Tuesday, December 23, 2014

Elementary, Mrs. Watson



INT: WINCHESTER PUB, Early evening.  SHERLOCK HOLMES and JOHN WATSON are settling into a booth with two full pints. INSPECTOR LESTRADE walks over to the booth, pulling on his overcoat.

LESTRADE
Bang-up job again, you two. As per par for the course. I'll head down and book the scumbag. I never did get what he was doing with all those bendy straws, though.

SHERLOCK
(keeping his eyes on his mobile as he types in rapid-fire)
Of course you didn't. Your mastery of rote procedure and protocol in no way prepares you for the kind of incisive insight I bring to the table. I would have thought by now that was more than clear.

LESTRADE rolls his eyes.
JOHN
Check the blog later, he surely means to say.  Join us for a round? Mary's on her way to meet us.

LESTRADE
Take a raincheck if you don't mind.  Cheers.

JOHN raises his glass. SHERLOCK  raises one hand in a wave, without lifting his eyes from the phone. As LESTRADE exits, he passes MARY WATSON as she enters the pub.

LESTRADE
Evening Mary. Dynamic duo's in the back corner there.

MARY
          Oh, thanks Greg. But, you're not staying then?

LESTRADE

Nah. Got some rote procedures to master at the station.

He smiles wryly and continues on his way.

MARY
          Oh. Well, oh. (Calling after him) Bye then!

She walks back towards their booth and waves as she approaches.
JOHN
Mrs. Mary Watson.

JOHN smiles warmly. MARY kisses JOHN on the head as she takes off her coat and slides in next to him.

SHERLOCK
(eye still glued to his phone)
How is the wee bairn, Mary?

MARY
Oh fine, fine, good. Asleep! Nursed down just before I jumped in the cab, Mrs. Hudson’s got it all under control, as always. So, I got your texts! Sounds like another case wrapped and sorted? 

SHERLOCK
Indeed. Do join us in a celebratory gesture.

MARY
          Don’t mind if I do!

She gestures to a waitperson, who approaches with a notepad and an expectant look.

MARY
          Pint of stout, thanks!

JOHN
(after a momentary pause)
What? Wait. ‘Scuse me? Waiter?

The waiter returns, brow furrowed.

JOHN
(clearing throat)
I’m sorry, my wife, terribly sleep deprived, new baby, you know how it is, I’m sure. Anyway, I’m sure she meant to say she’d like a club soda. Or maybe some tea. Would you like some tea, love?

MARY
          I’m quite sure I’ll take the stout, thank you.

JOHN
But Mary, you’re, um (trying to keep his voice down, clearing his throat again uncomfortably), you’re . . . (whisper) breastfeeding.

MARY
          And?

SHERLOCK looks up from his phone and observes. The waiter attempts to hide his growing impatience.

JOHN
But, you can’t, I mean you shouldn’t, I mean, isn’t it, I mean . . .

MARY
(returning her gaze to the waiter)
          Pint. Of. Stout, please.

The waiter nods and walks away.

JOHN
          Okay, clearly I’ve, uh,  missed something here.

SHERLOCK and MARY
          Clearly.

JOHN
          But, you’re breastfeeding!

MARY
Yes, as you said. I am. I’ve done almost nothing BUT breastfeed for weeks on end, actually. Love it though I do, I’m ready for a wee drink.

JOHN
I just – I didn’t think that was allowed, is all. You were so careful not to have even a drop while you were pregnant. You and the midwives told me all about that.

MARY
          Yeah, I was. And behold, I’m no longer pregnant.

SHERLOCK
          Surely you’ve observed this rudimentary fact.

JOHN
I do have a grasp on that bit of obvious, yes, thank you.

MARY
          Well, so it’s completely different now.

JOHN
It is? You don’t care that the alcohol going to get into your milk, then?

MARY
But that’s just it. Now that the baby is born, it’s completely fine to have a drink or two. All the experts say so. It’s not really going to even reach the baby, much less cause any bother.

SHERLOCK
          She’s correct.

The waiter returns with her drink. MARY takes it and raises her glass.
MARY
          Cheers!

SHERLOCK raises his glass in kind and clinks it to hers.

SHERLOCK
Cheers to you and the bairn. And his well-meaning but underinformed dad.

