First, I had dinner with a close friend. She told me about the experience a family member had with her OB with her first baby. I was ANGRY! Actually, I was surprised at the degree of anger I felt. I drove home and almost sat right down at the computer to write the next post. But, reason prevailed, and I think it is best to address the issue we discussed in a future posting. There WILL be a posting about how some physicians manipulate (even scare) women into Cesarean deliveries -- without telling them all the risks involved for both mother and baby.
Today, I was reading some more chapters in a text book for lactation consultants. I read one passage about medications, including epidurals, used in labor and their effects on breastfeeding. My husband, ever patient, at my request came into the room so I could read a passage to him. (I was snuggled in the recliner with Tessie on my lap. He, on the other hand, was reading in a chair WITHOUT a dog in his lap.) I am quite certain he listened only out of love for me and not because he has great interest in the topic. I must admit he has learned a lot over the past almost three decades of living with a childbirth educator and lactation enthusiast. In fact, he can advise a newly expectant mother with only three words: "Squat and breastfeed". He will admit he doesn't know how to explain much beyond that recommendation, but he affirms that it is very important to prepare to "squat and breastfeed".
After reading the paragraph, I emphatically stated something like "Doctors should tell women this stuff! They should have bath tubs in every labor room! They should provide free classes so their patients can learn natural comfort measures and position to help labor labor to progress normally! Hospitals should provide doulas (professional labor support persons) for every woman". Then I remembered I was NOT queen of the world, and reluctantly had to accept that this would probably never happen in the current health care system.
Before too long, I will be writing a post on the effects of labor medications on breastfeeding (in greater detail than what I have posted previously). At least women can become more aware of what these meds often do to them and their babies and can make informed decisions. All I can say, once again, is that God's design for childbirth works well in the great majority of cases IF we would just support it! Save the technology for those situations where it is really needed.
But, for now (I bet you thought I forgot!), I decided to provide a list of medical reasons for NOT breastfeeding or not using breast milk alone when feeding a baby: Here it is (from the World Health Organization/United Nations Children's Find. Baby Friendly Hospital Initiative. Prt II: Hospital Level Implementation. Geneva: World Health Organization: 1992; World Health Organization-United Nations Children's Fund. Acceptable medical reasons for use of breast-milk substitutes. Geneva. World Health Organization; 2009.)
Infants who may need supplementation/complementation of breastmilk feeds:
- Infants with very low birth weight (less than 1500 gms -- about 3.3 pounds) or who are born before 32 weeks gestational age. These babies may need something called human milk fortifier to increase certain nutrients and calories.
- Infants with severe dysmaturity (post mature/over long gestation) with potentially severe hypoglycemia or who require therapy for hypoglycemia and who do not improve through increased breastfeeding or by being given breastmilk.
- Infants whose mothers are severely ill (includes psychosis, which is a severe mental imbalance), sepsis (severe body wide infection), eclampsia (a pregnancy related disorder which can cause stroke and other fatal events) until healed, or with HIV infection (this information depends on where in the world you live, and whether or not you are exclusively breastfeeding. Exclusively breastfed babies of HIV positive women are less likely to contract the virus due to the protective structure of human milk), herpes simplex virus type 1 if the lesions are on the breast (can breast feed from the unaffected breast IF the lesions are covered -- always check with the appropriate health care professional before breastfeeding when active herpes lesions are on the body).
- Infants with acute water loss (e.g. during phototherapy for jaundice), if increased breastfeeding can not provide adequate hydration.
- Infants with inborn errors of metabolism (metabolic disorders -- e.g., galactosemia, phenylketonuria, maple syrup urine disease). These infants can not ingest breastmilk, or can ingest limited quantities with supplementation of artificial baby milk, or can breastfeed IF the mother follows a strict diet. Each condition requires different treatment. Follow the instructions of your baby's physician carefully.
