I just read an article on parenting research and had to respond.  The article is about a study which found that parenting basically sucks and we are lying to ourselves if we say otherwise.  This research paper was published in Psychological Science. Research proves parenting is costing us $193,000 and change per child to raise them, and this doesn’t take into account the emotional and social toil we are subjecting ourselves to.  According to research, parents are “angrier and more depressed” then their unencumbered counter parts.    This “new paper shows that parents fool themselves into believing that having kids is more rewarding than it actually is. It turns out parents are in the grip of a giant illusion.”  Really???

The article continues:  “All parents know that having kids is a blessing — except when it’s a nightmare of screaming fits, diapers, runny noses, wars over bedtimes and homework and clothes. To say nothing of bills too numerous to list. Some economists have argued that having kids is an economically silly investment; after all, it’s cheaper to hire end-of-life care than to raise a child. Now comes new research showing that having kids is not only financially foolish but that kids literally make parents delusional.”

The way they conducted the research may show that we lie to ourselves at times to get through rough spots but I strongly disagree that my children have been leaching away my soul and resources.

My children have been the best thing that happened to my life.  I am the first to admit that I have started out with an emotional deficit from the way I was raised.  So maybe that is why they were able to help me grow in so many ways.  They were able to teach me about true unconditional love which, by the by, has helped my marriage and my relationships with close friends.  They have taught me to give away my energy for a good cause and NOT expect anything back.  Do it because you want to, not because you are hoping to have something given to you in return.  True bliss.  I had never been truly blissful; felt all was well with myself and the world, until I was ice skating with my children one day several years ago.  They taught me how to be in the moment, let go of the small things, don’t be obsessive, guilt is a wasted emotion, worrying is an even bigger waste of time and emotion.    Be peaceful.  Be grateful for what you have.  People before things.  So many lessons to be learned.  And like good teachers, my children unrelentingly kept at me with these lessons until I got them!

I don’t think I am delusional about how hard it is to have children.  Having my children is also the hardest thing, by far, that I have ever done in my life.  I stayed at home with them for years and was so BORED in the beginning.  This forced me to get out in the world with them and over come my shyness and try all sorts of new things.  Was it hard on us financially?  You bet!  We are still recovering for the years I was not earning money and they were helping us spend it.

Having a child should not be entered into lightly.  They are not just another “step” on the ladder to human success.  But if you are brave and ready to be challenged, get ready for the change of you life!  I wouldn’t trade it for the world.  The research article ends; “Of course parents should be commended for one little thing they do: maintain the existence of humanity. I praise them for that, but I think they’re both heroes and suckers.”   Why is it that I just feel lucky?

I do have to tell you that I would never make it without my husband.  He is a programmer and can help me with almost everything.  When I went to log into my website today, it didn’t take me to where I am used to going.  I got a different page and was panicked!  Where did my site go?  How could I find it???  I had no idea.  Fortunately, he did.  With a few cut and pastes and key strokes, I was back in business.  I would be no where near as hip with tech if he didn’t have my back.

I do love that this technology does give us access to such info!  When I run across a problem that I can’t solve in my practice, I now have many cyber friends who can help me out.  I love the articles and links I have access to.  I love my webinars that I host monthly for the United States Lactation Consultant Association.  I love learning!  It used to be that I would have to wait for a new book to be published, wait for a breastfeeding conference to come to my area (Maybe 1-3 in our area per year.  I used to have to drive long distances to get my knowledge fix.), or call someone long distance to get more info.  No more.

Maybe this technology is a good thing.  Sigh.   I am a modern girl after all?

OK, what else can we do?  We can exercise, eat healthier, not smoke.  AND we can BREASTFEED our babies.  Breastfeeding can help with diabetes protection in three unique ways.  First of all, if a mother develops gestational diabetes during pregnancy, the longer she breastfeeds post-natally will help protect her from developing type 2 diabetes herself.  The longer she nurses, the better the protection.  Secondly, breastfeeding will help prevent her baby from developing Type 1 AND Type 2 diabetes in their life time.  Again, longer is better.  Many breastfeeding benefits are great if a mother breastfeeds for even 1 month.  What many families are not aware of is that breastfeeding protection is dosage related.  A little is great, more is fabulous!  We forget that the American Academy of Pediatrics recommends breastfeeding exclusively for 6 moths, then slowing introducing solids, and continuing breastfeeding for at least one year.  The World Health Organization recommends nursing for at least two years.

