I used to talk to the fathers in my breastfeeding classes about how important they were to helping their wives successfully breastfeed. I emphasized the father's role as encourager and support person for his wife. I suggested he bring her a drink when she was nursing, and offer to change the baby etc. All of those things are important. However, I recently met a very interesting Army midwife and lactation consultant who gave me a very different perspective!
Major Jarold (Tom) Johnson is much more than a healthcare provider in an army hospital. He is also the father of seven breastfed children. In the breastfeeding classes Major Johnson teaches, he helps fathers learn how to REALLY help their wives breastfeed. He teaches dads how to recognize a good latch and how to help both mother and baby nurse successfully.
So what exactly does Dad do?
Evaluate Latch
Dad is in the perfect position to really see how baby's latch looks. So it is important that he know what to look for. He should look for a wide-open mouth with the nipple and areola deep in baby's mouth. Baby's cheeks will look full, and baby's chin and nose will be touching the breast. His lips should be flanged around the areoala.
Evaluate Suck
Dad is also in a great position to help Mom evaluate baby's suck:swallow ratio. Once her milk lets down, baby should be swallowing with every suck or at least every other suck. Baby will have spurts of actively sucking and swallowing, then he may rest for a half minute or so before beginning another suck/swallow burst.
Evaluate Pain
Breastfeeding should NOT be painful. Pain is an indication that something isn't right. Usually the problem is the latch. If Mom is experiencing discomfort, Dad can slide his finger between the baby's chin and Mom's breast, pulling down on the chin while he pulls baby's head in tighter to the breast. Sometimes it may take two or three tries, but this technique should deepen the latch and eliminate any pain.
A father's role in breastfeeding success cannot be overestimated. The husband who is willing to focus on evaluating his baby at his wife's breast will reap multiple rewards: a grateful wife, a healthy thriving baby, and the knowledge that he played an integral role in the process.
Sunday, November 22, 2009
Wednesday, November 11, 2009
Medications and Breastfeeding
It makes me sad when a mom tells me, "I really wanted to breastfeed, but my doctor said I couldn't because of a medication I have to take." Sometimes, in very rare cases, the medication may truly be incompatible with breastfeeding. Certain drugs like Lithium, argatroban, any type of radioactive iodine, any chemotherapy agent and a handful of other drugs are definitely not safe for a nursing baby.
However, many medications that may be acceptable come with a manufacturer's label discouraging use by nursing women. Why is this? Perhaps it is an attempt by the drug manufacturers at CYA (just in case something were to happen....) Perhaps a drug may not be safe for use during pregnancy, so the assumption is made that it isn't safe during lactation either.
Whatever the case, many health care practitioners are quick to tell a mother that they can't continue breastfeeding while taking a certain medication, even if the evidence does not bear that out. Ideally, it really is best to limit the medication a breastfeeding mother takes to only what is truly necessary. But when a mother needs a particular medication to be healthy, she should certainly take it!
Dr. Thomas Hale, Ph.D. has devoted much of his career as a pharmacist to studying the effects of various medications on breastfed babies and on the breastmilk itself. He is a professor of Pediatrics at the Texas Tech University School of Medicine. Dr. Hale, who is widely recognized as the leading authority in this field, has authored a book called Medications and Mothers' Milk which is now in its thirteenth edition. Any health care provider who works with nursing mothers and babies should have a copy of this book to use as a reference.
Dr. Hale defines the following categories for lactation risk when considering a particular drug:
L1 - Safest - These drugs have been taken by many breastfeeding women with no adverse effects. Controlled studies fail to demonstrate a risk to a nursing infant, and the possibility of harm to the breastfeeding infant is remote, or the substance is not orally bioavailable to the infant.
L2 - Safer - These drugs have either been studied in a limited number of breastfeeding women without any increase in adverse effects in their infants or there is scant evidence of a demonstrated risk likely to result as a use of these medications.
L3 - Moderately Safe - There are no controlled studies in breastfeeding women; however, there is a possibility of a risk. Or controlled studies that do exist may show only minimal non-threatening adverse effects. These drugs should be used only if the potential benefit justifies the potential risk to the infant.
