Intro

All content of this blog is my own opinion only. It does not represent the views of any organisation or association I may work for, or be associated with. Nothing within this blog should be considered as medical advice and you should always consult your Doctor.

Baby is using you as a dummy - it's just for comfort!

Perhaps the most frequently uttered words on parenting forums and groups worldwide and every time I just want to shout "yes a baby getting comfort from it's mother - perish the thought, quick ring a baby tamer - otherwise they will be breastfeeding at fifteen and co-sleeping into their twenties!"

What is the big problem in our culture with young infants being dependent on their mother?  I know at the moment there are big social pressures to leave the baby ASAP and reclaim independence, but they are so teeny and dependent for such a short time.  Believe it or not very quickly it's over and baby is busy exploring the world, too busy to want to spend hours with mum, and the time when mum can meet every need with just her body is gone forever.  The breast meets every need a young baby has; hormones to help them sleep (yes this is why your baby want's to feed to sleep, yes it's normal, no they won't do it forever!) nourishment, immunological protection, warmth, security, the list goes on and on...

Non nutritive sucking (or "just for comfort") is the fluttery sucking that happens at the end of a breastfeed, when the rhythmic swallow pattern has ceased.  It is hugely important to a baby on many levels: neurologically, psychologically and physically - so much so that if a baby is bottle feeding, they should have access to a clean finger or pacifier.  But lets really look at what that is - it's an artificial nipple, a copy, a substitute for the real thing; even the name "dummy" tells you exactly what it is.  When baby refuses it in favour of their mothers breast, the real thing, should we really be surprised?   If someone wants to use a dummy, and is aware of all the implications (which I will come onto in a moment) - that's absolutely their choice, but we have gone far beyond that, to where a mother nurturing her infant is no longer desirable or even normal, instead the idea panics many - mum is told "bad habits" will form, or he will never sleep, or whatever other fantastic myth someone has decided to attribute to it - ah yes he was a late potty trainer, well that's because you breastfed on demand - rod for your own back.

It starts at birth, because babies biological instincts are such a contrast to what our society now deems acceptable, to our cultural norms.  Human infants are only born with 25% of their developed brain; the other 75% develops after birth - experts believe this is due to increased brain size which has forced earlier delivery to enable baby to fit.  Some now feel the first few months out of the womb, are actually a fourth stage of gestation - baby should still be attached to mum but externally. As a consequence of this immaturity, the human infant is forced to rely on external support, especially during the first 6-12 months of life (McKenna)  They are programmed to be near mum, feed little and often, and frequently cry when they are put down away from her.  To to combat this, instead of responding to baby (or "give in" as some claim),  mums are told to give a "lovey" or comfort blanket so that baby can smell you when not with them, or take security in an item.  I was once told this concept originated from orphans who had no mothers - I've no idea if it's true but really, is it healthy for a child to be securely attached to a piece of cloth rather than a human?  doesn't matter if mum is here, as long as I have my lovey and we see children carrying these round at 4/5 years old!  In cultures and social circles where mum keeps baby close and feeds on demand (not schedule feeding purely for nutrition) - having a security item is beyond rare.  Has anyone studied the psychological impact outcome long term of "loveys"?

Perhaps some get wary as they see toddlers right through to school age children wandering round the supermarket, attempting speech through a plastic plug and think of the horror if they were expecting this from a breast.  But the reality is that whereas pacifiers are habit forming, a baby gradually cuts down their feeding as they develop - sure some toddlers will have phases of manic feeding, often tied in with a big change such as starting nursery, house move or mum returning to work, it's still a big reassurance and comfort to them; but the big need to non nutritive suck diminishes dramatically after the first six months which ties in with introducing solids.

Comforting your baby with the breast and meeting all their needs will not make them clingy, dependent, unsociable, needy, non sleepers - or anything else that gets sold as a pitfall - this is what baby is born biologically expecting.  In fact overwhelming evidence shows that the better we meet an infants needs, the more confident, independent and sociable the young child becomes.  But if you think about it that makes perfect sense in terms of human nature - the more secure we feel, the more confident.  Pushing independence and forced separation actually has the opposite result of making the recipient "cling on", searching for reassurance.

As mentioned above - the breast is the norm and the pacifier is the "intervention", and so with that comes the potential for risk; sucking is intended to be intricately linked with feeding - so separating the two is a significant shift.  Studies have linked numerous issues with dummy use and whilst research can never prove something 100% when several studies begin to find the same outcome, it is of course worth considering in the decision making process.  Some babies seem to take one with no obvious impact, whilst for others it can cause problems almost immediately.  Level of use is also significant - using one for a short period when driving, or perhaps when sorting one twin and another needs to wait, can of course be helpful and unlikely to impact massively on many babies - especially once breastfeeding is established; but frequent use can create dummy addicts, rarely seen without one.  I've even seen some mothers use them to make a baby stop babbling too loudly in public, or just because they had finished their bottle - despite baby being completely content; to me this is completely inappropriate.

1) SIDS - whilst some studies "appear" to show a reduced risk of SIDS when using a pacifier (although this research is definitely worthy of discussion!), others believe pacifiers increase the risk of SIDS by exerting abnormal pressures on the oral cavity, affecting the throat.  The significant piece of SIDS research also showed stopping using a pacifier created the most significant risk - and how do parents guarantee a baby keeps on accepting one? I plan to discuss this more in another blog post as it has been requested on "Ask The Armadillo".

2) Changed oral development - adverse outcome has been strongly highlighted in relation to dentition,  dental caries and malocclusion (Bowden, Paunio, Rautava & Sillanpaa, Karjalainen, Ronning, et al,Ollila, Niemela, et al, Gizani, Vinckier & Declerck).  Extensive used has even been linked with changing oro-facial structure and long term issues such as sleep apnoea (although this risk is greater for non breastfed infants)

3)  Reduced duration of breastfeeding - many studies have linked both early introduction of a bottle and pacifier use with shorter duration of breastfeeding.  One found:
Pacifiers may be an effective weaning mechanism used by mothers who have explicit or implicit difficulties in breastfeeding, but they are much less likely to affect infants whose mothers are confident about nursing
Whilst another found increased risk regardless:
Among 249 children still breastfed at 1 month, the risk that a child would be weaned at any age between 1 and 24 months was higher in pacifier users than in non-users. The association remained even after adjustment for the child's age, sex, birth weight, socioeconomic status, and age at introduction of bottle-feeding.
I think how a pacifier is used may also influence this.  If baby has breast for "food" and pacifier for "comfort" (ie the mum desperately trying to prevent bad habits), once his nutritional needs are met elsewhere, he is far more likely to wean and stick with his comfort item - these are the babies parents often claim "self weaned" long before the normal biological age.  This ties in with another study that found the more times per day the pacifier was used, the higher the risk of early weaning.

4) Reduced time at the breast - In the early days, hunger is driven partly by a hormone called CCK - the same hormone that induces relaxation and sleep.  After a feed baby has a high level of CCK, which tells him he’s full, but it drops again after another 10 or 20 minutes, so he thinks he’s hungry again. He may go through this loop several times, in what’s known as “cluster feeding,” before dropping into a solid, longer sleep. There is suggestion this system allows baby to fill their whole digestive system so excess hunger doesn't occur during a longer sleep spell. The key point is that sucking, not swallowing makes baby feel full and therefore pacifiers can cause babies to miss feeds which can impact further in the following ways:.

