Breastfeeding Choices

At this month’s Healthy Birth Workshop we heard the stories of three moms who overcame challenges in breastfeeding.  Both the World Health Organization and American Academy of Pediatrics recommend that all babies breastfeed exclusively for the first 6 months of life, and continue to nurse for up to 1 (AAP) or 2 years of age. However in reality, while around 75% of US babies are breastfed at the start, only 35% are still nursing exclusively at 3 months and only 14.8% at 6 months. Around a quarter of breastfed babies receive some formula before they are 2 days old.

Some hospitals are working hard to increase the breastfeeding rate by becoming accredited as Baby-Friendly.  NYU Langone Medical Center is one of only two hospitals in NYC designated as “Baby-Friendly” (the other being Harlem Hospital), and we were delighted to welcome their lactation consultant, Barbara Holmes IBCLC, to speak and answer questions from our audience of expectant parents. She was joined by three moms who shared their very different and very inspiring journeys to providing their babies with breastmilk.

When Lulu was pregnant, her midwife told her that, due to breast reduction surgery when she was 16, she would not be able to breastfeed.  Despite a change of care providers and encouragement from her doula, her midwife’s comment had planted a seed and she remained anxious that breastfeeding would be difficult or impossible for her.  Her son’s birth was “the most intense, amazing experience of my life”.  After he was born, she held him skin to skin as her doula expressed a little colostrum – “and boom! We were off”!

While nursing was initially a little uncomfortable, Lulu clearly remembers the sensation of Oscar’s corrected latch as he nursed during a lactation class at the hospital the day after he was born. She tried to hold on to what this had felt like as they worked on his latch over the following days, encouraged by her sister, who had nursed both her children. Lulu’s sister helped her to visualize how her nipple sat in Oscar’s mouth as he nursed.  And, perhaps most importantly, encouraged her to relax, let go of her anxiety, and allow things to fall into place. Over the two months since his birth, she and Oscar, supported by her husband, have learned together how the teamwork of breastfeeding works for them. She is proud and grateful, particularly given her earlier fears, to be “the only food source for him”.

Whilst in labor with her twin daughters, Justine unfortunately developed pre-eclampsia and needed a cesarean section.  Separated from her daughters for the first 24 hours due to a difficult recovery, she did however begin to use a breast pump.  At her request, she was wheeled straight from Recovery to her daughters in the NICU. Alaia, skin to skin on her chest, immediately began to root, latching on and feeding happily and hungrily.  However little Sylvan was unfortunately quite sick and not yet able to breastfed. Instead, Sylvan sucked on her daddy’s pinkie finger while her sister nursed.

Justine began a routine of nursing and pumping every three hours around the clock – nursing Alaia and pumping for Sylvan, who was fed via a feeding tube. They faced more challenges before leaving the hospital, including a bout of mastitis for Justine, and some formula feeds during a longer hospital stay for both girls than they had hoped for.  Once home, however, the girls breastfed exclusively, gaining a pound a week in the beginning, and continued to do so until they were six months old and adding solids. Justine has found nursing to be a very healing experience and “one of the most gratifying ways to connect with” her daughters.

Justine had two pieces of advice for new and expectant moms. The first was to pump early and often if separated from their babies. She credits this, along with her nutrient-dense diet, for her rich supply of breastmilk.  Hospital grade breast pumps are designed specifically to help build and maintain a healthy milk supply if the baby is not able to do so through effective suckling. They can be used in hospital and rented for home use for as long as you need them.

The other was to seek help early when it is needed.  Justine was challenged by oversupply and an overactive letdown – which she describes as an “elite problem” among twin moms, who usually have the opposite worry.  This meant her letdown could be too strong for her babies, who were sometimes choking and spluttering at the breast. She sought a lot of help with this from her postpartum doula, lactation consultants and breastfeeding clinics and highly recommends that others do the same if they face difficulties.  As well as hiring a private lactation consultant to visit you at home or in the hospital, La Leche League meetings (free) and breastfeeding support groups led by lactation consultants are two great sources of help and advice for nursing moms.

