We Don't Get No Respect -- But That's OK

Over a decade ago, a colleague and I talked with some neonatologists at a nearby children's hospital about using pasteurized breastmilk for preterm babies whose mothers could not or would not choose to provide milk for their own babies.  We heard the typical "It's too expensive" argument.  Also, they just did not believe it was even necessary.  Studies were somewhat limited, so our suggestions went nowhere.

A few years ago, long after I left my position as a lactation consultant at the NICU, I heard from my colleague that the physicians had agreed to use breastmilk from a milk bank.  Evidently, a registered dietician and also a pediatrician lobbied for its use.  After giving all babies -- whose mothers' gave permission -- pasteurized breastmilk instead of formula, they saw a significant difference in the health of these babies. They knew that the babies whose mothers provided their own breastmilk fared much better.  Now, they could see that pasteurized human milk significantly improved the health of babies whose mothers did not provide breastmilk.   Fewer serious complication, like NEC, and other infections occurred (remember breastmilk helps prevent infection).  The hospital saved a huge amount of money caring for these babies, even with the cost of the milk (now about $5 an ounce).  Babies whose mothers provided their own milk did not receive pasteurized milk, unless there was a problem with the mothers maintaining their milk supply while pumping.

Now that hospital is opening a breastmilk bank!  I am glad to see this, but smile a little and shake my head.  Lactation consultants, like Rodney Dangerfield, "don't get no respect".  We knew over a decade ago what this hospital has more recently "discovered".   The hospital could have saved millions and millions of dollars in health care costs if this program had been implemented back in the early 2000's.  More babies would be enjoying life with fewer developmental and health complications.  More babies would be alive.

But, it's going to happen now, and many, many babies who would not have received the brain-growing, life protecting nourishment of breastmilk will now have it.  And fewer babies will die because they won't be getting formula.

My son is studying to become a registered dietician.  He told me as I was writing this article that another large hospital system in the area has been ordering pasteurized human milk for its special care babies.  His words:  "I don't understand why any baby in the hospital would be given formula".

The most recent statistics I have located are that the cost of a NICU stay is about $3000 a day, and this does not include helicopter flight to the NICU or any surgeries.  A 32 week old baby who is taking about 12 ounces a day of breastmilk has a "food" bill of $160 a day.  If these pre-term babies are well enough to go home only one week sooner than formula fed babies (the estimate is one to two weeks), savings to the hospital is almost $20,000 per week.  Now multiply that by a NICU which cares for 20 preemies a month, and you get a savings of around $4,800,000 a year.  And that is for just one NICU.  The CDC states that nearly one-half million preterm babies are born in the US each year.  If each premature baby is able to go home one week sooner because it has received breastmilk, then savings to the health care system is 10 BILLION dollars a year.

Now, that figure can be off somewhat either way  Some babies are born just a little premature and don't require a long enough stay for savings to be seen.  Others are born very premature, and require more costly care, including surgeries.  Many babies have mothers who are providing their own breastmilk, so there is little cost for giving it to the babies.

Still, the savings to the health care system each year could be enormous.

Even more important is that preterm babies who are given human milk will fare better developmentally, including brain development.  The health benefits they receive can last a lifetime.  Babies who receive breastmilk while in the hospital, and over the first year of life receive the greatest benefit.  Additional saving occur because these babies are less likely to be rehospitalized for respiratory and other infections.

God is a God of economy.  Nothing He creates, in its' untainted state, is wasted.  The droppings of animals fertilize the plants.  The plants take in carbon dioxide from the breaths of animals.  The plants provide food for the animals, and the cycle continues.  In the organic form, nutrition is optimal.  There are no harsh chemicals to make the animals sick when they eat the plant food.  All the nutrients the animals needs are present in their God planned diet.

Human milk is the same.  The mother takes in food.  She makes healthful milk for her baby.  It is complete.  There is nothing lacking.  Breastmilk is used more efficiently in the baby's body than is formula.  This results in which results in less waste.   There is no packaging to end up in a land fill. Breastmilk is free.

Breastmilk does a baby good.  It does premature and sick babies especially good.  It does the family good.  It also does the health care system, the environment, and the taxpayers good.  It even does the heart of a lactation consultant good -- even though we don't get "no respect".  Right, Kitty? 

Standard Breastmilk? "Ain't" No Such Thing!

I follow Dr. Jack Newman on Facebook.  He is a physician in Canada who is an expert in human lactation.  Some new technology allows good analysis of the fat content of human milk.  Here is Dr. Newman's commentary.

Dr.Jack Newman

Here is something many of you will find interesting. A friend of mine, a physician, had her milk tested at her hospital, as they were testing a new machine. (She is breastfeeding an older child). The results? 6.8 g/100ml fat (so about double the concentration of full cream cow's milk and about 70% more than that of formula), 83 calories/100ml (or 24% more than in formula), and 2.4 g/100 ml of sugar (or about 1/3 that in formula).

They analyzed 8 samples altogether (7 from mothers of premature babies on the ward) and they got very different results from each sample. One of her colleagues asked her at the end: "So which milk is good?"

Which only proves that too many physicians don't understand that there is no such thing as standard breastmilk. Every mother produces milk which varies from feeding to feeding, from day to day, from morning to evening, from week to week. And the milk is tailored to the needs of her baby as the baby's needs change. And if there is no such thing as standard breastmilk, then a formula can never duplicate breastmilk.

