Tuesday, June 27, 2017

Your Secret Weapon for Breastfeeding Success

From the NPR Morning Edition, June 26, 2017
by Glenni Lorick, IBCLC

Yesterday NPR (National Public Radio) ran a fascinating story about breastfeeding mothers in Namibia. It is really worth taking a few minutes to listen to it.  It turns out that mothers there struggle with breastfeeding just like mothers in the United States do. They get sore nipples; they may have supply problems; they have to learn to breastfeed just like American moms do. However, they have a huge advantage that the vast majority of US moms do not have: a culture of breastfeeding.

The Grandmother Factor

This article explains in detail how the Himba people in the northern desert of Namibia have a culture that makes breastfeeding work. They live in mud huts, and babies are born at home, so there is no separation of mother and baby after birth for medical procedures. Their maternal and infant mortality rates are both high. For every 100,000 births, 265 mothers die, and or every 1000 live births 36 babies die. Obviously, I am not advocating giving birth in a mud hut as a solution to our breastfeeding problems. And even Himba mothers do struggle with learning how to breastfeed.

When 17 year old Bethany had her baby, her mother
supported her and taught her how to breastfeed.
But that is where they have the amazing "Grandmother" factor. Himba mothers actually go in the third trimester of pregnancy to the compound where their own mother lives. The new grandmother sleeps in the hut with mother and baby, even serving as an alarm clock to awaken the new mother and remind her to nurse. The grandmother teaches the new mother how to position the baby, how to help baby get the best latch possible, how to safely sleep with baby, and all the other little details necessary for parenting. The new mother remains with her mother for several months following the birth.

In the US we have a generation of great-grandmothers whose doctors told them that formula was the best way to feed a baby. Their daughters who are now grandmothers likely had no support for breastfeeding from either their mothers or the medical community. This lack of help often spelled lactation failure for that generation of mothers. Those who persisted are able to support their daughters in an amazing way, and usually those daughters benefit from their wisdom.

A grandmother who can help with breastfeeding is a treasure.
But there is another glaring obstacle that mothers in the US face. They are expected to jump right back into the routines of life within days or weeks after giving birth. I have worked with mothers who had to return to work or school as little as 2 weeks after giving birth. They aren't even able to give their bodies time to recover, let alone get breastfeeding well-established. The scant 6 weeks that so many employers deem as "generous" maternity leave is actually the bare minimum to move a mother beyond the post-partum period. Employers who allow 12 weeks are much more in tune with what mother and baby both need.

Another big difference between our culture and the Himba culture is the normalization of breastfeeding within the society. There it is completely expected that mothers will feed babies at the breast. Although there is some supplementation with goat's milk when mothers don't have enough milk, it is not the normal way to feed a baby in that culture. In contrast, new mothers here often feel uncomfortable and embarrassed about breastfeeding their babies with anyone else around. We do not have a breastfeeding culture here where children grow up seeing breastfeeding as the normal method of infant feeding.

Lessons We Can Learn from the Himba People

So how can we take this information and use it to increase breastfeeding success among US mothers? I see several ways in which we can learn from the Himba culture.
Skin-to-skin contact during the early days is
critically important for Mother and Baby.

  1. Mothers and babies should NOT be separated at birth for any reason unless there is a genuine medical reason. Many hospitals have implemented policies to protect the Golden Hour because the evidence clearly points to improved outcomes when mothers and babies have this uninterrupted time together immediately after birth until after the first feed. 
  2. Mothers and babies should have as much skin-to-skin contact as possible in the early post partum period. Research shows that this elevates hormone levels which increase mother/baby bonding. It also helps milk come in faster and increases the rate of breastfeeding success.
  3. Mothers need to go home to somebody who will take care of them as they are learning to care for and feed their babies. This person needs to be supportive of breastfeeding, ideally having breastfed herself. Mothers need several weeks of this encouraging care and support. If a supportive grandmother, sister, aunt or close friend is not available to fill this role, a postpartum doula is an option. A Nurturing Moment actually offers a postpartum support package that provides some of this kind of ongoing support to new moms who don't have a grandmother/sister/friend to help out. It is very interesting to note that in the NPR broadcast yesterday morning they actually mentioned IBCLC's as an alternative for mothers who don't have "the Grandmother factor."
    India has a mandated 6 month maternity leave!
  4. Our lawmakers need to get serious about providing a minimum of 12-16 weeks maternity leave to employees. As a small business owner, I understand the hardships that can cause, but as a lactation consultant, I see daily the hardships caused by the lack of adequate maternity leave. Research as well as the experiences of mothers and companies in the rest of the world have clearly shown the benefits of making sure that a strong maternal leave policy is implemented across society. 
  5. From their earliest days, children need to see breastfeeding as the normal way that babies are fed. Children's books should feature pictures of babies nursing, not getting a bottle. Mothers should try to expose their children to other breastfeeding mothers, explaining that this is how babies are designed to be fed. Science classes at the elementary level should include breastfeeding in their curriculum when children are learning about mammals. At the secondary level, breastfeeding should be included in instruction about reproduction and family planning. A breastfeeding culture is built by one mother and baby at a time normalizing infant feeding at the breast. I am optimistic that together this generation of mothers can make that happen!