5) Reduced breastmilk supply - as feeding becomes established, the only indications mum's body gets about how much milk to make is how often baby feeds and how effectively they empty the breast.  When introduced in the first few months pacifiers can cause infants to miss feeds, and prevent mum's body receiving the cues about how much milk to produce.  As the most common reason for stopping breastfeeding is "insufficient milk supply" (whether perceived or actual) and most infants have a pacifier which may interfere with this mechanism.
6) Reduced weight gain - several studies have found regular pacifier use is associated with fewer feedings and reduced gain:
Findings indicated that the pacifier group breastfed approximately one less time per day and had a 15 to 30 minute shorter total suckling duration per day during the first 4 months of life than the group who did not use a pacifier. During the first 2 months of life, infants who used a pacifier had a mean of 0.5 feeds less per day and had 15 to 30 minute longer feeding intervals than infants who did not use a pacifier.
7) Reduced efficiency at the breast -
Sucking on an artificial nipple is different from sucking at the breast. The artificial nipple is already formed and fairly rigid. The breast is soft and flexible. The baby must open his mouth wide to latch on to the breast, and the nipple goes to the back of the mouth, away from the movement of the gums and tongue. A caregiver can coax a pacifier into a baby's closed mouth. The muscles of the mouth and face and the tongue move differently when sucking on an artificial nipple; the action used to drink from a bottle or to calm down with a pacifier won't get milk out of a breast. 
Switching back and forth from breast to artificial nipple is a lot to ask of a baby in the early days of learning to breastfeed. A baby who tries to suck at the breast the way she sucks on a bottle nipple or a pacifier will quickly become frustrated and may cry, fuss, or refuse to nurse. She won't get much milk, and she may have a difficult time learning to breastfeed effectively. (LLLI)
8)  Nipple confusion and soreness - the different technique required for a pacifier can cause  -one study found babies were twice as likely to have breastfeeding problems as those who didn't have a pacifier (73% developed problems compared to 30% that did not)

9)  Ear infections - several studies have found a connection, with one finding risk was doubled if the baby has the pacifier 5 or more times per day.

10) Increased risk of thrush - because the fungus that causes thrush thrives at room temp on moist surfaces a pacifier has the potential to increase rates of thrush. Several studies have found a greater incidence of candida, the fungus that causes thrush among babies who used a pacifier - the research suggested it may affect a baby’s ability to effectively clear sugar from his mouth.  May also be linked with tooth decay - see here.

11) Increased risk of infections, including antibiotic resistant strains - One study found a wide range of disease-causing bacteria, fungus and mold on pacifiers that young children had been using.  They added that pacifiers can often grow a slimy coating of bacteria called a biofilm, that actually alters the normal bacteria in a baby or toddler's mouth. That biofilm can spur inflammation and potentially increase the risk of developing gastrointestinal problems such as colic or even ear infections.

In fact, the same types of bacteria found on a common pacifier have been linked to cardiovascular disease, metabolic syndrome, allergies, asthma and autoimmune diseases, said study author Dr. Tom Glass, a professor of forensic sciences, pathology and dental medicine at Oklahoma State University.

The researchers cultured 40 different species of bacteria from the 10 used pacifiers. One pacifier was contaminated with four different strains of Staphylococcus aureus. What was particularly concerning, said Glass, was that many of the bacteria growing from the used pacifiers were resistant to commonly used antibiotics such as penicillin and methicillin. (1)

12) Habit forming - some infants use their pacifier as their comfort item, and thus are not keen to be parted with it!  Resulting in prolonged dependency (the opposite of it's original aim then!) on an item and less autonomy.  In older babies it can hinder babbling, resulting in delayed speech and can discourage toddlers from chatting, which they need to do to develop their language skills (The National Literacy Trust).

13) Reduced sleep - some babies very quickly will start to wake when they hit a light sleep cycle and don't have their pacifier (it falls out earlier during the deep sleep phase), not fun trying to locate and give back to baby numerous times per night!

14) Different brain patterns - A study examined whether nursing influences brain activity in the newborn and whether there are differences in this respect between breast and pacifier sucking.  They noted the amplitude of the EEG increased significantly during breast-feeding in the posterior cortical areas in both hemispheres with a slight predominance on the right. Pacifier sucking had no significant effects on EEG activity.
Conclusion: Nursing effects a change in the brain activity of the newborn. The cortical response to nursing is most probably a result of activation of the neurohumoral mechanisms related to hunger and satisfaction, including the hypothalamic, limbic, and other brain stem structures, which also regulate the sleep-wake cycle and modulate the level of cortical activity with respect to attention and vigilance. (J Pediatr 1998;132:646-51.)

So next time you tell a mum to "knock that on the head - he's only using you as a dummy", remember - the reality is baby uses the dummy as a breast, sometimes with consequences. Ultimately finding out WHY baby has such an intense sucking need they need to suck excessively outside of feeding is probably more helpful.  In taking air, disturbed gut flora (antibiotics, vaccines etc) tongue tie etc can all cause gastric discomfort eased by sucking.

References:

1. Tom Glass, D.D.S., Ph.D., professor, forensic sciences, pathology and dental medicine, and adjunct professor, microbiology, Oklahoma State University, Tulsa, Okla.; Ben Hoffman, M.D., pediatrician and medical director, Children's Safety Center, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Ore.; Nov. 2, 2012, presentation, American Society for Clinical Pathology meeting, Boston

Effective breastfeeding - it's not all about the latch

It was a new mum that first mentioned this to me, and as soon as she did it dawned on me that she was totally right.  When supporting mums, lots of focus is on latch - because obviously the better the latch, often the less pain and the more effectively baby can feed; but all too often we meet a mum with a slow gaining baby who is always wanting to feed, or perhaps a mum with sore/cracked nipples sometimes resulting in a the shape of a lipstick! and then we hear "the midwife/health visitor has checked my latch and said it was fine...".  Really if I had a pound for everytime I heard it, I would be writing this blog from Mauritius

This mum called me because she fell into all three of these categories - her baby was being supplemented with expressed breastmilk because of very slow gain, nipples were sore which the midwife had put down to baby spending long periods at the breast (with her supposed "perfect latch") and mum instinctively knew something wasn't right that was being missed.  Almost as soon as I had stepped through the door mum posed the question that had been bothering her: "everyone keeps telling me everything is fine, but I really don't think she's actually having much milk, yet when I say she doesn't seem to swallow lots,  they just keep saying latch looks fine - can it appear fine and yet baby still not take much milk?

And she's right- there's often little emphasis from mainstream sources on how to tell if baby is actually drinking lots of milk, either to mums or to health professionals; sure jaw moving and a swallow pattern generally gets some coverage - but does such basic information really help a new mum or busy health professional?  

Whilst latch is a significant indicator, there are several problems with relying solely on it; firstly unless you are trained and experienced specifically in this area, identifying good latch from not so effective can be a tricky job.  Babies can look well latched on and in fact be swallowing little, and others can start well and gradually close their mouth as the feed progresses.

Those helping in the early days often hand over to someone else for later care - so some never see the longterm outcome of their advice, never realise that latch they thought was "fine" really wasn't.  Shoes are my favourite example - it's comparable to someone saying their shoes hurt, having whopping great heel blisters and then an experienced shoe fitter telling them that "sorry, but they appear to fit fine".

Secondly even if someone feels confident assessing latch, it's about more than just what is going on externally and is visible to the eye; as a very wise lady one told me - unless you have x-ray vision to see what is going on inside, it's impossible to state with any certainty things are "fine" - not when mum is presenting with all the signs something isn't right.  Milk transfer is still the key -  is the baby effectively milking the breast and drinking to satiation when they get there?  or are they attempting the equivalent of drinking through a squished straw and running out of steam before they are truly finished, often never experiencing the "drunk" look babies get at the end of a feed, perhaps wanting to feed again an hour later?

Lastly latch can be subjective - some infants "appear" to be attached suboptimally, yet take lots of milk, fill nappies appropriately and are content and settled between feeds; if mum and baby are happy with time spent at the breast and baby is growing as expected - sometimes the phrase "if it aint broken, don't fix it" is worth remembering.  
LLLI - Asymmetric latch

Back to the mum I started with; I observed a feed in her favourite position - mouth was wide and taking some breast tissue, rather than just the "nipple suckling" that causes hollow cheeks and seems to be the typical "bad latch" often recognised.  However baby was not latched asymmetrically, and it became immediately apparent that whilst baby occasionally swallowed, little milk was being consumed; mum was totally right.  Had the midwife been watching for milk transfer as well as latch, it would have been picked up a lot earlier than when I saw her at 6 weeks.

The next bit of this article is lifted from another recent entry I made: Is my breastfed baby getting enough?  (and things you can do if not) - and it perfectly highlights how a baby may "appear" to some to be latched "ok", but it actually not latched well enough to be able to drink efficiently!  

The first clip below shows "nibbling" or ineffective feeding: Baby is doing almost no drinking. A baby who breastfeeds only with this type of sucking could stay on the breast for hours and still not get enough milk. Something needs to be done here and if achieving a better latch, using compression doesn’t help, the baby almost certainly needs to be supplemented (Newman).