This does not mean that milk donated from a mother breastfeeding an 11 month old is not good for the baby who is 2 weeks old. The milk of a mother breastfeeding an 11 month old is still closer to what a baby of 2 weeks would get from the breast than formula.

Fewer Deaths from Doggie Treats than from Formula Feeding

The news in the past few days has again and again focused on the deaths of hundreds of dogs over the past years due to tainted doggie treats.

http://www.nbcnews.com/health/pet-jerky-treat-mystery-nearly-600-animals-dead-still-no-8C11436330

I love dogs, especially my rat terrier, Tessie.  Of course we should be careful what we feed them.  When we know of a food source that is considered dangerous for our pets we should avoid giving it to them.

Tessie Hess

The news and other media is careful to let us know how to best take care of our pets -- including what foods are best and which to avoid.  The FDA is getting more involved with dealing with tainted dog food from China.

Compare this situation with another one.  

Approximately 900 babies in the US die EACH YEAR because they were not breastfed.  Perhaps the formula was not tainted, as has been the case in some infant deaths worldwide over the decades, but formula is not a "perfect" food for human babies.  Some babies truly suffer because they were given formula instead of breastmilk.

For article on risks of formula feeding, by Allison Stube, MD, click on
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/

For a list of formula recalls, click on
 http://www.naba-breastfeeding.org/images/Formula%20Recalls-W.pdf

Yet, we do not see infant feeding death rates on the news, even though they are higher than what has been calculated for our dogs.

Even worse, millions and millions of babies worldwide have died because they were not breastfed.  Formula companies promised good health, but failed to even deliver life beyond infancy for these babies. Millions upon millions more suffer from diseases they would not have had to endure if they had been breastfed.


I wonder . . . when will the news start carrying stories about the risks of infant formula with even one half of the energy they have devoted to doggie treats?  

The news is focusing on "those bad Chinese".  Perhaps they are still learning about food production methods, perhaps not.  

But what is our excuse?  When will our government and health care system, including physicians and nurses, simply provide accurate information to mothers about their infant feeding choices?  Clearly, most babies survive with a degree of health when they have been formula fed.  Women are free to choose this option.  More babies survive with greater health when they are breastfed.  The specifics of why this is the case are not readily provided to expectant and new mothers.

Yet, most women have received more information on these tainted doggie treats than they receive on the risks involved with formula feeding . . . and those risks are very real.

Don't our babies deserve at least the same consideration as our dogs?

Great Response to the "Shipped Breastmilk" Article Recently Published in Pediatrics

Allison Stube, MD wrote the following response to the article which discussed online purchases of breast milk, found to be "teeming with bacteria".  As Paul Harvey would say, here is "the rest of the story."

Alison Stuebe, of the Academy of Breastfeeding Medicine wrote the following response to the milk sharing study in Pediatrics published on line this week.

Breastfeeding Medicine


A new study in Pediatrics has spawned provocative headlines, contrasting images of human milk as “a nourishing elixir, or a bacterial brew.” Researchers anonymously bought breast milk from 102 online sellers. Milk orders were often packaged poorly, arrived well above freezing, and — as one might expect with milk unrefrigerated for days — were rife with bacteria.

But that’s really not the whole story. First, consider who participated in the study. By design, the authors communicated with sellers only by email, and cut off the conversation if the sellers asked about the recipient infant or wanted to talk by phone or in person. Milk was shipped to a rented mailbox to make the process anonymous. Of the 495 sellers the authors contacted, 191 sellers never responded, 41 stopped corresponding before making a sale, and 57 were excluded because they wanted to communicate by phone or asked about the recipient baby. Another 105 did not complete a transaction, leaving 102 of the original 495 sellers approached who actually shipped milk. Of these, half the samples took more than 2 days to ship, and 19% had no cooling agent in the package.

It’s highly plausible that milk sent with no questions asked, via 2 day or longer shipment, and (in 1 and 5 cases) without any cooling whatsoever, was collected with less attention to basic hygienic precautions. The bacterial load in study milk samples therefore doesn’t tell us about the relative safety of milk obtained following a conversation between buyer and seller about the recipient baby and then shipped overnight on dry ice in a laboratory-quality cooler. Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination. The authors acknowledge this limitation in the study, but that subtlety has been lost in the media coverage.

It’s also not clear from the study to what extent bacteria found in milk reflect contamination vs. “good bacteria” that are present in milk. A growing literature demonstrates that “fresh from the tap” breast milk contains a wide variety of bacteria, and these bacteria colonize the infant’s gut. The study reported in Pediatrics did not distinguish between species of bacteria, nor did they compare the frozen samples with freshly expressed breast milk. The salient question is not, “Is there any bacteria in milk bought online?” but “How much more disease-causing bacteria is present in milk bought online, compared to milk that’s fresh from the breast?”

Moreover, news coverage has not considered the broader context of infection risk in infant feeding. Powdered infant formula is not sterile. Therefore, both the World Health Organization the Centers for Disease Control and Prevention recommend feeding all newborn babies liquid formula. If a newborn is fed powdered formula, the WHO and the CDC recommend cleaning bottles in a dish washer with hot water and a heated drying cycle, heating water to at least 158 degrees F (70 degrees Celsius) to make formula, and using formula within 2 hours of preparation.

