The “Help” We Provide for Breastfeeding Families

Posted on February 27, 2013 by

I think we can all agree that anyone helping a mother with breastfeeding difficulties almost for sure has the mother’s and baby’s best interests at heart.  And, I am sure it is safe to say, we all want a happy healthy breastfeeding mom leaving our care with her happy well-gaining breastfeeding baby.  I don’t think that is a stretch.  But here’s the rub: we, as a healthcare community, are doing a pretty crappy job at supporting moms.   Too many moms are not meeting the World Health Organization’s recommendations of exclusive breastfeeding ‘till 6 months. In fact, many are not breastfeeding at even 2 months, or even 1 month—and even fewer are doing so exclusively.  And who is to blame?  We are!  Healthcare providers who see moms for breastfeeding support (and we have all had our 18-, or 20-hr WHO breastfeeding course I know!).  WE have got to say enough is enough.

I have said this before and I will say it again: we have done a fantastic job at getting moms to initiate breastfeeding–they are doing it in record numbers almost everywhere.  In Canada, almost every single mother who gives birth tries to breastfeed (percentage from high 80s to high 90s).  In Europe, tons.  In the US–over 75%.  Australia, New Zealand–beautiful.  And then almost everywhere, a very large chunk of these mothers leave hospital not breastfeeding or not breastfeeding exclusively.

The numbers are certainly much better when the mother has been in midwifery.  But still, too many mothers under midwifery care get less than optimal help with breastfeeding. Doctors? OB/Gyns, Pediatricians, Family docs, yikes!!  Well, they really get no instruction in breastfeeding support despite the Academy of Breastfeeding Medicine’s wonderful guidelines on what the med schools should teach and what the students and docs should learn.  Many are fantastic—but far too many are not even minimally qualified to provide feeding instruction to parents. Nurses?  Massive amounts of non-evidenced based dogma thrown into their education when it comes to breastfeeding.  Protocols about feeding schedules that have never been shown to be helpful and can provide a false sense of security.  Supplementation regimes that come from–well, I have no clue where they come from because they are likely made up.  Wrapping and swaddling babies (a practice that has been shown to be detrimental to baby’s neurodevelopment, breastfeeding initiation, latching, and feeding, and mother and partner/baby bonding), etc., etc.

But before I get accused of a holier-than-thou attitude painting everyone else with a frustrated brush, I will share with you who is the object of my disappointment: that’s right–my profession, the International Board Certified Lactation Consultant, IBCLC.  For all the wonderful things IBCLCs do (and we really do do wonderful and extraordinary things!), sometimes we just get it really wrong. After all, WE should know better.  We are the only health professional in the world specifically trained to support and care for the breastfeeding dyad.  Don’t get me wrong, many LCs do phenomenal work and their praises should be sung and sung often because it is not easy work.  It is often frustrating working in an environment where a mother is bombarded by industry marketing artificial feeding as superior.  Where free samples are thrown at her every time her baby even whimpers.  It is not easy constantly trying to educate other healthcare staff about what physiologically normal feeding, growth, output, and behaviour in the newborn look like.  It’s not easy convincing a doc to hold off on sugar testing/supplementing and instead put the baby skin to skin for an hour and get that baby breastfeeding to see if those sugars (which of course are normally low in the first hour after birth) will rise on their own without adding artificial feeding.  It’s not easy convincing a doc to release a frenulum on a baby whose mother has no nipples left despite excellent latching and positioning. No, the job of an IBCLC, though rewarding and wonderful, is both challenging and demanding at the best of times.

So, why am I disappointed? Because as a profession we are supposed to work in the face of non-evidenced based, non-evidenced informed practice.  WE are supposed to have faith in breastfeeding, faith in, and knowledge of, and understanding that, and appreciation of a mother’s body, given the right support, will know what to do to feed her baby.  WE are supposed to be aware that a baby has great survival instincts and when given the right opportunities will communicate his needs to his mother.  WE are supposed to trust that with a little guidance and good information things will tend to go right, not wrong.  Sure, there are exceptions.  Sure, there are times that despite the support it will not work, or even can’t work.  But those are in the minority.  After all, how did we get to many billion strong on this planet (before the introduction of artificial baby milks) if it didn’t normally work and work most of the time?

