Is it Poison?

Do you formula feed your baby, as a supplement or as a full diet?  Have you ever heard someone call it poison?  Don't worry.  Take a deep breath; you aren't alone.  Statistically speaking, it's not gonna hurt your baby.  Read on!

Recently I was hanging around at a breastfeeding event.  I had a copy of Defining Your Own Success and a an SNS stashed in my bag, just in case a low supply mom showed up.  The room was full of doulas, midwives, and others from the natural birth crowd.  Lots of crunchy mamas and supportive others.  Well, on day one there was some drama and people started slinging the word "poison" around with regard to the formula.  They said it so casually, but with such vehemence.  They had such looks of disgust and derision on their faces.  They used the word formula in the same tone of voice you'd use to describe dog feces.

I was there with women who know me, my story, and that I use formula.  I was standing in front of this one particular woman who is my friend, and as she spoke to me she hissed the word poison and my breath caught.  Didn't she remember that the SNS in my bag was used for formula?  Didn't she know that the bottle I fed my baby as I walked out the door that morning was half similac?  I was really hurt by the use of the word "poison" to describe the nutritious substance that I choose to give my baby when he is hungry and the tap's run dry. 

I was especially hurt because one of the women who said it (twice) is a good friend who pays lip service to the fact that there is a place for formula.  She's forever saying that it isn't formula she hates, it's the marketing.  It isn't formula she hates, it's the formula company.  Apparently she doesn't hate poison.

No - Formula isn't perfect; neither is peanut butter, nor sushi, nor a medium rare steak.  Lots of things can make us sick.  Formula has it's dangers, just like car rides and exposure to other humans.  Heck, too much sun can cause cancer and we all love the sun (without it we'd DIE)!  Formula may even contain some chemicals I'd prefer to avoid, but so does the smog, so does the tap water, so does the fabric in my car.
 
Even if we disagree with marketing tactics, or particular chemical make-ups of various formulas, why can't people just take a deep breath and be thankful that women who need it have it?  Regardless of the reason why they need it. 

As BEST-feeding moms, we need to start changing the way we talk about formula.  Our lactation professionals need to be especially cognizant of this.  The real poison isn't in the formula, the formula is just a food.  The real poison isn't even in the marketing of the formula company, that's all stuff we can throw away.

The real poison,
the poison that has the power to strike at the heart,
the poison that has the power to impact relationships,
the poison that has the power to lead a baby to malnutrition,
the poison that draws a line in the sand and says "come to war" and "I am better than you"
is the small-minded, petty, selfish belief that any one of us knows what's best for another human being.

Walk a mile in my shoes.  Feel your hungry baby snuggle up to your breast and coo while sucking down some "poison" and enjoy that big old smile when he's finished.  Look back at his 4lb 12oz photos while you play with his healthy little body, a body half-built with nourishment from formula.  Then tell me how you feel about my choices.  Then tell me how you feel about the food I choose for MY son.

Yes, this is a breastfeeding blog, but it is also a BEST-feeding blog.  I support all moms who are making the best choice for their little ones.  That said, I am going to follow this rant with a post about safe use of infant formula, and some of it's benefits.

The American Academy of Pediatrics states: "Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months after birth. Infants weaned before 12 months of age should not receive cow's milk feedings but should receive iron-fortified infant formula."

Lactogenic Foods

Two of the most important aspects of managing milk supply are hydration and nutrition.   Drink enough water, eat regularly, have a hot meal; these are things I've been told over and over. 

Nursing moms are supposed to get extra calories.  Any experienced momma or lactation professional will tell you that.  Even WeightWatchers has a plan designed to provide extra calories for nursing moms.

It sounds easy, but there is a little bit more to it than indulging in twinkies, at least for the low-supply mommies!  We need all the help we can get, so paying extra attention to our diets can give us a little extra umph right when we need it most.  I'm pleased to tell you that "watching our diets" doesn't have to be difficult!