They each take a hearty swallow. JOHN watches in exasperated befuddlement.

JOHN
So you support this, too, then, mate?

SHERLOCK
Why wouldn’t I? It’s perfectly logical.

JOHN
Go on. Enlighten me, then.

SHERLOCK
Very well. The Thomas Hale guide, considered to be the authoritative source on lactational pharmacology  - meaning medications and other substances in human milk - states that “mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.” In other words, as soon as it’s out of mother’s bloodstream, it’s also out of her milk.

MARY
And that’s pretty much exactly the amount of time a baby will go between nursing sessions, about two hours or so.

SHERLOCK
Mmm. There you have it.

JOHN
Okay. Okay, well, wouldn’t it be better for mums to, what’s it called, pump and dump? Just to really get it out of her system, be on the safe side?

SHERLOCK
Certainly not, don’t be ridiculous.

JOHN
Why is that ridiculous?

SHERLOCK
Tell me, Dr. Watson, when YOU have to sober up, do you need to drain a liter or two of blood, to get it out of your system?

JOHN
          Don’t be absurd.

SHERLOCK
Equally as absurd for a lactating mother. Pumping does nothing to speed the metabolism of alcohol. The only reason a mother should ever pump related to drinking is if she plans to be away from her infant for an extended period of time, but the point of that is to maintain her supply in lieu of any missed feedings, not to somehow detoxify her milk. All that is needed is the passage of time.

MARY
Right, I read that on Kellymom. Great resource, by the way, all the information there is based on evidence.

SHERLOCK
          My favorite.

JOHN
You. Have a favorite breastfeeding website.

SHERLOCK
NO, my favorite type of information. Research and evidence. Further, Dr. Jack Newman, an MD who specializes in lactation, shared the results of a breastfeeding mother who once analyzed her own milk and cited the findings on her blog. See for yourself.

SHERLOCK pulls up a website on his mobile browser and hands it to JOHN.

SHERLOCK
“The alcohol content in breast milk immediately after drinking is equivalent to a 0.0274 proof beverage. That's like mixing 1 oz of 80 proof vodka (one shot) with 2919 oz of mixer . By the way, 2919 oz is over 70 liters. Two hours after drinking one (strong) drink the alcohol has disappeared from the sample. Completely harmless to the nursing infant.”

MARY
0.0274 proof. I heard there’s more alcohol present in fruit juice. Not that we’re giving the baby fruit juice yet, but the point remains.

SHERLOCK
Not to say that mothers should be getting falling down drunk and then caring for their children, of course, but at that point it is a safe parenting issue more than anything else. A drink or two, spaced out over several hours, seems to be just fine.

MARY
But if you’re still feeling concerned, the best timing for a drink is right after a feeding -or even during the feeding - so there’s plenty of time for metabolism to do its thing. And I’ve just come from doing exactly that!

JOHN
(giving the phone back to SHERLOCK and throwing his hands up in defeat)
Alright. I get it. Bottoms up, Mrs.

MARY smiles and squeezes his arm affectionately.

JOHN
(to SHERLOCK)
Just how the hell do YOU know anything about sodding lactation in the first place, anyway?

SHERLOCK
Well I do take an interest in all things relating to our species. And the means by which we feed our young is a defining characteristic of all mammals, after all.

MARY
It’s where the term “mammal” comes from in the first place.

SHERLOCK
Quite right. The very nomenclature of our biological classification.

SHERLOCK clinks his glass to Mary’s again and takes another drink.

SHERLOCK
Also I rather like babies.

He takes another swig of his drink.

SHERLOCK
Don’t tell anyone.

MARY
Your secret is safe with us.

JOHN
For now.

MARY gets her own mobile phone out and begins showing off photos of the newest addition to the Watson family.


FADE TO BLACK.


