Breastfeeding: Instinct or Instruction?

This brochure is cool — everybody needs to read it, particularly if you’re pregnant, a new mom, or have ever had breastfeeding problems with your current baby or a previous one. I will say that I do think that breastfeeding is instinctive… but that we’ve seen so many wrong and unnatural ways of feeding our babies, that this is what we automatically assume, thinking it’s what is right and natural. Have you ever noticed that one of your older children, or the child of a sibling or friend, has unconsciously or subconsciously picked up on some little habit, phrase, movement, or mannerism of one of their parents? If we only see women feeding babies with bottle, then that’s the way we’re going to automatically (but not necessarily “instinctively” or “naturally”) hold our babies. If everyone tells us that you must sit or lie down in this position in order to properly hold or position your baby, then you’re going to think that everything else is wrong… when it’s not necessarily so. We want to do what is right, so we listen to the “experts”; and as long as they’re telling us right, then that’s all well and good. But if they’re accidentally (or purposefully) leading us astray, then we would be better off shutting our ears and doing what truly is natural.

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The Size of a Newborn’s Stomach

This is an interesting article one of my facebook friends posted. It includes a little chart that shows the size of a newborn’s stomach, from day one through ten. On the first day, the baby’s stomach is only about the size of a shooter marble, and by day ten, it’s about the size of an extra-large chicken egg. So, the moral of the story is — don’t worry that you’re not producing very much milk those first few days, because the baby couldn’t tolerate it anyway! Funny how that works, huh? — the mom produces a tiny amount of milk but very highly concentrated (colostrum) in those first few days when the baby’s stomach can’t hold much, and then as the baby’s stomach grows, the mom’s milk “comes in,” and she produces enough to feed him. I wonder how many mothers have been discouraged in the hospital and perhaps even put off from breastfeeding altogether due to not producing “enough” milk right at the first. And even worse if this is at all reinforced by doctors or nurses, and she becomes one of those women who thinks she “just can’t make enough milk.” Sure, there are some who for reasons of hormones or surgery or something actually and truly cannot make enough milk; but these are a distinct minority. Most others just need encouragement, rest, and time with their baby to produce all the milk the baby needs.

Breastfeeding and PCOS

Wow, what a full post! You may or may not be familiar with “Hot Belly Mama,” but she recently gave birth to her first child under less-than-ideal circumstances (what that means, exactly, she has not said, just that her birth experience was not what she wished and hoped for), and in this post writes about her experiences with breastfeeding in the hospital.

She has PCOS, which, apparently, causes delays in breastfeeding and low milk supply in up to 30% of affected women. None of the medical staff at the hospital had any information for her on that, and she didn’t realize at the time that PCOS could affect her breastfeeding. The nurses couldn’t help; the lactation consultants couldn’t help; and, well, let’s just say that she began referring to her child’s pediatrician as “the evil Dr. Jones” for her much worse than lack of helpfulness — did nothing but promote formula (while saying she was 100% pro-breastfeeding). Also, the doctor refused to let the baby leave the hospital until she gained weight, without regard for the stress the hospital was causing the mother, without any apparent knowledge of how PCOS might affect breastfeeding and milk supply, without being able to help, without diagnosing the baby’s tongue tie and upper lip tie (which were also affecting her nursing ability [for a long post on tongue tie, click here]), and without any apparent regard for the parents’ already working with lactation consultants and being willing to go to the doctor every day until the baby gained weight (in other words, it’s not like they were neglectful parents, but were doing everything possible).

But the angel of the story was the La Leche League leader who did what none of the professionals apparently could do. Although she had no knowledge of PCOS herself, she started searching the internet for advice and information, and was able to help this new mother, when others could not or would not. When doctors and nurses get irritated by people who are willing to listen to those who are not doctors and nurses, or those whom they consider to be quacks, perhaps they need to be reminded of stories like this, and how a “regular person” was able to solve a problem that the others could not. This is not to say that the nurses and lactation consultants didn’t try — I’m sure they did. But they didn’t have the knowledge base to help, and although this woman was in the hospital for three days, the lactation consultants didn’t come up with the information to help her in that time. But a LLL leader did. Sometimes, it’s not education but dedication that matters.

