Tuesday, July 27, 2010

Breastfeeding: Another Way of Saying "I Love You"

Mississippi's WIC program has a new video on their web site entitled, "Breastfeeding: Another Way of Saying I Love You." The 15-minute long video explains why breastfeeding is important and follows several moms on WIC and covers everything from breastfeeding a pre-term baby to returning to work full-time and pumping. What do you think of this campaign?

Breastfeeding: Another Way of Saying 'I Love You' from MSDH Communications on Vimeo.

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Tuesday, July 20, 2010

Guest Post: Breastfeeding Counselor Chronicles: African-American Moms

Today I am pleased to present a guest post by Saray Hill, an IBCLC who worked with low-income African-American moms as a WIC breastfeeding counselor. Here she recounts her experiences working with the moms, shedding some light on the low breastfeeding rates in this community.

Working as a breastfeeding counselor with African-American moms in California in a disadvantaged area posed many barriers. Women had to deal with the lack of food on the table, often the absence of a partner and multiple children in the household which, in some cases, were with multiple partners. There was also an overwhelming lack of breastfeeding support among family members, friends and employers. When discussing breastfeeding with them, I frequently heard the reply, “Breast is best, but I’m not going to do it.
 When I questioned them further as to their reasons, answers ranged from, “I have to go back to work”, “Breasts are for my man, if my man’s sucking on them, I don’t want a baby sucking on them”,  to “I will be leaking.
 For many of the moms, there was even the fear of having sexual thoughts or sensations while nursing. Many sexual connotations were brought up that gave my idea of breastfeeding a whole new meaning. Also, the baby’s gender was frequently a factor in whether the baby would be breastfed. If the baby was a girl, possibly. But a boy? No way. 
Every piece of information given to these moms that contradicted their breastfeeding beliefs was not enough to change them.

After a counseling session, some of these moms would come out with a new breastfeeding mentality that would lead to them pumping their breasts and bottle-feeding the breastmilk to their babies. Even though this was a huge improvement, it still wasn’t direct breastfeeding. Remember, breastfeeding is not just about nourishment, but also about nurturing and bonding. Realistically, how would a mom be able to establish a full milk supply for her newborn by exclusively pumping and with all of the barriers they were up against? That’s right. Not very easily.

I remember a case where a mom decided to pump and bottle feed her breastmilk to her baby and, in the end, became dedicated to fully breastfeeding. However, her situation was a bit different as this was her first baby, she had a family support system and there was a partner present. But, they knew nothing about breastfeeding and didn’t identify much with it.

There were also expectant moms who were very excited about breastfeeding. It made my day whenever I met one of them. I would share resources and we would have a seemingly great connection, but I would never hear from or see them again after they left the office. Their phone would be disconnected or they wouldn’t return my phone calls. Basically, they would disappear, only to reappear a few months later after they had their baby, who was now being formula fed. When I would ask what happened, the responses I received were that it hurt when they breastfed, or the baby was crying all the time, or he/she was always hungry, or the hospital gave the baby a bottle and many more. These are sad situations as the reasons given could have been explored and prevented if I would have been able to follow up throughout their pregnancy and given them the anticipatory guidance needed to avoid these situations. Where were their OBGYNs, nurses, pediatricians and lactation consultants when this happened?

There were some truly excited moms who would breastfeed. These moms were typically younger than 25, it would be their first child and they would have a mom and family support to count on. It would not matter if the partner was involved, as long as her family approved of her decision to breastfeed her baby. Usually, somebody in her family had breastfed and recommended it. In some other cases, the baby's father was involved and wanted the baby to be breastfed.

I would sporadically encounter a mom who had breastfed her first child, but didn’t want to breastfeed this child or would breastfeed him/her for a shorter length of time. Things become increasingly more difficult when there’s more than one child in the household and a lack of a solid support system.

I met a mom who said she would not breastfeed because it was very painful with her first child. After counseling with myself and other staff members, I helped her achieve a comfortable latch. She said, “You just helped me get over my past trauma about breastfeeding...thank you, but I’m still not going to do it.