Why is breastfeeding  not being emphasized as a protective health benefit?  Are we worried about making families feel guilty?  Is there very little money to be made and a TON of money to be saved (I wonder how the pharmaceutical companies feel about that!)  If we saved the billions of dollars we hear about from breastfeeding, many medical businesses would be struggling.  Who are we really trying to protect?  Our mothers?  Our babies?  Our economy?   Breastfeeding will help protect all of these.

Let’s talk about the time it takes to remove milk.  The younger the baby is, the more frequently the mother will need to remove her milk.  This is for two reasons.  One, her baby is growing very quickly.  During the first three months, breastfed babies grow an incredible amount.  If you look the World Health Organization growth charts of breastfed babies, you will see that they grow a lot in these months and then slow down into a steady upward slope.  Once a baby reaches about three months of age, their need for breastmilk remains fairly steady.  Most babies need about 30 oz of breastmilk a day until about one year of age.  Complimentary solids are added at about six months of age.   In many other countries, mothers return to work much later so they need to remove their milk less often.   Under 3 months of age, mothers often need to remove their milk about three times in a full work day.  Remember, it is not just a 9-5 job.  You have to drop the baby at child care, get to work yourself, and at the end of the day, reverse the process.  Your nine hours with lunch has now become about 10-11 hours.  It is recommended when babies are under four months or so that mothers remove their milk about every three hours.  If a baby is over four months, mothers are often able to remove their milk every four hours or so, and if the baby is over eight months or so most mothers are able to remove their milk just once while away from the baby.  If a baby is over one year of age, most mothers don’t remove their milk at all while separated.  They nurse the baby before they leave and then when they return from work.

Notice there are many “or so” and “abouts” in these above statements.  This is because each mother and baby are different and each pair will need to create  a unique set of guidelines for themselves.  These are general recommendations which mothers need to tailor to themselves.  In general, it takes about 20-25 minutes total to remove the milk.  Mothers should wash their hands before removing their milk but they do not need to wash out their pump kits if they are pumping.  Many mothers bring an extra insulated lunch bag with an ice pack and just put their pump kit in there, chill it between pumps, and wash it when they get home.  If any of you are doing lots of pumping at home, you can do this as well.  I do recommend you wash it in hot soapy water every twelve hours.  By chilling the kit between pumps, it stays safe and clean for multiple pumps.  It takes a few minutes of prep to get ready to remove milk, about 15 minutes to actually remove the milk, and a few minutes to put things away.

The next step involves how the milk is going to get out of the breast.  I have used the term “remove” her milk instead of pump her milk on purpose.  Some mothers find that hand expression is easier and more effective than even a good breast pump.  I was fortunate enough to attend the Human Milk Banking Association of North American’s International conference in the Fall of 2005.  I heard about Brazil’s Human Milk Banks and was blown away.  I do have a point here, just a moment!  In Brazil, the fire men, yes, fire MEN, pick up and drop off the donated human milk from mothers.  They are also trained in some lactation support if mothers should need it.  However, because in Brazil they have very high breastfeeding rates mothers are much more successful with breastfeeding then they are here at home.  Isn’t that cool!?  All right, back to our real subject, removing the milk.  My point is that almost all of these women who are participating with the milk banks use hand expression to remove their milk for donation.  No pumps involved.  So, it is possible to hand express very effectively.  Stanford University in California has a great website which includes an excellent video clip of explaining and demonstrating how to hand express.   We love our technology in the US, so most women I work with do own a breast pump, but remember, if this is not working well, consider hand expression or a combination of both to maximize milk removal.  I will talk about pumps in another blog, in the meantime, make sure you are spending your money wisely on a quality pump.  They are not all created equal and more money does not necessarily mean a better product.

