Breastfeeding Coalition of Boone, Clinton and Montgomery County

Future Coalition Plans

2012-01-28T00:05:00.000-05:00

After announcing my resignation as chair of the Boone, Clinton and Montgomery County Breastfeeding Coalition and spreading the news, unanimously I've heard, "Not interested in taking over the position." The real tragedy is that I spent hours and hours establishing our coalition as a non-for-profit and gathering the appropriate resources to best offer lactation stations, pump rentals, support groups, and provider networking within our three counties. We have a savings account and this blog.

While I had no intentions of abandoning the coalition, I am not in a position to make the changes our counties so desperately need. Working outside the hospital infrastructure, I am limited in my influence.

My clientele base currently, is supported in their choice to breastfeed. The vast majority exclusively breastfeed through six months, and they are all offered provider support, a mother support group, and have available to them a good source of lactation supplies and tools as they might prove necessary. More importantly, my responsibilities with Believe Midwifery Services have escalated so that I can commit to little else.

Rather than kill the coalition entirely and have someone later have to recreate the wheel, I've decided to continue the coalition in blog. I'll maintain the non-for-profit status, the bank account, and will continue to be a resource, but primarily through writing and sharing my findings and thoughts here. The support group will continue, hosted by Believe Midwifery, and we'll continue to offer ourselves as a Hygeia retail center. January Gilley CLC is working towards her IBCLC and certainly has interest in offering a support group in Montgomery County. We can support her in those efforts, and as always, the Lactation Station will continue in Thorntown Turning Leaves Festivals. Beyond that festival however, I can not commit at this time.

Maybe another passionate breastfeeding advocate will surface within the community and be eager to continue the walk. Until then, I'll carry the torch.

Resignation

2012-01-11T00:47:00.001-05:00

I would like to announce my resignation, pending replacement, as chair of the Tri-County Breastfeeding Coalition. Please share the word among the community, so we can find an enthusiastic leader able to jump in and make great strides within our community for breastfeeding families. Further details will be shared at our upcoming meeting this Friday at 10am, with replacement to assume leadership in March.

Reflux and Cow Milk Allergy: Is there a link?

2011-12-17T20:15:00.002-05:00

Reflux seems to be the hot ticket diagnosis for newborns and many are prescribed pharmaceuticals to manage symptoms or are instructed to initiate a dairy elimination diet. GER, or gastroesophageal reflux, is present in virtually every infant however. It is a normal physiologic event. Respectfully, it can also be quite dangerous, even fatal, but discerning between a scenario that is truly pathological is important as interventions imposed on an otherwise normal physiologic process can undermine breastfeeding and lead to early weaning, imposing risks of its own.

Reflux is considered physiologic when the infant thrives well and experiences no complications. Regurgitation of at least one episode per day occurs in half of all newborns through three months of age infants, increasing to more than two-thirds of all infants by four months of age, finally decreasing to 5% of children between the ages of ten and twelve months. Symptoms can be normal through two years of age.

Pathologic GER is reflux associated with other manifestations, such as, failure to thrive or weight loss, feeding or sleeping problems, chronic respiratory disorders, esophagitis, hematemesis, stricture, sideropenic anemia, apnea, apparent life-threatening episodes or sudden infant death syndrome, and Sandifer's syndrome. Recurring respiratory symptoms is an atypical presentation without the regurgitation and vomiting, but reflux just the same.

Food allergy is actually a secondary GER, and is considered GERD or GER disease. This diagnosis is difficult to make. Infections, metabolic and neurologic disorders are also causes for secondary GER.

Cow milk intolerance defines any reproducible clinical adverse reaction to cow milk, and is suggested with increased total or specific blood immunoglobulin (Ig) E or positive skin-prick test, but no reliable routine test is available for definitive diagnosis. Cow milk allergy is reported in 0.3% to 7.5% of infants, most before the fourth month of life. In breastfed infants, allergy occurs in approximately 0.5% of babies.

Approximately 30% to 70% of infants with cow milk allergy manifest dermatological symptoms, and 20% to 30% manifest respiratory symptoms. Meaning, more than half with cow milk allergy demonstrate symptoms involving more than one major system. Clinical response to an elimination diet and a challenge is the diagnostic principle for food allergy. Diagnosis of specifically cow milk protein enteropathy ideally necessitates the proof of small bowel damage with patchy partial villous atropy and increased intraepithelial lymphocytes.

Natural tolerance in infants who are affected by cow's milk is frequently achieved within the first years of life. A quarter find remission by two years of age, half by three, and 78% by 6 years of age. GER and cow milk allergy are generally self-limiting symptoms, possibly interrelated, with only a small proportion of infants who will continue to have the disease-related symptoms after early infancy.

Soy-protein-based formula is NOT recommended in the initial treatment of cow milk allergy (CMA), although most infants with IgE-mediated CMA may do well on soy formula, particularly after the age of 6 months. Soy is not effective in preventing allergy and the atopic manifestations are comparable in the cow milk verses soy groups.

Breastfed infants have less and shorter reflux episodes three and four hours after feeding, which is believed to be contributed to more quiet sleep, improved clearance rate, and enhanced gastric emptying, and may be related to differences in macronutrient content such as lipids and other components such as growth factors. When a CMA-related GERD is suspected, a dietetic trial with complete avoidance of CMP (with calcium supplementation when required) in the maternal diet is suggested for 3 to 4 weeks. When helpful, CMP should be reintroduced in the maternal diet to prove any casual relationship.

However, prior to recommending an elimination diet in our practice, the Nurse Midwives investigate thoroughly the breastfeeding relationship for oversupply. This alone can cause colitis and is easily rectified. Probiotics are vital, as Lactobacillus is quite beneficial for atopic dermatitis and of course, gut health. Finally, although it is politically incorrect for a midwife to suggest ditching store bought milk for raw milk, I don't believe humans were created to drink orange juice without consuming the orange, nor do I believe we were created to consume cow's milk without all the components removed through pasteurization, or frankly with all the preservatives, antibiotics, fortifiers and hormones. Can we diagnosis a cow milk allergy if real cow milk isn't even being consumed?

Salvatore, S. & Vandenplas. Y. (2002). Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics, 110(5), 972-983.

Lanolin verses Expressed Breastmilk on Painful and Damaged Nipples

2011-12-03T01:37:00.002-05:00

I'll be honest, my first go-to is the hydrogel. This is an entirely anecdotal intervention however. We don't often have breastfeeding difficulties in our practice, and when we do it is often a baby that needs a chiropractor or has a tongue tie, which is immediately corrected by a little snip at the 48 hour home visit. More common nipple pain seems to be a phenomenon of hospital born babies, or rather a multitude of interventions. Every now and then however, a mom will present with what I uses to be oh so familiar... damaged nipples from a poor latch.

Evidence has been brief about how to best treat damaged nipples, outside of fixing the latch of course. A 2010 study by Abou-Dakn, Fluhr, Gensch & Wockel compared highly purified anhydrous (HPA) lanolin verses expressed breastmilk for the treatment of painful and damaged nipples associated with breastfeeding. Eighty-four mothers were included in the study and results were rated by a Nipple Trauma Score. Outcomes favored the HPA lanolin group, reaching statistical rates for healing rates, nipple trauma and nipple pain.

Now we need a study comparing the HPA lanolin and the hydrogel. Either way, I tell my nurses that if they give a client lanolin or a hydrogel, they also need a lactation consultant. Neither should be a matter of routine.

Colic Ease

2011-12-03T00:26:00.000-05:00

Wish Garden was generous in donating Colic Ease for our review and it was a hit for the Andrews family.

"Yes, it has helped. We use it instead of the Gripe Water, and instead of the Gas Drops we were using. We also see our chiropractor once a month, and this past visit, her second cervical vertebrae and another down the middle of her spine were out. He said one of them control the enzyme release from the liver, and she was not breaking down the milk like she needed to. After the adjustment, she has been a completely different baby. We still use the Colic Ease at least once a day though, and she is doing great with it!"

Colic Ease Ingredients Include: Fennel seed, Catnip leaf, & Peppermint leaf extracted into approx. 60% vegetable glycerine, 30% Rocky Mountain spring water and 10% grain alcohol.

It is typically priced at $12.99 for a one ounce bottle, and can be found at Believe Midwifery Services.

Breastfeeding Trends by Ashley Kenyon RN

2011-11-30T00:21:00.000-05:00

Ashley is the new chair of the Howard County Breastfeeding Coalition and a Registered Nurse and Practice Educator for Believe Midwifery Services. While researching breastfeeding trends to increase her own knowledge base, Ashley discovered the 1940s to have a great impact on declining breastfeeding rates. She thought our readers might enjoy her findings.

Widespread acceptance of oral contraceptives may have resulted in the decline of breastfeeding.
The belief that infants needed to be on a schedule and fed at certain times made the irregular feedings of breastfeeding seem unrealistic for busy mothers.
Pediatricians recommended formula in the 1940s, and mothers listened to them.
Sexualization of the breast may have caused may to feel uncomfortable with breastfeeding.
Separation of mother and infant during the day and night is seen as independence and is often sought after. This separation however, can make night nursing difficult for some mother infant pairs to start breastfeeding off on the right foot.
Little support was offered to mothers in the postpartum period and they began to believe formula feeding would be easier.
Formula became easily available and marketed as an acceptable substitute.

The use of anesthesia during labor and birth made breastfeeding difficult at first and with no support women may give up during this early period.
Formula is often given when the infant is in the hospital nursery.
Physicians often recommend formula when infants have various problems.
Formula companies began finding new ways to improve formula and make it closer to breastmilk.
Many times physicians do not discuss or encourage breastfeeding.
Because formula was available for a cost many wealthy woman felt they were purchasing the best for their babies.
Medical community began encouraging early weaning.
Nurses and doctors were not properly trained to help mothers and babies successful breastfeed.

IBLCE Disciplinary Procedures

2011-11-13T15:48:00.000-05:00

On October 31st, 2011, IBLCE announced the immediate release of their new IBLCE Code of Professional Conduct, which replace the former Code of Ethics. This professional group has had more controversy surrounding its professional code than any other group I have been a member. At one point, the code stated that lactation consultants were not to contradict the client's medical provider. In a field whose evidence largely opposes the standard of care and with its experts passionate about changing the tides, this particular rule created concern enough for several to turn their back on their once respected organization. Again, our leaders are being questioned.

IBLCE offered two weeks within which stakeholders and the public at large were solicited to comment on the draft, many of which were, in fact, incorporated in the final Code of Professional Conduct. The final version can be found here. The surprise is, IBLCE also crafted a new Ethics and Discipline process that was not discussed with its members at large prior to release. Big changes include:

The current E&D procedures now applies only to those holding the IBCLC credential, as opposed to the previous Code of Ethics applying to "any and all applicants for any IBLCE examination," causing students and aspiring lactation consultants to pay attention to professional ethics expected of them if they hoped to sit the exam. This change also means that those seeking professional liability insurance as a student may find great difficulty, as removal of these sensible standards leaves insurance companies without confidence that students are also under similar expectations as their mentors.

Another important change is in the detailed process of how a case would proceed against an IBCLC for whom a complaint was filed, and found initially to have merit. The OLD Discipline Procedures set out a formal administrative hearing, including the accused's right to counsel, and an opportunity to hear and cross-examine witnesses, even though the formalities of trial evidence were not required. A record was to be kept (presumably in case of an appeal). All procedures were done under oath and although lengthy, it was a "rather lovely description of a hearing designed to protect the rights of the accused while permitting examination of allegations of misconduct," states Elizabeth Rooks JD, IBCLC.

The NEW E&D Procedures have retreated from this process, significantly. Currently, the committee chair has "sole discretion" to determine if a compliant that comes into the IBLCE is frivolous or invalid. One person is now the gatekeeper for all procedures that are to follow. No justification. No accountability. Ultimate power. If such complaint is deemed to have merit, the accused will be mailed a copy of such procedures, a summary of the compliant, and a list of the E&D Committee members. The accused is not allowed to see the original complaint, rather a summary. It is unclear if the accused is even made aware of who filed the compliant. The accused has 30 days to respond.

A three-member review subcommittee is then appointed to "clarify, expand or corroborate the information provided by the submitter." The review committee can contact the complainant, or the accused, for additional information and may, at their discretion, contact any other individual who may have knowledge of the facts. This here, is the great concern. Elizabeth Rooks JD, IBCLC states, "It is unheard of, at least in USA judicial proceedings, for judges and their courthouse clerical staff to go out in search of evidence. Rather, they ask the parties and their lawyers to proffer evidence, under oath and rules of evidence designed to promote the veracity of the facts."

The Review Subcomittee would them make a finding, and recommendation of sanction, which it presents to the full E&D Committee. There is no formal hearing or trial-type proceedings, no hearing of witnesses, and the rules of evidence are not applicable. Legal counsel is not expected to participate in the process, unless requested by the accused and approved by the E&D Panel. Although, the IBLCE may consult IBLCE legal counsel. Nothing under oath. No right to face the accuser. No right to see the original compliant. All investigatory proceedings conducted in private, and in confidence, without the accused there. Investigations may be conducted sui generis by those serving in an adjudicatory capacity. Accused must seek and be granted permission to use a lawyer, but IBCLE has legal counsel assured all along the way. Appeal on grounds of material errors of fact only, yet the record containing the facts alleged and investigated is under seal.

Not sure our quest to gain credibility as a genuine, independent yet interdependent profession within the infrastructure of maternal and child healthcare will be respected with a professional group demonstrating utterly lay disciplinary actions. Lactation consultants are questioning the background of the IBLCE board members, and more specifically the IBLCE's legal counsel. Once again, I am grateful my job doesn't depend solely on my lactation credentials.

2011-11-10T14:05:00.000-05:00

From Tina Cardarelli IBCLC - Indiana State Breastfeeding Coordinator:
On paper we wanted to improve our ranking on the CDC Breastfeeding Report Card for “number of IBCLC’s per 1,000 births” which is a great marker for access to care. Since 2009 when we began this program, we had 2.67 IBCLC per 1,000 births and in 2011 we rose to 3.33 per 1,000 births. Access to specialized breastfeeding care in Indiana now surpasses any of our neighboring Midwestern states but remains well below higher performing states. The full impact of these programs will not be felt until the 2012 Report Card when I expect a huge increase. In addition to the test scholarships, we offered free study guide textbooks and free and low cost 45 hour LCERP study courses with Linda Smith. We are proud to have played a role in improving access and bringing new talent into the field with a focus on populations, hospital, communities and agencies that did not previously have an IBCLC.

Thank-you Tina Cardarelli!! Our Coalition Appreciates You!!

Lactation Degree

2011-11-03T14:23:00.000-04:00

Several years ago, I was one of the first graduates in the country with a degree in lactation. At the time there were two universities offering such degrees and the vast majority of our profession were utterly unaware of the availability of an academic preparation for our field. In fact, my nursing associates poked fun - "Well, if you can get a degree in lactation, then you can officially get a degree in anything!"

Today I learned that both Ivy Tech State College and the University of Indianapolis are exploring the potential to offer an associates degree in lactation. Fantabulous! I look forward to hearing future up-dates.

Should Neonates Sleep Alone?

2011-11-02T15:06:00.000-04:00

Morgan, Horn & the popular Nils J Bergman (2011) published the article, "Should Neonates Sleep Alone," in the journal of Biological Psychiatry. Their conclusion is that separation of the newborn from its mother has a profoundly negative impact on the quiet sleep duration and is a stressor for the human neonate, as they are ill equipped to cope with such separation. The impact is far from benign.

Code of Ethics for IBCLCs

2011-11-02T02:04:00.000-04:00

Received an e-mail from IBLCE this week...

"After a process of detailed review and thoughtful revisions based on stakeholder feedback, the International Board of Lactation Consultant Examiners® (IBLCE®) announces a new Code of Professional Conduct (CPC) which replaces the IBLCE Code of Ethics.

New Disciplinary Procedures and a Complaint Form accompany the new Code of Professional Conduct."

An active discussion on Lactnet is focusing on the soft stance of the board regarding the International Code of Marketing. Should an IBCLC who works for a formula manufacture have her certificate removed? The board says not.

Go-Lacta

2011-11-02T01:54:00.000-04:00

A client of mine recently asked my opinion on Go-Lacta. I honestly had never heard of it, so did a little reading.

Go-Lacta is a galactagogue, which are special foods, drinks or herbs which people believe can increase a mother's milk supply. You might be familiar with Fenugreek or Blessed Thistle. Go-Lacta is the Asian counterpart, obtained from the leaves of the Malunggay tree (YouTube video here). In most parts of the Philippines, women take malunggay leaves mixed in chicken or shellfish soups to enhance breast milk production. The mechanism of action has not been explained but it was effective as a galactogogue and has been used by generations of nursing mothers.

