16 January 2006.

Angela Smith claims in a suit that she followed unwritten procedures given by supervisors when she returned from maternity leave by notifying her supervisors when she was leaving her work area to use a breast-milk pump during her two 15-minute breaks per 12-hour shift. She was fired because of her alleged failure to follow hospital guidelines, which she noted that other employees leaving to take smoke breaks outdoors do not follow.

"God made form out of chaos and we made chaos out of form, and it is a rare human being who is not, in some secret place in his heart, scared to death that we shall not be able to turn chaos into form again before it is too late" (Rollo May 2007, Love and Will, W. W. Norton & Co.; Reprint edition).

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).

Saturday, September 21, 2013

A parenting forum with a twist!

The Alpha Parent forum is here! 

Finally, a haven in which you can get knee-deep in debate without worrying about being nice, political correctness and other inconveniences. 

We've also added some quirky features you won't find on other parenting forums. Dive in!

Tuesday, September 17, 2013

Triumphant Tuesday - Breastfeeding with an Unsnipped Tongue Tie

One in 10 babies are born with tongue-tie, a condition which can prevent them from breastfeeding effectively. Just a quick snip can solve the problem, so why is tongue-tie still being under-diagnosed? The truth is that midwives carried scissors in their kitbags to deal with tongue-tie until the 1940s, at which point bottle-feeding became more common and offered a practical solution to breast-feeding problems. From that moment onwards, midwives would need to be specifically trained to perform a tongue division. Certainly, the advent of formula has a lot to answer for.

In the story you are about to read, the baby was born with severe tongue-tie which made breastfeeding painful and inefficient. Yet rather than snip the tie, medical professionals pushed the mother to give formula. Fortunately for the baby, she had a quick witted and conscientious mom.

“By the third trimester of my pregnancy I had developed gestational diabetes and my baby was breech, so I was scheduled for a c-section. However my waters broke before the scheduled date and I ended with an emergency section. We had more or less immediate skin to skin (see photo), and then Robyn was cleaned and weighed and we resumed skin to skin in recovery. With help from a midwife, I positioned Robyn at the breast for the first time. She took a few sucks and then fell asleep.

Lethargic baby

For the first night in hospital, that's how it went. As soon as the midwife put her in her cot, Robyn would wake and cry and root; the midwife would then hand her back to me only for Robyn to fall asleep after just a few sucks. Repeat ad infinitum.

The next day, each midwife would offer a hint or tip (strip baby off, position her this way, no that way, tickle her feet) but nothing would keep Robyn awake. They gave me a private room the second night (I think our antics had disturbed the other mums), yet that night was just the same, except now I had a midwife complain that I wasn't mobile enough. I have an illness called Crohn's disease, which means I was unable to take the usual painkillers. I therefore had to take a codeine based medication which wasn't as effective.

The second day, we were discharged from hospital as the midwives were sure Robyn was just a sleepy baby and would get the hang of feeding soon enough.  I was relieved. I had a grand total of 0 hours sleep over the two nights, and thought that once we were home I would have my partner's support and could recover and get to know my baby in peace.

Baby losing weight

Day 3 and 4 arrived and so did our home midwife. On day 4, Robyn was weighed and had lost nearly 10% of her body weight, was jaundiced (see photo) and not producing any wet or dirty nappies. I knew some weight loss and jaundice was to be expected, however the midwife stressed that  Robyn was at the limits of what could be considered normal, and if I didn't feed my baby then she would be readmitted to hospital. I was terrified my baby would be taken from me and worried that if she went to hospital she would be given formula, we would be separated and we'd never get breastfeeding established.


I spent a lot of time on Google while holding my sleeping baby. I stopped taking my painkillers in case they were having an effect. I tried pulling out my nipple for Robyn to latch onto.  I tried stimulating my nipple by hand, using a breastpump, and a niplette style device. I tried lots of different positions and techniques. I came across an article online about posterior tongue tie and thought the pictures looked kind of like Robyn's tongue, so I asked if there was any chance Robyn could have tongue tie. The midwife told me not to be so silly, and grabbed Robyn and pushed her onto the breast. Robyn screamed and that was the last time she came near my breast for days.

