Do hospital *swag bags* help mothers to breastfeed?

Do hospital swag bags help moms to breastfeed?
Not in their present form!

I really like the idea of bags for ALL mothers being free of formula samples and related gear/advertisements/coupons.

I do NOT like the idea of those bags carrying products which intimate that they are *essential equipment* for nursing mothers. According to the website,
http://ecochildsplay.com/2009/08/16/forget-formula-samples-hospitals-give-out-breastfeeding-support-bags/
they contain these items:
* The cool, handy bags
* Samples of nursing pads, breastmilk storage bags, lactation tea, and other goodies.
* Info and coupons from companies such as Lansinoh, Bravado! Designs, Ergo, BebeAuLait, and My Brest Friend.

So what is the message they are sending?
That mothers will need THINGS to stop them leaking, make enough milk, cure their sore nipples hide their breasts (and babies) while nursing and even to enable them to nurse (pillows).

While some mothers will find some of these products useful, we tend to forget that mothers already have all the breastfeeding equipment they need. These other products often hinder rather than help, especially if they are not used appropriately.

What new mothers REALLY need is access to current, research-based information. We need to make sure they know who to call for help - LLL Leaders, WIC breastfeding coordinators/ peer counselors, IBCLCs, etc. These people can tell them where to get breast pumps or other aids, as
needed. In other words, they need a resource list. I would also like to see mothers to go home with SIMPLE baby care instructions and charts they can fill out to show poops, pees and feedings.

Most of the mothers who stop breastfeeding do so in the first few days. They have no idea what to really expect and are easily overwhelmed. Even mothers who have read all the books and have seen other family members and friends nurse have a hard time coping with a new baby.
Getting them over this hump is the thing to do.

Losing weight whilst breastfeeding

My “Happy Earth Day” blog entry elicited a number of enquiries about weight loss whilst breastfeeding, so here is some information on the subject.

Women who are not breastfeeding lose weight much more slowly than nursing mothers. Breastfeeding is a natural and safe way to lose weight with very little effort.

The first naturally occurring loss of weight follows the birth of the baby. Almost all mothers continue to lose a little more weight in the next few days, mostly through the lochia fluids.

Pregnancy and childbirth takes it’s toll, so it is very important for newly-delivered mothers to eat well no matter how they are feeding their babies. Small, frequent meals are usually more acceptable and digestible at this stage.

It takes a mother about six to eight weeks to establish milk production. This is a good time to simply eat and drink when you are hungry and thirsty. Nursing mothers do not need to eat or avoid any special foods or drinks in order to produce good milk, so just choose foods that you normally enjoy. The good news is that most breastfeeding mothers continue to lose weight until their babies are four to six months old, all without dieting! Better still, a lot of the weight comes off your hips and thighs. What a great reason to breastfeed!

As the saying goes, it takes nine months to put on pregnancy weight, so you can expect it to take at least nine months after the birth to come off. Breastfeeding speeds up weight loss, because milk production uses about 500 calories a day.

If your baby is at least six months old and you feel the need to be more pro-active in losing weight, then there are safe ways to do so.

The first step is to replace high-calorie, high-fat desserts with fresh fruit and do a little more exercise.

If you like the idea of joining a diet program, Weight Watchers has one especially for nursing mothers. Eating 1,800 calories a day will enable you to both lose weight and maintain an adequate milk supply. Most importantly, avoid any diet plans which specify eating less than 1,500 calories a day.

Aim to lose about a pound a week. Low-carbohydrate diets often result in more rapid weight loss, which can be a concern for nursing mothers. Not eating enough can affect both your milk supply and your own health. There is more information on this in the references below.

Further reading:

Eat Well, Lose Weight While Breastfeeding, by Eileen Behan, RD.

I am breastfeeding my baby and I want to lose weight. Is a low carbohydrate diet safe for a breastfeeding mother?
http://www.llli.org/FAQ/lowcarb.html

Herbal weight loss products and breastfeeding http://www.kellymom.com/nutrition/mom/mom-herbalweightloss.html

Weight Loss After Pregnancy
http://www.breastfeeding.com/for_moms/weight_loss_after.html

References:

- Subcommittee on Nutrition during Lactation, Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, Nutrition During Lactation Washington, DC: National Academy Press, 1991 p.15, 74, 140.

- Kramer, F. et al. Breastfeeding reduces maternal lower-body fat J Am Diet Assoc 1993;93(4):429-33.