Studies suggest that most parents don’t follow these guidelines. Importantly, formula packaging doesn’t include the CDC language, instead advising parents to “ask your baby’s doctor about the need to sterilize water and preparation utensils before mixing formula.”

Online information from formula companies is even less explicit. In an article titled, “10 Things to Know about Bottle Feeding,” a formula company web site suggests:

If baby wakes you up to eat, try this tip from New York City mom Michele Bender: ‘I’d measure the formula and keep the powder, water, and bottle on my night table. I could mix it right there rather than having to go to the kitchen. It sounds minor, but at 3 a.m., one less step is great.’

These instructions directly contradict WHO and CDC recommendations by suggesting parents use room temperature water to mix formula. Given the very large number of infants who are fed powdered formula, inaccurate information on formula preparation is a far greater hazard for infant health than milk bought online.

What we need is education on safe handling of food for infants to minimize the risk of food-borne infection for babies. ABM has published evidence-based guidelines for human milk collection and storage, and HMBANA has developed detailed guidelines on safe milk collection. Broadly disseminating this information will provide mothers who are milk sharing with guidance on how to minimize risk. Health care providers need to engage families, inquire about milk sharing, and discuss this practice in an informed consent context, rather than dismissing milk sharing as unacceptable. Similarly, we need formula-feeding families to have complete information on how to minimize risk of catastrophic infections.

And then there’s the “ick” factor – what The Verge alluded to in their coverage as “Women and their dirty femine fluids.”

In a provocative essay titled, Milk sharing and formula feeding: Infant feeding risks in comparative perspective?, Karleen D. Gribble and Bernice L. Hausman explore why health authorities proscribe human milk sharing as dangerous, but provide parents with information to assist them in the management of the risks of formula feeding.

There is a well recorded historical legacy of suspicion concerning mothers and their milk. In its current iteration, this suspicion leads to the conclusion that corporations are considered more trustworthy than women to provide healthful nutriment to infants.

Cultural proscriptions around breastfeeding and milk-sharing are not new, but rather reflect centuries of debate about the role of women’s bodies in society. As Lia Moran and Jacob Gilad write in From Folklore to Scientific Evidence: Breast-Feeding and Wet-Nursing in Islam and the Case of Non-Puerperal Lactation:

It should be clear by now that in many societies the rules regarding breast-feeding, were laid down by men, and tend to support male-dominated institutions. For example, in those countries which observe Muslim civil law, the duty of a woman to feed her husband’s children, the duration of feeding and the conditions under which she may feed children other than her own, thus establishing links of milk-kinship, are all prescribed by a male-dominated paternal legal system. The feeding of one woman’s child by another has been used in different societies to make peace between two tribes, to consolidate clan unity, to prevent marriage, to create clients, and in sum, to attain objectives which lie far beyond the nursing woman’s own interest.

Indeed, the nursing woman’s own interest is not part of the discourse around online milk sales. The market for human milk exists because of the mismatch between promoting “breast is best” and prioritizing real support for mothers and babies. Moms buy milk online because they want to breastfeed, but they are unable to meet their infant’s needs with their own milk. Often, these moms are victims of the “Booby Traps” that stymie so many women, ranging from uninformed health care providers to outdated maternity practices and bottom-of-the-barrel policies for parental leave in the United States. In other cases, a mother’s body simply can’t make enough milk for her baby, despite heroic efforts to sustain breastfeeding. We could obviate much of the demand for online milk sales if we changed policies and practices. We might also find ways for more moms to make enough milk if we devoted a fraction of the resources currently directed at erectile dysfunction to lactation dysfunction.

“Breast milk as bacterial brew” pushes lots of cultural buttons — from the “ick factor” to our reliance on mass-produced and marketed substitutes, rather than women, to nourish our children. Let’s stop pressing buttons, and start looking for solutions, so that more families can achieve their infant feeding goals.

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine. She is a member of the board of the Academy of Breastfeeding Medicine. Posts on the ABM blog reflect the opinions of individual authors, not the organization a whole.

Guilt, "Bad" Feelings, Anger, Distrust and Informed Decision Making

I recently visited an OB office.  It has respected and well liked physicians.   I was a little surprised to notice there was not one breastfeeding poster anywhere.  Neither was there a poster advertising formula posted anywhere, so I thought, "They are not promoting one or the other."  (Ideally, breastfeeding should be promoted since it is the health standard).  But, when I was shown the storage closet, there were bags and bags of free formula and formula company written literature on infant feeding.  (See post:   "A Lesson in Slick Advertising").  These bags are given to women around their 28th week of pregnancy. 

Other than perhaps a brief conversation with her doctor, the formula company literature was all the mother-to-be receives regarding infant feeding.  Score-- formula: 1, breastfeeding: 0.  Even if there is a conversation about infant feeding, breastfeeding still looses.  The best score possible is formula: 2, breastfeeding: 1.  Even that is debatable.  It would depend on how well the physician knows the topic.  It would also depend on any personal bias the physician might have in favor of formula feeding.

Distributing formula samples and formula company written breastfeeding information, coupons, and freebies gives a strong impression that formula really is the health care system's recommended infant feeding choice.  Breastfeeding often gets a "Well, we know that breast is best, but ... "   This approach to infant feeding education, i.e. giving out formula company literature to cover both breastfeeding and formula feeding information for the mother, has been the case for decades.

