All posts in lactation consultants

Supplementing with formula? Learn more about DHA/ARA additives.

(This is a great newsletter from Healthy Babies Happy Moms, Inc a wonderful clinic in Rhode Island that helps moms navigate the early days of motherhood and breastfeeding. I thought this information was important and want to share it with Milkies readers.)

Sometimes, a lot of what we do at HBHM Inc. involves helping moms navigate the system to get what they need for their particular situation. Read below for the experience of one of our clients, a Rhode Island mother of two small children, who is also a RN with a Master’s of Public Health. In this instance, she taught us new information on DHA/ARA content in formula and an insurance benefit we were not even aware of, which might be helpful for mothers who need formula because of a low milk supply.

DHA/ARA Concerns and Insurance Coverage of Formula

Controversy surrounds the use of DHA and ARA additives to infant formula. While DHA and ARA are compounds are also found in breast milk, manufactured sources of DHA and ARA are structurally different and may not actually be beneficial. More concerning are the potential negative health effects of these additives, which remain largely untested in infants. DHA and ARA additives can expose babies to environmental contaminants and fungal toxins. These contaminants and toxins are most concerning for infants with immature immune systems and can cause unpleasant side effects in all babies. For a full discussion of the dangers and side-effects of DHA and ARA in infant formula, visit this link.

The side effects of DHA and ARA are what I noticed first in our newborn. I had to give him formula due to a low supply issue I have had with both of my children, despite my best efforts to exclusively breastfeed my babies. He had watery explosive diarrhea, excessive foul smelling gas and what I suspected was abdominal cramping by observing how fussy he became when he passed gas or had diarrhea. Our pediatrician said “babies have gas” but I felt like this was more than just a common case of fussiness. I learned about the possibility that DHA and ARA were to blame from the website www.HealthyBabiesHappyMoms.com. Figuring that this was an easy change to make, I set out to buy formula that did not contain DHA or ARA. Sounds simple, but it wasn’t.

After hours spent pouring over formula websites and on phone calls with formula companies, I learned that most formula makers have stopped producing formula without DHA or ARA. The only company that makes a formula without these additives is Baby’s Only, however, this formula is a “toddler” formula and I did not feel comfortable giving this formula to my newborn.

Through my research I discovered that Good Start does make a DHA/ARA free formula but it is only sold in Canada. I called the Canadian Good Start company (Nestle) to ask if I they could send some formula to me but they couldn’t do it. Customs rules do not allow things that are regulated by the FDA to be sent across borders. The man I spoke to on the phone was perplexed. Why was I calling him about this formula when it is actually made in the United States and then shipped to Canada? I wanted the answer to this question too so I called the American Good Start company. I know that you manufacture this formula here, I said, could you just send me a can? But no, they couldn’t. “Not FDA approved for sale in the US,” was the response I received.

I happened to have a friend who was visiting Canada at the time and she brought three precious cans of DHA/ARA free formula back for me, hidden in the trunk of her car. My baby is now three months old and we’ve been using the formula for the past two and a half months. He’s doing so well on it, virtually no gas, normal poops. He’s an incredibly happy and easy baby. But we’re running out of formula and I don’t have anyone to get it for me now. Short of driving six hours to Canada to get it myself, I’m out of luck.

My solution is the one that you may also have to consider, if you are concerned about DHA and ARA in infant formula. Through my research I learned that while all formulas contain these additives, they contain them in different quantities. Earth’s Best, Enfamil and Good Start contain 17mg of DHA and 34mg of ARA per serving but Similac contains less, 8mg DHA and 22mg ARA (personal communication with formula company representatives via phone). If you choose to use Similac, at least you will be exposing your baby to the least amount of DHA and ARA possible.

One unexpected surprise from my previous experience was to find out that Moms with low milk supply can get supplemental formula for their babies for free through insurance. To take advantage of this benefit, ask for a prescription for the formula from your baby’s pediatrician. Some insurance plans may also require that the pediatrician submit a letter of medical necessity in which she should state that this is a breastfed baby with “failure to thrive” due to low breast milk supply. Other insurance plans do not require a letter for babies under 1 year old and only a prescription is required. It’s best to call your insurance provider to ask what sort of documentation is needed.

In my personal experience, I have dealt with two insurance carriers (Blue Cross Blue Shield of New England and Tufts Health Plan) and I have had formula covered without any issue. As a mom with a low milk supply, having formula covered by insurance is such a gift. Paying for formula after heroic attempts to establish adequate milk supply would be like adding insult to injury. It is good to know that insurance companies support the efforts of breastfeeding mothers with low milk supply by helping them to make up the difference in the amount of milk their baby needs. Hopefully, they will be equally supportive someday of coverage for lactation consults and breast pumps!