*****

Elementary, Mrs Watson
by Anne Tegtmeier
December 2014 Picture via Huffington Post



















Wednesday, December 11, 2013

Battlestar Galactagogue: On Fenugreek and Other Products for Perfect Production

Pop Quiz: Assuming physiological normalcy for both mother and infant, a healthy milk supply depends on:
a) Making sure mom goes through a batch of lactation cookies at least once a week.
b) Getting the best tincture from a health food store.
c) Drinking 4 cups of breastfeeding tea blends every day.
d) Obtaining a prescription for Domperidone.
e) None of the fracking above.
Following on my recent theme of nursing support in the age of social media, breastfeeding support products are more easily available than ever before. How is this going for us?  Have we, with all our good intentions in making galactagogue products more widely available, contributed to the (apparently growing) perception that mothers can't have a normal milk supply without teas, tinctures, cookies, and pills?

First off, what is a galactagogue?

Defined: Ga·lac·ta·gogue: gəˈlaktəˌgäg/ noun. 1.a food or drug that promotes or increases the flow of a mother's milk.  Common and popular herbal  options include blessed thistle, fennel, and the most famous reindeer of all: Fenugreek.  Drop into any mom's forum, and you'll see that every thread discussing supply will inevitably include recommendations for various galactagogues, in drug (i.e. Reglan or Domperidone), food (oatmeal for all), and herbal forms, fenugreek being by far the most well-known.

A brief stroll down the aisle at New Seasons, a local Whole Foods-like company in the Portland area, revealed these options:



So, here I go with another post in which I preface with a disclaimer and close with a hedging qualification. Let me be clear: There is nothing at all wrong with galactagogue use when needed! I cannot stress this enough. Part of the very reason we have such a diverse array of options for galactagogues in the first place is because women in vastly different cultures in a variety of ecosystems all over the world have sought them out and passed them down through generations.

The world is very different now - so many undeniable improvements, and yet the matter of marketing as a major force in our collective psyches is a critical one. Let's think about this: how does formula marketing actually function? The most effective formula marketing depends on insidiously undermining women's confidence (I discussed this here and then illustrated it here, a la Mad Men). Is the promotion of galactagogues as something lots and lots of women are likely to need really that different, purely psychologically speaking?

It IS different in some crucial ways because it's not artificial infant milk, of course, and ever moreso because it's not as though well-intentioned companies like Motherlove are engaging in underhanded tactics like slipping samples into gift bags of hospitals. And they possess nowhere near the financial oomph that massive corporations like Abbott wield. My point is not their intention, but the effects on us as a community of mothers. What overall effect does the promotion of galactagogues (whether from professionals, peers, or by the company itself) have on attitudes toward breastfeeding? We collectively need to ask ourselves if this is helpful.

Boiling it down, is it helpful for us to have so many mothers believing that A) they cannot produce a normal supply without purchasing and consuming a product or products, even really high-quality ones? Again, taking a peek into any peer support forum is guaranteed to provide multiple examples of galactagogue recommendations flowing as freely as an uninhibited milk ejection reflex. And possibly even more damaging, is it B) helpful for mothers with genuine low supply to be taking them (haphazardly in many instances, i.e. all-fenugreek-all-the-time) without addressing or even identifying the underlying issues?

And as one learns more about herbal galactagogues in particular, you can't help but notice that most herbs function by supporting the health of the mother, working with whatever underlying condition may have caused or contributed to her low supply in the first place (many of the most effective galactagogues work primarily on the digestive system, for example, the very core of maternal health). Low supply doesn't just happen randomly to moms who are unlucky; there is always a reason. But just as with the matter of breastfeeding advice in general, the most critical point is to tailor the plan to each dyad, and to use when NEEDED.

Again I find myself on the horns of a dilemma. I am truly glad and grateful that a variety of galactagogues are so readily available when mothers need them, and often in such good quality and variety. And yet. I want to discuss all of the above, with pros, peers, moms, and companies too, but I also want to convey this bottom line:

Moms, you do not have to take galactagogues Just Because. Not as a preventative measure, not even "just in case."

So say we all.*

P.S. Yes, I am hereby claiming the Battlestar Galactagogue name as my very own, especially if I decide to create my own herbal blends as part of my future practice. I CONTAIN MULTITUDES.

P.P.S. Aside from galactagogues, there are many other 'helpful' products being marketed to breastfeeding mothers which have a very much related effect, as corporations recognize this category of mothers as a largely untapped group and try to figure out how to profit off of them. (This sounds terribly cynical, I realize.) Take the recent Milkscreen products as merely one example.  Since I like to drop in on Babies R Us et al once in a while to keep in touch with the latest products that are widely available - and thus the marketing moms are being exposed to -  I may address these other products in a follow-up post.