We have talked about the time it takes, the way to get milk out, now let’s talk about a private space to remove the milk.  First of all, a bathroom really doesn’t cut it.  Would you want to make your lunch in one?  Many women end up moving their milk in a bathroom because there is simply no other place to do it.  This is a shame.  Most places of work, with some creativity, could create a little corner for moms to do this for their babies.  Some lucky mothers have their own private offices with a lock on the door.  One client of mine works at Google.  They have a special lactation room set up for her to use if needed.  Another client works at the U of M hospital.  They actually have some rooms with hospital grade pumps for their breastfeeding mothers to use.  These ladies are set!  Most mothers have a bit more of a challenge.  I have a mother who has converted a corner of an office into a mini-lactation area by hanging a curtain.  Some mothers put curtains across their cubicle doors.  Other mothers go out and pump in their cars on breaks.  In Michigan, this doesn’t always work, the past few days are a case in point and also February can be rough!  I work with many mothers who simply have NO place to pump or even a car to pump in.  These moms are often the ones going back to work even earlier, at three weeks sometimes.  We then make the best plan we can and she breastfeeds at home and uses some formula while she’s working if needed.  Remember, any breastmilk healthy mothers can provide for their babies is better then none!  I took The Business Case for Breastfeeding Training about a year ago and they had picture of all kinds of places to pump, rooms, corners of rooms, and tents!  Yes, tents!  A manufacturing company couldn’t provide a room, so they set up a pumping tent in their warehouse!

I have found that the biggest factor that leads to success is having a strong plan for returning to work.  Remember The Business Case for Breastfeeding created by the Health and Human Services?  These materials are available to all of you as well.

Finally, if anyone knows of a business that is breastfeeding friendly as an employee or a customer, the Washtenaw County Breastfeeding Coalition is looking for nominations to help recognize these fabulous businesses!  We need to let these businesses know that what they are doing is important to us as a culture.  To nominate a business or to get more information, visit http://www.motherfriendlyworkplace.org/

In my opinion, our working mothers in the United States are not well protected.  Here it is really up to their employers as to what mothers are offered in terms of returning to work and job protection.

Most of the mothers I work with are going back to work.  In the past, I talked to them about what their options really were.  Sometimes families are not aware of all the costs of returning to work.  Usually we spend more on nice clothing, gas, take out food, and then of course we have childcare, which is quite expensive.  Here is a website that can help you figure out exactly what it will cost you to return to work.  Many times once all of the costs are added up, it might not seem like the amount of money that is actually left over is worth the unwanted separation of mother and babies.

However, because of the fragile nature of the job market in Michigan, I now have reservations about encouraging mothers to explore the possibility of whether to return to work or not.  I worry about whether there will be a job available for my mothers later when their babies are older.  Also, according to a 2009 article in the New York Times, men make up 82% of those being laid off.  Therefore, it is becoming more common that women are the sole bread winners for their families.

The fact is many mothers truly have to go back to work, whether they want to or not, because they simply cannot afford to lose their income or their job security.  I hate the tension between mothers working outside the home and those at home with their babies.  What I wish for, is that each woman decides what she wants to do, stay home or not.  If a new mother truly wants to return to work right after her baby is born, I support that fully.  If she wants to stay home with her baby for years, I support that fully as well.  Isn’t that true feminism?  Each woman deciding what is right for her and her family?  I am sad that it seems as if we have switched from one model of what womanhood means, staying at home and raising a family, to a new definition of womanhood that also lacks choice.  It involves maybe having children or not, but returning to work in rather quick order once the baby is born.  In other words, all women have to work outside the home.  I would love more options for the women of the United States!

Next week I will start a series on how to make the transition to work smoothly for breastfeeding mothers.  There are many great resources and it can be done, especially with support and good resources.

My next thought was about breastfeeding, as it almost always is, and I thought, wow, what is more “green” then breastfeeding!  It is one of the few things I can think of that goes directly from manufacturer (mom) to customer (baby)!   And can grow a whole baby!

I wasn’t surprised that others agree.

According to EcoMall, “Breastfeeding is probably the most overlooked means of contributing to the health of our planet.”

I began to think about what does it take to formula feed a baby?  I thought about all of the energy and resources it would take to produce formula.  Then I thought of all of the trash the use of formula creates.  I thought about the equipment needed to actually feed the baby the formula.  I started looking around for some data on how many resources would be used in the formula feeding process.  I found some interesting links to some estimates on this subject.  Then I wondered about how healthy these cans were for our landfills, would they cause leaching of toxins?

After that, I started to worry about our babies! I was not aware of the leaching that takes place with these cans of formula.