Now compare this to the clip below, where baby is doing some really good drinking: The pauses are very long (this is the mouth filling); this baby could spend a very short period of time on the breast and still be getting plenty of milk (Newman)


Note the difference in positioning in these clips.  In the first baby is meeting the breast almost vertically - with nose, mouth and chin meeting the breast at the same time.  As you can see the baby's nose sites very close to the breast, potentially making it difficult for him to feed well and breathe easily.   In the second clip baby's head is flexed back and the chin meets the breast first, the nose is then well clear from the breast tissue.  This asymmetric latch means more of the areola below the nipple than above is in baby's mouth - allowing him to milk the breast easily and consume lots of milk.

It's also not always a case of excellent or bad - there can be a whole host of "good" drinkers too, which is another great example of why timing feeds just doesn't work.  A baby feeding as per the really good drinking clip is is likely to be satiated super fast, maybe as little as ten minutes - the next clip below shows a "good drinker" - still milking the breast effectively, but not quite as well as the "really good feeding" above (note the shorter pauses) so maybe he will take 20 minutes.  The baby in the very first clip is likely never to be truly satiated and may hang around an age and then want to feed again perhaps only an hour later.  Please note these times are only examples!



You can see more asymmetrical latch clips here.

WIN......A T-shirt and bag from Lactivist!! (Mothers Milk Marketing Board)

To celebrate winning "Best Breastfeeding Blog", I am very excited to announce this giveaway offer in association with Lactivist - who promote gentle parenting and breastfeeding with witty slogans on t-shirts, bags, badges, keyrings and cards.

I'm a big fan of lactivist products - you can have the tees with shoulder poppers or envelope sleeves, short or long! there's even an organic range to go at! 

The image is my eldest in her "I love mummy milk" shirt many moons ago now! <IMAGE REMOVED>

Another favourite of mine bears the slogan "I like milk from my mum, not from just any old cow."

For this giveaway you can choose a tee of your choice - it doesn't have to be a breastfeeding slogan if you prefer to promote co-sleeping or cloth nappies.  Plus a nifty shopping bag!  If you don't have any children under four, they make a great gift with Christmas around the corner, but maybe keep the bag for yourself ;)

Something else I think definitely worth a mention for the expressing mums, are some stickers that adhere to a bottle and read "100% Mummy Milk" - one mum commented she felt very proud promoting she was using human milk, as everyone always assumes it's a substitute in the bottle!

Entry Details:

  • Open to UK members only.

  • Reply either here or on the lactivist thread on Facebook telling us which is your favourite design.

  • Share any article on this blog and then let me know where you've shared it.  If you share in more than one place, one entry for each share ie your blog - 1 entry, twitter - 1 entry etc, appropriate forum - 1 entry etc 

  • Invite a friend to the Facebook Group - if they join and reply on the message there with your name - 2 entries

  • Suggest a slogan - share what you would like to see printed - 1 entry
Closes: Wed 13th October 9pm

Brugo Mug Giveaway Winners....

I am very pleased to announce the winners of the Brugo Mug Promo are:

Enes Radica


Debborah Bottcher

Please email me and I will let you know how to claim your prize.

Congratulations!

Breastfeeding & (whispers) Bonding

Breastfeeding and bonding is probably one of the least discussed "reasons to breastfeed".  Whilst many mums can acknowledge their child might have more colds or minor infections – bonding provokes a hair raising reaction in most quarters.

It is of course a complex issue, unlike health implications, waving studies about reduced child abuse etc don't cut it for many – likely because for most parents feelings are extremely hard to quantify. You can’t measure them, nor compare to what someone else is feeling. Formula feeding mothers love and care for their infants and cannot understand how this would be different if they breastfed.

The only people who can truly compare bonding between breast and bottle fed babies, is mothers who have done both. Even one of each is not really reliable, due to all the other possible influencing factors.

So I would like to kick this subject off with an article written by an amazing lady I know and mum of eight!  Five formula fed and three breastfed:
I want to share my experiences with you in this article, as you can imagine it has taken a lot of soul searching on my part to ponder the question; what is the big deal about breastfeeding and bonding?

If breastfeeding is considered just as a method of transferring milk into baby, then on the surface there does not seem to be that much difference. One could argue that bottle feeding mums have the advantage as their babies can look straight into their eyes, something that most newborns correctly latched on will not manage to do until they are older.

As a breastfeeding mum it can be easy to feel just like a milk machine and that is all baby wants you for. Everyone else can get a cuddle and the minute baby gets close to you, all baby wants is milk and will not settle until you feed him. You may be sore, you are probably leaking milk everywhere and well it can all be rather undignified to start with. A far cry from the rose tinted pictures of mum breastfeeding baby happily that you imagined! Rather then looking adoringly down on your newborn, you are probably busting for the loo, as you haven’t managed to get off the settee for the last few hours!

I am deliberately painting a negative picture, because breastfeeding can be blooming hard work to start with and that’s when all is going well. Throw in a baby who is not latching well, thus causing mum to be in pain, mastitis, thrush, cracked nipples etc and it can be a relief to go over to bottle. You often hear it don’t you, I only started bonding with my baby once we had switched to formula and the pain stopped. I was dreading feeding him as it hurt so much………………..

I can relate to that, because I have been there, done that. It was a relief at the time, the regrets come later. When you raise your head out of its sleep deprived state, when you ‘have your body back’ when your baby is not in your arms constantly anymore, when those chubby hands are caressing a plastic bottle instead of your breast. When baby gets excited at the sound of the bottle lid coming off, rather then you lifting your top. When your baby simply doesn’t smell like your baby anymore!

When you stand with your seriously ill baby on your shoulder and you look at a breastfeeding display in the children’s ward, citing all the things that breastfeeding protects against, all the things that are making your baby so ill and you know that you have failed that baby.

If only you had tried harder, the pain wasn’t really that bad if only, if only, if only……………….

Of course none of us have a crystal ball, breastfed babies do get ill and hindsight is a wonderful thing. And of course you *love* your baby. You would challenge anyone who dare suggest that you could love your baby anymore were you still breastfeeding. But still, you see other mothers breastfeeding and you are simply green with envy. You justify it to yourself that they obviously had a much easier ride then you. Their baby could not possibly have been as hungry as yours. They do not have other children to take care of. Their skin is not as sensitive, whatever was the problem or was perceived to be the problem you have a justification for having to give up.

And at the end of the day it’s just milk right. You love your baby just as much, you know your baby just as much. A happy mother = a happy baby! Formula is not poison, ok breast milk is best but formula is good enough…

Putting aside the obvious health issues here, you are deluding yourself. It does matter, and it matters a great deal - but you do not know that, because you have been robbed of your nursing relationship before it even started. And how could you know really? You simply do not know what you are missing, as you have not been able to experience it.

Now fast forward a few babies. Quite a few babies in my case. You seek and find the right support whilst you are still pregnant. You listen, you learn, you surround yourself with other happily breastfeeding mothers and it is beginning to dawn on you that actually they did not have an easier ride then you. They had support when it mattered! So you grow quietly hopeful that maybe, just maybe you will be able to feed this baby yourself. Maybe it will not all end in tears, regrets and recriminations.

And then your new baby girl is here, born at home surrounded by all your loved ones and she latches on beautifully, so far so good. There is no pain, as you both know what you are doing. You have the confidence to co-sleep from the start, making night feeds so much easier. You have your breastfeeding counsellor on speed dial, lol, but really you do not need her as it just works. And you fall hopelessly and utterly in love with this little bundle. You treasure every moment you have with her at the breast. You love that drunken sailor look she gets all the time. You love the fact that she only wants you and all you have to do is lift your top and let her disappear under your jumper and she is happy.

And you simply cannot bear to be parted from her. Even when she is fast asleep in her basket you need to move her from room to room with you or you feel as though your right arm has been cut off. You know when she will want feeding as your milk will let down seconds before she wakes up. You put her at the other end of the bed to give yourself some room to sleep and you wake up seconds before she does and you realise that you haven’t moved but your newborn has managed to wriggle across until she is right next to your boob! You cannot stop sniffing her because she smells so good; so familiar and sweet and you get such a kick out of seeing her grow. Knowing that it is all your milk that has caused those chubby dimples. And then you get the first smile as she is coming off the boob, your milk dribbling down her chin. And then the first raspberry blown that has you both in fits of giggles. Chubby hands stroking your breasts, a little mouth contently glugging away and you just feel on top of the world.