On the bottle

I began feeding her expressed milk first via syringe, then by cup and finally I resigned myself to the fact that my baby did not want my breast and began bottle feeding expressed milk.

On day 12, I went to my local peer support group. I felt such a failure and cried as I brought out Robyn's bottle and fed her in front of the other mums. But they put me in touch with a support worker.

On day 13, the support worker came to see me. She managed to get Robyn to latch briefly, for the first time in 10 days! But alas, I couldn't replicate it when left by myself.

I had another visit at day 15 and we made the decision to try nipple shields. Excitedly, I (well, my husband) rushed out to buy some. I put one on, brought Robyn to my breast, and she pulled it straight off, her latch was so poor it broke the suction - repeatedly. But then, I offered the other breast minus shield, and she fed! A full feed! On day 15 (coincidentally her due date) she had her first ever full breastfeed. I was beaming. It was if a lightbulb went on in her head.

Off the bottle

It took a little while, but I weaned her off bottles and fully onto the breast. This wasn't actually as difficult as I feared. I did it by reducing the bottles gradually. Robyn was able to feed off my left side much easier, so I began offering the left breast on demand during the day, and would offer a bottle when she got frustrated or after a couple of less successful feeds. Gradually she was able to feed more off the breast and be satisfied so I didn't need to offer a bottle. I then did the same on the right breast, and saved the night time bottle feeds till last as her feeding was much poorer when she was tired.

Unfortunately, by week 5 my nipples were so sore I couldn't carry on any longer. Robyn was still poor at feeding - she made clicking noises and dribbled a lot of milk. I visited my doctor, and brought up the subject of tongue tie again. The doctor said that even if she did have tongue tie (which he didn't think she did), it didn't affect breastfeeding. He suggested it might be thrush, and said 'if it hurts, don't do it'. I went back to expressing and bottle feeding till my nipples healed, then we continued with at least one bottle feed a day to rest my nipples else I would be in agony.

Around this time I noticed Robyn's top lip was very different to mine. When at the breast it stayed curled under, I tried gently flicking it out but it wouldn't move. Intrigued, I looked more closely and found a piece of skin tethering her top lip to her gum. I brought it up at Robyn's 6 week check and her doctor agreed to refer her to the hospital.

Tongue-tie assessment

When I arrived at the hospital, a nurse came to assess Robyn's feeding and ask questions about her history. Then the surgeon came and put his gloved finger in her mouth to suck on. The two of them agreed that Robyn had a moderate tongue tie - which wasn't even the problem I had been referred for!

I cannot believe I went through 8 weeks of struggling to feed my baby before her problem was diagnosed - even though I raised concerns all those weeks before. Yet Robyn's tongue tie was not snipped as they felt that she would grow out of it. Despite the hospital’s failure to snip, there was some improvement immediately after the hospital visit. I think the surgeon stretched the tie while examining her. Robyn stretched her tie even more herself when she started solid foods (she used to get food stuck in the roof of her mouth because her tongue wouldn't lift).

Robyn was 13 weeks old before the pain during breastfeeding finally went (or was only fleeting). She's now coming up to 11 months old and we're still proudly breastfeeding! I don't really understand why some moms wouldn't at least give breastfeeding a go, it's best for baby, best for mum, and it's free.”

Get your own blank Bingo Card here.

Email me with your story to appear on Triumphant Tuesday!

Monday, September 16, 2013

The devolution of breastfeeding: part two

Welcome to part two in a trilogy of posts examining the cultural distortion and disintegration of breastfeeding. The stories you are about to read provide a snapshot of the widespread cultural trend to denormalise, and thus warp, our view of lactation. You can find part one here.

Infant formula as grand metaphor
Sydney, Australia, 1 September 2005. 