After all of this, it was clear.  Breastfeeding is green!  La Leche League of Ann Arbor will be having a booth this year to promote breastfeeding and help support breastfeeding famalies.   Breastfeeding information will be provided as well as a comfy chair to come and take a break and nurse your baby.

You may need help and support to be “green” and breastfeed, and La Leche League is there to help you do it!

I want to make sure it is clear that it is my job to help mothers feed their babies in the manner of their choosing.  I get calls all the time from families who want to/need to wean, and from formula feeding families who have questions about appropriate feeding for their babies.  There is not much support out there, period, and I help families all the time and it is not my job to judge them in their choices.  Rather it is my job to support them in whatever decision they make.  I feel I do a good job with this.

So, back to breastfeeding…My plan for this next column was planned before I even wrote my last one.  It was to talk about some of the research that is out there.  I did look at the studies one of the commenters provided.  I was familiar with the old one from the 70’s.  One of the problems with that study is that until recently we didn’t have good definitions of how to categorize a “breastfed” baby.  Is it one that has been breastfed once in their life?  Twice?  40 times?  Or what we now consider the standard, exclusively breastfed.

This means nothing but breastmilk has passed through that baby’s lips.  My first child, while he was breastfed, he was not exclusively breastfed.  We used formula in the beginning as we transitioned to nothing but breastmilk.  So, my first baby would not now have qualified for this category, exclusively breastfeed, although he received nothing but breastmilk from 3 months until 6 months when we started solids for him.

Many older studies put all the babies who received some breastmilk in the breastfed category.  So my son would have been included with the “breastfed” babies when he in fact started out completely formula fed and switched to breastmilk over time.  What we find is if we tease out the babies who only received breastmilk, we see the biggest differences in outcomes.  We do this with breastfeeding “initiation” as well.  A woman who puts her baby to the breast, even once, is put in the breastfeeding initiation category.  It doesn’t matter if the baby actually feeds, if it hurts the mother, or she never does it again.  The JOINT Commission on Health is now looking at these breastfeeding numbers and have found a more useful number would be who is “exclusively” breastfed while in the hospital for their maternity stay.   So, it is rightfully confusing as to what these terms mean.

There was an article that was written in the Atlantic many months ago which caused many important discussions about breastfeeding.  It was interesting that when I was discussing it with my friend Joe, the father of two breastfed babies.  He said something like, “Even if there isn’t research proving breastmilk is better for babies, doesn’t it just seem like the right thing to do?”  This is getting back to the idea that we are mammals and mammals breastfeed their babies.  But fortunately for Joe and all of us, there is good research out there showing that most babies are healthier from breastfeeding.

People argue that most breastfeeding studies aren’t rigorous enough.  In particular, you cannot do double blind, randomized controlled studies with infant feeding.  Most parents have strong feelings about how they are going to feed their babies and don’t want to be part of a feeding experiment.  There are a few that are in the middle, not sure if they are going to breastfeed or formula feed, but most are sure.  On the other hand, as with all scientific studies, the researchers have to show that no harm will be caused by their study and the fact is we cannot promise that formula feeding will not cause harm.  You could say, “Well, you can’t show that breastfeeding won’t cause harm!”  While that may be true, it doesn’t matter because regardless of how people feel about breastfeeding, it is the biological norm to feed a human baby with breastmilk.

I am not going to beat you over the head with studies but there is a wonderful meta-analysis of breastfeeding research done in 2007.

A meta-analysis is one of the best types of research evaluation.  They looked at many breastfeeding studies (9000!) and tossed out the weak ones and keep the best studies with rigorous methods.  The other thing I did was google “Risks of Formula Feeding” to see what came up.  Read some of these and see what you think.  Finally, Marsha Walker, one of the world’s leading experts on breastfeeding, has a wonderful page on this subject.

In my mind, the science is clear.

That’s a lot of cash and more importantly, a lot of babies dying unnecessarily.

The author of the study, Dr. Melissa Bartick, makes it clear the mothers themselves are not to blame.  Parents receive many mixed messages about infant feeding and then lack support for breastfeeding from the moment their babies are born.  I feel this undermining of breastfeeding begins even before that.  Our culture is not a breastfeeding culture.  Many mothers do not come from breastfeeding families.  They have to become pioneers in their communities in order to participate in biologically appropriate infant feeding practices.  They get flack from their families and friends, stares in public, and pressure to wean from the first day of their baby’s life.  Often, their health care practitioners make it seem like an even choice.  Breastfeed, formula feed, eh, about the same.