I'm not telling you to count calories!
I'm not telling you to reduce fat!
I'm not suggesting another pill to pop!

I'm saying to figure out which lactogenic foods you like, and then work them into your diet every single chance you get!  Woohoo!

I want to give a shout out here to Hilary Jacobson who wrote an excellent book titled "Mother Food" that totally rocked my world.  I'm not going to give away all the information in her book - because there is no way I could ever do that even if I wanted to.  Mother Food is packed full of information about what foods help with milk production, why and how they work, and even historical information about how these foods have been used by cultures around the world.  If you are a nursing mom who needs to increase milk supply, buy this book.  You won't regret it.  It's one of my top three favorite breast-feeding books.

OK, on to the good stuff.  What foods are going to help you make more milk?
Here are just some of them, the ones that are my favorites:

• Malt (Malt-O-Meal, Malted Milk) - Try to eat some malt-o-meal or oatmeal (see below) every day.  I add the malted milk powder to my coffee (chickory coffee see below), ice cream, and pretty much anything else I can hide it in.  You may have heard that beer is good for supply.  That's based on this same premise. While many people speak out against alcohol during lactation, I feel that's fodder for a different post.  Suffice it to say, I and many of my friends have seen a little beer go a long way.  Make sure it's dark, like Guiness.  LLLI has a page with good information about the safety of beer while nursing.
  
• Beans (Chickpea, Mungbean, Lentil) -Try hummus, and add to soups!
  
• Root Veggies (Carrots, Beats, Yams) - These you can eat just like normal.
  
• Whole Grain (Oatmeal, Barley, Rice) - Yum.  I eat the oatmeal like normal, and add barley and rice to soups.  You can also work the oatmeal into lactation cookies or oatmeal bread!  May moms also drink barley water to increase production.
  
• Leafies (Kale, Arugula, Spinach, Swiss chard, Chicory, Collard greens) - I prefer the Kale and Spinach, but listed the others for your benefit.  You can eat them any way you want.  I prefer my spinach in a calzone, Arugula in a salad, and Kale in soups!
  
• Yeast - You can take nutritional or brewers' yeast as a supplement, or you can add it to foods like lactation cookies! YUM!  I will post some recipes soon.
  
• Nuts (Almond, Cashew, Macadamia) - Try to eat them raw, instead of roasted.  Of course roasted is better than not at all.  I prefer almonds, and I drink Almond milk every day (it comes in a yummy dark chocolate flavor).
  
• Spices (Dill, Caraway, Fennel, Basil, Marjoram, Turmeric, Garlic, Ginger, Anise) - I dump almost all of these into soups.  I use many of them in spaghetti sauce, on roasted chicken, sprinkled on a salad, etc.  Work them into your diet just like any other spice.  One of my favorite ways to get galactogogues and lactogenic herbs is in a nice warm cup of tea!  One word of caution, ginger is supposedly bad for mothers who have lost a lot of blood recently.
  
• Healthy Fats (Olive Oil, Chicken Stock) - It seems like all around the world wise old grandma's are giving new mommies soup.  Often it's chicken soup!  I don't know why, but this works.  Home-made chicken soup, especially with rice (a whole grain!) helps my supply every time.
  

There are many other lactogenic foods, herbs, and supplements.  These are just the ones that I lean on when I need a boost.  For more information on this topic you can certainly check out Mother Food, or let me know what other foods you'd like to see added to this list!

Happy cooking :)

The Double DIaper - A Little Off-Topic

Alright, this is way off-topic, I know!

The cutie-bug needed to have surgery last week, and as a result he will have a catheter for a period of two weeks.  Lucky for us, he gets to spend this time at home.  Unlucky for us, we have to take care of the catheter!  Well, that's not really a big deal.  The hard part is taking care of the diapers while the catheter is in place.

We were told to "double diaper" until the catheter is removed.  It took us several days to really figure out what the heck we were doing.  In the meantime we got very little information that was helpful on how to double diaper.  I've decided that there should be a "double diapering tutorial" online.  Since I couldn't find one, I am making it!

