Why Aren’t Moms Meeting Their Breastfeeding Goals?

In the Pediatrics research article, Baby-Friendly Hospital Practices and Meeting Exclusive Breastfeeding Intention, scheduled for publication in July 2012, the authors conclude that most moms will not meet their personal breastfeeding goals.  According to the Pediatrics study, more than 85% of the new moms in the study said they intended to breastfeed for three months or longer, but just 32.4% met their mark.

The study found that moms who were most likely to meet their goals:

• Were married
• Had given birth to other children
• Started to breastfeed within an hour of birth
• Had babies who were less likely to be given formula or pacifiers during the hospital stay

 Of these findings, breastfeeding exclusively while in the hospital, without giving supplemental formula, was the most significant factor in reaching breastfeeding goals.

So, what were the indicators that correlated with a mother to be less likely to meet her breastfeeding goals? 

• Obesity
• Smoking
• Planning to breastfeed for longer durations

Still 32.4% of the moms in the study didn’t meet their goals of exclusively breastfeeding for 3 or more months.  The American Academy of Pediatric recommends exclusive breastfeeding for the first 6 months. 

We are failing our moms!  

Why is this happening?

Study after study has shown that new moms need breastfeeding support to be able to meet their personal breastfeeding goals.  (Cochrane meta-analysis)

So what does this breastfeedingsupport look like?

• We need peer to peer support (like a support group) where we can learn from our friends and teach one another about the lost art of breastfeeding.
• We need access to affordable and effective prenatal breastfeeding classes that are routinely promoted by our OBGYNs and midwives, so that we can increase our breastfeeding initiation rates. 
• We need capable, caring lactation support in the hospital that can assist us when we need help and guidance, and recommend local breastfeeding support for when we leave.
• We need hospital practices that support breastfeeding, like skin to skin in the first hour, even after a cesarean birth, and limited visiting hours.
• We need access to affordable, on-going lactation support, from a trained certified lactation consultant (IBCLC) starting from day one until we decide to wean our baby.
• We need our health insurance to cover the cost of qualified lactation services, just as they do with routine well-baby check-ups.
• We need pediatricians to value breastfeeding and recognize that breastfeeding will protect their patients from so many preventable chronic illnesses.  So, when a concern arises about breastfeeding, we need them to immediately share with us breastfeeding resources in the community, both free and for payment.
• Ideally, we need lactation consultants (IBCLCs) in our pediatricians’ offices so that when issues are brought to our attention at our appointments we can receive immediate and ongoing breastfeeding support and assistance.
• Lastly, we need formula companies to stop sending free formula to every new mom.  If a mom needs or wants to use formula, she can get it at any local grocery store… no judgment!  Yet, let’s not make it so easy for new moms to succumb to self-doubt.  Do you know that the WebMD article, Most Moms Don't Meet Own Breastfeeding Goals, that first shared these findings from the Pediatrics' study happens to be placed RIGHT NEXT to a HUGE Similac formula advertisement.  Seriously???

Why do I think breastfeeding support for all moms is imperative?

As a married, breastfeeding in the first hour, and ‘no formula supplementation’ mama, it was the lack of community breastfeeding support that led to me not meeting my personal breastfeeding goals and that is something I will always regret.  When my milk was dwindling as my son turned 4 months old, it was never recommended by a health professional to see a lactation consultant to increase my supply.  Why was formula an acceptable substitute for my son in their eyes?  It doesn’t make sense to me.  Why didn't this doctor recommend that I see a lactation consultant?  

My story is not unique.  I meet women every day who feel guilty for not meeting their personal breastfeeding goals.  This doesn't have to continue!

Support, support, support!  It’s what we all deserve for ourselves and our babies!  We need to make this happen NOW!

How Can I Keep Up My Milk Supply While on a Business Trip?

Dear SDBFC,

Do you have tips on your first (business) trip without the baby when you're breastfeeding and have to pump (in my case, baby will be 9 mo.)? 

Thank you!