So why may I ask did an IBCLC tell a mother of a small baby (maintaining her own percentile curve, watched by a pediatrician who was okay with baby’s progress) already on solids who had been sick with a bad cold for a few weeks and lost 3 ounces,  ”She’s too small, you love your baby, don’t you? Supplement!”

Seriously? We’re not talking about a 6-day old.  We are talking about a baby over 6 months.  Where is the evidence?  Okay, in all fairness this is just the mother’s side of the story—perhaps she misheard, or misunderstood?  But then why did she walk away with the perception that the IBCLC said/felt that?

Another IBCLC is telling mothers to give up breastfeeding and switch to bottles because she is torturing/hurting/harming/ not helping her baby (again, the mother’s point of view.  Also important to note we have had almost a dozen different reports about the same IBCLC in our area).

Another one sells pumps to mothers during the appointment and then charges per hour for the consultation!

Every single day we get emails from moms who have been told absurd information from their doc, nurse, midwife, doula, naturopath, chiropractor, cranial sacral therapist—way more so than from LCs—true.  But almost daily there are still the ones from LCs that make me cringe: an LC at a very prominent hospital told the mother to put some sugar into her newborn’s formula to encourage him to take more.  An LC who tried to teach the baby how to suck effectively by using a bottle (never been any evidence to show this works, nor is safe).  An LC who swaddles the just-born baby handing him to the mother and then letting 12 hours go by before even talking to the mother about breastfeeding.  And the NICU LC who tells the mother to come back in 3 hours to breastfeed and just before mother comes back the LC gives the baby a full bottle feed of formula, “Sorry, I needed to document a feed before I took my break”.

There are more. But the point of this blog is not to smear my profession, just to call out some of its flaws.  As in every profession one gets the bad apples with the good, and I would like to think that in this profession of the IBCLC there are way more good and amazing apples than bad.  I know it!  In a future post I will discuss steps I believe we could take to remedy the situation and prevent such poor practice being inflicted on new and unsuspecting mothers.

Posted in Breastfeeding in General, Education in Lactation Medicine, Sigh... | Tagged , , , , , , , , , , | 2 Comments

Allergies–THE BIG ONE!

Posted on October 14, 2012 by

Sigh…yes, I am talking about anaphylaxis.  I have been following with great interest the research on whether it is a good idea for the breastfeeding mother to eat the allergen her baby is allergic to, or whether she should abstain altogether.  Well, unfortunately, the jury is still out.  And, depending on which side of the pond you are on, you will either be encouraged to eat the food or not while you continue to breastfeed.  The key thing, and critically important, is obviously, to continue to breastfeed.  I shudder to think what would happen to little babes who are anaphylactic to dairy and their moms quit breastfeeding and are faced with trying to: A) get their milk back –not always easy to do! B) Scramble to get donor milk; C) have to use soy formula–fraught with its own risks to the baby; or D) go for some hydrolyzed formula—the risks of which we still are not fully aware, and even then, can an anaphylactic-to-dairy baby truly tolerate any cow’s milk product?  We are not sure all can.

But no matter what side of the argument you fall on, one thing is for sure–we have got to figure this one out soon because anaphylaxis is becoming more prevalent than ever before.  Luckily, breastfeeding has become popular again so we are at least conferring as much protection on our babes as possible.  A bit more guidance though for how moms should navigate through these murky allergic waters would be helpful.  I will do my best to stay on top of research as it comes out and ask that you use this forum to do so as well.

In the meantime, though I have my own personal experience of this topic to share in a future post, I would love to get feedback on what your experience is in this area.  Are you a breastfeeding mom of an anaphylactic child?  If so, are you eating that allergen or avoiding it?  What kind of signs and reactions are you seeing, if any?

I am also very curious to know, How are you dealing with the emotional aspect of having an anaphylactic baby in the first place? Submit your comments and I promise to get to them quickly.

Thanks for your feedback!

E

Posted in Breastfeeding in General, Sigh... | Tagged , , , , , , , | 3 Comments

Facebook Smarten Up!

