Your Superpower: Making Breastmilk!

by Glenni Lorick, IBCLC

Did you know that you have a superpower (well, maybe more than 1...but today we're just focusing on one)? If you are a female, your superpower is that you can make breast milk! You are able to completely sustain another living being on this incredible liquid that your body makes. It is really mind-boggling to think about, but the whole human race would have long since died out if you didn't have this superpower!

Your Amazing First Milk

The bottle on the left contains colostrum; the bottle on
the right contains mature milk. Picture from Wikipedia.

Some mothers actually begin leaking colostrum while they are still pregnant. As soon as your baby is born and the placenta is delivered, there is a huge hormonal shift that puts your body into milk-making mode. From the moment he is placed on your chest skin-to-skin right after birth and takes his first meal at your breast, you are giving him just the right amount of colostrum. His tiny stomach can only comfortably hold about 5-10 cc of fluid, and that is just what he gets in his first feed.

Colostrum is pretty thick and has a yellowish color. Some moms call it "Liquid gold!" It really is very valuable because it does some amazing things for your baby!

• It coats his intestinal tract forming a protective seal against any pathogens.
• It is very high in IgA and IgG, two immunoglubulins that offer your baby tremendous protection.
• It has higher concentrations of Vitamin K than mature milk.
• It is low in fat, but high in proteins and enzymes that a newborn needs.

From Familyholiday.net

Your Milk Keeps Changing

Between day 3 and 6 your milk will "come in." Your breasts will feel full, and the colostrum will begin changing to milk. It is really important to avoid getting engorged; the best way to do that is to nurse frequently. 

Your milk is absolutely amazing in so many ways:

• It has natural DHA and ARA, two fatty acids that are critical for brain development. Although many formulas have added artificially created forms of these two acids, they do not function the same way that the naturally occurring substances do.
•  Although it is relatively low in protein, it is high is specific proteins that your baby needs like taurine. 
• It contains lipase and lysozyme which helps breastmilk to be more rapidly digested and utilized by your baby. That's why breastfed babies need to nurse every 2-3 hours.
• It is low in iron, but lactoferrin makes that iron highly bioavailable to your baby!
• Specific IGA antibodies that form in response to any bacteria or toxin a mother is exposed to.

Breast Milk Handling 101: A Primer for Childcare Workers

Photo from freerepublic.com

by Glenni Lorick, IBCLC

Just the other day I got a call from a mom who was pretty upset when she picked up her baby from daycare to find that they had microwaved her milk to heat it, despite the fact that she had actually purchased a bottle warmer specifically for them to warm her breast milk. She had every reason to be upset! Microwaving breast milk actually causes changes in its nutritional composition. It can also cause "hot spots" where one part of the milk is actually hot enough to scald baby's mouth.  She asked me if I had information I could provide her for her daycare. The CDC has put together a terrific handout on handling breast milk that you can print and post as a reference for workers.

Breast milk Handling Facts 

Take good care of a mother's "liquid gold"!

1. Breast milk is NOT gross. It is not an unclean bodily fluid. Nor is it unsanitary. It is actually full of live antibodies that will help the baby you are about to feed stay healthy. Baby's mama has made the decision to provide him breast milk because she knows it is the ideal food, perfectly designed for his optimal growth. As baby grows, the milk he receives will change somewhat in composition to keep us with his changing needs.
2. Never microwave breast milk. Since breast milk IS a living fluid, microwave radiation can actually alter it's nutritional make up. It can cause certain components to break down and can significantly altar the anti-infective components of breast milk. There are a variety of alternative methods for heating breast milk. Immersing it in warm water or using a bottle warmer is ideal.
3. Do NOT shake breast milk. Instead, gently swirl it to mix the hindmilk and foremilk. Shaking it can begin to break down of nutrients and can also introduce air into the milk, causing baby to have an upset tummy!
4. After you have fed a baby part of a bottle of breast milk, you can't save it for the next feed. When baby's saliva comes in contact with the milk, it begins to break down the components. Therefore, give baby just the amount of milk you think he will take. It is better to have to add another ounce than to have an ounce left over that you must discard. To his mama, that milk is liquid gold, so it kills her to know that even a drop goes to waste.