Placentophagy

If you want to know why someone would choose to consume the placenta, here is a post by one such woman.

Before you click, first this disclaimer, from the post:

(This is not a post for judgment. If thought of eating the placenta for medicinal reasons makes you sick, just pass by this post please).

So, as my mother would always say, “If you can’t say anything nice, don’t say anything at all.” If you think it’s gross or disgusting (or, ahem, Dr. Amy, “fetishizing the placenta”), and you just have to say something, you can leave such comments here, not there.

The tears welled and I pushed the bowl away, looking up at the bearer, staring into his eyes, they looked down at me in offering: I bring nourishment. But I felt nothing.  Not an ounce of thanks or grace or contentment.  Not anger or sadness.  Just  blankness, emptied like a vessel that was once full to the brim with anticipation and joy, of grateful waiting. The nothingness was pulled thick like suffocating wooliness over my body, then my throat and finally my head. Emptiness had become the heaviest, scratchiest of weights. And I began to sob.

I’ve never experienced this — the only time I was sad or cried after birth was barely enough to be called “baby blues”, and was always or usually in response to (or at least augmented by) a lack of sleep, except perhaps for what might make anyone cry, such as the death of a loved one. Since I don’t seem to have a problem in this way, and I’m a bit squeamish, I haven’t been tempted to consume the placenta; but I can see that it could be a great benefit to many women. I got this link from a facebook friend of mine, and she said that the person she knows locally who dries and encapsulates placentas is very busy, so I guess a lot of women have already benefited from it, and are spreading the word.

But it was just…

NavelGazing Midwife has written a thought-provoking post on birth trauma and birth rape.

One thing that stood out to me (probably because of the recent posts “At least you have a healthy baby” and “You should be grateful“) was the discussion of trauma in the setting of societal norms. In part,

Is Postpartum Post-Traumatic Stress Disorder (PPPTSD) an illness of luxury? If we were huddled in a migrant camp, would we really be concerned that the doctor pushed our legs apart to do a vaginal exam? Or would the multi-rape experiences overshadow the minimal intrusion the roaming doctor or midwife does.

Is PPPTSD judged by societal norms?

When I was in sexual assault self-help groups (almost always led by therapists), there was a tendency among the women to rate the abuse, almost always minimizing their own. “Well, I was just sexually abused at twelve from the guy next door. She was six and it was her brother. She had it much worse than I did.” Over and over, we had to remind each other (and be reminded) that rating the abuse discounted our own.

This is one of the angles I was searching for — maybe I hit on it well, maybe not — in those posts. If we compare outcomes, results, feelings, failings, etc., we will probably find that we are both better off and worse off than others — comparatively speaking. But should we compare ourselves with ourselves? That’s not wise. If we compare ourselves and our situations with how good they could be, we can always find something lacking. If we compare ourselves and our situations with how bad they could be, we can always see that it could be worse. But does the fact that we are not the lowest of the low mitigate the fact that we are in some way suffering and/or in pain? Why should we compare the level of violation we feel to what someone else “must feel” from having been violated in a different way? Is that helpful? If it is, then perhaps we should; but I don’t think that it really is helpful.

In one way, it is this “comparative way of thinking” that may embolden some people to continue acting in a hurtful way. “Well, sure, I did X, but at least it wasn’t as bad as what this guy over here did!” Using that criteria and logic (or illogic), a mass murderer could justify himself by saying, “At least I didn’t murder millions of people, like Hitler and Stalin did — I only raped and murdered 50 women!” ?!?!?!? “Well I may have raped 10 women, but at least I didn’t molest any children!” ?!?!?!? Are comparisons really even valid, when you’re comparing a rotten apple to a rotten orange? They’re both rotten fruit! — why try to make it sound like either one is acceptable?!