One double-blind, randomized controlled study by Estrella et al (2000) demonstrated a 51-58% increase in milk supply in preterm mothers exclusively pumping on day four, and even greater on day five, at 152-176%. No reported adverse effects were seen in either group.

An earlier study in 1996 was conducted by Almirante and Lim, which demonstrated the lactating-enhancing effect of malunggay leaves as evidenced by a greater increase in maternal serum prolactin levels and percentages of gains in the infant's weights among the lactating mothers who took the malunggay leaves. The same authors repeated the study in hypertensive mothers and had similar outcomes.

100% vegan 100% plant-based 100% natural
A bottle of 60 capsules costs $19.95.

2011-10-27T11:37:00.002-04:00

Breastfeeding Promotion Act. The Breastfeeding Promotion Act of 2011 (H.R. 2758, S. 1463) amends the Civil Rights Act of 1964 to protect breastfeeding women from being fired or discriminated against in the workplace. It also ensures that executive, administrative, and professional employees, including elementary and secondary school teachers (in addition to non-exempt employees covered by the previous amendment), have break time and a private place to pump in the workplace. Click here for more information.
Stolen from Tina Cardarelli's Breastfeeding News

Long-Chain Polyunsaturated Fat

2011-10-21T01:20:00.001-04:00

Through my career, the focus on long-chain fatty acids has changed significantly. It seemed to gain the greatest attention when added to infant formula and advertisements claimed infants who consumed such milk would have increased IQ.

Certainly in our midwifery practice, the Nurse Midwives encourage supplementation of long-chain fatty acids during the antenatal period, particularly second trimester, because pregnant women are nearly incapable of consuming enough in their diet due to current levels of mercury contamination.

In the first year of life the brain increases rapidly in weight from 350g to about 1000g. It then represents 10% of total body weight and, as the brain has a relatively low (65%) water content it accounts for 10-15% of the dry weight at this time. The solids of the brain are composed mainly of lipid (60%), subdivided into phospholipids, sphingolipds, gangliosides and cholesterol, with the phospholipids (65%) predominating in the cerebral cortex.

Formula manufactures recognized the deficiency of long-chain polyunsaturated (LCPs) fats in artificial breastmilk compared to human milk. The cerebral cortex requires significant amounts of these LCPs, especially arachidonic docosatetraenoic, docosapentaenoic acid of the n-6 series and docosahexaenoic of the n-c series, especially in the first year of life. Remember its controversial entry into the market during the turn of the century?

DHA and AA was added to infant formula, sourced from fish eyeballs or grown on fungus, and done so without prior testing or FDA approval. Those persuaded to pay high dollar for the new and improved formula were in fact, the population researchers would study to determine safety. Ethical? No. Legal? Yes. The FDA does not monitor nutritional supplements.

There is no doubt that brain function in breastfed babies and those who are supplemented with artificial human milk are different. In fact, evidence demonstrates that those who do not receive human milk are not as intelligent as those who are - or rather, they don't reach their own potential. It seems the first four months, with regards to long-chain fatty acids, is the critical period. Artificially fed babies clearly needed the addition of DHA and AA to the basic formula of artificial breastmilk. The methods in which this was introduced however, is what seems to have shocked the lactation community.

Women were persuaded that this new formula was either the key to a smart child, or that their milk was somehow now insufficient. Lactation consultants worked to dispel the misconceptions and earnestly resisted maternal or neonate supplementation of any kind (iron, vitamin D, essential fatty acids, flouride, etc.) in fear this would encourage the belief that breastmilk was inferior.

Now a decade and a half into my career, and in a position that allows me to drop my defenses, I am interested in ways a mother can supplement her diet to improve her health and that of her newborn. It is a basic principle that breastmilk is better. There is no argument and my clients appreciate that fact without my having to persuade them. Our clients also recognize that we live in a contaminated world and a convenience-based society with an overwhelming dependence on convenience foods, so while pregnant and breastfeeding, renewed energies for improving their health surfaces.

Evidence does show that while breastmilk is overwhelmingly stable, maternal supplementation of DHA does in fact increase both maternal plasma phospholipids and milk lipids. Consumption of two high-DHA eggs a week does not appear to have negative effect on total-serum-cholesterol, but can elevate DHA concentrations. Low-EPA, high-DHA fish oil is also effective maternal supplements for increasing breastmilk DHA.

One study (Helland, Smith, Saarem, Saugstad & Drevon, 2003) demonstrated that maternal supplementation of very-long-chain n-3 PUFAs during pregnancy and lactation (from cod fish oil), as compared to long-chain n-6 PUFAs (from corn oil), increases mental processing scores of children at the age of four. Higher maternal intake of DHA resulted in higher maternal plasma levels and thereby increased transfer of DHA to the fetus. IQ points were increased by 4 points among school children (cod fish oil verses corn oil), with no harmful side effects. Head circumference and mental processing skills were also significantly different between the two groups.

It is important to note, that simply because breastmilk offers minimal amounts of DHA, does not mean it is not sufficient for optimal growth and development. Supplementation should not be recommended across the board, but diet should be evaluated and supplementation introduced as appropriate
(Jensen, Maude, Anderson, & Heird, 2000).

2011-10-18T20:09:00.002-04:00

Domperidone

2011-10-18T20:09:00.000-04:00

Lactnet has been buzzing about the controversial pharmaceutical, Domperidone. It is a wonder drug in our profession, but one the Food and Drug Administration (FDA) argues is dangerous.

Over the last few months, USLCA has been working in conjunction with Dr. Thomas Hale from the Infant Risk Center at Texas Tech University towards obtaining approval from the FDA for the use of Domperidone for breastfeeding mothers experiencing with an insufficient milk supply. Domperidone was once the gold standard for those select mothers suffering with insufficient milk supply, but for the past few years, practitioners have been unable to (or only with great difficulty) offer this option.

Dr. Hale and the USLCA have worked with the FDA to obtain Orphan Drug Designation for Domperidone, defined as those intended for the safe and effective treatment, diagnosis, or prevention of rare diseases/disorders that affect fewer than 200,000 people in the U.S. Safety and efficacy must still be established through adequate and well controlled studies, bu the orphan qualifies for grants to conduct such studies. Once the required studies are conducted, they are submitted to the FDA for marketing approval. USLCA and Dr Hale are currently apply for grants with the hope of eventually obtaining marketing approval for Domperidone. Mothers throughout the country, owe Dr. Hale a standing ovation for his efforts and successes.
US Lactation Consultant Association September eNews

CLC course in INDIANAPOLIS

2011-10-01T13:33:00.001-04:00

Healthy Children's Center for Breastfeeding is holding a Certified Lactation Counselor (CLC) Course in Indianapolis from February 27 – March 2 2012!!

“The Center for Breastfeeding's Certified Lactation Counselor training program is a forty hour course designed to provide a solid, up-to-date, research based body of information regarding lactation as well the art of counseling. This course is offered at a variety of locations throughout the United States and around the world, training over 1,500 participants annually. Learners are engaged in over forty hours of didactic and experiential activities during this five-day course. On the final day, an examination is offered by the Academy of Lactation Policy and Practice (ALPP). The exam consists multiple choice questions (some of which refer to photographs). A certificate, and the designation Certified Lactation Counselor (CLC), is awarded by the Academy of Lactation Policy and Practice to all learners who pass all of the competencies and who agree to comply with the Scope of Practice and the Code of Ethics. Participation in the exam is not required of learners. However, it is only after successful completion of the course and examination that the Lactation Counselor Certificate is conferred. Participants of the course receive continuing education credits regardless of the outcome of the examination. The certificate expires after three years, and may be renewed by submission of a minimum of 18 hours of continuing education.”

Influence of Heat Treatments on Milk Components

2011-09-28T21:04:00.000-04:00

When I first started donating milk, I had many human milk advocates question why others would risk obtaining milk directly from the donor, as opposed to a human milk bank where donors are screened and milk is pasteurized. I attempted to rationalize that while I appreciate the benefits of screening and pasteurization, there certainly are benefits of human milk lost during the pasteurization process that many recipients desire.

As more evidence presents regarding HIV and breastfeeding, particularly flash boiling human milk of those with HIV prior to feeding the child, interest regarding the influence of heat treatments on the milk components grows.

Linda Smith (2006) has compiled some data for us:

Cellular components of human milk is destroyed at 62.5 degrees Celsius for thirty minutes. They are completely destroyed via freezing.

Lipids are stable through boiling, but increased breakdown occurs into that of fatty acids after freezing and thawing.

Minerals are stable through pasteurization and freezing.

Two-thirds of Lactoferrin is lost after thirty minutes of posteurization at 62.5 degrees.

Secretory IgA is stable at 56 degrees of pasteurization for thirty minutes, but destroyed with boiling.

Lysozymes are stable when pasteurized at 62.5 degrees Celsius for thirty minutes, but mostly destroyed after 15 to 30 minutes of boiling.

Other immunoglobulins are stable when pasteurized at 56 degrees Celsius for thirty minutes.

Bifidus factor and Gangliosides are stable through boiling.

Mother's Diet & Milk Composition

2011-09-28T20:42:00.001-04:00

I am frequently asked about how mom's diet might affect her milk composition. I don't mean specifically which foods should a breastfeeding mother avoid. The answer to that question is none (unless a known allergy has been identified), but more specifically, how can human milk be altered by maternal diet?

This question first interested me many years ago when it was suggested that a diabetic mother not breastfed because the glucose in her milk may negatively impact baby, if it were to become too high or too low. However, a little research demonstrated that in fact, glucose is quite stable in human milk and most certainly, breastfeeding provides a plethora of benefits to both the diabetic mother and her child.

Later in my career, I wondered if a failure to thrive baby might be benefited by maternal supplementation of essential fatty acids. I learned that this component is somewhat vulnerable to manipulation in the maternal diet; therefore, the recommendation has some merit. At the same time, I learned that babies whose mother have had gastric by-pass surgery can suffer consequences if she is not sufficiently obtaining necessary vitamins and minerals.

While human milk is quite stable, in spite of mother, there is some room for caution and certainly some room for manipulation. Currently, I am attempting to manipulate human milk in my practice by supplementing mothers with Vitamin D, rather than routinely supplementing babies.

Here are a few facts for your pocket brain (Linda Smith, 2006):
Milk Component
Total Milk Volume = Not affected by mother's diet, except possibly in maternal starvation conditions
Carbohydrates = Not affected by maternal diet
Proteins = Not affected by maternal diet
Lipids = Fatty acid profile can be affected, although total fats are unaffected
Cellular Components = Not affected
Immune Factors = Not affected
Fat-soluble vitamins = Slight variance related to fat levels in milk
Water-soluble vitamins = ARE affected by maternal diet
Minerals = Macronutrient elements, iron, chromium, and cobalt are NOT affected, yet there is possible affect to human milk with iodine, fluoride, zinc, manganese, selenium, and lead

Soy Formula

2011-09-28T20:31:00.000-04:00

Compiled from Health Education Associates and other references:

Soy formula has the highest incidence of wheezing, rhinitis and otitis. Chandra 1989
Soy is at least as allergenic as cow's milk. Eastham, Kjellman, Mendoza, Arment, Chandra, Gruskay, Ellis
Adverse reactions follow within three weeks. Fomon, Powell, Ingkaran, Haffejee, Iacono, Redel
Soy is associated with poorer response to vaccinations. Zoppi, Businco, Hahn-Zoric
Soy fed infants have higher rates of illness. Zoppi, Businco, Lonnerdal
Soy formulas have zinc deficiency and low selenium concentrations. Lonnerdal, Smith, Fitzherbert
Soy formulas have high levels of manganese. Lonnerdal, Smith
Soy formulas have high levels of aluminum. Freundlich, Hawkins, Greer
Soy formulas are associated with increase risk of autoimmune thyroid disease. Fort et al.
Soy formulas are associated with increased risk of diabetes. Fort, AAP 1994
Soy formulas may have long-term effects on cholesterol metabolism. Mott, Kallio, Cruz
Soy has plant steroids (phytoestrogens) that may effect human babies. Lonnerdal, Whitten, Landau, Cruz, Irvine, Clarkson, Sheehan
Soy formula has no lactose, which may affect brain development.

Dr. Hale

2011-09-27T01:13:00.000-04:00

I've posted a few times about a workshop I attended many months ago now, actually just over a year ago, with Dr. Thomas Hale. It most certainly was one of the best workshops I've attended on breastfeeding. I am still gaining insight from my notes.

One area of lactation that seems to be changing daily is our understanding of breastfeeding and HIV. Dr. Hale shared that HIV transmission occurs with breastfeeding involution, so while exclusively breastfeeding, risk is nil. This makes perfect sense with what we already knew to be true about HIV and breastfeeding, those exclusively breastfed did not become infected, but infants who were supplemented with formula were at risk. I'll admit that because our practice does not care for HIV clients, I have failed to keep up-to-date on this subject matter, but for curiosity's sake, I'd love to stumble across a great article that sums up what we know to be true today (not necessarily what our nation's recommendations are).

Another interesting suggestion Dr. Hale offered is a reminder that progesterone can inhibit milk synthesis, but we don't know when this occurs in individuals, and clearly it seems to vary from woman to woman. Although it is believed progesterone receptor sites are eliminated in the first week, experts are questioning if some women in fact, maintain receptors. His suggestion was to start with the mini-pill and if tolerated, the Depo or IUD could then be administered.

When increasing milk production, synthesis depends on increasing the number of lactocytes, emptying of the breast, and maintaining moderate levels of prolactin. This takes six to seven days to increase lactocytes so a recommendation of "staying naked in bed" must last six to seven days to gain big effect.

Reglan is a medication administered to those with low supply (particular due to the controversial nature of domperidone), which is rather unfortunate because Reglan does cause depression in 12-13% of women, and tartive dyskanesia in others, particularly if taken longer than three months. Dr. Hale's recommendation was after three to four weeks of (30-45mg/day divided in three doses) therapy, to decrease to 10 mg a week. As well, Reglan is only effective for women with low levels of prolactin. Other causes of decreased supply are not benefited. He suggested measuring prolactin levels prior to the onset of therapy, although if there is no increase in supply in the first week, one can discontinue.

These sheets really will be kept for many years, there is just so much wisdom in them. Every medication typically offered was discussed and phenomenal notes were provided. I certainly recommend attending any workshop he may be speaking, as I can't think of another presenter that I gained more valuable information from.

PUMPING MILK at WORK?

2011-09-26T01:05:00.000-04:00

Holly Hopkins shared with us during our most recent coalition meeting:

Dr. Hoffmann is seeking mothers who are pumping in the workplace, to consider sharing your insights and experiences. She is a professor at Purdue University and is interested in learning from moms who used to pump at work, are currently pumping at work, started pumping at work but had to stop, or had planned to pump at work but were unable to do so.

She's requesting a thirty minute interview, and can be reached by e-mail or phone: 765-496-2225.

Your interview would be part of her sociological study of moms who return to work and continue to breastfeed. Your responses would be completely confidential, as required by Purdue's research rules.

If you only have time for a brief survey, please visit her website.

Coalition Meeting

2011-09-26T00:59:00.001-04:00

This past Friday, the Coalition met for the month of September, 2011. Penny Lane MSN, CNM, IBCLC was present as the coalition's chair, with January Gilley CLC the coalition's treasurer. Holly Hopkins MSN, CNM, CLC, Ashley Kenyon RN, Kristen Kile RN, and Erin Syslo, Infant Toddler Specialist were also present.

Introductions were shared, with very brief review of the coalition's history. Members shared their hopes for the coalition, which consisted of efforts to reach young mothers, extending greater efforts towards making the community aware of our efforts, recommitting to offering Lactation Stations at county festivals, and establishing a thriving support group in both Montgomery and Clinton County.

The coalition plans to terminate the established yahoo group, replacing this method of communication with both the blog and our Facebook page.

The Thorntown Turning Leaves Festival is this weekend. Volunteers needed.

Believe Midwifery Services plans to assume responsibility for the breastpump program. A hospital grade pump will be purchased initially and then items for purchase will follow.

A Hale, Medications and Mother's Milk, text was donated to the newly established Howard County Breastfeeding Coalition. It was suggested the second be donated to our local pediatrics office.

Penny shared that the State Breastfeeding Task Force has recently changed to the "Indiana State Breastfeeding Coalition," and meets quarterly. Smaller focus groups have been created, which our members were encouraged to attend. Interest was voiced for both the Community Outreach group, led by Dane Nutty, and the Educating the Provider, leader unknown. However, further information regarding objectives were desired.

Believe Midwifery Services is offering a FREE Breastfeeding Class for parents in October. Please promote! And Penny Lane MSN, CNM, IBCLC plans to offer a Breastfeeding Class for Providers in the next few months...date to be announced.