First, I read the headline: “Infant formula makes the taxman whimper”. Then I read the article. But nowhere is there any mention at all of infant formula or even of feeding babies. Instead, the article describes the results of new research by the Australian Federal Treasury showing that the tax and welfare changes introduced by Prime Minister John Howard and Treasurer Peter Costello have resulted in a jump in after-tax income by almost a third more than inflation in the first decade of the Howard Government.

Using my powers of deductive reasoning, I conclude that all 20 of the hypothetical families featured in the Treasury study are failing to breastfeed their children. Furthermore, I conclude that these same families are not really making out nearly as well financially as the fat rats in the Howard & Costello Cheese Factory portrayed by the journalist.

After all, families that fail to breastfeed their children have to spend quite handsome sums not only on buying a breast-milk substitute but also in contending with the short- and longer-term fallout, whether for themselves or their children, across the entire life course. This includes, among other nasties, impaired brain development and visual acuity, heightened risk of premature mortality and multiple ailments, for example, cardiovascular, respiratory and diarrheal disease, type 2 diabetes, ear infections, allergies, obesity, breast and ovarian cancer in mothers, childhood leukemia, rheumatoid arthritis, and even mothers’ capacity to deal with stress.

Or perhaps I've got it all wrong. Maybe it’s nothing more mysterious or complex than a headline writer who sees the words “infant formula” as metaphor, the verbal equivalent of the still-ubiquitous feeding-bottle ideogram in the world’s airports, you know that back-lit graphic symbol of a child’s feeding-bottle suspended prominently from terminal ceilings (along with signs indicating where the toilets are located) that shows mothers – including, ironically, breastfeeding mothers – where they can go and comfortably feed and otherwise care for their children.

In the mind of the headline writer, then, this is unquestionably how things really are child-feeding wise, at least in Australia. But “infant formula” is not only synonymous with “child-feeding”; it has also attained the lofty, even enviable, rank of complete societal metaphor covering neatly such key conceptual images as family formation patterns and child-bearing and rearing practices.

Yes, that must be it. In fact, I’m sure it is. You see, what convinced me was when I replaced “infant formula” with “breastfeeding” in the headline. Somehow, “Breastfeeding makes the taxman whimper” just didn’t have the same authentic ring.

How long is “prolonged”?
Geneva, Switzerland, 30 September 2005. 

The report by Mandel and colleagues about the fat and energy content of expressed human milk in “prolonged” lactation provides as interesting a scientific analysis of the composition of human milk as it does a glimpse at the cultural bias from which the analysis is made.

Indeed, the authors’ very definition of “prolonged lactation” is at odds with the article’s last sentence, which appears to acknowledge the contribution of anthropologist Katherine Dettwyler to our collective understanding of the normal and natural – not the prolonged – duration of breastfeeding for modern humans: 2.5 years at a minimum and about 7 years at a maximum.

The article’s last sentence also provides a striking contrast to its first: “The optimal duration of breastfeeding is unknown.” Even if we don’t know yet, from the perspective of child-led weaning it is safe to say that at least the children do.

Unfortunately, the American Academy of Pediatrics’ open-ended recommendation – “Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child” – has not been cited fully; whereas the World Health Organization’s policy –“while breastfeeding continues for up to two years of age or beyond” – has been omitted entirely.

That researchers are only just getting around to investigating human milk’s fat and energy content after one year of lactation speaks volumes about breastfeeding’s perceived nutritional and psychosocial value for toddlers. It also brings to mind, at the opposite end of the child feeding spectrum, the widespread belief just a generation ago that human milk was fine but only for babies born at term; that is, until researchers took a look at the milk of mothers who actually delivered preterm and concluded that it was in fact better suited for babies born early.

The statement “Whether continued high saturated fat and cholesterol intake through breastfeeding beyond the first year of life is beneficial in unknown” only serves to reinforce the article’s cultural bias. (Why wouldn’t it be? After all, breast milk is still milk.) Not so long ago pediatricians believed that breast milk was “low” in iron, at least compared to infant formula. If breast milk is now seen as “high” in saturated fat, to what is it being compared?