Your older children imitating you by breastfeeding their dolls, suggesting baby needs feeding so they can get on with their play and then your toddler coming up to you and asking to have some too. So you end up with both of them at the breast and of course your toddler does not know what to do, but you feel such a rush of love and it heals so many wounds, wounds you never even knew you had.

The conversations you have with your teenager, as to why she was not breastfed, did you not love her enough? Ouch! How do you answer that one?

And through it all those breastfeeding hormones are working their magic. Everyone around you is surprised at the change in you. The kids and your husband are commenting on how much calmer you are. “Mum you are a much nicer person you know!” From a friend:” What has happened to you, you have really changed!” (Incidentally that friend ended up breastfeeding her last baby for 3 years, having f/f the first 4!)

And what about you? You gain a new self belief. You at long last feel comfortable in your own skin. You are WOMAN hear me roar! Your milk has superpowers it must have. Your baby grows into a toddler and tells you so, so it must be true! And you discover another thing about breastfeeding that you never knew. It is such a brilliant parenting tool when you have a toddler. How on earth did you ever manage without it before?

There are hardly any tantrums, you have the perfect tool right there, strapped to your chest and you use it willingly and gladly. And there is such joy, such indescribable joy. You are finally doing what you were meant to be doing. It’s natural and all of a sudden you are the one who other mums come up to and tell their breastfeeding story of pain and failure and justification and you see yourself and how you used to be.

And you feel sad, so very sad that these mothers will not be experiencing the joys and the sheer magic of breastfeeding. And you get angry too, angry at the system that lets mothers down, angry at the health professionals who robbed you of your own nursing relationship with your older children and you vow to do something about it. You become a breastfeeding counsellor yourself and you have come full circle really.

Breastfeeding it makes a difference it really does!

Cow and Gate Toddler Formula Milk TV Advert Banned in UK!

I've now stopped doing handstands long enough to blog about this!
Many of you will remember my post only last month, having a bit of a rant at the "big follow on con", and specifically how misleading this advert was with it's great big iron scam!

It seems the Advertising Standards Authority agreed with me:

An ad for Cow & Gate Complete Care Growing Up Milk has been banned for for falsely claiming that most young children do not get enough iron to prevent development problems.

In the TV ad, created by Euro RSCG, a voice over said: "Did you know eight out of 10 toddlers aren't getting enough iron?".

The ad showed a woman giving her child a giant 12-litre cup of milk before the voice-over continued: “It’s not surprising – meeting 50% of their needs would mean drinking 12 litres of cow’s milk per day, or just two beakers of Cow & Gate Complete Care Growing Up Milk, as part of a varied diet helping to support brain development, strong bones and teeth, healthy growth.”


Accompanying on-screen text read: “Recommended daily intake of iron = 6.9mg from a variety of iron-rich foods which may include Growing Up Milk.” Three people challenged whether the claim that “eight out of 10 toddlers aren’t getting enough iron” could be substantiated.; the Advertising Standards Association ruled it could not.

The ASA said it received expert advice that there was no recommended daily allowance (RDA) of iron for toddlers and that, for food labelling purposes, the value of iron recommended for children between the ages of one and three years was set at 6mg. Iron absorption was regulated at intestinal levels and different amounts of iron were absorbed from the diet depending on the requirements of the body.


The study by Nutricia examined the diet itself, and not the subsequent absorption of iron contained within that diet, and so could not conclude that the individual children in the study were not getting enough iron, the ASA was told.

The ASA found that the figure 6.9 mg was an average recommendation for different aged and shaped toddlers, not the amount of daily iron recommended as being necessary for preventing development problems associated with iron deficiency in individual toddlers, before concluding the ad was likely to mislead.

The ad breached CAP TV Advertising Standards Code rules 5.1.1, misleading advertising, and 5.2.1, evidence. The ASA said it should not be broadcast again in its current form.

Analytical Armadillo wins award for best breastfeeding blog!

I am extremely excited to share that Analytical Armadillo has been awarded the title of "best breastfeeding blog" by the Mother's Milk Marketing Board.

Best Breastfeeding Blogs – Analytical Armadillo wins Award

By admin, on September 20th, 2010

Whilst The Analytical Armadillo blog only started in July this year, the author is no newbie to breastfeeding and parenting. Her easy to read and understand style has meant the blog has quickly become extremely popular worldwide, and not just for those breastfeeding.

Subjects include reflux , waterbirths , SIDS and safe formula feeding.

The Analytical Armadillo has been awarded the Mothers Milk Marketing Board Seal of Approval for these reasons:
  • The quality of research backed information about breastfeeding
  • Personal experiences and anectdotes shared
  • Willingness to go out there and post about ‘dangerous’ subjects.

 Congratulations Analytical Armadillo – you can now display the Mothers Milk Marketing Board Seal of Approval with pride!
http://www.lactivist.net/?p=1858
ps Lactivist is also running a great giveaway offer!  To enter and maybe win a copy of Ina May’s Guide to Breastfeeding, click here

Incubators out - how many babies have died unnecessarily?

So I blogged back in July about Kangaroo Mother Care, and it seems on this front things are really hotting up!  A story hit the media last week that finally got the world's attention; a baby born at 27 weeks, was declared dead after doctors spent 20 minutes unsuccessfully battling to get him to breathe.   with no vital signs, they broke the news and mum asked to say goodbye to her baby.  Two hours of kangaroo mother care (KMC)  later, he began to breathe.  His mother (luckily) followed her instincts and gave him some colostrum on her finger - he took it and his breathing became regular...


Whilst this is a lovely heart warming story, it inevitably makes you wonder - how many prematures pronounced as stillborn, got two hours of skin to skin?  how many prematures are rushed away from their mothers under the false belief artificial high powered technology can do a better job?  Even when Jamie began to breathe, doctors dismissed this as a reflex action - how many other infants have done this and it's been dismissed as a reflex?  As someone on an internet list pointed out, perhaps its fortunate for this baby that those early signs were dismissed as a reflex, as he may not have survived further resus.  I for one find this terrifying!

My own son was only 6 weeks early, had agpars of 9/10 and yet was rushed with urgency to the SCBU where they immediately wanted to supplement with artificial breastmilk substitute and put him under a heated cot.  When I declined the panic was tangible, but this is what we do?!?  ok well on your head be it! I endured 13 days of sheer hell for daring to defy, question, seek alternative advice (for which I still owe Annalisa and Nils so much!) and decision make myself.  Change from this norm will NOT come easily.

Whilst some are stunned by this story, Nils Bergman has hardly batted an eye:
This is an emotive story, but hardly original!
Unusual, but occurs ... actually right here in Cape Town just two weeks ago !
Susan Ludington-Hoe opens one of her books on Kangaroo Care with a similar anecdote.
Nils Bergman

Nils believes it is all down to the protest despair response I discussed in my first blog post:

To almost all newborn mammals, separation from mother is life-threatening. This activates a very powerful defence response, which is to shut down and immobilise
He hypothesises that because the nervous system of prematures is so immature, if there is stress during delivery the only way their body can cope is to "shut down" to survive. 

It is "skin-to-skin contact" which is the key, because the deep sensory fibres from the skin go to the "emotional processing unit" of the brain (amygdala), and tells the brain "you are safe". This de-activates the dissociation (un-safe mode), and restores the regulation (safe mode) - which is the real function of the vagal nerve.
Nils Bergman

So why then are we still taking babies away from their mothers and putting them in an artificial womb like environment?  As I mentioned before, not a single study has shown adverse outcome with KMC - yet women still have to endure being separated from their babies, why?  I wonder if the decision makers have ever taken a call from the mum of a premature infant, desperately trying to produce enough breastmilk in an environment so removed from normal, she may struggle even to express enough for a small feed.  To hear her sob she has never even held her baby, she's only allowed to stroke a finger through a hole in the side of his incubator.  We sometimes forget that incubators are as artificial to a mother as they are to baby; she may be in shock her baby has come early, may feel grief for the end of her pregnancy and then has her baby taken from her.