I believe that some of these women who refused to breastfeed were listening when we discussed the risks of artificial infant feeding, but they didn’t want to publicly admit it as they were scared to try breastfeeding. They knew it was best for their infants, but if they decided to try, who would they turn to if and when a challenge should arise? Their families either had never done it or were unsuccessful. The pediatricians? They have no time for breastfeeding problems. The breastfeeding counselors? We just weren’t available 24/7. All these factors make artificial feeding more attractive and enticing.

I believe the best way to help African American moms embrace breastfeeding is not just by educating them, but by educating their family members as well. Building a support system with breastfeeding-friendly healthcare professionals. Connecting to community members -- real people, just like them, who care about how artificial feeding is affecting the health of their youngest and future generations. These community members need to work on creating a breastfeeding family acceptance support system to encourage and support the young mothers to breastfeed and help design a more caring and humane society, from the very beginning, through bonding and nurturing. They simply can’t do it alone; it takes a village.......

Saray Hill, BS, IBCLC, RLC is the Founder/President of Mother's Utopia , an organization focused on supporting, protecting and promoting breastfeeding. She is also the creator of the only Twitter breastfeeding support party in Espanol, El Club de Lactancia.

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Friday, July 16, 2010

Formula Companies Say WIC & US Government Shouldn't Discriminate

I came across a really interesting article in the Washington Post titled, “Lobbying fight over infant formula highlights budget gridlock.” You may or may not be aware that in the United States, the biggest purchaser of infant formula is the US government via its WIC (Women, Infants & Children) nutrition program. Basically, the formula companies offer state governments rebates (sometimes as high as 98%) of the wholesale cost of the formula in exchange for an exclusive contract. They’re not being benevolent; they know that WIC doesn’t give a mom who’s formula feeding full-time enough formula to get her through the month and they’re betting when she does have to come out of her own pocket to buy formula, she’s going to stick to the brand she gets for free from WIC. To put in perspective how much WIC spends on formula, the WIC budget for fiscal year 2009 was about $7.3 billion and about $850 million went to the formula companies.

So you’ve noticed lately that the formula companies have all kinds of extra special ingredients they’ve added to the formula. These additives are things that are naturally found in breastmilk, like DHA, ARA and probiotics. Of course these additives are not the same as what is found in breastmilk, because that’s impossible. So the formula companies have to get them somewhere else, like from algae. There’s no proof that these additives confer any benefit to the baby, save for a few formula-sponsored studies. But of course these new formulas are more expensive, and as they add in more functional ingredients, the original, regular iron-fortified versions disappear from store shelves.

What does this have to do with lobbying? According to the Washington Post article,

“When WIC was reauthorized in 2004, Congress tucked in language telling states that when soliciting bids for infant formula, they could not require manufacturers to include or omit specific ingredients. You can guess what happened next: Formula makers began submitting bids only for the costlier products. A February 2010 Agriculture Department study pegged the added cost at $91 million annually, more than a tenth of the infant formula budget. Now new formulas with even more ingredients -- and even higher prices -- are being offered through WIC. With WIC up for reauthorization, the Senate Agriculture Committee has approved a measure to require the Agriculture Department to assess the additives. A House committee this week is poised to consider a similar provision that directs USDA to get the best scientific advice before deciding whether to provide costlier foods with extra ingredients.
Not surprisingly, formula makers -- Abbott, Nestle and Mead Johnson -- are lobbying hard against the provision. So is the manufacturer of the additives, Martek Biosciences Corp., which has brought in well-connected Democratic lobbyist Lanny Davis. “

There are a lot of issues here we could tackle. First, is the too cozy relationship the formula companies have with WIC. The fact that the infant formula companies are spending big bucks to lobby in Washington proves just how lucrative this business really is, and what a shame that such an inferior product is being fed to the majority of babies, some from day one. We could also focus our rage on how although the FDA has approved these functional ingredients as “safe,” no one can prove there’s any actual benefit for babies, and if there were, what does that say about the infant formula business? Essentially they’re making it all up as they go along, constantly tweaking the recipe. It’s one big experiment, so for the babies who got 2001’s version, uh…sorry about your eyesight and IQ points.

While all of these aspects of this saga make me stabby, I have to admit I wasn’t expecting the formula companies to pull the race card. But lo and behold they did! According to the International Formula Council, which is made up of representatives from Nestle, Enfamil & Similac, to not force WIC to buy the formula with the functional ingredients would create a “two-tiered system, in which nutritionally at-risk WIC participants, many of whom are minorities, are denied access to products widely available to the general public.”