*Not actually speaking for all. Just geeking.

Monday, November 11, 2013

Help Me To Help You: The Promise and Pitfalls of Peer Support in Social Media

Macierzyństwo, 1905 by Stanisław Wyspiański

This is quite the time to be a new breastfeeding mom. Support for breastfeeding has never been more abundantly available, especially when it comes to social media forms of it. There are multitudes of message boards, there are blog followings with regular, lively discussions, there are lactation support websites with many different specialties - and then there's the juggernaut (you see what I did there) that is Facebook, of course. Breastfeeding discussions come up regularly on fan pages for various bloggers and organizations, but the liveliest action by far is in the groups, whether open, closed, or secret. I have no idea if anyone has ever tried to get a ballpark idea of how many Facebook breastfeeding-related groups there are, but there have to be hundreds if not thousands.

So this is great, right? It's what we've always strived for, yes? Nursing moms helping one another, spreading positive promotion of breastfeeding, cheering each other on by the dozens, this is living the dream. In many, many ways, absolutely yes! But in some other ways, well . . . it gets complicated.

I'm part of quite a number of different groups and boards, some of them breastfeeding specific, others more about parenting in general. I witness and sometimes participate in breastfeeding-related threads on a daily basis, and have been doing so for years. You know that saying "The more you know, the more you realize you don't know?" The deeper I've gotten into my lactation science program at school, the quieter I've gotten on those threads. Note my long period of radio silence on this very blog; it's definitely related. Partly due to being absurdly overcommitted, fer sher, but part of it is also due to a growing realization of my own limits.

In the boards and the groups and the pages, within any given breastfeeding thread, there's an ever-variable mixture of totally great advice, utterly terrible advice, and advice that could maybe, possibly, perhaps be good - IF we had a hell of a lot more information about the mother and baby at hand. All this comes with a liberal serving of emotional support- never something to be discounted; at times it is what the mother needs more than anything.  And ALL OF IT IS MEANT TO HELP. But when it comes to even the seemingly-simplest of nursing issues, how can moms possibly sort this all out? Sometimes they'll get lucky and go with advice that happens to be sound, and all is smoothly resolved. But sometimes, not.

Let me see if I can illustrate this with an example. In my Advanced Case Studies class a few terms ago, one of our texts was the excellent book "Case Studies in Breastfeeding: Problem-Solving Skills and Strategies" by Karin Cadwell and Cynthia Turner-Maffei. In it was an table that sums the social media support dilemma up perfectly.

As part of learning the Eight-Level Lactation Consulting Process, a chart was laid out with six different dyads, labeled A through F. Eight columns listed the various steps: 1) History, 2) Assessment, 3) Symptoms, 4) Problem Formulation, and so on.  The interesting part: Column three was identical in every case. "Mother describes hard breast with shiny skin; breast larger than normal and warm to the touch; breast pain."

Every single mother presented with the exact same symptoms. And EVERY SINGLE ONE OF THEM had a totally different underlying cause, with a different strategy devised to address their issue.

But in (totally well-intended!) online situations, many sympathetic moms will read the presenting symptom and only know their own individual, unique experience of that symptom. That experience might be relevant to the mother at hand - and it also very well might not. And sometimes moms simply want to share their own stories in return, which is also a very valid need - but conflating that with offering advice is treading into very tricky territory. This was an insight shared with me by Jennifer Tow, and I think about it frequently when following such conversations. It can be so hard for both storyteller and advice-seeker to know whether the shared story has any practical relevance to the situation at hand.

Case in point: Fenugreek might very well have helped your supply, but it is absolutely not appropriate for every woman, nor is it a panacea for supply issues in general, which can range from simply turning around some poor management in the early postpartum period to very complex physiological conditions.

Lactation pros are sometimes present on such threads - and it is worthwhile to note that they are often the ones offering the LEAST advice of all. This may be partly for financial reasons, partly for liability concerns, but primarily because they know full well just how individual each case really is. Without a maternal health history, information about the birth itself, a feeding assessment, an oral evaluation, and any number of other relevant pieces, the full situation is incomplete - and that's not even getting into the options for how to actually address the issue (once it is actually identified) with a comprehensive care plan. The variables are endless and the details always, always matter.

