Breastfeeding Presentation - A little encouragement for me and other birth professionals

Hello all! I have been in a terrible hiatus lately as I over-prepared for my presentation. (Background: I'm now a pre-nursing major - officially nursing in the fall - and had a breastfeeding presentation for my nutrition class).

But right now I'm pumped at how the presentation went! I wanted to just share my thoughts, and I hope you'll find them as encouraging as I did.

Before the presentation, I was nervous about a number of things. I had a lot to talk about and not a lot of time. I knew this was probably one of very very few changes these pre-nursing and nursing majors would have to learn about breastfeeding, and I was determined to do it right. Besides the issues of a couple group members (yes, group project love), I had the issues of talking about breastfeeding without anyone shutting down because they felt guilty or didn't agree. I had a textbook that stated formula feeds once daily at three weeks were no big deal and didn't even discuss the supply and demand principle. 

I had already come up against nervous nursing types before the presentation. We had asked at the beginning of the semester if we could have someone come in and demo breastfeeding for the class - we were shot down. While the professor was supportive, the dean was concerned about repercussions and denied the request. When the class learned of this, I got some fun comments - "Someone would do THAT?!" "I would be so embarrassed." etc. The typical. 

My response: I knitted a breast hat for the baby doll and a breast model for our display. I also was lucky enough to be able to order to very cool breast model from Childbirth Graphics. 

Our group had divided up the work, and I had taken the overview portion of the presentation. About a month before the presentation, one group member had a family emergency and dropped, so I took her part as well. In the end, my topic list was the following:

• breast anatomy/physiology
• latch
• positioning
• oxytocin
• prolactin
• supply/demand priniciple
• maternal nutrition (calories and nutrients, tandem nursing, loosing weight, increasing supply, placentophagy).

And yes, you read the last one correctly. I was going to talk placentophagy (eating the placenta) to a bunch of nurses.

Needless to say I skipped breakfast that morning.

But....despite all this, I was very encouraged afterwards!

I started with the current recommendations (WHO and AAP) and compared the Healthy People 2020 Goals to the US and WV 2010 rates. I got some shocked looks that it was that bad - yes, it is that bad. (for reference, WV has a breastfeeding initiation rate of 52%, national average around 75%, goal of 82%.)

We talked about the breast, and I explained how latch works, how latch has to be effective to initiate supply and demand, how to tell a bad latch, how prolactin works, how oxytocin works, how you can use that information to understand how to increase suspected low supply, how demand at the breast is essential for supply, etc etc etc. A lot of nods, some lightbulbs going off about - maybe why it didn't work for them/someone they knew. I talked about maternal nutrition, about how much weight loss was average, how much typically began to effect supply, some considerations with what might be lacking in diet and what supplements were probably not necessary for the infant/mother, what things a mother might take to increase supply, and why some eat the placenta. 

Yes, placentophagy got some gasps, but I told them that I wanted to address the topic so they could gasp now rather than with the mother who asked for her placenta. Also addressed that some mothers may want the placenta for other reasons besides encapsulation (culture respect) and they needed to be ready to deal with such a request. 

I didn't get stoned afterwards.

In fact, I got a lot of questions and comments afterwards. "What about breast reduction - how does it effect?" "See, I had that problem too, that makes sense now." And on.

I'm so pumped about the feedback with this presentation; I can't even convey. I'm not naive enough (quite) to think that it's a huge impact - one class out of many, and many won't even make the nursing program in the end. However, there are a least a few nurses out there who know a little more about breastfeeding and who might be a little more supportive. Yes, unfortunately there are a lot of nurses out there who seem to know nothing about natural birth and breastfeeding. But there are those who do care...

And it's got to start somewhere right?

Thoughts on the birth battle

Recently I have been becoming more and more disgusted watching the arguments in the birthing world. I'm sad part of me is less "green" about it all, because I certainly like the hopeful, optimistic me. 

Part of this stems from my entering nursing school (well almost - I'll know by April if I'm accepted) in an effort to continue down my path to helping birthing women while trying to support my family. I feel like a spy in my classes with nursing majors, like I'm trying to figure out how the brain works to so blindly trust the medical model at the expense of common sense, mamas, babies, and families.