These mothers are extremely vulnerable during what can be a traumatic experience, and as it stands women cannot even sleep on the same ward as their baby!  In our SCBU & NICU unit (which were together) there was around 26 cots and 6 mother's rooms.  Many are discharged home without their infant (yes really whilst supposedly trying to establish breastfeeding!) and end up in a frantic pattern of trying to express enough, get milk to the ward in time, sterilise everything required and then visit their baby - which of course is made a whole lot more interesting if you already have another child or few at home! 

So  many people fund raise for SCBU, yet I only ever hear about the next 15k required for a snazzy incubator.  I know if people feel that saved their baby, they feel they are doing the right thing in helping others to also have access to technology; but just think what a profound difference this money could make if it was spent keeping babies and mothers together - not only in terms of health outcome in the short term, but breastfeeding rates would soar!  there would be a real longterm gain.

Perhaps we need a campaign to provoke change?  Anyone feel strongly enough to hop on board and help organise something?  If so email me!

The normal newborn & why breast milk isn't just food

So far the posts I've made on this blog have been my own work - but I found this piece whilst hunting for something else and felt it was well worth sharing as it echoes so many of my own views.  I think I've also seen it shared before, so apologies if it's a repeat for some of you - I didn't just want to drop the link as I'd like it to hang around the blog, plus fantastic as I think the author is - her page has a repeating pattern background which I find makes it hard to read.

Anyway enough waffle here it is:

Normal Newborn Behavior & why the breast isn't just food

What is a normal, term human infant supposed to do?


First of all, a human baby is supposed to be born vaginally. Yes, I know that doesn't always happen, but we're just going to talk ideal, normal for now. We are supposed to be born vaginally because we need good bacteria.  Human babies are sterile, without bacteria, at birth. It's no accident that we are born near the anus, an area that has lots of bacteria, most of which are good and necessary for normal gut health and development of the immune system. And the bacteria that are there are mom's bacteria, bacteria that she can provide antibodies against if the bacteria there aren't nice.

Then the baby is born and is supposed to go to mom. Right to her chest. The chest, right in between the breasts is the natural habitat of the newborn baby. (Fun fact: our cardiac output, how much blood we circulate in a given minute, is distributed to places that are important. Lots goes to the kidney every minute, like 10% or so, and 20% goes to your brain. In a new mom, 23% goes to her chest- more than her brain. The body thinks that place is important!)

That chest area gives heat. The baby has been using mom's body for temperature regulation for ages. Why would they stop? With all that blood flow, it's going to be warm. The baby can use mom to get warm. When I was in my residency, we would put a cold baby "under the warmer" which meant a heater thingy next to mom. Now, as I have matured, if a baby is "under the warmer," the kid is under mom. I wouldn't like that. I like the kids on top of mom, snuggled.
Now we have a brand new baby on the warmer. That child is not hungry. Bringing a hungry baby into the world is a bad plan. And really, if they were hungry, can you please explain to me why my kids sucked the life force out of me in those last few weeks of pregnancy? They better have been getting food, or well, that would have been annoying and painful for nothing.

Every species has instinctual behaviors that allow the little ones to grow up to be big ones and keep the species going. Our kids are born into the world needing protection. Protection from disease and from predators. Yes, predators. Our kids don't know they've been born into a loving family in the 21st century- for all they know it's the 2nd century and they are in a cave surrounded by tigers. Our instinctive behaviors as baby humans need to help us stay protected. Babies get both disease protection and tiger protection from being on mom's chest. Presumably, we gave the baby some good bacteria when they arrived through the birth canal. That's the first step in disease protection. The next step is getting colostrum.

A newborn baby on mom's chest will pick their head up, lick their hands, maybe nuzzle mom, lick their hands and start to slide towards the breast. The kids have a preference for contrasts between light and dark, and for circles over other shapes. Think about that...there's a dark circle not too far away.

Mom's sweat smells like amniotic fluid, and that smell is on the child's hands (because there's been no bath yet!) and the baby uses that taste on their hand to follow mom's smell. The secretions coming from the glands on the areola (that dark circle) smell familiar too and help the baby get to the breast to get the colostrum which is going to feed the good bacteria and keep them protected from infection. The kids can attach by themselves. Watch for yourself! And if you just need colostrum to feed bacteria and not yourself, well, there doesn't have to be much. And there isn't because the kids aren't hungry and because Breastmilk is not food!

We're talking normal babies. Breastfeeding is normal. It's what babies are hardwired to do. 2009 or 209, the kids would all do the same thing: try to find the breast. Breastfeeding isn't special sauce, a leg up or a magic potion. It's not "best. " It's normal. Just normal. Designed for the needs of a vulnerable human infant. And nothing else designed to replace it is normal.

Colostrum also activates things in the baby's gut that then goes on to make the thymus grow. The thymus is part of the immune system. Growing your thymus is important. Breastmilk= big thymus, good immune system. Colostrum also has a bunch of something called Secretory Immunoglobulin A (SIgA). SIgA is made in the first few days of life and is infection protection specifically from mom. Cells in mom's gut watch what's coming through and if there's an infectious cell, a special cell in mom's gut called a plasma cell heads to the breast and helps the breast make SIgA in the milk to protect the baby. If mom and baby are together, like on mom's chest, then the baby is protected from what the two of them may be exposed to. Babies should be with mom.

And the tigers. What about them? Define "tiger" however you want. But if you are baby with no skills in self-protection, staying with mom, having a grasp reflex, and a startle reflex that helps you grab onto your mom, especially if she's hairy, makes sense. Babies know the difference between a bassinette and a human chest. When infants are separated from their mothers, they have a "despair- withdrawal" response. The despair part comes when they alone, separated. The kids are vocally expressing their desire not to be tiger food. When they are picked up, they stop crying. They are protected, warm and safe. If that despair cry is not answered, they withdraw. They get cold, have massive amounts of stress hormones released, drop their heart rate and get quiet. That's not a good baby. That's one who, well, is beyond despair. Normal babies want to be held, all the time.
And when do tigers hunt? At night. It makes no sense at all for our kids to sleep at night. They may be eaten. There's nothing really all that great about kids sleeping through the night. They should wake up and find their body guard. Daytime, well, not so many threats. They sleep better during the day. (Think about our response to our tigers-- sleep problems are a huge part of stress, depression, anxiety).

I go on and on about sleep on this site, so maybe I'll gloss over it here. But everybody sleeps with their kids- whether they choose to or not and whether they admit to it or not. It's silly of us as healthcare providers to say "don't sleep with your baby" because we all do it. Sometimes accidentally. Sometimes intentionally. The kids are snuggly, it feels right and you are tired. So, normal babies breastfeed, stay at the breast, want to be held and sleep better when they are with their parents. Seems normal to me. But there is a difference between a normal baby and one that isn't. Safe sleep means that we are sober, in bed and not a couch or a recliner, breastfeeding, not smoking...being normal. If the circumstances are not normal, then sleeping with the baby is not safe.

That chest -to -chest contact is also brain development. Our kids had as many brain cells as they were ever going to have at 28 weeks of gestation. It's a jungle of waiting -to-be- connected cells. What we do as humans is create too much and then get rid of what we aren't using. We have like 8 nipples, a tail and webbed hands in the womb. If all goes well, we don't have those at birth. Create too much- get rid of what you aren't using. So, as you are snuggling, your child is hooking up happy brain cells and hopefully getting rid of the "eeeek" brain cells. Breastfeeding, skin-to-skin, is brain wiring. Not food.

Why go on and on about this? Because more and more mothers are choosing to breastfeed. But most women don't believe that the body that created that beautiful baby is capable of feeding that same child and we are supplementing more and more with infant formulas designed to be food. Why don't we trust our bodies post-partum? I don't know. But I hear over and over that the formula is because "I am just not satisfying him." Of course you are. Babies don't need to "eat" all the time- they need to be with you all the time- that's the ultimate satisfaction.
A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process. They are not "hungry" --they are obeying instinct. The instinct that allows us to survive and make more of us.

http://www.drjen4kids.com/

Waterbirths - a hidden cause of breastfeeding problems?

The popularity of water births has increased dramatically in recent years; not only do many hospitals now offer a pool, but the price to hire or buy one has fallen too, making them more accessible to mums birthing at home.  Water births are also often suggested as a natural way to try and avoid pharmacological pain relief, which may impact upon labour outcome, baby or breastfeeding.

