One For The Dads

My brother-in-law, Greg Wind, wrote the article to share with our Dads back in 2007. There is some great information in here on how they can participate in and support your breastfeeding endeavors. Enjoy!

Dads, you just had a screaming, beautiful, pooping, sleeping miracle.  Have you noticed the difference in how time passes yet?  Not so much in a line as in fits and starts, right?  When your baby looks at you, time can stand still, and then you make up for that golden moment trying to feed, change and bathe that child before the next chorus of “the Overtired Breakdown.”  Maybe time will crawl when you try and do the math of infant feeding schedules superimposed on infant sleeping schedules and sprint again as that math goes out the window with a missed nap.  Oh, and don’t forget to take time to enjoy every stage because you’ll never get it back.

 The feeling probably goes double for the mother of that miracle, and if she’s getting up for night feedings and pumping on a regular basis, she’s got less of a day to accomplish everything.  I’d add up the hours for you, but it might depress you and I want you to get to the happy ending below.

 In our over packed lives, why would anyone go for a Stone Age strategy like breastfeeding?  It hurts, it takes longer, it requires exposure of otherwise hidden skin, and on top of it all, if reinforces those nasty prejudices of the woman as primary-to-sole caregiver.

 If you’ve made it to this article, you’ve probably heard about the health benefits for the mother and the baby.  Even the formula people say breast milk is best.  If you’re taking the time to read this, you’re likely in no danger of dropping all of the baby care in mom’s lap.  Plus, there’s that bonding we hear so much about.  My wife, a working mom, says of breastfeeding “you have to, but you get to, too.”  The benefits are real. So why not give it a spin to see if it’ll work?  Remember that no one – no one – talks about the hidden long term benefits of formula.

 If you and your baby are lucky, the tike has a mother that lets you weigh in on baby care decisions – even if it’s to grunt and say “I dunno.”  If you chose to support the breastfeeding decision, you are now committed to supporting the breastfeeding process.  You thought you were getting off the feeding hook, right?  Sorry.  The actual breastfeeding will forever remain a mystery to me and most men, but there are things you can do to help.  Here are just a few:

> Get over it – If you’re squeamish about feeding in public or even being around during feeding, get over this as soon as possible.  Not only is America coming to the realization that breastfeeding is natural and normal, but it’s actually been legislated in many states that women are allowed to breastfeed wherever they darn well please.  If breastfeeding can take place during an outing or while enjoying your company, that’s like adding time to her day.  Doing two things at once = more time! 

> Feed the baby pumped or “expressed” milk – Expressed is actually a good word for it because it takes less time to pump than to feed a baby.  The baby will also usually take a bottle feeding faster than a breast feeding.  If you give the baby a bottle, you are putting time back into the mother’s day and you get a taste of that bonding everyone talks about.  Expressed = faster = more time + bonding for you.

> Wash stuff – You may have noticed that time has become a theme here.  A significant amount of the time required for pumping is in washing the pump components.  You can wash stuff.  You’ll still be a man when you’re done.  If you find this works for you, go ahead and find other stuff to take care of.  Every chore you take off her plate counts double during infant care.  Not that you could ever cash those brownie points in, but it might help you to know that you’re getting twice the credit.

> Keep the list of benefits top of mind – On top of being time consuming, breastfeeding will be frustrating from time to time.  It’s the stuff of thousands of support groups.  I’m not exaggerating.  When mom reaches the end of her rope, it doesn’t always mean she wants to stop.  She might just need support so she can keep going.  Remind her that her options are always open, but she chose breastfeeding for very good reasons.  And it will help you to remember the benefits, too when you aren’t getting the attention you’re used to.  Longer, healthier life for your family = more time.

> Talk to other dads – I’m lucky enough to have a sister and three sisters-in-law going though infant care at the same time.  Talking to them makes my wife feel more confident and happier.  And while they discuss pumping and feeding, I hang out with the boys.  Not only do we all get time out to talk about sports, but on the occasion we feel like talking about breastfeeding (yep, it happens) we’re all coming from the same point of view.  Trust me – you’ll feel far more comfortable talking about it with other new dads.  Try discussing a slow flow nipple with non-dads and see how far you get.