Check out this great website here- www.HealthyBabiesHappyMoms.com.

Are Breastfeeding Recommendations Unrealistic?

This week I posted a link to an article that suggested mothers are feeling too much pressure to breastfeed. The author referenced a study in which mothers seemed “stressed” and felt their doctor focused on six months of breastfeeding at the exclusion of the overall health of the family.

We know there are a few moms that are physically unable to breastfeed. That must be a truly frustrating ordeal and I have nothing but respect for mothers in that situation. However, the majority of mothers and babies are physically able to breastfeed. So why are only 14.8% of babies are exclusively breastfed for six months? A few social factors that are associated with shorter duration include smoking during pregnancy (10%), Caesarean birth (32% of births), a baby going to NICU and mom returning to work before 6 months of infant’s age (55%).

The majority of research shows that many moms are also undermined in their goals for a strong milk supply and suitable latching baby by early supplementation, pacifiers and inappropriate birth interventions. The guilt that so many mothers feel about their unsuccessful breastfeeding attempts can make the recommendations of exclusive breastfeeding for six months feel unfair. I understand the frustration, but it should not be directed at the recommendations for exclusive breastfeeding, but the raod blocks that created the difficulties to a fulfilling breastfeeding experience.

Several articles have discussed this study and the suggestion to soften up the 6 month recommendation. The rationale is that if we just took the pressure off mothers they would be happier and more confident in their mothering ability. This theory is based on lowering the bar to make everyone feel like they accomplished something reminds me of giving every kid a trophy so no one feels bad. Except the kid/trophy scenario is a somewhat arbitrary contest, unlike breastfeeding.

With a new baby, life changes forever and completely. One physician observed many families attempt to regain control during the chaotic early months by changing the feeding method in hopes baby sleeps longer and relieves stress on the family. What new parent hasn’t wished for a magic, baby-whisperer trick to get their baby to sleep faster and for hours at a time?

So the choice is framed, family harmony or exclusive breastfeeding. Hmmm- I wonder which will prevail?

A Tale of 2 Births –

If we were designing maternity care practices today, what would they look like? We could start with an evidence based approach that would allow the best outcomes for infants and mothers – fewer interventions and supportive of breastfeeding. How does that compare to the typical experience of a mother having a baby in a hospital today?

Here is The Tale of 2 Births as told by Melissa Bartick, MD of A Peaceful Revolution. A Peaceful Revolution is a blog about innovative ideas to strengthen America’s families through public policies, business practices, and cultural change done in collaboration with MomsRising.org.

Many moms feel guilty about the challenges they faced while breastfeeding, and quitting far earlier than planned. Is it possible the breastfeeding difficulties could have been minimized, or avoided altogether, with a different attitude about the process of having a baby? Are some mothers “set-up” by their doctor, nurses and pediatrician to fail at breastfeeding?

As you read, ask yourself which example is most like yours. Can you connect your hospital experience to the breastfeeding challenges you faced?

Peaceful Revolution: Motherhood and the $13 Billion Guil
t

Birth number 1: Having a baby in the ideal, family-friendly United States:

You give birth with the help of a birth doula. She helps you avoid a c-section or vacuum assisted birth, which is why your hospital hired her. Your baby is wiped off, then put directly onto your chest, skin to skin, with his head between your breasts. The nurse puts a blanket around you both, and then your partner cuts the cord. The nurse evaluates his initial transition to life outside the womb as he rests on your chest. As you lay semi-reclining, happy and exhausted, your baby uses his arms and legs to crawl over to your breast and he starts nursing. You and your partner are left undisturbed for an hour to enjoy your new baby, who has now imprinted the proper breastfeeding behaviors thanks to this initial breastfeeding. You are then transported to your post-partum room with your baby on your chest.

The nurse returns and weighs, measures, and examines your baby right there in your room. You are with him as she gives him his vitamin K shot and antibiotic eye ointment. Your baby is handed back to you, and again placed on your chest skin to skin. He stays in your room with you until you go home. From your prenatal class, you knew in advance to ask most of your visitors wait until you go home, so that you can get some rest, and you turn the ringer off your phone, so that no phone calls will wake you. Before you leave the hospital, your baby’s routine heel-stick blood test is done while he is nursing, and you are amazed to see he doesn’t cry at all. You are discharged with clear instructions around breastfeeding, and phone numbers to call if you need help. You are not given samples and “gifts” from a formula company.

Two days later, you see your pediatrician, who is a little concerned about the baby’s weight, but your baby otherwise looks healthy. He quickly refers you to a licensed International Board Certified Lactation Consultant, and all you pay is your standard co-pay. She does a careful assessment and advises increasing the frequency of nursing for a few days, and that does the trick.