Our final speaker had a very different story.  Two years ago, Eva was diagnosed with a precancerous condition which required her to have a double mastectomy. Just two months later, she was shocked to realize she was pregnant. As delighted as she was, however, she was devastated to realize she would not be able to breastfeed her baby and set about seeking an alternative to formula. During her research she came across a blog which mentioned the possibility of donated breastmilk.  Encouraged by her childbirth education teacher, Eva decided to reach out to her local community in Brooklyn, which she jokingly describes as “one big giant lactating nipple”. She posted on local parenting listservs and was overwhelmed by the supportive responses she received – offers of help and information; space in other moms’ freezers; donations of stashes of milk; and promises from pregnant women of donations to come once their babies had arrived. This was going to work.

Eva and her husband spent much of her third trimester running around Brooklyn with a little cooler visiting donor moms and collecting pumped breastmilk, in preparation for her son’s arrival. Her downstairs neighbor offered to let them store a chest freezer in the basement, opening up more space for milk storage. She developed a screening method to check her donors’ health status, for example offering to pay for standard tests if they had not been done prenatally.  She spent time with her donors, meeting them in their homes and watching them nurse their own babies.  It was a wonderful exercise in community building, and by the time her son was born, Eva was ready.  Other than a brief spell on day two due to a milk shortage whilst in hospital, Oliver has been fed exclusively on breastmilk (and, more recently, solids). He has even been able to mostly have milk matched to his age and developmental stage, expressed by moms with babies at that same age. Eva believes they will make it to a year exclusively on donated breastmilk. Oliver is 9 months old, happy and a very healthy 22lb, all from his parents’ dedication and the generosity and care of countless other mothers in Brooklyn and beyond.

As Eva pointed out, although many women have not heard of the possibility of donated breastmilk, milk sharing has a long and strong tradition around the world – some of Eva’s donors, for example, told stories of grandmothers who had nursed villages during the Second World War. Whether from a human milk bank or private donations, it is a wonderful alternative to formula if for whatever reason breastfeeding is not possible or supplementing becomes necessary.

Breastfeeding; pumping; donated milk; bottles; cups; SNS…

There are so many ways in which our children can receive the benefits and liquid love of breastmilk.

Healthy Earth, Healthy Birth

Let’s promote a healthy earth by giving to healthy birth!

Our challenge this year is to raise money to change the face of maternity care through the 2012 Healthy Birth Ambassador Challenge! This Earth Day, donate to Choices in Childbirth to support our education, outreach, and advocacy efforts…become a Healthy Birth Ambassador!

We are committed, and we know you are too. Take the Healthy Birth Ambassador Pledge! Once you are an ambassador, you will receive birth facts and advocacy news. We will update you on how to spread the word to make this challenge a full-forced movement!

Our plants at the CiC office are looking super healthy today. Must be because we are nurturing and respecting them so much.

In Her Words: Birth Story

CiC would like to give a HUGE thank you to Trina Evans, a birth doula, and this week’s guest writer.

On my 24th birthday, I had an appointment with my physician who confirmed my suspicions that I was pregnant. I was planning to meet with a midwife, which he supported, as long as I chose a hospital birth. I was planning a hospital birth, there was no concern there, it was definitely the best option for me.

At the time, I was working in a group home with high risk youth. I was very sick, losing 10lbs in the first 2 months of pregnancy. I felt drained, run down, and not in control of my emotions. I remember at one point closing a door and locking it behind me when kids started getting in my face. I had no energy and no desire to deal with it. My midwife took me off work 2 months prior to my due date. The baby was doing well, growing on schedule, and I did manage to gain 26lbs. I always say that my body took over to protect him, but knocked me out in the process.

I never wrote a birth plan and I really didn’t even know Birth Plans existed. When we talked about the birth, all I knew is I wanted to labor in the bath. The hospital had bath tubs in every room, for laboring, but not for birthing. I spent a lot of time in the bath through my pregnancy, and I knew that would help to relax me. I wasn’t opposed to any form of pain relief. I just figured, I would decide in the moment. That was all I had considered, it’s all we had talked about, it’s all I really knew.

