August Informed Birth Gathering

In honor of World Breastfeeding Week, we’ll be discussing Breastfeeding–How long are you going to do THAT?!

Monday, August 2nd
7 pm
4736 Eagleridge Circle

See you there!

July’s Informed Birth Gathering

Hi all,

We’ll be meeting next week for our monthly Informed Birth Gathering. This month’s topic will be “Your Birth Team.” Whether you are birthing at home or in the hospital, deciding who to invite to your birth is a very important decision! Come talk to other parents about how to put your team together.

Date: Monday, July 5th
Time: 7 pm
Place: 4736 Eagleridge Circle, Pueblo

Homebirth Preparation Class

This class is specially designed for those planning a homebirth. We will cover the following topics:

–Preparing your home for the birth
–Gathering supplies
–Assembling your birth team
–The midwives’ roles and supplies
–Birth options
–Transport and emergency plans

This class is not intended to replace a comprehensive childbirth series. Labor and birth physiology and comfort measures and other important topics will not be covered in detail.

Cost: Free! Please bring a snack to share. Sorry, childcare not available.

Please RSVP to Gina at 719-369-4368 or safepassagebirth@gmail.com.

Vote for July’s Informed Birth Topic!

Childbirth Retreat Workshop

This summer, instead of offering a series of childbirth classes, we’ll be holding the series in a weekend retreat format. Same great class, different style! Call me at 369-4368 to register. Dates to be finalized soon.

Topics include:

 Birth in our culture and your choices and options
 Pregnancy and prenatal care
 Labor and birth physiology
 Comfort measures and techniques
 Interventions and complications
 Breastfeeding
 Postpartum and baby care
 Community-building

Two excellent books and many informative handouts are included with your registration fee of $150 (discounts available for current doula or midwifery clients).

The Problem with Exclusive Pumping

By Gina Gerboth, CPM, IBCLC

This topic is one that comes up in breastfeeding support circles over and over. It’s one that we are just now fleshing out our thoughts on and our protocols for. It is a new challenge that we lactation consultants are dealing with: how to support the mother who has decided, for whatever reason, to exclusively pump her breastmilk and feed it to her baby via bottle instead of feeding directly at the breast. And it’s one that I feel passionate about, and believe I hold a dissenting opinion about in my local lactation circle.

Exclusive pumping, or “eping” (pronounced eep-ing), is most definitely a recent trend. It is a decision that is sometimes made out of necessity, and sometimes by choice. The reasons women choose to exclusively pump are varied; some have a conception of directly breastfeeding as being too restrictive, some have emotional barriers (such as a past history of sexual abuse), and some are simply uncomfortable with the thought of putting their babies to breast. For the most part, this post addresses the intentional choice to exclusively pump, but, naturally, the information is important for all who are eping or supporting women who are.

The first consideration regarding eping is to explore why this is a trend. I believe there are several contributing factors. The first is that we have reached a point in our culture where there is less and less misinformation about the importance of breastfeeding. We know, without a shadow of a doubt, that breastmilk is important on many fronts: nutritionally, immunologically, socially, and economically, among other things. Except for a few denialists, it is an accepted truth. As such, it is difficult for women to choose an inferior choice, which we know formula to be. This brings me to my second concern: most women (and truly many health care providers) are ignorant as to the importance of what we call the delivery system. While we, as a society, now know how important breastmilk is, we have a lot to learn about why direct breastfeeding is equally important. This ignorance does not serve those women we support, for it is all too easy to “take what we can get” and encourage women to at least pump and bottle feed their own milk. Thirdly, I believe this trend, in large part, is due to marketing. One very popular breast pump manufacturer, Medela, has been a source of controversy regarding their marketing tactics. Medela has, over time, begun to separate breastmilk from breastfeeding, and has all but convinced women that if they are to provide their babies with mother’s milk, they most certainly will need a breast pump in order to make it tolerable. One sound bite from a Medela ad proclaimed, “When you choose to breastfeed, you’re doing what’s best for your baby. When you choose Medela breastfeeding products, you’re doing what’s best for you both.” Do you find this shocking? I do. And if you think Medela’s reach isn’t very far, think again. They are the premier line of pumps found on store shelves from boutiques to Target. They have extensive government contracts, and are in contract with many state WIC programs. They fund much (valuable) breastfeeding research. They are big. You can read a very thoughtful post on this topic here.

