Suggestions for Successful Breastfeeding in the First Few Days

The last blog covered preparation during pregnancy for breastfeeding after delivery.  This posts picks up just after the baby has been delivered and placed skin-to-skin on your abdomen.  This post will not include everything you might find in a more detailed book. It does address some of the most important things to do or understand in order to avoid common problems.

1.  Spend the first hour or two after birth relaxing in a semi-reclined position with your baby skin-to-skin.  Baby's front should rest against your body.  All baby's body parts should be in contact with you or resting against a pillow.  Babies don't like their legs dangling in the air!  The semi-reclined position works well for twins. 

C-section moms can ask the operating room nurse to place the baby skin to skin on your chest, and cover the baby with a blanket.  Dad or other support person needs to be beside you to ensure baby does not roll off your chest while you are on the operating table.  Many times, babies will latch and breastfeed even before surgery is completed!

Semi-Reclined Position.  This baby is in a "onesie". Skin to skin is best accomplished with baby wearing a diaper only.  If mom perceives the room is to cool she can have someone adjust the thermostat and/or place a light blanket over the baby. Drawing courtesy of La Leche League International.

The time immediately following delivery is very important for mom and baby (with dad, too) to get acquainted and for baby to breastfeed. (Some of the reasons have been presented in earlier blogs.) The nurse can explain to other family members waiting outside your room what your are doing and why it is recommended.  This way, you won't have to deal with any pressure yourself.  Of course, if you want to have other family members join you, you can do so.   However, many new mothers are uncomfortable having others around them when their breasts are so fully exposed.

Whatever you decide, baby should stay on you and not be passed around for others to hold at this time.  There will be plenty of time for others to hold the the new family member later.

The Semi-Reclined position and different positions for baby while mom is semi-reclined.  Drawings courtesy of La Leche League International.

Routine newborn procedures can be delayed for a couple of hours until baby has breastfed.  Hospital policies seem to try to trump what research has taught us.  Still, you are a health care consumer and the baby's mother.  As long as your baby have no immediate problems which require medical intervention, keeping baby on you, and allowing him or her to breastfeed is the BEST thing to do at this time for you and for your baby. 

Giving the best care for the patient should be the goal of every health care professional.  Let your labor nurse know your plans for the first hour or two after delivery as soon as you arrive at the hospital.  Always be courteous, but you may also have to repeat your intentions until the message is understood and accepted.

2.  In those first days, watch for feeding cues.  Breastfeed right away and don't wait until your baby begins crying to feed  him or her.  Babies become "disorganized" and will tire quickly.  When they do get to the breast, they will often nurse a short while and then fall asleep. Baby's blood sugar can drop, making baby sleepier.  This can cause delay in feeding, starting a downward spiral. 

If you put your baby to breast as soon as you notice the feeding cues, your baby will give you its best feeding. Signs that your baby wants to breastfeed are:  baby sucks or smacks its lips, brings his hand to his mouth and begins to try to suck on it, i.e."rooting".  She may try to find "the nipple" while someone else is holding her.

Keep in mind that this recommendation is for the first few days, or perhaps week or so.  Once your baby is consistently nursing well, and gaining weight well, you can wait a bit if you need to to feed the baby -- but don't wait too long!

Avoid pacifiers until your milk supply is well established, your baby has mastered breastfeeding and is growing well.  Most breastfeeding experts recommend 4 weeks of "mama only".  After that, pacifiers don't seem to interfere with breastfeeding as much.  (There can be other problems with long term pacifier use.  Talk with your baby's doctor or do some online research).

One problem with the early introduction of pacifiers is that the baby will be less likely to give you feeding cues.  Instead, he or she will just suck harder and more frequently and wait until hunger leads to crying.  At this point, your baby may not feed as long or as well.  The time delay on feedings can add up over the day and a feeding or two may be missed completely.  Your milk supply can suffer. Your baby may loose more weight than he or she should.

There is one exception for the normal newborn with regard to pacifiers.  Studies have shown that giving baby boys a pacifier during circumcision provides comfort.  The stress hormones in the baby's blood are lower when they have the pacifier than when they do not.  Once your baby is brought back to you, remove the pacifier and put it in your bag.  Offer your breast for comfort.  You can bring the pacifier out and give it to him after about 4 weeks, if you think it is necessary at that time.

When breastfeeding a newly circumcised baby boy, remember to place a large amount of the petroleum jelly provided by the hospital on the site of the circumcision.  This will decrease pain from pressure or urination, and allow him to focus on breastfeeding better.

Newborn's have a very small stomach which slowly enlarges over the first month.  A baby who is a day or two old will take in about 1 teaspoon at a feeding since this is what his or her stomach will hold.  That means they may be nursing a LOT -- up to twelve to fifteen times a day during the first few days.  They definitely need at least eight feeding a day, beginning on day two (they can sleep a lot on day one, especially if mom had medications for pain in labor).

Sometimes babies will "cluster feed".  This means they will feed frequently for a period of time, and then take a nice long nap, up to five or six hours.

As long as your baby is nursing well at least eight times a day, and is peeing and pooping as he or she should for that day, enjoy the nap -- and try to get one for yourself.  However, if these parameters are not being met, go back to skin to skin time. and attempt to feed your baby every two to three hours.   Keeping a log of feeding and pees and poops will help you know when to wake your baby for a feeding.  Most hospitals have one they give to all nursing mothers.  If you would like to see a sample, click on 
http://www.freeprintablemedicalforms.com/preview/Baby_Feeding_Schedule


Let your baby breastfeed as long as he or she desires, but if the feedings are taking longer than 45 minutes, ask the lactation consultant or nurse to evaluate baby at the breast.  As your baby grows, you will see, even in the first weeks, that he or she won't feed as often.  Many become more efficient and can feed in a shorter period of time.  

The time you invest in best practices for breastfeeding success in those first days and weeks will have big payoffs in time and money saved later on -- plus your baby will become smarter and healthier by the day!

Photo/Chart is by Katie Wickham BScN, RN, IBCLC, BCLS of Babies First Lactation.  Used with permission.

3.  Spend lots of time skin to skin with your baby.  The more your baby lies against your chest, the more quickly your milk supply will increase, and baby's intake will grow.  Your baby will be calmer.  His or her heart rate and breathing, and also blood sugar levels, will be more stable.  Just having your baby skin to skin increases your output of oxytocin, an important hormone for breastfeeding, for bonding, and for keeping your healing uterus nice and tight to minimize blood loss.  Neat design, huh?  What a wise God to take care of the "details".

If you begin to feel sleepy, wrap your baby in a blanket and give him or her to an awake, alert, adult, or put the baby back in it's bassinet.  Floors in hospitals are hard and babies don't do well if they fall onto the floor from the bed!

Be careful with visitors.  Without meaning too, they can interfere with your skin to skin time and with breastfeeding itself.  Just remember that you and baby come first.  Visitors will go home and sleep all night.  You can't.  Make a plan now on how you will manage the most important things.

4.  Make certain your baby has achieved a deep and comfortable latch.  If you feel pain or pinching, the latch is not correct.  Remove your baby in order to let him or her re-latch. To do this in a way which protects your nipple and keeps it from being damaged by the baby's clenched gums, place your finger, with the nail trimmed short, into the baby's mouth, AND BETWEEN THE GUMS.  HOLD YOUR FINGER THERE while removing your baby.