Are you as disgusted as I am? And do you, for one single, solitary second believe that the formula companies are worried about the health and fate of black and brown babies? And while I do appreciate their “concern,” wouldn’t a better way for them to prove how much they care about poor babies of color be to stop aggressively marketing their product to their mothers? Or perhaps they could back off, and let the decision be based on science, not their own bottom line? Maybe they could think about how, if formula eats up even more of the WIC food budget, that means less fruits and vegetables for WIC eligible families. Heck, since they care so much about the poor, maybe they should think about all the families who will no longer be able to receive WIC because there won't be enough money to go around once we cover their worthless functional ingredients?

I think we all agree that if the ingredients were really going to make a difference, and protect and nourish formula-fed babies in a manner more like breastmilk, that the increased cost would be justifiable and we'd be all for it. So if the formula companies are so sure that their new products are superior, why not let scientists--ones NOT on their payroll--determine it?

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Thursday, July 15, 2010

Quote of the Day: Michelle Obama

"And finally, it’s one thing we can think about, is working to make sure that our kids get a healthy start from the beginning, by promoting breastfeeding in our communities. (Applause.) One thing we do know is that babies that are breastfed are less likely to be obese as children, but 40 percent of African American babies are never breastfed at all, not even during the first weeks of their lives.

And we know this isn’t possible or practical for some moms, but we’ve got a WIC program that’s providing new support to low-income moms who want to try so that they get the support they need.

And under the new health care legislation, businesses will now have to accommodate mothers who want to continue breastfeeding once they get back to work. (Applause.) Now, the men, you may not understand how important that is. (Laughter.) But trust me, it’s important to have a place to go."
Michelle Obama, in speech to NAACP, July 12, 2010

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Wednesday, July 14, 2010

Wordless Wednesday: Breastfeeding in Fashion Ad

1993 ad for Bisou Bisou

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Saturday, July 10, 2010

Guest Post: How do you know when you'll stop breastfeeding?

I'm pleased to present a guest post today by Karen Angstadt about what happens when you reach your original nursing goal, but you and your baby want to continue nursing. Did you originally think you'd breastfeed for 6 months, then go on to enjoy breastfeeding for two years or more? How did you feel, and when is the right time to stop?

When I was pregnant, I hired a doula. She was a very warm woman who knew a lot more than I did about birth and breastfeeding. She had a big impact on my breastfeeding success because she was available by phone to help with questions and even came to my house to help me correct my daughter's latch.

What was less obvious to me was how her actions impacted how I viewed breastfeeding. When we met, she was "still" breastfeeding her nearly-3 year old son. I liked everything else about her, so I didn't voice my discomfort with the idea of nursing a toddler. But I "knew" I'd never be OK with that.

My plan was to breastfeed for a year. It was a challenge, especially after going back to work when my baby girl was only 10 weeks old. But that year of breastfeeding and responding to my baby changed me. I understood in a whole new way that weaning at the one-year mark wasn't as obvious as it once appeared.

My baby girl had no sense of weeks and months. She lived in the moment. And when I was with her, especially during breastfeeding, I lived in the moment too. It was time away from deadlines and hurry. It was a comfort for both of us to reconnect and cuddle.

So when her first birthday arrived, it just didn't make sense to stop. We were connected and both our needs were being met. We continued through toddlerhood until past the midpoint of my next pregnancy, when she told me the milk "tasted funny" and I had been encouraging weaning due to breast tenderness. We agreed when the baby arrived and the milk returned she could nurse again.

She is now five and her sister nearly three. Little sister is still nursing two times daily, and appears to have no interest in stopping soon. Big sister will occasionally ask to nurse alongside her sister, and although I understand in a way that I never thought I would, my old prejudices about age still sometimes creep in at these moments.

Do I let her? Sometimes. Either way, I do my best not to let my old way of thinking, since proven incorrect, be the leading voice in the decision. 

Karen Angstadt is a birth mentor, wise woman and mother of two. Karen is the founder of Intentional Birth  and the host of A Labor of Love radio show on VoiceAmerica. 