Professional and governmental organizations, like the World Health Organization, the Centers for Disease Control, the Office of the Surgeon General, and so on, state that breastfeeding should be "promoted, supported, and protected".  They also state that health care professionals should not use formula company literature for patient breastfeeding education.

It is common knowledge among lactation professionals and these organizations that the wording of formula company literature is carefully crafted. Their intent is to increase the chance women will at least supplement with formula.  These companies know that if they can get women to start supplementing, mothers will be totally bottle feeding formula sooner than they intended.  

Yet, in office after office, all across the country, women receive free cans -- even cases -- of formula, along with advice on breastfeeding.  Obviously, there are no breastfeeding "freebies".  There is little money to be made by companies when women breastfeed -- except for some companies which make pumps.  However, their income does not come near what formula companies can make.  The largest formula company in the USA made almost 14 billion dollars in 2012.  It sounds like money they spend on direct marketing to physicians and women has a great return on investment.   Believe it or not, they stated in their SEC report that they were committed to helping women and babies achieve the best health possible! 

Really?  That is like trying to help someone achieve the best transportation possible, and giving them a rusty bicycle with mismatched wheels and one flat tire.   Their literature tells the buyer that cars are considered better, but that many people find them too hard to drive, that cars are expensive to repair, and so on.  They give instructions on now to drive the car, but suggest "supplementing" with their bicycles.  

OK, that is not the best analogy, but you get the idea.   The problem is, we are talking about the lifelong health of women and their children.  Formula companies do not tell women that their product increases the risk of asthma, diabetes, certain childhood cancers, atopic disease, allergies, ear infections (and ear surgeries and hearing loss), respiratory and GI illnesses, and so on for their children. They do not tell women that formula feeding decreases the IQ, alters the development of the babies brain, weakens the immune system, and results in a smaller thymus gland (which supports the immune system) in the child as an adult.  They do not tell women that not breastfeeding increases their risk of breast, ovarian, and uterine cancer, metabolic syndrome and diabetes, heart disease, stroke, rheumatoid arthritis, and Alzheimer's dementia.

No, they major on the minor.  The tell women that breastmilk is deficient in Vitamin D (not true for most women and babies). They point out how inconvenient breastfeeding can be.  They practically insinuate that it is selfish to breastfeed.  (See the post "A Lesson in Slick Advertising")

Picture by birthing and breastfeeding.com  Used with permission of the owner.

One sympathetic person I spoke with said "The women want the free stuff".  That might be true, but I suspect women want something more -- something they might not be used to getting, or realize is missing.  They want the respect required to provide them with the unadulterated, research-based truth about their infant feeding choices.  They want to know the risks of formula.  Only then can they make a truly informed decision.  Once that decision is made, they should be respected enough to be given full support, in word and action, for their decision.

I have informally polled expectant women over the years.  Almost without exception they tell me "Even if I plan to formula feed, I want to be told about the risks.  It is my right.  Once I make my decision, I want that decision to be respected".  I happen to agree with them.

Courtesy of The Alpha Parent.  TheAlphaParent.com

Women who choose to formula feed receive 100% support while in the hospital, and after.  Women who choose to breastfeed do NOT receive 100% support in most hospitals.  Those with the "Baby-Friendly" designation are an exception.  Many hospitals still give out free formula or gift bags which contain literature and advertising from formula companies, even if formula is not inside.

What does all this say to the mother?  The experts she depends on for the best care and information are in essence telling her "Breast is best, but formula is the standard, just fine, very acceptable, and quite healthful way to feed your baby.  Here, take this sample.  Oh, and read the literature in the 'gift bag' to learn about breastfeeding."

Yet, the American Academy of Pediatrics states that breastfeeding is the standard to which all other methods need to be compared.  They consider how a women feeds her baby to no longer be simply a lifestyle choice, but a health care decision.  I wonder:  in what other area of health care is the information limited with regard to the risks of a certain, commonly used procedure?  Physician and hospitals have patients sign a paper which lists the risks associated with surgery.

Although not immediately obvious, the effects of formula feeding can be just as devastating as a surgical complication -- sometimes worse.  Some hospitals do have women who choose to formula feed sign an informed consent document before they are given formula.  This makes sense to me and to others who are aware of the significant risks of artificial baby milk.  Like surgery, sometimes the choice to formula feed is elective.  Sometimes it is necessary.   Either way, it is still an "intervention" into the norm.


I was able to talk with expectant women on their first visit to this office.  One of the questions I asked was "What have you heard about breastfeeding".  Almost all told me, "not much".  I explained five or so of the top benefits (higher IQ, costs savings on formula alone of up to $3000,  decreased risk of asthma and diabetes, and decreased risk of childhood cancer.  For mother:  decreased risk of developing breast, uterine and ovarian cancer, decreased risk of developing heart disease, stroke, Type 2 diabetes, and Alzheimers dementia),  Not surprisingly, their interest in breastfeeding shot up significantly.  I encouraged them to do an online search on their feeding options, including risks of formula feeding, to talk with their doctors, and then decide what they wanted to do.