So when you add all of that time back into the day, bond with the baby and take time out to discuss the designated hitter, you’ll find that breastfeeding is a pretty good deal for you.  You get a chance to be an everyday hero just by washing stuff and understanding.  Mom will feel the pride of feeding her baby with her body and that will make you both happier.  Everyone will be healthier.  Plus (I promised a happy ending, remember?) it’s free.  Take those thousands of dollars and put it toward the college fund, or better yet, reward yourselves for all of the time you gave the baby and take some time to feed the parents at the nice restaurant or sports stadium of your choice.  Just remember to have a couple bottles ready for the sitter.

The Benefits of Breastfeeding

A few years ago I had the pleasure of attending a conference about the “Use of Human Milk and Breastfeeding Education for the Registered Nurse.” The speaker was Diane Spatz, RN PhD, an associate professor at the University of Pennsylvania and a clinical nurse specialist at the Children’s Hospital of Philadelphia. It was a fascinating day, and as usual, I learned a lot. Her most interesting lecture was her first one about the benefits of human milk. I thought I would pass this information along to all of you, as a reminder of the wonderful gift you are giving your baby!

Most women cite infection prevention as their number one reason for breastfeeding. Babies who are breastfeed have decreased incidence and severity of RSV, gastroenteritis, diarrhea, respiratory, ear and urinary tract infections. For premature babies, the benefits are life saving with a decrease in the incidence and severity of meningitis, blood infection, sepsis and necrotizing enterocolitis. ($200,000 is spent of each case of NEC alone!) These babies also have a decreased incidence of retinopathy of prematurity, SIDS, diabetes, and obesity. Their hospital stay is shorter and less expensive than formula fed preemies. Breastfeeding for these compromised babies is truly medicinal.

But do you know why that is? It is due to something called the “Enteromammary Pathway.” This is a maternal response in which anything the mom comes in contact with (microorganisms, food antigens etc.) travels thru her gut and lymphatic system causing antibodies to be produced that are then passed along thru her breast milk to protect her baby. It is for this reason that mothers of preemies are encouraged to touch everything their baby comes into contact with in the NICU.  Their exposure to everything their baby is exposed to protects their baby from hospital borne illnesses.

In addition to the infection protection, breast milk has a biological specificity that is exactly what the human newborn needs. The fat content of breast milk accounts for half the calories and it adjusts throughout the feeding and the day. Amazingly, the fat content is 30% higher in mother’s who deliver preterm infants, because those babies need it! The DHA and ARA in breast milk (which have now been artificially added to formulas) enhance the babies’ visual acuity and brain maturation.  Some fats are also anti-viral, anti-fungal and anti-bacterial. The lactose in breast milk enhances calcium absorption and is easily broken down to provide a constant nutrient flow to the brain.  Other carbohydrates promote the growth of healthy bacteria in the gut and decrease pathogens by increasing the acidity. Protein in breast milk is low in quantity but high in quality and is primarily the easy to digest whey protein. It is also immunologic with proteins that breakdown infectious agents.  Lastly, breast milk is full of antibodies, infection fighting white blood cells, hormones, vitamins and minerals that are essential for the general hydration and nutrition of your baby.

But you already knew all that didn’t you?  Keep up the good work!

Introducing the Bottle

Mothers frequently ask me “When is the best time to give a bottle and how do we do it?” For many women, it is source of anxiety, but a necessity at some point or another. Fortunately, it is fairly easy if you do it in a controlled and timely fashion, rather than at three in the morning when you are desperate!

Obviously, my goal is to help mothers breastfeed successfully, whatever that means for them. If mothers need to give a bottle, I hope to help them give a bottle of expressed breast milk instead of formula. The most important thing to know about being able to breast and bottle feed, which many women need/want to do, is that it can be done. However, it can’t be done in the hospital, right from the get go. If you want to nurse, you have to spend the time getting breastfeeding off to a good start. This process usually takes about 3 to 4 weeks of exclusive nursing. If you do that, and nurse exclusively through the three week growth spurt, your milk supply will be well established. In addition, your baby will have learned how to nurse correctly and giving a bottle at this time will not “undo” that!

Early bottle introduction causes a host of problems for the breastfeeding family. First, these babies are usually given formula and too much of it. Babies who are nursing get only a small amount of colostrum (mother’s early milk) at each feeding, which is exactly what they need. Bottle fed babies tend to get 2-3 ounces of formula, which is much harder to digest. It prevents the meconium (baby’s first waste) from being passed quickly, suppresses their appetite and keeps them from feeding frequently, which they need to do to bring their mother’s milk in. In addition, hospital bottles have a standard size nipple, which is much smaller than a mother’s breast. Babies learn immediately to position their mouth incorrectly for breastfeeding when they are given this bottle. When they replicate that on their mom, it hurts!