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Saturday, July 3, 2010

"A Crisis in the Crib" Carnival: How can we save the lives of black babies?

"Disparities are differences that ought not be..."

Did you know that the United States is ranked 29th in the world when it comes to infant mortality? That over 400 babies under the age of 1 died in Shelby County, Tennessee in 2006 and 2007? That black babies are three times more likely to die before their first birthday? That in some places, like Memphis and Milkwaukee, the infant mortality rates for black babies are more in line with third world countries than the wealthiest nation in the world?

These are some of the sobering statistics brought to light by the "A Healthy Baby Begins With You" campaign, created by the US Office on Minority Health and featured in the documentary A Crisis in the Crib.

As we see in the documentary, the campaign has taken a unique approach to helping lower the infant mortality rates. The campaign focuses on pre-conception health, hoping to improve health outcomes for babies by making sure their mothers and fathers are as healthy as they can possibly be before they even decide to have children. To this end, Tonya Lewis-Lee, the face of the campaign, traveled around the country speaking to high school students about why taking care of themselves is so important.  In one scene, when she asked if anyone in the room knew of someone who had lost a baby, several hands went up, including one teenager whose sister had died at 5 months of age after weighing a mere 12 ounces at birth, and never leaving the NICU.

In addition to having Tonya Lewis-Lee as the spokesperson, the campaign also created a Pre-Conception Peer Educator Program (PPE) which trained minority college students to go into the community and speak to people about pre-conception health, including preventing STDs and how a father's health can impact the health of his babies. They gave people pamphlets and hosted free health screenings. I loved the grassroots outreach and think this is a great way to reach people where they are, as well as educate college students about healthy habits, which let's face it, most of us were not too concerned with.

So after reading all of this you're probably thinking that it's outrageous and sad that there are still such health disparities, but that poverty is a huge factor here and that these disparities won't disappear until families pull themselves out of poverty. Eh eh. As shown in the documentary, black women who are middle class, college-educated and have access to health care are also three times more likely to lose their babies in their first year of life.

Let that marinate for a minute. For black women, the greatest determining factor of whether or not their babies will die in the first year of life is their race. In fact, studies have shown that black educated women had higher infant mortality rates than white high school drop outs. I think that this is one of the most powerful messages of the film, that even if we were to get everyone in our communities healthy and seeing a doctor regularly, that racism would mean that our health outcomes would always be worse. The stress of being a black woman in America trumps healthy habits.

And while I think that pre-conception health is vitally important, that battling systemic racism in the healthcare field is a lofty goal, and that preventing babies from being born too small and too early is going to make a huge difference in these numbers, I was sorely disappointed that the words "breastfeeding" and "breast milk" were not uttered once in the entire film.

Increasing breastfeeding rates in the black community is actually not even one of the campaign goals, which I certainly find to be strange. The film shows several families who have babies in the NICU and not one mention of these moms pumping breast milk for their babies or how breast milk can literally be the difference between life and death for a preemie in the NICU. As I sat and watched a couple in tears, sitting next to their baby in an incubator, talk about how they spend 24 hours a day in that hospital and wish there was something they could do to take the baby's pain away and make her better, I was shocked that breastfeeding was not mentioned as a way to save the lives of black babies. In fact, I only caught one mention of breastfeeding and only because I am eagle-eyed and was really looking for it. At the 29:58 mark, there is footage of a health fair where a pamphlet from the Shelby County Breastfeeding Coalition is sitting on a table, next to some bottles, a hand pump and breast shells. That's it. Sigh.

Although "enjoy" seems to be the wrong word, I really did learn a lot from this documentary and I would encourage you to take the 30 minutes to watch it. If you know a young person of color who is a college student, send them some information about the PEP. More people need to understand how prevalent infant mortality is and that simply by being black you are at a greater risk of losing your baby before his first birthday.

This is an important film and a topic that is not discussed nearly enough amongst activists. While some  spend their time getting enraged over what are deemed to be unnecessary interventions during labor, we'd all do well to remember that across this country sisters and their babies will be at a disadvantage before they even get to the hospital, and even if they have a perfect, intervention-free birth. Our babies are dying and they don't have to be. These disparities ought not to exist.

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