- Dusdieker, L. et al. Is milk production impaired by dieting during lactation? Am J Clin Nutr 1994; 59:833-40.

I have been busy!

See my comments at the Times Union online about a truly awful book and the new WHO-recommended baby charts:

http://tinyurl.com/pck2cp
and
http://tinyurl.com/cjztkp

I also wrote a letter to the editor about CDC recommendations for nursing mothers with regard to the swine flu epidemic. Hopefully, that will be published soon.

Happy Earth Day!

Breastfeed, because it is not nice to fool Mother Nature.

It's a natural, renewable resource and is all the baby needs for the first six months of life.

A woman starts to produce colostrum quite early in her pregnancy. Her baby receives this concentrated milk, which is rich in immune factors, as soon as he is born. During the next couple of weeks, the colostrum slowly changes into mature milk and productivity increases to meet the baby’s needs. Continued milk production depends on milk removal – the more her baby nurses, the more milk the mother will produce.

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It requires no resources for packaging, shipping or disposal.

The manufacture of artificial formulas involves the need for huge dairy farms, milking machines, cattle feed, manure disposal , formula factories, packaging and shipping, with it’s attendant costs.

“If every baby in the USA is bottle-fed, almost 86,000 tons of tin plate are used up in the required 550 million discarded babymilk tins.”

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No precious energy is wasted producing artificial baby milk and related products.

Mothers do not need special foods in order to produce milk for their babies. Human milk is ready to serve from the original containers. Breastfeeding does not require heating, cooling or sterilizing.

“Although energy required to boil water and sterilize bottles and nipples can readily be accessed in industrialized countries, it more often than not comes from polluting nuclear or power generating stations. In poor countries women often spend hours every day collecting scarce firewood. A bottle fed baby needs about 1 litre of boiled water to prepare feeds and 2 litres to sterilize the bottles and nipples. This requires more than half a kilo of precious firewood per day.”

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No land needs to be deforested for pasture or crop production.

Dairy farms require arable land to raise feed as well as space for the cows themselves.

“The production of artificial baby milks requires hundreds of millions of lactating cows. In India alone, to replace breastmilk, 135 million lactating cows would be needed. In Mexico to produce 1 kilogram of baby milk would require 12.5 square metres of cleared land.”

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It does not create pollution from the manufacturing of human milk substitutes, bottles, nipples and cans.

Think about the resources needed to make the glass and plastic bottles and silicone teats, very little of which is recycled, and the resulting pollution.

“Phthalates, a chemical used in the production of plastic, has been identified in all 15 brands of infant formulas, tested by the Ministry of Agriculture, Fisheries and Food in Great Britain. Nine of the brands tested had levels high enough to result in reduced sperm counts in rats.”

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It helps space babies by suppressing fertility in the mother.

“Breastfeeding reduces fertility rates and prevents more births than all other forms of birth control combined. In Africa breastfeeding prevents an average of 4 births per woman. In Bangladesh breastfeeding prevents about 6.5 births per woman. Chilean women, exclusively breastfeeding for six months, reported no pregnancies while of those bottle fed, 72 per cent became pregnant.”

Breastfeeding women rarely menstruate while their babies are exclusively breastfeeding. Not only is there money saved on sanitary products and their disposal, but there is a considerable impact on the environment.

“In the UK, each menstruating woman uses between 286 and 358 towels or tampons per year, 98% of which are flushed down the toilet. Fifty-two per cent of these are released untreated into the sea where tampons require 6 months to biodegrade, sanitary towels need longer. The plastic liners on sanitary towels will not biodegrade and remain as a pollutant”

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REFERENCES

http://www.reducepackaging.com/article.html

The Ecological Impact of Bottle Feeding, by Andrew Radford, Baby Milk Action

http://www.infactcanada.ca/ren_res.htm

Breastmilk: the perfect renewable resource

http://www.lllusa.org/green.php

Human Milk is Green, Ecologically Speaking...

PUTTING OUR BABIES AT RISK

Did you know that the World Health Organization lists formula as only the fourth choice of infant feeding methods? They are, in order; a mother breastfeeding her own baby, another woman wet-nursing the baby, feeding human breastmilk acquired from a milk bank and lastly, formula.

Why am I mentioning this? Because most people do not fully understand the risks of not breastfeeding, even in a first-world country like the USA.