But is the assumption water births do not affect breastfeeding correct?  I've always been a big advocate, but I'm now not convinced things are that cut and dry.  I know this will probably raise eyebrows for a lot of people, but I now think there is a very real possibility that water births can contribute to problems.

As many lactation supporters will know, when a healthy baby is born naturally without exposure to medication, when placed on mums chest they will crawl to the breast, root, self attach and begin breastfeeding.  All their instincts are primed for this immediately after birth, which is why UNICEF and  the World Health Organisation strongly recommend skin to skin and initiating breastfeeding within half an hour.



As long as there are no underlying issues such as tongue tie or palate abnormalities - this group by far has the highest rate of early lactation success, and it's far less common to find mums in this position suffering from problems such as sore nipples, latching issues, breast refusal and so on.

But I'm not sure this is the case for water births; as the "breast crawl" becomes more well known, mothers are starting to mention it - and I'm finding more are stating their baby simply didn't do it.  In fact now when I'm supporting a mum who describes a normal unmedicated delivery followed by problems initiating feeding, my next question is "was it in water?".

How could water cause a problem?
As mentioned above, the primary instinct for a newborn is to locate the breast and feed - but how does it do that?  We know that during pregnancy the nipples and areola darken and enlarge,  because we know newborns with immature vision, see the contrast between dark and light most easily; but infants do not rely solely on sight, in fact it may actually play quite a small role in terms of initially locating the breast.

The infant's senses are stimulated by the sounds and feel of the mother's body and more importantly in this case, scent - as you can see in the clip above, baby is constantly smelling and tasting.

Why?
Mum's sweat and the amniotic fluid on baby, both play a very significant part in the breast crawl and newborn breastfeeding (and many sources also link this with bonding, but one for another blog post I think!).  Mum's sweat smells the same as amniotic fluid, which is still present on baby's hands - so he uses this taste to guide him to the breast, which is also conveniently located close to the armpit.  As the breast is actually an enlarged and modified sweat gland, this means the odour is strongest in the area baby needs to reach.

A 1994 study examining whether the infant found the nipple by smell states:
One breast of each participating mother was washed immediately after delivery. The newborn infant was placed prone between the breasts. Of 30 infants, 22 spontaneously selected the unwashed breast.  We concluded that the infants responded to olfactory differences between the washed and unwashed breasts.
Lancet. 1994 Oct 8;344(8928):989-90 
I don't have access to the full study to find out what the other 8 did, but they may not have crawled anywhere or become disorientated due to analgesics, perhaps separated from mum too - which as seen in the clip above can also influence co-ordination.  I think this also clearly highlights why babies should not be removed, wiped and wrapped in a towel before being given to mum!

Evidence?
A 1997 study entitled "Unique salience of maternal breast odors for newborn infants" found:
Human infants are particularly responsive to olfactory cues emanating from their mother's nipple/areola region. Beginning within minutes after birth, maternal breast odors elicit preferential head orientation by neonates and help guide them to the nipple. Such odors also influence babies' general motor activity and arousal, which may contribute further to successful nipple localization and sucking. To some extent, the chemical profile of breast secretions overlaps with that of amniotic fluid. Therefore, early postnatal attraction to odors associated with the nipple/areola reflect prenatal exposure and familiarization
There's more...
I also found a small study from 2001 that specifically explored crawling behaviour based solely on scent:
Breast odour as the only maternal stimulus elicits crawling towards the odour source -This study investigated the influence of breast odours per se on orientated physical movement of neonates. In total, 22 babies were observed during two trials on a warming bed. In one trial, a pad carrying the mother's breast odour was placed 17 cm in front of the baby's nose; in the other trial a clean pad was used. More babies moved towards and reached the breast pad than the clean pad. Conclusion: Natural breast odours unsupported by other maternal stimuli therefore appear to be sufficient to attract and guide neonates to the odour source.
Birthing in water strips the process of these vital odours and tastes for baby - given the above it seem to me it at least explains why some babies born in water don't crawl.  I cannot locate any research examining breastfeeding success rates following a water birth, but I would be fascinated to see any if it exists.

My first thoughts were that if using water in later, it would from a breastfeeding point of view make most sense to use just in early labour, to give time for mums body scent to return to normal levels; but many advocates suggest hitting the water too early can slow labour.  I wonder how feasible it is to keep waist up out of the water if the room is nice and warm and perhaps if you have large breasts that would still end up submerged, wearing a comfortable bra (amazingly as per the picture I managed to find!)  it may also be worth leaving the pool for delivery and ensuring you were dried thoroughly to prevent any dilution of amniotic fluid.  If this does not appeal, until I've seen hard evidence examining water birth impact on the breast crawl - I'd say it's worth considering staying where we normally reside, on dry land.

Alternative natural pain relief ideas:
Exercise during pregnancy: may make your labour shorter and less painful. A study published in the American Journal of Obstetrics and Gynecology, reported that women who continued running or aerobic dancing during pregnancy enjoyed labours about 30 percent shorter than women who stopped exercising. Women who maintained a regular exercise program also required less labour stimulation and fewer epidurals, episiotomies, and caesarean deliveries. An Italian study in the same journal examined women having their second or third babies, who rode an exercise bike three times a week for thirty minutes. They began around the fifth month of pregnancy, and during labour maintained higher endorphine levels and reported less pain than a matching group of sedentary women.  The link contains more information about exercising safely whilst pregnant.

Heat: In the same way heat can help period pains, it can also help in labour.  Wheatgerm bags (or alternative filled bags) may be safer than hot water bottles if you are moving about lots and perhaps applying pressure with them.  The link also contains details of how to make your own.

Active birth: although the media most often portrays labour women flat on their back, this is the not a productive position - think about gravity.  Trying positions like kneeling over a bed or birth ball; squatting and rocking hips can often not only offer more relief but help to keep labour progressing.

Massage: Some mums like to be massaged during labour, whilst others prefer not to be touched.  Avoiding oils on the chest which could mask mum's own odour would appear to be a sensible idea.

Hypnobirthing: Many mums swear by hypnobirthing as a fantastic way to reduce pain.  If you do not fancy going the whole hog, visualisation techniques such as imagining the baby moving down the birth canal or balloons inflating with each contraction, then floating away as they dissipate can be great coping strategies.

Nesting: Some mums find making themselves a big nest of beanbags and duvets to snuggle in can provide security to feel comfortable and relaxed during labour.  As muscles are contracting, the more relaxed you can be, the less pain you will feel!

Explore the pain and breathe: A natural reaction to pain is to recoil and if it's your first labour, perhaps be afraid.  Some women find focusing on the pain and exploring it mentally, helps to reduce how much it hurts.  This is based on the concept that pain is how the brain interprets labour contractions because of our inbuilt cultural belief labour hurts - read about the opposite end of the spectrum and orgasmic birth here

Tens Machine: Another popular choice although scientific evidence shows mixed results.  Women seem to find this method of pain relief most effective, when worn over a longer period, ie it's less effective if put on when the pain gets severe in labour - you need to put it on as soon as you get the first twinge for maximum benefit when things get going.

Finally...
Good pain relief in labor is not the same as a perception of personal control or satisfaction in childbirth. In other words, you may have significant pain during your labor, but feel in control during the process and have great satisfaction afterward. On the other hand, you might have total pain relief during your labor, but feel totally out of control and unhappy about your experience when it is over. 
In most languages, the word for the process of giving birth describes a process of work (labor), not of pain. Remember that labor pain is more than a physiological process; coping with labor pain is emotional and complex and results in feelings of fulfillment and achievement for women. Therefore, satisfaction with labor is not necessarily related to the efficacy of pain relief. Your midwife should work with you during the prenatal period to identify personal coping strategies and encourage you to make efficient and effective use of these resources (2).
from an excellent article here

New specialised infant formulas - evidence or experiment?

Something I've been wondering recently is how the safety of new breastmilk substitutes is established, what about those that are very different such as say lactose free or amino acid based?  If anyone has any further research links, please do share. Bear with me as this may be rambly!

Human milk is particularly high in lactose and infants produce "lactase" to break it down into glucose and galactose.  In fact human milk has the highest lactose level of all mammalian milk providing 40% of baby's energy requirements, particularly important to the rapidly growing brain and the nervous system. 