Erin Syslo, Infant Toddler Specialist shared her efforts to educate day care providers, both facility and in-home, within Clinton and Boone County about caring for the breastfed baby. A sample breastfeeding policy for the child care setting is available on the IPN website or another sample is here. The state has provided magnets that will also be distributed with feeding tips and breast milk handling information. The coalition will compile a list of resources, have them printed and available for Erin, so when she begins her visits in the spring of 2012, she can share with day care providers.

Next Meeting: The THIRD FRIDAY of December, at 10am.

Lactation Matters

2011-09-23T01:32:00.001-04:00

Lactation Matters, a new blog published by ILCA, has launched a new feature called, "Clinicians in the Trenches." Their hope is to highlight those who are doing outstanding work in the field of lactation and encouraging others through innovative care practices.

The first story was entered today, focusing on Colette Acker and The Breastfeeding Resource Center.

If you know someone who is bringing light a new idea within their practice, share! Robin Kaplan and Amber McCann can be reached here. They ask that you include "Clinician in the Trenches" in the subject line. Every two weeks a new clinician will be featured.

2011-09-16T23:21:00.001-04:00

No Joke

2011-09-09T00:40:00.001-04:00

A new father, observing his wife breastfeed their newly born daughter for the first time, said to one of the nurses that works for me, "So, I wonder who was the first person to actually try this?" She said everyone in the room just starred and he had no awareness of just how ignorant that statement was. I am rather alarmed too, but it does in fact demonstrate how far from nature our culture has veered.

Coalition Meeting

2011-09-07T23:15:00.000-04:00

September 23rd is our next breastfeeding coalition meeting at 10am, prior to our support group meeting at noon. We haven't met for quite a while, so please join us to catch up and get back into the work we love, supporting breastfeeding women. We anticipate having a few new members and will be hosting a speaker who will discuss how to support the breastfeeding mother whose baby is in childcare while she works.

If you have any topics you'd like me to add to the agenda, please e-mail me or leave a comment to this post. I plan to discuss lactation stations, pump rentals, support group, and identifying a new action plan for our coalition.

Erin Syslo, Infant Toddler Specialist

Certified Trainer for The Program for Infant/Toddler Care

Review of Baby GooRoo Book Marks

2011-08-24T19:35:00.001-04:00

This past week, while visiting the local WIC World Breastfeeding Celebration, I discovered a bookmark by babygooroo.com that I just fell in love with, The Scoop on Poop. I immediately visited the company's website, hoping to order a bundle for my clients and discovered that rather than having the opportunity to order fifty of the one bookmark, I had to place an order for a bundle of four different bookmarks, including, Keep Your Baby Safe from SIDS, Signs that Your Baby is Positioned Well, and Signs that Your Baby is Well Fed.

As a midwife in private practice and a lactation consultant, I am super critical about reading material I provide my clients. In fact, I write most of them myself, but haven't created the perfect visual for baby poop during the first few days. Not wanting to make the investment and be disappointed by risk-based public health focused material, as opposed to evidence-based, empowering material for informed parents, I sent an e-mail requesting the opportunity to review their bookmark package. They kindly responded, and sent a few additional items. Joy!

This is the best picture I can provide you for the bookmarks. The printing quality alone - large size on sturdy card stock with glossy lamination - is quite impressive for the price of only $0.35 for the bundle. Each are quite visually appealing.

The Scoop on Poop marker is especially cute. "Nothing comes out the bottom unless something goes in the top!" One side illustrates what to expect the first week, with large diaper graphics specific to either meconium, transition or breastmilk consistency stool. A note at the bottom reminds mom when to call for help and I must note, is both accurate and provider-friendly ("health care provider" rather than exclusively physician).

On the reverse side of the marker, diaper quantities are illustrated with smaller detail to the consistency to the stool, which helps the parents count diapers appropriate for each day of life through the first week. "A stool is a stain the size of your baby's fist, or at least 1 teaspoon of solid material."

The second marker, Signs that Your Baby is Well Fed, does not disappoint. The front size lists all the various indications that baby is "full" or well-fed, with an endearing African American baby at the top. The reverse side has the same baby pouting and exclaiming, "I'm hungry!" with another list of signs baby is not well-fed. The lists are quite thorough and again, the marker is provider-friendly and visually appealing. Certainly happy to add both of these to my practice's educational material.

The third, Signs that Your Baby is Positioned Well, offers all the important indicators, in very clear and easy to understand terms, that baby is well latched and sucking effectively. On the reverse side, a list of all the important assessment points of poor latch with an illustration of a shallow latch. Again, the author has used a dark toned baby, to represent diversity beyond "vanilla."

Keep Your Baby Safe from SIDS, was the book mark I was most concerned would give instructions that would oppose those we teach in our practice. We are advocates of bed-sharing and teach our families how to do so safely. This marker does not oppose bed-sharing specifically, listing on either side instructions with how to lie baby safely down to sleep. Regular check-ups with the baby's doctor and obtaining immunizations are among the recommendations for preventing SIDS.

My above statement about having to order the bookmarks in a bundle was incorrect. Each bookmark can be ordered individually in bulk.

Breastfeeding Ready, Set, Go! was another generous gift sent by the gooroo baby company and again, I am rather impressed. I appreciate greatly the baby pictures, which not only perfectly illustrate the specific point being discussed, but are quite diverse and adorable. Teaching points are brief and reader-friendly for all literacy levels, yet also engaging and thorough. This booklet is printed on card-stock and bound with a metal ring. I imagine having one of these in the reception area for clients to browse through or maybe available in a retail store to purchase as a gift for a new mother. The price is very reasonable at only $5.75.

My only suggestion would be to add Dr. Hale's website information as a resource for mothers discerning if any particular medication is safe while breastfeeding. Referring them exclusively to their health care provider (again, appreciate the provider-friendly terminology) will often lead to the recommendation to pump and dump, as even pediatricians and sadly, midwives, are unaware of Dr. Hale's vast resource. If I were to someday have a bit of money, I would happily add these booklets to the free materials provided to each of our clients.

Finally, the fourth edition of the Amy Spangler Breastfeeding booklet was included in my mailing. I have seen these numerous times throughout my career, available in several hospitals I have been employed, but inconsistently offered to mothers. I suspect that is simply because Medela offers a similar pocket-size book free to anyone who is willing to ask and Amy Spangler's booklet is $3.00 each (an incredible deal in itself!). If ordered in bulk orders 100+, they are priced even lower.

I do wish rather than discussing the advantages of breastfeeding, the author would take a more risk-based approach. Babies aren't smarter if breastfed; they are less so if provided food other than human milk.

A question and answer teaching approach is used, which I believe many mothers appreciate. The breast anatomy is up-to-date and dinner-and-dessert style breastfeeding is recommended. A dose of vitamin K is recommended at birth for the newborn, and daily supplementation of vitamin D. The vitamin D dose is out-of-date however, and no mention of supplementing mother in lieu of baby is discussed.

This critical lactation consultant placed her order today for each of the above items and very much looking forward to distributing them within our breastfeeding classes.

Eats on Feets

2011-08-21T23:59:00.001-04:00

Eats on Feets, an on-line networking group for human milk sharing, has created quite a stir within the lactation community. The organization has chapters all over the world, connecting those in need of milk with those who are willing to donate, each within the same community. The individual chapters do not organize or manage milk sharing. They do however, offer information in effort to assist parents in making an informed decision about milk sharing. While the main website hosts a forum, Facebook is a popular connection point. You can find the Indiana chapter simply by searching "Eats on Feets Indiana."

Aurora Breastfeeding at 11 Days

2011-08-06T12:25:00.002-04:00

Orion breastfeeding at TWO months

2011-08-06T00:53:00.000-04:00

Ornery Boys

2011-08-05T23:48:00.001-04:00

My twelve-year-old son, Noah, was a cruel older brother today and did a "titty-twister" on my four-year-old son, Samuel. I have no idea where they learn these ornery things. Samuel of course did it right back to Noah with all his little-tough-guy effort, and Noah screeched, "Now I am going to get cancer!"

Noah then returned the favor once again, and Samuel cries out, "AHH!! Now I am not going to be able to get pregnant!!"

World Breastfeeding Week

2011-08-05T23:31:00.006-04:00

The Boone County WIC Department has asked me to speak about the benefits of breastfeeding at their World Breastfeeding Week Celebration. I am thrilled to do it. The topic however, is a bit daunting. My gut reaction, and honestly what I might present is in fact, that I can't think of a single benefit. I can't.

Human babies were created to be fed human milk from his or her mother's breast.

If I were asked to speak about the benefits of having a healthy renal system, I would in fact be sharing the great disadvantages and heart-ache associated with dialysis. The same would be true if I were to discuss the advantages of having a healthy respiratory system. The only real benefit comes in not having to live on a ventilator. I am grateful my musculoskeletal system is also intact, preventing me from having to suffer the great disadvantages of living in a wheel-chair or being bedridden. My breasts function and my child suckled with great success. I do not, nor do my boys, have to suffer the consequences of not having been breastfed.

Women who breastfeed are not super moms. Breastmilk is not liquid gold. It is milk created specifically for human babies. Anything else is inferior.

Had I not been so blessed in my own breastfeeding experience, each of my boys would have had an increased risk for nearly all infectious diseases, from the simple ear infection to meningitis. They might potentially have faced debilitating allergies or a compromised immune system, even cancer or diabetes. Their mere survival would have been less likely had we not had such a successful breastfeeding experience.

My boys are all at the very top of their class. (I suppose I should be forthright and share that they are educated at home, so they are the only student in their particular class. I suppose that means they could have the worst scores in their class too!) They are very bright boys and human milk is certainly part of that success. This particular point is one that is quite controversial. It seems to hit the hot button for many people. Breastfeeding has in fact been associated with enhanced performance on tests specific to cognitive development and while these differences are slight, they can make the difference between independent living and assisted living, or SAT scores that provide a full scholarship to college or a hefty student loan. The American Academy of Pediatrics has long recognized this "benefit." Research in this one particular area is over-overwhelmingly solid. The wheel is round. Not breastfeeding does hamper intelligence.

As for me, had I not breastfed my children, I would most certainly have increased my risk for breast cancer, as well as uterine, ovarian, and endometrial cancer. Osteoporosis and diabetes would have more greatly impacted my life as well. I certainly might suffer these devastating conditions, but if I do, they should not enter my life as early or be as significant had I not breastfed for as many years. If for no other reason though, the emotional health risks associated with not breastfeeding is certainly enough to get my husband on his knees praying for a fruitful breastfeeding relationship. I was a happier woman and he was a happier man.

The research is honestly quite daunting. Decades ago, we knew virtually nothing. Today, there is a plethora of evidence demonstrating the disadvantages associated with not breastfeeding, from health consequences, to the financial strain on our nation, to even increased child abuse. I would suggest that in spite of all we currently do know, we have only begun to understand the complexities of human milk and the breastfeeding relationship.

The World Health Organization recommends exclusive breastfeeding through the first six months of life and thereafter, complementary foods while breastfeeding continues for up to two years of age or beyond.

This year's theme for World Breastfeeding Week is 3D. WABA suggests that advocates of breastfeeding tend to be two-dimensional. We focus on time (from pre-pregnancy to weaning) and place (the home, community, health care system), but neither has much impact without a THIRD dimension - communication. We live in a time where individuals and global communities connect across small and great distances at an instant's notice. New lines of communication are being created every day, and we have the ability to use these information channels to broaden our horizons and spread breastfeeding information beyond our immediate time and place to activate important dialogue.

Boone County has a Breastfeeding Coalition and I encourage each of you to join. We were established in 2006 and this past year were one of two Indiana Breastfeeding Coalitions awarded as the Coalition of the Year. Our coalition in particular was granted this honor because of our blog, which is just one step towards advocating for breastfeeding 3D.

Boobie

2011-07-14T16:22:00.000-04:00

Noah, my almost thirteen-year-old, was invited to a girl's house for her birthday swim party last weekend. He was the only boy and was quite thrilled with the invite. After returning home and sharing about his wonderful time, he said, "Mom, wanna hear about my super embarrassing moment?"

"Well, they call their little brother (who is probably about seven years-old), Boobie. I asked why they nicknamed him that and her older sister said because he was breastfed until he was a year-and-a-half!!"

Noah (having been breastfed until he was four-and-a-half) responded sheepishly, "Yeah. That's a really long time."

Ha! Ha! Ha! Ha! Ha!

2011-07-05T16:08:00.000-04:00

It is ludicrous

to even discuss modesty

in the context of breastfeeding

when scanty women's clothing

is so well tolerated in the media,

at the workplace, and in public.

Peggy O'Mara (October, 2005)

Off Topic: Let's Discuss Aluminum

2011-07-02T15:37:00.001-04:00

Vaccines are a controversial topic among breastfeeding families, so I don't fear its discussion here will fall on deaf ears. Since the H1N1 crisis, I've had questions about aluminum in our vaccines. Is it the new thimerosal?

Aluminum is added in a number of vaccines and although it is a naturally occurring substance, even harmless when swallowed, is it safe when injected into newborns? The FDA has quite a bit of information about aluminum toxicity on their website. I was actually surprised to learn that aluminum is found in intravenous solutions, like dextrose solutions, and can reach toxic levels with prolonged parenteral administration if kidney function is impaired (including premature babies). TPN, which many tiny premature babies are offered as their sole source of nutrition, causes a build-up of aluminum in the bone, urine, and plasma. This is fairly difficult evaluate however, but can be very serious, and the FDA takes this very seriously. The ASPEN suggests, and the FDA requires, that all injectable solutions be limited to 25 mcg; as this is believed to be a safe level.

The disconnect then comes when we evaluate the aluminum level in vaccines. Using the 5 mcg/kg/day criterion, Robert Sears MD (2008) discovered that a 12-pound, two-month-old baby could safely receive 30 mcg of aluminum per day but a newborn who gets a Hepatitis B injection on its first day of life would receive 250 mcg of aluminum.

Each vaccine lists the level per shot of aluminum on its packaging. DTaP ranges from 170-625 mcg, depending on the manufacturer, and Pediatrix is listed as 850 mcg! Even more alarming, two-month-old babies are receiving several vaccinations at once, multiplying their aluminum levels to upwards of 1225 mcg.

Has the use of aluminum in vaccinations been researched? Dr Sears comments in his Mothering, 2008 article, "Is Aluminum the New Thimerosal?" that not only was he unable to find any evidence that the issue had been researched, but the American Academy of Pediatrics warns that aluminum can cause neurological harm.

The older vaccine DTP was the first to contain aluminum and at such low levels, there was no concern. Then in the 1980s, the PedVaxHib was released containing aluminum, then HIB and later Hepatitis B in the 1990s. The turn of the century brought Pneumoncoccus and even Hepatitis A, each containing aluminum. Administering four vaccines certainly goes beyond insignificant levels of aluminum for a young child, but even more alarming, this seems to have escaped everyone's attention.

Why not just remove aluminum as has been done with thimerosal? Apparently, it isn't that simple. Aluminum is an adjuvant; meaning, it helps vaccines work more effectively. "When the metal is mixed with the vaccine, the body's immune system more easily recognizes the vaccine and creates antibodies against the disease," (Sears, 2008, p 51). Thimerosal was easier to omit because it had nothing to do with the efficacy of the vaccine. However, why does one brand of HIB vaccine require aluminum to make it work and another does not? Why does one brand of DTaP vaccine contain four times as much aluminum as another?

For a current list of vaccines and their thimerosal contents, go to www.vaccinesafety.edu/thi-table.htm

Providers can be diligent about ordering vaccinations that contain less or no aluminum. They can also be mindful of giving only one aluminum-containing vaccine at a time.

Sears, R. (2008). Is aluminum the new thimersol? Mothering, 146, 46-53.

Mastitis 101

2011-07-02T00:51:00.001-04:00

Mastitis is most often caused by Staphylococcus aureus and Escherichia coli bacteria. These bacteria typically enter the nipple via a crack caused by a poor latch; however, some women seem to be more prone to breast infections, potentially due to anemia, thinner skin, or because of extreme engorgement. Symptoms include a red, sore spot on the breast, followed by a red line progressing along the plugged duct, fever and chills. Mothers typically share that they can't get off the couch, like they were suddenly overcome with a really bad flu. Sometimes babies refuse to nurse because the milk is said to have a slightly saltier taste due to the higher level of sodium in the inflamed tissue.

The most typical medical management is antibiotics, although this is certainly not the gold standard among lactation consultants. Antibiotics are not without harm. Most importantly, they are too often initiated prematurely. There's a fine line between plugged ducts and mastitis. Plugged ducts can also be quite painful and inflammation may be present, but the fever is typically absent. Antibiotics are not helpful in this scenario, and in fact, only introduce risk.

Instead mothers should be encouraged to breastfeed, to massage the affected area gently, to apply heat, and most importantly, a thorough discussion with regards to optimal latch should be prioritized by the provider. In fact, bras are quite often the culprit.

