Pregnancy, Prematurity and Pumping

First up — I was invited to do a guest post on the “Breastfeeding with Comfort and Joy” blog on my experience with pumping breastmilk for someone else’s baby. The post was inspired by this video, entitled “Prescription Milk,” which focuses primarily on the importance of babies — particularly premature babies — getting human milk for their nutrition.

It was so touching that the mother featured in the trailer chose to celebrate and memorialize her daughter’s brief life, by continuing to pump milk even after her own baby died, so that other babies might live.

My personal experience was that I had over-supply issues, so being able to pump extra was a blessing, instead of having to try to minimize my production. Some mothers may not be able to pump enough milk to feed their babies, but there isn’t enough donated milk to supply all the babies who need it. If you are currently pregnant or breastfeeding, or know someone who is, please look into becoming a milk donor through the Human Milk Banking Association of North America, your local hospital, some other organization, or (like I did) just giving a friend bottles or bags of milk. You have to be screened to make sure you aren’t carrying any diseases that may be transmissible through breastmilk, so get started on the process as soon as you can.

Pregnancy is the perfect time to start preparing yourself for breastfeeding. The best way to do that is to talk to women who have successfully breastfed, and watch women breastfeed. I emphasize, “successfully breastfed,” because so many women tell horror stories of how awful breastfeeding was, and how they ended up with sore, cracked, even bleeding nipples, or how they “tried to breastfeed, but I never could make enough milk,” or some other unsuccessful breastfeeding experience. You wouldn’t ask a poor man how to become a millionaire; you wouldn’t ask a teenager for tips on a successful marriage; and you definitely wouldn’t ask me for tips on how to run fast or throw a baseball. 😉 You would instead seek out someone who had been successful in whatever it is you were wanting to succeed. Likewise, don’t ask someone who had a horrible time breastfeeding for breastfeeding tips (even if the lactation person she saw at the hospital said she was doing everything right, or she is otherwise sure she did what she was supposed to do). Or if you do, don’t be surprised if you, too, have a horrible time breastfeeding! Instead, seek out those who had an easy time, who were successful, who had no pain, who nursed as long as they wanted to (and/or longer than they expected). If you don’t know anyone that fits that description, or feel awkward asking to watch them as they nurse their babies, don’t despair! There is a book filled with beautiful and intimate breastfeeding images, along with clear and simple text, to help you see what a good latch really looks like and how to achieve that.

Get the book now, while you’re still pregnant, read the text, study the pictures, take it with you to the hospital (or just keep it at your bed-side table if you’re having a home birth), and start breastfeeding off not just correctly but confidently. As World Breastfeeding Week draws to a close, let’s not just celebrate breastfeeding, but help support women as they breastfeed, and remove hindrances that would keep them from success.

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Update — I just noticed that WP has added a “like” feature to posts — that’s cool! 🙂

Diaper-free

I’ve mentioned “elimination communication” once or twice before on this blog, and the more I hear about it, the more interested I am in it. Here is a blog post from “Dr. Momma” on EC, including a video showing babies being pottied and interviews with their parents. There are many links to more information on that post, so I would encourage all of you who are even remotely interested (even if it’s in a “what in the world??” sort of way) to read it and/or bookmark it for future reference.

Breastfeeding and WIC

Today, I read this post, “Is WIC shooting the CDC in the foot when it comes to breastfeeding rates?” It was an interesting take on a couple of new studies that have been released: racial and ethnic disparities in breastfeeding, and how breastfeeding (yes, even in America,) could save over 900 babies’ lives per year, and reduce diseases and health-related costs. One thing the blogger pointed out is that women who sign up for WIC have lower rates of breastfeeding (initially, at 6 months and at 12 months) than women who are eligible for WIC but don’t sign up for it [and both WIC-eligible groups have lower rates of breastfeeding than women who are not eligible for WIC at all]. So, it appears that women who are in the lower socio-economic bracket are less likely to breastfeed than women who are in higher brackets (not eligible at all for WIC); but also that women who could get WIC (but don’t) have more success with breastfeeding than women who are on WIC. Taken at face value, it does appear possible that WIC may be undermining breastfeeding efforts. However, “face value” may be incorrect.

One of my friends who, among other things works with WIC doing lactation support, wrote a post on this article on her blog, citing some of the reasons why women who are on WIC have low breastfeeding rates, including among other things that they are more likely to have the low-income jobs such as working at a fast-food joint, and may not be able to pump enough to feed their babies, or face other such obstacles.