Perhaps it would be useful at this point to really clarify why, indeed, nursing at the breast is so very important. We are limited here, by good research. In a quick literature review, I really found very little regarding the mode of delivery of human milk. In fact, it can be very difficult to interpret any studies regarding breastfeeding, because there is much disagreement even in defining breastfeeding: considerations regarding exclusivity and duration are challenges enough, but to try to separate out delivery method is a new frontier to be sure. So, instead of a literature review, I offer my interpretations.

First the “harder” reasons (and this list is by no means exhaustive, I welcome comments or additional thoughts on the matter)…

We know that bottle fed babies are at a greater risk of having orthodontic problems. This is due to the bottle itself, not the milk. Bottle fed infants will incur the same risk, regardless of what is in the bottle.

We know that bottle fed infants have poorer visual acuity. This is thought to be due to the perfect positioning and bilaterialism of breasfeeding. Regardless of the fluid, this will be a risk for any bottle fed baby.

We are just starting to understand the intricate interaction between baby’s saliva and an immune response by the mother. That is to say, that when an infant who has been in contact with some sort of pathogen nurses at the breast, we are discovering that mothers will launch an immune response and produce antibodies to pass through her milk to help the baby fight the pathogen.

I suspect that one of the most heavily touted “benefits” of breastfeeding, the reduced risk of otitis media (ear infections) will not be reduced to the same extent that it is through direct breastfeeding. Yes, the breastmilk is antibacterial and antiviral, but it is believed that it may be part of the positive and negative pressure that takes place when a baby nurses that helps the eustachian tubes drain properly. Additionally, nursing at the breast ensures the baby is held in better position to facilitate this drainage.

We understand, too, that breastfeeding is preventative against SIDS. While there may certainly be something about the milk itself that is protective here, I believe that in large part it is the nighttime interplay that happens between a mother and her nursling that protects a baby from SIDS. Contrary to popular opinion, sleeping through the night at an early age is not a good thing. It is coming to light (1) that babies who sleep deeper are more likely to die of SIDS. Breastfed babies generally feed more often at night, and we know from research, that it is a myth that formula fed itself causes babies to sleep longer stretches. It is more likely part of the symbiosis of breastfeeding and co-sleeping. Co-sleeping facilitates those night feedings and night feedings are protective against SIDS. I suspect, that eping mothers are going to have behaviors more similar to bottle feeding mothers, and thus that SIDS protection is diminished.

I am reaching out on a limb and going to speculate that breastmilk fed infants will have a higher rate of early childhood caries (ECC), as they will experience the pooling of milk that occurs with bottle feeding along with the higher lactose content of breastmilk. Again, this is more speculation than anything.

As for the “softer” reasons…

Most importantly, I believe eping will reduce the duration and exclusivity of the child receiving breastmilk. It is no secret that it is hard to maintain a full supply by exclusively pumping. With only 14% of infants being exclusively breastfed as recommended by the AAP and WHO at 6 months, I am certain this already-abysmal number will be lowered further with eping.

Breastfeeding under the best of circumstances has its challenging moments for everyone. Without the inherent rewards of nursing–the prolactin highs, the convenience of having baby’s food at the ready, those milky grins of thanks from the baby–it would be challenging indeed to persevere and continue with what can only be called a strained relationship with the breast pump.

And as for the maternal rewards for breastfeeding, I think that this is something we can only guess at. Because supply issues go hand-in-hand with exclusive pumping, I don’t think it’s a leap to say that pumping does not elicit the same hormonal response in the mother. This likely means that the reductions in cancer, the weight loss, the assistance with child spacing are not going to be as profound in the eping mother. Only time and research will tell for sure, though.

Finally, those of us who have successfully breastfed know that there is a reward, something special that develops between mother and baby, that comes when we nurse our children. We know that this bond (a term I don’t love because we all bond with our children) carries on long after the breastfeeding relationship has ended. It makes my heart sing when the new mothers I work with get to experience this for themselves. And I weep for those who do not.