Even in the face of an actual infection, antibiotics can often be avoided. Twenty-four hours has often proven to be enough time to rid mothers from all signs of infection, most likely due to the plethora of blood circulating through the breast. Time might be all that is necessary, while allowing baby to suckle at the breast at his or her leisure.

Dr. Jack Newman shares that 50 percent of women in his clinic avoid antibiotics, and I would venture to guess that only about ten percent require antibiotics in our practice. This is assuming early symptoms are taken seriously. No bras should be worn during the engorgement days. Foot massages are nice. Daily Immune by WishGarden is an herbal remedy that can assist a mother through recovery, or better, assist in the prevention of mastitis. Cabbage Leaves should be in the refrigerator of every new mother, as they have a long history of offering cool relief for the engorged breast. Avoiding caffeine can also prove beneficial to mothers who otherwise seem particularly prone to suffering mastitis.

If mastitis still rears its ugly head, the homeopathic remedy Phytolacca at a dose determined by an experienced midwife can prove effective. Our practice has experience with WishGarden's Mastitis Remedy and Mastitis Compresses and each mother has shared tremendous relief with these products. We have also used a pokeroot recipe rubbed on the breast, castor oil compresses, a cold poultice of raw potato, lecithin, Vitamin C, echinacea and zinc supplements. If mastitis repeats, it is wise to have the mother assessed for anemia.

Getting a Good Night's Sleep

2011-07-01T23:37:00.000-04:00

"Common sense tells us that night waking is not a pathological abnormality but a temporary disturbance," states Peggy O'Mara in her Mothering, 2007 editorial, March edition. Here are her ideas:

Accept night waking as normal.
Sleep when baby sleeps.
Don't turn on the light or change diapers when the baby wakes at night to nurse.
Don't count how many times you're awake at night.
Don't look at the clock in the middle of the night.
Nap on weekends, or whenever you can get help with the baby.
Carry on.

Volunteer Opportunity

2011-06-20T13:53:00.000-04:00

To meet the needs of breastfeeding mothers and families, the Indiana Mother's Milk Bank is once again providing Lactation Stations at the Indiana State Fair. This year, they have expanded to THREE stations and with 5 additional days to the fair's duration, THEY NEED YOUR HELP!!

There are no requirements for volunteers, just a willingness to help mothers, infants, and families. Volunteers will help make sure mothers are comfortable, refill and distribute information, and pass out promotional items. Fathers, you are also asked to volunteer!!

Volunteers receive free admission to the fair, free parking, and a t-shirt. Please contact Fernanda Agnes, IMMB Lactation Station Coordinator by e-mail at feagnes@immb.org. Questions can also be asked of the IMMB Program Manager, Dane Nutty, at 317-536-1670 or by email at dnutty@immb.org.

The Lactation Station will also be supporting the Indiana Black Expo and volunteers are needed from Thursday, July 14th, through Sunday, July 17th. Contact Fernanda to volunteer.

Why breastfeed?

2011-05-30T17:42:00.000-04:00

Ever see a smart cow?

Breastfeeding Matters

2011-05-30T17:30:00.000-04:00

Based on an article in Lancet in 2003, breastfeeding prevented an estimated 1,301 thousand deaths, whereas insecticides prevented 691 thousand, complementary feeding saved 587 thousand, the H influenzae type B vaccination saved 403 thousand, zinc supplementation saved 351 thousand and clean water, sanitation, and hygiene saved 326 thousand lives. Where do we focus our money and attention in educating for improving maternal and child health?

Long-term Pumping Tips

2011-05-30T16:40:00.000-04:00

I can preach and preach about exclusive breastfeeding and how working to feed on the breast is worth every bit of effort mother's invest, but for those that genuinely must face long-term pumping, Linda Smith IBCLC offers a few tips:

First, buy or rent a good quality pump with vacuum pressure of 100-250 pounds and the ability to cycle at 30-60 times per minutes. Plan to spend at least $200. You get what you pay for when it comes to pumps. I once heard a lactation consultant say, buying a breast pump from a formula company is like trusting someone to pack your parachute that would profit if it didn't open. There are fewer than five high quality breast pump manufactures. Speak to your local lactation consultant before purchasing a pump, but also LEARN TO HAND-EXPRESS!

A woman's breasts will release most of their stored milk in the first 10-20 minutes. Be prepared to pump about twenty minutes every two-to-three hours, with one four-to-five hour stretch once per day. The goal is to mimic your baby's feeding pattern. Do not allow the milk to engorge your breasts. This will cause your milk supply to dwindle.

Each woman is different. Some women's breasts dump quicker. Others release slower. Some breasts store more. Some less. A small-breasted woman may need to pump more often than a woman with more glandular tissue and more storage capacity.

The milk-producing cells settle into a production rate that maintains total volume at about fifteen percent more than what baby demands per day. To increase supply, increase demand. Work to empty more frequently and more thoroughly. To decrease volume, allow some milk retention. It takes 1-4 days for the breasts to respond to new demands.

Maintain your supply at about fifteen percent more than baby needs. This allows you to freeze a bit more than baby requires currently. Your little one may have a growth spurt. If you find all your milk is used up without opportunity to freeze additional supply, pump more frequently to increase your supply as baby would otherwise nurse more often to do the same.

What you eat and drink has very little to do with milk composition. Additional fluids affect bladder function, not milk supply. A good diet is important to you, as is brushing your teeth and wearing your seat belt, but it does not directly alter your milk composition.

Hormonal contraceptives may cause a sudden and possible permanent drop in milk supply. Even progesterone-only products may affect some women. Be cautious.

Maintaining a milk supply usually becomes easier with time and then mother's can be a bit more neglectful with their routine.

Long-term milk production may suppress fertility in the same way long-term breastfeeding does. Don't count on it however.

Maintaining a milk supply for a baby is a separate issue from how the milk is fed to the baby and the mother-baby relationship. Pay as much or more attention to the baby as the pump.

Linda J Smith (1998)

The Perfect Breastfeeding Diet

2011-05-17T14:45:00.001-04:00

DOES NOT EXIST!

What to feed your baby is simple: breastmilk and more breastmilk. Moms often stress however, in what they should eat or avoid to make their milk perfect. However, the composition of breastmilk is very stable and difficult to manipulate. It is as near to perfect as any substance on earth.

What you eat has the biggest effect on you, and sets the stage for what you will feed your toddler and growing child.

Eat a wide variety of foods in as close to their natural state as possible - raw vegetables, fresh fruits, and whole grains.

A diet that includes lots of different fruits and vegetables provides necessary minerals, vitamins, protein, and fiber. Many benefits of these plants are yet to be discovered, so eat a wide variety, particularly those brightly colored fruits and vegetables and lots of dark, leafy greens.

Eat fruits and vegetables fresh.

If available, buy good quality organic foods. They have a higher nutritional value and often taste better.

Know that variety and diversity is key. Eating smaller amounts of lots of different foods ensures that all your nutritional bases are covered, reduces your breastfeeding baby's risk of developing allergies and food sensitivities, and lessens the likelihood of any unpredictable or undesirable effects from eating excessive amounts of any one thing.

Stay hydrated, but drink to thirst. Not beyond.

Drink coffee, caffeinated tea, and teas in moderation. Varying the herbal teas you consume can help you avoid unwanted medicinal effects.

Nice Article on Meeting Legal Requirements in the Workforce

2011-05-17T12:16:00.000-04:00

Read here in the American Medical News about A private place for nursing mothers: Legal requirement is easy to meet by Victoria Stagg Elliott

IBCLC Survery, second phase

2011-05-17T12:02:00.001-04:00

In March of 2011, all IBCLCs in the United States were asked to complete a survey looking at Reimbursement for IBCLCs. Now USLCA would appreciate your willingness to complete the second phase of the survey looking at current workplace issues facing IBCLCs in the United States.

In July of 2010, USLCA released "International Board Certified Lactation Consultant Staffing Recommendations for the Inpatient Setting." This statement discusses the recommendation by Jan Riordan, in her book Breastfeeding and Human Lactation, as having available an IBCLC seven days per week on all shifts with the in-patient setting. This conincides with the AAP recommendation in "Breastfeeding and the Use of Human Milk" that hospitals have lactation experts available at all times. The World Health Organization states that breastfeeding mothers should have access to certified lactation consultants. The USLCA supports these views and has used this statement to recommend the number of IBCLC full time equivalents (FTEs) in the inpatient setting based on the available literature.

As an administrator of a rather busy homebirth midwifery program, I am both thrilled and empathetic for local hospitals. I have recognized the basic need for IBCLCs in the hospital setting since the onset of my nursing career; however, I am also blatantly aware that Indiana Medicaid has exceptionally low reimbursement rates, so much so that remote hospitals can't provide even the most basic services and are closing through area communities. Lactation reimbursement is not in itself an reimbursable fee.

Initially, my thought was to require the IBCLC credential as a core competency for bedside Registered Nurses, yet this eliminates the ability of the consultant to devote time towards program development, administration of lactation services, education, research, and greatly limits her ability to be successful clinically due to other commitments in her role as a bedside nurse. Our practice requires that all providers be certified as IBCLCs and our assistants all have the CLC credential.

This statement does give resource to how a facility might calculate FTEs in a tertiary center for IBCLC coverage which is quite helpful, but likely only appropriate for the large tertiary center with a greater clientele and specialty base from which the administrator can reallocate funds. Smaller remote centers certainly don't have the same financial cushion.

While I've spent many years frustrated at not having the proper attention and respect provided to the very core principle as breastfeeding within the maternity profession, the fact of the matter is, if we don't address Indiana Medicaid issues, of which more than half of our childbearing families participate, all aspects of maternal and child health will continue to decline across the state. Hospitals will continue to shut their doors to maternity services and those few who remain will be the larger tertiary centers, who will have the funds to support lactation services, but will also have a rather enormous demand that the consultant would be utilized as little more than a latch expert.

Maybe just as frightening is the realization that when hospitals feel forced to provide a lactation consultant, they have such little understanding and appreciation for the IBCLC credential, they readily sign off on the IBLCE application for any nurse willing to sit for the exam. Her education towards becoming a nurse, while likely offering no breastfeeding education what-so-ever and her time spent working the floor as a bedside nurse, absent a mentorship with an experienced consultants, is often sufficient to sit the exam following a one week course and no further application of those skills. This short-sightedness will ultimately be the demise the credential, as I neither mothers or professionals will trust the IBCLC as the genuine expert in lactation.

Those interested in participating in the 10-20 minute research survey by 6/10/2011, can visit the survey monkey at http://www.surveymonkey.com/s/TBNPP2V. If you have any questions or concerns, please contact the Executive Director Scott Sherwood at: Info@uslcaonline.org or 919-861-4543.

CAM

2011-05-07T23:16:00.004-04:00

Consumers of health care are increasingly searching for providers who practice a more integrative approach or "one that is based on the scientific principles of Western medicine and incorporates not only the client's own beliefs and customs but also ancient health care practices and remedies still new to Western medicine (Humphrey, 2003, p 63)."

COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM)

Confused by all the may specialties? Alternative therapies are those used instead of conventional medicine; complementary therapies are those used in addition to conventional medicine. Because CAM therapies are not the norm today, they are considered unconventional. However, they were once very conventional, and someday may again become very commonplace.

More and more physicians are integrating CAM therapies into their Western medical practices. CAM is an integral component of midwifery care. The lactation profession as well, is increasingly placing value in such therapies, although they must walk a much more careful path. Lactation Consultants are not typically independent practitioners so must be exceptionally mindful not to diagnose or prescribe therapies which would not only be outside their scope of practice, but might really anger the client's primary provider if their recommendation is not otherwise a therapy they would endorse.

However, women are keenly aware of the need to protect their vulnerable fetus and newborn, and so are increasingly motivated to research what other options are available for any given ailment, prescribed medication or routine medical recommendation. It is often their lactation consultant that becomes that necessary bridge of information between a well researched lactating mother and a physician with only rudimentary knowledge of alternative and complementary healing (and therefore does not take them seriously or has great hostility towards their use).

Not only do I, as a midwife, encourage mothers to research alternative healing options, but I also encourage them to investigate their options for complementary and alternative (CAM) providers. Here is a brief introduction.

Naturopathy
Naturopathy is based on the idea that good health can be be achieved or maintained by taking advantage of the natural healing powers in all human beings and by using "natural substances" for healing. Most practitioners have four years of basic training in biosciences and then complete an additional postgraduate four-year training program at one of two accrediting universities in the United States. A graduate must then pass a licensing exam to practice as a Naturopathic Doctor or ND. Not all states recognize and license naturopaths (Humphrey, 2003).

In general, doctors of naturopathy avoid conventional mainstays of treatment, such as drugs or surgery, preferring instead a wide range of "natural" therapies. These might include water massage, acupuncture, or herbal and nutritional therapies. Naturopaths are not necessarily knowledgeable about breastfeeding and may offer treatments that would be unsafe to the breastfeeding couple. One would want to ask about their credentialing in this particular area, with the gold standard being the IBCLC credential.

Chiropractic and Osteopathy

"Chiropractic was invented a century ago by practitioners who believed that all human health problems originated in the spine" (Humphrey, 2003, p 77). Many styles of chiropractic care have originated since that time. Today a Doctor of Chiropractic (DC) receives four years of undergraduate biosciences training and completes a four-year postgraduate training program approved by the Commission on Accreditation of the Council on Chiropractic Education. They are certified by the National Board of Chiropractic Examiners.

Some chiropractors do have strong opinion that manipulation of the spine can "cure all." Others, like naturopathic doctors, may suggest herbs, nutraceuticals, vitamins, minerals, and dietary changes in addition to spinal adjustments. While expertise varies, many chiropractic doctors are well educated in the areas of diet, exercise, and lifestyle counseling. Again, a chiropractor may not be well informed about breastfeeding issues, though may of them are quite supportive.

Like chiropractors, osteopaths can help both chronic and acute musculoskeletal problems, but they are generally believed to be more competent than chiropractors due to their more extensive training. A Doctor of Osteopathy (DO) receives much of the same training as a conventional medical doctor. Their training consists of four years of undergraduate wok in bioscience, another four years of study at an osteopathic medical school, a one-year internship, and another two to six years in a residency program. Osteopathic doctors are board certified by the National Board of Osteopathic Medical Examiners and are licensed to practice medicine in all fifty states.

Osteopathic manipulative therapy, or OMT, is designed to help relieve pain and illness. One form is cranial therapy, which has proven a very successful remedy for newborns struggling to latch.

Aromatherapy

Using essential oils as therapeutic agents is termed aromatherapy. These preparations are highly concentrated and highly potent; typically used in very small amounts after dilution in other oils or water. Essential oils have an aroma that effects both the emotions and the body. Depending on the type of oil and the purpose for use, it may be added to bathwater, inhaled, applied to skin or more rarely, ingested. While these oils may lift your mood or calm you down, they are also healing.

Aromatherapy is a personal love of mine and in spite of a great deal of research, the educational avenues in which one can become a certified aromatherapist is quite perplexing. I'll be sure to post more about this specific CAM therapy in the future...stay tuned.

Homeopathy

Traditional herbal medicine, as we are all most familiar, works through opposition, attack, or against something in the body that is causing illness. Antibiotics work this way. They kill bacteria. Antiemetics stop vomiting by countering the development of nausea in the body. Homeopathy on the other hand, is a two century old practice that approaches healing through the belief that "like treats like." After reviewing the client's symptoms, a remedy that produces the same symptoms in overdose is then offered in an extremely diluted (and thus safe) amount.

Homeopaths receive their training and practice from a wide variety of schools. Homeopaths can be certified in their field as a Certified Classical Homeopath, of CCH. Very few skilled homeopathic practitioners exist in the United States; Europe has not only skilled practitioners, but homeopathic medical clinics and even hospitals.

Bodywork and Massage Therapies

This trade is quite extensive, a touch-based therapy. Training and credentials vary from state to state. Many are skilled in breast massage, but many of these techniques aren't advised for nursing mothers.

Any one of these providers might suggest nutraceuticals or herbal medicines without understanding how they may affect a nursing mother or her child. Consider whether your chosen provider has any lactation expertise (not the same as experience).

Nurse Midwives

As primary practitioners for women and their newborns, Nurse Midwives offer a unique approach, offering both the conveniences and benefits of Western Medicine and a long history of healing wisdom utilizing a plethora of CAM therapies. Nurse Midwives complete a four year undergraduate study with license as a Registered Nurse, then complete graduate training including a midwifery residency. Nurse Midwives are certified following a national board exam and are licensed in all fifty states. Their individual expertise, including lactation, in very individualized; however, all were educated in the midwifery model of care which holds in high regard the relationship between a client and her midwife, as well as a non-interventive approach to healthcare.