I think lactation professionals have been reluctant to bring this matter up because seriously, the good intentions of everyone ARE so deeply felt and appreciated, and who wants to be the Scoldsy McBuzzkill who rains on the peer support parade? Honestly, where would we even BE without peer support? The progress we as a society have made in reclaiming breastfeeding has everything to do with it, and we owe an immense debt of gratitude to the founders of La Leche League, the most famous breastfeeding peer support group of all time. LLL began as peer support, continues as such, and is AWESOME for it . . . but there's a fourth L in that organization that makes all the difference in the world. Every meeting is facilitated by a Leader. Some meetings need more active guidance, in others the mothers need very little input, but that guidance is there for a reason.

For the most part, I write this post not because I have solutions to propose, and certainly not because I think lactation consultants should be the only persons allowed to speak about breastfeeding (because how paternalistic would that be?), but because I want to open this up for discussion. Let's talk about this. IBCLCs, moms, other perinatal professionals, breastfeeding peer counselors. I truly believe that unless the formula companies have become so devious that they're willing to plant undercover undermining minions on message boards ( . . . actually, let's not rule that out altogether), every mother posting in groups and boards is doing so mainly because they genuinely want to help. This is not an easy topic to discuss, but I think it's time.

How can we best help each other to help each other?



Thursday, February 7, 2013

First Blood, Then Milk

A reading from this week's Breastfeeding Politics & Policy class stopped me in my tracks, for obvious reasons.
"I think she looks like you," [the lactation consultant] says with a wink.

"I'm adopted," I say blankly. It's a telling response. I'm so accustomed to discounting the physical resemblance people claim they see between me and my own mother that I forget Faith and I are related. Even though I have the episiotomy stitches to prove it. Which, right now, are hurting me a lot.

Lisa studies me for a while.

"So am I," she replies slowly. Then she shows me a picture of her own (breastfed) daughter, now eight years old. Bright eyes, mile-wide grin, she looks like a miniature version of her mother.

And that's when I know it is no accident that Lisa has devoted her career to helping mothers forge abiding, biological bonds with their babies. Nor is it any accident that I desire this relationship so deeply. Your body out of mine. From my body into yours. First blood, then milk. These are the living threads that weave mother and child together. As much as I love my adoptive mom, this bond is a connection we never had. And as for the unknown woman who gave birth to me, we were lost to each other before I was even as old as Faith is now. And for about the twelfth time today, I begin to cry.





Another rumination of mine on adoption:



Tuesday, October 2, 2012

Calculated Risk: New Milkscreen Calculator Product for Breastfeeding Mothers


There's a new product hitting the aisles. Milkscreen Calculator claims to evaluate a lactating woman's supply and tell her whether her production is adequate. Is it designed to reassure nursing mothers, or to prey on their insecurities? Who designed this? And how exactly does it work?

Brought to you by Upspring Baby, the same company that created the alcohol test strips for breastmilk, Milkscreen Calculator is introduced on their webpage like so:

DO YOU MAKE ENOUGH BREASTMILK FOR YOUR BABY?
GET MILKSCREEN CALCULATOR
Many moms wonder: How much breastmilk do I make, and is it enough for my baby?
 
Take the new Milkscreen Calculator test and learn:
  • How much breastmilk you are making
  • If you need to increase breastmilk production
  • Baby's weight gain and weight percentiles
  • How to naturally increase breastmilk production
  • How to overcome common breastfeeding problems
It's no secret that anxiety and insecurity about milk supply are leading causes of premature weaning. Milkscreen Calculator states that "50% of moms stop breastfeeding because they are concerned they are not making enough for their baby." In a video interview,  Dr. Susan Landers, a fellow of the Academy of Breastfeeding Medicine who helped develop the Calculator, she explains that the product was indeed intended primarily to reassure mothers who have unfounded fears about their supply.