From the comments on the original blog, I learned more about what WIC does and how it operates. I had a vague idea, but since I had never “crossed paths” with it before, didn’t know much beyond that. One of my friends was on WIC during or right after her divorce, and I knew she got food as well as food stamps, but I didn’t know how much food she got just for herself and how much just for her children (and I’m not sure if she was breastfeeding still at the time). [There may be others in my acquaintance who are also on WIC, but it’s just not a topic of conversation; I know that some of my friends when I was younger were also on WIC, welfare, and/or food stamps, but it’s just not something I’ve ever had to deal with personally.] So, “the more you know, the more you realize you don’t know” — the comments on that post had some specifics for how much food a breastfeeding woman could expect to receive, and how much less (or perhaps even none at all) she would receive if she switched to formula-feeding (although she would receive free formula and/or coupons for it). It’s possible that I would have qualified for WIC (but I don’t know, since I never really even thought about applying). Had someone suggested it to me, I probably would have declined, because I wouldn’t have needed any formula, since I was planning on breastfeeding and staying at home, and not needing anything they had to offer.

I wonder how many other people have that same idea of WIC — that it’s a source for free or reduced formula — which would be a sort of “selection bias” that might skew the data about women who are eligible for WIC but choose not to be on it (or don’t realize they’re eligible), vs. women who get on WIC. To be honest, the researchers may have looked at this, but I didn’t read the whole report since it is quite lengthy. If they didn’t look at that, I think it would definitely skew the results, because more women who never intended on breastfeeding to start with, or who had less of a commitment to breastfeed, may have gotten on WIC at the outset, while WIC-eligible women who were planning on breastfeeding so “didn’t need anything WIC had to offer” (or so they thought, as I did, erroneously) stayed off it. Definitely food for thought.

Another possible skewing would be the barriers to breastfeeding that women who need WIC face, that women who are eligible for WIC but don’t get on it, may not face. For example, a stay-at-home mom who is making it on her husband’s income, though it’s tight, would not need to pump while at work; while a single mom would of necessity have to work (and pump, if she is to continue breastfeeding), which could cause moderate to severe difficulty with continuing to breastfeed.

In other words, there are reasons why there might be a difference in the women who are all eligible for WIC, with some getting on it while others don’t, and it might be this “self-selection” that causes the difference in WIC-eligible breastfeeding, rather than WIC “shooting the CDC in the foot” when it comes to breastfeeding support.

Newborn Photo Gallery

This is a really cool website, with pictures of babies with various conditions (and some who are completely normal, for comparison). Divided into various categories like ears, eyes, nose, mouth, etc., it covers lots of different problems, benign conditions, and “variations of normal” which are not problems at all. Some of the pictures were difficult for me to look at (particularly the pictures of the eyes, because I can practically start crying just by looking at someone else’s infected eye — my eyes don’t have to hurt at all and I’ll start sympathetically tearing up; or the pictures of the babies crying, which made me want to comfort them), but for the most part, they have been just interesting clinical pictures.

I discovered a new term — ear pits. I’d never heard that term before, but both my children have one, in exactly the same place on the back edge of the ear. It basically looks like a pock mark — a tiny depression like where a deep scab or a chicken pock had been.

And there were reminders of how awful and awesome genetics is. For instance, in the picture of the baby with the very low-set ears, it was discovered that he had Trisomy 18. Most babies with low-set ears do have some sort of genetic problem, such as Trisomy 18 or Down Syndrome.  There were another condition in which it was noted that although the baby had X characteristic, tests ruled out any renal problem. I forget what it was — something about his ears, I think — signified a higher risk of a problem with the kidneys. One might think that the ears would have nothing to do with the kidneys, but I would suspect (knowing what [little] I know of genetics) that the genes that control the development of the kidneys are in close proximity to the genes that control the development of the ears. There were a few other statements like that (and I’m only up to the “neck/clavicles” pictures), in which a physical finding was related to a higher risk of some internal problem. Which is interesting, to say the least.

h/t Diana at Birth at Home in Arizona

Update — one of my readers pointed out that there is a section on circumcision on this website, which includes pictures of babies for whom circumcision is contraindicated and when there is no medical contraindication. It points out,

Though widely practiced in various parts of the world, circumcision remains a controversial issue, with passionate feelings on both sides.  The AAP has a policy of “neutrality” on the issue, and many physicians agree that both the medical risks and benefits of the procedure are small, so usually the decision is made by the family for reasons that are culturally, religiously, or emotionally based.