I started getting pre-labor pains on a Thursday, a day after my due date. I was excited, I was ready!! My midwife said there was a good chance labor would start soon, and that I would likely have my baby over the weekend. I called my mother, who was 4 hours away, and told her what was going on so she could come for the labor and stay afterward.

By Saturday night, I was starting to feel a little on edge. I called my midwife and she came over about 5pm on Saturday. I asked her to check my progress (it was the first of only two vaginal exams I had through the whole process). I was 2 cm and showing signs of progression. My midwife had been at a birth all day, and said she would go home and get some rest. She told me to try to go to bed early, and that I would likely be up in the middle of the night in labor. How exciting!!

I started getting stronger pains, still nothing unbearable, but I definitely knew they were there. I timed a few, and they were sporadic, and at best 10 minutes apart lasting about 20 seconds. We went to bed and the next morning by 9am, my mom told me that she thought it was time to go to the hospital. I didn’t want to go, my contractions weren’t regular, and I didn’t want to be “that woman” showing up at the hospital at only 2-3 cm. I held off for about 30 minutes, but my mom urged me to call the midwife, who told us she would meet us at the hospital.

Since it was winter in Canada It was cold, icy, snow laying everywhere, making the road rough. It was a long 10 minute drive! When we got to the hospital, our midwife hadn’t arrived yet, so we waiting. It wasn’t long, but I was definitely not comfortable anymore.

When we got into the room, my midwife checked me – the second cervical exam of my entire pregnancy. I was 9 cm!! How could I be 9cm when I hadn’t even had a consistent contraction pattern yet? It didn’t matter at that point, I wanted to get in the tub. It was my only plan for labor! So they ran me a nice warm bath. I got in the water, took a deep breath, and completely relaxed….and in that very moment, my water broke, and I was feeling pressure, oh so much pressure. At that point, I looked at my midwife and said “do you think I should take something, just to take the edge off?” She said I didn’t need it, the hard part was over. That was all I needed to hear.

Since you aren’t allowed to birth in the tubs, and I was feeling pushy. I had to get out of the bath. I had only been in there for maybe 5 minutes, how disappointing. I got up, I could barely walk, there was just so much pressure. I stopped on the toilet, thinking I needed to go. For those of you who haven’t birthed, as the baby comes down, it feels just like a bowel movement. I made my way to the bed and was helped in. My midwife told me not to lay on my back, that my side would be better.

In the births that I have seen, women lay on their backs, so I thought the request to lay on my side was a little strange, but I did it anyway. I started pushing, and yelling. I knew it was close, I knew this was the end. I pushed as hard as I could, and my support team was getting excited. I was somewhat in my own world, all I knew is that my body was telling me to push, and that is what I did.

I felt the ring of fire, and almost instantly, all the pain was gone. He was here! At 11:27am, an hour after arriving at the hospital, and only half an hour of pushing, my baby was here. My midwife placed him directly on my abdomen. He had a short cord, and that was as high as they could get him, but I didn’t care. I had my baby. He was warm, wet, and beautiful.

My son was born posterior, or what they call sunny side up. Since he came so fast, and he was posterior, it left me with a 3rd degree tear. My midwife asked for some assistance from an OB for the repair. It was the only time I had seen a Doctor since that very first appointment. The repair was awful. It was the first time I reached for the gas, and I passed right out. I don’t know how long the repair lasted, or how many stitches it took, but it healed well.

I was home by 8pm that same day, less than 24 hours after giving birth. I had my family around me, I was comfortable, relaxed and happy. My midwives came to my house to do check ups for the first week, and Konner was doing awesome! I healed quickly, despite my 3rd degree tear, and was out shopping within a few days. I couldn’t wait to show off this precious little baby.

When I had Konner, I was not educated about birth. I knew I wanted a midwife, I knew I wanted to be in water. I knew that having a doctor didn’t mean a better outcome. That’s all I knew. I had a completely natural, drug and intervention free birth, in a hospital with my midwife by my side. No pressure for induction, no pressure for IV, for monitoring, for anything else. I loved the birth of my son, and will always have fond memories of that day.

You can learn more about Trina Evans at  www.trinaevansdoulaservices.com

If you would like to share your birth story, please send it to Julia@ChoicesInChildbirth.org