Our ANM babies LOVE their mama milk!!

Help Baby Stay Healthy

A mother produces antibodies in her milk to any bug, virus, or illness that she comes in contact with. That's why it's a really good idea for a breastfeeding mother to spend a few moments cooing over and playing with all the other babies in the room. It's also a good idea for her to give the workers a hug. It will help her baby to stay healthier because she will have come in contact with whatever germs happen to be in his daycare environment and will pass antibodies to those specific germs to her baby. Encourage your breastfeeding mothers to take just a minute extra every day getting all those good germs!

Chubby Babies Lactation Cookies Bring Good Luck AND More Milk!

By Wendy Short Carlton, Guest Blogger

Chubby Babies Cookies from Good Natured Gourmet

I've been desperately trying to find anything that will help increase my milk supply. I had tried the malunggay, fenugreek, reglan, mother's milk tea, increasing water intake... All of which did not produce the results I had hoped for.

The women at ANM even provided me with a recipe for lactation cookies. However, when I started shopping for supplies, I noticed this was going to be quite an investment for something I wasn't even sure was going to work. I was feeling frustrated, defeated, tired, and almost to the point of giving up with exclusively breastfeeding.

Then, I saw ANM advertising a premade mix for lactation cookies. All you have to add is a stick of butter and an egg to the mixture. With preparation and baking, everything takes about 15 minutes. That's it! Although both mixes I purchased were DELICIOUS, I tried cooking the second batch about a minute longer which made the cookies hold together a little better. Both mixes I tried were very moist and tasty and made my house smell heavenly! I think they may have also brought us good luck in selling our house because our house sold the day after I made them!

As far as an increase in milk production, I noticed some difference in how long my 4 month old son stayed full. Typically, he nurses every 2-3 hours during the day. At night, he'd wake up at least once around 2 or 3 am to nurse. The cookies seemed to help extend this time to about 3-4 hours during the day, and he ended up sleeping through the night!

I would definitely recommend this product to moms who need a boost in their milk supply. These cookies disappeared from the plate fast in our house. My husband enjoyed several before realizing what they were! I will be going back for more soon. 

Traveling with Breast Milk, Infant Formula and Baby Food

Photo from   Modern Milk Sharing

You are finishing up your last minute preparations for a quick business trip when all of a sudden you remember all the breast milk you will be pumping while you're away from baby for three days. The thought of dumping all that milk makes you absolutely ill, but what in the world are you going to do with it all?

I've got great news for you! You can take it home with you - even if you're flying! The Transportation  Security Administration has actually created a page specifically to address the needs of traveling parents. Basically, parents are allowed to carry whatever breastmilk, baby food or infant formula that their infant will need. Furthermore, mothers traveling without their babies are also allowed to carry breast milk.

Of course, every mother knows that keeping breast milk cold is vitally important. The TSA has addressed that as well. I called today and spoke with a very knowledgeable and helpful agent who actually sent me additional information.

Breast Milk

• Breast milk must be separated from other property and declared to a Transportation Security Officer (TSO) prior to entering the checkpoint. Parents are allowed to bring as much breast milk as they will need for the trip. Mothers who have pumped and frozen their milk while traveling may bring that frozen milk with them.