So, the first few weeks should be about getting a good latch and getting your supply established. If you want to give expressed breast milk in a bottle when the time comes, you can also use this time to collect some milk to give later. There may be several opportunities for this in the early weeks. If you get engorged, you can pump just enough to make yourself comfortable, which may mean only pumping a half ounce! You may also have times when the baby takes only one side, falls into a milk coma and doesn’t take the other. In that case, pump the side he doesn’t take and save that milk. You can mix the milk from several different pumping sessions to make one bottle. When you collect a total of 3 ounces, stick it in the freezer, and you have milk for your first bottle!

Develop a plan for the first time you give your baby a bottle and have someone other than you do it. I like moms to leave the house and do something for themselves. Arrange for dinner with a friend, a haircut, or shopping to get some clothes that you fit into! The reason for this is that first of all, you probably need a little alone time after three weeks of exclusive nursing. In addition, if the baby sees, hears, or smells you, the baby may protest and wonder why you are not feeding him/her. And if the baby protests at all, the person with the bottle may quickly give up and pass the baby back to you!

It is best to time it so that you leave the house right before your baby is due to eat, and pump just before heading out the door. This gives you a few hours to do what you want, and you can nurse right when you get back. This pumped milk can be used immediately, if necessary, or goes into the freezer for the next time your baby gets a bottle. When your baby gets a bottle, it should be a bottle with a wide base and nipple, not a standard size. Thaw your frozen milk, pour it in, and have it at room temperature or a little warmer for the baby.

When done this way, bottle introduction is usually pretty uneventful. Be prepared for a mix of emotions when you come home and find out everything went fine, which is after all, what you want! Then make sure that the bottle is offered every few days, especially if you will be going back to work. If you do that, though your baby will always prefer you, he will take a bottle without difficulty when he needs to!

Rhode Island is the First US State to Support Breastfeeding Mothers by Becoming Bag-Free!

Through the hard work and dedication of many hospital employees throughout the state, and the gentle insistence of our Health Department, Rhode Island became the first “Bag Free” state in the nation. I realize it is old news by now, but for those who don’t know, this means “women who give birth in Rhode Island will no longer receive infant formula marketing packs when they head home from the hospital.”(www.banthebags.org) In an event held at the State House on November 28, 2012 Rhode Island’s First Lady, Stephanie Chafee, Lieutenant Governor, Elizabeth Roberts, RI Department of Health Director, Michael Fine, and Marsha Walker from the Massachusetts Breastfeeding Coalition’s Ban the Bags campaign all celebrated this achievement and “spoke of their commitment to breastfeeding families and their support of the hospitals’ efforts in this giant step forward in removing the commercial barriers to breastfeeding.”(www.banthebags.org)

I think that most everyone who heard about this knew that it was a good thing for the health of babies in our state. Some weren’t happy about it, but I really don’t think they understood what it means. And let me be clear: it does not mean that mothers will not be able to receive formula in the hospital if they choose not to breastfeed. The hospitals will still have formula, and will still provide it for your child if you want it. What they will no longer do, is routinely give out discharge packs with free formula to mothers as they leave the hospital. Dr. Melissa Bartick, a Boston MD, wrote in a very public debate with MA Governor Mitt Romney that giving formula samples to new mothers was akin to giving Big Macs to patients on a cardiac floor. As Marsha Walker has said many times, “Hospitals should market health, and nothing else.” When nurses send new mothers home with a bag of free formula, it is an implied endorsement of that product. “State health officials noted that studies link these giveaways to decreased breastfeeding rates, which is not in keeping with their efforts to promote optimal health for mothers and infants in Rhode Island.”(www.banthebags.org)

We all know the benefits of breastfeeding. This information has been well promoted among the public health community for years. But “because breastfeeding is the gold standard infant nutrition that provides optimal healt
h for both mothers and infants, lactation experts have recently shifted to describing the risks of formula feeding rather than the benefits of breastfeeding. For mothers, not breastfeeding is associated with an increased risk of post-partum blood loss, post-partum depression, and ovarian and breast cancer when compared with women who do breastfeed. For children, risks of formula feeding include an increased incidence and severity of a wide range of infectious diseases as well as chronic diseases such as diabetes mellitus and obesity.” (MacNamara et al, 2012) When framed that way, doesn’t it make sense not to promote an unhealthy behavior? Especially in a hospital, where we really have the opportunity to help mothers get off to a great start establishing healthy habits with their baby!