Another, and gentler, way to completely break the latch is to lay your finger along the side of his or her mouth. Pointing your finger from chin to nose, or nose to chin.  Press down against your breast and wait for the baby to "pop off" (see link below).  Always protect your nipple!  If this technique does not work, then use the previously described one.

Allow the baby to latch again as many times as necessary to get a deep latch.  A shallow, or "nipple" latch, often leads to nipple soreness and injury.  In addition, your baby won't get as much milk. 

Be patient. Your baby will learn from his or her trial and error to open wide and latch deeply to be allowed to stay on the breast and get the milk!

There are many good books and online video clips to help you understand what makes a good latch.  You can see a what a good latch looks like, and also the "pop off" technique by going to http://newborns.stanford.edu/Breastfeeding/FifteenMinuteHelper.html

 Even with proper latching, you may still feel a little nipple tenderness in the first few days.  If so, rinse your nipples with cool water (NO soap), pat them dry, express a little colostrum or breast milk, and gently rub it on your nipples.  If this does not help, then rub a little anhydrous lanolin onto your nipples after rinsing them and patting them dry.  The reason for the rinse is that saliva is a digestive fluid.  You don't want a digestive fluid on tender nipples which might be microscopically abraded.  Healing should occur faster with the rinse and application of the breastmilk, or if needed, lanolin.

For nipple pain beyond mild tenderness, have a lactation consultant examine your breasts, observe a latch, and so on.  She should be able to identify the cause of the injury and recommend the appropriate measures to take for healing and prevention of additional injury.

5. Keep track of your baby's wet and soiled diapers to make certain he is getting enough milk.  One wet and one poopy diaper is expected on Day 1, two wets and two poops on day 2, etc.  One Day 5 there should be six wet diapers and four or five poops.

The thick, tarry, stool, called "meconium" should be passed in the first 24 hours.  The stool begins to change color over the next 3 to 4 days (blackish green to green to greenish yellow to yellow).  You can see "poop progression pictures" at http://www.breastfeedingmaterials.com/view-breastfed-baby-stool.  The photos are not pretty, but they are very helpful in understanding what the poop of a breastfed baby should look like.

Many moms think the baby has diarrhea, but normal yellow stool can be runny, and is usually somewhat loose.  Again, the following link has an example of a feeding, wet, and messy diaper log.  http://www.freeprintablemedicalforms.com/preview/Baby_Feeding_Schedule

6.  If supplementation becomes necessary it can be given with WITHOUT using a bottle.  But first, lets take a look a a fairly common reason for supplementing -- too much weight loss. 

Babies come with about 10% to 15% extra fluid at birth.  This prevents dehydration during the first 3 or so days, until mom's transitional milk comes in.  As the babies fluid level begins to drop, thirst, as well as hunger, begins to drive his or her desire to nurse.  This "happens" to occur just about the time mom's "milk supply" comes in.  If baby is nursing well and frequently, then mom may feel "full", but does not become "engorged".  Engorgement, though common, is not "normal".   It is more likely to occur if baby is not feeding frequently or well.  This can be caused by the effects of labor medications, missed feeding cues, lack of skin to skin contact, and formula supplementation.

Most hospitals will note when baby looses 7% of its birth weight.  The doctor will prescribe supplementation (mom's milk or formula) for the baby with a 10% weight loss.  One problem with this protocol is that some babies have a LOT of extra fluid on board at birth because mom was induced, was given Pitocin, lots of IV fluids, or had a C-section with IV fluid.  Instead of the typical 10% to 15%, the baby could have 20%, more or less.

A recent study indicated that babies diuresed (peed off) the overload fluid in the first 24 hours.   The authors suggested that the baseline weight for the baby be taken at 24 hours post-birth.  This diuresis of extra maternal IV fluid in the baby, in addition to normal weight loss in the first few days, can put the total weight loss at 10% very quickly. Thus, a perfectly healthy and normal baby may be subjected to the risks associated with formula feeding when, in reality, once the mother's contribution to baby's fluid load has been taken into consideration, the baby would not need the formula. 

If this happens to your baby, do the following:

* Talk with the doctor before allowing any supplementation.

*Discuss your labor and birth experience.  If you had a lot of IV fluids, or IV fluid within 2 hours of delivery, let the doctor know.

*Look at your own body.  Are you feet and legs still swollen?  Have your breasts been swollen (sometimes to the point it is hard for the baby to latch)?  Mention this to the physician.

*Evaluate the baby.  Has the baby been feeding well?  Are the pees and poops normal?  Does the skin, and the mucous membranes of the eyes and mouth look normal?

*If any blood sugar readings were taken, were they normal?  Were they correctly done?  Only a lab test can confirm low blood glucose (sugar) readings.

If everything mentioned above checks out OK, then ask the doctor if supplementation could be delayed for 12 hours, and continue to observe the baby.  A dehydrated baby has signs of dehydration.  Also, a lactation consultant can observe and assess a feeding session. She can do a pre-and post feeding weights of the baby to confirm milk transfer (special scales are required for this, so it may not be readily offered).

If supplementation is required for a medical reason, consider the following:

*the size of the baby's stomach

*using your own milk for supplementing

*feeding with another device instead of using a bottle.

One formula company helped to fund a study which showed that "supplementing 10 ccs of formula increased the success of breastfeeding".  Of course, the trumpets came out and formula was once again declared to save the day.

In reality, the study should have reported that LIMITING formula supplementation to 10ccs increased breastfeeding success.  When babies are supplemented, they are often given significantly more than 10 ccs, affecting their desire to breastfeed.  By limiting formula supplementation, babies were more likely to go back to breast.

If you begin using hand expression in addition to breastfeeding on Day 1, you milk supply will increase more quickly.  This colostrum can be given to the baby via a spoon or medicine cup right then.  The lactation consultant, and possibly your nurse can show you how.

Express your milk for a few minutes 5 times a day, after or between feedings.  Ask the nurse for a small container to store the milk in if your baby is asleep and not ready to take the colostrum.  You can feed it to him or her at another time.  You won't get much more than a "puddle in the middle" of a plastic teaspoon at first (may 2 to 3 mls -- 5 mls equals one teaspoon).  That's OK.  Every session builds your supply.  If your baby is not nursing well, you can begin giving it to her to keep her blood sugar levels normal.  If supplementation is required, you will have more milk to when you express milk for that feeding. 

If you have been advised to pump for any reason, incorporate hand expression into your schedule.  One study found that by adding hand expression five times a day to the regular pumping schedule, women produced more milk.   To learn how to do hand expression, go to http://newborns.stanford.edu/Breastfeeding/HandExpression.html

If you are asked to pump on Day 1 or 2, you may not get any milk out.  This does not mean you do not have any milk. It means the pump is not designed like a baby or like you hand.  It can not get out the smaller amounts of colostrum in mom's breast.  A few moms will have a larger amount of colostrum, and the pump may be able to remove some at the first session.  The next sessions may not yield any results until mom's transitional milk supply begins to comes in.  Do not become discouraged if the pump can not remove milk in the first day or two.  This is normal.