Milk’s fat content varies considerably among species, and even within the same species, for example the kangaroo that routinely produces two milks for different-age offspring. It’s time we adopted the perspective that what Mother Nature has provided is the default even as we strive to understand why.

We could take a cue from the results of Australia’s first study of mothers who were breastfeeding children at least two years of age or older (107 mothers aged 21 to 45 years (average 34 years) and 114 children aged 24 to 78 months (average 36 months)). When children were asked about breastfeeding, nearly all said they breastfed because they liked the milk and it made the feel happy or good. They also reported that breast milk tastes “as good as chocolate” and “better than ice cream”.

Pushing pacifiers and panning co-sleeping
Washington, DC, USA, 10 October 2005.

The American Academy of Pediatrics revises its SIDS recommendations today, including in favor of using pacifiers from one month of age and against co-sleeping. The Academy doesn’t get a free ride, however; almost immediately the world’s foremost mother-to-mother support organization, La Leche League International, the International Lactation Consultant Association, the Academy of Breastfeeding Medicine and the United States Breastfeeding Committee issue their research-based dissenting responses. The League notes that “the obvious omission of input by the AAP’s Section on Breastfeeding may account for the fact that breastfeeding management issues were not taken into consideration”. Reaffirming that “the baby who is exclusively breastfed for six months is the appropriate resource model,” ILCA noted that “very few of the studies cited in the AAP policy statement defined either exclusivity or duration”. The president of the Academy of Breastfeeding Medicine describes the statement as “a truly astounding triumph of ethnocentric assumptions over common sense and medical research”. Meanwhile, the United States Breastfeeding Committee recommends caution before advising pacifiers for breastfeeding infants even after one month of age. It also emphasizes the importance of closeness to one’s infant and supports the statement of the Academy’s Section on Breastfeeding that mothers and infants sleep in close proximity.

From one extreme to the other 
New Brunswick, Canada, 11 October 2005. 

The Irving newspaper group has pulled the latest issue of Here magazine, a free weekly magazine targeting urban youth, from store shelves and fired its editor after a close-up photo of a breastfeeding baby appeared on its cover. The photo is an extreme close-up of a tiny suckling baby; the cover promoted a story about World Breastfeeding Week, which began on 1 October, while highlighting the low rates of breastfeeding in New Brunswick. Irving news executives replaced the photo with a cartoon drawing of a woman holding a baby in a blanket. Former Here editor Miriam Christensen says she was fired on 6 October after Brunswick News executives recalled the original cover from delivery trucks and stores across the province. She is surprised at her former employer’s reaction to the photo, and says she didn’t think an image of a nursing baby would offend anyone. Brunswick News vice-president Victor Mlodecki told CBC the original cover was inappropriate for some of the locations that might have distributed it. Freelance journalist Brent MacDonald wrote the story and is angry the photo was pulled. He says the cover was an important part of the piece. He says he doesn’t work for the paper any more. “The photo was pulled, the image of a mother breastfeeding her baby, and it really didn’t do justice to the story, or the real issue here, that mothers in New Brunswick aren’t breastfeeding their babies and babies are being short changed.” According to a report of the New Brunswick Advisory Council on the Status of Women, 64% of NB mothers who gave birth between 1998 and 2003 breastfed (the national average was 85%) but only 26% breastfed for four months (48% nationally) and 17% past six months (39% nationally).

Making breastfeeding the exception 
Dallas, Texas, USA, 23 October 2005.

To: The Susan G. Komen Breast Cancer Foundation, Dallas, TX

I am writing to say how pleased I am to read the section of your site on “Not Breastfeeding”, which states:

There has been much debate about the effects of breastfeeding on a woman's risk of breast cancer. Although the issue is still under investigation, there is now good evidence that breastfeeding protects against the disease, particularly in premenopausal women. 
Add this reduced risk of breast cancer to the other benefits of breastfeeding—such as fewer childhood infections, fewer sick days used to care for an ill child, a quicker return to pre-pregnancy weight and possibly a lower risk of ovarian cancer—and there are compelling reasons for women to choose to breastfeed their children if the resources are available and they are capable of doing so.