Double diapering basically allows for the diaper area of your child to remain completely dry and clean inside of an "inner diaper" while all the urine is absorbed by an "outer diaper."   Here's how it works:

• After doing any clean-up or maintenance required for your baby, you place one diaper on the child that has a hole in it, strategically positioned over the catheter site.
• You gently pull the catheter through the hole of the "inner diaper."
• You place a larger, very absorbent, "outer diaper" over top, making sure the catheter is placed to drain into the center padded area. 

This isn't really that difficult once you get the hang of it, but I sure do wish I'd been given some more "helpful hints" in the beginning! So here are step by step instructions to create your double diapering system:

• Prepare by having two sets of diapers when you get home
• A box of disposable diapers the next size up from normal. For instance, my son wears size 1, so I bought a box of size 2.  We used Pampers Swaddlers Sensitive.  We went through about 30 of these in two weeks.
• A box of "super absorbancy" disposable diapers, like the overnights, the two sizes up from your normal size.  Since I couldn't find these in size 3, I ended up using a diaper three sizes up from normal, and that has worked just fine for us.  We used Huggies Overnights.  We went through about 45 of these in two weeks.
• Some people prefer cloth diapers - I use cloth diapers normally.  I want to be clear that while this process sort of works with cloth diapers it really becomes a sopping mess very quickly.  
• You have to have the waterproof barrier between the inner and outer diaper.
• You have to cut a hole and seal the edge of the hole on the inside diaper.
• You need to have a super absorbent outer diaper that wicks away the dampness from the inner diaper.
• We DID try this.  It was a sopping nightmare and I recommend just going with sposies for the duration of your double-diapering adventure.

• Prepare a diaper changing area.  When you have to change a double diaper, especially on your own without help, you'll want a comfy place for the child with something to amuse them.  We placed a changing pad in front of the mirror on my dresser.  We also left a couple of toys there to keep the little hands busy.
• Make sure you have wipes ready.
• Make sure you have a clean washcloth to pat dry.
• Make sure you have the double diaper ready (see next step, about the "batch")
• Make sure you have neosporin, or any other medicines prescribed by your doctor on hand
• It helps to have an extra pad under the baby's bottom so that you can swap it out for a fresh one each time.  The catheter will leak on your changing pad during the diaper change.

• Prepare a "batch" of double diapers instead of doing them one at a time.  It makes things allot easier when you never have to scramble to put one of these together.  My doctor told me not to worry about it ahead of time, but I wish I had created a good stash before the surgery.  It would have been one less thing to worry about when we got home.  

To create your double diapers:

• Grab a handful of your inner diapers (the one size ups), and an equal number of outer diapers (the two size ups).  I do about 5 at a time, every couple days.  It takes a while to do them.
• Gather some medical tape and a good pair of scissors. 
• Get something to do this on, because it makes a bit of a mess.  I use a pillow case.  It's easy to shake off and then throw in the wash.

 

• Take each of your inner diapers and open them up the way you would if you were about to diaper your child.  Then fold the diaper in half lengthwise.  
• Noting where on the diaper the catheter would be, make a horizontal cut.  You'll notice I do this high on the front because my child is a boy.  Also, I was told to cut a cross shape, I find that this single cut works better.

This is the point where things get messy.  You will notice fibers coming out of the diaper.  These little sandy pieces may actually be chemical components that turn to gel when they get wet.  If you don't seal the edges this stuff will get all over your baby, and render the "keep dry" effect of the double diaper useless.  It's especially frustrating when you've been told not to bathe your baby!  

So you want to seal the edges!

 

• Using medical tape (the cloth works better than the paper), tape the cut edges of the diaper closed, leaving a hole.  See the diagram below.