So what do we do with this? I am sure that breastfeeding professionals will read this and say, “We know it’s best to directly breastfeed, but women are going to do what they’re going to do.” (I know this, because this is a conversation I have monthly with breastfeeding professionals, with me coming down on the side of looking like a hard-ass.) And, “It’s far better than formula.” Well, yes, of course. Those statements are so obvious, they hardly have a place in this dialog in my opinion. In fact, the WHO recommends direct breastfeeding first, expressed mother’s own milk second, donated human milk third, and formula as a distant forth in infant feeding. (2) But just as it is our job to explain the risks of formula feeding, it is our job to explain the risks of eping. It is not the same as breastfeeding. It’s just not. This does not mean that we guilt women into it, or harp on them, or shame them any more than we would do if they chose formula feeding. But we certainly don’t withhold information from them. I am certain that women are not aware of the importance of the delivery method and thus we must educate them (and ourselves).

It occurred to me today, while having this argument for the 976th time, that bottle feeding is an intervention. Any type of bottle feeding is something that “comes between” the biological, physiological feeding of a baby. Just as with any intervention, there is a time and place for it. But in the world of birth and breastfeeding we hold the concept of “informed consent” very highly indeed. Women should be informed of the risks, benefits, and alternatives to every intervention that they’ll encounter in their pregnancy, birth, and breastfeeding experiences. It is our duty if we want to empower women to make decisions that work for them.

And, indeed, eping is an intervention of great importance. Many mothers get off to an irreparable start with breastfeeding and simply cannot overcome their initial challenges and get the baby to the breast. Some women have deep and heavy trauma from their past that they cannot will under their control. Some simply choose to. And, of course, we will offer them our support, just as we would offer it to women who employ the intervention of expressing and bottle feeding their milk for work, or on occasion, or those who partially provide breastmilk and formula, or those who decide not to breastfeed. But I encourage any of you who support nursing mothers on a regular basis to make sure that they are firstly informed of the big picture–the risks, the benefits, the alternatives to all feeding methods, and secondly that you have done all you can to support them to overcome any barriers, difficulties, or misconceptions regarding breastfeeding. And then you can say you did your job.

Notes:

(1) See the work of James McKenna.
(2) http://whqlibdoc.who.int/publications/2003/9241562218.pdf

Pushed: A Book Review

Pushed: The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block

My rating: 5 of 5 stars
I really cannot recommend this book more highly. It is accessible and readable, all while providing an abundance of evidence regarding our (America’s) broken maternity care system. I am sure that it pulls many people outside of their comfort zones regarding their childbirth decisions, but that’s good. Question your assumptions, do your research, and change the system–one birth at a time.
View all my reviews >>

Summer Blessingway

We are starting a new tradition in our birth community! Each season we will host a Blessingway for all our mamas who are due soon. We hope you can join us for the Summer Blessingway. We’ll be celebrating the journey of four mothers on Saturday, June 19th, at 1 pm. Call me for location: 369-4368.

Summer Childbirth Classes

New Childbirth Series Starting Soon! Natural Childbirth Classes Starting Soon! This 8-week series of independent, comprehensive classes are held on Thursday nights from June 24th through August 12th, from 6:30-9:30 pm.

Classes cover a wide range of topics including:

 Birth in our culture and your choices and options
 Pregnancy and prenatal care
 Labor and birth physiology
 Comfort measures and techniques
 Interventions and complications
 Breastfeeding
 Postpartum and baby care
 Community-building

Classes are taught by an ALACE-certified instructor, who is also a midwife, certified doula, and lactation consultant. Two excellent books and many informative handouts are included with your registration fee of $150 (discounts available for current doula or midwifery clients).

Call Gina today to reserve your spot! 719-369-4368

June Informed Birth Gathering

Our June topic will come on June 7th and we will discuss Sibling Concerns. Thinking of adding a new baby to you family? Already have one on the way? Come talk with other parents with the same concerns.

We’ll be reverting back to our location at the Eagleridge office due to some logistical issues. Please feel free to bring a dessert or snack to share!

7-9 pm, Monday, June 7th
4736 Eagleridge Circle in Pueblo