So our tiny little state has really done a big thing for families who deliver their babies here. Next on our agenda: having Rhode Island become the first state in the nation with all birthing hospitals designated as Baby Friendly. “The Baby-Friendly Hospital Initiative (BFHI) is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. The BFHI assists hospitals in giving mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.”(www.babyfriendlyusa.org) Currently in Rhode Island, Newport, South County and Westerly hospitals have all achieved this status. Throughout the world, the majority of hospitals are Baby Friendly. It is only here in the USA, which is so heavily influenced by the business of formula marketing, that Baby Friendly hospitals are in the minority. Interested in helping to make this happen? Contact your local hospital and ask that they do everything they can to achieve this designation and deliver only at a hospital that has it. Consider joining the Rhode Island Breastfeeding Coalition (RIBC) and joining our advocacy efforts. You can read more about this wonderful organization and ways to get involved at the following link: www.health.ri.gov/partners/coalitions/breastfeeding. We hope that you will join us!

The Effects of Birth Control on Breastfeeding

Some of you might remember this article, but I feel compelled to run it again as I had two instances of this last month. A mom will start the mini-pill and quickly watch it affect her milk supply, sometimes with a very dramatic decrease. I wanted to remind everyone of what I see clinically in some of my patients who take the mini-pill, so I can prevent other mothers from going through the same thing!  Please remember that this is my anecdotal experience, not at all backed by research, and is different from what the pharmaceutical companies and many doctors and midwives believe. Also, I see moms with issues, so my population is skewed!  There are many who have no problems with the mini-pill at all. But it is something for all moms to be aware of, especially if they have concerns about their supply. 

So much of my work is about asking the right question at the right time. I had a perfect reminder of this over the summer. I was sitting by the pool watching my boys play with some of their cousins. My sister’s sister-in-law was sitting next to me and we were talking about her beautiful little boy who was 9 months at the time. He is happy, chubby and very well nourished by his mom who has been nursing him. And he has rock star hair to boot! She was lamenting the difficulty she has had with maintaining her milk supply for this baby. It was an experience much different than her first child, for whom she felt she had an abundant supply. And of course, we had been in contact regarding this since the baby was born. She was doing all the right things: eating and drinking well, pumping when necessary, nursing on demand and trying to get adequate rest. But she really felt she had to stay on top of this with this baby and couldn’t figure out why. And frankly, neither could I.

Then our conversation went on to other things and we eventually got talking about plans for the future. Nosey me asked if and when this little boy would have a younger sibling. And his mom replied that she would love to have another one someday, but was on the pill now and they were waiting a little bit longer for all the usual reasons. “You’re on the pill?” I asked. “Yes, since he was 6 weeks old,” she replied. “Wasn’t that when you started having problems with your supply?” I asked.

She went on to say that she was assured by her MD that it was safe to take this mini pill while nursing. I told her that she received correct information. It is considered perfectly safe for babies  to nurse when their mothers take the mini pill. What she wasn’t told though, was that in the fine print of the drug literature, it clearly states that it can cause a decrease in your supply. In fact in light of this new information, I was absolutely amazed that she had nursed this baby as well as she had! Many mothers that I work with in this situation lose their milk supply significantly within about 2 weeks. It is usually a very sad situation, as they were told it was safe for the baby, but not told that the side effect is a significant reduction in milk supply. They had no intention of weaning, but it happened dramatically and much sooner than they would have liked.

How did I miss this in someone who is essentially part of my family? It’s all in the questions I ask and I honestly am learning new stuff every day. I will never make that mistake again, but will probably make a new different one! In the meantime, I hope everyone reading this has learned a little something about birth control pills and nursing. And also, please tell me or any other health care provider you deal with everything you think they might need to know, even if you think it is inconsequential.

It just might be the one thing they need to know!

Nipple Shields – To Use or Not To Use?

I used to hate nipple shields and never used them. My bias was based on literature that came out many years ago that indicated they caused nipple damage, usually because they were used incorrectly. They also contributed to lazy latches with ineffective drainage of the breast leading to a subsequent decreased milk production and infant weight loss. So I basically just steered clear of them, thinking that no good could come from using them.

