Breastfeeding Choices

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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.

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