  

  Photo from Daphne ph

• If you don't want your breast milk to go through the X-ray screening, you must request an alternative screening before placing it on the belt.
• When traveling with an infant or toddler, passengers are also allowed to bring into the screening checkpoint more than 3.4 ounces of pre-mixed baby formula (in a liquid, or frozen state); milk products; juice; gel or liquid-filled teethers; bottled water; and canned, jarred, processed baby food and essential non-prescription liquid medications. You must declare these items to a TSO prior to entering the checkpoint.
• While passengers may be requested to open a container, they will never be asked to test or taste any of these items. If a container cannot be opened, the containers may be allowed into the sterile area only after it and the passenger undergoes additional screening, which may include a patdown. 
• All frozen items are permitted as long as they are solid and in a “frozen state” when presented for screening. Cooling liquids or gels used to keep medical or infant child exemptions cold are not bound by 3-1-1 requirements and may be presented at the screening checkpoint in a frozen or partially-frozen state. It is important to remember, however, that any item must be properly screened before being allowed into the secure area of the airport.

Breast Pump

• Individuals traveling with or without a child may bring a breast pump through the screening checkpoint. However, all child-related devices are subject to screening by the Transportation Security Administration (TSA). 
• You will be asked to place the breast pump in a plastic bin provided at the screening checkpoint and onto the x-ray conveyor belt before walking through the walk-through metal detector. If it does not fit through the x-ray machine, Transportation Security Officers will visually and physically screen the item. 
• You may place it in a clear plastic bag prior to x-ray screening if you are concerned about contamination, but you must provide your own plastic bag.  

Cooling Elements

Current Transportation Security Administration (TSA) regulations permit regular ice, frozen gel packs, and dry ice in checked baggage and carry-on bags.

Checked Baggage: Regular ice and frozen gel packs in checked baggage are not restricted by TSA. When regular ice is transported, TSA recommends a cooler. For dry ice:

Courtesy of  Eats on Feets

• TSA requires that its packaging permit the release of carbon dioxide gas.
• The Federal Aviation Administration (FAA) limits each piece of checked baggage to five pounds of dry ice.
• The FAA requires that each package of dry ice be marked “DRY ICE” or “CARBON DIOXIDE SOLID."
• The FAA requires that each package of dry ice be marked with the net weight of the dry ice or an indication that the amount of dry ice is five pounds or less. 

Carry-On Bags: TSA allows frozen items (regular ice, gel packs, and food) at the screening checkpoint as long as they are solid and in a “frozen state” when presented for screening. If frozen items are partially melted or have any liquid at the bottom of the container, the ice liquid container must meet 3-1-1 requirements. For dry ice:

• TSA requires that its packaging permit the release of carbon dioxide gas.
• The FAA limits each piece of carry-on baggage to 4.4 pounds of dry ice.
• The FAA requires that each package of dry ice be marked “DRY ICE” or “CARBON DIOXIDE SOLID."
• The FAA requires that each package of dry ice be marked with the net weight of the dry ice or an indication that the amount of dry ice is 4.4 pounds or less.

Cookies to Help Mom Make Milk!

Did you know that there are certain foods that help your body produce more milk? Oatmeal, brewer's yeast, flax seed, wheat germ, whey protein, avocado, malunggay (a food from the Philippines) and even stout beer are some of the foods that our moms have had success with.

Last year I discovered that a company had produced "Lactation Cookies" that they were selling for an arm and a couple of legs. I decided that we wouldn't be stocking them because I can't justify the pricing, especially when it's so easy to make them yourself! And honestly, the homemade ones are so tasty that these cookies will quickly become a family favorite!

So here is our tried and true recipe:

Mommy Milk Cookies

Ingredients

1 Cup Butter
1 Cup Raw or Natural Sugar
1 Cup Brown Sugar
4 Tablespoons Water
2 Tablespoons Flaxseed
2 Large Eggs
1 Teaspoon Vanilla
1 ½ Cups Flour
½ Cup Wheat Germ
1 Teaspoon Baking Soda
1 Teaspoon Salt
2 (Generous) Tablespoons Brewers Yeast
3 Cups Rolled Oats
9 oz. (Minimum) Chocolate Chips