However, I do have one suggestion with regard to the last 12 words of this text.

Parents are routinely encouraged to protect their children’s lives and well-being by having them vaccinated against the major childhood diseases and transported in safe car seats, and by keeping potentially dangerous substances (e.g. medicines and cleaning products) out of reach. But surely no one would consider adding a qualifying phrase like “if the resources are available and they are capable of doing so”.

There are two points here. The first is a question of logic – if the advice is taken, the health of mothers and children is protected and the risk of disease, and injury or death, is lowered, irrespective of resource availability or capability; and, second, it is difficult to see why the nutritional norm for mothers and babies should be the subject of a qualified endorsement when every other public-health recommendation is presented in a straightforward categorical manner.

Yours sincerely,
James Akre
Geneva, Switzerland

The irony and the paradox 
Dundee, Scotland, 27 October 2005. 

Today, I learn that fewer than half of all mothers in Dundee, Scotland, are breastfeeding their babies when they are discharged from hospital. Figures released by National Health Service Tayside to Marlyn Glen (a member of the Scottish Parliament who co-sponsored the Breastfeeding (Scotland) Act which, since March 2005, protects the right of mothers to breastfeed publicly) show that although the number of mothers breastfeeding is rising, breastfeeding rates in Dundee are still far lower than elsewhere in Tayside (the region takes its name from the River Tay and covers 3000 sq. miles with a population of 400,000 people). In 1997/1998, only 30% of mothers were breastfeeding at the time of discharge. Though 2003/2004 figures show a rise to 46%, this is still nearly 10% lower than the rate for Tayside as a whole. The real revelation, however, is the rate at six weeks postpartum: just over a quarter (26.4%) of Dundee’s babies are being breastfed at this point, the lowest rate in Scotland. (By comparison, just over half of women initiate breastfeeding in Argyll and Clyde, and by six weeks only 32% are still at it)

Oh, the irony and the paradox! It was in Dundee between 1985 and 1989 that Peter Howie and colleagues undertook their history-making study of feeding practices and sickness episodes, especially gastrointestinal disease, among 618 mother-child pairs in the first two years of life. They are the first researchers to overcome previous methodological difficulties to demonstrate, once and for all, that even in a middle-class environment in an industrialized country it is, indeed, breastfeeding that makes the significant difference in protecting babies against infection. Their results are a beacon in the literature no doubt, though all but forgotten it seems, at least as far as today’s Dundee mothers are concerned. Obviously, there’s still a lot to do to bridge the gap between science, policy and practice to protect the health of mothers and children.

More real-world examples of attitudes that are incompatible with Nature's plan will be posted in part three, next week.

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).

Tuesday, September 10, 2013

Triumphant Tuesday - Breastfeeding While Working Full Time

There is no need for a mother to stop breastfeeding if she returns to employment. A baby that is losing his mother’s presence need not lose her breast milk too. Just as the mother still has moral obligations to her baby, her employer has legal obligations to her. Choosing employment close to her baby or pumping milk while at work or requesting flexible hours are all options. Continuing to breastfeed will help to maintain the unique life-giving bond mom has created with her baby.

You are about to read the story of a mother who returned to work full-time when her son was just seven weeks old. After the struggle she experienced to bring him into the world, she wasn’t going to let employment demands prevent her from giving him the milk he deserved. In her story, she provides handy hints on how to increase breastmilk supply and how to store and transport breast milk, as well as giving an honest account of the challenges.

“On June 7th 2013 I marked one year of successful breastfeeding to my now 14 1/2 month old boy, Ayden. Considering I have 12 and 10 year old boys that I was not so successful with when it came to breastfeeding, I never thought I would have made it this far. I had my older two children at 20 and 22 years of age. I can honestly say that I have more time, patience, and support this time around in my 30s. I have also armed myself with more knowledge...thanks to The Alpha Parent and a breastfeeding facebook group that I am a part of. I know that without these resources I would not have made it.
When I had my first son 12 years ago, the hospital had no problem offering me the small 2oz bottles of Enfamil and quite frankly, I had no problem accepting them. I had no pamphlets, knowledge, experience, or awareness of breastfeeding. I had never seen another woman breastfeed so to me, it seemed like formula was the normal choice.