We were all appalled to hear that melamine was deliberately added to the milk used for baby formula in China. Equally shocking, however, is melamine being used in the USA as part of the actual formula manufacturing process. http://children.webmd.com/news/20081126/melamine-in-us-baby-formula

Last October, the FDA said it did not know of any safe level of melamine in baby formula. Then, on November 28, 2008, without any further research, the agency announced that melamine and cyanuric acid are safe in baby formula at levels up to 1 part per million. Nobody knows if ANY melamine is safe. We do know that similar concentrations of either melamine or one of its relatives in their products have been found in formula made by Abbott, Nestle, and Mead Johnson, who make almost all of the formula sold in the USA.

Why has the formula not been recalled?

That is the question being asked by Illinois Attorney General Lisa Madigan. Madigan revealed that the FDA “apparently withheld the results of its testing from the public for over three weeks, and then only disclosed the information in response to a FOIA request by The Associated Press.”
http://www.washingtonpost.com/wp-dyn/content/article/2008/11/26/AR2008112600386.html?hpid=sec-health

Consumers Union is asking the same question. Jean Halloran, the group’s director of Food Policy Initiatives, urged the FDA “to immediately make public all of the results of its tests for melamine contamination in food,” even those with levels below what would trigger agency action.”
http://www.ajc.com/health/content/health/stories/2008/11/28/infant_formula_recall.html

What a disgrace that the FDA needed to be forced to reveal this information to the public!
Not to worry though, because on December 3, 2008,” the FDA and WebMD today announced the first-ever partnership between a U.S. public health agency and a private health-information provider. The partnership will enhance the FDA's ability to get crucial information to the American public, FDA Commissioner Andrew von Eschenbach, MD, said in a news conference.”
http://www.webmd.com/news/20081203/fda-webmd-announce-partnership

Right…
And this will increase consumer confidence in the FDA?

Unfortunately, melamine is not the only problem.

There is a long history of formula being recalled because of manufacturing errors.
http://www.breastfeeding.com/advocacy/advocacy_recalls.html

Reasons include:
- black plastic particles being found in some cans of formula
- metal particles in formula cans
- peeling can liners
- cans did not contain the labeled amount of inositol, a nutrient required under 21 CFR section 107.100.
- concentrated infant formula being manufactured with lids intended for ready-to-feed formula. The potential existed for a consumer to follow the lid directions (DO NOT ADD WATER) and not properly dilute the formula prior to feeding.
- contamination with Salmonella.
- adulterateration because it may have been produced under unsanitary conditions whereby it may have been rendered injurious to health. Furthermore, the product appears separated and was been linked with mild gastrointestinal illness.
- contamination with glass particles

More recently, on December 2, 2008, the New Mexico Health Department reported that one baby died and another was hospitalized due to infections caused by different strains of the bacteria Enterobacter sakazakii. Both babies had been fed powdered formula, which the CDC says has been associated with contaminated powdered formula products.

Certain steps can be taken immediately, however, to prevent or mitigate E. sakazakii disease. In a joint conference on infant formula safety in February, 2004, the World Health Organization and Food and Agriculture Organization of the United Nations made the following recommendations:

1) encourage industry partners to develop a range of affordable sterile formula options;
2) consider setting an industry standard for Enterobacteriaecae and E. sakazakii in infant formula;
3) inform infant caregivers of the risks associated with nonsterile, powdered formula; and
4) consider feeding high-risk infants sterile formula if they cannot breast-feed. The findings of our case review suggest that all neonates as well as premature infants should be included in this high-risk infant category.< http://www.cdc.gov/ncidod/EID/vol12no08/05-1509.htm

Unfortunately, this information has not been widely disseminated. Even hospital maternity units continue to provide powdered formula for newborns, and so mothers go home with their babies and free samples, believing that it is safe. Of course this *free* formula is not really free at all. It is provided by the formula companies, who fight amongst themselves for the “privilege* of sharing their bounty, whilst passing on the costs to consumers. Hospitals act as middlemen in these marketing tactics, in return for “gifts” which include supplies and equipment, and even cash.
http://www.ibreastfeeding.com/Volume%2035.pdf#page=2v

Formula companies know that mothers trust their doctors. When a hospital provides a certain brand of formula, it is conferring on it its seal of approval, and mothers will almost always continue to use that brand when they go home.

Formula companies also know that babies who receive even one bottle of formula in the hospital are more likely to be weaned from the breast by the time of their first doctor’s check-up.
http://www.naba-breastfeeding.org/images/Just%20one.pdf

So why do the stats show an increase in breastfeeding?