How does this work? From what I can tell on the site, the product you purchase is basically just a container into which you measure your pumping output. After registering on their site and filling out a questionnaire which collects more data on you and your baby, you are given a pumping schedule. In the example cited in the FAQ video, you are to nurse your baby at a set time, then pump three different times at hourly intervals. You will then enter your data online and receive an analysis of your supply, such as this example:



I should fully admit right up front that I have a hard time being objective about this. As someone who works with nursing mothers in my clinical training to become an IBCLC (supervised by preceptors at all times), it breaks my heart to think that a mother who was producing well but did not respond well to pumping (or had a faulty pump, or poorly fitted flanges, or any number of other variables) could potentially be told that her supply was inadequate by this product. There are mothers who have successfully breastfed their babies exclusively, with perfectly healthy weight gain, who report never being able to elicit more than a few drops from a pump. Perhaps it was an equipment issue, perhaps hand expression might have worked for her, who knows? What would Milkscreen Calculator tell a mother like this?

Conversely, if it's used on a newborn (they state not to use it prior to 8 days old, but day 9 is still very, very early), honestly, mom might still be producing well due to that postpartum hormonal abundance . . . and baby might actually have some issues that prevent them from actively transferring well. So baby feeds passively on mom's surplus letdown for a while, and a few weeks later, her supply actually does start to dwindle because the demand end of the supply & demand equation was never strong enough. But hey, the Milkscreen told her everything was just fine.

In a few places on the site, the company mentions that moms that were found to have low supply according to their calculations may want to consult with a pediatrician or a lactation consultant (after trying some of their automated suggestions for increasing supply). Which, in my mind, begs the question, wouldn't a better effort be to increase access to IBCLCs in the first place? By the time a mother in this position seeks professional help - if in fact she does or can - she may be facing an uphill battle to bring her supply back on top of addressing the root cause of the baby's poor transfer.

To give the company the benefit of the doubt, I do believe the intention was to create a product that would reassure most mothers that their supply is normal and healthy - after all, for most women, it is, as long as poor management doesn't interfere with the natural process. Does it succeed in this goal? Or is it more likely to just exploit their fears? A little from column A, a little from column B?

What do YOU think? Am I overreacting in my concern? (It would hardly be the first time. True fact.) If this product is a helpful and accurate one, and my reasoning is faulty, I would love to be reassured by an explanation. Building confidence in new mothers is a very, very good thing; I am far from convinced that a preprogrammed Calculator is the right tool for that job.

*****

UPDATE 10/5/12:

Yesterday, I received an email from the CEO of Upspring Baby. I share it here with her permission,

Dear Dou-la-la,

I am the CEO of UpSpring Baby and saw your recent post about our new product, Milkscreen Calculator.  I thought you raised some very reasonable questions, and many of the same ones that were raised when we launched the product at the annual ILCA conference in July. 

We recognize that this is a complex product that is intended to address a common concern of new moms:  that their milk production may not be sufficient to support their baby’s needs.  Milkscreen Calculator’s mission is to help moms overcome this common worry, either by reassuring her that her production is normal (in most cases), or by helping her overcome a high or low supply by directing her to an LC.  We know many moms quit breastfeeding, or begin formula supplementation, because they think they are not making enough breast milk.  The main purpose of this product is to educate mom and help her gain the confidence she needs to continue breastfeeding.  And for women with low or high production, we hope the test will give them the extra encouragement they need to seek professional help so they can increase or decrease their production.

If you are interested in discussing the product further, I would appreciate the opportunity to speak with you directly.  While we have tried to anticipate most of the basic issues, I’m sure there are more things we can learn from experts in the field.  Prior to launching the product, we sought input from LC’s and pediatricians who have specific expertise in breastfeeding medicine in order to be as thorough as possible. 
 
Thank you,

Caroline

What do you think? 

Thursday, August 2, 2012

Our Babies, Our Guts, Or: What Napoleon Dynamite Can Teach Us About Breastfeeding

Mmm, Gut Flora
Is it normal for a breastfed baby to go for days without pooing? How about weeks? It comes up fairly regularly (puns always intended around here) in online breastfeeding-related support groups, and the conventional wisdom/majority opinion is inevitably that infrequent stooling in exclusively breastfed infants is fairly common and thus, it is normal. But what do we mean by "normal"? If by normal (in this context) we really mean common, then yes, that's true. But does that, therefore, equal healthy?