Prenatal Preparations

Fast forward to recent times. My husband and I were trying to conceive for over a year and during that time I read many books and on-line articles about breastfeeding, making home-made baby food, and other baby related topics. I continued researching throughout my pregnancy and also discovered The Alpha Parent. Soon enough, it was time to give birth.
An Eventful Birth Day

At 6am on June 7th (two days after my due date) my husband and I checked in at the hospital for a scheduled induction. I had scheduled the induction on my due date because I was worried due to having polyhydramnios (excessive amniotic fluid) and I was known to have 9 pounders. With the polyhydramnios I knew that if my water were to break, it could potentially result in the cord coming out first and the baby's head or shoulders clamping it, resulting in serious harm. Due to the complications that could happen with polyhydramnios, my previous missed miscarriage at 10 weeks and the fact that this pregnancy had also been a threatened miscarriage, I thought it was my best option. 

I was given Pitocin via IV and then during my exam I was told that I was 2cm. Although I started contracting, my body did not seem to progress. Hours later I was still at only 2cm but then stretched to bueno! The contractions progressed but I remained at 3cm late into the day. They decided to break my water for me to see if it would speed things up but all attempts were unsuccessful. My body just would not dilatepast "almost 4". I had planned on going without an epidural but sometime after dinner time I caved.

At one point after 7pm my medical team suddenly rushed in during my contractions. They were checking me, checking the monitor and what not. This kept happening during each contraction. Around 8pm the Doctor briefed me that the baby's heart rate was dropping during contractions and mine was escalating (or vice versa...I can't recall who was which). She said that the baby was stressed and he could possibly have his cord wrapped. She also informed me that due to his rather large measurements he could get stuck and that would be a scary situation. So, I went with her suggestion: emergency C-section.

At 8:18pm they pulled my son out of my body. I felt like my birthing experience was stolen from me. A big part of me wishes I did not agree to the c-section but then again, I don't know if I would have had a successful outcome.

I had my husband follow the baby to the nursery while I had my tubal ligation immediately after the C-section. This was my third living child. I had two children with a previous marriage and my husband had two with his previous marriage. We both wanted a child together, which made five. Taking on more than five children was financially and practically unfeasible so I asked the hospital to sterilize me after the c-section.

To the Breast

After the procedure was complete, I was wheeled into a recovery area. I recall being completely out of it and then all of a sudden being handed my big 9.2lb bundle of boy, my son, Ayden. I unhooked my gown at the shoulder in front of everyone and immediately started to nurse. I had wanted to nurse immediately upon his birth but that option was not afforded to me so I was not going to wait a minute longer. I knew exactly what to do and the nurse affirmed that I was a pro. Little did she know that I had read about it and even watched tutorials. Her comment made me feel amazing!

I swear Ayden ate every 1-2 hours. Exhausted and sore, I struggled with breastfeeding. As Ayden ate so often and for so long I feared I wasn't providing enough and even asked my husband to request formula from the nursery. They explained to him that since my goal was to breastfeed only, that I should not introduce a teat or formula to him as it would disrupt the whole supply and demand process with my husband suggested that I listen to them.

After leaving the hospital Ayden nursed every two hours for 30-40 minute periods, probably comfort nursing. I co-slept and fed on demand not believing in scheduled feedings or naps. Ayden was a peaceful baby, sleeping mostly.

Returning to Work

After the first week home I started pumping one side after letting Ayden eat on the other. This way I could build up a breastmilk stash in the freezer for when I was to return to work. I was fortunate to freeze 3,500 ounces after just six weeks. I set my alarm and pumped at least every two hours, day and night! I would often read The Alpha Parent postings from my Kindle during night pumping sessions, thus arming myself with more powerful knowledge. 