Directions

- Preheat Oven to 375 Degrees
- Mix Flaxseed and Water, set aside for at least 3-5 min.
- Mix Butter and Sugar in a large mixing bowl
- Add Eggs to butter and sugar, mix well
- Add Flaxseed and Vanilla, blend
- In separate bowl sift dry ingredients except the Oats and Chocolate Chips
- Add Dry ingredients to Butter/Sugar/Eggs and mix well
- Add Oats, Mix
- Add Chocolate Chips, Mix!
Bake 8-10 min.
Makes approx. 4-6 dozen

Action Step 12: Make Donor Milk Available

From the Human Milk Banking Association of North America

August is National Breastfeeding Month. The United States Breastfeeding Committee has begun a campaign of 20 steps in 20 days to support breastfeeding. These steps are based on the Surgeon General's Call to Action to Support Breastfeeding. We'll be taking a close look at some of these steps over the next few weeks! The information below comes from page 49 of the above document.

Action 12. Identify and address obstacles to greater
availability of safe banked donor milk for fragile infants. 

Growing evidence supports the role of donated human milk in assisting infants with special needs, such as infants in newborn intensive care units who are unable to receive their own mothers’ milk, to achieve the best possible health outcome. In these situations, use of banked donor milk may protect the infant from the risks that might result from not breastfeeding. Unfortunately, demand for donor milk outpaces supply because of logistical challenges related to transportation of donated milk, the lack of clarity in oversight, and the high cost of providing banked human milk. A national strategy is needed to efficiently and effectively address the issues involved in providing banked donor milk to vulnerable infant populations.

Implementation Strategies 

Conduct a systematic review of the current evidence on the safety and efficacy of donor human milk. A systematic review will provide a common understanding of the health outcomes resulting from the use of this milk by analyzing the results of all of the available published research. Additionally, a systematic review will help identify any areas where the evidence is not conclusive and where more research is needed.

Establish evidence-based clinical guidelines for the use of banked donor milk. Necessary components of the guidelines include discussion of the use of donor human milk for a variety of infants, such as those who have a low or very low birth weight, are premature, or have particular medical needs; issues related to collection of and payment for donor milk; and the complex biomedical ethics of prioritizing the distribution of banked donor milk.

Convene a study on federal regulation and support of donor milk banks. Such a study could examine possible models for regulating and funding milk banks. In addition, it should consider
policy options to address concerns about biomedical ethics related to compensation for donating milk and the for-profit sale of banked donor milk. It also could examine models for payment, including WIC or health insurance program benefits that cover the use of banked donor milk. It is important also to consider how human milk banks might be a resource in planning responses to national emergencies.

Getting Involved

At A Nurturing Moment we are passionate about seeing a human milk bank in Alabama. Melissa did her Master's Thesis on Human Milk Banking. Currently the closest milk bank is in Texas. 

However, a bank is being developed in Jackson, MS. They are in the process of raising funds to get started. On October 4 they are having a very special fund-raiser -- A special one-night screening of Donor Milk: The Documentary at the Grandview Cinema in Madison, MS. Following the film there will be a question and answer panel with Amy Vickers - executive director of the North Texas Milk Bank, a couple whose baby received donor milk, mothers who have donated, Jarred King - one of the film's producers and Linda Pittman - executive director of the Mother's Milk Bank of Mississippi. 

One key to having a milk bank in a community is the demand for donor milk by the neonatologists. In the Jackson, Mississippi area, the neonatologists regularly prescribe donor milk for those preemies who desperately need it. Parents have the right to demand that their baby receive donor breastmilk if mom isn't making enough milk for baby.  In the future every state should have at least one milk bank, and many states will have more than one (Texas already has two.) We look forward to the day when Alabama has it's very own Human Milk Bank!

Extended Breastfeeding and Toddler Nutrition

Photo courtesy of freedigitalphotos.net

One of our moms was in the store chatting with us this week. She asked if there was any nutritional value to her milk now that her baby is 15 months old. While her pediatrician is supportive of her continued breastfeeding, her Ob/Gyn had told her that there was no need for her child to continue nursing because the milk had no nutritional value at this point.

