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

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.

Baby Led Weaning – a perfect partner to breastfeeding

The concept (and video) are known as Baby Led Weaning. The practice is very common in Europe, and I discovered the video at an International Lactation Consultant Conference – I knew I had to spread the word to every parent looking for a better way to introduce solids. The title is a bit misleading – the video is not a how-to-wean from the breast. Instead it challenges the idea of introducing solid food that is not solid by any means and food most of us would not eat under any circumstances.

This is a great strategy, and pairs seamlessly with breastfeeding. For all of us that enjoy traveling light, it makes perfect sense to share your food with your baby. Instead of carrying around jars, spoons and asking the waitress to ,”Please warm this up”, you simply use your baby’s tendency to put everything in her mouth to introduce new flavors and textures, allowing her to choose what she likes and moving seamlessly to a varied diet. Often times we do this at mealtime without realizing it. As parents we instinctively share appropriate foods at mealtimes. Baby Led Weaning gives specific strategies to make a variety of foods easier for your baby to handle.

I had the incorrect perception that infants would choke on harder foods and should only be offered soft options like pasta and ripe pears. From around 6 months of age, babies will not even get food to the back of the mouth to swallow – that explains why most offerings end up on your baby or on the floor! I like the phrasing of the narrator “There will be a mess, but it will be less of a problem if you prepare for it.” As with anytime your baby is eating, she should sitting upright and supervised at all times.

The video gives some tips for cutting the food you offer into shapes that are the right size and shape for her to pick up. For example-toast cut into sticks is much easier for your baby to grab and hold onto than bread. See toast stick picture (right)

To simplify mealtimes, cut all of the veggies you serve into 3 inch stick shapes. Slightly cook the veggies for only a few minutes. You want them only softened, not mushy, or baby will have a hard time holding them. Since babies shouldn’t have salt, leave all seasonings off and let family members add them when they plate their vegetable serving. Here is a screenshot of veggie sticks cooking (left)

Parents can offer babies the entire apple or pear (leaving the skin on to make it less slippery and easier to hold). (apple shot) The infants can nibble off what they can, experience new textures tastes and practice self- control with their food choices.

If you place an assortment of foods on a high-chair tray, allowing the baby to choose what she prefers, while dropping much of it on the floor and into her lap – you are allowing your baby to determine her level of adventure in eating. The narrator suggests that babies that are allowed to choose their own food adventure are less likely to become picky eaters. This may be true to some extent, however, research has shown a portion of strong food preferences is genetic and a baby introduced to solids using this strategy may still have strong food likes and dislikes.

When Breastfeeding Doesn’t Work (from Healthy Moms, Happy Babies)

love those happy babies

Healthy Babies, Happy Moms is wonderful group of Lactation Consultants in Rhode Island that support families through every stage of parenthood. I subscribe to their newsletter and I thought this month’s topic was especially important to share.

“This month’s article addresses an important issue – when breastfeeding just plain doesn’t work. A lot of factors must come together for successful breastfeeding. Sometimes there are issues with the mother, sometimes issues with the baby and sometimes issues with the mother’s and baby’s support system. Many times we can address these issues and resolve them, yet there are still occasions when despite our best efforts, breastfeeding doesn’t work.

One of the hardest situations for me to be in is the one where breastfeeding just doesn’t work out as planned for a mother and her baby. And if it is hard for me, it is obviously infinitely more difficult for the family that is experiencing it. But sometimes, despite the best intentions, it comes to an end much sooner than anyone wants. My role in that situation is often one of a realist. I am in the home, I know the history, and I see everything the mother is experiencing, in addition to a hungry newborn. Many times, I am just confirming what a family already knows, but needs to hear from a professional who they feel can see the whole picture objectively…

But can a lactation consultant be objective? Aren’t I supposed to encourage exclusive breastfeeding and do everything I can to facilitate that? I like to think I can do both – be objective and encourage breastfeeding at the same time. It is probably my neonatal ICU background that often reminds me that the most important thing is that the baby is fed. Hopefully, it is breastfed or fed breast milk. Ideally, I want to educate women and give them reasonable options, so that the choice is theirs, according to their experience and desires, not mine. I want them to be able to achieve their goals with regards to breastfeeding, whatever they may be and however different they may be from another woman’s. When I have the privilege of being invited into other people’s homes, I always try to remember that people are having me there to receive an honest assessment and opinion of their unique situation. And with that, I believe I owe them a customized, reasonable and realistic plan.

So, why doesn’t it work sometimes? Most often, I think it is because help arrived too late. I think if women knew how important the first few days are in establishing a good milk supply, they wouldn’t wait to seek advice. But what if you have had an unexpected C-section and have a toddler at home, and a house full of helpers/guests? Sometimes, a woman can only do so much, especially if she has had major surgery herself. Some women have all that happen and more but still have an abundant supply, yet don’t want to nurse, and call me to help them stop. Life is not balanced sometimes.

Milk production actually starts around the 14th week of pregnancy when hormones cause the ducts and lobes to proliferate (think bigger, tender breasts). This continues until the 28th week when the second phase of milk production causes colostrum to be produced. This production only continues if the breast is adequately stimulated after the delivery of the placenta, and colostrum will be gradually replaced by transitional milk. Production of mature milk usually begins around 10 days after delivery and by about 4 weeks, if all is going well, a mother’s milk supply is well-established.

If the baby is not nursing frequently, is causing damage to the mother, or is losing weight, a board certified lactation consultant should be contacted immediately. While none of those situations are ideal, they can be fixed. There are options other than suffering through it (which may lead to failure in establishing milk supply). The most important thing is getting that supply established early on. We can almost always get the baby to nurse well if the milk is there. But once the supply begins to decrease, and you experience the subsequent drop in hormones, it is a process that is very hard to reverse.

In the end, breastfeeding is an extremely private decision for a family, and a unique experience between a mother and baby. Each case is different because the desires of and situations surrounding every mother and baby is different. It’s what keeps my job so interesting and enjoyable. But if your goal is to breastfeed and you’re concerned that things aren’t getting off to a good start, contact a professional quickly. Those first few days can truly make all the difference.

There are many reasons that breastfeeding can be unsuccessful or end earlier than planned. But we hope the message you take away after reading this article, is to contact a professional at the first sign of any difficulty. Getting to the issues early on can keep you on a successful track with breastfeeding.

For more information on our products and services, you can always contact us at www.healthybabieshappymoms.com. ”