- Infants whose mothers are taking medication that is contraindicated when breastfeeding (these are rare but include cytotoxic drugs (chemo-therapy), certain radioactive drugs such as iodine-131 (why I had to stop breastfeeding. However, in many cases, the break from nursing is short lived and breastfeeding can be resumed), and anti-thyroid drugs (other than propylthiouracil) or mothers who are abuse legal or illegal drugs. Breastfeeding is not recommended in these situations except as noted with prophylthiouracil).
- Newborn infants at risk of hypoglycemia due to impaired metabolic adaptation or increased glucose demand (small for gestational age, late preterm, those who experienced hypoxic/ischemic stress, those who are ill, and those whose mothers are diabetic) IF their blood sugar fails to respond to breastfeeding or breastmilk feeding. Supplementation is usually temporary, but depends on the baby's condition and ability to breastfeed over time.
We often think "breastfeed" (mother's milk) or "bottle feed" (formula). But, there are MANY options. Some can keep the mother and baby going in the direction of exclusive breastfeeding at some point in the future. The recommended milks, in order of benefit to the baby, are, starting with #1:
- Mother's colostrum/milk: directly from breast
- Mother's colostrum/milk: freshly expressed
- Mother's colostrum/milk: refrigerated (5 - 7 days in the colder part of the frig, not the door)
- Mother's colostrum/milk: frozen (recommendations vary based on the temperature of the freezer. It can be frozen one year at -4 degrees F, then thawed in frig over 24 hours, or in a warm bowl of water, gently swirled but not shaken. NEVER microwave breast milk or formula. There can be hot spots which can burn baby's esophagus, plus components of human milk can be damaged.)
- Fortified (if necessary) mother's own milk for pre-term infants.
- Pasteurized donor banked human milk
- Hypoallergenic infant formula
- Elemental infant formula (whole proteins have been removed and replaced with amino acids)
- Cow's milk based infant formula
- Soy infant formula
Newborns often do not become good breast feeders if they are given supplements in a bottle. They can begin to refuse to breastfeed, leading to early weaning. Babies use their "suckling" muscles differently when bottle feeding. If possible, it is best to wait until your baby has become a "champion nurser" before introducing a bottle. Usually, parents are advised to wait until the baby is at least 4 weeks old, and has learned to breastfeed well, before introducing a bottle.
If a newborn needs supplementation, milk can be given by spoon, cup, periodontal or other appropriate syringe, disposable/one-use eye dropper (because germs can grow inside the bulb), feeding tube, or nursing supplemental system. Ask your lactation consultant, hospital nurse, or local La Leche League Leader to teach you how to feed your baby with any of these methods so you can continue to progress toward exclusive breastfeeding.
For moms who plan to pump and bottle feed, be aware that this is very difficult. Don't forget it will take twice as long to pump and bottle feed your milk to your baby than to breastfeed. You will need to use a hospital grade pump with double set up and hand express for best results. You must be diligent with your milk expression schedule.
It can be challenging to increase and maintain enough milk without the baby nursing, but it is possible. Allow your baby "skin to skin" time to help increase supply. If you have the option of the baby nursing at your breast, and you are interested in pursuing it, work with a lactation consultant or La Leche League Leader. Otherwise, keep in mind that all your hard work with pumping still has great benefits for you and your little one.
Obviously, if a baby will not be able to suckle at the breast, or if mom has decided to not breastfeed at any future point with this baby, then bottle feeding is a convenient option. If/when you do supplement with a bottle, it is a good idea to incorporate paced bottle feeding.
As you can see from the above list, there are very few reasons babies should be denied breastmilk.
There are common diagnoses, like lactose intolerance, based on incorrect assumptions. Why is this "problem" of lactose intolerance not a valid one? Because breast milk contains lactase, an enzyme which digests lactose, the primary sugar in human milk. It is lactose which gives human milk its sweet taste, sweeter than any other milk from living creatures.
When we drink cows milk, we can experience lactose intolerance because lactase is NOT actively present in the milk. Lactase is present in sufficient quantities in breastmilk to prevent intolerance. I have my own findings and theory as to why some babies have trouble with excessive gas, reflux, etc. . . . but that might be another blog.
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