BLUE SKY UPDATE Summer 2009

Last weekend I attended an excellent conference in Nagoya run by the Japanese Association of Lactation Consultants (JALC). They are working so hard to educate and inform Japanese doctors, midwives and health professionals about breastfeeding developments and changes in our understanding of how breastfeeding works.

Speakers included Jan Riordan, who wrote the definitive textbook for all students of lactation called Breastfeeding and Human Lactation, and Dr Christina Smillie whose DVD on Baby-led breastfeeding has significantly changed the way I (and many other IBCLCs) work with mothers and babies, with HUGE success. You may have seen it at one of my workshops.

I was also lucky enough to have dinner with Dr. Smillie in Tokyo, where she shared lots more of her clinical experiences, and emphasised that so much of breastfeeding success is about KEEPING MOTHERS & BABIES TOGETHER.
Evidence is mounting that everything goes better for mothers and babies where they spend lots of skin-to-skin time together, with baby snuggled on mum's chest, whether baby is awake or asleep. The release of oxytocin in both mother and baby provides numerous benefits for both, but especially, babies seem to be able to breastfeed better, and mothers produce more milk. I will post more about the benefits of oxytocin soon.

My new group, Heart 2 <3 (heart to heart), for parents of babies up to 2 months old has just started this year, and although each session has been small so far, we have enjoyed ourselves and the babies immensely. It is an opportunity to come and ask questions, without having a full-on lactation consultation, and you can ask questions or compare notes with other parents, share stories, and discuss any topic that is relevant to you and your little baby. Older babies are not excluded...just drop me a note first. Next session is tomorrow afternoon, and August and September sessions are in the works.

The first Blue Sky CPR/AED course is being held in Shibuya tomorrow morning (busy day!!) We have a whopping 23 parents registered! There will be a section at the end focusing on infant CPR, which I believe every parent should know. Our next CPR course will probably be in September or October. The waiting list is already open. This course is run in association with the Tokyo Fire Department and Dave Paddock from English Adventure.

Little Angels playgroup has its last session before the summer next Friday, July 17th. It will be a pot luck lunch, so please bring a plate of food to share. Our potlucks are always popular so please let me know if you plan to join us, as places are limited.

My breastfeeding workshops for expectant have been flooded with people this year, which has been fantastic! Upcoming dates are July 18th, September 13th, October 18th, November 15th and December 13th.

In other news:
La Leche League has a toddler meeting on Friday July 31st. The next regular meeting will be September 11th.
I will be talking at Tokyo Pregnancy group on Thursday August 27th.

I will be here throughout the summer, and apart from a couple of days in Nasu, I am available for lactation consultations and phone and email help as usual.
Have a wonderful summer, and if you are in Tokyo, keep cool!!

WONDERFUL breastfeeding video...MUST SEE!!

Click here
For some unknown reason this video has been flagged by Youtube as unsuitable for minors!
It is a video used in breastfeeding education classes. How can breastfeeding a baby be considered unsuitable for minors to view???

Why not human milk?

Reposting my frustration.

Why do babies automatically receive commercially manufactured milks when they are in need of extra milk?

Why don't hospitals value more highly the milk produced by a baby's mother?

Why aren't commercial milks on prescription as medicinal products?

Why do hospitals send mothers home without proper instructions for feeding their baby?

Why do we so willingly accept non-human milk for human babies?

Why do we accept our breasts are not up to the job of fully nurturing our babies?

Breastfeeding Does Not Create Sagging Breasts

Breastfeeding Does Not Create Sagging Breasts; Study Throws Out Old Wives' Tale
Myth Dispelled at American Society of Plastic Surgeons Annual Meeting

For Immediate Release: October 28, 2007

BALTIMORE – While the benefits of breastfeeding are unquestionable, many new mothers choose not to for fear of sagging breasts. However, breastfeeding alone has no impact on a woman’s breast shape, according to a first-of-its-kind study presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2007 conference in Baltimore.

“Many women who come in for breast surgery tell us their breasts are sagging, drooping or are less full because they breastfed,” said Brian Rinker, MD, ASPS Member Surgeon and study author. “Although the amount of sagging in the breasts appears to increase with each pregnancy, we’ve found that breastfeeding does not worsen the effect.”