My conclusion: In many ways we're all guilty of the same blindness.

Both sides of the birth war use the same methods of guilt and anger, the same self-righteous attitude. 

Before I get hate mail, let me be clear that I am certainly on the homebirth, breastfeeding, unassisted if you want it side. 

But we're not free from the negatives - the failure to see some options as appealing to others even we will feel they're dangerous (so hard!). And to be honest, I don't know what we do about it - if anything.

It is absolutely true that we often make women feel guilty for not breastfeeding.

Mothers should feel guilty about not breastfeeding - just as they should feel guilty about giving a child a Coca-cola and a donut instead of milk and a banana.

But how do we prevent that guilt from turning into defensive rationalization and inability/refusal to change? How do we communicate with love, empathy, and understanding?

I think we have to start with these assumptions - we do not know all the reasons a mother may choose to do "X" and she is not at the same place we are.

The second assumption, to me, is the hardest and the most important. We can talk until we're blue in the face about the risks of not breastfeeding (which as a note is proven more effective than presenting it as the benefits of breastfeeding - study) but without long-term cultural change we are not going to get there with everyone.

I hate this.

The idealist in me wishes I could help everyone, save every mama and baby from a bad birth, but I can't. No one can. We can try our damnedest and then we just have to hope. Things may not change now, but down the road these seeds may sprout and bloom. We just have to keep planting and watering and weeding. 

Breastfeeding Misinformation begins with Doctors and Nurses

As some of you may know, I have recently gone back to school. I've applied to a local RN Associate Degree program and am working on related coursework. One of my courses this semester is Nutrition and Diet Therapy, and as part of the course requirements, we're presenting group projects. Yes, pregnancy nutrition was taken by the time I got to sign up, but I managed to snag breastfeeding.

I started by scanning my textbook (which is required as we're primarily presenting the text information and supplying research to compliment). I came across this gem: "The adjustments [of breastfeeding comfortably] are easier if supplemental formula feedings are not introduced until breastfeeding is well established, after at least 3 to 4 weeks. Then it is fine if a supplemental bottle or two of infant formula per day is needed." [Contemporary Nutrition: A Functional Approach]

I had a few choice words and then set out to find the research to disprove it. I'm presenting that here.

First - The statement goes directly against current breastfeeding recommendations. WHO states that "exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding with appropriate complementary foods up to two years of age or beyond" (Citation) American Academy of Pediatrics goes this far: Supplements (water, glucose water, formula, and other fluids) should not be given to breastfeeding newborn infants unless ordered by a physician when a medical indication exists.” and “Pediatricians and other health care professionals should recommend human milk for all infants in whom breastfeeding is not specifically contraindicated and provide parents with complete, current information on the benefits and techniques of breastfeeding to ensure that their feeding decision is a fully informed one.  When direct breastfeeding is not possible, expressed human milk should be provided." (Citation) Healthy People 2020 Targets are exclusively breastfeeding through 3 months - 46.2% and exclusively through 6 months - 25.5% (Citation)

Second: Formula Supplementation has been linked to early breastfeeding cessation: “Partial breast-feeding (supplementing more than one bottle of formula per day, measured at 1 month postpartum) was associated with shorter breast-feeding duration. This latter effect was minimized by frequent nursing (seven or more times per day), despite formula supplementation.” (citation) 

And finally: “Clinicians who recommended formula supplementation or who do not think their advice about how long to breastfeed is very important may be sending signals that exclusive breastfeeding is not something that mothers should value highly. In addition, our results indicate that many clinicians do not feel confident in their skills to support breastfeeding and may have limited time to address the issue during preventive visits. As for mothers, experiencing problems with the infant latching on or sucking seems to be a risk factor for not exclusively breastfeeding.” (Citation - I found the full article through Ebscohost and cannot link it directly. You can comment/email me for the file and I will be happy to supply it.)

I'm excited to use the information I've found to disprove such a fallacy and educate other nurses. Let's hope they listen...