I went back to work when Ayden was seven weeks old. I missed him terribly; however, it felt good getting back into a routine. I had a wonderful seven weeks bonding with Ayden however the structure of employment was welcoming. Immediately upon returning to work my supervisor transferred me from an open cubicle to a private office with a locking door. Knowing that I had a private place to pump with no issues was a God send. I pumped 1-3 times each day at work, depending on my work load. Some of my colleagues were unaware of what I was doing. I would place a sign on my doorthat read "Please do not disturb. Come back at [specific time entered]." 

Transporting the Precious Cargo

I would put no more than 5oz in a storage bag and put it in the freezer standing up and it would freeze in like a rock shape. Once frozen, I placed all bags in large zip locks in the freezer as well as my deep freezer. Later on, I realized that this was not the best method as the corners or areas would crack and leak milk. I lost a lot of milk this way and started laying them flat on the freezer shelf. I then filed them in a basket and always placing the newest milk in the back. It was a filing system for my milk. It not only looked better this way as well but also took up less space in my freezer. After dinner each evening I would lay out bags on the counter to thaw for the following day at daycare.

Supply Fears

There came a point, at around 4 months, when Ayden was eating more pumped milk than I was expressing each day I started to worry. I wanted so badly to avoid formula. That's when I started taking supplements. I took Mothers Love More Milk Plus every day. I also made 1/2 cup of steeled cut oats each morning and evening, power pumped and drank Mothers’ Milk tea.

I produced plenty of milk and even made Ayden one extra bottle for daycare every day (a total of four bottles per day)...just in case! There was no way he was going to have formula. I'm so happy that I had an abundant storage, but then again, I pumped a lot! Below was my pumping schedule upon returning to work:

-Every 2-3 hours in the middle of the night, regardless if Ayden woke or not.
-0545 pump one side
-0700 nurse Ayden on other side
-0900 both sides
-1300 both sides
-1500 both sides
-1800 one side / nurse Ayden on other side
-2000 one side / nurse Ayden on other side
-Sometime between 11pm to midnight, one side / nurse Ayden on other side

Work Struggles

There were pros and cons to pumping at work. On the plus side, pumping helped me de-fog and de-stress at times. However, on the down side, sometimes it felt like pumping was in the way. When I'm on a role with something I don't like interruptions. It makes me feel like I got knocked off of the wave and have to paddle back out again and ride in on another wave.  

The worst thing about pumping at work was sometimes missing or delaying my scheduled pump times due to my supervisor having random all hands meetings or one on one meetings about specific projects I was working on. In my field August and September are very demanding months. I work in Federal procurement and we are trying to obligate the funding prior to midnight on September 30th. In addition to not being able to take planned leave, we have to work mandatory comp or overtime during these months.

By around 5-6 months Ayden started getting clingy.  It was a struggle with him wanting to be held all of the time. I didn’t feel resentful considering I worked 9.5 hours a day, but it was a struggle. Once he started eating food he started cutting back on the nursingbut I continued to pump during the feedings he used to eat (hey, I still needed supply for daycare). At 12 months of age Ayden had still never had cows’ milk. 

I've read many articles that explain how formula fed babies tend to have higher chances of being overweight in comparison to breastfeed babies. The growth patterns of my three children support this theory. My third baby (the one who had breastmilk only) was my heaviest baby at birth weighing 9 lbs 2 oz whereas my other two were 8 lbs 15 oz and 8 lbs 13 oz yet if you look at their growth charts, my breastfeed baby weighed less at his well baby check-ups than my formula fed babies.

I have not only meet my goal of 12 months with providing Ayden only breast milk - I have exceeded it! Thanks to the knowledge and tools I have gained from The Alpha Parent, I have been able to successfully breastfeed my baby for 14 months and counting! You can too!  

Get your own blank Bingo Card here.

Email me with your story to appear on Triumphant Tuesday!

Mengenai Saya

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