Saturday, May 16, 2009

The spring rush has arrived!

I don't know about all of you, but my life has been hectic these past few weeks. Since the first of March, I have been out of town 6 times (a couple of those times were for five days), my husband has been on three business trips, my daughter has played through a season of soccer and has started on tee ball, my own softball season has started, my daughter's been going to school more than normal in preparation for the end of the year, the stormy weather has knocked a tree down into our garden and broken garden boxes and our greenhouse (and because it's been raining so much, we've had to try to fix it in spurts, so it's still not ready for us to garden!), we've celebrated five birthdays and an anniversary and Mother's day, and all the other stuff that comprises our normal lives.

And to top it all off, my allergies are bad enough that I've finally given in on taking allergy medicine, but the only medicine we have has made me feel exhausted constantly, and we haven't had the time to go to the store yet to get a different kind.

I'm tired.

But that is nothing new to any of you, I'm sure. I don't think mothers are not tired at any point in time for many years after their youngest are in diapers.

My kids are taking the rush tolerably well. My daughter, independent and out-spoken 4.5 year old that she is, has taken this all in stride and is just going about her merry way. The couple of trips I was gone for several days, she was a little whinier the day I got back, but otherwise she's been fine. I've been worried about my son who's 2.5 years old and still nursing, particularly with the travel and me being gone for so many days in a row. The first 5 day trip I took, he was fine when I came home, if a little clingier for a couple of days. The second 5 day trip I took, though, he didn't do as well at. His sleep patterns totally shifted, which was oh-so-much-fun. Luckily, by now we've gotten back to normal, and since we don't have any other long trips away planned until at least August, life will be normal for a while before I/we are gone again.

Of course, this isn't to say that life won't be hectic. Tomorrow we're all leaving for NC for a wedding my husband is in. We have another wedding next month. At some point we'll take a nice, relaxing (hah!) visit to the beach. We have another wedding in August, as well as a possible trans-Atlantic trip for me. I'm sure that we'll have pressure (not necessarily of the bad sort) to take the 14+ hour drive up to the in-laws since it'll have been a year in July since we've been up there. Whether or not we give in to the pressure is a different story.

But that's sort of the way we like it, I think. We do it every year - the hectic running around and never sitting down thing. It lasts from about March until December. I'm just glad that the kids go so easily with us. I think we're helped greatly with that because we co-slept with both of them, co-sleeping in hotel rooms is not something new to them, and extended nursing really helps my son. Despite the craziness of my travel schedule, he has come back to nursing every time I've gotten back from traveling. It might take him an hour, or even twelve, to ask to nurse again, but he has done so without fail. And while at one point, I couldn't wait to be done nursing, I find that it serves as a comfort and re-connection for both of us now when I come back after being gone for a few days. I definitely never thought that I would be a mother who nursed her child for several years, but it appears that I will be, given that my son turns 3 this summer.

Of course, it could be that he gets done this summer. All the travel may get him too busy, and we may just wake up one day and realize we haven't nursed in several days. He may potty train this summer, though I have no hopes for that. Who knows what other milestones he may reach this summer, or if he reaches any at all?

As always, I find myself looking forward to what the coming months will bring, and who we'll be when they're over.

Friday, May 15, 2009

Coping with Criticism about Breastfeeding

"Why don't you just give that baby a bottle?"

"When are you going to stop nursing....he's starting to walk now!"

Comments like these can be very hurtful to a mother who is trying to do what is best for her baby. Sometimes friends or relatives are simply uninformed about the many benefits of breastfeeding. Or perhaps they may not understand how important it is to a mother to nurse. The sad fact is that even some doctors are not very well informed about breastfeeding. While they learn the basic anatomy and physiology of breastfeeding in medical school, they are often not taught how to support and encourage nursing mothers. If they don't have personal experience with breastfeeding, they may not be very supportive at all. Mothers need to think through their responses before they encounter this situation. In her article "Coping with Criticism about Breastfeeding" in Valley Babies magazine (Vol 3, No 1), Suzanne Rickman offers some excellent pointers.

The Critical Health Care Professional
Any time a health care professional suggests she wean, a mother should get a second opinion. The American Academy of Pediatrics (AAP) recommends that babies be exclusively breastfed for the first 6 months of life, with continued breastfeeding for a year or as long thereafter as both mother and baby desire. The World Health Organization (WHO) actually recommends that mothers breastfeed for at least two years. So if a doctor or other health care professional expresses disapproval of a breastfeeding relationship, a mother can calmly explain the AAP and WHO recommendations. If the disapproval becomes harassment, she may need to find a new health care professional.