Remember, those yearly charts which show how many babies are breastfed are produced by a formula company, Ross Labs. What they do NOT tell you is that the figures include every baby who was ever put to the breast, even once, whether or not there was any transfer of milk. They do not tell you that almost all of the babies that leave the hospital *breastfeeding* are also being bottle-fed formula. Compare this to the National Immunization Survey (NIS,) which provides important information on rates of breastfeeding, including exclusive breastfeeding, in the United States.
http://www.cdc.gov/breastfeeding/data/NIS_data/survey_methods.htm

And then we come to the most important question of all.
If formula feeding is so risky, why do hospitals and WIC give babies formula?

Even without the overt risks, there is also the problem of affordability.
On November 25, 2008, a baby in Tampa, Florida, almost died from water intoxication and malnourishment. At 5 months, the baby weighed only 8 pounds, 6 ounces. His mother had not received enough cans of formula from WIC to meet her baby’s growing needs. She could not afford the $16 to $18 for each of the additional five to seven cans, and so she had been diluting what she did have with water.
http://www.examiner.com/x-1022-Orlando-Parenting-Examiner~y2008m12d2-Diluted-formula-nearly-kills-Tampa-baby

This mother said she had no idea that watering down her baby’s feeds would hurt him. Many mothers are not aware that WIC is a SUPPLEMENTARY food program. It was never designed to provide all of the formula that a baby needs, only part of it.

How can we prevent further tragedies?

That is the subject for another column, but here are a few, proven, methods.
We can:
- offer all mothers accurate information and practical help to enable them to get breastfeeding off to a good start
- give teeth to the current laws protecting women’s rights to nurse in public and pump and nurse at work
- ensure a safe, sustainable and affordable supply of formula for mothers who cannot nurse.

These are such simple things to do. They are worth doing to save the lives of our children.

See also:

http://children.webmd.com/news/20081126/melamine-in-us-baby-formula

http://www.msnbc.msn.com/id/28000145

http://www2.tbo.com/content/2008/dec/01/011656/authorities-diluting-formula-save-cash-almost-kill/

http://babycafejapan.blogspot.com/2008/09/melamine-and-breastfeeding.html

http://www.nrdc.org/breastmilk/formula.asp

How to Choose a Lactation Consultant

You and your baby deserve the very best care possible, from a qualified, experienced, and compassionate health care professional. Unfortunately, not all mothers get accurate, up-to-date breastfeeding information or support in a timely manner. Many of them struggle unnecessarily and end up weaning their babies prematurely. They often blame themselves, but the opposite is true. Mothers do not fail at breastfeeding. It is our society that has let them down.

Pregnant parents are often encouraged to interview and choose a pediatrician before their baby is born. It is also a good time to interview and choose a Lactation Consultant.

For example, did you know that anybody can call themselves a Lactation Consultant? However, only those with extensive experience and training, and who have passed an rigorous exam, are entitled to put the letters IBCLC (International Board Certified Lactation Consultant) after their name.

It is a good idea to schedule an interview (which should be free of charge) to see if the Lactation Consultant is a good fit for your family’s needs. Be sure to include these questions on your list.

What are your qualifications?

How many years have you been practicing?

When did you last attend a breastfeeding conference to update your knowledge and meet the continuing education requirements for recertification?

What kind of experience do you have? Do you work in a hospital situation where you see mostly newborns, or do you have a more general practice where you see the whole range of breastfeeding, from newborns through to older nurslings?

Did you nurse your own children?

Do you encourage mothers to call anytime for general information and to determine if their concerns warrant an office visit?

How flexible are your office hours? Do you schedule your consultations around babies’ nursing patterns ?

Do you encourage mothers to bring their partners or other support people to consultations?

Do you allow enough time during consultations to put everyone at ease and to address all of the mother’s breastfeeding and parenting concerns?

Do you take a complete history, offer a written care plan and do follow up?

Do you offer prenatal consultations to teach breastfeeding basics and help to build mothers’ confidence in their ability to both nourish and nurture their babies at the breast?

Do you offer consultations so that mothers who will be returning to work or school can discuss their options?

Do you have the knowledge and expertise to help mothers and babies who are facing special breastfeeding challenges?

Do you follow the World Health Organization’s recommendations on weaning?

Do you abide by the World Health Organization’s Code of Marketing of Artificial Breastmilk Substitutes?

How much do you charge and when are fees payable?

Is there a sliding scale for low-income families?

Do you offer special packages and gift certificates?

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