Thursday, June 15, 2017

Does Your Baby Sleep....Like a Baby?

by Glenni Lorick, IBCLC
Does your baby sleep like a baby? You know, waking every 2 or 3 hours, maybe crying, nursing or taking a bottle, then falling back asleep? Physiologically newborns are not programmed to sleep a stretch longer than about 4 hours. By about 6 months, they might be capable of sleeping a stretch of at least 6 hours (many infants do sleep longer) at night. The fact is that some babies are simply born with easier temperaments than others, making nighttime much easier for some parents than for others.

Why Babies Wake Up

A newborn has a tiny tummy. In fact at birth his tummy will hold about 5- 7 ml of breastmilk comfortably. Many formula feeding parents mistakenly think that their babies need to take most of the 60 ml formula bottle the hospital gives them. Even 20 ml can cause baby's stomach to be too full, leading to discomfort and spitting up. Newborns nurse very frequently - every 2-3 hours or perhaps even more often. Breastmilk is designed to digest quickly, so often newborns wake up hungry after just an hour or two.

Many infants will cluster feed in the evening because that is how they prepare for a slightly longer sleep stretch at bedtime. Breastmilk composition changes throughout the day. In the evening, there is less milk, but it is actually higher in long-chain fatty acids like tryptophan (that wonderful amino acid found in turkey that makes you want to fall asleep after Thanksgiving dinner). It is also higher in sleep-inducing melatonin. A lot of mothers worry that they don't have enough milk in the evening because baby is nursing non-stop. So they end up supplementing in the evening. But that really isn't necessary. The frequent nursing helps baby get what he needs and helps mama produce more milk.

As they approach about 2 months of age, some babies do start sleeping longer stretches of 4-8 hours at night. That is normal. But it is also normal for babies to continue waking several times at night to nurse. At this age babies are still sleeping pretty deeply when they are actually asleep.

Around 4 months many babies experience a sleep regression. A baby who was sleeping a 6-8 hour stretch may suddenly be waking every 3 hours again. The good news is that baby's brain is maturing. The bad news is that these changes are permanent. You will need to help your baby adjust to falling back asleep when he awakens. One way to do that is to help him learn to fall asleep in his crib without you. Most experts do not recommend letting baby "cry-it-out" because research has shown that can actually be harmful. However, there are gentle methods to help baby learn to sleep. The No Cry Sleep Solution by Elizabeth Pantley is a terrific resource that many parents have found to be invaluable.

Where Baby Sleeps

The American Academy of Pediatrics came out with revised sleep recommendations in 2016. They recommend that babies sleep in a "separate but proximate"sleep environment. That means that baby should sleep in Mom and Dad's room, but not in their bed. Nevertheless, in this revision, the AAP did acknowledge that mothers do sometimes fall asleep while nursing. 
"However, the AAP acknowledges that parents frequently fall asleep while feeding the infant. Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep. It is important to note that a large percentage of infants who die of SIDS are found with their head covered by bedding. Therefore, no pillows, sheets, blankets, or any other items that could obstruct infant breathing or cause overheating should be in the bed. Parents should also follow safe sleep recommendations outlined elsewhere in this statement. Because there is evidence that the risk of bed-sharing is higher with longer duration, if the parent falls asleep while feeding the infant in bed, the infant should be placed back on a separate sleep surface as soon as the parent awakens."

 Dr. James McKenna is a professor of Biological Anthropology and the director of the Notre Dame Mother-Baby Sleep Laboratory. He has written extensively on the biological reasons for mothers and babies to share sleep environments. He also has created safe co-sleeping guidelines that any family who is practicing co-sleeping should be very careful to follow. Everyone agrees that the most dangerous place for an infant to sleep is a recliner or sofa, even with a caring adult. If that adult falls asleep the risk of the infant suffocating is many times greater than it would be on a firm sleep surface such as a futon or firm mattress.

Getting Help 

Fortunately  we have a local infant sleep expert. Dana Stone is the mother of four children. When she had serious sleep issues with her last baby, she looked for answers. She knew that the traditional cry-it-out method wasn't right for her family, so she found a program that helped her gently teach her child to sleep. She ended up becoming a certified Sleep Sense consultant and has helped dozens of local families get a good nights' sleep.  She offers a free download for parents entitled "Five Steps to Getting Your Baby to Sleep Through the Night." It is important to recognize that nobody expects an infant to sleep through the night. Physiologically they just aren't ready to do that. However, later in the second half of the first year, many babies are capable of sleeping an 8 hour stretch. Dana is able to work with your individual situation and help your baby sleep a little less like a baby!