Kristi

-------------------------------------------------------------------------------------------------------------

Dear Kristi,

Absolutely!  Taking a business trip, when you have a breastfeeding baby at home, doesn't have to be as daunting as it sounds.

Here are a few tricks to maintain your milk supply and keep your baby comfortable while you are away from him.

1. If you have the opportunity, pump a few extra times a day for a good two weeks before your leave on your business trip.  An extra pumping session in the morning and right before bed can help to build a surplus in your freezer for when you are away.

2. Make sure your little one is used to taking the bottle several weeks before you leave on your trip.  There is nothing more frustrating for a partner or caregiver if the baby is refusing the bottle when mom is gone.  Plus, you won't have to worry about what your baby is going to eat while you're travelling.

3. Bring a double, electric pump AND a hand pump with you on your trip.  The double electric will hang out in your hotel room or accompany you to work.  This will insure that you are truly DRAINING your breasts several times a day.  Try pumping 15-20 minutes at a time, with some breast massage.  

The hand pump is great for the inconvenient times where you only have a few minutes to pump, but you want to relieve the fullness.... like on the plane or during a business dinner that went a lot longer than you anticipated.  This will help so your aren't leaking through your snazzy business blouse or exploding any shirt buttons:)

4. Create a pumping schedule that allows you to pump several times a day while you are away.  Kristi, since your baby will be 9 months old, my guess is he is probably nursing (about) 5 times in a 24 hr period.  If that's the case, try to pump 5 times in 24 hours while you are away from him.  This may mean you have to wake up once in the middle of the night to get in that extra pumping session, but it will be worth it to help maintain your supply.  Plus, this separation is only temporary!

5. Bring a small cooler with blue ice to keep your pumped milk fresh during those work hours.  Transfer it to the hotel fridge when you get back to your room.  Your milk will stay fresh for 24 hours in the cooler with the ice packs and 5-7 days in the hotel fridge.  No need to pump and dump!

Large freezer bag6. Pack a larger freezer bag that zips (think Trader Joe's freezer bags) and some extra ice packs.  This is for the ride home.  You can take all of your pumped milk back home with you.  Just store it in breastmilk storage bags, place it in the freezer bag with ice packs, and pack it in your checked bag.  No need to even have a discussion with TSA about your breastmilk:) 

7. When you get back home, my guess is that you and your little guy will want to take a mini nursing honeymoon, which means just nurse and nurse whenever either one of you wants to.  Reconnect and enjoy one another!

Warmly,

Robin

----------------------------------------------------------------------------------------------------------

What tricks have worked for YOU when you went on a business trip away from your breastfeeding little one?

If you have a question you would like to submit for our series Help a Breastfeeding Mama Out!, please add them to the comment section of this article, share them on our Facebook page wall, or send it through the contact link on our website.

Newborn Hands: Why are they always in the way while breastfeeding?

Oh, those sweet little newborn hands.  Such a love/hate relationship we breastfeeding mothers have with those hands.  We love to hold and kiss those sweet-smelling hands, yet when it’s time to breastfeed, those annoying little clawing paws won’t get out of the way!  The minute our breast is out and ready to feed, those newborn hands are like defensive linemen, blocking any entry into our baby’s pecking mouth.

So, what’s the deal with those hands? 

Why is it that immediately when our baby realizes he is starving, his hands get in the way?

 Fun fact #1: Did you know that your baby has been using his hands in this fashion while in utero?  Ultrasounds show babies bringing their hands to their faces before swallowing amniotic fluid.  This is actually a process in the feeding pattern, which explains why babies bring their hands to their mouths when they are hungry. 

Fun fact #2: Did you know that if your baby’s face is not touching your breast as you initiate a breastfeeding session, he will use his hands to find your nipple?  Newborns have incredibly poor eyesight and use all five senses to locate and latch on to the breast.  Those little hands are searching for your breast to help bring it closer to his mouth.

So, what’s a mom to do when her baby is crying to eat, yet his hands are blocking every chance she has to put her breast in the baby’s mouth?