It is not an even choice.  Mothers I have meet all around my area, wealthy and low income; all want the same thing for their babies, what is best.  It is not a life style choice, it is a health choice and your “choice” can save your baby’s life.

In a recent blog by “thefeministbreeder” breastfeeding as a health issue was presented in this way, “You know what else saves lives?  Car seats.  So, why aren’t people spitting mad at the NHTSA for saying that?  Why aren’t they leaving thousands of comments on car seat articles saying “But I just couldn’t afford a car seat, why are you trying to make me feel guilty?!?!” Well, maybe it’s because our society will admit that car seats save lives, and we’re willing to give them out free at fire stations and hospitals if we have to because it is that important.”   She maintains that breastfeeding is that important to our baby’s health.  The medical evidence seems to be backing her up.  The lack of car seats caused 400+ deaths in three years.  We have over 900 babies dying in one year from lack of breast milk.

I was just at our “Community Baby Shower” which is held every year at St.  Joseph’s Hospital’s Women’s Health Center.  Pregnant or early post-partum mothers can come and talk with vendors about anything that might impact their baby.  A mother came up to me and said her milk supply was dropping.  Her baby was in an isolette at the NICU (a special hospital nursery for sick babies) so she couldn’t put her baby to breast.  She was just able to pump her valuable milk for her little baby.    She had never intended to breastfeed her baby, but her Neonatologist, her baby’s doctor, had told her it was critical for her baby’s health to have her breastmilk, and by god, she started pumping!  Now her baby is getting the most appropriate nutrition possible.  Breastmilk was a health concern, not a lifestyle choice.  And breastmilk is healthiest for all babies.

Is breastfeeding the car seat of health for babies?  If so, let’s help mothers buckle up their babies.  Let’s send a consistent message of support for the fabulous protection she is giving her baby, her milk.

When I think about all of the things a doctor would need to know about a baby, about their normal development, what is abnormal and needs further investigation, it is overwhelming.  So, it is not shocking that they might not be aware of the latest scientific research on breastfeeding.  It is shocking to find they have had such a lack of basic training to begin with from their university.

So, is it the doctor’s fault?  In general, I really don’t think so.  I genuinely feel doctors have the baby’s best interests at heart.  It is really our culture’s lack of valuing normal human infant feeding, i.e., breastfeeding, to the degree that a university that offers a program on medicine that does not have any information about the feeding practices of the species that they are studying, human mammals.  Mammals, get it?  This refers to our ability to make milk from our mammary glands.  This is how our species is designed to feed their babies.  Again, not to blame the university, it is our culture.

If your doctor does not know the answers to breastfeeding questions, what should they do?  In the Ann Arbor area, we tend to have great doctors who seem to know what they  know.  In the above mentioned blog, the doctor reports that on their first day of medical school, the dean told them, “Fifty percent of what we are teaching you is wrong, we just don’t know which fifty percent”.

If your doctor hears a click in your newborn’s hip at one of the first exams, they have to worry about hip dysplasia.  Do they take care of it right then and there in the office?  No, they refer the baby to a pediatric bone specialist.  So, perhaps it is right when a doctor has an infant feeding question that they are not sure about, that they refer to an IBCLC.  Many of the clients that I see have been referred to me by their doctors.

As an International Board Certified Lactation Consultant (IBCLC), breastfeeding is my area of specialty.  Having studies breastfeeding intently for the past 14 years, I am still shocked at what I don’t know.  There is so much to learn in this small, but very important, specialty.  Because I am the Professional Development Director of the United States Lactation Consultant Association, I have access to many of the founders and leaders in our field that can help me when I am not sure how to proceed.  Maybe we need to know when to ask for help?

There are many MDs who are working hard to try and make up for this basic lack of training in the medical profession.  Dr. Nancy Wight, a California Neonatologist, has been doing her darnedest to help MDs learn about breastfeeding.  She teaches seminars, lectures, does grand rounds at hospitals, and publishes research findings.    She is helping other doctors learn what they were not exposed to in their formal education.  Good job, Dr. Wight!