Given a Rx and Directions to Wean?

2011-05-07T22:09:00.001-04:00

I have been told many times through my career, when I am asking why any particular woman "weaned early," that her physician advised it due to a prescription prescribed while she was sick or due to anesthesia related to surgery. I find it rather peculiar that nearly forty percent of our birthing women are having major abdominal surgery to bring forth their child and subsequently breastfeed, but later are told these same medications are grounds for weaning as if this is "being safe, rather than sorry."

If such advice is given to you, please question the advice. Ask your healthcare provider the following questions, as offered by Sheila Humphrey in her book, The Nursing Mother's Herbal:

Why, exactly, must I wean?

What are the benefits of weaning?

What are the risks of weaning?

What are the pros and cons of your recommended treatment?

What other treatment choices are available to me?

Where is the information to guide us?

"It may take effort to find correct information, but given the importance of breastfeeding to you and your baby, it will be time well invested. "Few medicinal substances are strictly off-limits. Even prescription drugs are generally compatible with breastfeeding. Yet safety is a relative thing. Is the treatment safe or unsafe- compared to what? To weaning and formula? To using another drug or herb? (Humphrey, 2003, p 33)"

Meeting Minutes

2011-04-04T04:47:00.004-04:00

These are quite delayed, my apologies.

In attendance were January Gilley CLC, Shawn Billings, Rixa Freeze PhD, Penny Lane CNM, IBCLC, and Holly Hopkins CNM, CLC.

The group discussed their removal from the Boone County Community Foundation as the new director does not support our cause. We have since requested sponsorship through Boone County WIC and the ARC program have accepted this request. The relationship is somewhat different however, as we must request our monies specifically and they will then distribute it accordingly.

Discussion was raised regarding the coalition becoming non-profit on their own account. It was discussed that our being a non-profit would limit our lobbying abilities. Rixa will research our options.

The Montgomery County representatives will approach the new mayor for World Breastfeeding Week, requesting a proclamation. Previous mayor did not support our cause.

Rixa is reviewing Baby Stay Asleep. Penny and Holly are reviewing Sleeping with Your Baby. Each will be shared here on the blog.

Discussion regarding our upcoming Lactation Station season: contact festivals earlier. January to contact director for Strawberry Festival in March.

Grants were received providing a scale for Holly's office - Free Weight Clinic. Additional $500 was requested from IPN for a lending library, and Lactation Station sign. When additional monies become available, Rixa had suggested purchasing a Skin-to-Skin DVD to distribute to local hospitals with information on Baby Friendly. Parent version of the DVD was to be released in January, which can be placed in our lending library. As well, Rixa suggested purchasing the Impact of Birthing Practices on Breastfeeding by Linda Smith for distribution to the community libraries.

Investigate March of Dimes grants.

Discussion regarding whether we were interested in hosting a breastfeeding conference - suggested speakers mentioned.

The coalition was awarded this past year in part due to the blog, so ideas were offered in how to enhance our work here. Recently a client of Believe posted a review of the Evert-It, Holly received a Bobby for her office, several clients reviewed cookies for increasing milk supply, MotherLove herbals are currently being reviewed and several new books and DVDs are being reviewed.

Pumps were once again discussed, as the coalition needs to place an order with Hygeia. Discussion still surrounds what products would best serve the community. We will e-mail our representative for clarification on a few points. Hospitals will be called to inquire about breastpump needs (Rixa contacted Cathy Hall and learned of the maternity centers closing). Penny will contact Frankfort Hospital.

Our support group needs another boost. Fliers need printed and distributed. Annoucements in the community calendars need to be utilized. Ideas. Leadership in Clinton County?

Additional note: Coalition has received three Medications & Mother's Milk by Hale. One was donated to Believe Midwifery Services Lafayette office and one will be provided to a dermatologist in the community who instructs clients to wean if on any medication, as well as the Vein Clinic who has also instructed clients in the past to wean based on prescription therapy.

FREE Lounge Webinar with Linda Smith

2011-03-24T23:55:00.000-04:00

Health e-learning is hosting an exciting Lounge webinar with Linda Smith IBCLC on April 6th & 7th.

Impact of Swaddling on Breastfeeding Infants

Please check the Lounge Schedule for date and time details (set your timezone at the top).
There are limited places for the live presentations, and it is first-come, first-served basis however, the recordings will be available immediately after each presentation.

Attend in 3 Easy Steps!

Sign up for a free member account if you don't have one (all our past and present students already have a username and password).
Practice logging in with your username and password prior to the event (check that it works!).
Register your interest on the Lounge Schedule so we can email you the details the day before the event with details on how to attend.

Vitamin D UPdates

2011-03-12T15:20:00.002-05:00

Nearly a decade ago, supplementation of vitamin D in breastfed babies was a controversial issue, as it threatened the integrity of breastmilk, the most natural and perfect form of mammal nutrition, and gave the illusion that artificial breastmilk was more suitable for meeting the needs of human babies.

The podcast by the Breastfeeding Medicine offered here, reminds us that the American Academy of Pediatrics recommends that all babies be supplemented with 400 units of vitamin D daily, starting within the first few days following birth. Their rationale is that very few mothers have sufficient vitamin D levels and minimal amounts are transferred via milk to the baby.

We now know that vitamin D plays an important role beyond bone health and the prevention of rickets. It is also vital for a healthy immune system and has profound effects on metabolism. Season flu in fact, has been related to low vitamin D levels, as well as multiple sclerosis, rheumatoid arthritis, lupus, tuberculosis, diabetes, cardiovascular disease, and various cancers. Scientists are only beginning to understand its effects on various organ systems.

The Institute of Medicine (IOM) published (Nov 2010) their revised statement on vitamin D requirements. The Estimated Average Requirements (EAR), the daily amount expected to satisfy the needs of half of all people was increased from 200 to 400 IIU/day and the Recommended Daily Allowances (RDA) was raised to 600 IU/day. Another important change made by the IOM was the increase of the Tolerable Upper Intake Levels from 2,000 to 4,000 IU/day. These recommendations are a work in progress.

The great question is, "Can we test mother's Vitamin D levels and/or supplement her to avoid routine supplementation in baby?"

Can routine supplementation create toxic vitamin D levels for the unborn baby? Can it cause birth defects?

The Clinical Lactation journal published an article this month (2011) titled, Recommendations during Pregnancy, Lactation and Early Infancy. It answers the above questions this way, "the amount of vitamin D to achieve the lower level of normal in the mother of 32 mg/mL or 80 nmol/L (in the absence of sunlight exposure: achieved with a daily prenatal vitamin containing 400 IU up to 4,000 IU/day in some women) does not translate into adequate levels in her milk, and thus, for her baby. In this scenario, the mother is replete but on the lower end so her infant is obligated to receive 400 IU/day vitamin D to ensure adequacy in that infant."

As well, the article shares that, "The IOM statement suggests that the vitamin D deficiency is overestimated, yet using their own guidelines of a circulating 25(OH)D level of less than 20 ng/mL, in our two pregnancy studies of over 700 women, more than 75% of African American women, 50% of Hispanic women, and 20% of Caucasian women met the criteria for vitamin D deficiency (Wagner, p28)."

These findings led to the revised American Academy of Pediatrics (AAP) statement of 2003, recommending 200 IU of vitamin D supplementation to all infants receiving less than 500 ml of fortified formula per day to begin within the first 2 months of life. Continued reports of rickets, limited dietary resources of vitamin D, inadequate sun exposure for vitamin D synthesis, and an enhanced understanding of vitamin D physiology and its actions have led to the most recent revision of the AAP statement in 2008.

All infants and children should be supplemented with a minimum of 400 IU per day of vitamin D, beginning in the first few days of life, per the AAP. The issue today seems not to be toxicity, but rather too little vitamin D. It appears the daily vitamin D dosing of less 10,000 IU/day for extended periods is safe (Heaney et al., 2003; Vieth, 1999; Vieth & MacFarlane, 2001).

This particular article offers a table in which the provider can help discern the appropriate dosage based on the variability of where their client lives, their diet, lifestyle, body composition and the seasonal affect. The authors recommend supplementing lactating women at 6,400 IU/day to sufficiently raise maternal milk vitamin D levels into adequate range, so the infant is ingesting at least 400 IU/L breastmilk. The safety of this regimen has not been fully tested however. On an individual basis, if a health care professional prescribes higher doses to a lactating woman, it is recommended that the woman's breastfeeding infant have levels checked to ensure that the baby is vitamin D replete. Alternatively, the lactating woman can be provided sufficient vitamin D to achieve a total circulating 25(OH)D level of at least 80 nmol/L or 32 ng/mL and to give her breastfeeding infant the time-honored 400 IU vitamin D/day. The mother and infant in this scenario would achieve normal vitamin D status, but on the downside, both would need to be supplemented.

The Nurse Midwives at Believe Midwifery Services can offer vitamin D level testing at a very cost-effective rate. Our Nurse Midwives recommend supplements from this source when appropriate.

Tight Lingual & Labial Frenulum

2011-03-12T14:19:00.003-05:00

The tight lingual or labial frenulum often challenges breastfeeding couples, and lactation consultants are often without resources for correcting this scenario.

Tongue-tie (ankyloglossia, tight frenulum) is a condition in which the bottom of the tongue is tethered to the floor of the mouth by a membrane (frenulum) so that the tongue's range of motion is unduly restricted. The labial frenulum tethers the upper lip to the upper gum without the ability to flange the lip outward, as is required to maintain an optimal latch.

Presentation of Tongue-Tie

The presentation of symptomatic tongue-tie may vary widely, including symptoms and signs in both infant and mother.

Maternal presentation is commonly characterized by:

Nipple pain and/or erosions

Painful breasts

Low milk supply

Plugged ducts

Mastitis

Frustration, disappointment, and discouragement with breastfeeding untimely weaning

Infant symptoms and signs include:

poor latch and suck

clicking sound while nursing (poor suction)

ineffective milk transfer

inadequate weight gain or weight loss

irritability or colic

fussiness and frequent arching away from the breast

fatigue within one to two minutes of beginning to nurse

difficulty establishing suction to maintain a deep grasp on the breast

gradual sliding off the breast

“chewing” of the nipple

Falling asleep at the breast having taken

What is a Frenotomy?

A frenotomy is a procedure to clip the thin piece of tissue that connects the tongue to the floor of the mouth or gum. It can be used to treat breastfeeding problems in newborns who are tongue-tied. It is a quick procedure and causes minimal discomfort to the infant. A frenotomy can also be used in older children or adults to treat speech or dental problems.

The Nurse Midwives with Believe Midwifery Services are breastfeeding advocates and appreciate the challenges a tight frenulum cause breastfeeding dyads. Both midwives are experienced in this procedure and are available for referrals at (765) 436-7527. Their website can be found here.

Resources

The Breastfeeding Medicine offers an 11 minute podcast specific to this issue.
YouTube never fails to provide resources. Here is one sample. This little guy is much older, and upset, than our typical clients at Believe Midwifery Services, as we tend to diagnosis and correct this issue within the first few days.
Brian Palmer has several wonderful resources. Those can be found here, here, here, here and here.

2011-03-12T02:41:00.003-05:00

The March 2011 issue of USLCA's Clinical Lactation journal is now available online. I appreciated the article, Promoting Breastfeeding Self-Efficacy, by Betty Carlson Bowles, Ph.D., RNC, IBCLC, RLC. The author reminds lactation consultants that what we say to mothers has a tremendous impact on whether they initiate or continue to breastfeed.

It is an unfortunate reality that the most persuasive health risk messages use fear to gain compliance. We invoke fear as healthcare practitioners, even threaten. An even more unfortunate truth, it works. The stronger the fear appeal, the greater the change in attitude and behavior. However, when this tactic is used to persuade women to breastfeed, the mother must feel she is capable of performing the behavior recommended.

Her confidence in her ability to breastfeed will determine her choice, the effort she will expend, whether her thoughts are self-enhancing or self-defeating, and how she will respond to breastfeeding challenges (Bowles, 2011). Lactation consultants can enhance breastfeeding self-efficacy. This article offers a Breastfeeding Self-Efficacy Scale (BSES), which can be used as an assessment tool to identify mothers at risk, individualize confidence strategies and target limited resources to those most in need.

2011-03-03T00:42:00.002-05:00

Happy IBCLC Day to all of our community lactation consultants!!

"Isn't he a little old for that?"

2011-02-21T13:04:00.000-05:00

--We work for National Geographic.

--I'm trying to raise his IQ.

--We're very old-fashioned.

--We're part of a study.

--Oh, he's weaning now. He's down to ten times a day.

--My MIL insists. She nursed my husband until he was 6.

--He doesn't sleep through the night. He doesn't like solid foods. He sleeps in our bed. We pick him up all the time and we don't believe in spanking. I am only trying to be consistent.

--He likes it.

--My mother is the U.S. Surgeon General.

--Well, that's one opinion.

--Oh? I hadn't noticed.

--He's allergic to artificial nipples.

--Hmm, no one's ever asked me that before!

--Actually, no, I'd love to talk about it. Do you have time for coffee?

--What? And give up this bust line? Why do you ask?

--If she can't depend on her mother, whom can she depend on?

--No response. Just stare.

--Oh, my baby weaned. This is my sister's baby.

2011-02-16T19:23:00.000-05:00

The Health Care Reform law included a provision that requires employers to provide reasonable break time and a place other than a bathroom for new moms to express breast milk at work. ACNM and the Association for Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) advocated for this provision and we are hopeful that it will increase the rate of breastfeeding among working moms.

The Department of Labor is now seeking public comment on how this provision will be implemented. If you have experience as a breastfeeding mother, a breastfeeding educator, or expertise in workplace support for breastfeeding, please visit the United States Breastfeeding Committee’s website and submit your comments by February 22, 2011 .

Please share this information with your colleagues and friends!

MILKMAKERS Cookies

2011-02-03T00:52:00.002-05:00

I was blessed with the opportunity to taste a batch of MILKMAKERS delicious cookies. Their secret ingredients (oats, brewer's yeast and flax seed) all help to support lactation.

Oats boost milk supply, and are a nutritional powerhouse providing whole grains, fiber, iron and an abundance of healthy vitamins, minerals, and antioxidants. Brewer's yeast is a traditional herbal remedy used to stimulate and increase the production of breastmilk and is a rich source of the B-vitamins and amino acids essential for nursing moms and their babies. Flax seed provides an abundance of omega-3 fatty acides, necessary for brain development, which can be passed from mother to baby through breastmilk.

A few of my clients happily took home a few cookies for sampling and each and every one responded with how fabulous they tasted. These mothers were otherwise breastfeeding without difficulty, so weren't entirely sure if the cookie increased their milk supply, but they had much less guilt indulging in a fabulous treat if it benefited their baby.

One Mother shared, "OMG the cookie you let me try is AMAZING! Now, I can't say that with one cookie I noticed more or better milk supply, but the taste of the cookie itself is great. Nice and moist and flavorful.. I loves me some chocolate! I'm going to have to get on the site and see how much they are. YUM."

More recently however, I gave a dozen cookies to a mother exclusively pumping and am quite interested to see if she noticed an increase in her milk supply. Stay tuned...

A simple Google search will lead you to a number of cookie recipes for enhancing breastmilk supply, such as this one:

Major Milk Makin' Cookies
Recipe by Kathleen Major
Detailed recipe with photos found here

1 1/2 c. whole wheat flour
1 3/4 c. oats
1 tsp baking soda
1 tsp salt
3/4 c. almond butter or peanut butter
1/2 c. butter, softened
1 c. flax
3 T brewer's yeast
1/3 c. water
1 tsp cinnamon
1/2 c. sugar
1/2 c. brown sugar
2 tsp vanilla
2 large eggs
2 c. (12oz) chocolate chips
1 c. chopped nuts of your choice

Preheat oven to 350 degrees Fahrenheit

Combine flour, baking soda, cinnamon and salt in a bowl.
In a large bowl, beat almond butter, butter, sugar, brown sugar, vanilla, brewer's yeast, flax and water until creamy.
Mix in eggs.
Gradually beat in flour mixture.
Mix in nuts and chocolate chips.
Add oats slowly, mixing along the way.

Place balls of dough onto greased baking sheets or baking stones.
Press down each ball lightly with a fork.
Bake 12 minutes.

However, MILKMAKERS would make a fabulous gift for any mother. Order online and a batch of MILKMAKERS cookes will be baked fresh and delivered straight to your doorstep.

Orion and his Momma from Indianapolis

2011-01-30T15:57:00.001-05:00

Inverted or Flat Nipples

2011-01-25T15:30:00.001-05:00

I was sent the below product for review and although I hadn't the need to trial it personally, I was quite excited about reviewing it. Various products exist on the market for everting the nipple, when necessary, for optimizing latch. Each of these products however, I find somewhat intimidating.