• Let your baby suck on his fingers to calm himself at the breast.  When he moves his hands, he is already at the ‘restaurant’ and will be ready to breastfeed.
• Try not to tuck your baby’s hands under his body or swaddle him while breastfeeding.  Tucking his hands can disorient him.  Think about if you were trying to eat with your hands tied behind your back.  You would most likely feel off-centered and clumsy.  Babies need their hands to keep them stable, just like we need our arms to our side or in front of us when we eat.
• If you have sore nipples and the thought of your baby clawing them makes you yelp just thinking about it, then keep your baby’s face touching your breast.  Try laid-back breastfeeding to assist with this.  In this position, you can wrap your baby’s hands AROUND your breast and he will come in with his face instead.
• Catherine Watson Genna, one of the most amazing lactation consultants I have ever met (and also the head researcher in an infant hand-use while latching study) recommends this technique in the Lactation Matters article, An Interview with Catherine Watson Genna, “Sometimes babies do get caught in a ‘reflex loop’ of sucking their hand, moving away, and then sucking their hands again. Moving the baby slightly so his face touches mom’s breast can interrupt this loop and get the baby to move his hands away and look for the breast with his mouth again.”  More information can be found in her article, Facilitating Autonomous Infant Hand Use During Breastfeeding

So, maybe those roaming little hands are actually helping our babies to become better breastfeeders.  Who knew?

Why Does My Milk Smell Sour?

Dear SDBFC,

This weekend my hubby wanted to give our son a bottle, so I thawed some milk that was pumped mid-February (2 months ago). When I was putting it in the bottle it smelled sour like spit-up. Why is that? He still ate it and it didn't make him sick. Is my milk bad? That was the oldest milk I have so I thought it would be fine still.

Thank you!

Natalie

******

Dear Natalie,

There are many reasons why your milk may smell sour.  

Storage

What are you storing your milk in?  Sometimes the breastmilk storage bags can let in smells from the freezer, which may make your milk smell less than desirable.  Try storing in air-tight glass containers to see if this helps.  Also, store your milk in the back of the freezer, rather than the door, so that the milk doesn't defrost as the freezer door stays open.  For terrific information about milk storage guidelines, check out Mother and Child Health's article: Storage and Handling of Breastmilk.  

Excess Lipase

Your milk may have excess lipase in it, which can cause stored breastmilk to smell sour or soapy.  Lipase is a beneficial enzyme found in breast milk that helps break down milk fat.  If your breastmilk has excess lipase, the longer the milk is stored, the stronger the smell becomes.  The milk is totally safe for the baby to consume, but some babies may reject the milk because of its strong scent and change in flavor.  To break the cycle of the excess lipase, you can scald your milk after you express it, so that you can store it and use it at a later date.  Here are two great resources, one by Christina Williams and one by Simply Rebekah,  about scalding breastmilk to get rid of excess lipase.

For a more detailed explanation of excess lipase, check out Kellymom's article: My Expressed Breastmilk Doesn't Smell Fresh.

Natalie, as long as you are following proper breastmilk storage guidelines, sour milk doesn't always equal spoiled milk.  Hope these resources help!

Warmly,

SDBFC

What Can I Do About My Fast Let-Down?

Dear SDBFC,

What are some good nursing positions if you have a fast let-down?

Sincerely,

Alanna

********

Dear Alanna,

When moms have a very fast let-down, babies often have difficulties tolerating the fast and furious flow.  Some choke and sputter at the breast.  Some pull off and get sprayed in the face.  Others pinch down on the nipple, as if trying to put a kink in the water hose.  All of these can cause somewhat uncomfortable feedings for mom and baby.

So this is what you want to do.... Work with gravity!

Recline and lean back

When you lean back, it can slow down the flow a bit, making it more comfortable for your baby to feed. Place a pillow behind your back on the couch or your diaper bag behind you while nursing in public.  Then slide your bottom to the edge of your seat and you are now reclined.  

Position your baby in a diagonal or upright position

When your baby is laying on his side, it is hard for him to coordinate his suck, swallow, breath when the milk is pouring into his mouth.  Think about it... have you ever tried to drink a glass of water laying down on your back?  I'm choking just thinking about it!  So, sit your baby up a bit and let gravity help him as well.  This works well when the baby is facing tummy to tummy, either sitting in your lap or somewhat diagonal.