Needless to say I was aghast that a medical professional who should have known better would say such a thing. However, this incident highlights a much larger issue within our culture. Many people, both within the medical community and outside of it, don't understand why in the world a mother would nurse a child who can walk, talk, and ask for "Nursies."  They mistakenly assume that it is simply the result of a mother selfishly meeting some maternal need she perceives. What they fail to recognize is that mother's milk is still an extremely valuable source of nutrition, antibodies and long-chain fatty acids for an older nursling.

A 2005 study written up in Pediatrics showed that the milk of mothers who had been breastfeeding for over a year had significantly higher levels of fat content than that of mothers whose babies were younger. The researchers felt that the energy contribution from mother's milk to the child's diet was significant. Other research indicates that breastmilk continues to be a major source of other nutrients for as long as a child nurses. In fact, according to Dewey (2001), "Breast milk continues to provide substantial amounts of key nutrients well beyond the first year of life, especially protein, fat, and most vitamins." Her research indicates that 448 ml (about 15 oz) of breast milk fed to a child between 12 and 23 months old provides the following percentage of the daily requirement:

• 29 % of energy
• 43% of protein
• 36% of calcium
• 75% of vitamin A
• 76% of folate
• 94% of vitamin B12
• 60% of vitamin C

Further research indicates that the antibody protection afforded by breastmilk continues to protect a child into toddlerhood. Concentrations of Lactoferrin and Secretory IGA even increase slightly in the second year year of life. That means that children who continue breastfeeding past the first year of life continue to have increased immunological protection. This is especially important for parents who choose to delay vaccinations.

However, extended breastfeeding is good for mom, too! The longer a mother breastfeeds, the greater protection she has against pre-menopausal breast cancer, cervical cancer, osteoporosis and several other conditions. Some mothers who practice extended breastfeeding even report a delay in return of fertility.

Even if the breastmilk itself didn't offer significant benefits for baby, the intimacy with mom associated with nursing a toddler provides tremendous reassurance for a little one who is busy exploring his world. Nursing remedies a host of ills from a bleeding mouth to pain from shots. It is also a great way to help an older baby learn about delayed gratification, because unlike a newborn, a toddler doesn't need to nurse on demand.

So if you're thinking about nursing past a year, rest assured that you will be continuing to give your baby the very best possible nutrition. By extending the wonderful start he has had at your breast, you're continuing to give him a precious gift. He'll thank you for it every day!

Breastfeeding Isn't Just a Lifestyle Choice

The American Academy of Pediatrics has recently taken its strongest stand ever in favor of breastfeeding. In the current issue of Pediatrics, they make this statement: "Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice." This is encouraging news for breastfeeding advocates because it reinforces the message we've been giving mothers for years. It isn't a matter of breast milk being a superior food. The fact is that human milk is the standard food for human babies. Anything else is an inferior substitute.

I will be the first to aggressively defend a mother who, for reasons beyond her control, has had to resort to using some infant formula to help her baby. It's kind of like using medication when you have to. Nobody wants to keep a child on medication unnecessarily, but what a blessing that the medication exists for those babies who need it!

However, I hope that this AAP statement will open the door for more honest dialogue between doctors (both Ob/Gyn's and Pediatricians) and their patients. When a doctor tells a mother that it doesn't really matter how she feeds her baby, it may serve to undermine her confidence and her belief in breastfeeding. With the advent of this new policy statement, any doctor who doesn't actively support and encourage every patient to breastfeed is either unaware of the research contained in this document, or truly doesn't sincerely care that his or her patients might receive substandard immunological protection.