Usual pattern of discourse:
One parent: "My baby usually went for 4 or 5 days without pooing. Then she'd have a huge blowout/poo all day on the fifth day."

Another parent: "Breastmilk is such a perfect substance that the baby's body just absorbs it all! Breastfed babies don't need to poo regularly." 

Third parent: "Yes! Breastmilk is used so efficiently that there isn't any waste. Mine used to poo explosively once a week. It was just her 'natural rhythm', I guess."

Me: "But . . . if a baby not pooing is a sign that the body is 'absorbing it all', then what does it mean when a baby actually poos? That they are not using it so efficiently and aren't getting the nutrients? And if they are then having blowouts later - doesn't that mean they were not 'using it so efficiently that there is no waste' after all? (And on to information about infrequent stooling sometimes being a symptom of food sensitivities, suggesting a look into gut healing if it;s feasible for the mom, etc, blather, rinse, repeat.)"
You get the idea. I'm always conflicted about this topic and its usual pattern because the women arguing in favor of infrequent infant stooling ARE breastfeeding advocates and are trying to encourage and reassure other mothers. I can't NOT support that right? The intention is so good.

I posit that something being common does not, in itself, mean that it is therefore healthy. 

This frequent conversation was on my mind when I shared this link from The Healthy Home Economist on Facebook yesterday and enjoyed the brief discussion that followed. From her post on relieving baby constipation:
"As little as ten to fifteen years ago, it was almost unheard of for a breastfed baby to be constipated.  In fact, the baby books at that time almost universally stated that breastfed babies don’t get constipated. Nowadays, however, this situation is becoming more commonplace and the continuing decline in the quality of the diet of nursing mothers is a likely reason.
While it is an unpopular position within the breastfeeding community, the diet of the mother clearly impacts the quality of her breastmilk (fats, vitamins and minerals in breastmilk vary considerably based on the mother’s diet although protein and immunoglobulins do not) and studies such as the Chinese Breastmilk Study confirm this.

"Suggesting that a lactating mother can eat whatever she wants and still produce quality breastmilk is also irresponsible and defies all common sense and historical study of healthy traditional cultures which put great emphasis on the quality of the diet of nursing mothers."

I appreciate that she's willing to state an  unpopular opinion on two matters: That even a breastfed baby needs to stool regularly (the body "using it so efficiently" does not mean that there is zero waste and that it just dissolves magically; that's simply not how human digestion functions, whether said human is an infant or an adult), and that maternal diet DOES in fact have an impact on breastmilk composition. Yes, breastmilk absolutely IS still preferable to formula, even with a suboptimal diet, but that does not mean a nutritionally inadequate diet and a healthful diet (and what "healthful" means definitely and obviously varies from individual woman to individual woman) are therefore equivalent.

I think we as breastfeeding professionals and advocates are frequently afraid to address maternal diet because we don't want to create additional pressure on mothers, and I completely get that. I don't want moms to feel that they have to eat "perfectly", and opinions also do vary on what optimal nutrition even is, I know. (Believe me, I know.  Vegetarian? Vegan? Paleo? Raw? Low Carb? Macrobiotic? Kosher? Gluten-free? SAD? GAPS? FODMAPS? Aiiiieeeeee!)  

However, I do feel sometimes that we're assuming that women's commitment to breastfeeding is so fragile and tenuous that giving information that includes suggesting improvement to their nutrition, within whatever their means are (more on that in a sec) will cause them to throw up their hands and give up. I want to give moms more credit than that. Yet I have also heard (as in read-on-forums) moms deciding to formula feed because they can't afford a perfect organic diet for themselves, so what's the point? Clearly we need to do a much better job of getting accurate info out there re: this. 

To wit, while this very conversation was taking place, a comment was posted on an article about the Bloomberg initiative: "[Breastfeeding is] only healthier IF the mother eats properly and chooses to not take in UNHEALTHY substances. . ." 

To which my classmate Catherine replied: "Right. Because all those cows whose milk is being used to make Similac are on an organic diet (and eating "properly" - so no grains) and are never given unhealthy substances." Those cows are not farmed on a different, uncontaminated planet, either.

Christie Haskell then summed it up neatly: "We want people to know that eating healthy does make things better for baby, but we don't want to fuel the idea that if you don't eat healthy, you might as well formula feed either." This is the dilemma.