Sidelying

Now, I realize that this goes somewhat against the above two suggestions, since you are no longer reclined and baby is now on his side, but check this out.  When you feed in the sidelying position, any milk that cannot be swallowed by your baby can just slide out of his mouth, while he is feeding.  Sure, your bed or couch might get a little wet, but just place a towel under the two of you and nurse away!

For more information about this topic, check out our recent article: Foremilk vs. Hindmilk: The Unnecessary Controversy

For other terrific photos of laid-back breastfeeding, check out the Biological Nurturing Web site.

Do All Exclusively Breastfed Babies REALLY Need Iron Supplements?

When I read a policy statement from the American Academy of Pediatrics stating that exclusively breastfed babies need to be supplemented with iron starting at 4 months, I have to wonder…

Are they saying that my perfect nutrition for my baby is no longer PERFECT? 

Are they saying that what my body produces is suddenly SUB PAR? 

This caused me to do a little research.  What IS the deal with iron in breast milk? 

Does my 4 month old really need those nasty-tasting drops?

According to my research, I found that not all exclusively breastfed babies need iron supplementation.  In general, babies are born with enough iron in their system to last at least 6 months, of not until they have tripled their birth weight. (Riordan and Wambach, Breastfeeding and Human Lactation)  According to the Womanly Art of Breastfeeding, there is not a lot of iron in breast milk, yet there is not supposed to be, as it is more completely absorbed from breast milk than in supplements or formula.   Also, breast milk contains a protein, called lactoferrin, which binds to the extra iron that the baby cannot use, keeping it from feeding harmful intestinal bacteria.  Iron supplements, for a baby who is not iron-deficient, can often overwhelm the lactoferrin, causing an overgrowth of intestinal bacteria, resulting in diarrhea and possible microscopic bleeding.  WHAT???

And, my biggest RED FLAG went off when I found a Letter to the Editor of Pediatrics, called Concerns With Early Universal Iron Supplementation of Breastfeeding Infants.  In this article, the executive committee of the Breastfeeding Section of the AAP states that they have “major concerns about universal iron supplementation at 4 months in breastfeeding infants” and that the authors of the above policy “acknowledged that this report was submitted for review to the AAP Section on Breastfeeding, but they did not mention that we disagreed and provided our additional recommendations 2 years ago.”

HMMMMM!  So, clearly my breast milk is much more perfect than the AAP was trying to make it sound and universal iron supplementation of exclusively breastfed babies over 4 months is NOT ideal.

So, how would you know if your baby actually needs iron supplements?

Which babies are more at risk for iron-deficiency anemia? (according to www.kellymom.com)

• Babies who were born prematurely, since babies get the majority of their iron stores from their mother during the last trimester of pregnancy.
• In addition, there is evidence that babies whose birth weights are less than 3000 grams – about 6.5 pounds – (whether term or premature) tend to have reduced iron stores at birth and appear to need additional iron earlier.
• Babies born to mothers with poorly controlled diabetes.
• Theoretically, babies born to mothers who were anemic during pregnancy could have lower iron stores, however medical studies do not show this to be a problem. Babies born to mothers who are anemic during pregnancy are no more likely to be iron deficient than those born to mothers who are not anemic during pregnancy.
• Babies who are fed cow’s milk (instead of breast milk or iron-fortified formula) during the first year of life.

If your baby falls into one of these categories, you have the right to ask for your baby’s hemoglobin to be tested for anemia, rather than automatic iron supplementation.  And, if your baby does test positive for anemia, there are many Iron-only drops that you can give your little one.  No need for that multivitamin because your breast milk has all of those vitamins already in it!

In addition, when your little one is over 6 months and ready to start solid foods, consider those with a healthy dose of iron, like the ones listed on one of my favorite baby food sites, Wholesome Baby Food.  No need to try that boring white rice cereal, just because it is fortified with iron!