Posted on February 3, 2012 by

Open Letter to Facebook

February 2nd, 2012

Dear Facebook Management,

As the Executive Director at the International Breastfeeding Centre I have the privilege of working with healthcare professionals, med students, midwifery, nursing and lactation students from all around the world.  As President of the Ontario Lactation Consultants Association, I have the privilege of representing over 1000 lactation consultants in our fair province.  In these capacities I write to you appalled at FB’s blatant disregard for human rights in Canada.  I had understood FB to be a company with a vision, with integrity, with courage.  By allowing its employees to remove breastfeeding photos posted by FB users and suspending user’s accounts for posting such photos, FB is discriminating against women and infringing upon their rights to free speech and free expression.  This is not courageous—this is cowardly.  As well, in suspending accounts, and sending bullying threats to its consumers, FB is sending a clear message to the public that though breastfeeding is protected under our Canadian Charter of Rights and Freedom, FB doesn’t care about these rights.

For a moment though, I would like to talk to you not as a breastfeeding advocate, nor as a mother of 3 breastfed children (one of whom is a newborn currently still breastfeeding); not as an educator in the field of lactation medicine, nor an author of numerous protocols used worldwide in hospitals and birthing centres; not as an international speaker; not even as a blogger, researcher, or employer.  Instead, I would like to speak to you as an investor.

It is as an investor where I am just as appalled: FB stocks are going public.  Congratulations to a company that has seen an unprecedented growth in such a short time, a company whose future and stability look very attractive.  But there is a little glitch that concerns me greatly: you can’t seem to keep control of your employees.  How well can a company be run if its employees exercise their own powers by voicing opinions on the public stage, within the FB product, that is in direct opposition to the vision and direction of the company?  This is unimaginable for a corporation going public.  If FB employees are going rogue without any repercussions then this is not a company I would be interested in investing my money.  The fact that FB cannot keep a handle on the discriminatory and unfair hurtful practices of its employees who disregard and disrespect the human rights of Canadians is of real concern.  Add that this discriminatory behaviour hurts women and children and I am sure my FB and Twitter friends,  Blog readers, and over 1 million website users would agree.

Banning breastfeeding photos was yesterday’s bad idea.  Such superficial pseudo-puritanical behaviour flies in the face of everything FB has shown itself to represent.  Smarten up FB. Get a hold of your staff, do some house cleaning and have the courage of your publicly-stated convictions to get current.  Stand behind the apology you made to Emma Kwasnica, reinstate all FB accounts and photos and ensure such foolish and costly actions never happen again.

In so doing you will show Canadians you are a company of integrity and responsibility and one worth investing in.

E.

 

Posted in Sigh... | 4 Comments

Test Weighs

Posted on November 18, 2011 by

I am in the research stage for one of my chapters for my book Breastfeeding the Baby Who doesn’t Latch (working title).   This chapter is about health care practitioners (HCPs) and the actions we take that undermine the mother and/or potentially cause a baby not to latch or to stop latching.  Right now I am looking into this most interesting practice of test weighs:  Weighing the baby before and after a feeding to determine how much the baby got.  Yes, a future blog topic as well, but for right now, I am looking for experiences of this.  Are you a mother, or do you know of one, who has had to go through this?

Did it help or hinder your breastfeeding?

  • If you feel it helped, how did it help?
  • Did it give you confidence, information, help guide your actions?
  • If it hindered, why?  In what way? Did you feel undermined?  Frustrated?  Helpless?  Other?

What actions were taken as a result of the test weighing?  Was your baby supplemented?  If  so, how?  Do you feel this had an impact on your breastfeeding? Positive or Negative?

Please indicate how old your baby was at the time of the test weighing and also let me know for how long you had to continue the practice.

Would appreciate brief answers but feel free to give lots of examples.

Thanks so much,

E

Posted in Breastfeeding in General, Education in Lactation Medicine, NYL, Sigh... | 4 Comments

Nipple Shields, Friend or Foe

Posted on October 26, 2011 by

I have an upcoming blog with www.scienceandsensibility.org on Nipple Shields.  Before I post that one I would like to get some feedback from you, as a practitioner or as a mom, on your experience with shields.

