Dealing with Unwanted Criticism

An interesting article on dealing with those lovely well meaning comments from friends and family members that are something akin to having someone kick you in the back of the knees.

http://www.breastfeeding.asn.au/bfinfo/dealing.html

Bottles after the first month = Probably not a bad idea (Yes I know this will raise lots of eyebrows but hear me out)

I started out my career as a lactation consultant as a breastfeeding purist.  I felt that if it wasn't the boob then it was unnatural and somewhat wrong.  Over the years my pragmatic streak combined with the stories mothers were telling me made me change my position.

Mums who had exclusively breastfed their babies for 5 months were running in to challenges because the baby refused to be fed any other way than from the breast.  400 years ago not really a problem, because there was usually an aunty or someone who could help out if mum needed to be away.  But fast forward to modern times.  Sometimes mums get sick and have to go to hospital, sometimes they have to go to a wedding, sometimes they just want to go on a date with their partner that doesn't require they squeeze it in between feeds.  Breastfeeding Aunties with clean bills of health just aren't as plentiful as they used to be so reality often requires adaptation.  Enter the bottle.  Once a baby figures out how to feed effectively from the breast add about two to four weeks.  Then after baby has had a good morning feed express off what is left in your breasts. Stick in the fridge and then in the evening it can be giving to a partner or given by yourself before baby goes to bed.  Now this is cool for two reasons.  It is mostly hindmilk (fatty sleep inducing milk) because it was pulled off at the end of a feed.  So now baby will learn to take a bottle, will get full on your own milk, and will hopefully give you a bit extra sleep in the night.

What sort of bottle to get:
Bottle marketers and formula marketers are both excellent at what they do and will try to tell you that their bottles are the best because of this or that reason.  The reality is that it only matters if your baby has a facial issue such as a cleft, or palsey.  If your baby can breastfeed and doesn't have palatal or neurological issues then any bottle will do.  Just stay away from dodgy plastics, and if it it comes from a dollar store I would avoid it.   Medela, and Ameda, are my safe bets but there are hundreds of bottle manufacturers that are making excellent bottles out there.  Just keep them clean during the day and sterilize them once a day and you should be all good.   Dr. Sears has put out a good guideline on selecting and cleaning your bottles located here.

First Month: Bottles and Breastfed Babies

Bottles in the Beginning = Bad Idea

Simply put:  When a baby is learning to breastfeed don't mess with their head.  Suckling on a breast and sucking on a bottle require two totally different skills. If the breast is low on milk (as can occasionally happen), and a doctor or midwife has prescribed a top up.....please whatever you do...avoid a bottle.  It flows fast and if the baby has been hungry up until this point they will most likely decide that your breast is frustrating and just too much hard work, and many then just say forget it and will start refusing to go to the breast.  Plus some studies have shown that at least in premature babies their temperature can drop and they can have more frequent episodes of their oxygen level dropping.

First give baby a fighting chance:

So how do you provide supplementary feeds to a baby if not in a bottle in the beginning.  First get the baby naked down to a nappy and skin to skin with mother.  Often this is all you need to do to stimulate the baby's natural feeding instincts, and has the added benefit of stimulating your milk supply.  I am not kidding about this.  Clothes between you and your baby in the first few weeks can be the natural enemy of breastfeeding success.  So give them the best chance and get naked together and warm (hat on baby, open front shirt or sweater on you, blanket over babies back, or just a warm room.)

Tube to the Breast

 My preferred method if baby is attempting to suckle well is to try tube to the breast.  This is a smallest gauge nasogastric tube (can usually get from the special care unit of the hospital) attached to a syringe with the tip cut off with sterile scissors.  The syringe is filled with either pasteurized breast milk from another mother or artificial baby formula.  The tube is placed so that it will end up with the tip at the nipple tip and angled so that it will protrude from the corner of the babies mouth.  (pictures are soon to follow).  You can also use a commercially available set up from Medela called a supplemental nursing system.