The study examined 93 women who were pregnant one or more times prior to having cosmetic breast surgery. Fifty-eight percent of patients reported breastfeeding one or more of their children. The duration of breastfeeding ranged from 2 to 25 months, with an average of nine months. Fifty-five percent of respondents reported an adverse change in the shape of their breasts following pregnancy.

As the first study to examine what impacts breast shape in connection to pregnancy, plastic surgeons found that a history of breastfeeding, the number of children breastfed, the duration of each child’s breastfeeding, or the amount of weight gained during pregnancy were not significant predictors for losing breast shape. However, body mass index (BMI), the number of pregnancies, a larger pre-pregnancy bra size, smoking history, and age were significant risk factors for an increased degree of breast sagging.

Nearly 104,000 women had breast lifts in 2006, up 96 percent since 2000, according to the ASPS. In addition, more than 329,000 women had breast augmentation, making it the top surgical cosmetic procedure in 2006.

“Women may be reluctant to breastfeed because of this unfounded myth that doing so means the end of youthful breasts,” said Dr. Rinker. “Now, expectant mothers can relax knowing breastfeeding does not change the appearance of their breasts.”

Breast milk provides indisputable health benefits to infants. Research has shown breastfed infants have improved general health, growth and development as well as a lower risk of many acute and chronic illnesses than bottle-fed infants.

TPG true or false answers

Answers to the Tokyo Pregnancy group True or False quiz.

TRUE or FALSE

Babies don’t need any other food or drink apart from breastmilk until at least 6 months of age because breastmilk has all the nutrients a baby needs in the right amounts for optimum health and growth.

TRUE

Breastfeeding means you won’t get any periods until your baby is weaned (ends breastfeeding).

FALSE Your menstrual cycle generally returns after baby starts solid foods, or starts to sleep through the night. Some people have periods returning as early as 2 months after birth and some much later, like 18 or more months after birth.

Rooming-in with my baby in the hospital/clinic will make it easier for me to learn my baby’s signals and respond to him more quickly

TRUE

I will probably be especially tired if I breastfeed only.

FALSE Being a new parent can be tiring, no matter how you feed your baby. Breastfeeding is much less hassle than bottles and sterilizing equipment and looking after a child who could be more prone to illness.

Baby’s heart rate, oxygen levels and body temperature are better regulated when baby is placed in skin to skin contact with mother’s bare chest

TRUE Skin to skin contact on mother's chest is great for all babies, and can often help solve many breastfeeding problems! Not just 5 minutes a day, lots and lots of skin to skin….you are your baby’s natural habitat!

An occasional bottle of formula in the hospital or at night is nothing to worry about

FALSE Babies can quickly develop a preference for the rapid flow or hard teat of the bottle, and may not go back to breastfeeding easily. Formula also changes the way the baby’s body works, and can allow the entry of pathogens and allergens into the baby’s gut, which can increase the risk of allergies and illness later on. Even just one bottle does that.

Breastfeeding on demand develops bad habits and a clingy child.

FALSE Breastfeeding on demand allows a baby to self-regulate his own intake. If his needs are met at the breast (food, warmth, comfort) he will grow up feeling very secure and loved. Some babies take longer to become confident in their surroundings than others, and breastfeeding can help ease them through transitions and feel more secure in new places. The breastfeeding relationship is about so much more than just the milk.

It is difficult to satisfy a baby with breastmilk alone

FALSE Breasts make milk according to the degree of breast fullness. So if baby takes milk out, your breast is emptier, so you make milk faster again. If baby has unrestricted access to the breast, and you can hear him swallowing when he nurses, you should be able to make as much milk as your baby needs. (Refer also to the "use it or lose it" label in the right-hand column for more information)

Breastfeeding helps to lower a mother’s risk of osteoporosis (losing bone density)

TRUE

I need to introduce a bottle as soon as possible so that baby learns to take one from my husband or a babysitter

FALSE Be careful introducing bottles before breastfeeding is well established, as baby may prefer the bottle and reject your breast. Babies can learn at any age to take a bottle from a caregiver if mother is not available for breastfeeding.