"Consider what effects a lactose-free artificial infant formula could have on the infant fed on it" (health-e-learning)

So I had a Google to try and dig up research around the subject of lactose free formulas - but it seems to be really thin on the ground.  I can't find anything that compares the outcome of infants fed lactose free formula compared to those breastfed or fed a standard formula - either in the short or longer term.  In fact I can't find anything period that compares outcome when infants get their energy from something other than lactose... I'm sure before sale they would need to run trials to show infants gained weight and appeared to be developing normally? but where are these studies and what period is this considered over? has anyone studied areas other than just growth such as the nervous system, brain development or rates of illness?

So I had another Google.
I found one article that mentioned a study that compared the outcome for breastfed, standard cow's milk fed and soy fed over a twelve month period - a dig later I found it.

Growth and development during the first year of life of infants fed breast-milk, milk formula or soy formula
If you're interested in reading the abstract, you can visit the link above - I think the last sentence is the most telling:
Statistically significant differences were observed mostly between breast-fed and formula-fed infants.
So surely given this someone is going to focus on researching this and also over a longer period than twelve months? There are markers in breastmilk that suggest a much longer term impact - but who will fund it?  I'm guessing no breastmilk substitute company is going to be spending the money examining this...

I then googled to find any studies pertaining to the brain and found this 2010 study:
CONCLUSIONS: The development of brain electrical activity during infancy differs between those who are breastfed compared with those fed either milk (infant formula) or soy formula, but is generally similar for formula-fed groups. These variations in EEG activity reflect diet-related influences on the development of brain structure and function that could put infants on different neurodevelopmental trajectories along which cognitive and brain function development will proceed.

Ah well that's reassuring then.

None of the above touched on lactose free - if a standard formula can show significant differences, what about one that removes a large component?  Or what about one that is an entirely different make up such as free amino acid-based hypoallergenic versions.  I would be really interested in any research anyone has on these - the long term results of only being fed free amino acids has surely been studied before use, but I'm suspecting probably not?  Interestingly even those who promote this type of formula state it is only appropriate if extensively hydrolised formula cannot be tolerated - why if it's so good?!

I then had a news item delivered that described a new fat free formula - it was far lower in calories as skimmed milk was used, energy was derived from "protein concentrate"; but protein in breastmilk is low and a minimal contributor to energy - so again what is the impact of this sort of substitute?

During my hunt I also found studies where various other ingredients had been added to breastmilk substitutes to try and improve outcome - some appeared beneficial, others not so - but what about all the infants fed formula before the "latest must have ingredient"? what about the infants that don't fare well in the testing?

I also realised that:
Manufacturers may propose the addition of a new ingredient to infant formulas by demonstrating the safety, not the efficacy (the capacity to produce an intended effect under the realistic situation of product use), of the proposed ingredient.
So as long as a product has been shown safe for infants, it can go in the milk - at what point is the line drawn?  it appears manufacturers can change the makeup of formula as suits, providing they use substances shown to be safe (and as this article highlights they regularly do based on price).  But doesn't research covering formula study typical formulation rather than a situation where someone has removed the fat or lactose or changed composition significantly in other ways such as removing fat?

I can totally appreciate that for mums who have a seriously ill infant from food related conditions,  something like a specialised formula may feel like the only answer (and at times it may indeed be).  But what is worrying is that if a baby is refluxy/unsettled even after mum has cut dairy/soya from her diet - some specialists are suggesting a specialist formula as the next step; even for those breastfeeding.  Despite the fact we know breastmilk has factors that support normal gut development; often without even looking in baby's mouth to see if other reasons for a problem exist or contacting a lactation consultant,  ie not as a last resort.

What's even more worrying is that some sources state if we do not consume lactose, we stop producing lactase - and thus become lactose intolerant.  Making an accurate diagnosis pretty essential!

What we also need to remember is that specialist formulas are hugely profitable - and that whilst manufacturers are not allowed to market these directly to parents, they can market them to Health Professionals....

It feels as though infant feeding and babies are almost one big experiment - very profitable but at what cost?

Brugo Mug Giveaway!! International Offer

Ok I said when I got 300 Facebook fans I would give a nifty little something away - so how about  a couple of Brugo Mugs?

One thing I distinctly remember about having a tiny baby was never getting to finish a hot cup of tea, instead I used to find either untouched or half consumed cups dotted around the house like a disbanded army by the end of the day.

Although breastfeeding mums have a good excuse to grab the remote, some snacks and snuggle up feeding - many don't want to risk holding a hot drink over baby at the same time

I'd like to say this improved dramatically as they got older, but a far more common scenario was: put baby down for nap, run round grabbing a bite to eat and a quick tidy round, decide to make a brew, pick up paper, sit down read one line, have one sip and hear the familiar sound of baby waking.  No really, it's like they have an inbuilt sensor!  Once they're walking, crawling and pulling things from high surfaces - tea consuming opportunities reduce even further (I like my tea can you tell? lol).

My partner in sympathy bought me an insulated mug, which was handy in that it kept the drink warm long enough to have a chance to drink it - but as anyone who has used one will know, thermal mugs keep things hot; meaning it can be quite a while before your drink is cool enough to swallow without scorching half the lining of your throat.  With hectic new baby life, that meant I could even manage to forget I had a hot drink sat cooling somewhere!

So when I spotted Brugo mugs online I thought ooooooooooooohhhhh, that might be handy for a breastfeeding mum....

What's nifty about a Brugo mug?
Well apart from the fact they look rather good, it comes down to Brugo's Thermodynamic Technology, which in English means not only does it keep drinks warm for several hours, it also cools some to the perfect temperature for you to drink....clever huh!

The lid has three options; lock, sip and tip and cool.  When you first make your drink if you want to drink some straight away, you can twist the lid to the tip and cool setting.  Tip the cup away from you for a few seconds and some of the liquid moves into the patented temperature control chamber.
 
You then swill with a "brandy" motion and that sip is instantly adjusted to the perfect temperature, while the remaining liquid in the main chamber stays hotter.

As the drink in the main chamber cools (generally by the time it's about 3/4 full), you can then switch to "sip", bypassing the cooling option and driniking straight from the cup.  Lastly, and probably obviously there is the "lock" function which makes it spill proof.  Please note - if you turn the cup upside down and shake it, a small amount of liquid will be released, it is not completely sealed so don't throw it in your handbag!

Is it perfect?
Being analytical, things are rarely perfect!  I would like the option of a handle and I would prefer a slightly more indented lid to give a more ergonomic feel when drinking - but all the pros mentioned above out weigh these for me.



Want to win one?

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My partner wants to share the feeding, natch!

I use the terms dads/partners simply for ease of reading in this post, but I also understand family dynamics come in a wide range of packages.  It is relevant to any significant other(s) supporting mum with a new baby so please don't be put off by titles.

I first wrote about this in a dispelling myths article a few years ago, but I've noticed it still pops up a lot online:
"I want dad to be able to get involved in the feeding so he can bond",
"We're going to mix feed so dad can help with night feeds",
"My partner says I will need to rest and so we plan to introduce a bottle ASAP, so he can be involved in all aspects of caring for baby".
Most people probably don't see anything wrong with these statements, it all sounds perfectly reasonable; indeed I remember uttering similar with my first, it's just what "non extremists" do right?  I confess I started out a very "mainstream" mum (by the apparently essential labeling system parenting seems to demand) but the more I trained, read and experienced, the more I began looking for evidence rather than opinion - and the more I wondered about dads, bottles and bonding.
 
How ever did dads bond before common bottle use?  Are men too intended to lactate? perhaps that's one for another blog post!  If not what is their role?

Certainly for a long period in time, babies and children were "women's work", (although prior to this evidence suggests care of infants was shared in many societies) but as the change in communities happened so came "modern man” - someone who shared the chores, cooking and childcare.

Dads feeding became something marketed by the artificial breastmilk substitute companies; "feed the baby to bond and help out your partner, be the good dad" was born! It fits great with the hands on dad thing and women proudly announce their husband or partner of course wants to get involved with feeding - like a badge of good parenting. Some of you might remember the advert recently for a follow on milk, it showed a dad pacing with baby at night and the voice over "I promise to do my share of the night feeds"?