One of the first comments on NGM’s post was from Rixa:

Pain (or suffering) is like a gas: it fills the available space, no matter how small or big.

Breast Reduction — Don’t Think So!

Although you can’t tell it from my head-shot, I would say I’m, um, “blessed” enough to qualify for a breast reduction should I want one. I don’t, for a number of reasons.

[Also, if you don’t have large breasts, you may be tempted to be envious of those of us who do. Don’t. It’s not all it’s cracked up to be. It would be nice to be able to walk into a clothing store and not worry about finding a shirt that either doesn’t button up the front; or that buttons up the front, but doesn’t gape. It would also be nice to wear the same size in top and bottom. I hate bra-shopping, because it’s almost impossible to find a good bra that’s comfortable for longer than a few hours. It seems that most bra manufacturers design bras for the average woman in mind, and then just add extra fabric to accommodate larger sizes. HAH! So, I just get them from Enell. They are comfortable and supportive. Most of my friends would have a drawer full of pretty bras of all different fabric types and designs; I counted myself lucky to find one that fit. Forget “Victoria’s Secret”! They only stock certain bra sizes — only up to, I think 38C, or perhaps 40C, and the biggest D size you could get was 36. I guess that’s their only definition of sexy. :-/ Also, I was always suspicious of whether guys were attracted to me or to them. Sometimes it wasn’t hard to tell with certain Mr. Wandering-Eyes! And finally — “the bigger they are, the harder they fall!”]

So, with all that I could say negatively against having large breasts, why wouldn’t I get a breast reduction? For many reasons! One would certainly be money. I don’t just have spare cash floating around to use on cosmetic surgery. But, let’s say I won the lottery or something… Nope! Still wouldn’t!

I’ve seen the surgery done several years ago on some cable channel (probably Discovery Health), and, well, let’s just say I sat there with my arms crossed over my chest in a protective fashion for nearly the entire duration of the show. Basically, they stuck a fat-melting-and-sucking rod into the breast and jiggled it around, back and forth, and in and out — making me cringe. Then, there was too much skin on the breast when they were done, and the woman would just end up with saggy boobs, so they had to do a breast lift or tuck. This involved (take a deep breath, everyone) cutting off the areola, drawing together the skin from both the upper and lower part of the breast, so that it wouldn’t sag, then sewing the areola back onto the breast. I don’t know if this is still the typical way it’s done, but the thought of it just makes me hurt vicariously. And the recovery is quite painful and long, as well. But that’s not the biggest reason.

The biggest reason is, quite frankly, the likelihood that I could not breastfeed future children, should I have any more. One of the blogs I read is by a woman who among other things had a breast reduction many years ago, prior to having children. She was very prepared that she wouldn’t be able to breastfeed when she finally had her son, because her doctor had warned her that she had only a 30% likelihood of being able to nurse her own babies due to the surgery. I just don’t think I could take that risk. Having nursed my two children, it would be extremely hard on me emotionally if I could not breastfeed any other children I might have — and made that much worse by knowing that it was due to some choice of mine, something elective that I did not need to have done. Yes, most babies don’t suffer ill effects from formula; yes you can still snuggle your baby even if you don’t breastfeed… but it just doesn’t seem the same to me. And it wasn’t for this other blogger either.

She was prepared for nursing not to work, but she wanted to try, just to see if she could. I’ve heard of other women who have had breast reductions, and were able to partially but not completely breastfeed. I’m not sure if that percentage of women who can breastfeed after a reduction includes only those who can completely breastfeed their children, or all women who have at least some retained ability to produce milk are included in that 30% figure. From what I understand, the reduction process (either the liposuction or removing the areola, or both) can interfere with the ability to breastfeed either by destroying the milk glands themselves, or destroying or “rerouting” the ducts that transport the milk from the glands to the areola. In the first instance, not enough milk would be produced; in the second, the milk would be produced, but could not reach the baby. So, it seems that some women who have a breast reduction will have some parts of the milk-producing or -transporting system be destroyed or compromised, but others will still be intact.