L4 - Possibly Hazardous - Positive evidence exists showing a risk either to the breastfed infant or to the mother's milk production; however, the benefits from the use of the drug may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which a safer drug does not exist or is not effective.)
L5 - Contraindicated - Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant, or it is a medication that has a high risk of causing significant damage to the infant. The risk of using these drugs in nursing mothers absolutely outweighs any possible benefit from breastfeeding.
The next time you are faced with needing a medication, be sure to ask your doctor to check Dr. Hale's book. If he doesn't have it, find a lactation consultant who does, and do your research! There's no need to stop breastfeeding unless you absolutely have to!
However, many medications that may be acceptable come with a manufacturer's label discouraging use by nursing women. Why is this? Perhaps it is an attempt by the drug manufacturers at CYA (just in case something were to happen....) Perhaps a drug may not be safe for use during pregnancy, so the assumption is made that it isn't safe during lactation either.
Whatever the case, many health care practitioners are quick to tell a mother that they can't continue breastfeeding while taking a certain medication, even if the evidence does not bear that out. Ideally, it really is best to limit the medication a breastfeeding mother takes to only what is truly necessary. But when a mother needs a particular medication to be healthy, she should certainly take it!
Dr. Thomas Hale, Ph.D. has devoted much of his career as a pharmacist to studying the effects of various medications on breastfed babies and on the breastmilk itself. He is a professor of Pediatrics at the Texas Tech University School of Medicine. Dr. Hale, who is widely recognized as the leading authority in this field, has authored a book called Medications and Mothers' Milk which is now in its thirteenth edition. Any health care provider who works with nursing mothers and babies should have a copy of this book to use as a reference.
Dr. Hale defines the following categories for lactation risk when considering a particular drug:
L1 - Safest - These drugs have been taken by many breastfeeding women with no adverse effects. Controlled studies fail to demonstrate a risk to a nursing infant, and the possibility of harm to the breastfeeding infant is remote, or the substance is not orally bioavailable to the infant.
L2 - Safer - These drugs have either been studied in a limited number of breastfeeding women without any increase in adverse effects in their infants or there is scant evidence of a demonstrated risk likely to result as a use of these medications.
L3 - Moderately Safe - There are no controlled studies in breastfeeding women; however, there is a possibility of a risk. Or controlled studies that do exist may show only minimal non-threatening adverse effects. These drugs should be used only if the potential benefit justifies the potential risk to the infant.
L4 - Possibly Hazardous - Positive evidence exists showing a risk either to the breastfed infant or to the mother's milk production; however, the benefits from the use of the drug may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which a safer drug does not exist or is not effective.)
L5 - Contraindicated - Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant, or it is a medication that has a high risk of causing significant damage to the infant. The risk of using these drugs in nursing mothers absolutely outweighs any possible benefit from breastfeeding.
The next time you are faced with needing a medication, be sure to ask your doctor to check Dr. Hale's book. If he doesn't have it, find a lactation consultant who does, and do your research! There's no need to stop breastfeeding unless you absolutely have to!
Sunday, November 8, 2009
Response to Dr. Rosemond
I am an advocate of Attachment parenting, but I am also an advocate of parents using common sense and setting age-appropriate boundaries for their children. I believe the two actually go hand in hand.
The little that I had read of popular author and speaker John Rosemond in the past led me to appreciate his practical common sense approach to parenting. Recently I had lunch with my good friend Lysa Parker, one of the founders of Attachment Parenting International. Dr. Rosemond was planning a visit to Huntsville; therefore, he came up in our conversation. I told Lysa I appreciated his common sense approach (remember, I haven't read a LOT of his stuff...just a little and mostly dealing with older kids). Lysa explained that he is a strong opponent of all things AP. I was quite surprised.
I wasn't able to go hear him speak, though I would have liked to, but I did see an article in the Huntsville Times today that I found to be quite enlightening. Apparently in his address to about 250 people at Huntsville High School he said " 'psychobabble' about fostering a child's self-esteem and being ultra-involved in a child's life has had a disastrous effect on children's behavior." According to the article, he also said "his mother 'never paid much attention to me,' but she set clear ground rules for what she expected from him at an early age."
I read that line and felt sorry for him. Setting ground rules with clear expectations is wonderful. However, as a 61 year old adult his memory is that his mother never paid much attention to him. And now he is advising a generation of parents not to become too attached to or involved in their children's lives.