The Critical Friend
Sometimes a mother may feel pressure from friends to stop breastfeeding. If a close friend didn't have a positive breastfeeding experience, she may unwittingly discourage the new mother. The fact is that breastfeeding really can be very challenging in the early days. So if a woman is surrounded by friends who don't support her decision to nurse her baby, she may very well decide to give up. That's why it is important for expectant mothers who want to breastfeed to ally themselves with a good support group prior to giving birth. Then those mothers who have been successfully breastfeeding will be able to provide the necessary encouragement.
The Critical Family Member
It can be especially hard when a new mother receives criticism rather than support from her own family. If her mother didn't nurse, she may not understand why it's so important. When the criticism comes from a mother-in-law, it can be just as difficult. In a situation like this, the new father is a key player. He needs to run interference for his wife and protect her from discouraging members. He might even provide those critical relatives with some helpful resources.

The Annoying Stranger
When a stranger makes a comment about her breastfeeding, a mother has several options. She can ignore it, respond to it with tact, or get upset. Certainly, it is better to avoid the latter! Here are a few options for a tactful response:
• Use friendly humor. If someone says "How long are you going to nurse that baby?" You might respond with, "Oh, at least for the next five minutes."
• Be gentle, not defensive. Perhaps the critic has never seen a nursing mother. Maybe breastfeeding is something new. Realize that this might be the perfect opportunity to educate her about breastfeeding.
• Give a factual response. Explain the AAP recommendations. Give the critic some food for thought.

Friday, May 8, 2009

Human Milk in the NICU

In February of 2009 the National Association of Neonatal Nurses Board of Directors published a position statement entitled "The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit."
Based on a body of research which clearly demonstrates the superiority of human milk for premature infants, this position statement clearly enunciates optimal guidelines which should all NICU nurses should follow.

Responsibility toward the Mother

It is critically important, according to this position statement, that mothers be provided a hospital-grade double breastpump and pump kit. They should be encouraged to pump every 3 hours for optimal milk production. Keeping a pumping log will help both mother and healthcare provider to make assessments and adjustments. Receiving the mother's colostrum helps prepare the immature intestine by coating it with Immunoglobulin A. Fat content is an important factor when looking at the milk a mother pumps for her preterm baby. The paper recommends the use of a crematocrit to determine the fat content in order to determine how much human milk fortifier might be necessary to provide the caloric value necessary for optimal growth and development.

Responsibility toward the Infant
Obviously the neonate is the nurse's primary patient. Studies show that even a preterm baby as young as 28-30 weeks can demonstrate rooting and areolar grasp and latching behavior. Skin to skin exposure has been shown to have a myriad of benefits. After pumping a mother can allow her baby to nuzzle and lick her empty breast. The authors of the position paper recommend the use of a nipple shield to help the premature infant suckle more effectively and obtain more milk in early feeds.

The publication of this position paper is an important step in validating what many NICU nurses already knew. As research-based evidence continues to mount about the amazing benefits of breastmilk for at-risk infants, hopefully we will see more and more breastfeeding support in NICU's everywhere!

Sunday, May 3, 2009

Breastfeeding Claims Under Attack...Again

In an article published on on April 27, Lauren Cox asserts that claims about the benefits of breastfeeding are overblown. This comes about a month after that Atlantic article in which Hannah Rosen disputed the medical benefits of breastfeeding. I actually responded to the Atlantic article in a previous post.

This interesting timing of these 2 articles undermining the benefits of breastfeeding in such a short period of time makes me wonder what's up. I've thought of several possible reasons
1. Some mothers may feel pressured by the growing pro-lactation movement and are reacting to that perceived pressure in writing.
2. Maybe the artificial human milk industry has done a pretty decent job of convincing the general public that breastmilk and infant formula are about equal.
3. Or perhaps, as I wrote in my previous post, the studies that do indeed show conclusive benefits are titled and the abstracts are written in such a way that artificial milk isn't depicted as a causative factor in multiple negative infant outcomes.

Whatever the reason, it is more important than ever that breastfeeding advocates rely on solid scientific evidence for every claim we make. The American Academy of Pediatrics Policy Statement, Breastfeeding and the Use of Human Milk, contains 216 references to studies, scholarly articles, and public policy documentation dealing with the superiority of breastmilk over artificial milk for infants. While it may not be feasible to read every study in detail, a cursory review of this literature demonstrates overwhelming, objective evidence gathered in reproducible study conditions that repeatedly prove the inferiority of milk substitutes.

It is true that some mothers are unable to breastfeed for one reason or another. And some mothers do struggle with supply issues. A lact-aid with supplement can help. Nevertheless, there is an International Code of Marketing of Breastmilk Substitutes which strictly prohibits many of the kinds of marketing which the large infant formula companies do in this country. Until the United States government decides to enforce this code, we will continue to see the systematic undermining of breastfeeding in this country. No doubt about it, our work is cut out for us! But we have science and nature on our side, and that's a winning combination!