You enjoy three months paid maternity leave, at 80% of your usual pay. Your baby sleeps within arm’s reach of you, and because you taught yourself how to breastfeed lying down in the dark, you awake fairly refreshed every morning.

When you return to work, your employer allows you flex time. Your employer has a policy that allows new parents to bring their infants to work, so often you bring your baby with you. As in other companies with such policies, your coworkers enjoy having a baby around, and you feel happy, calm, and productive.

When your baby gets more active, you put him in the daycare near your worksite so you can nurse him during lunch, and you can pump milk in the lactation room at work. You bought a nice pump with your insurance’s Durable Medical Equipment allowance. After 6 months, you introduce solids. A few months later, you really don’t need to pump any more and you and your baby enjoy breastfeeding for another year. Your baby is so healthy that you’ve never had to miss a full day of work.

Does that sound like your birth experience, or does this?

Birth number 2: Having a baby in the real United States:

Your give birth to a healthy baby, and you’ve never heard of a birth doula. The umbilical cord is clamped and cut before anyone can say, “It’s a boy!” Immediately, your baby is whisked across the room to the warmer where Apgar scores are assigned, he’s given a shot of Vitamin K, and antibiotic eye ointment is slathered in his eyes, clouding his vision. He’s placed on a cold scale and weighed and measured. He is examined by his nurse, who takes him to a different room to do her evaluation. He is bathed, washing off his mother’s scent. At last, he’s professionally swaddled into a nice tight parcel and handed to you to hold, cradled sideways in your arms.

He’s not skin to skin, and he can’t move his arms and legs to crawl to the breast. Before you know it, an hour has passed since his birth, and since he’s missed the window of “alert time” after birth, he slips into a deep sleep without having spontaneously breastfeed. You attempt to interest him in the breast, but he is really too tired to try very hard. Because he’s wrapped up and has been given a bath, he can’t use his sense of touch and smell to crawl his way over to find your breast. You don’t know enough to unwrap him and feed him immediately after birth, because your prenatal class didn’t stress the importance of skin to skin contact during the first 3 days of life. That was all discussed in a separate breastfeeding class and you didn’t really have time or money to take two classes.

Just as you’re getting to know your new bundle of joy, the staff decides to check his temperature and his blood sugar. His glucose level is 45 — normal for a newborn, but low for an adult. His temperature is a little low, too — all that time in the bath, the cold scale, the swaddling, and the time away from his mom’s body heat has led to hypothermia.

Hypothermia and hypoglycemia can be signs of a serious infection, so immediately he is taken from your arms down to the nursery, where he gets what’s known as a sepsis evaluation. Lying under a warmer down the hall from you, he gets his blood drawn, and then is left in his bassinet in the nursery to be observed for a few hours so you can’t spend time with him as you recover from giving birth. He gets a 2 ounce bottle of formula, most of which he vomits, since the stomach of a five-hour-old baby is no bigger than a teaspoon, the perfect size to digest the colostrum your breast secretes for him in the first few days.

Finally, your baby’s brought back to you, swaddled in a nice package. He’s more alert, but never imprinted breastfeeding very well, and he’s very stressed from all the day’s events. He might be full from the formula he’s given, and doesn’t breastfeed well. He tries later in the day. The nurses try to help you, but it feels like they all give you different advice, much of it conflicting. Little do you know, their advice is based on their personal experiences rather than any scientific evidence because they haven’t had much training in breastfeeding. You don’t know what to believe. Finally, your baby goes to the nursery for the night “so you can sleep,” and he is brought in for you to feed him. He doesn’t like it in the nursery, so he cries, and you don’t get much sleep either.

You have some pain when he latches on, and you’re told that’s normal. You’re so excited about his birth that you talk to everyone by phone, and lots of people come to visit. They pass him around. Maybe someone wants to give him a bottle, and you figure, ok, why not. He’s chewing on his fist, but no one ever told you that means he’s hungry, so you give him a hospital-issued pacifier to suck on instead of his hand. You don’t know that giving formula and pacifiers in the hospital will undermine your efforts to breastfeed. It’s surprising the nursing staff doesn’t inform you of this, and you didn’t learn it in your prenatal class. You’re too embarrassed to feed him with everyone there. Finally, your guests leave, but by this time, your baby’s frantic, and nursing doesn’t go well as a result.

Overnight, as he stays in the nursery, he gets weighed, and he’s lost more weight than he should have. The doctor says it’s because your milk isn’t in yet, and recommends more bottles. He still sucks happily on a pacifier and sleeps in the nursery despite his alarming weight loss, and no one suggests that you nurse him more often, room in with him, get rid of the pacifier, or see a lactation consultant, all of which would help put him back on track with breastfeeding.