Just so you know, I made it clear at the onset of the conversation that the choice of what they wanted to do regarding infant feeding was theirs to make.  Their care providers would support that choice.  I was giving information out of respect for their capability to make the best decision for themselves and their babies.  I just wanted to make sure each mother had the information to make an informed decision.  I also make it clear, when discussing the feeding effects on IQ that formula feeding does not mean the baby will become the village idiot.  A lot of smart people were formula fed.  However, the evidence in obvious in how breastfed babies do in school.  Research shows they do better.

Every one nodded, and some even smiled.  I believe they appreciated the respect they were given.  One even said "Thank you."

One mother told me "I formula fed my first child.  He has (one of the ailments).   I am interested in breastfeeding now I know it might prevent it in this baby".  The mother of multiples was amazed at the cost savings  (up to $6000 in the first year for twins/$9000 per year for triplets!)  Her mother in law was with her for the visit.  This grandmother to be told me after pulling me aside that she had nursed her first baby only a few days, but nursed each baby over a longer and longer period of time.  She proudly told me that her youngest, a daughter, was in pharmacy school.  She said "I always knew she was more capable mentally than the others.  Now I know why."  Another mother told me, "I was planning on formula feeding, but now that I know about breastfeeding, I am going to think about doing that."  

WHY didn't these women -- especially those who had delivered other babies -- know more about the difference in breastfeeding and formula feeding on the health of their babies and their own health? 

Women are not brainless creatures.  They do not need a paternalistic medical system to make decisions for them by limiting the information they receive.  "We don't want to make women feel guilty if they want to formula feed" is NOT justification for giving out formula company propaganda.  It certainly is not justification for not telling women the risks of formula feeding and why breastfeeding is the biological norm for feeding their babies. 

Even the US government, in one of its educational books on breastfeeding, points out the "risks of formula".  These books are printed by the millions and made available free to American women via health care organizations, lactation consultants, and so on.

"Breast is best, but formula is also good" just does not cut it.

The free formula can keep a worried mother from asking for help with breastfeeding   This "rescue baby food" is within her reach when she is vulnerable.  She gives her baby a bottle . . .and then another ... and then another.  Very soon, she "can't make enough milk", or her baby refuses to latch onto the breast.  Formula companies know this.  They count on it.  The formula company has another mother and baby, literally, in it's ill-gained money filled pocket.

This issue prompted me to develop the following poster a few day ago.  I wish I could have put it in the nurses' station and the OB offices yesterday!  I would love to see it or something like it in every nurses' station and physician's office in OB practices across the nation.  It would be great reminder, and also help them become familiar with the risks of formula feeding -- information they could pass on to their patients.  A real dream would be a poster like the "FYI" inset poster to be displayed where patients could see it.  However, I know better than to hold my breath while waiting for this to happen.

Poster for OB offices and nurses stations.  Use the  FYI poster for patient education.  Both posters available by clicking on page tab at the top of this blog.

It is going to take some time.  It will take the effort of a huge number of women and even men to get doctors and hospital administrators to understand the wrong that is occurring.  Formula has it's place, but it should be a rightful place, based on truth in advertising.  It is better for a woman to go into this important health care decision with her eyes wide open than to learn later that she had been blindsided by lack of information or by misinformation. 

Guilt might be a problem for women who still choose to formula feed. It is something we all deal with when we make a health care decision knowing it is not the best one.  Sometimes, due to circumstances in our lives, it is the best we can do.  Of course, those feelings can be intensified because women realize they are making a health care decision for their own children.  If breastfeeding is not the choice or not an option, it is important to remember that genetics and nurturing also impact the child's development.  It doesn't all hang on breastmilk alone.  Still, breastmilk is a major factor in optimal growth and development, and that fact can not be denied.

Some women say "My children are just fine" as a defensive mechanism when they feel some guilt. When compared to the general population, they are "fine".  But, when compared to breastfed children, facts are facts.  Their children, at some point in their lives, do cope with some health or developmental disadvantages which breastfed children and adults experience to a lesser degree or not at all.  Sometimes those disadvantages are not so mild -- they can be devastating.

"Bad" feelings might follow situations where women can not breastfeed, It is sad when breastfeeding, in rare cases, is simply not an option.  Adoptive mothers who can not produce milk after trying to do so can feel this.  Women who have endocrine disorders which limit their milk supplies still feel bad they can not breastfeed their babies totally.

These are honest, normal emotions.  We all experience them when our best efforts do not produce the results we desire.  This can be in the area of our health, our finances, our children, our careers, our relationships, and so on. This is simply part of life.  I have put down my thoughts on how to deal with any "infant feeding disappointments" in the post "But What If" and also in "When Breast is NOT Best".  Perhaps they might be of some help if you are dealing with any negative emotions related to formula or breastfeeding decisions or circumstances.

A much worse emotion to be vented toward the care provider is anger.  Anger that the health care providers women trusted in did not see fit to give them all the facts so they could give their informed consent to formula feeding.

Even worse is the distrust that develops toward their care providers when the mothers of children with severe asthma, or diabetes, or battling a childhoood cancer learns that the disease and the stress on all of the family which resulted, might have been prevented.  It might have been prevented if had they been given the truth about the risks of formula feeding or had they been given 100% support in their efforts to breastfeed while in the hospital.

Health care providers will truly earn that name when they stop saying what formula companies love to hear:  "Women might feel guilty!"  "Benefits of breastfeeding" (vs. "Risks of formula feeding") and so on.  Informed decision making, and informed consent requires full disclosure.  It is given in every other area of health care.  Expectant and new mothers deserve the same respect. 