So, in other words, it’s a medical procedure done for non-medical reasons, and may actually cause many medical problems, including losing the tip of the penis and even rarely death. There are videos of babies undergoing circumcision using three different methods, but I cannot watch any of them.

Twin Home Birth Story

Click here to read Robin Elise Weiss’s story of the home-birth of her 5th and 6th children — identical twin girls. A lovely story!

Breastmilk contains Stem Cells

Which means that formula is a very, very distant second place substitute for breastmilk! Click here to read the story.

In light of the untold benefits of breastmilk, it is important that hospitals (being where 99% of American women give birth) support breastfeeding women. Instead, there is subtle (and sometimes not so subtle!) undermining of women in various ways. One of these ways, is by sending women home with a “diaper bag” or some other sort of bag, filled with all sorts of things designed to get them to choose formula — samples and coupons, at a minimum. There is an alternative: Healthy Baby Bounty Bags! This link has a sample letter you can print out and send to your hospital, to let them know about these breastfeeding support bags, as well as a picture of them and more information.

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Today’s news of my pregnancy — no more bleeding, no more red, only slight spotting, of brown, and very little to none of that within the last 24 hours. Thank you, everyone who commented! Your experiences have helped me feel better. Will keep you updated…

[Update — I did end up miscarrying soon after writing this.]

“Baby Wise”

Recently, I made a comment about not liking the “Baby Wise”,  and one of my readers asked me why.

I’ve not read the books, although I have read excerpts of the book that people have put online, and I’ve seen it in action with several of my friends and acquaintances. It just seems to be completely unnatural, and it is antithetical to attachment parenting which is what I favor.

I’ve heard many women say that they had to supplement with formula, because they didn’t make enough milk. Well, breastfeeding is about supply and demand; and if the baby doesn’t “demand” enough — isn’t eating enough — the mother won’t produce enough milk, which is why supplementing with formula frequently leads to complete cessation of b/f-ing the baby ends up nursing less and less, instead of more and more. Also, physical contact between mother and baby helps improve milk supply; and the BW program dictates that children never nurse to sleep (one friend said she “had to” wake up her children when they fell asleep nursing, so that they could learn to fall asleep on their own – why?), and also has set times when children — infants — are to “play” or be on their own, alone in their cribs – why? So they can become accustomed to amusing themselves and not bothering mommy, I suppose. The reality is, that infants do best when they are with their mothers and with their family basically as much as possible – they learn more by observation, they feel comforted and cuddled when held, etc.

The female body is designed to nurture her babies, to give comfort and sustenance — the maternal hormones dictate it, for one thing. Labor is started and helped on by oxytocin coursing through the mother’s body — oxytocin is also the hormone that is released during breastfeeding, as well as during orgasm. It is a bonding hormone. Nursing our babies makes us feel bonded to them; natural labor (and particularly a vaginal birth) floods women with oxytocin, which is one of the reasons why women have such a strong maternal response immediately after birth, and just want to hold their babies for hours. When a baby cries, nursing mothers experience milk let-down. (Some are worse than others – I recently read a humorous story about a woman running to the store for something and leaving her baby at home, and a baby in the store cried, or she called home and heard her baby crying in the background, and *whoosh* she started leaking.) That is the normal, natural response. It is an artificial response for a mother to hear a baby cry and look at her watch and see how many hours and minutes have passed since the last time the baby ate, to see if the baby might be hungry.

Sometimes babies just get hungry or thirsty oftener than every three hours. Don’t adults frequently want snacks or a little something to drink? It is not physiologically normal for a newborn to sleep through the night, yet that is one of the big benefits pushed by the proponents of BW. An alternative is to have the baby with you in or near your bed, so that when the baby wakes up for nourishment, you can get him without having to get up, and you can basically “sleep-nurse” — with neither you nor the baby fully waking up. Studies have shown that both mothers and babies get more total sleep and mothers wake up more refreshed when they have their babies sleeping close by, rather than having to get out of bed, go down the hall, nurse the baby back to sleep, and walk back up the hall, and back to bed.

Another “selling point” of BW is that babies are learning to be disciplined, and scheduled — specifically so mothers can plan their days around their babies scheduled naps, instead of having uncertainty. Well, this much I can tell you — with children, there *will* be uncertainty! 🙂 Many children self-regulate or self-schedule — you can practically set your watch on their sleep-wake schedule (even without BW); but there will always be *something* that could disrupt your plans. Even the most scheduled child will have days that are “off schedule” — something will happen that will wake them up early, they’ll go through a growth spurt, have an earache, be teething, whatever, and it will throw everybody for a loop.