Then in the fall of 2007, I attended a conference hosted by the Rhode Island Breastfeeding Coalition (RIBC) on “The Challenges of Breastfeeding the Near Term Infant.” The speaker was Molly Pessl, RN BSN IBCLC, and she changed my mind about nipple shields. She taught us all how they really get the baby who isn’t quite term in their development nursing at the breast. These babies look like they should be able to nurse without difficulty, but developmentally, they are not quite there and the shield makes all the difference. Many of them were bottle fed and were used to plastic. The plastic shield tricks them into getting on the breast and its firmness makes it easier for them to drain the breast when used correctly. I started using them in these circumstances and found that she was absolutely right! Christina Smillie MD, FAAP FABM, who spoke at the 2009 RIBC conference on “Baby Led Breastfeeding” agreed with this use of the nipple shield, and supported anything that gets the baby nursing directly from the breast.

Now I sometimes feel as if I am passing nipple shields out like candy. I don’t leave home without them. They are always the last resort, after first assessing the situation and trying to get the baby to nurse without it. I make sure the family is aware of all the contradictions and side effects of improper use, and agrees to frequent weight checks and follow up with me. I explain that use of the shield is a temporary thing. I find that usually after about 2-3 weeks of good nursing and weight gain, the baby doesn’t need it any more. They wean easily and all those difficulties in the beginning are a distant memory. Once they understand all that, we give it a try….

I have had many moms burst into tears when I help them latch their baby on the breast with the shield. They are thrilled to see milk in the shield and so proud of the intake we are able to measure on my scale. The swallowing they witness is much stronger than what had been happening without the shield, if they were ever even able to get the baby on the breast! The family is happy, and then so am I.

There are two other situations in which I use nipple shields. One is for the mother with flat or inverted nipples. That is probably not a surprise to anyone. It provides the baby with something to latch onto without causing the mother any pain. I also use them for babies who latch without incident, look absolutely perfect on the outside, and despite numerous suggestions on positioning and support , still cause their mother pain. I never am really sure why this happens and nothing fixes it. But the shield does. Mom nurses pain free, and like the other situations, the baby eventually weans off it.

So this is all good, right? When used in these situations and while working with someone knowledgeable about breastfeeding and infant growth and development, it really does fix problems and get the baby nursing. However, now I am running into a much bigger problem.

You can get a nipple shield anywhere. Target, Babies-R -Us, and Walmart all sell them. As a result, I am seeing moms at 3 weeks post partum, who brought a shield to the hospital after buying it in the store and started nursing with it immediately after birth. They never even tried to latch on their own. They assumed that since it was in the store, it was just one more thing they had to have to breastfeed. I am called in because the baby isn’t gaining weight, mom reports she has no milk and had to start supplementation. And at this point, there is not a lot I can do. The hormonal response that establishes and maintains a woman’s milk supply has come and gone. The window of opportunity to get things off to a good start has been missed. It is heartbreaking to have to tell a mom this and have her realize she probably never needed to use the shield in the first place.

What has typically been happening in situations like this is that the baby has spent a tremendous amount of time at the breast, using the nipple shield as a pacifier. The shield slides in and out of the baby’s mouth, and the breast is not drained. I see this immediately when I ask the mom to show me what she has been doing. The only milk the baby gets is from the mom’s letdown. Mom interprets the length of time at the breast as a good thing, not realizing that the baby is wasting calories with all the ineffective sucking, and not gaining weight. The ineffective draining of the breast then causes her milk to dry up, as you have to remove the milk in order for it to be replaced.

The key to all this is that these feeding devices are intended to be used under medical supervision. While it clearly states that on the packaging, it is on the back and the last thing mentioned, after stating all the things a nipple shield is good for. I have complained to the manufacturer about this, and have been told that they are working to make that statement more noticeable, but will continue selling them in retail stores.

At HBHM Inc., we have a very specific protocol that we follow when using shields with a family that involves frequent follow up and weight checks. I am planning to revise that protocol with our new website launch to include not selling these shields to moms unless they are working with us or I can confirm they are working with another healthcare provider. I am sure many mothers will not appreciate that extra requirement. But I don’t want to be responsible for providing someone with something, that when used incorrectly and without guidance, can have such grave consequences. I will let the manufacturers and retailers get the credit for that!