So what has happened over the last ten years to warrant such a strong statement from the AAP? The statement acknowledges that methodological issues have been raised about some of the studies that have been done. However, the data upon which this statement is based comes from the report prepared by the Evidence-based Practice Centers of the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health Human Services. It clearly shows that babies who are not exclusively breastfed for 6 months have a 77% higher chance of developing ear infections and a 63% greater chance of contracting an upper respiratory infection.

In many public health sectors, there is a growing emphasis on wellness and prevention of illness as opposed to treatment. The illnesses that breastfeeding helps prevent include asthma, RSV, Necrotizing enterocolitis (NEC), Leukemia, Celiac Disease, atopic dermatitis, gastroenteritis and Diabetes (Types 1 and 2), and numerous other conditions. It also reduces the risk of SIDS by 36%.  Another way to look at this data is to see that using infant formula increases an infant's chances of having these conditions.

In this document, the AAP also emphasizes the importance of work-place support for breastfeeding mothers. They cite The Patient Protection and Affordable Care Act passed by Congress in March 2010 which mandates that employers provide “reasonable break time” for nursing mothers and private non-bathroom areas to express breast milk during their workday.

We encourage all mothers to discuss this new AAP statement with your Ob/Gyn and and your pediatrician. Here at A Nurturing Moment, we will do all we can to help you as you nurse your baby, but it makes a big difference if your health care providers offer their support as well. If you have a particularly supportive doctor, please leave a comment so others will know how wonderful he or she is. (Positive comments only, please.)

The Difference Between Breast Milk and Formula

Recently an expectant mom was in the store getting some last minute supplies for her baby. I love getting to know our customers, and since I'm a lactation consultant, I usually ask moms if they plan to breastfeed. Usually they say "yes." Sometimes they are undecided, but want to try. And every once in while, a mom will flat out say "no." That's what this mom said. But her reason absolutely floored me. She said, "I don't have to pay for formula, I'll just get it free, so there's no need to breastfeed." I was so taken aback by her comment that I was speechless!

I've had some time to think about it now, and if I could have that conversation again, here is what I would say:
"Breast Milk actually sets the standard for what your baby needs. We often say it is 'ideal' or 'nature's perfect' food for baby. However, it really is the norm. Anything else is substandard. Breastmilk is a living fluid filled with antibodies, enzymes, proteins and nutrients that are specifically designed for your baby. In fact, your breast milk changes as your baby grows.

"The very first milk your baby receives is called colostrum. It is particularly high in antibodies. In fact, doctors sometimes refer to colostrum as baby's first vaccination. It helps to protect baby's lungs, throat and intestines, and to "seal" baby's intestines to prevent harmful substances from penetrating the gut. It also has a laxative effect to help baby eliminate the meconium more quickly and prevent newborn jaundice. The small quantities of colostrum that your newborn receives are the perfect amount for his tiny stomach and readily digested. It is low in fat, but high in proteins and carbohydrates so baby gets exactly what his body can handle.

"No formula has ever been created to even attempt to replicate the properties of colostrum. So even if a mother isn't planning to breastfeed, we encourage her to pump her colostrum and give that to her baby.

"Between the 2nd and 6th day of baby's life, your breast milk "comes in." The breasts fill up and begin producing more copious supplies of milk designed to fill baby up and help baby achieve optimal growth. Actually for about the first two weeks, colostrum is still present in the milk, so we call it "transitional milk."

"Your milk changes from morning to evening and continues to evolve to meet your growing baby's needs.  In the morning you have a more abundant supply of milk, but in the evening it is higher in long-chain fatty acids. No man-made substance can copy these diurnal variations!"

That is what I would have said if I had been able to collect my thoughts quickly enough. And I would have told her that when her baby gets a little older, the amount of free formula she gets won't be enough to satisfy him, so she'll still end up buying formula. Then I might have added that by not providing breast milk for her baby, she is increasing her baby's risk of developing a myriad of health problems from juvenile diabetes to obesity to  childhood leukemia.

Do you think it would have made a difference?