Women who have had a C-section may experience a delay in producing more colostrum and then transitional milk.  So might women who lost a lot of blood, or women with endocrine disorders like diabetes or PCOS.  Do everything you know that will help with your supply: skin to skin, hand expression, frequent feeds, pumping, etc.

If supplementation is required, and you do not have enough milk to express at the time, formula is available, and is preferable to cows or any other type of milk alone.  Some hospitals have pasteurized human milk from a milk bank. You can ask if it is available.  If so, request it.  It can be expensive, so you will have to see if your insurance will cover it.  If not, you will have to decide is you want to pay the extra amount required for it.

Once your colostrum begins transitioning toward mature milk (around day 4), and your baby is feeding well (least eight times in a 24 hour period), you can discontinue the hand expression.

7.  When you are ready to try upright positions for breastfeeding, start out with the cross-cradle hold and the football/clutch hold.  Wait until your baby can breastfeed well before using the commonly seen cradle hold.  Most new babies do not have the head control required to latch correctly and maintain a deep latch while in the cradle hold.  

Drawings Courtesy of  La Leche League International.  For more illustrations or info click on the link below:

 http://www.llli.org/faq/positioning.html

Here are some tips for using the upright positions:

*  Do not put your hand behind the baby's head!  This can push his chin toward his chest.  This makes it difficult for your baby tomaintain a seal or to swallow.  Place your had at the nape of your baby's neck (as shown above) with your palm between his or her shoulders.   Your fingers will rest lightly against its jaw/side of face/side of head.  This will allow your baby to adjust his or her head into a comfortable position for nursing.

*In most cases, in the early days, it is a good idea to continue to support your breast from underneath while the baby is latched.  A newborn may have difficulty maintaining a deep latch if the weight of mom's breast is more than baby can manage.  In this case, the breast begins to slide toward the front of baby's mouth, and breastfeeding has become "nipplefeeding" -- the deep latch becomes too shallow.

*Use as many pillows as it takes to support your arms in a comfortable position while you are sitting upright.  If you hold your baby and your breast without pillow support, your arms may begin to tire, causing the baby to slowing slip down from a deep to a shallow latch.

*Ask an LC or nurse to work with you when you try upright positions.  They can evaluate how things are going and may any necessary suggestions for your comfort and baby's latch.

*Avoid pressing down very far on your breast to clear baby's airway.  Baby's were designed with flat noses so they can breath when "smooshed" at mom's breast (Ah, the details considered by our wise God!).  If your healthy baby can't breath, he or she will pull away of break the latch to breath. If you see this occurring, latch your baby, and then press on the baby's diaper area with the arm that holding the baby. This will help bring his or her head back to clear the airway.  If your baby continues to breastfeed, even if you can not see the airway he is clearly getting air.  When a mother presses down too much on her breast so she can see the airway is clear, it can tilt her nipple up toward the roof of her baby's mouth, and cause some abrasions on the tip of the nipple.  It also can cause a deep latch to become a shallow latch.

8. Always work with a lactation consultant, a Le Leche League Leader, or another breastfeeding expert if you have any problems.  If you try to figure it out on your own, you may not be successful.  Then, trying to make it work becomes harder.  Many moms are simply tired at this point and reach for the formula bottle.

9. Some mothers plan to pump and breastfeed.  This is better than formula feeding, but it is hard to do over the long term.  Babies are made to maintain and increase mom's milk supply.  Pumps lack some of the things babies do in this area.  Also, it takes longer for mom to make antibodies for the baby if a baby has picked up a germ.

If the baby breastfeeds, the germ transfers to mom's body via the breast.  She starts making antibodies, which go back to the baby in her milk, sometimes even during that same feeding  This protection process can be delayed with pumping and bottle feeding.  Plus, it takes twice as long to pump and then bottle feed, unless someone else always gives the bottle. If mom is doing all the work, she has to be very dedicated!

If you decide that pumping and bottle feeding is what you need or prefer to do, then you will need to rent a hospital grade pump. Using a pump designed for use three times a day or less may not work as well.   A hospital grade pump, along with a double pumping kit, will help you build and maintain your supply longer.  Double pumping saves time and also can increase the release of prolactin, a milk making hormone.

You will need to pump during each time the baby would be coming to breast.  Pumping once during the night in the early week increases the levels of prolactin in mom's body, which increases milk supply. With diligence, many women can provide their milk for their babies for several months.  Some can make it for a year or more.  Don't forget that adding hand expression to the pumping, and spending time skin to skin with your baby can help you maintain and even increase your supply.

Understanding and applying the God designed basic principles of breastfeeding which have worked for women over history will promote your success with breastfeeding.  Introducing some "modern day" interventions in this natural process can disrupt everything that hormones and common sense support.  Those interventions include: unnecessary separation of mother and baby immediately after birth and during the first few days;  placing a newborn on a "schedule" (a reflection of our modern society) instead of immediately responding to feeding cues; and introducing the artificial "teats" of pacifiers and bottle nipples.  Anything which affects this intense mother-baby time, and the natural flow of the "breastfeeding dance" mother and baby learn in the early hours and days, can easily push successful breastfeeding off track.

Sometimes, medical issues arise which can interfere with the normal establishment of breastfeeding.  WORK WITH THE LC in these cases.  There are ways to keep mom's milk going, as well as ways to feed the baby so he or she will still be able to come to the breast for feedings at the appropriate time.  Not all medical professionals are knowlegable or skilled protecting breastfeeding in these circumstances.  The LC will be a great resource of information and support. 

One such medical situation which occasionally occurs is "tongue tie".  We are learning more about this minor, yet disrupting, anomaly. There are different types of tongue tie. They present themselves differently in the baby's mouth and in feeding efforts.  Tongue ties (also known an ankyloglossia) occur when the membrane which connects the tongue to the floor of the mouth is too short and keeps the tongue from executing its full range of motion and also from full extension.  Baby is not able to cup the nipple or hold a seal at the breast.  Some ties are easy to identify while others are not.  

An LC might suspect (or even know for certain) there is a tongue tie, and the pediatrician may think one does not exist in the baby.  What can follow is a prolonged period of nipple soreness for mom and inadequate weight gain ("failure to thrive") in the baby.  This is due to less than normal milk intake because of sucking issues caused by the tie.  The following link goes to a site which provides good information and photos which might be helpful for the mother to share with the physician: http://cwgenna.com/quickhelp.html.  Local Le Leche League groups can often recommended physicians who are knowledgeable about correctly diagnosing and treating tongue ties.    

During your pregnancy, do not be afraid to chart your course for early breastfeeding with your care providers, your family, and your friends.  Of course, use wisdom in making decisions of medically necessary interventions. Watch out for "routines" which may possibly be easier for hospitals in managing patient care but which actually are not the  best practice for you and your baby.  Plan in pregnancy to incorporate actions in labor, delivery, and immediate postpartum which will minimize breastfeeding problems (see previous post).

Pray for wisdom and support, and for an easy and natural transition into the "4th trimester".  Your baby has been very close to your body for nine months.  There is no evidence that training a newborn to be separated from mom is beneficial.  You baby will learn to adapt to increasing intervals of separation.  By the time your baby is three months old (the end of the 4th trimester) he or she will probably be very content to nap in the baby bed, enjoy play time in the arms of others, and so on.