Frankly, aside from sleeping through the night at an abnormally early age, I don’t see any of the supposed benefits of BW, in any of my nieces and nephews. Disciplined? Scheduled? No more than anyone else. I think that the way you raise your children in the toddler years have a lot more to do with how they act in life, than how much they are scheduled as infants. It’s the “daily grind” of child training — teaching children to be polite, not interrupt, etc., that has more to do with how children act than whether or not they were schedule-fed as infants. I know lots of kids whose parents followed BW, and lots of kids whose parents did not follow BW, and lots of kids that I don’t know, and I can’t tell a difference with any of them.

Several years ago, I read a description of a study scientists did, in which they took a dog, and put it in a large box, that was rigged so that it would give an electric shock on one side of the box or the other. Whichever side of the box the dog was on, the researcher would shock; of course, the dog would jump over to the other side of the box… then the researcher would shock *that* side, and the dog would jump back. The dog would do this for some time, until it finally figured out that it was useless to try to avoid the shock, and finally it just laid down on the box, and let himself be shocked repeatedly. Psychologists call it “learned helplessness.” That, to me, is what BabyWise is. Somehow, I think that when children learn that they are helpless, that’s not a good thing; but when they learn that their mothers love them and care about them (which infants learn from being held, cuddled, loved, nursed, having their needs tended to), they build self-esteem, and feel valued.

Granted, some people let their children walk all over them, which is probably one thing that helps to swell the ranks of the BW contingent. I’m not necessarily advocating that women drop everything at the first hint of a whimper from their three-year-old to tend to his every whim! But it’s not like you have to choose between being ultra-strict and ultra-indulgent — there is a lot of middle ground, and plenty of room to find the right balance of tenderness and strictness.

Another reason why I don’t like it, is that in the earlier edition(s) at least, the author claims to get his authority for his ideas from the Bible. [I think the newer versions are much less “Scriptural”, thankfully!] I’ve read excerpts that make my skin crawl. He seems to have a myopic view of God and the Bible, and, I would say, he wrests the Scripture to fit his predetermined views. The worst thing, which literally made my jaw drop the first time I read it, was when he based his view that children should be left to cry on their own, on Jesus’ saying on the cross, “My God, My God, why hast Thou forsaken Me?” I forget exactly what Ezzo said, but it was something along the lines of, God didn’t respond to Jesus’ cries, so parents shouldn’t respond to their children, either. In trying to find the exact quote (it was some time ago that I read it, and I’m thinking it was a comment on some blog post or article that I read a few years ago), I found this pdf file which mentioned it, in the context of a critique of the book or system, or whatever you want to call it. I’m going to be saving the pdf file to my bookmarks (I haven’t read the whole thing yet; but what I have read, I agree with), so I can have it on hand to share with Christians who might be persuaded into thinking that Baby Wise is founded on clear Scriptural principles.

Concerning Scripture twisting, GFI faults us for quoting a public statement from Focus on the Family that noted that the Ezzos have “repeatedly cited Matthew 27:46— ‘…My God, my God, why have you forsaken me’—in support of their teaching that mothers should refuse to attend crying infants who have already been fed, changed, and had their basic needs met”. GFI says they are concerned with our use of Focus’s statement because “when Focus on the Family was informed they were misquoting the Ezzos on this point, they dropped it from their correspondence.” Focus’s current statement, however, once again expresses concern with GFI’s misuse of Matthew 27. In addition, Focus Vice President Hetrick states, “Focus did not misquote the Ezzos; we quoted their materials accurately.”

In defense, GFI’s critique states, “The Ezzos don’t for one minute believe or teach that Jesus hung on a cross to teach us that mothers should refuse to attend crying infants.” Rather, the “Father’s nonintervention in the suffering of His Son is the ultimate example that speaks against the fraudulent notion that love always requires immediate intervention.” To employ this idea in the context of a discussion of how mothers should respond to their crying infants, however, is to use Christ’s suffering to justify a practice of letting a baby cry. Since Christ’s suffering on the cross for our sins was a unique event for a very specific purpose, it should not be used even indirectly to justify letting infants cry. Furthermore, God did answer Jesus’ cry on the cross (Ps. 22:24).