This blog is supposed to be about breastfeeding from a Christian perspective.  What better perspective on providing full disclosure to expectant women than "Do unto others what you would have them do unto you?" or "Love your neighbor as yourself."

Grandy Can't Deliver!

I had the pleasure of taking care of my three grandchildren in their home for over 24 hours.  In fact, I returned home just this afternoon.

I wish all grandmothers had children this easy to take care of.  No, they are not perfect.  However, their parents have done a wonderful job in teaching them manners, the need to obey the person in charge, etc.  NO meltdowns by any the kids, and so, NO meltdowns by their "grandy".

There is something about a nursing toddler who is separated from his mother for a day or more which pulls at your heart strings.  It also tickles your funny bone.

The children go to bed around 8 p.m.   Late in the afternoon, the baby began asking again about his mother.  He would go to the window and say "Ma Mum" in a pitiful little voice.  I explained each time he did this that she would be coming home "tomorrow".  He seemed to accept the answer . . . for about 10 minutes.  The concern and longing in his voice was tangible.  I was so sad for him, but knew that the reunion would be extra sweet because of the separation.  

Around 6:30 p.m., I was about to carry the baby down the stairs.  The t-shirt top I was wearing was pulled down enough to show some cleavage when I had picked him up and held him in my arms for the trip down the hard, wooden staircase.  He noticed.  Both little hands patted my breasts, with one hand on each.  "Nummies?"  he questioned, with a certain  (possibly, hopeful?) look in his eye.  I laughed out loud and had to tell him that my nummies did not have milk anymore.  He patted again, perhaps to make certain I understood that he knew nummies have milk.  After all, that has been his experience all of his short little life!   I explained again, and that was the extent of the tactile exploration.

But, once we were seated in the big recliner in the living room, preparing to read a book, his little hand pointed out the window, and he soulfully asked "MaMum?"  He wanted his mommy so much.  

I am home now.  His uncle and aunt are staying with him and with his siblings today.  His parents will be home is just a few more hours.  Both he and his "MaMum" will have a special reunion and his little world will be totally right once again.  And he might wonder if I told him the truth about "nummies".  After all, the ones he has access to DO have milk!

As Baby Grows

"How long should a woman breastfeed her baby?" This is a question I am often asked in class or when I am  doing hospital rounds.  I usually repeat part of latest statement on the subject by the American Academy of Pediatrics  (AAP).  Currently, breastmilk ONLY is recommended for the first six months.  It is the perfect, complete food for the baby.

Around six months of age, a reflex which causes babies to push food out of their mouths (extrusion reflex) disappears.  Now, I wonder why that reflex is even there?  Maybe starting solid food too early is not a good thing?

 Babies will start grabbing for food off mom's plate and putting it in their mouths around the sixth month. This is a good sign they are ready for solid food.  Check with your pediatrician and/or La Leche League and/or other "baby food" source for recommendations of what foods to add and when. 

The AAP also recommends continuing breastfeeding for AT LEAST one year.  It cites benefits for feeding until age two or after.   Don't forget:  studies are indicating that the longer the baby breastfeeds, the bigger his or her brain will grow.  That alone is a great incentive to try to continue breastfeeding if you run into problems early on.

The average age of weaning worldwide is significantly higher than in our culture.  We been a "formula" culture a long time.  We have a long way to go before being comfortable with young children going to mom's breast for a snack, for a bedtime feeding, or for comfort.  If people would think of breastfeeding the older baby as medicine, or brain food, they could appreciate the benefits and be less disapproving. 

But, why would the average person consider these benefits?   When was the last time you heard or read about of these benefits for babies AND for three and four year olds?

There are cultures where attitudes about long term breastfeeding are very relaxed.  People have seen children die from disease after they were weaned, so they realize the protection breastfeeding provides. But the sanitation processes available in a culture is not the sole criteria for determining if it is "safe" to wean a baby around a year, or even to formula feed.

In our culture mothers hear comments like "You're still nursing?  Don't you realize he KNOWS what he is doing?"  (I would hope so -- he is going to his favorite spot in the world -- cuddled close to his mom. He is enjoying the sweetness of her milk).

One of the most precious things I have seen lately is my little 21 month old grandson interacting with his mama.  This little guy loves his mama so much I have seen him flirt with her!  When he wants to breastfeed, he lets her know by special words and looks that he needs mama and her sweet milk.

It was pretty standard in Biblical times (depending on the era and location) for children to breastfeed until they were three to five years of age.  Very likely, there were some cultures where breastfeeding lasted longer.

Nothing better has been developed over the past thousands of years to feed to babies and young children.  The mothers who want to continue breastfeeding for health reasons may be few, but they are not acting foolishly.

 I believe the decision of when to wean is a personal one between mother and child. I have yet to find anywhere in the Bible where the father had any input with regard to breastfeeding.  All passages refer to the mother and her infant or child.

However, family dynamics must be considered. There is a balance between caring for one's child and respecting a husband's desires.  My thoughts are that the principle of "husbands love your wives" applies very strongly in this case.  This will prevent an intense emotional struggle for the wife to "submit" to her husband when she feels she is abandoning the emotional and physical needs of her baby.  In most cases, if the father understands the health benefits to both the child and the mother, he will be supportive of breastfeeding. But, like it is for most women, most men do not know the risks of formula feeding.  They base their feeding preference for their wives on limited, even erroneous, information.