As a woman, my first thought is, "How much will that hurt?" I was therefore never eager to suggest the trick to clients. However, the Lansinoh Latch Assist actually made me think, "How cute." The simple fact that this product is non-threatening to an already over-whelmed mother gives it high marks in my opinion. Here is the review provided by one of my clients. Thank-you!

Lansinoh Latch Assist review

Pros:
Compact
Easy to Clean

Cons:
Messy
Tricky to get the hang of

Overall, the Lansinoh Latch Assist is a good product. It helps to draw out flat nipple to help the baby latch on better. It worked well for me. However, when you use it, milk is also drawn out and can spill if you aren't careful. It can also be tricky to get the hang of when you're holding the baby and trying to use it at the same time. I found that I had to hold the baby and get him latched immediately because my nipple wouldn't stay out. It wasn't painful though and it did draw out the nipple dramatically. All in all, I would recommend this product to other moms and especially in the first few postpartum days. We had a tough go at nursing for the first few days, but this product did help greatly and I will definitely use it with the next baby if the same issues arise.

Crocheted Baby Hat

2011-01-25T02:19:00.001-05:00

I am going to make a few of these and even a few of these. I am hoping some of our clients will enjoy them!

Twelve Breastfeeding Days of Christmas

2011-01-25T00:29:00.000-05:00

I've had this fabulous jingle for years and started sharing it day by day this past December on the blog, but alas...was not successful. Rather than wait for another year, I thought I would share here so those of you who can stick to a schedule better than me can pass the joy next Christmas season.

Each of you know how the twelve days of Christmas plays out right?

On the first day of Christmas
There stood before me,
A mother wanting to breastfeed!

This repeats on and on until...

On the twelfth day of Christmas,
There stood before me,
Twelve supportive employers,
Eleven strangers cheering,
Ten nursing nooks,
Nine celebs a-nursing,
Eight friends a-helping,
Seven partners protecting,
Six great IBCLCs,
Five Baby-Friendly Hospitals,
Four (FABM) MDs,
Three support groups,
Two doula/midwives,
And a mother wanting to breastfeed!

Breastmilk and Stem Cells

2011-01-23T16:17:00.000-05:00

Human milk and the process of breastfeeding, never fails to amaze me. In a significant piece of research that will help ailing babies, scientists have discovered the presence of stem cells in human breast milk. A pilot study has already been undertaken where the stem cells will be given orally to sick babies and will be published in the 23 rd volume of the peer reviewed journal, Human Cell.

Researchers said, "Breast feeding is an example of allogenic stem cell therapy where the child receives mesenchymal stem cells from the mother as a natural gift." The hypothosis is that the mesenchymal stem cells isolated from human milk can be effective in the treatment of certain neonatal diseases like neonatal sepsis, respiratory diseases and others, which form important causes of infant mortality world across.

Stem cell numbers in colostrum contains about 50,000 cells per ml while mature milk contains hardly 50-100 cells per ml. Hence, in the first five days the baby gets 5 million stem cells per kg body weight per day!

2011-01-23T16:05:00.001-05:00

Enhancing Baby’s First Relationship: A Parents’ Guide for Skin-to-Skin Contact with Their Infants gives a general overview of the findings (length 20 minutes). If you have difficulty opening the video from the link above try this link.

Enhancing Baby’s First Relationship: Results from a Study on Mother-Infant Skin-to-Skin Contact presents the findings in more detail (length 28 minutes). If you have difficulty opening the video from the link above try this link.

The Guide to Support the Use of the DVDs was created to help facilitators introduce either DVD to groups of new and expectant parents or to health practitioners, and to facilitate the discussion of the material presented after the viewing. It includes supplementary information on mother-infant skin-to-skin contact.

2011-01-23T15:49:00.000-05:00

It has been recently estimated that 3,564 of the world's children under 5 years of age die each day (1,301,000 each year) from causes that are preventable by optimal breastfeeding. In addition, for every child who dies, hundreds of others are sick and miserable from illnesses preventable with optimal breastfeeding. Lancet, 05, July, 2003

Call to Action!!

2011-01-22T01:03:00.000-05:00

Well, the lactation profession couldn't be more thrilled with the Surgeon General's Call to Action to Support Breastfeeding.

"In the U.S., most women want - and try - to breastfeed. Unfortunately, one mother's interest alone is not always enough to make breastfeeding possible." The Surgeon General wants to "make it possible for every mother who wishes to breastfeed to be able to do so by shifting how we as a nation think and talk about breastfeeding."

The complete report can be found here. "This Call to Action describes in detail how different people and organizations can contribute to the health of mothers and their children. Rarely are we given the chance to make such a profound and lasting difference in the lives of so many."

I like that within the discussion of the importance of breastfeeding, formula feeding is identified as a risk rather than breastfeeding as a benefit. The long controversial risk of leukemia to those not provided mom's milk was noted, as well as diabetes. Moms who choose not to breastfeed are also at greater risk for mortality, such as breast and ovarian cancer. Postpartum depression was also recognized as a risk associated with not breastfeeding.

Breastfeeding is a national issue and not only for the health benefits it offers mom and baby, but also for the economic impact it makes on our country and the environmental impact it makes on our earth. The Healthy People 2010 target is for 75 percent of mothers to initiate breastfeeding and fifty percent to continue through six months, with 25 percent continuing through the first year. Exclusively breastfeeding was also addressed with 40 percent of women through three months and 17 percent through six months. In 2007, 75 percent of mothers initiated breastfeeding, 43 percent were breastfeeding at six months, and 22 percent were breastfeeding at 12 months. Among breastfed infants born in 2007, an estimated 33 percent were exclusively breastfed through the age of three months, and only 13 percent for six months. I am a real oddity.

Barriers to breastfeeding in the United States were cited as: lack of knowledge, social norms, poor family and social support, embarrassment, lactation problems, employment and child care, and barriers related to health services.

The report states, "Many people, including health professionals, believe that because commercially prepared formula has been enhanced in recent years, infant formula is equivalent to breast milk in terms of its health benefits; however, this belief is incorrect." Additionally, "the incongruity between expectations about breastfeeding and the reality of the mother's early experiences with breastfeeding her infant has been identified as a key reason that many mothers stop breastfeeding within the first two weeks postpartum."

Shocking to me is that "only 57 percent of U.S. hospitals and birth centers allowed newborns to stay in the same room as their mothers." Allowed?

Action 1. Give mothers the support they need to breastfeed their babies.
Action 2. Develop programs to educate fathers and grandmothers about breastfeeding.
Action 3. Strengthen programs that provide mother-to-mother support and peer counseling.
Action 4. Use community-based organizations to promote and support breastfeeding.
Action 5. Create a national campaign to promote breastfeeding.
Action 6. Ensure that the marketing of infant formula is conducted in a way that minimizes its negative impacts on exclusive breastfeeding.
Action 7. Ensure that maternity care practices throughout the United States are fully supporting breastfeeding.
Action 8. Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community.
Action 9. Provide education and training in breastfeeding for all health professionals who care for women and children.
Action 10. Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians.
Action 11. Ensure access to services provided by International Board Certified Lactation Consultants.
Action 12. Identify and address obstacles to greater availability of safe banked donor milk for fragile infants.
Action 13. Work toward establishing paid maternity leave for all employed mothers.
Action 14. Ensure that employers establish and maintain comprehensive, high-quality lactation support programs for their employees.
Action 15. Expand the use of programs in the workplace that allow lactating mothers to have direct access to their babies.
Action 16. Ensure that all child care providers accommodate the needs of breastfeeding mothers and infants.
Action 17. Increase funding of high-quality research on breastfeeding.
Action 18. Strengthen existing capacity and develop future capacity for conducting research on breastfeeding.
Action 19. Develop a national monitoring system to improve the tracking of breastfeeding rates as well as the policies and environmental factors that affect breastfeeding.
Action 20. Improve national leadership on the promotion and support of breastfeeding.

Surgeon General's Call to Action

2011-01-19T16:28:00.000-05:00

The Surgeon General's Call to Action to Support Breastfeeding will be released tomorrow, Thursday January 20, 2011, at a launch event from 10:00 am to 11:00 am EST. We are told that the launch will be webcast live - you can access the webcast link tomorrow morning from the www.surgeongeneral.gov homepage. The actual document will also be posted and linked off the home page.

Also, USBC's news release and press kit materials will be posted after midnight at the following link: www.usbreastfeeding.org/SGCTA. Use this resource to contact your local hospitals and newspapers!

To the members of this coalition, if you would like to join us in a stakeholder call on The Surgeon General's "Call to Action to Support Breastfeeding," please be present at Believe Midwifery Services by 3pm EST.

Dublin, Ohio Annual Breastfest Conference

2011-01-19T12:39:00.001-05:00

March 18th & 19th, 2011 ~ Marriott Northwest

Featured Speakers
Karin Cadwell PhD, RN, IBCLC - Faculty Healthy Children Project, founder Baby Friendly USA and Delegate to USBC
Kajsa Brimdyr, PhD, CLC - International Lactation researcher and producer of the DVDs "Skin to Skin in the First Hour after Birth"
Dr. Marc Belcastro, DO - Medical Director of the NICU and Newborn Nursery at Miami Valley Hospital
Ann Twiggs, RD, IBCLC - Ohio WIC Breastfeeding Coordinator at Ohio Department of Health Ohio practitioners panels
Skills teams for Ohio Designated Baby Friendly Hospitals

For hotel reservations:
The Columbus Marriott Northwest
5605 Blazer Parkway
Dublin, Ohio 43017
For online rservations: http://www.marriott.com/hotels/travel/cmhnw?group-Code=laclaca&app=resvlink&fromDate=03/17/11&toDate=03/20/11
Please reserve your room by March 10th for conference rates of $106.00

Conference Objectives
Explain the Baby Friendly Hospital Initiative
Discuss how to create a breastfeeding culture within hospital, clinics and offices
Discuss professional education needs for the BFHI designation
Describe basic breastfeeding education for mothers and families
Discuss techniques for early initation and maintenance of breastfeeding
Demonstrate basic lactation skills
Discuss risks and medical indications of supplementation
Explore the importance of non-seperation of mother and baby
Explore the barriers and solutions to implementing the Baby Friendly Hospital Initia-tive
Define breastfeeding resources in the community

Application has been made for IBLCE CERPs and Nursing contact hours.

Contact Lynne Castele RN, IBCLC for CERP questions: lbc50@zoominternet.net

Conference Agenda

Friday, March 18
5pm –6:45pm Registration, exhibits, bookstore, refreshments6:45pm—7:15pm President’s welcome–Noreen Edwards
7:15-7:30 Skills lab set up
7:30-9:30- Step 5 Skills Labs– Maintaining lactation-Ohio Baby Friendly Hospitals staff

Saturday, March 19
7am-7:45am- Continental breakfast, exhibits
7:45-8:00 am- Opening
8-8:15-Welcome- ODH Spokesperson
8:15-9:15- Overview of Baby-Friendly hospitals in the USA9:15-10- Steps 1 and 2– Policy and Professional Education10-10:30- Step 3– Prenatal education11:15-12:15- Step 4-Strategies for the first hour12:15-1:30- Lunch, grants, scholarships, awards
1:30-2:15- Step 6 panel-Exclusive breastfeeding
2:15-2:30- Step Steps 7, 8 and 9-Breastfeeding management
3:45-4:45- Step 10 panel-Community resources
4:45-5– Questions, evaluations

Registration is on a first come basis, no confirmations will be sent.
Full refunds will only be issued for cancellations received prior to March 15th.
No partial CERPs or CEUs will be issued.

Deadline

2011-01-19T00:27:00.000-05:00

February 28, 2011 is the postmark deadline for the early recertification by exam application deadline. Postmark your 2011 application on or before February 28th and receive the largest discount. Apply.

2011-01-08T01:07:00.000-05:00

Celine Dion shares in an interview about breastfeeding her twins, "It's tiring but an intense joy."

Proactive Approach to Breastfeeding

2010-12-31T00:39:00.000-05:00

A proactive approach to breastfeeding from Rixa Freeze PhD

Desiree of Hitting My Stride, 6 months pregnant with her first baby and planning to breastfeed, recently asked me this question:

Do you know if there's a way to help my chances of being able to breastfeed? Everything I'm reading says that it's not a problem until it's a problem and there's not a lot you can do proactively.

Great question! I would argue that there is a lot you can do proactively to ensure a successful breastfeeding relationship. A proactive approach to nursing your baby covers three main elements:

1. Individual choices
2. Institutional policies & care provider actions
3. Uncontrollable circumstances

Nursing my newborn son minutes after he was born

Individual Choices
Let's look at the first element, the one you have most control over: your individual choices. These can include your knowledge about and familiarity with breastfeeding, the use or avoidance of pain medications and certain interventions during labor, and your parenting choices.

First, let's discuss knowledge and preparation. Most of us grew up and live in a culture of bottlefeeding. Often, bottlefeeding norms become deeply embedded, without us even realizing it. For example, if we are used to seeing babies drink from a bottle, we might unconsciously hold our babies and position our breasts in their mouths as if we were feeding with a bottle. Bottlefed babies are held on their backs, facing the ceiling. The bottle's nipple is centered in their mouth. Breastfed babies, however, are held stomach-to-stomach, wrapped closely around their mother. They latch onto the breast asymmetrically, placing their chins deep into the breast and taking in a large amount of the lower areola. I love Laura Keegan's illustrations of how bottlefeeding norms affect breastfeeding in her book Breastfeeding With Comfort and Joy.

Unless we have grown up surrounded by nursing mothers, we might lack essential knowledge about breastfeeding: how to get a baby latched on, how to help the baby empty the breast efficiently, normal newborn eating and sleeping patterns, and solutions or preventive remedies for common breastfeeding challenges (plugged ducts, sore nipples, etc). Books, websites, videos, lactation consultants, and breastfeeding support groups fill this role today.

As I mentioned in a Breastfeeding Carnival post about "What I didn't expect when I was expecting", when I was pregnant with my first baby, I read extensively about breastfeeding. My favorite book was Dr. Jack Newman's Ultimate Breastfeeding Book of Answers. I read the book several times and watched the videos on his website. By time I was full-term with my daughter, I knew what a good latch should look and felt like, how to position the baby properly in relation to the breast, how to identify and solve common breastfeeding problems, and when to get help for more serious issues. There are many fantastic breastfeeding resources, too many for me to list here; please refer to my top birth and breastfeeding books or browse through my book reviews.

Next, there are many choices we can make during labor and in the immediate postpartum period. Our choices about pain medications, timing of the birth (i.e., elective induction or cesarean), place of birth, and care provider can influence breastfeeding outcomes. For example, both intravenous and epidural/spinal pain medications during labor negatively affect breastfeeding rates, even among mothers who intended to breastfeed and/or who had already successfully breastfed a previous baby. The amount of skin-to-skin contact right after birth affects breastfeeding success; the more skin-to-skin, the higher the rate of exclusive breastfeeding upon hospital discharge. Breastfeeding rates are also higher in Baby-Friendly institutions; if you are lucky enough to have access to Baby-Friendly care (whether officially recognized or not), this might influence where you decide to give birth. I won't go into detail here about how various labor interventions & practices affect breastfeeding. For more information, read Linda Smith's book Impact of Birthing Practices on Breastfeeding.

Finally, there are the choices we make as we parent our babies: Do we nurse on cue? Do we feed on a strict schedule? Do we sleep close to our infants, either in the same bed or the same room? Do we use pacifiers or introduce bottles, especially in the first several weeks? Some of these choices will help establish a successful breastfeeding experience; some may negatively impact breastfeeding. Take the time to think about and research these options.

Institutional Policies & Care Provider Actions
A second element of breastfeeding success depends on institutional policies and care provider preferences. We have less control over these factors than we do our individual choices. For example, if you give birth in a hospital with a policy of routine nursery observation for healthy newborns, keeping your baby at your side may be an enormous challenge. This is where careful decision-making in the prenatal period is key--to the extent that you have choices, of course. Many of us are constrained by insurance restrictions (only X hospital is covered, not Y or Z), state regulations (whether home birth or birth centers are legally allowed), or care provider preferences (in some areas, no physicians will attend VBACs or vaginal breech births).

Labor management and postpartum routines can influence breastfeeding success. For example, going into labor spontaneously, using non-pharmaceutical pain relief during labor, and having immediate, uninterrupted skin-to-skin contact after the birth all contribute positively to breastfeeding rates. This is not to say that you will not be able to breastfeed if you have an epidural or a cesarean, just that those circumstances can lead to more breastfeeding challenges. Educate yourself about which birth practices or postpartum policies are most likely to enhance your ability to breastfeed and how to overcome challenges that may arise if certain interventions become necessary. Make wise, thoughtful choices--as much as you can given your geographical location, your financial situation, and your insurance coverage--about where and with whom you will give birth.