As your baby grows, you can "pattern" feedings.  An example of patterning feedings is to feed the baby more frequently in the evenings.  This usually leads to longer stretches of sleep at night.  

Don't get too involved with feeding schedules.  Baby have growth spurts, get thirsty, and seek comfort.  These things will not fit into a schedule.  

Growth spurts occur when baby is about 3 weeks, 6 weeks, 3 months, 4 months, and 6 months of age.  Your milk makes your baby grow to the point she needs more milk with her feedings.  She will want to nurse more often for a few days.  If you feed her when she wants to nurse, your milk supply will increase.  She will return to her normal feeding routine, but with more milk filling her tummy.

Seek assistance and support from breastfeeding experts available near you, whether in the hospital or in the community.  Other women who have successfully breastfed can be an invaluable source of support.  Most of all, ENJOY this special time of your life as a woman.

Breastfeeding Does a Mother Good

Before I get into some tips on breastfeeding in the first few days after delivery, I need to backtrack a bit.  We've taken a look at some of the reasons breast milk and breastfeeding are so healthful for the baby.  However, I've barely mentioned how breastfeeding is good for the mother.

Breastfeeding over months, vs. days, is associated with reduction in the following risks.  In other words, formula feeding increases these risks for mothers:

Breast cancer
Ovarian cancer
Uterine cancer
Rheumatoid Arthritis
Osteoporosis
Type 2 Diabetes
Alzheimer's Dementia
Cardiovascular Disease

The longer the mother breastfeeds, and the more children she breastfeeds, the greater the protection.

About 10 years ago, I read where one study found that women healed more quickly from birth related injuries (episiotomy, tears, C-section incision) when they breastfed, although the reason was unclear.

God's design not only includes nutrition, and protection for the infant, but He planned breastfeeding as a way to provide protection for mothers.  What a loving God we serve!

He also planned a way to help women deal with the demands of mothering little ones.  Prolactin, a hormone related to milk production, also causes a sense of relaxation, and even sleepiness in the mother.  Even though she may have to stop in the middle of a task to feed the baby, there is a reward for doing so.  This emotional and physiological perk helps her deal with what could be a frustrating interruption.  One La Leche Leader I knew many years ago said the prolactin was better than Valium!  At  least it is free and does not cause addiction.  Some researcher also believe it brings out "mothering" feelings.  All of these benefits, which seem to be for the mother, could also be for the baby.  A nursing mother is probably less likely to shake or otherwise hurt her baby because of the effects of prolactin.

Working mothers will miss fewer days of work because the baby is less likely to become sick enough to require her to stay at home.  That in itself prevents stress.  Also, prolactin is released during pumping or hand expression, so those little relaxation breaks can really be appreciated on stressful days at work.

Breastfeeding literature mentions weight loss as a benefit.  This could depend on the length of time mom breastfeeds.  The longer the baby is breastfed, to more likely weight loss will occur.  At first, mom's body may even hold on to fat stores laid down in pregancy in order to provide food for the baby in case there is "famine".  As the baby grows, and takes more calories from milk, mom's weight begins to melt away, assuming she is not increasing her calorie intake too much.

Women who are breastfeeding should never reduce their daily calorie intake below 1500 kcals.  Exercise is recommended to help with weight loss.  Taking baby for a walk a few times a week burns calories. Exercise releases endorphins in mom to increase her sense of well being. Taking walks outside provides some Vitamin D from the exposure to the sun.

Use wisdom in how much sun exposure you allow for baby and yourself.  You probably should cover the baby's head with a hat on hot, sunny days. Let baby's arms and legs be the location for the "Vitamin D factory".  Climate, season, and length of time outside can effect how much UV rays mom and baby receive.  Plan accordingly.  There is some concern that using sun block can prevent the synthesis of Vitamin D.  Try to find the balance between some and too much sun exposure.  

Moms who desire to exercise extensively may want to feed their babies, then exercise.  Lactic acid, a    byproduct of energy used by the muscles during exercise, can build up in the milk. It takes a little time for it to be reabsorbed into mom's system.  By the time baby is ready to feed again, the baby is less likely to refuse the breast due to the bad taste of "lactic acid milk".

One benefit many women mention is the convenience breastfeeding offers to a busy mom.  All a mom has to do is grab a diaper and the baby and go to the store, out to the park, and so one.

There is no need to worry about running out of formula.  Power outages are not a problem.  Empty store shelves which often occur during local emergencies don't worry the breastfeeding mother.  There have been incidences where the mother and baby were stranded for days or weeks due to bad weather.  Breastfeeding babies fair better in those types of situations because its food is always fresh and available. 

The cost of formula impacts the family budget in a significant way.  Buying formula can cost up to $3000 per year, depending the type of formula the doctor recommends.  On top of that, add the costs of medications, doctor visits, and even some hospitalizations and surgeries because the baby did not receive the anti-infection protection of human milk.

With breastfeeding, there is less stress on the family finances.  In fact, if mom needs one or two new appliances, such as a washer and dryer, saving on the cost of formula can pay for the purchase!  Or, the family can better afford to take trips together, and so on.

Many women describe a special bond with their babies which results from the closeness required to breastfeed.  Some women have been able to pick up on the fact that something was wrong with their little one.  Breastfeeding's intimate contact helped them sense something was not quite right, and babies were treated for an illness or disorder sooner than could have occurred with bottle feeding.

One of my favorite experiences was seeing my baby smile while at my breast, and then see the milk I had produced flow out of the side of his mouth during that brief "I love being with you, Mom" smile.  Of course, the hormones released by nursing probably helped that feeling of my melting heart, but I know my baby simply enjoyed the closeness to his mother and the sweet taste of my milk.  Now, that's a wonderful benefit, available only to a breastfeeding mother.

Preparing During Pregnancy for Breastfeeding Post Delivery

If you have been reading the previous posts, hopefully you have decided to breastfeed if you had not made that decision already.  There is not much to do directly to prepare your breasts.  When I was pregnant, we were advised to rub our nipples with a terry cloth washcloth to "toughen them up" so we would not experience sore nipples when the baby started nursing.  The problem is, there is no callous forming tissue, so nipples don't toughen this way.  For women at risk for pre-term labor, this action has the potential, at least theoretically, to start labor since oxytocin is released into the blood stream.  There is also a risk of injury to the nipple tissue and possible infection of the rubbed area.

We now understand that a correct and deep latch minimizes soreness.  A poor and shallow latch causes nipple pain and damage. 

Still, there ARE some practical ways to prepare, while you are still pregnant, to increase the likelihood of breastfeeding success.

Your choice of care provider and place of delivery can impact your birth and breastfeeding experience.  These, I think, tend to work together.  You may have a care provider which supports your choices for handling labor and birth, but if you deliver in a place where lots of medical intervention is standard, the course of your labor can be affected. If there is a chance your care provider might not be available for your delivery, you may be at risk for more medical intervention than you desire. The results of interventions you may experience in your labor could have negative affects on breastfeeding.

Obviously, home birth offers the most natural approach.  There is no invasive, or labor altering medical equipment or medications available.  Studies indicate that for a low risk mother and baby, with a qualified birth attendant present AND qualified medical care available as backup, home birth is a safe option.  But, home birth is not for everyone.  Personal choice or medical conditions can eliminate this option.