In our clinic at the International Breastfeeding Centre, we are now seeing babies on nipple shields in record numbers–and mothers want them off!  I use to see 1 or 2 a week, now we see a few every single day–some days 5 or 6.  And in the past, many of the babes I would see would have been started on a shield after a week or two of age at the earliest, with the rare one having been started sooner.  Now, we are seeing them routinely given when the baby is days or even hours old.  Some mothers are handed them in the delivery room, before baby has even had a chance to know where the breast is!!

The number one reason mothers are given a shield, or it is suggested to them to get one, is for the baby who is refusing to latch.  In the short term, this sometimes works–but what are the long term ramifications?  Some mothers are given them to prevent or treat sore nipples.  I often see this makes things worse, but once in a while a mother says it helped–but then, again, long term, regardless of why she was given the shield, she ends up at our clinic with a host of other issues: baby pulling at the breast due to slow flow, drop in milk supply, baby addicted to the shield and can’t get off, etc, etc.  But there must be some mothers out there for whom the shield saved her breastfeeding and the baby did not get addicted—otherwise, why would practitioners use them so routinely?  They, the practitioners, must be convinced the shields do more good than harm, right?  I don’t know if that is correct or not, but I would love to hear from those who do use them.

So, my question to you is, do you see them helping short term and long term?  If they were helpful, for how long, for what issue, and how long until you got baby off the shield?  If they were not helpful, or only for a short bit, were there other issues that arose as a result of using the shield, and, if so, what were they?   Were you able to get baby off the shield in the end?

Thanks for the feedback.

E

Posted in Breastfeeding in General, NYL | 29 Comments

THe Wool Pulled Over Our Eyes

Posted on September 21, 2011 by

If you read my blog at www.scienceandsensibility.org on September 15th then you read my stance on bottles.  If you haven’t had a chance to read it might I suggest you peruse that one before starting here? As here I would like to approach the topic from a different angle.

There have been some brilliant marketing campaigns over the year—campaigns that have sucked women into doing the craziest things—look at the cosmetic surgery industry—huge!  Look at smoking—“respectable” women did not smoke, as a rule, before they were latched onto during the First World War.  Smoking was marketed as part of our emancipation and chance to be more like men!  What about commercials for laundry detergent, household cleaning products—where do you think we get the name Soap Opera?

But one you really gotta admire is that of the bottle makers.  Baby-bottle makers, that is.

Here we have been cruising happily along for thousands of years, transitioning our babies from the breast (the mother’s or a wet nurse) to a cup (and not a sippy cup I might add!) and all of a sudden we need something different?  Something more expensive, harder to get because we now need to go to a store vs. our own cupboard;, harder to clean –have you noticed all the bottle-cleaning brushes, the bottle-sterilising equipment, the manufactured “need” for sterilising in the first place?  Something that has not been proven safe for the baby: not only does it raise the heart rate and breathing rate and decrease the oxygen saturation in newborns but the baby uses muscles differently on the bottle than at the breast.  Furthermore, the bottle may have an effect on the baby’s hard palate possibly changing it forever, and it has the potential to change the shape of baby’s upper maxillary (the area above the upper lip) forever.  As well, teeth come in differently and with different timing because of the bottle.   Furthermore, we have had scares like BPA in the plastic—but is that the end of it?  Will there be a new scare because of the newer BPA-free plastic?  But I digress….

So what about this “need”?  How did the wool get pulled over our eyes? Where did it come from?  I would say that the majority of mothers I see (and I see tons of mothers) have been told at sometime, “You better make sure your baby knows how to take a bottle early on otherwise s/he may never take a bottle!”  What that really means is, “If you don’t get your baby take a bottle you will be chained to him/her forever and you will never get any freedom and never get to go anywhere by yourself and you will lose all autonomy and identity as a woman, a wife/partner, professional, mother to your other kids, etc.”

Is this true?  If your kid never takes a bottle does that mean you will never have freedom?  I don’t think so.  In fact, I know this NOT to be true.  We all have different ways of mothering and so “freedom” means different things to different mothers.  It’s time to take the wool away from our eyes and see that we can be free, strong, independent, and professional women and still mother our babies in a way that meshes our lifestyle choices with the needs of our babies.