Uncontrollable Circumstances
Sometimes breastfeeding is challenging due to circumstances beyond our control, no matter how carefully we planned and prepared. Some of these factors might include tongue tie or cleft lip/palate, prematurity, Down's Syndrome, NICU stay, low supply due to hormonal imbalances or insufficient glandular tissue, overactive letdown, and so on. We might have a baby who just won't latch on well, despite all the right techniques! A proactive approach to breastfeeding means knowing how and where to get help if these challenges arise. For example, knowing about tongue tie might help you identify that as a potential culprit if breastfeeding is unexpectedly difficult and painful, despite doing everything right.

Before you have your baby, be sure you know who your local IBCLCs are and if insurance covers their services. Know when and where your local LLL or other breastfeeding support group meets. Ask around about breastfeeding-friendly family physicians or pediatricians, so if your baby has certain medical complications that affect breastfeeding, you'll have someone on your side. Gather together a supportive network of friends or family members who can help if you encounter breastfeeding challenges.

In sum, can you take a proactive approach to breastfeeding? Yes you can!

A New Vital Sign for Maternity Care

2010-12-19T19:19:00.000-05:00

The Joint Commission, the organization that accredits US hospitals, has recently rolled out a bundle of perinatal quality measures. Not only are these measures designed to improve perinatal quality, but specifically work to increase the proportion of newborns who consume only breastmilk during their hospital stay.

As a labor & delivery nurse a few years ago, with some expertise in lactation that was not at all appreciated by the hospital's administration, I was told by the Nursing Director that if there is one thing she knows about breastfeeding more than me, it is "that the Joint Commission has no concern about breastfeeding." She can read further about their lack of concern here.

On the first page - and repeated two more times - the committee makes this suggestion: "Compliance with the new core measure may require facilities to modify their paper charts and/or electronic medical records. Thus facilities may want to consider charting modifications that support breastfeeding such as length of time of skin-to-skin contact, especially immediately following birth." Shall I repeat that last line, "such as length of time of skin-to-skin contact, immediately following birth."

A new study in the Journal of Human Lactation demonstrates a strong dose-response relationship between skin-to-skin care and exclusive breastfeeding at hospital discharge. Interesting study, with interesting controls.

Here are a few fliers and handouts designed by the Loma Linda University Perinatal Services Network for promoting early mother-infant attachment and breastfeeding.

Adapted from Amy Romano's article in Quickening, (2010) vol 41.

Baby-Led Weaning

2010-12-15T00:18:00.003-05:00

Platypus Media, LLC kindly shared with me a copy of the DVD, I Can Fed Myself! A Baby-Led Approach to Introducing Solid Foods by Gill Rapley, MSc. And I like it!

I'll admit though, the teaching is bitter sweet. You see, my children are all grown beyond the early steps of initiating solid foods and I realize now, I had it all wrong. While I ardently protected my children's right to self-wean from the breast, I did not necessarily protect their right to control what and when they ate solid foods and could easily have created a premature weaning from the breast. This was a concept I simply hadn't considered.

Often I am asked as a midwife what the best method is for introducing foods to babies who have started reaching for mom's food. I typically steer parents away from highly processed, pureed baby foods and encourage them to simply blend whatever healthy food the family is eating for dinner, of course not until they reach six months of age.

I wasn't entirely off. The big question posed by the author of I Can Feed Myself! is: Do babies require pureed foods? I had always assumed so.

What if we let baby set the pace of feeding solids, just as we trusted them to eat at the breast? Think about the four month old. They are discovering textures, grabbing for toes, faces, toys, our spoons and food. Once they start grabbing food, we assume they are hungry and need to supplement beyond breastfeedings.

This DVD challenges that thought. Baby simply wants to touch and taste your food. They aren't calorie deprived and searching for satiation. Unfortunately, many parents are under this illusion and therefore, manually stuff their babies full of pureed foods, filling up their babies so they fail to seek the breast. Aggressive weaning almost always initiates and mom soon looses her supply.

The gut isn't mature for food other than mom's milk, until about six months. Around this time babies are grasping food and other objects and placing them in their mouths. They taste, bite, even chew, but very little is swallowed. This is still play for them. It isn't about feeding. Developmentally, the baby simply isn't able to move the food to the back of their throat. We often spend much of feeding time rescooping food that is pushed out of the mouth by the tongue for this exact reason.

When solids are introduced with baby in control (details regarding best first foods and how to prepare them are offered on the DVD), they don't change their breastfeeding patterns for another few months. Diapers will soon enough reveal baby has mastered the skill of swallowing, in their own time.

This seventeen minute video is packed full of useful information and leaves parents questioning why they ever did it differently, and frankly, leaves practitioners guilty they ever adviced otherwise. To watch a clip, visit YouTube here.

PlatypusMedia thank-you for the opportunity to review this media. Believe Midwifery Services, LLC will definitely be incorporating this DVD into our childbirth education classes. Our Thorntown Breastfeeding Support Group will also be hosting a showing this Friday at noon. Join us!

To purchase your own copy of I Can Feed Myself! A Baby-Led Approach to Introducing Solid Foods by Gill Rapley, for $79.95, visit http://www.platypusmedia.com/.

On the FIRST day of Christmas...

2010-12-09T20:45:00.001-05:00

There stood before me,
A mother wanting to breastfeed!

Labor Inductions... Reducing Cesarean Rates?

2010-12-05T23:05:00.000-05:00

"A study in the July 2010 issue of Obstetrics& Gynecology underscores why the midwifery model of care - a model which minimizes interventions - should be the standard of care for women. Researchers set out to investigate the link between labor induction and cesarean birth, and discovered some telling findings." Read further here.

While working at Witham Hospital, I became well aware of how good physicians can obtain bad reputations from the natural birth community simply based on their induction rate. At the time, Dr. Winkler and Dr. McCarty were the two obstetrical providers in the practice and both held stern ground in not inducing labor without a genuine medical indication prior to 39 weeks. However, once reaching 39 weeks, most all moms were lining up for their induction leading to a fairly high induction rate by World Health Organization standards.

It is quite common in obstetrical units for nurses to triage phone calls of clients sharing concerns that are nothing more than normal discomforts of pregnancy, yet they aren't seeking reassurance that their pregnancy is healthy and normal, but instead the perfect compliant that will justify an early end to their miserable pregnancy.

I distinctly remember being told by a pregnant mother that if the on-call physician did not induce her labor (at 37 weeks), then she would be happy to take her business elsewhere. The truth was she could go to any other local hospital and her wish would be granted. These two doctors declined her request and risked loosing her as a client. They refused to put her baby at risk and herself, for the sake of her own convenience.

Not one of these physician's peers would fault them for inducing women earlier. They all did it in their own practice. Women want early inductions, and we're all about women's rights. However, they would have failed to withhold the oath, "do no harm." These physicians stood firm in the face of persecution and I was quite impressed.

Around the same time, one of the physicians discontinued his routine practice of artificially rupturing the amniotic sac in elective inductions. This would otherwise commit the client to birth, or more specifically, cesarean section because too often mom or baby simply wasn't ready. The attempt to induce failed and this physician was comfortable telling mom after a day or two's effort to induce, "Sorry, we need to discharge you home as your induction was not successful. We can reschedule you in a few days." The nurses gave this physician a round of applause and many of us began to choose him as our own provider.

Women simply don't recognize the safety hazard of induced labor, even prior to 37 weeks. Researches have estimated that 20% of cesarean births could be attributed to labor induction. That would bring most all hospitals down into the range the World Health Organization has deemed as most appropriate for optimal maternal/child health outcomes. I question what is going on in the Indiana counties with more than 50% cesarean rates and furthermore, why our state's Attorney General hasn't jumped all over those providers! We have two counties with neonatal death rates as high as third world countries. I am sure those same counties oppose Nurse Midwifery as well.

For more information about induction of labor, read here. For improved outcomes in your own birth, and clearly your breastfeeding experience, choose a physician or better, a Nurse Midwife that stands on evidence and is not persuaded by the trend of today's failing maternal and child health trends.

Expressed Breastmilk vs Lanolin for Sore Nipples

2010-12-05T23:03:00.000-05:00

Nipple pain associated with breastfeeding is understood by our culture as an inevitable suffering if one chooses to breastfeed. Mothers who continue to persevere through the trauma, most often end up discontinuing within the next few weeks due to insufficient supply. Their breastfeeding relationship was doomed from the start.

Lactation consultants are working hard to prevent this cascade through education on the optimal latch and seeking assistance if mother does have painful breastfeeding. It seems however, that once sore nipples do occur, outside of correcting the latch, our approach for healing isn't always based in evidence.

Recommendations are rather diverse: topical creams, solutions, sprays, time-restricted breastfeeding, exposure of the nipple to dry heat or ultraviolet light and air-drying, hardening of the nipple skin, and pre- or postnatal breastfeeding education. Expressing breastmilk onto the nipple and letting it air dry is another widely recommended treatment that is also with supporting evidence.

Researchers M.Abou-Dakn, J.W. Fluhr, M. Gensch, and A. Wockel (2010) recently published a paper titled, "Positive Effect of HPA Lanolin versus Expressed Breastmilk on Painful and Damaged Nipples during Lactation" in the journal of Skin Pharmacology and Physiology.

The study was well done and revealed significant differences in pain score between the two treatment groups. The group using highly purified anhydrous "(HPA) lanolin showed a faster decrease in nipple pain intensity during feedings. In this group, nipple pain began to decrease with the commencement of treatment, while in the group using EBM, pain intensity initially increased and peaked on the third day postpartum."

Interestingly, there was also a difference in the pattern of complications between the two groups: "in the group using EBM, 8 women suffered from breast engorgement and 3 developed mastitis; in the HPA lanolin group, only 4 women developed breast engorgement and there were no cases of mastitis."

The authors concluded, "a significantly better outcome for patients treated with topical HPA lanolin as compared to EBM." They further conclude from their study that "the current recommendation for any topical treatment of sore nipples during breastfeeding should be revised in favor of HPA lanolin."

Lanolin creates an air-permeable temporary barrier and promotes moist wound healing when applied to injured skin. It is proven to have anti-inflammatory, antimicrobial, skin-protecting and barrier repair properties. Hydrogels work in this same manner and in my own clientele, I have had remarkable results within just a day or two. I would be very interested to see a trial comparing the lanolin cream with the hydrogel for healing; however, lanolin is clearly the more cost-effective option.

Sitting the exam in 2011...

2010-12-02T22:48:00.002-05:00

...2011 is the last year that you can qualify for the IBLCE exam before new requirements go into effect.

Postmark Deadlines for the 2011 Exam
February 28th and March 31st offer discounted fees.

First time certification candidates will be required to complete the following education and clinical practice experience prior to applying for the 2012 exam:

90 hours of pre-exam education in human lactation and breastfeeding AND
meet ONE of the following requirements: be a registered/licensed/recognized health professional in their country OR have completed BOTH of the following general education requirements: 8 general educational courses of one semester, or equivalent, in length and 6 additional continuing education subjects AND
clinical breastfeeding practice hours.

See further information here regarding specific educational requirements.

Breastfeeding Log

2010-11-26T14:32:00.003-05:00

I'd like to provide my clients with a breastfeeding log, either one already created that the practice must purchase or one we can create on our own. I would greatly appreciate comments regarding your favorite log, or what you might appreciate in such a log to make it both provider useful and mother-friendly.

2010-11-16T19:13:00.000-05:00

United States Department of Labor

2010-11-11T17:28:00.001-05:00

This fact sheet provides general information on break time requirement for nursing mothers in the Patient Protection and Affordable Care Act ("PPACA"), which took effect when the PPACA was signed into law on March 23, 2010.

Humbled and Grateful

2010-11-11T17:24:00.002-05:00

The Boone, Clinton, and Montgomery County Breastfeeding Coalition was chosen (tied for) Coalition of the Year!!

"This coalition's main activity is to educate moms about the importance of breastfeeding, utilizing an impressive website filled with current, helpful information. The coalition also offers various support groups and drop in center times, and is constantly looking for new ways to collaborate with organizations in their regional area. The founding member and driving force behind this organization, Penny Lane, is one of the most knowledgeable people working in breastfeeding in Indiana today."

Golly. What an honor. We couldn't be more grateful.

Gotta Love that Peter Hartmann

2010-11-02T17:06:00.003-04:00

who recently stated, "The lactating breast uses more energy than the brain -- but only 200 researchers study the breast, compared with 38,000 neuroscientists."

IRS says Breast Milk is Not Beneficial Enough

2010-11-02T15:43:00.003-04:00

David Kocieniewski from the New York Times offers mocks the irony of the IRS denying a tax break for nursing mothers using a breast pump. "Denture wearers will get a tax break on the cost of adhesives to keep their false teeth in place. So will acne sufferers who buy pimple creams," states Kocieniewski. "People whose children have allergies might even be allowed the break for replacing grass with artificial turf, since it could be considered a medical expense." Nursing mothers however, no such luck.

The Internal Revenue Service has ruled that breastfeeding does not have enough health benefits to qualify as a form of medical care.

This decision will effect those using flexible spending accounts as of January 1st, 2011. Ironically the decision comes as part of a healthcare overhaul which has the goal of encouraging preventive medical procedures, like immunizations and screening tests.

The IRS considers breast milk a food that can promote good health, the same way that eating citrus fruit can prevent scurvy. As Kocineniewsi wittingly puts it, "No orange juicer. No breast pump."

Apparently we must prove to the IRS that the wheel is indeed round. Nearly every single American, whether they choose to breastfeed or not, can tell you that breastfeeding is not simply good for mothers and babies, but improves their overall health. The New York Times agrees that the decision of the IRS is absurd -- enough to put the story on the front cover, above the fold!

"A Harvard Medical School study released this year concluded that if 90 percent of mothers followed the standard medical advice of feeding infants only breast milk for their first six months, the United States could save $13 billion a year in health care costs and prevent the premature deaths of 900 infants each year from respiratory illness and other infections." The IRS never has had a reputation for understanding cost-savings however.

"The cost of buying or renting a breast pump and the various accessories needed to store milk runs about $500 to $1,000 for most mothers over the course of a year, according to the U.S. Breastfeeding Committee, a nonprofit advocacy group. Lactation consultants, who can cost another several hundred dollars, also would not be considered an eligible expense."

Mothers, get to the nearest breast supply store, and purchase your breastpumps on your flex spending account TODAY!

FREE Safe Sleep Symposium

2010-09-17T14:22:00.002-04:00

Experts don't agree about much, but they do agree that how and where babies sleep is very important. Some say babies should always sleep alone. Others say they never should. In Indiana, as in many other states, even the government has recently engaged the issue with its safe sleep campaign.

Birth Matters is hosting a Symposium, because of the strong belief that balanced, complete information is critical in helping families make their own best decisions.

Saturday, October 2, 2010 at the **Memorial Coliseum** three experts, with varying perspectives on what is 'safe' or 'best' for infant sleep, will come together to offer their information and take questions. Please visit our website for more event information www.safesleepindiana.wordpress.org and to download their event flyer.

Troubleshooting Your Pump

2010-09-12T02:15:00.002-04:00

Rule Out Weak or Ineffective Pump
Do you feel suction from the pump when you put it against your cheek? You might ask your lactation consultant if she can test it using a vacuum gauge specifically for breastpumps. A baby uses pressures of 100-250 mm hG, so your pump should get at least 100 lbs of pressure in 1-2 seconds. If you find your pump has a weak pump, return it to where you purchased it. You might also learn to self-express, assuming you are not pump-dependent.

New Problem with a Previously Well Working Pump
Clean all the parts and if necessary, soak gummy parts in vinegar. Check all parts for cracks and looseness. Hairline cracks will affect suction. If there is a white filter between the tubing and motor, it must be bone-dry and clean. Double check pressure settings. If you have recently taken new medications, such as birth control or a decongestant, these may quickly decrease your milk supply. Call your lactation consultant.

Realistic Expectations
If you pump right after your baby eats, don't expect much. Wait about an hour or until baby typically has a long sleeping stretch. You might pump on the other side that baby is nursing from or pump in the morning.

If you are pumping instead of nursing, you may collect anywhere from 2 to 8 ounces per breast. Pump long enough, ten to twenty minutes per breast. Thoroughly empty your breasts so your body knows to make more milk. Do not go longer than five or six hours without emptying your breast.

Throw out the pacifier. Satisfy baby's suck need at the breast. Any bottles given in your absence can be replaced with little cups.

Why is Mom Pumping?
The pump replaces the baby. If you have ruled out issues with the pump, the issue may be emotional. If your baby is a premie, pump after visits to the nursery and visit baby as much as possible.

Discuss bringing baby to work for nursings with your boss and your spouse. Don't assume they won't agree to this arrangement. Ask for what you want. Companies are trying to become more family friendly.