Birth centers are located near or are inside hospitals.  They offer support for natural approaches to labor and birth.  If necessary, medical assistance is just a few doors down, or a few blocks away, and is part of the same system.

Labor and Delivery units in hospitals tend toward a medicalized handling of birth.  There is more pressure to stay in bed, stay tethered to the fetal heart monitor, not eat or even drink in active labor, have IV fluids, have an amniotomy (break the bag of waters) or receive Pitocin (a drug which causes contractions), have an epidural, and deliver by C-section.

Teaching hospitals, especially, seem to introduce interventions more readily. They have to provide learning opportunities for medical students and residents.  Care providers deliver who there tend to be trained to more actively manage labor and birth. They often impose time limits before starting the next intervention.

Still, there are hospitals whose nurses and physicians are very open to natural delivery. They will do a great job of supporting women who want to minimize medical intervention.

Do you homework thoroughly.  This choice is important enough to seek God's wisdom and guidance.  Pray for direction.

I once overhead a group of residents and their attending talking during shift change report.  They were discussing one woman who wanted to have a VBAC (vaginal birth after Cesarean section).  One of them asked why she had a C-section with the first baby.  No one knew, but the comment was made, "perhaps it was two hours from shift change."  It seems that if labor is progressing too slowly for some physicians, they will push a decision to go ahead and do a C-section before a shift change.  It takes a while for the new shift to gear up for surgery (of course they can always handle an emergency C-section at any time).  They think it is better to do surgery when everything is organized than to risk needing to do one at shift change.  Before hearing this, I had never considered "5:00" to be a risk factor for having a Cesarean!  Baby may be fine, mother may be fine, but labor may be slow.  However, it is 5:00 (two hours before shift change on most 12 hours shifts).  Just in case labor continues to stall, do the C-section now instead of risking that the baby might not be doing so well during shift change and one might have to be done then.

But, what if the baby continued to do well, and and the mother continued to do well?  What if labor would finally progress in a couple of hours if everyone just had a little more patience?  Too late!  Shift change!  C-secton!  And mom and baby are exposed to increased risks associated with an operative delivery. These risks include a decreased chance of breastfeeding success -- not to mention all the health issue which result from formula feeding.

The place of delivery, it's philosophy of care, and the philosophy, training, and experience of the care provider (OB, midwife, etc) all impact breastfeeding.  A woman who has been induced a little early for fear of a 'big baby', who had a lot if IV fluids and Pitocin, and who needed an epidural over the long labor before ending up with a Cesarean because of a "failed induction" is more likely to experience problems with breastfeeding.  Women who deliver without interventions or medications are less likely to have problems.

Childbirth preparation classes can affect breastfeeding success.  When investigating which classes to take, inquire about the philosophy of the course.  Is it consumer oriented?  Will is cover the pros, cons, and possible alternatives to childbirth interventions?  Does it provide objective, factual information on the effects of pain medications on labor, and baby, and breastfeeding?  Does it teach a wide variety of comfort techniques to help you cope with pain?  Does it cover ways to support a vaginal birth and ways to decrease the chance of needing a Cesarean delivery?

Hospital classes tend to tell you what to expect. However, they usually do not go into a lot of information on ways to support natural birth and ways to avoid a C-section.  But, some do provide more complete information and have a consumer oriented philosophy, so check them out.

Contact the director or coordinator who is in charge of birth classes, and ask the above questions.  Also, contact you local La Leche League group for recommendations for both care providers and for places of delivery.  They tend to know the scoop and are happy to share what they know.

Take a breastfeeding class and/or attend a La Leche League meeting or other breastfeeding support group meeting.  You can glean a lot of great information from these sources.

Be careful of the literature many doctors provide.  A lot of it is given to them by the formula companies.




Read some good books on childbirth and on breastfeeding.  For childbirth, I recommend Pregnancy Childbirth and the Newborn by Penny Simkin, et.al, and Natural Hospital Birth:  The Best of Both Worlds  by Cynthia Gabriel.   For breastfeeding, go with The Womanly Art of Breastfeeding by La Leche League (just focus on the breastfeeding material -- take or leave the other material on parenting, etc.),  and  The Nursing Mother's Companion by Kathleen Huggins.  There are other good books on birth and breastfeeding out there.  These are just the ones I like personally and have no problem recommending.

If you have inverted nipples, or other anatomical or endocrine issues which might impact breastfeeding, make an appointment during pregnancy with a certified lactation consultant (LC).  She can assess your situation and make recommendations which can help breasfeeding go better.

It is helpful for all women to have support from a lactation consultant soon after the delivery and for the first days after birth. See if  your place of delivery has LCs on staff and how much they are present on the unit.  Especially if medical issues arise which require special approaches to feeding the baby, a lactation consultant can be an invaluable resource.  She can help you avoid pitfalls which can sabotage breastfeeding.

Develop a birth plan and go over it with your care provider prior to labor and delivery.  Take a copy for your labor nurse to read and discuss you desire with her.  Tell her you are looking forward to her helping you meet your goals.  Keep the plan to one page.  If it is any longer, it won't be read or remembered.  Keep the tone positive.  Start with your top 5 requests, written in bullet points, and then add another 5, also in bullet points.  For breastfeeding, one would be "I want to have my baby placed skin to skin on my abdomen immediately after delivery and allowed to remain there until she has finished her first breastfeeding."

Prepare to labor without pain medications, and   minimize the use of pain meds.  They can lead to problems with labor, lead to an operative delivery (forceps, vacuum extraction, or C-section), impact the baby's overall condition, and cause a disorganized suck.  Any or all of these can cause problems with breastfeeding.

A recent study has shown that epidurals are associated with cessation of breastfeeding in about 30% of the women studied.  This was the result after accounting for other factors, like education level, ethnicity etc.   Some studies show no effect, but there are flaws in some of them.  For example, one study compared women who had epidurals with women who were given narcotics.  The study should have compared women who had epidurals with women who had no medication.  Other studies indicate that epidurals do negatively affect breastfeeding.

It is very important to note, as some of the studies did, that most of the problems can be handled and corrected with time AND support of a lactation consultant.  Studies show that without good information and support, breastfeeding is more likely to fail.  IF YOU HAVE ANY  PROBLEMS, WORK WITH THE LC!  Don't try to fix them on your own if you are not certain what is going on or how to fix the it.

Anxiety and tension make labor longer and hurt more.  To decrease your need for pain medications, learn and practice many comfort measures, especially positions and techniques which help you meet each contraction with relaxation. These can include, slow dancing, sitting and rocking on a birth ball, sitting on a birth ball in a shower or relaxing in a warm bath. (If you are at home, and your "water has broken", do not take a bath.  Instead, shower.)  Use a slow or patterned breathing technique, or even moan using low pitched sounds during a contractions.

A good class will give you a variety positions and techniques to help you cope with labor.  If you still find that you need medication for pain, chances are you have progressed pretty far in labor.  As a result, you will have minimized the total amount of medication taken.  This can minimize any potential negative effects on labor and breastfeeding.