1. Place the tape on one side (I start on the outside.)  Try not to let the tape touch the open edges before you are ready, or else the fibers will make the tape not stick.
2. Use a finger to push the tape through the hole.  Place the finger on the not sticky side, this way you are pushing the tape against the edge it is meant to cover, and not getting fibers on the tacky side from the opposite cut edge.
3. Tape down the other side (For me this is the inside.). Continue steps 1-3 working around the hole until there are no more exposed edges.
4. Tape down any sticky spots or loose tape on the inside.  You don't want it to stick to baby.
5. Finished Product Front (see the arrows to identify each piece of tape and direction I taped in)
6. Finished Product Back (see the arrows to identify the tape and direction, including the piece that covers a sticky spot)

• To make things easy on yourself, go ahead and assemble the double diaper by opening your "outer diaper" and then placing the "inner diaper" inside.  
• Fold the double diaper back up, and you have a diaper ready to stack!

If possible just change the outer diaper!  Our physician's instructions were to change the inner diaper only when it was soiled or damp, otherwise twice per day when we medicated the site.  Changing the outer diaper is just like normal, except that there is a diaper inside instead of a baby bottom.  When you need to change the inner diaper:

• Open the outer diaper and remove it.
• Open the inner diaper and carefully pull the catheter back inside.
• If the inner diaper is dirty (poo) be sure to put a wipe between the catheter and the soiled area.
• Clean any soiled areas with wipes & remove the inner diaper.  Then dry by patting gently with a clean washcloth.
• The catheter should be hanging down, and probably dripping, on the extra pad you can replace after each diaper change. 
• If there are any surgery incisions you want to avoid using wipes there because they can cause stinging.  Instead use a damp washcloth.
• Apply any ointments or medicines to the baby's surgical and/or catheter site as directed by physician.
• Open the new double diaper, leaving both diapers together.
• Place the double diaper under baby's heiny.
• Gently pull the catheter through the sealed hole of the inner diaper.
• Close up the inner diaper. 
• Double-check the placement of the catheter (you don't want it poking out to drip down baby's leg) and then seal up the outer diaper.

Viola!  You are now a pro!

I hope this was useful for you!  Please leave a comment and let me know if it helped you, or if there is anything you think should be added.

 

Donor Milk

Now, we all know that formula itself is not bad or evil.  If it weren't for formula my little one wouldn't have survived his initial days as a preemie baby.  I myself was given formula from about one month on.

We also know that there are too many resources to list here explaining why breast-milk is best.  It's practically common knowledge that when possible babies should get breast-milk.  In case you weren't aware, you can see the CDC site and the WHO site for the official recommendations.  Some more in depth lists of breast-milk benefits can be found on the Dr. Sears site and too many others to list.

I am unable to produce a full diet of milk for my son, and so my baby and I have been truly blessed to receive milk donations from other breastfeeding moms.  For mothers who are simply unable to produce enough, or any, milk of their own donated milk can be the answer.

What is it?
Donor milk is simply human breast-milk that has been expressed or "pumped" by a one woman and shared with someone else, usually for the benefit of a child not her own.

Actually, people donate milk for purposes other than feeding babies too!  Human milk is used in some burn units, organ transplants, and is even patented for use in meat-packing plants to kill E. Coli bacteria! It can also be used to treat gut and bowel syndromes, renal failure, metabolism problems, ulcers, immunodeficiency diseases, burn victims, and infectious diseases such as intractable diarrhea, gastroenteritis, infantile botulism, sepsis, pneumonia, and hemorrhagic conjuctivitis in both children and adults. 

Why would you use it?
Above I've listed some reasons people use donated breast milk, but for this discussion we are referring to milk used to nourish a child.

Some families choose breastfeeding for health benefits only to find out that breastfeeding exclusively (or at all) is not an option for the mother.  I know, I know, you've heard that "everyone can breastfeed" but this simply isn't true.  There are many women who struggle to produce milk.  This could be because of the mother's health issues, prior surgeries, problems with the health of the child interfering with milk transfer and ultimately the mother's supply, absent mothers, non-biological mothers (adoptions), maternal death, etc.