You must trust whoever is caring for baby in your absence. If you feel uncomfortable, drop in unannounced several times. If you are concerned, take your baby and leave. This applies to friends and family as well.

Find support! Realize that non-baby work may have to be neglected for several months, but also find encouragers when you do have to return to your employed position. Some La Leche League groups have working mothers.

Tips are summarized from Linda Smith's fabulous resources. (1998).

2010-08-30T16:14:00.002-04:00

When I first saw this add for a breastfeeding advocacy shirt, I was confused, wondering how I was missing the joke. Then I realized the joke was on the model, who apparently was a bit oblivous, as well as the art director to the point of the statement! Funny.

Breastfeeding Awards of Excellence

2010-08-25T04:48:00.001-04:00

Don’t forget to place your nominations for The Breastfeeding Awards of Excellence. A 7th category has been added for Mom Friendly Business of the Year. Please take a moment to nominate your deserving local businesses.

• Rookie of the Year Someone who has recently entered the lactation field and has “hit the ground running” and is already making a difference.
• MVP/Most Valuable Player I think that this award speaks for itself!
• Hospital of the Year Wouldn’t you like a plaque on your hospital’s wall?
• Coalition of the Year I can think of several coalitions who could win this one, but I am not the one nominating!

This year two new categories have been added:

• Physician/Physician’s Office of the Year
• Parent Advocate of the Year A Parent who is making a difference and paving the way for other Moms and Babies.

I know firsthand that you are very busy people; this will only take a few minutes. Click here to make your nominations.

Nomination Period ends Sept 15, 2010.

2010-08-25T04:45:00.002-04:00

Survey for Breastfeeding Mothers
Click here for a study by Thomas Hale and Kathleen Kendall-Tacket, Survey of Domperidone and Metoclopramide Use in Breastfeeding Mothers.

Oral Care in the NICU
Click here to read The Use of Colostrum and Human Milk for Oral Care in the Neonatal Intensive Care Unit by Diane Spatz PhD RNC FAAN and Taryn Edwards BSN RNC.

Benefits of Prolonged and Exclusive Breastfeeding
Click here to read a journal article from Pediatrics, Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy by Liesbeth Duijts, Vincent Jaddoe, Albert Hofman, and Henriette Moll.

Thomas Hale PhD

2010-08-22T03:13:00.002-04:00

I had the great pleasure of attending a presentation by Dr. Thomas Hale, sponsored by the Greater Lafayette Breastfeeding Coalition.

I haven't heard Dr. Hale speak before but have followed his career for years and was excited to gain his wisdom in person. Too often, I've unfortunately realized, amazing authors don't translate well verbally. In fact, too many have knocked themselves right off the pedestal I had placed them because they were without their wise editor. I was a bit anxious to realize the fate of Dr. Hale.

He wasn't just good, he was absolutely fabulous! I left with the realization that not only is he one of the most engaging speakers I have ever heard, but he challenged my understanding of lactation so much so that he has lit a new fire under my bum. I am eager once again to soak up new evidence in the field, as it apparently has been entirely refreshed. Not all of this new science was welcoming to my old ears, but none-the-less, I was quite intrigued.

Some new tidbits I learned regarding The Control and Production of Human Milk is that the term "alveolus" is transitioning to "lactocyte." I like this new term. One point he reminded me of is during the early days of breastfeeding, when colostrum measures only about 30 to 60 mL per day, drugs simply won't enter mom's milk at a rate significant enough to impact baby. It is argued that the concentration is higher because colostrum quantity is so minimal; however, high concentration doesn't equal high volume. Medications simply aren't a concern, unless they would suppress mom's milk.

Other interesting points: It is a misconception that mom's make more milk at night. I need to get my hand on the research he mentioned regarding this point. I'll up-date as I learn more. Dr. Hale also shared that our long held belief that milk production reduces by increased production of the Feedback Inhibitor of Lactation hormone, yet the presence of this hormone can not be confirmed!

Moms who share milk with no concerns because they know they are free of STIs, do you know your CMV status? If you are shedding the virus and your donor baby has no antibodies, you might just cause a fatal accident according to Dr. Hale.

Much more too come...stay tuned.

2010-08-21T18:00:00.002-04:00

The Tri-County Breastfeeding Coalition in Ohio is hosting Marsha Walker RN, IBCLC on October 15th, 2010 from 7:45 am to 4:30 pm. The Holiday Inn will host the workshop in Boardman, Ohio.

Marsha is high on my list of favorite speakers and is my first go-to author when I need reminding of how to manage a particular challenging breastfeeding scenario or argue a legislative or ethical issue within the field of lactation.

Topics for the workshop include: Help I am going back to work!, Reaching exclusive breastfeeding goals, Late preterm birth and breastfeeding problems, Advocacy - client to coalition, and Q&A.

Registration is $95. Please call 1-330-726-1611 for reservations.

Un-Breastfeeding-Friendly Day Care Centers

2010-08-21T15:38:00.002-04:00

If you know of a day care center in need of breastfeeding-friendly training, contact Tina Cardarelli and she will organize these efforts!

PESI

2010-08-18T00:31:00.002-04:00

PESI HealthCare is offering a workshop in the Indianapolis area on Friday, October 22cd, from 8am to 3:30pm.

Breastfeeding: New Strategies for Improved Outcomes Seminar

The workshop will be located at the Indianapolis Marriott. Cost is 4179.00. Speaker is Carolyn Zara, RN, MSN, PNP, WHCNP, IBCLC. Topics discussion will focus on keys for initiating breastfeeding, managing low milk supply, bottlefeeding the breastfeeding baby, latch-on techniques that work, and colic or gastroestophageal reflux.

The brochure can be found here: inside and outside.

Diana West

2010-08-17T22:47:00.002-04:00

The Western PA Lactation Consultant Association is hosting Diana West, author of Making More Milk, on Friday, September 10, 2010 at the Western Pennsylvania Hospital in Pittsburgh, PA. CERPs and CEUs are being applied for.

The cost will be $75 for members and $100 for non-members.

Registration and more details can be found at the WPLCA website.

Conference Topics Include: Breastfeeding after Breast Surgery, Assessing Low Milk Production, Helping Millennial Moms Breastfeed, Making More Milk, and Counseling Moms About Low Milk Supply.

2010-08-14T03:28:00.000-04:00

Watch this all the way through.

Lactation Support in the Workplace

2010-08-14T02:57:00.002-04:00

The Indiana Perinatal Network has created a resource for employers and employees for learning how to help women breastfeed while returning to work. Effective July 1st, 2008, Indiana legislature required employers support breastfeeding employees and of course, our new federal healthcare plan made this a national agenda.

No biological significance!

2010-08-02T23:05:00.003-04:00

Sometimes I almost loose faith, "The complex sugars were long thought to have no biological significance, even though they constitute up to 21 percent of milk," then I remember that I am not the only one completely in awe of the magnificant composition of breastmilk. How could any man of science genuinely believe there is any waste in mammal milk? Any man of such thinking should have his name hung in neon lights across every scientific billboard as a quack!

To give more background to the above quoted sentence, the principle component of breastmilk we know as lactose, harbors an indigestible substance that favors the bifido bacterium. The complex sugars derived from lactose promote the growth of the bifido strain, and serve as decoys for noxious bacteria that might attack the infant's intestines. The sugars are very similar to those found on the surface of human cells, and are constructed in the breast by the same enzymes. Many toxic bacteria and viruses bind to human cells by docking with the sugar surfaces, but they will bind to the complex sugars in milk instead. Dr. Mills states in the article here, "We think mothers have evolved to let this stuff flush through the infant."

Other interesting quotes from the article: "Everything in milk costs the mother - she is literally dissolving her own tissue to make it." Or, this quote, "We were astonished that milk had so much material that the infant couldn't digest," Dr. German said. "Finding that it selectively stimulates the growth of specific bacteria, which are in turn protective of the infant, let us see the genius of the strategy - mothers are recruiting another life-form to baby-sit their baby."

And my favorite in closing..."Such findings have made the three researchers keenly aware that every component of milk probably has a special role. 'It's all there for a purpose, though we're still figuring out what that purpose is," Dr. Mills said. "So for God's sake, please breast-feed."

Statement from Surgeon General

2010-08-01T21:49:00.002-04:00

Dr. Regina M Benjamin, the US Surgeon General, has released a statement regarding World Breastfeeding Week.

I am committed to promoting and supporting optimal breastfeeding practices with the ultimate goal of improving the public's health. This is because breastfeeding is the best source of infant nutrition, and it provides immunologic protection and health benefits both to breastfeeding mothers and to the children they nurse.

She reminded us of the breastfeeding support offered in our new Affordable Care Act through providing mothers time and safe place to express their milk and requires healthcare plans to offer certain preventative services without cost-sharing requirements, including counseling and support for mothers who want to breastfeed and for nursing mothers.

Dr. Benjamin plans to release a "Call to Action" this fall with explanation to how all sectors of the community can help create an environment that is supportive of mothers who choose to breastfeed.

Let's see if our local leaders will support World Breastfeeding Week!

Hale Conference in Our Neck of the Woods

2010-07-30T14:08:00.002-04:00

Dr. Hale will be presenting in Lafayette on what else, Medications and Mother's Milk! I am thrilled. He is a phenomenal lactation speaker and the symposium is only $45. This is an amazing opportunity. Call the Kathryn Weil Center at 765-449-5133 to register for the August 19th breastfeeding symposium.

Iron Supplementation

2010-07-22T13:16:00.002-04:00

Since I've discussed the vitamin D controversy, I can't skip the issue of iron supplementation. Compared with what is believed to be required of baby each day, breastmilk appears to fall far short. In reality, the full-term infant is born with large physiologic stores in the liver and hemoglobin, which, along with the iron in breastmilk, are sufficient to meet requirements for about 6 months if babies are exclusively breastfed (Walker, 2006).

Approximately 50% of the iron from human milk is absorbed by the infant compared to 7% from iron-fortified formula and 4% from fortified infant cereals. Seems to me that infant cereals should never be in the cabinets of a breastfeeding family's kitchen. Waste!

If mom is deficient, supplement mom; however, the iron concentration in milk is not influenced by the maternal iron status. The infant who is exclusively breastfed for the first 6 months of life is not at risk for iron deficiency anemia (Duncan et al., 1985).

"Lactose, which promotes iron absorption, is present in higher concentrations in breast milk, especially compared to commercial formulas, some of which contain no lactose at all. Breastfed babies do not suffer microhemorrhages of the bowel as some formula-fed babies do, so they will not have iron depletion through blood loss (Walker, 2006, p 23)."

Another interesting point, iron is bacteriostatic - attracts bacteria. All that extra iron supplementation sits in the gut, minimally absorbed, attracting bacteria and increasing occurrences of diarrhea, inflammation and allergy responses. Iron is breastmilk is minimal yes, but also readily absorbable so little is left behind to invite dangerous pathogens into baby's vulnerable system. Seems our creator had it all figured out!

Vitamin D & My Frustration with the Medical System

2010-07-22T12:06:00.003-04:00

Every few years the vitamin D discussion arises and again I am looking for a new recommendation, although realize soon enough that it is nothing more than renewed interest to an old topic. I am always perplexed that the discussion gains such attention because a quick read will clearly demonstrate that we only need apply a bit of common sense.

Vitamin D is not actually a vitamin or a nutrient at all. Rather, it is a precursor of a steriod hormone formed when the skin is directly exposed to ultraviolet B radiation in sunlight. While vitamin D is synthesized in the skin upon exposure to sunlight, many people obtain the bulk of their vitamin D from foods that are supplemented or enriched with it.

Human milk is not deficient in vitamin D. Infants suffering from vitamin D deficience and rickets do so from a deficient of exposure of the skin to sunlight (Walker, 2006). Breastfed babies have unfortunately suffered from poor bone mineralization and rickets. However, this resulted from a lack of sufficient sunlight. Exclusive breastfeeding results in normal infant bone-mineral content when maternal vitamin D status is adquate, when neonatal stores are normal, and when the infant is regularly exposed to sunlight (Walker, 2006, p 19).

Breastfed infants require approximately 30 minutes of exposure to sunlight per week if wearing only a diaper, or 2 hours per week if fully clothed without a hat to maintain normal serum 25-OH-vitamin D levels (Specker et al., 1985; Walker, 2006). Darkly pigmented infants require a greater exposure to sunlight to synthesize the necessary level of vitamin D. According to the Institute of Medicine (IOM), only if the infant or the mother is not regularly exposed to sunlight, or if the mother's intake of vitamin D is low, would supplements of 5 to 7.5 micrograms per day be indicated for the infant. However, the American Academy of Pediatrics recommends that all breastfed babies be supplemented with 200 IU of vitamin D per day beginning in the first 2 months of life unless they are weaned to at least 500 ml per day of infant formula (AAP, 2003). The AAP further recommends limited one's exposure to sunlight to reduce the incidence of skin cancer. Delimma...lacking common sense.

Marsha Walker (2006) suggests these considerations in her text, Breastfeeding Management for the Clinician, when assessing one's needs for vitamin D supplementation:

Is the baby being exclusively breastfed? Is he or she being given medications, other foods, or drinks that could interfere with nutrient absorption such as calcium? Chronic calcium deficiency increases vitamin D metabolism with secondary vitamin D deficiency (Clements et al., 1987).
What was the vitamin D status of the mother during her pregnancy? Was the baby deficient in vitamin D stores as a fetus, was the baby preterm, what is the mother's current vitamin D intake and exposure to sunlight?
Is the baby's skin deeply pigmented? Is he or she from a poor socioeconomic background? Is he or she malnourished or does the baby have fat malabsorption? How old is the baby? Overt rickets is more common in children older than 6 months of age (Pugliese et al., 1998; Sills et al., 1994).

Is the AAP afraid of looking racist as opposed to telling a dark-skinned woman to step out into the sun more frequently, or fearful of appearing shovanist if they tell a working mom that her and her child need more daylight time? Are they genuinely naive to the impression this recommendation gives mothers when if breastfeeding they require supplementation but if providing formula their baby is safe? Is it ironic that the vitamin D supplements are manufacteured by the formula companies? Do we even know the recommended level of vitamin D supplementation? Vitamin D is fat-soluable, meaning we can consume toxic levels.

Delineating high-risk groups is the professional response. Dark-skinned, exclusively breastfed babies who spend much time indoors just might need supplementation of vitamin D, while avoiding the implication that breastmilk is deficient in this substance. Modern living is the issue, not inadequacy of human milk!

Keeping it Exclusive

2010-07-22T10:28:00.003-04:00

Food intolerances during infancy are common and thought to be related to the failure of adequately developed tolerance to antigens (Walker, 2006). Breastfed babies develop a tolerance of sorts to food allergens due to an active process in breastmilk. Infants not offered such luxury have an atypical gut composition and decreased numbers of bifidobacteria which predisposes them to allergic disease, inflammatory gut disease, and rotavirus diarrhea (Walker, 2006).

Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants; namely, bifidobacteria are no longer dominant and obligate anaerobic bacterial populations develop. Lactobacillus bifidus is predominant and gram-negative enteric organisms are almost completely absent is the exclusively breastfed infant's gut. Relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to formula-fed gut flora pattern (Walker, 2006). If breast milk were again given exclusively, it would take 2 to 4 weeks for the intestinal environment to return to a state favoring the gram-positive flora.

What about supplements you ask? A higher incidence of atopy and allergic rhinitis was observed in adults who had received vitamin D supplementation during their first year of life. This information continues to support the importance of exclusive breastfeeding during the first half year of life and the avoidance of adding solid foods, infant formula, additives, supplements, or beverages to an infant's diet before maturation of the gut (Walker, 2006).

Additional Interesting Points
The human insulin content in breast milk is significantly higher than the content of bovine insulin in cow's milk. Insulin content in infant formulas is extremely low to absent. Insulin supports gut maturation. Infants who are exclusively breastfed for at least 4 months have a lower risk of seroconversion leading to beta-cell autoimmunity. Short-term breastfeeding (less than 2-3 months) and the early introduction of cow's milk-based infant formula may dispose young children who are genetically susceptible to type 1 diabetes to progressive signs of beta-cell autoimmunity. Sensitization and development of immune memory to cow's milk protein is the initial step in the etiology of IDDM (Walker, 2006). Of further importance, exposure to infant cereal during the first 3 months of life in genetically predisposed infants significantly increases the risk of developing diabetes.

Bilirubin levels also correlate inversely with the number of feedings over the first 3 days of life. Bilirubin functions as an antioxidant to protect cell membranes. Breastfed babies have higher levels of bilirubin than formula-fed babies because they are suppose to! Artificially normally elevated bilirubin levels when feeding babies infant formula has not been shown to be beneficial (Walker, 2006).

2010-07-07T12:37:00.001-04:00

WABA World Breastfeeding Week 2010 calendar is now available!