Here are my suggestions for alternatives to the baby being fed by a bottle:

1] Many women find ways to conveniently bring the baby along:  wrapping baby up in a baby wrap or carrier and taking the baby along (who will likely sleep very well carried like this) and mother’s hands are free to shop, work, and do anything really, except drive a car, of course.

2] A mother who uses a nanny or other caregiver/helpers can take that caregiver with her and the baby and keep the caregiver off in the wings somewhere, texting/paging/calling her when the baby needs to eat.

If it is necessary or desired that the baby be left with someone else:

3] Some women time their outings around baby’s feedings, keeping their errands short;

4] Others have baby fed with a cup (not a sippy cup because that can cause the same challenges as a bottle);

5] Have the baby fed solids (after around 6 months if exclusively breastfed, earlier if there are weight issues or other challenges; and after 3 months if supplemented with artificial baby milks)—mother’s milk or the supplement can be added to the solids—the kid does not need to drink the supplement, just consume it.

Posted in Breastfeeding in General | Leave a comment

Permission to Quit

Posted on September 2, 2011 by

How many times have you been told by a nurse or another LC that your patient just needed permission to quit? I have heard this so often and have always had mixed feelings about the statement as well as the idea.  First of all, why would a mother need my or your permission to quit breastfeeding?  If this is something she wanted to do than surely I am not near the top of her list of people to consult.  But, you might argue, that if she has been seeing me in the clinic and after we have built a nice relationship and I have been working hard to help her through a difficult time, you might feel she will feel a sense of regret, or that she has disappointed me if she quit.  And yes, I can relate to that.  Some mothers have emailed or called or come in and said, I am sorry, I just can’t go on—it hurts too much, or the baby’s not latching is tearing me up inside, etc.  Working through the thoughts and feelings with the mother I hope helps her to see she is not letting me down.  She is not letting anyone down—it’s not about that.  She has tried her best and needs to move on.  But is that asking for permission?

I have had a number of mothers who tell me they do not enjoy breastfeeding at all.  They are doing it because their partners have asked them to, or their mothers want them to, or they know this is best for their baby, or they feel pressured by someone.  You must know this is a very small percentage of the mothers I see as I tend to see a very committed population who have gone through hoops to see us at our clinic.  And with mothers like that, we talk about why they felt the need to initiate breastfeeding in the first place and what would make it more enjoyable, easier, or less problematic.  Again, permission?  I don’t think so.    A cry for help, more so.

And there are some mothers who have struggled through everything—non latching baby who then starts to bite when he does eventually latch; and then mother gets mastitis or an abscess; or a yeast infection, or all three! And the baby is fussy or gassy and is screaming all the time.  And she perseveres and things don’t seem to get better and she is crying all the time and getting no sleep and she still perseveres…so, is she waiting for me to say “hey, it’s okay, it’s not working, you did your best, give him the bottle and you will both be happy and you will never look back”?  Hmmmm…I have had a few mothers that have told me that after they quit they never did look back, but here, I must argue.  And that’s because I have heard from many more that said, “You know, just when I was ready to throw it all in you/he/my mother/friend/LC were/was the only one helping me hold on.  And a year later I can say we are happily breastfeeding”.  Or the mother who says, I threw in the towel—I just couldn’t do it anymore.  And I just wish I had had my husband, or mother or mother in-law, or friend, or LC, etc who would have said to me, “Hey’ it’s okay, we will find a way through this, here’s a plan, let’s take it hour by hour,  baby steps”.

You see, who am I to give someone permission to do something that may affect her life and that of her baby forever?  No matter what she has gone through or how much she looks to me for guidance it is not for me to say, “It’s okay to stop—you gave it your all”.    For one, I don’t want that kind of responsibility!!  And I can’t believe all the LCs, nurses, docs, doulas, midwives, LLLs who have told me they gave a mother permission to quit.  Yikes!  That’s playing around with some ethical stuff there I don’t feel is my place to do so.  No, if a mother needs permission to quit breastfeeding then it is herself she needs to ask, and herself to whom she must grant such permission.  And whatever her decision I will support her and help her to get through it the best I can.

Posted in Education in Lactation Medicine | Leave a comment