The reason we suggest this is it still requires that the baby is fed from the breast, they mentally process that the breast is a comfortable rewarding place to get food and then when your own milk comes flowing then you just subtract the tube. 

It is akward and can take a couple of people to get it sorted in the beginning but soon becomes easier.  I have a lady whom I worked with who was eventually able to tandem feed her twins using this set up.

This is by far my first choice when a top up needs to be delivered, plus usually there is less spillage. 

Variation: You can try and see if you can jump start a baby to suckle at the breast by trying a nipple shield over the breast with a tube under neath.  This will often tickle the babies vagal nerve and then will encourage a reluctant feeder to feed. You can then provided them with the extra milk via the tube underneath the shield.  

Finger Feeding

For a baby who is less coordinated and really cannot yet get their head around suckling at the breast (due to birth trauma usually) I recommend trying finger feeding. Before you move to finger feeding though the baby must first prove that they cannot latch onto a breast.  So undress them down to their nappy and put the baby skin to skin between mum's breasts and see if the baby will bounce down and try to latch on on their own.  If they can latch on, then use the tube to the breast technique.  If they just sniff and mutter at the breast then try this technique instead.

This is where babies are placed in the crook of your arm and the tube with the milk is taped on their finger and the finger is placed in the babies mouth.  By wiggling your finger with the pad side facing toward the roof of their mouth you are often able to stimulate their sucking reflex by tickling their vagus nerve.  Then when they are sucking on your finger you release a bit of the milk from the syringe.  Repeat until they have finished the required amount of milk and then return them skin to skin to their mother.  This is a very important part.  Please do not wrap up a baby that has had birth trauma and leave them to sleep all day in a  bassinette away from the perfectly designed healing space of their mothers chest.  If mum is not available or needs a break then this baby needs another warm body from the family if possible to help them to heal the fastest way possible. 

Cup Feeding or Spoon Feeding

Spoons are our friends in the first few days.  When a mum is expressing those precious drops of colostrum I don't want one drop missed so I  use a clean teaspoon.  They get every last drop nothing is wasted and they can be used by a mum by herself as opposed to using a syringe which usually requires three hands. Milk is expressed into the spoon then when there is a small pool fed to the baby you place it in the baby's mouth and they tend to lap it right up. If you need to measure volumes carefully then you can do this by filling it with water and then drawing it up in a syringe to measure volume the spoon can hold (do not feed the water to your baby this is just for measuring).  Then you have an idea how much the spoon can hold.  I have yet to find a baby that I couldn't spoon feed.  And there is no wastage of the milk.

 

Once the volume is over 5 mls then a cup, like a small medicine cup can be used to feed the baby. However be careful for spillage.  One study showed that over 38% of the milk could be lost during cup feeding, fine if it is formula but not fine if it is expensive or hard won breastmilk. And not fine if the baby needs volume.

For more information please feel free to have a look at the following:

Protocol from the Academy of Breastfeeding Medicine on Supplementation of Breastfed Infants

Stateside breastfeeding observations

I have been back in the states for 5 days now and have yet to see a baby being breastfed.  Or many babies for that matter, nor pregnant women.  I have seen two pregnant women all up since arriving.  Babies seem to live in front packs, which is encouraging but was quite saddened by the obvious sale of breast feeding capes, next to bottles that were so cute that even the bottle hesitant me was tempted to buy one.  So maybe babies are being breastfed they are just being hidden as if they are too shocking to be seen by the general public.  I must explore this.  It must just be that I am not in the right locations but it reminds me of my friend Sophia's quest to find a squirrel while she was Stateside and he subsequent failure to find one.  Will a confident breastfeeding mother be as elusive to find?  Have I just become so used to Kiwi mothers relaxed feeding style that I have forgotten after 10 years what the breastfeeding culture is like in the States?  I am in San Francisco so I expected a degree of openness here.  Now mind you it is winter so that could definitely be a factor.  But I am intrigued by this.  Stay tuned...I will look harder.

very cool Kangaroo care Article

Here is the New York times article