It may be possible, if you are wanting an epidural late in your labor, to see if the anesthesiologist can give you just enough medication to lessen the pain but keep your motor neurons "awake" so you will be more likely to push the baby out.  This decreases the chance of needing an operative delivery.  The effect on the baby should be also be less.

Consider hiring a doula (a professional labor support person) to care for and encourage you during labor.  Studies have shown that the presence of a doula decreases the chance of operative delivery, like forceps and C-sections.   If you can't have a doula, try to have at least one woman who has experienced labor, who knows comfort measures, and who has a positive attitude about labor, birth, and breastfeeding.   Yes, baby's daddy (as a Christian, hopefully your husband!) can be wonderful at providing emotional support, but women helping women provides a type of nurturing support most dads can't.  Plan to enjoy the support available from both, if possible. 

Tell the physician, nurse, and/or midwife NOT to suction the baby's nose and/or mouth for at least one minute to see if the baby can clear it's own airway.  Almost all normal newborns can.  Suctioning can cause swelling of the membranes in baby's nose.  Abrasions can occur in the baby's mouth, on the palate.  Both can lead to latching and breastfeeding problems.

Tell the physician or midwife NOT to cut baby's cord for at least three minutes.  Studies do not support early cord cutting.  If the cord is cut immediately, 40% of baby's blood volume remains in the placenta and cord.  At one minute, 20% remains in the placenta and cord.  Delaying cord cutting allows baby to have an easier transition to air breathing without stressing his or her brain and other organs.

When baby is born, have him or her placed immediately on your body, skin to skin. (This should be discussed with your care provider before labor.)  The amniotic fluid on your body helps your baby begin to reorganize and locate the nipple. Your heart beat, voice, and the amniotic fluid-like scent being emitted from your areolas (the dark skin around your nipples) also calms your baby and helps him locate your breast.  The nurse can wipe baby while baby is on your tummy.  It has been suggested NOT to wipe babies hands as the amniotic fluid on them helps them locate the breast and nipple.

Skip the hat.  Babies kept skin to skin with their mothers don't need it.  It just gets in the way of mom smelling and touching ALL of her baby.

Your baby will be colonized with the organisms (germs) from you body before picking them up from someone else -- a good thing.  The nurse can wipe your baby off right there on your tummy.  The less disruption your baby experiences, the more likely she can accomplish the self attachment sequence.  This lets her take in a nice meal of colostrum during the first hour or two after birth.  Routine newborn procedures can be delayed for a few hours.  

Breastfeeding take priority because it impacts your baby's health more than weighing, measuring, and giving the Vitamin K shot right away.  Even if the you have a C-section, in many cases, baby can be placed skin to skin on your chest so she can have the opportunity to breastfeed right away.  Some hospitals have developed a "sterile pathway" so that mom is the first non-sterile thing a baby touches after C-section birth.

Sometimes a  medical situation prevents immediate contact with the mother.  Don't worry, babies are capable of figuring out how to self attach later on.  But, getting your colostrum into your baby during the first one or two hours of life plays an important role in the regulating your baby's blood sugar, colonizing its G.I. tact, and decreasing the need for supplemental feeding with formula, so try.  Your baby will take a long nap, beginning around the end of the second hour.  The colostrum helps prevent blood sugar from becoming too low during that time.

See www.breastcrawl.org for a video clip produced by the World Health Organization.  It shows what babies can do right after birth.  The cultural birth practices(such as holding baby cheek to cheek with mother)  are different than in American places of birth, but the breast crawl is recognized as being universal.  Once again, God's design is on display.

In this video, the baby is has been wrapped and placed next to mom's face before being unwrapped and placed on her abdomen.  In other videos shown in breastfeeding classes the baby is immediately placed naked on mom's tummy and not removed until baby latches and nurses.  Once baby is on mom's tummy and chest, the baby's movements help her find her mother's breast, and the pumping of her legs to get her there helps massage mom's  uterus. This causes it to contract so bleeding is diminished.  Neat, huh?  Or should I say, epic, huh? 

The nice thing about infant self attachment is that all mom has to do is relax in a semi-reclined position and let baby do the work.  She will naturally stroke and soothe her baby, and even

The Semi-Reclined Nursing Position.  Baby Can Be Placed at Any Angle for C-section Moms.  Picture Courtesy of La Leche League International.

make attempts to help her find the breast. When baby is placed skin to skin on mom, her body will keep her baby nice and warm.  If mom feels baby is getting cool, a light blanket over both of them usually takes care of the problem. Or, the thermostat in the room can be adjusted. Research confirms that mom is the best baby warmer ever made.  Skin to skin contact can cause remarkable changes in a sick baby.

A recent article told the story of a premature baby who was dying. The mother wanted to hold her baby against her body (sometimes called "kangaroo care") so she would die in her mother's arms instead of in an isolette.  As this tiny baby lay against her mother's chest, something remarkable happened.  Her breathing and heart rate became stronger.  Her color changed from gray to pink.  The doctors and nurses were amazed.  They knew this baby was dying and that there was nothing else medical science could do.  Yet, this simple act of placing this baby next to her mother worked a "miracle".  They doctors continued to treat the baby, and she is now a healthy little girl.  They expected her to have some brain damage due to lack of oxygen, but her mother had pumped her milk for her baby.  Since breast milk promotes normal brain growth, it overcame the whatever damage occurred in this case.  People reading this story were amazed -- except the lactation consultants.  We understood how all of this worked to save that baby's life.  Once again, God's design to protect His tiny ones was on display.


In the semi-reclined, or "laid back" position as it is sometimes called, mom will not have to worry about how to hold the baby this way or that way. Trying to feed a brand newborn while mom is in an upright position can be a little difficult sometimes. 


If you prefer to sit up, use the cross-cradle or football hold for that first feeding. (Cradle hold is usually NOT recommended until baby has more control of its head and can latch correctly and maintain the latch).  If you find all of this fiddling to be frustrating, why not just lie back with your baby lying with its nose between your nipples?  This helps her smell and see the target!  Relax, be patient, and give your little one time to work through this process.  Usually by one hour, they have found the prize and are enjoying their reward.  Often, it is long before that.  You can always try upright positions later.

There are also some important tips to help promote success in breastfeeding during the first days and weeks.  I will cover these soon.

A Lesson in Slick Advertising

If I were not a believer, and if I wanted to sell a dilapidated old cabin located in a swamp full of big ol' hungry alligators, I would consider contacting a formula company to write the ad.  It would likely read something like this:  Lovely, historic rustic home, with water view, in an area teeming with aquatic wild life that loves interaction with people.  

It could be argued that, technically, the words are true, but the message is definitely manipulated.

Once again, I deviate from my intended course.  However, I am just going to trust that I have some help in the direction this blog takes with each post.  "The heart of man (or woman) plans his way, but the Lord establishes his steps." (Prov. 16:9) 

The Lord established my steps today.  I assisted in a skills fair at the hospital.  This means I parked myself at a "station" as some of the areas best RNs came by to learn or refresh on how to instruct women to use a breast pump.   During slow times I tried to find other things to do (note to self:  bring a book to skills fair next time).

I noticed the cabinet where the discharge "gift" bags  were located.  I think a better name for them is "formula and breastfeeding literature to steer you toward formula feeding" bags.   I opened one.  At first glance, the "educational" literature seemed to strongly support breastfeeding.  However, if you look more closely, you see words used with such precision it would make a politician smile in admiration and want to take notes.