From a purely nutritional standpoint formula is of course a viable option to provide the baby with nutritious sustenance.  To achieve the more psycho-social benefits of breastfeeding there are tools like supplemental nursing systems.

However, some people still wish to provide breast-milk, or find that their babies are unable to tolerate formula well.  For instance, some babies with GERD have worse reflux when fed with formula.

For more information on why breast-milk would be an important consideration you can see the links provided above.

Where do you get it? 
I believe the best and safest way to obtain donor breast milk for your baby is from women in your own social-mommy-network.  To me, this feels safe (more on safety later), and it's the method I use to find milk for my son.  I put the word out when we are low on milk and mothers in my support network (or their friends) offer up any extra milk they have.

By far, most of our donors are working mothers who have a huge pumped supply in the freezer and they don't want to have to "toss it" when it reaches the expiration date.  They would rather give the milk to another child who can use it.  Some of our donors have continued pumping the extra milk just for the purpose of donating it!  Sometimes when we are in extreme need of milk a mom (usually a closer friend) will pump especially for the purpose of giving the milk to my cutie-bug.  Honestly though, we normally get enough of the larger donations from moms who are already pumping anyway that there isn't a great need for people to go out of their way to have special pumping sessions for us.

Even though the majority of moms who donate to us are friends, or at least friends of friends, the majority of our milk volume comes from really large batches received through community groups like Human Milk for Human Babies, or Eats on Feets.  Both of these groups can be found in local communities all over the place by searching facebook, or searching their websites (linked above).

Human breast-milk can also be found through "milk banks" that basically sell breast-milk.  Banks are perhaps the safest option, but they are also the most difficult way to obtain milk. First you have to have a prescription, then you have to have money, and then you have to meet the requirements to receive the milk.  Because of low supply, the banked milk is given to babies with severe health problems first.  This milk is pasteurized for safety, and some moms have pointed out that the pasteurization process takes away some of the immunological benefits of the milk.

How much does it cost?
This is a tricky question to answer.  First, let me say that donor milk from a bank, while hard to get to begin with, is the most expensive option.  Sometimes insurance may help.  I don't know much about the process though, so if you are interested and need help figuring it out let me know.

True donor milk, from one mom to another, should always be "free" because assigning a monetary value to the milk invites scams.  You don't want to pay by the ounce, because some people thin or stretch the milk out to make money, and this can be dangerous for your baby.

However, even "free" donor milk has a high price!  It takes allot of time to search out donors and arrange for obtaining the milk.  Driving around to pick up the milk uses gas and puts miles on your car.  Plus, it's a nice gesture to provide a courteous thank you note or little gift to the donating mother.  This doesn't need to be anything expensive, and it certainly isn't required, but I like to do it anyway.  Just think, each bag of milk you receive had to be pumped.  This woman spent time hooked up to a machine to provide this milk!  She could have easily tossed it, used it to make soap, or just left it in her freezer til it went bad.  Instead she shared her liquid gold with you!  Give her a card, or a little box of chocolates... whatever is within your means, and expresses your gratitude.

How do you know it's safe?
I think this is one of the most important questions! I would be remiss if I did not tell you that the FDA does not support the use of donor milk unless it comes from a milk-bank.  This is primarily because of the risk of transferring infectious diseases and the potential risks of medication (or recreational drugs) in the donating mother's milk.

Those two very real possibilities make the use of donor milk seem a little frightening.  However, the way you obtain your milk can go a long way to limiting these risks!

Always accept only milk that was (a) originally pumped for the donating mother's own child OR (b) pumped specifically for your child by a mother who is currently breastfeeding her own child.  This means that the milk you are giving your child was considered safe enough for the other mom to provide her own baby.  Normal people are not going to poison their own children, and therefore you are mitigating risk to your own babe.