An hour before you’re due to go home, the lactation consultant comes in briefly to check on you, but because her department is so understaffed, she couldn’t see you earlier when you needed it most, and she has little time to spend addressing your problems. On your way out, a nurse hands you a marketing bag from a brand-name formula company, complete with free samples of formula and information on breastfeeding that makes it sound a little hard and scary. She tells you if you have any questions, to just call your pediatrician.

The first night at home, things don’t go well. It’s the middle of the night, and your baby won’t stop crying when you try to breastfeed. You wonder if you should just give up. You reach for that ready-made bottle and his crying mercifully stops. The problem is solved, at least for now.

You are really motivated to breastfeed, so in the morning, you try to find a lactation consultant. You talk to someone you find in the yellow pages called a “lactation counselor” who is willing to help, but your insurance won’t pay. You find someone else called a “lactation consultant.” You have no idea what the difference is between a “lactation counselor” and a “lactation consultant.” Since these professionals aren’t licensed in any state, you have no way of knowing if they know what they are doing.

You meet with the lactation consultant, but have to pay out of pocket. She helps you. Afterwards, you have to file a claim with your insurance company and hope they reimburse you, all while caring for your newborn. The lactation consultant recommends pumping with a double electric pump to help you build up your milk supply, which is now threatened because of all the formula the baby got, and because his breastfeeding technique is not really good enough yet to extract milk well, since he didn’t learn properly right from the beginning. Your insurance won’t allow the breast pump to come out of your Durable Medical Equipment allowance, and you try to pay for it with your Flexible Spending benefit card, but it’s denied. You pay $250 out of pocket. Good thing you had a gift card to pay for all that!

You go to your pediatrician for follow up. Since your pediatrician got very little training on breastfeeding, he doesn’t know how to help you, but is concerned that your baby has lost too much weight, and advises giving some formula. You don’t know what to do because the lactation consultant’s advice was different.

Ugh!!! This is really hard, you think. Eventually, things miraculously end up working out, just because you persevere through thick and thin, and your partner and family and friends are very supportive. By about 4 weeks, your baby is now exclusively breastfeeding, and gaining well. And you are enjoying what time is left of your unpaid leave under the Family Medical Leave Act. But, you have only two more weeks before you go back to work. You can’t afford any more time off.

You start pumping to build up a stash of frozen milk for your return to work. You arrange with your employer a place to pump — how lucky you are that it won’t be a bathroom! You go back to work, and before long you discover your milk supply is dwindling and now your baby wants to nurse all night long. You are exhausted.

You call the lactation consultant who tells you that it’s common to see a drop in milk supply when moms go back to work. She explains that pumps aren’t as efficient at removing milk as your own baby is, so your milk supply may drop, and your baby makes up for it by nursing more when you are with him — it just so happens that that’s at night. “It’s called reverse cycle feeding,” she tells you. You wonder why you never heard about this before, in any of your follow-up visits with your pediatrician or OB.

You want to see the lactation consultant again, but your insurance will only reimburse you for visits during the newborn period. Well, you think, at least my insurance paid for something — my friend’s insurance doesn’t reimburse anything for lactation help.

You nearly fall asleep at the wheel driving to work. “This is crazy,” you think. “My baby needs me to be alive, more than he needs me to be breastfeeding.” Finally, you give up. You just can’t do this anymore. You are very sad and disappointed.

You become a statistic: one of the 41% of US mothers who wean before 3 months. You feel guilty as hell, especially when all you ever hear is how great breastfeeding is, and now how that new study shows it could save the US economy $13 billion/year, and how everyone says it saves lives and how it will make you healthier too. You just wish all these people would just shut the heck up.

So, now that you’ve heard the difference between what your experience could have been like, and what it was actually like, you tell me:

Do you feel guilty for not breastfeeding? Or do you feel angry because it didn’t have to be this way?

And if you answered “angry,” then take that anger, and write to your hospital — tell them you want them to become a Baby-Friendly hospital, so that no one else will have to go through what you did just to feed your child. Write to your state and federal legislators — tell them to support laws that make breastfeeding easier, like licensing of lactation consultants, and the requirement that insurance companies reimburse for lactation care and services. And write to your US representatives and senators, and tell them you want tax-credits for onsite childcare, and that you don’t want the US to continue being the world’s only developed country without paid maternity leave.

Yes, I’m a researcher and a physician, but I’m also a mother. Since I live in the United States, you can probably guess what my birth experience was like. Maybe you’ve heard me on the news saying that moms shouldn’t feel guilty. I’ve been there. So take that guilt and turn it inside out, and do something positive so that other moms don’t have to go through what you did. We all deserve better.