For starters, lets look at the subtle, but inaccurate, "suggestions" in the following paragraph.  I will add my comment after each statement. The formula company's words will be indicated by quotation marks.  If you have been reading this blog, you might be able to predict what my comments will be once you read the formula company's statements.

"For some (women) it is important to free up more time and let other family members bond with the baby."   Well, it seems the message here is that breastfeeding takes up way too much time and prevents others in the family from bonding with the baby.  We ALL know that the only way you can bond with a baby is by feeding it, right?  Of course, every dad practically demands to give the baby all of its bottles because that bond is Super Glue tight.

Don't forget, it takes no time at all to prepare formula bottles, and clean them.  Or course, it only takes an instant to pack up the formula, bottles, brushes, warmers, etc. when going on a trip.  Those pesky breasts are so inconvenient to take along!

Since formula increases the risks of a whole bushel full of illness for babies, think of all the time you will save.   How? You won't have to do the things you need or want to do because you are driving to the doctor's office, sitting in the waiting room, seeing the doctor, driving to the drug store, waiting for prescriptions, and driving home!   And, work?  Oh the convenience catching up on your work load at your employer's after being home with a sick baby for a few days.  Still, you can look forward to those more frequent days off to care for a sick baby. Women who breastfeed don't get the mini-"vacations".  They have to spend their vacation time on vacation!  How inconvenient!

Seriously, I don't know about you, but I don't think waiting for a prescription to be filled while holding a sick baby is the way I would prefer to "bond".  None of the other real results of formula feeding appeal to me, either.

"With bottle feeding, you would know exactly how much (your baby) has eaten . . ."  Well, this is true.  But, is it really important to know the exact amount?  Formula contains more "waste" product.  This means more poop. Breast milk is very efficiently utilized so there is less waste to pass through the baby.  What good is it to measure a food where a significant portion does not benefit the baby?  Also, why is it preferable to know how much of an inferior food is going into a baby versus a perfect food?  You can know the baby is getting enough intake by a variety of measures (satiety, pees, poops, alertness, weight gain, etc.). I won't even get into the effect of this foreign substance on the environment of the baby's G. I. tract.  That info is in a previous post.

"(You) won't need to worry about any medications or choices in your diet which could affect  your milk".  Really?  Every obstetrician, pediatrician, lactation consultant, most mother-baby nurses, and all pharmacists have rapid access to information on the safety of medications for breastfeeding women.  In reality, there are very few medications which negatively affect your baby.  There are safe alternative medications for some of these unsafe ones.  Since most mothers are young and in relatively good health, having to worry about taking a medication is not a day to day event.  However, when medication is necessary, a nursing mother should not take any over the counter medication without first checking a reliable source, like her doctor or pharmacist.  While a medication might be safe for her baby, there are a few which could cause a problem with her milk supply.

A breastfeeding mom should always remind the physician that she is nursing, how old her baby is, and how many times a day her baby breastfeeds.   One medication which might not be advised for a mother of a newborn might safely be taken for the mother of a 10 month old who is larger and is nursing less because solid food makes up part of his diet. The suggestion by the formula companies that medication concerns is really a non-issue in most cases.

Diet, also, is of relatively little concern.  Women all over the world eat a variety of foods, including spicy foods. They continue to nourish and protect their children by breastfeeding.  Most concerns about diet are cultural.  Only rarely, is any part of a healthy diet of concern.  

Some families have a significant predisposition to certain allergies, and caution may be advised. Also, there are a few herbs and foods which could cause a decrease in milk supply (check with your lactation consultant if you want a list). 

One questions has to be asked: What is preferable?  The mother having concern that her baby might have a bit of gas if she ingests a "taboo" food, or that her baby is given an inferior food during its infancy --  a time of critical development -- which can cause life long health issues?  Yet, the formula company plays on these, for the most part, unfounded fears.

By the way, do formula companies EVER write about concerns a mother may have about contaminated formula?  Formula which was manufactured with a incorrect amount of an ingredient added?  The answer is "no". I doubt they have plans to do so in the future, either.  Click here for a list of formula recalls over the past years. 

Scary, isn't it? 

Then there are concerns of formula "spoiling" due to improper preparation at home or being left out of the frig too long.  True, formula companies do caution about safe handling, But don't forget how inconvenient breastfeeding is when compared to formula feeding (as they would like you to believe).

Bottom line:  there are babies who die or who are permanently damaged because they were given bad or improperly manufactured formula.  Babies do not die when they are given sufficient quantities of breast milk (unless mom takes illegal drugs, or a rare disorder has not been diagnosed.)

Hundreds of babies die in the US each year simply because they are simply formula fed instead of breastfed.  These deaths are due to health issues which result from a weaker immune system, asthma, etc. which breast milk protects against.

A large number of factors in human milk are not present in formula at all.  Formula companies do not list all that is missing from their product.  However, they know how to send moms into a tizzy by pushing her "worry about what I eat and how it might hurt my baby" button.

"Vitamin D is one key nutrient that is low in breast milk".  Well, this must mean that because it is low, there is something wrong with breast milk, right?  But why?  Iron is found in low amounts in breast milk, but it is absorbed better than iron in formula. Lactoferrin is also present in milk and in the gut of the breastfed infant.  Lactoferrin maximizes the absorption of the iron that IS present in breas tmilk. The iron in breast milk is sufficient until the baby can supplement it by eating solid foods. Similarly, Vitamin D is low in human milk.  Vitamin D deficiency can occur in dark skinned babies who are not exposed to sun very often.  It can also occur in breastfed babies whose mothers are greatly deficient in Vitamin D.   It is only to reach the few who are at risk of developing rickets, a bone disease caused by Vitamin D deficiency, that doctors prescribe Vitamin D for ALL infants.  This does increase the sales of companies, including formula companies, which sell Vitamin D drops to parents of practically every baby born in the U.S.  I am NOT saying do not give your baby Vitamin D drops;  I am just noting that there is some controversy, and why.

Don't forget, according to formula company literature, Vitamin D is  "key" nutrient.  What about other key components found in breast milk like secretory IGA, or alpha-lactalbumin, just to name two?

"Additionally, it (Vitamin D) supports immune health".  This one makes me shake my head.  Yes, vitamin D supports immune health, but so do the two factors just noted, along with a myriad of other ingredients in breast milk -- ingredients which are totally absent in formula.  Vitamin D, a KEY nutrient supports immune health?  For crying out loud, Alpha-lactalbumin attacks tumors.  BAM!  Talk about immune health! 

Marketing formula spiked with Vitamin D as a real "plus" is like comparing a twin engine plane, with one engine not working, to a fighter jet.  The difference in the protection provided is huge.  The numerous and unduplicable componets in human milk more strongly supports the development of a healthy immune system than does a tiny squirt of Vitamin D added to formula!  There is nothing in breast milk to harm the baby's immune system. Many of formula's ingredients harm the baby's immune system!  A little extra Vitamin D can not come close to compensating.