You should always have a list of questions to ask a donating mother.  Here are the ones I ask:

• Do you have any infectious diseases? Specifically do you have HIV? (If they say yes, either pass on the milk or check with your pediatrician.  Dr. Newman has a site where you can email him questions about what is safe.)
• Are you currently on any prescription or over-the-counter medications? (Check the list for breastfeeding safety, and crosscheck against your own medications for any contraindications!  Dr. Hale has a great site about this, and Kellymom.com has extensive info.  Most medications are safe.)  *Be very careful if the mother has been treated for cancer with chemo!
• Do you consume recreational drugs, or have you ever?  (You want the answer to be NO.  If they have ever consumed any you should either pass on the milk or talk to a professional.  This is another time to use Dr. Newman's link above.)
• Do you consume alcohol, and if so how much? (You want their answer to be acceptable to you.  You can check out #5 on this list of myths from Dr. Newman.  I feel it's acceptable as long as we aren't talking about binge drinking or alcoholism.)
• Are you breastfeeding your own child?  Were you when this milk was originally pumped?  (To me this is the most important question.  I never take milk that was not intended to be "shared" with the mother's child.)
• What are the conditions of the milk currently? (Frozen, Fresh, Deep Freeze, etc.  I use KellyMom's excellent page as my own guide.)
• When was it pumped? (Compare to normal guidelines based on the answer to earlier question.)
• Why are you donating the milk? (If their own baby won't drink it as why.  Sometimes moms have a high lipase issue where the milk needs to be scalded to avoid a strange taste/odor.  This milk is perfectly safe, but some babies refuse it anyway.  If you have a high-lipase donor give a small batch of milk to your baby and be sure it's palatable before accepting a huge donation.  I've had high-lipase donors who scald the milk before freezing and we've never had a problem.  If you scroll down, this page has information about lipase.)
• You may want to ask about other things, like caffeine consumption, diet (organic, steroid free, dairy-free, etc.), or any other thing that might make you hesitant to use the milk.

By the time you get through those questions you will have a good feel for the person with whom you are speaking, as well as whether or not her milk is a good match for your family.


Kellymom.com has a great resource page with links to many sites supporting and explaining the use of donor breastmilk.

Please comment with any questions you have, or any information you think could be added to improve this resource!

My own little stash!

While on my retreat I got to bag and freeze my milk for the first time. I'm thawing it now. I was so excited. While I know it doesn't seem like much it's a big accomplishment for me!

Now I am a couple days ahead of myself in production for the "one bottle a day" plan.  The cutie-bug had been getting roughly one bottle a day of my own milk, but now he will get a whole bottle every day because I have a buffer!  Woohoo!


I am currently pumping between 5 and 7 ounces a day.  I hope to continue at least with this rate.

Kicking Stupid Self

I am not feeling like any kind of diva today.

I am so sick of bottles. I hate them. I hate being reliant on them, washing them, storing them, filling them.

I wish my boobs worked right.

Cutiebug's been sick and hasn't been eating well but today was especially bad. He'd been trying to eat the same bottle for three hours and gotten one ounce. He was coughing allot so I thought this was just the cold getting worse... NO... It was a clogged nipple on the stupid bottle and his idiot mother with defunct boobs couldn't figure it out and let him suffer for three hours.

When I figured it out I changed the nipple and he sucked it down and is all smiles. How this child can be so loving and forgiving is beyond me. I'm not feeling it right now. 

I just want to kick myself. 

In the boob.

Reinvigorating Breastfeeding Culture

Jennie Bever Babendure, PhD, IBCLC, wrote a very interesting article posted on Lactation Matters, the official blog of the International Lactation Consultant Association.  It's all about how a simple change in a pediatric office can have dramatic effects on the breastfeeding trends in their patient families. 

It was amazing the change that was seen when lactation consults became part of the normal medical practice.  I highly suggest reading this article! http://lactationmatters.org/2012/03/22/can-a-change-in-pediatric-office-policy-begin-to-change-the-culture-of-infant-feeding/