Updated to add… I’ve read through the whole pdf, and would recommend it for anyone to read. If you’re not a Christian, parts of it won’t be applicable to you; but there are many sections that deal with non-religious concerns about the Ezzos’ program (not solely “Baby Wise” but the whole program, although they bring up multiple concerns about things like breastfeeding, failure to thrive, etc.), that would be beneficial for anyone to read. Also, the parent website that the pdf was on has multiple sections with in-depth bulleted “Summary of Concerns.” For instance, in the “infant feeding” section, it says:

  • Lack of expertise and credentials. The primary authors of the material, Gary and Anne Marie Ezzo, are self-proclaimed experts. Gary Ezzo has no background or expertise in child development, psychology, breastfeeding, or pediatric medicine, and holds neither an associate’s nor a bachelor’s degree from any college; his master of arts degree in Christian ministry was granted through a program that awarded credit for life experience in lieu of an undergraduate degree. Anne Marie Ezzo worked only briefly as an R.N. decades ago. It is unclear what, if anything, Babywise co-author Dr. Robert Bucknam contributed to that book, since the earlier religious versions are essentially the same with additional material and do not have his name on the cover.
  • Risks for breastfeeding mothers and babies. Breastfeeding on a parent-determined schedule (including a “flexible routine” as it is called in Babywise) may reduce a mother’s milk supply and contradicts the recommendations of the American Academy of Pediatrics (AAP), which has stated, “The best feeding schedules are the ones babies design themselves. Scheduled feedings designed by parents may put babies at risk for poor weight gain and dehydration.”
  • Poor breastfeeding information. Although it is presented as authoritative, the breastfeeding information presented in Babywise is inaccurate and substandard (compare with the AAP Breastfeeding recommendations from the 2005 AAP Policy Statement on Breastfeeding and the Use of Human Milk).
  • One Size Doesn’t Fit All. All babies and mothers are treated alike without any respect given for individual differences in breastmilk storage capacity, rate of milk synthesis, rate of infant metabolism or stomach capacity.   In actuality, the number of feedings one mother’s body requires in order to supply her baby with plenty of milk each day will be quite different from other mothers around her. Similarly, breastfed babies need varying amounts milk in varying numbers and sizes of feedings, and they do not feed exactly the same way from one feeding to the next in any case. Ezzo seemingly expects all babies to respond in an identical manner.  This is no more realistic than expecting adults to consume the same amounts of food on the same schedule and grow (or lose weight!) at the same rate.
  • A high-pressure presentation impacts parents’ perception of what is at stake:
    • Pressure to maintain the regimen. The rules for sleep, feedings and wake time are portrayed as critical to follow in order to achieve a healthy outcome, while health and behavior problems for the baby, and sleepless nights for the parents, are predicted if the program is not followed. (Flexibility is praised but is described as small, short-term adjustments to the prescribed regimen. Parents are warned against making open-ended adaptations.)
    • Misplaced moral dilemmas. How well the parents and the baby adhere to the program is framed as a moral or biblical issue (e.g. permissiveness on the part of parents, uncooperativeness on the part of the baby).
    • Parents are reluctant to give up on the method. Health care professionals have observed that even when their babies were doing poorly on the program, parents often wanted to stick with it.

That alone is enough to bolster my opinion of this program’s faults and potential hazards. Furthermore, the pdf noted a serious discrepancy between what the Ezzos claimed, and what they could prove, as far as the number of pediatricians who recommend their program:

In the same context, we also noted that the Ezzos “have claimed to have a ‘network’ of ‘hundreds of pediatricians’ who provide them with ‘expert medical advice,’ but they have refused to provide the list when asked.”

GFI responded by noting that they have just started printing a list of their “medical advisory board” in the latest editions of PFP and BABYWISE. This is not the list of “hundreds of pediatricians” the Ezzos have claimed to receive advice from, however, but includes only 32 M.D.s, not all pediatricians, whose familiarity with and input to the GFI materials has been questioned.”

And, the Ezzos disparage feeding on demand (obviously! they’re huge proponents of scheduled feeding!), to the point that they will (apparently) not accept criticism from anyone who supports feeding on demand, saying they are all biased. However, as the pdf pointed out, “To require that a critic of the Ezzos not support demand feeding would be to effectively eliminate all challenges based on standard medical advice.” Yet, one of the ex-BabyWise mothers said that while the book said to “feed your child when he’s hungry,” other parts of the book said that if you feed your child more than every three hours, then the baby’s schedule will be disrupted, and it could cause problems. So which is it? Feeding your child when he’s hungry is feeding on demand.

Doing this research has strengthened my dislike for this program. The pdf has made me aware of issues that I had not known before about the Ezzos (particularly, their apparent divisiveness and near cultish behavior as regards this program.  It does not make me think any the worse of anyone who has used this program, but this confirmed my initial thoughts, from the first time I’d ever heard of scheduled feedings (back when I was a teenager), all the way up through now.