As I continued to read the booklet entitled Detailed Guide to Your Newborn's Nutrition and Well-being, tucked inside the gift bag, I learned that "according to recent research published in Pediatrics, these are some reasons moms reported why they supplemented with formula:

• Milk was delayed coming in

• Going back to work

• Didn't feel like the baby was getting enough

• Mom or baby got sick

• Baby had trouble latching on or suckling

• Pumping was too uncomfortable or inconvenient

 
Well folks, I guess it's time to crack open the formula if any of these situations arise! Certainly, the formula company did not address the fact that proper pre-birth education and post-delivery lactation information, treatment, and support could eliminate the need for supplementation in many of these situations.  I have the feeling that the list presented in Pediatrics was addressing the problem of breastfeeding failure.  In other words, what could be done to prevent cessation of breastfeeding due to these listed reasons?  But, as presented in the formula booklet, it sounded like "these are the valid reasons women choose to breastfeed."  Subtle but powerful.

This lists puts into the mind of some woman who read it that if these things occur, SUPPLEMENT!  Switch to formula! There was no encouragement that these problems could often be solved without supplementation. Neither did they suggest supplementation could be with human milk, which is recommended by the World Health Organization.  Instead, the section continues with

"Whatever your reason for adding formula feeding to our breastfeeding, XXXXX (formula name) provides formula tailored (emphasis mine) to your child's age and nourishes development that helps him reach key milestones."

Well, I would hope the formula wouldn't kill him so he could reach those milestones! And, tailored?  Human milk changes throughout the day, and over the weeks and months of a baby's young life to meet her needs.  THAT'S tailored.  Formula can not change.  It may be "off the rack and very poorly fitting", but it is definitely NOT tailored.

Finally, this company, like other formula companies, harps on the old DHA and ARA/AA addition to its formula which makes it "patterned after breast milk". 

I took the following photos to highlight formula company marketing "language". 

I am not picking on this one company.  It is simply a convenient example as it is one of the most purchased brands. Oops, I'm sure they would want to to say here that they are to MOST RECOMMENDED brand by pediatricians, so I will give the Devil his due (great cliche'!).

The back of the can states that (XXXX company's formula) "has DHA and Choline, brain nourishing nutrient found in breast milk".  The words are carefully selected to give the impression that the ingredients mentioned are just like those found in breast milk and they function as advertised on the label. 

But, let's take a closer look.

The DHA (docosahexaenoic acid) found in formula is different from the DHA found in human milk. It's molecular make-up is not the same.  The DHA and its concentration in human milk fluctuates depending on mother's diet and the how it is synthesized from precursors.  DHA is higher in pre-term milk than in term milk.

Formula companies come up with an average amount based on testing term breast milk, and put that amount into their formula.  More importantly, their source for the DHA (and AA/ARA) is quite different.  Formulas made in the US derive DHA from fermented microalgae.

Another long chain fatty acid found in human milk is AA/ARA (arachidonic acid).  The source used in formula is a soil fungus.  Both are grown and extracted in a lab.  The addition of these ingredients increases the cost by 15% to 25%,  yet there is little evidence they provide "clinically significant improvements in vision and intelligence in healthy term infants."(Walker, 2011) 

There are many potential problems which the use of these types of long chain fatty acids from the sources mentioned can cause. Research continues.  We do know that these additives can act differently in the body than does human DHA and AA/ARA.  The question is, how different and are there any unwanted effects?  Again, research is ongoing, but is suggests that problems exist.

 Cornucopia, an organization which engages in "educational activities supporting the ecological principles and economic wisdom underlying sustainable and organic agriculture" has researched the use of these additives in infant formula.  Their findings can be read at
http://cornucopia.org/DHA/DHA_QuestionsAnswers.pdf.
You may want to check out all of their articles on formula and these additives.  VERY interesting.  And yes, scary, too.

At this point, I am not going to address the addition of choline, other than to say, "one more down, hundreds to go", meaning they have decided to add another nutrient found among the hundreds in human milk.  Addition of a "super" new nutrient equals a new marketing campaign.  It will propagates the myth that formula is now even more like breast milk.  So close, in fact, one might expect the formula can to be at risk for becoming engorged. 

Scroll to the right to see all of this poster.  Copyright C.Hendricks www.BirthingandBreastfeeding.com.  Used with permission.

Because formula companies are so adept at "information with a 'spin'", I would not have them write an ad for human milk.  If they did, it would probably go like this:  Unstable, vitamin D deficient, inconvenient, unmeasurable, initially messy liquid which causes loose stools in the newborn.   

Unadulterated truth would require it to be written this way: Bioactive, all nutrient sufficient, readily dispensable, efficient superior food. May require initial learning curve for correct delivery, but perfect for setting up a protective G.I tract environment in the newborn.


Proverbs 15:4 tells us "The tongue that brings healing is a tree of life, but a deceitful tongue crushes the spirit."

In the case of declaring the "message of mother's milk", proclaiming the truth does, in reality, bring life.  It brings a life of normal good health, and in some cases, prevents death.

How many human spirits have been crushed by sick babies ?

What happens to the spirit, when someone realizes they received food that negatively affected their own mental and physical development and health?  What happens to the spirit of the woman who is fighting breast, ovarian, or uterine cancer if she learns that the time she could have spent giving her children perfect nutrition could have also decrease her own chance of developing this dreaded disease?  Don't you think she would have wanted to have been told the truth decades earlier?

When struggling with the health care consequences associated with my own exposure to "formula" as an infant, there are times my own spirit is a bit cast down.  When I think of how gracious God was in letting me learn about the health benefits of breastfeeding for my children and for myself, so I could make this informed choice, my spirit is encouraged.  Now, after learning so much more about the wonders of human milk and God's intricate design for breastfeeding, I experience a special joy knowing that my grandchildren have or are receiving such a great foundation for health which will benefit them all of their lives.  I am happy, too, that my daughter in law is investing in her own life long good health.  I pray that the information in this blog will reach many women so they, too, can enjoy the gift of good health as a result of God's gift of breastfeeding.

Wouldn't it be nice if formula companies simply advertised the truth about their product? Well, even though it does not and can not closely resemble breast milk, it does provide basic nutrition, as Dr. Ruth Lawrence, a physician and expert in human lactation stated -- just before she said that it "staves off starvation and predisposes to obesity."  

Although I am beginning to have some questions due to some of the additives, formula is still considered to be better than plain cows milk, goats milk, "plant milk", or the milk of any species -- except the human species.  And, if a mother can not or chooses not to breastfeed, and pasteurized human milk is not 
available, then formula is the next choice recommended by health care organizations.

But, something tells me that if more women really knew the difference in formula and breast milk, many more would elect to breastfeed.  I happen to think most people of my gender are just that smart.  Too bad so many of our physicians and hospitals don't have the education or the determination, or both, to lay out the truth.  I suspect formula companies hope they never develop that determination.  They likely devise marketing schemes to squash that development.

If formula companies did adhere to the spirit of truth in advertising, most women would learn the real facts about the differences in the feeding options.  After all, formula company's current, skewed, "educational" literature is in practically every obstetrician's office in America.  

Formula companies know if they listed the risks involved for mother and baby due to formula feeding, their sales would plummet.  But surely that would not be a problem for companies with such a strong desire to promote the health of our mothers and babies?  Right?  RIGHT?