On the other hand, once a woman has received objective, research based information on the risks of formula, if she does not want to breastfeed, I believe she has the final say. 

It will do little good if the mother is resentful of having to breastfeed because of pressure from her spouse.  Most likely breastfeeding "problems" will crop up and she will soon wean anyway.  A wise husband will offer to encourage her in practical ways.  The time he can spend cleaning the kitchen, or doing laundry, etc. if she will breastfeed, may encourage her to try.  A reluctant mother might find she enjoys this new experience when she does not feel the added pressure of having to deal with all the household tasks.

Some women have to cope with the long term effects of emotional, physical, or sexual trauma in their earlier years.  For some of these women, breastfeeding is too emotionally taxing.

Back to weaning.  My opinion is for mama and baby to continue breastfeeding until one or the other indicates, "I'm done."  Most women who understand the importance of breastfeeding will continue as long as it is feasible practically and emotionally.

Employment outside the home is a great challenge to nursing mothers.  In most cases, it can be done,  It takes planning and commitment.  For some women, knowing they can continue to work outside the home and still provide their babies with their milk makes having to leave their babies to return to work easier.  For others, it seems to be too much to manage.  Again, mom knows what she is capable of handling and should be the one who decides.  Still, I would encourage women to try to continue breastfeeding after they return to work. They may find that it does all come together and they can continue.  Providing any amount of breastmilk supports the baby's needs better than formula alone.

Weaning should occur gradually.  Abrupt weaning can be physically or emotionally traumatic for mom or baby, or both.  Check www.llli.org or other good breastfeeding web sites, or in the books I recommended earlier for tips on gradual weaning.  You will find recommendations which make sense to you and work for your situation.

Let's get back to the main purpose of this post -- the time between those first days of breastfeeding and weaning.  There are some things which will be helpful to know.  Below is some practical advice and "food for thought":

1. First, as your baby grows, he or she may not poop everyday.  Breastmilk has very little waste product. The older baby, beginning around three or four months, who is exclusively breastfed, may go several days without a bowel movement.  His or her body is simply using the milk efficiently.

However, when "poop day" arrives, be prepared!  Some mothers recognize that their little one will be "doing his business" soon.  They may see "squirminess", fussiness, a scrunched up, red face, and perhaps some signs unique to her baby.  These moms have learned NOT to leave the house until the "mission is accomplished" OR they have learned to take extra diapers, wipes, and baby clothing if they have to leave with the baby before the big poop! 

My first baby, after reaching about three and a half months, started going longer and longer between poops.  I was so concerned one day I called his doctor.  Dr. Judson Tripp, a wise and compassionate pediatrician, told me to relax and not worry.  "He's just using up all the milk.  He'll go when he's collected enough to fill his diaper". 

Constipation results in hard, dry stools.  It is not diagnosed by the length of time between bowel movements.   Exclusively breastfed, growing babies may go several days between poops. However, when they fill their diapers, the stool is soft, like the consistency of toothpaste.  Constipation (hard dry stools) is more likely to occur in formula fed babies.

2.   Sometimes, especially in warm weather, breastfed babies want a drink of water.  To get this, they nurse just a couple of minutes.  They are drinking foremilk, which is high in water and sugar, and low in fat.  Even in hot climates, bottle feedings of water only are not necessary.

Even during hot weather some mothers insist on feeding exactly on a schedule.  Think about this:  when was the last time you wanted a drink of water an hour or two after your last meal.  When you tried to get it, did someone tell you "Ahh ahh!  It's not time for you to eat.  You have another hour before you can have anything!"?  Give your baby a break and let him or her nurse when thirsty.

3.  Another problem with artificial schedules is the some women have smaller breasts.  They can make enough milk throughout the day for their babies, but storage is limited.  Their babies have to nurse more frequently, usually for a short time, to get the full amount of milk mom produces.  Telling them to feed every three hours just won't work.

4.  Some parenting programs encourage fairly strict feeding schedules for babies. In some of them, the number of breastfeeds per day is lowered as the baby grows.  This is not based on any scientific evidence.  As a result, many mothers starts to loose their milk supply.

Whenever milk stays in the breast longer than about three hours, a chemical marker is reabsorbed back into mom's blood stream.  This marker is sent back to the brain, and in essence says, "No one is taking the milk.  We need to cut back on production or the breasts might explode!"  (well, not really, but I can imagine this!).  The pituitary gland will start reducing the amount of prolactin and before long, mom's milk supply will be reduced.  The more breastfeeds or pumpings are delayed beyond a three hour point, the more the milk production is reduced.

Women who are working need to express milk by around the three hour point, even if all they can do it "pump and dump".  It is better to keep the milk supply up than to try to wait another hour and store the expressed milk.  Learn how to hand express so you can reduce the amount of milk in your breasts if you can't get to your breast pump on schedule.  

5.  Just as a reminder, there is no need to start giving cereal before 6 months to the healthy, breastfed baby.  ANY OTHER FOOD is a LESSER FOOD compared to breastmilk.  Also, when a stomach virus is going around, breastfeeding is the ideal way to feed your baby.  It is easier for baby to digest than anything else.  Electrolyte "formulas" are not as beneficial.  Some older babies will refuse solid food, but will take the breast during times of G.I. upsets.