My wise friend Arwyn, famed for her excellent blog Raising My Boychick, offered some important perspective with some difficult but extremely relevant thoughts, thoughts that we should keep in mind whether approaching this from either an advocacy role or a professional one:

[T]he majority of toxins in milk come from our own stored backlog, which were laid down when WE were fetuses and infants and children. They come from car fumes and factory fumes and "fire retardants" and water pollution, from a thousand things we cannot control and which big money is invested in preventing us from regulating. Does diet make a difference? Yeah, of course it does. But I think any conversation about diet that takes place outside of a dominant cultural conversation about how our waters and lands and air and food are polluted is the wrong approach.
Arwyn makes very important points - I always appreciate her asking the tough questions. I think it's important to have address ALL of these things. Socioeconomic issues, environmental contaminants, AND also maternal nutrition. And as an IBCLC-to-be, the subject I know most about is the latter, so therefore, it's what I'm most qualified to speak about - that doesn't mean I don't recognize the other things as significant factors. I don't have expertise in social justice or environmental science, but I do in human lactation  It's the area in which I have the best chance of making any significant impact as a professional, therefore it is the main focus of my voice on this matter. She is absolutely right that I still need to remember to consider the big cultural picture - and check my privilege - on a regular basis in all of these conversations.

It is absolutely true that our own health has already been dramatically affected by our grandmothers, quite literally - I say all the more reason to do what we can for our grandchildren in addition to our nurslings. I think we can strive to increase access and be sensitive and empathetic about resource inequity - and also not perpetuate myths in our roles as professionals or advocates about breastfed babies only needing to poo once a month-ish.


No conversation about this would be complete without a link to Jennifer Tow, who is one of the most experienced  and brilliant IBCLCs on the planet, and her poetic musings on "The Gut, Microbes and Poop":

Someday, I am going to write “Confessions of an IBCLC Heretic”, because for almost 20 years, I have been saying that it is absolutely not normal for babies of any age to have fewer than several significant bowel movements per day. Not per week! Per day. The more I learn about the gut and the gut-brain axis, the more I have to learn. But, I am confident that human milk is not “all used up” and that babies are not “efficient enough that there is no waste”.

Such comments do not even bear up under the scrutiny of common sense. If all those babies who stop pooping at 4-6 weeks are using up all the milk, what are the babies who are pooping 6-8 times per day doing? Making it?

And finally, even Napoleon Dynamite knows that maternal diet impacts milk composition.
 

 

Napoleon Dynamite: [drinks glass of milk] The defect in that one is bleach.
FFA Judge No. 1 : That's right.
Napoleon Dynamite : Yessssssssss.
Napoleon Dynamite : [drinks second glass of milk] This tastes like the cow got into an onion patch.
FFA Judge No. 2 : Correct.
Napoleon Dynamite : Yessssssssss. 
[Side note: Lily has taken lately to saying "Yesssssss," whenever she's mildly excited about something, and sounds exactly like Napoleon here.]

Monday, July 16, 2012

Difficulty Conceiving/Difficulty Breastfeeding: POLL



The last time we updated our intake forms at my school's breastfeeding clinic, we made sure to add a checkbox with "Difficulty conceiving?" to the maternal health history section. Reasons for fertility issues are myriad, but can definitely give us some clues as to possible underlying hormonal issues that can affect supply (more on that in an upcoming post, I hope). 

Yet in my (limited) experience so far, few mothers who sought fertility treatment received any indication from any of their prenatal care providers that they might in fact experience some challenges in the breastfeeding department. Before we get into the whys and wherefores, I thought it might be a good idea to get a sense of how common this lack of information is, however informal the poll.

So, would you pass this along to anyone you know who has experienced fertility treatments and might be willing to share this info? And of course, answer it yourself if it applies to you? I'd be most grateful.




This is just the opening of a potential ongoing conversation. There are many complex layers to this, and much to discuss.

[And hello there, o patient readers! I do indeed still exist, though between coursework for school and various other exciting outside projects (including promising memoir stuffs), I sometimes barely have time to parent, let alone wax lactosophical around here, much as I love to do so. I'm hoping that will start to change soon. Cheers!]

Sociable