The concept is actually a rather nifty idea on a couple of levels. Firstly whether mum breastfeeds is heavily linked with the support (or lack of) received from her partner, secondly mums also buy into dads sharing night feeds because as mentioned above, it makes seemingly logical sense in today's society to share all care.

When mum experiences problems, partners of course want to help resolve things. In fact I often say dads are "solvers".

Often they have no idea how to help with breastfeeding though and in absence of other ideas, infant formula may be suggested to “give mum a break” – the problem can be solved with a bottle! double whammy. Many understandably don't know how much this can impact in the early weeks - perhaps by reducing how effectively baby milks the breast resulting in soreness for mum, or how the fast easy flow of the bottle can cause baby to be impatient and fuss at the breast (particularly if supply is low and so milk flow slower) . Many don't realise that ”help” in the form of a bottle can compound whatever problem mum was having initially, reduce supply - increasing the need for further supplementation and longer term actually cause far more problems than it appeared to solve. Even if they did, many are not aware of the risks of not breastfeeding to baby or mum, or the impact of a bottle of artificial milk.  This can put a lot of pressure on a mum who feels torn by what she has previously been told, but also has a shared sense of lack of other options or coping strategies - how many get good breastfeeding education prior to having a baby?

In practice many mums struggle to express much in the early days, and if they do they may end up so full if a feed is missed they have to express anyway at the same time dad is giving the bottle. If it's before supply has settled, expressing can kick start an oversupply for mum - handy if it's planned for a return to work (as some mums do) not so much so for the new mum wondering why she has enough milk to feed half the street.  Some mums hate expressing, some babies hate bottles and sharing the feeding can end up a lot more work than mum just feeding baby.

But who decided men feeding babies was bonding or that this was the best role for dads/partners to assume?

Before you start yelling at the screen, hear me out.  The hormone oxytocin plays a hefty part in the bonding process; it has been shown to influence trust and social attachment between mammals, plus feeling good, relaxed, connected and less stressed or anxious.  Breastfeeding produces high levels of oxytocin, but it’s not a hormone exclusive to breastfeeding – other things also produce it at different levels. A 2009 study of 80 couples showed:
The more the men in the study cuddled their babies, the more their oxytocin levels rose. It’s like a feedback loop; the more you touch, the more oxytocin you have; the more oxytocin, the more you touch. But you need to initiate this feedback loop, by holding and touching and kissing your baby.”  (Fieldman 2009)
So if the cradling, gazing into baby’s eyes and interacting with them causes oxytocin, does the plastic bottle in hand actually increase it any? Couldn’t dads who want an exclusively breastfed baby do just the same minus bottle? Do dads actually find bottle feeding a bonding experience - or more of a bonding experience than other things they do with baby? Could bottle feeding actually just be considered bonding because it’s been suggested to us that it is, because of the culture we live in?

But what about help during the night?
Although the early weeks of life with a new baby can be hard for new parents, once these have passed it’s a lot easier to breastfeed at night than either person bottle feeding; if baby is co-sleeping or in a co-sleeping cot attached to the side of the bed, nobody even has to sit up. Compare that to the requirements to prepare substitutes safely and it’s a whole different ball game. 

I also think it's a bit of a myth that if men feed the mother gets more sleep - believe me when baby is up and hungry nobody in close proximity is sleeping through it; when it's your baby, you wake!  Another myth is that men need to feed to comfort baby - if baby suffers from colic or is unsettled it can be amazing what even a change of arms can do.  With slightly older infants, if you are confident they are satiated and they are refusing the breast -  dad can offer a clean little finger to suck and a comfy pair of rocking arms

A couple of studies have shown exclusively breastfeeding maximises sleep, particularly if co-sleeping/co-cot sleeping. A study from 2004 found the exclusively breastfeeding mothers slept approximately 20 minutes longer than mothers who were mix feeding (Gay et al). Another study examining quality of sleep found breastfeeding mothers got an average of 182 minutes of slow wave sleep, compared to 63 minutes for those exclusively bottle feeding. Slow-wave sleep is an important marker of sleep quality, and those with a higher percentage of slow-wave sleep report less daytime fatigue. (Blyton et al., 2002).

Whilst dads are often very keen to help out with bottle feeds in the first couple of weeks, I do have to wonder what percentage carry on with as much gusto once the new baby tiredness has kicked in and paternity leave has finished. Don’t some have jobs that need them to be on the ball at work?  If mum is still on maternity leave and doesn’t need to get dressed till noon, isn’t it more likely she will end up doing more night feeds during the week anyway if they’re both shattered?

What can dads do?
I’m firmly of the opinion that “having a breastfed baby” is the responsibility of everyone connected to baby - and partners/husbands/dads even grans absolutely have an extremely significant job! But is the right role at the end of a bottle?

One mum commented:
Frankly I think my husbands parenting skills are in no way diminished by his physiological inability to lactate, and find it a bit insulting that he has to be "included" in this way, as if he has no other role.
The truth is that there is lots of ways dad can help mum, bond, really enjoy the new baby and support breastfeeding:
  1. Get support - if problems arise perhaps dad can help locate some support in the area and go along with mum.  On the breastfeeding helpline we get lots of calls from dads and often they can be amazing hands on support when given information and a chance. If you’re still pregnant, why not get your partner reading up on how to tell if breastfeeding is going as expected and what to do if not?
  2. Skin to skin -  produces heaps of oxytocin and many babies are comforted by the broad warm chest of dad, just as they are snuggled against mum’s curves.  Mums think nothing of hopping into bed for some newborn snuggles, time out for skin to skin with dad can be just as bonding.
  3. Bathing baby - ditch the baby bath and hop in together.  Warm water produces oxytocin, as does skin contact and so both mums and dads report it being a great bonding time (and stops the screaming that can accompany some newborns in the bath!)
  4. Wearing baby - popping baby in a good baby carrier and heading off for a walk can give dad some one on one close contact time with baby and give mum chance for a bath and a snooze! If they don't fancy heading outdoors, many babies are content snuggled up pottering round the house.
  5. All together now - laying down to breastfeed can give mum chance for a well earned nap. If dad snuggles up too, he can keep an eye on baby (so mum can relax more) One dad in particular commented cuddling up with mum and baby when feeding made him feel particularly included.
  6. The collect and deliver – instead of expressing, some mums prefer to feed baby and then dad takes over care, before delivering baby back when hunger strikes.  By the time they baby is a few weeks old, mums can often do this without waking fully - especially with the assistance of dad.  As an added bonus the hormones delivered during the feed help mum drift nicely back off to sleep…
  7. Clean, cook, tidy!  - mum has done pregnancy and labour and deserves a babymoon.  If mum gets help in these other areas it can help her relax and enjoy this time.
  8. Massage for mum – an upper back and shoulder massage before a feed can be excellent in the early days; often mums hunch their shoulders when trying to breastfeed in mainstream positions, resulting in tension and stress across shoulders and the back of the neck.  There is also an acupressure point between the shoulder blades near the neck, linking the nerves in the upper spine with the breasts; massaging this helps trigger the milk ejection reflex (letdown) in some mums and can be beneficial when nursing or expressing.  At the very least mum should end up feeling more relaxed.
  9. Massage for baby – There are lots of reported reasons to massage your baby, again oxytocin is linked.  Why not see if there is a DVD or book as a "how to", or even a newborn group you could all attend together if your partner has leave.    
  10. Music & dance – A 2010 study by psychologists found that infants respond to the rhythm and tempo of music and find it more engaging than speech. They like to move in time to the music so get dads to flick on the stereo, and try a few different styles to find their groove.
  11. Snacks - in the early days very often as soon as mum feeds, hunger and thirst strike!  having a partner on hand to deliver snacks and water is fantastic.  If dad really wants to go for it, perhaps he could even bake healthy nutritious snacks?  including seeds, grains and the essential good quality dark chocolate.
  12. Protector - ok so for cave woman this would likely have been from some big ass tiger, whereas nowadays it tends to be from general interference from a host of well meaning people.  If dad is championing for mum, encouraging and helping if problems arise - not only is mum far more likely to succeed, but others will also be less quick to undermine.  If they do, dad will be in the know enough to step up and protect what is ultimately not only a significant factor in his partners long term health, but the corner stone of his baby's.