6.  When it comes time to wean, do so gradually.  In many cases, older nursing babies/toddlers are nursing only once or twice a day anyway.  Drop a feeding for a few days, and and then drop another one for a few days, etc.   There is a saying for the  mother who wants to wean an older baby,  "Don't offer, don't refuse".  This can help babies who are ready to wean do so a little sooner.  If a baby wants to keep breastfeeding, mom has the opportunity to re-evaluate before weaning.  As always, the decision is ultimately the mother's to make -- unless baby decides "I'm done!".

Sometimes babies go on a nursing strike. Some reasons may be obvious.  Some are not.   Le Leche League (www.llli.org) is a great source of what  you can do if your baby suddenly refuses the breast.

7.  Check with your baby's doctor, your OB, or the pharmacist regarding the effects of a prescribed or over the counter medication on your baby and on your milk supply.  Only in a few cases is a medication unsafe for a baby or causes a problem with mom's milk supply.  Often, a substitute med can be safely given instead.   Sometimes the recommendation is based on how much actual breastmilk baby is taking.  A baby who is nursing only twice a day, but eating solid foods, may be able to continue nursing, even if mom is on a medication of concern.  Talk with your care providers and pharmacist.  They will be able to figure out from solid resources, what it safe.

8.  Some mothers like to teach their babies a sign to use when they to nurse while mom is out in public.  Others come up with a code word.  Ours was "nummies".  My grandchildren used it too.  

9.  Don't breastfeed in a bathroom.  If you want a quiet, private place, dressing rooms or your car are much better.  Also, there are many styles of nursing capes for privacy when baby wants to eat at the mall, restaurant, the movies, etc.  These allow you to feed virtually anywhere (except a bathroom!) without exposure.  

An experienced mom can breastfeed discreetly just by lifting her top enough for the latch on, and then covering again down to baby's nose or "nursing interface".  You can try practicing in front of a mirror if you want to use the "top down" technique until you are comfortable that exposure will be minimal.

10.  Modesty is something Christian women are taught in Scripture.  Exposure should be considered in context.  Full breast exposure when nursing at home is different than full breast exposure while nursing in public, or when people are visiting you at home.  Women, including Christians, are all over the board on this issue.   Some will not breastfeed in public at all, but bottle feed pumped milk.  Others on the other end of the continuum have no problem with fully exposing the breast for nursing. (I do not like the phrase "whip it out" -- no one "whips out" a breast!  Women "uncover".)

Men tend to be sexually stimulated by seeing significant exposure.  They have limited experience with seeing the normalcy of women breastfeeding in all aspects of life, and can not compartmentalize what they see as well as men in other cultures. 

We, as Christian women, should be careful not to "defraud".  I Timothy 2:9 states that we should "dress modestly, with decency and propriety".  While that verse has particular meaning for the culture at the time it was written, the basic principle still applies in our culture.

Even though the exact interpretation of modesty is culturally defined, I think it is safe to say that excessive breast exposure in public places will NOT be thought of as as "modest", even in our low cut, tight top, culture.

11. Don't breastfeed in a moving car.  Your baby needs to stay in the car seat.  Find a safe place to park, and then feed the baby.  It isn't worth the risk to try to save the few minutes it takes to feed the baby.  One sudden stop or accident is enough to toss your baby out of your arms and cause injury -- or worse.

12.  Don't become upset when someone says something negative about your nursing, especially nursing an older baby.  You can ignore them.  Or, you can use the opportunity to teach them about the risks of formula feeding and the great benefits of giving your baby human milk for the first year and beyond.

13.  Consider becoming part of a breastfeeding support group.  Most communities have a couple of different types to choose from.  Some hospitals offer them, as well as Le Leche League or groups sponsored by lactation consultants in private practice.  Some churches offer groups for mothers and babies.  Try out different ones until you find one which "fits" you.

Be careful of any group which promotes breastfeeding advice which goes against what solid  research has shown. 

If a group goes beyond breastfeeding information as it's focus, feel free to take the breastfeeding advice and leave the rest.  While learning more about topics like good nutrition can be a part of the discussion from time to time, you do not have to grow and grind your own wheat and make your own bread to be a good mother!  

Your journey through the first year, or more, of breastfeeding will be filled with joy, perhaps an occasional struggle, learning, and amazement.  When it is completed, you will experience a great sense of satisfaction that you gave your baby "God's formula.

This posting completes the planned course of this blog.  However, I have enjoyed writing so much, that if I come across new information or experiences which I think are worth sharing, I will probably continue to add posts.  The nice thing about writing a blog is that the reader does not have to agree that the topic was worth sharing!

I hope the information provided by this project will help more women decide to breastfeed, or to continue breastfeeding a little longer for their own sakes and the sake of their babies.

I also desire that everyone who reads this blog will realize or remember that the loving God who designed human milk for human babies also created the universe.  He continues to control it even though things may seem out of control. He will one day redeem His creation.

In the meantime, each of us who know Him as our Savior and Lord, must continue to do what He has placed on our hearts and in our lives to do. Motherhood is one of the most important of those tasks.  For Christian women, mothering is a ministry to God's precious little ones.  Breastfeeding makes motherhood sweeter.  Soli Deo Gloria.