How Can I Respond to My Pediatrician Who is Not Supportive of Breastfeeding?

Welcome to our first edition of Help A Breastfeeding Mama Out!  Every Thursday, we will answer a question from one of our dear readers.  Do YOU have a burning question you would like answered on our blog Please email them to robinkaplan@sdbfc.com and we add it to our list!

Dear SDBFC,

Any advice for responding to doctors when they are unsupportive of breastfeeding past the first few months or uneducated about it (such as believing it causes cavities, etc.)?  Thank you in advance!

Sincerely,

Theresa

******** 

Dear Theresa,

My first response would be, "Can I have my records, please?"  

I hope that doesn't sound too harsh, but pediatricians are supposed to be one of the main practitioners you can turn to with regards to the health of your child.  If your instincts are telling you that this professional is not up-to-date on one of the best ways to keep your child healthy (BREASTMILK!!!), then I would look for another practitioner who has read some research since 1970.  

Our family has changed doctors many times over the past few years, as I wanted to make sure that we were getting the best, most research-based care possible.  I was tired of explaining my preferences for vaccinations and antibiotics.  Now, going to the doctor is a pleasure, as I am respected participant in the decision-making for the health of our family.

Now, as for articles to share with any practitioner about the benefits of breastmilk past a few months, here are a few of my favorite:

Natural Resources Defense Council: Benefits of Breastfeeding

American Academy of Pediatrics: Breastfeeding and the Use of Human Milk

Kellymom.com: The Many Benefits of Breastfeeding (Resources)

Are New Moms Bombarded with TOO MUCH Information?

So I would like to take a virtual raise of hands to see how many of us have googled ‘sore nipples’ or ‘increasing milk supply’ on a random Thursday night at 11pm?  What about ‘when will my baby sleep through the night?’

Sure, we are blessed to live in a time when we can go online to find information on anything, yet, how legitimate and correct is this information we stumble upon?  If I search ‘sore nipples and breastfeeding’, I get over 327,000 hits… that is INSANE!  That many people have written an article about sore nipples?

And the information overload doesn’t end there.

Oh, Facebook….how I love and hate you at the exact same time.  

While I love seeing photos of my friends on Facebook, I also find myself feeling in competition with them for who is the BETTER mom.  Who plans the best art projects?  Who looks like she is the most relaxed?  Who always looks like she is enjoying her role as mom?  It can sometimes make me feel badly about myself.

Now don’t get me wrong.  I think my favorite aspect of the Internet is the way in which we can share our personal stories.  Personal stories are incredibly powerful.  When I read stories about what other moms are dealing with, it can often put my current situation into perspective.  I can relate to someone else, via the Internet, and feel like I actually know this woman, although I have never met her in real life.  The connections and support are empowering!

Yet, sometimes I think the Internet is a little too much of a good thing.  When my friends and clients are telling me about how they googled ‘reflux’ last night and now have 10 different diagnoses for their baby’s fussiness at the breast, I feel like their stress has elevated, rather than dissipated.  Their main questions were never answered.  Plus, while there is terrific parenting advice online, there is equally horrible, judgmental, and biased opinions that can really bring a mama down.

So what can an Information-Bombarded mom do to bring back her sanity?

This past week, I spent 4 days with my family, without Facebook and Google Reader.  Instead, I hiked, reconnected with my kids and my siblings, cooked nutritious meals, sat and watched my kids go on a scavenger hunt in a garden for an hour, and actually read a REAL book!  It was so therapeutic to purposefully ignore what everyone else was doing and what they were presently concerned about.  It was all about my family instead.