According to the Times article, "One of the biggest errors parents make, he said, is that they are in relationships with their children rather than being figures of leadership and authority. Because of those relationships, he said parents hunger for popularity and acceptance with their children, something which he said nullifies their ability to lead."
I agree that the roles of parent and friend cannot be one and the same when a child is growing up. However, I consider my grown children dear friends. My son and I talk every day about everything under the sun. I wonder if Rosemond counts his grown children among his closest friends? Attachment parenting does not mean that we seek to be "popular and accepted" by our children. It does mean that we create a relationship with them which fills them with a sense of security and well-being. The relationship begins at birth and continues throughout the child's life. It does not mean that a parent does nothing but cater to her child's every whim.
The problem is that authors like Rosemond equate Attachment Parenting with Permissive parenting or parenting without boundaries. They fail to understand the premises set forth by Dr. William Sears. As both a pediatrician and a father, he has years of experience working with patients, but also a proven track record of raising terrific kids who are making a real contribution to society.
Rosemond believes that his approach to parenting is a Biblically based method. Yet the picture I see of God in the Bible is one of a loving Father who tenderly cares for His own or a shepherd who cares deeply for each sheep. Specific imagery related to breastfeeding and attachment can be seen in Isaiah as God talks about His loving care for His people. I think it's time that Christians begin advocating for strong Biblically based Attachment Parenting. If we truly want to raise a generation of selfless, giving, confident young adults, then we must teach them the most basic lessons of trust from infancy on.
The little that I had read of popular author and speaker John Rosemond in the past led me to appreciate his practical common sense approach to parenting. Recently I had lunch with my good friend Lysa Parker, one of the founders of Attachment Parenting International. Dr. Rosemond was planning a visit to Huntsville; therefore, he came up in our conversation. I told Lysa I appreciated his common sense approach (remember, I haven't read a LOT of his stuff...just a little and mostly dealing with older kids). Lysa explained that he is a strong opponent of all things AP. I was quite surprised.
I wasn't able to go hear him speak, though I would have liked to, but I did see an article in the Huntsville Times today that I found to be quite enlightening. Apparently in his address to about 250 people at Huntsville High School he said " 'psychobabble' about fostering a child's self-esteem and being ultra-involved in a child's life has had a disastrous effect on children's behavior." According to the article, he also said "his mother 'never paid much attention to me,' but she set clear ground rules for what she expected from him at an early age."
I read that line and felt sorry for him. Setting ground rules with clear expectations is wonderful. However, as a 61 year old adult his memory is that his mother never paid much attention to him. And now he is advising a generation of parents not to become too attached to or involved in their children's lives.
According to the Times article, "One of the biggest errors parents make, he said, is that they are in relationships with their children rather than being figures of leadership and authority. Because of those relationships, he said parents hunger for popularity and acceptance with their children, something which he said nullifies their ability to lead."
I agree that the roles of parent and friend cannot be one and the same when a child is growing up. However, I consider my grown children dear friends. My son and I talk every day about everything under the sun. I wonder if Rosemond counts his grown children among his closest friends? Attachment parenting does not mean that we seek to be "popular and accepted" by our children. It does mean that we create a relationship with them which fills them with a sense of security and well-being. The relationship begins at birth and continues throughout the child's life. It does not mean that a parent does nothing but cater to her child's every whim.
The problem is that authors like Rosemond equate Attachment Parenting with Permissive parenting or parenting without boundaries. They fail to understand the premises set forth by Dr. William Sears. As both a pediatrician and a father, he has years of experience working with patients, but also a proven track record of raising terrific kids who are making a real contribution to society.
Rosemond believes that his approach to parenting is a Biblically based method. Yet the picture I see of God in the Bible is one of a loving Father who tenderly cares for His own or a shepherd who cares deeply for each sheep. Specific imagery related to breastfeeding and attachment can be seen in Isaiah as God talks about His loving care for His people. I think it's time that Christians begin advocating for strong Biblically based Attachment Parenting. If we truly want to raise a generation of selfless, giving, confident young adults, then we must teach them the most basic lessons of trust from infancy on.
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