This blogger I’m referring to was able to breastfeed. Exclusively breastfeed. She went from expecting to have to feed her baby only formula, to being able to exclusively breastfeed for the first six months, and intended on breastfeeding him at least partially until he was twelve months old. She spoke most eloquently of the joy and satisfaction she found in breastfeeding, and particularly the pleasure of him contentedly nursing, needing nothing more than the comfort and milk she gave him. I would miss that. And I don’t want to.

2008 Breastfeeding statistics

In honor of World Breastfeeding Week, I’m trying to center this week’s posts on breastfeeding. The World Health Organization estimates that about 1.3 million babies around the world die every year from not being breastfed. Although the causes are multitude and much worse in “developing” countries (including things like using dirty water to mix the formula; diluting the formula too much to make it last longer; the natural antibodies and other protection that formula-fed babies miss out on that might keep them from developing devastating diseases in third-world countries), American babies are not immune to the ill effects of not being breastfed. Fortunately, we tend to have excellent medical care, so that the effects are minimal. Hopefully. [For premature infants, there is a marked decrease in necrotizing enterocolitis, which is often deadly, the more breastmilk the baby consumes. I forget the exact rate, but I think exclusive breastfeeding cuts the risk of this disease in half; even partial breastfeeding reduces the rate.]

It’s a national goal to increase breastfeeding rates, and to lengthen the time that babies exclusively breastfeed. So, how well are we doing? From the CDC’s official government statistics of 2008 come the following tables (I’m only including the PDFs that deal with breastfeeding):

Table 3, National Statistics asking if the child was ever breastfed (so I’m assuming even one time would be included) — only 62% of American babies were ever breastfed in 2008. That’s less than 2/3. Not good. The data is further broken down into how many weeks or months the babies were ever breastfed, with 9 months and 12 months both getting around 20%, and 18 months + being 10%. Considering the bias against nursing older children, and the number of mothers I know (either personally or via mommy groups online) that talk about trying to wean their babies at 9 months or by a year; and considering the looks women are given (or the rude, “Are you still nursing that child???) for nursing their older children, I actually assumed the numbers would be lower. There is also data about exclusive breastfeeding up to 3 months (12.9%) and 6 months (7.2%).

Table 7 looks at rates of breastfeeding, TV viewing and household smoking — an interesting combination to say the least! They’re broken down by states, with the national stats on the final line. I’m guessing that based on the high number of “0” in the various data fields that this information is incomplete for numerous states. For instance, California has zeros straight across, except in the number/rank of smoking, but it is one of the few states that has met the 2010 breastfeeding goals. Mississippi likewise has straight goose eggs (but I’m sure it’s *sigh* at or near the bottom for breastfeeding). So, make of that chart what you will.

Table 9 looks at the same rates as Table 7, but breaks them down by race instead of by state.

Finally, Table 13 looks at the trends in breastfeeding, with a summary of data from 2008 back to 1980. We’ve basically steadily improved in the last 28 years (how could we get any worse??), but we’ve still a long way to go.

Then there is some older data from the CDC — showing data from the 2000-2006, with some of the ’06 data still “provisional.”

  • 10 states – California, Colorado, Hawaii, Idaho, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington – achieved all five Healthy People 2010 breastfeeding objectives.
  • One in four breastfed infants are supplemented with infant formula within 2 days of birth. The corresponding rates of formula supplementation among infants who breastfed at least 3 and 6 months were 38% and 45%, respectively
  • Disparities in breastfeeding continue to exist, with non-Hispanic black and socioeconomically disadvantaged groups having lower breastfeeding rates.

At the bottom of the page are links to click to see the rates by state. If you click on the links, it will show you a map of the United States, with the different states in different shades of blue, with the legend indicating which percentile range the state is in. Depending on the data you’re looking at (ever breastfed, breastfed exclusively at 3 or 6 months, etc.), the range will be different — sometimes as little as a few points; other times as much as 10 percentage points.