My favorite ways to actively become more present:

• Turn off my computer and phone…. I can instantly be in the moment.
• Spend more time outside….even writing this article was more relaxing as I sat on my outside couch with my feet up, soaking in the sun and the rustling branches.
• Take photos with a real camera, rather than my phone.  This way I can’t be interrupted by calls or emails.
• Bookmark my favorite sources of legitimate Internet information.  This way I spend less time weeding out the crappy articles and just read the beneficial ones.  For breastfeeding resources, I love Kellymom and Best for Babes.
• Hide my ‘perfect’ friends on FB.  It has saved me hours of thinking aggravating thoughts now that I don’t have to read their posts every day.
• Find time to decompress every day.  Parenthood, while rewarding, demands nonstop attention, which can really wear one down.  Sneaking out to throw the ball to my dog or hiding in the garage while I do my laundry can help quiet my mind and my stress during the times I need it the most.
• Find those few friends who can truly relate to you and will offer non-judgmental advice.... or even better, just listen when you need them to.
• If at all possible, take a small vacation.  While I try to decompress on a daily basis, I find that the stress of being a working mom just builds and builds until I explode.  This short vacation, spending time in nature and eating great food, with little contact with the outside world, definitely helped me hit my ‘restart’ button. 
• Find practitioners in my community that I trust.  Rather than googling ‘thrush’ or ‘vaccines’ online, I have someone that I can contact personally and get a straight answer based on my personal situation.  I recommend for my friends in other areas to check out ILCA's website for a list of qualified lactation consultants.

How about you?  What would you add to this list?

Advice for the New Breastfeeding Mom

Dear New Breastfeeding Mama,

All rights reserved by Rebeca CygnusAre you feeling completely overwhelmed by your new profession as Mother of a New Baby?  Are you googling sore nipples and how often should my newborn breastfeed while sitting awake at 3:30am?  Are you like me and only prepared for pregnancy and labor, but forgot to read the books about how to take care of a newborn?

Well, then look no further, my sweet friend!  Put the google search DOWN!

While I don't have all of the answers to breastfeeding and parenting  (let's be honest....who really does?), I do have some short and sweet resources that may be helpful for you in your time of need.  

And if you don't find what you are looking for on this list, add your question to the comments and I will do my best to provide you with the help you need!

Here are my Top 6 Advice for the New Breastfeeding Mom articles:

1. My Newborn is So Sleepy!

2. Laid-Back Breastfeeding: Physically and Mentally

3. Napping and Postpartum Sleep Deprivation

4. Common Concerns While Breastfeeding - Sore Nipple Therapy

5. Common Concerns While Breastfeeding - Help!  I'm Engorged!

6. How to Bring in Your Milk Supply More Quickly

Know Your Newborn's Rights After a Hospital Birth: What Are Your Choices?

Did you know that you don't have to cut your baby's umbilical cord immediately after he/she is born?

Did you know that you could hold off on standard hospital procedures after your baby is born, given he/she is healthy, until after the first breastfeeding session (and beyond?)

I am somewhat embarrassed to admit, but I was one of those mothers who walked into labor and delivery trusting everything my OBGYN said.  I had not done any extra research on the policies and procedures that took place during a hospital birth.  I had no idea how these medicalized birth practices could impact my delivery, my child's future well-being, my breastfeeding initiation, and my recovery.  

Now that I have been in the birth and postpartum professional world for over 3 years, I am shocked about how little I knew about my rights during birth and beyond.  And I have a masters degree, dammit! I am an educated woman about everything else in my life, so why didn't I learn more about birthing practices?  

Fortunately, there are many research-based articles on the web that will help you make a decision about whether these routine hospital procedures are for you or not.

So which procedures are under your control?

1. All initial evaluations can take place while the baby is resting on mom's chest.

2. Your baby doesn't need a bath in the hospital - the vernix helps fight infections and is moisturizing, so rub it in!

3. If you don't have chlamydia or gonorrhea, your baby doesn't need drops in the eyes after birth.

4. Vitamin K shots - does your baby really need this?  

And these are just a few....

For more information about your newborn's rights after a hospital birth, take the time to listen to this fabulous online radio show episode from Pregtastic called, Know Your Rights!  Routine Hospital Procedures for You and Your Newborn.

Also, while you are at it, make sure your hospital is breastfeeding-supportive.  In 2012, you would think they all are, but, again, I was shocked at how many of them are not.  Best for Babes has a great article that can help you figure this out: Top 10 Questions to Help You Find a Breastfeeding-Supportive Hospital.