Baby needs additional water in hot weather

FALSE Babies need only breastmilk for the first six months of life (unrestricted access) In hot weather your milk has a higher water content. (Amazing stuff!) Baby may need to drink more frequently.

At each feed in the first few days after birth, my baby needs only half to one teaspoon of colostrum (the first milk in your breasts, full of antibodies and immunities).

TRUE but baby needs to feed very frequently, about 10 or more times day.

A new breastfed baby’s bowel movements are liquid.

TRUE (they look like yellow yoghurt!)

A healthy breastfed baby might do 5 poos a day

TRUE In fact they may do more than that, and that is OK too. Minimum 2 poos a day after the third day. Less than that means you need more help with breastfeeding.

If the hospital staff check my positioning during breastfeeding and it looks fine, but I am still having pain, it is possible there is something wrong with my breasts.

FALSE More likely you need some fine-tuning of your positioning and latch. Just because it looks fine to the staff doesn’t mean it is fine. If you have pain, it is not fine, but it doesn't mean something is wrong with your breasts. Call LLL or me.

It is hard to know how much milk baby is drinking at the breast, so pumping my milk is a good way to know how much I have available.

FALSE. Babies are much better at removing milk than pumps or hands. You might have a fantastic milk supply but not be able to express very much at all. Pumping puts another piece of technology between you and your baby. All feeds should be at the breast, and watch baby’s diaper output to know he is getting enough. After the first couple of days, you will see about 5-6 very wet diapers, and between 2 and 5 stools a day. If you are really worried about milk supply and baby’s weight gain, call or email LLL or me, and in the meantime, go to bed with your baby and feed, feed, feed! It's called a "babymoon"!

If you would like to receive LLL's meeting reminder notice each month, please send an email here and let us know who you are and your due date. If you would like further clarification for anything in this post, please post a comment at the link below or email me and I am happy to provide further resources.

Here is a helpful link to show how baby should latch on to the breast. Notice the mother's fingers do not appear on the breast on the side where the baby's lower jaw will attach. A good latch will ensure baby gets lots of milk, and then mother's breasts will make lost of milk too.

This article by Heather Harris is incredibly moving and inspiring. It makes you realise that if breastfeeding can be established with such tiny sick babies in resource-poor countries in West Africa, surely we, who live in such safe, clean and technologically-advanced places, can get breastfeeding sorted out better than we do.

Perhaps we just don't value breastfeeding enough.

The mystery of mother's milk

Happy New Year!
If you are here because you saw us in the January 2007 edition of Tokyo Families magazine, welcome! For people outside Tokyo, my article from their latest edition, the Mystery of Mother's Milk can be read online. This blog and my classes are also listed, along with other post-natal resources.

"Nothing prepares you"

"Nothing prepares you" is the title of one of the chapters in the new book "What Mothers Do, especially when it looks like nothing" by Naomi Stadlen.
This is the phrase she most often hears from new mothers when they discuss how they feel about becoming a mother. They often say that it was " a shock" to find out what mothering really entailed. Another article called "The reality of motherhood: What Nobody Tells you discusses how we usually underestimate how much our lives will change when the baby arrives. We have read the books, taken the classes, watched the videos, yet there is an underlying feeling that perhaps there was something missing in our preparations...surely it wasn't meant to be quite like this???

Recently Setagaya ward's volunteer bureau in Tokyo held a seminar where the speakers discussed their experiences of being mothers in a foreign country. Many of the Japanese women in the audience reported similar experiences when their families were posted overseas. The consensus was that in addition to culture shock, there should be a whole separate category called "new mother shock". Compounded with some degree of pre-existing culture shock, it can leave a new (foreign) mother feeling quite overwhelmed. Even if you expected your baby to bring some degree of change to your life, the extent of the real impact of baby's arrival on your life and your emotions can far outstrip what you anticipated. You may indeed feel that "nothing prepares you".

The first newborn baby you ever held may have been your own baby. Few of us have spent time with newborn babies, so we may not know instinctively what is normal. We may not have family or friends nearby to support us. So that is when we turn to the books or the internet to get some perspective. There is a huge market in writing for new parents, because everyone is worried, and lots of unqualified "experts" are cashing in on these vulnerabilities, telling us that they have the answers, their methods are the secret to unlocking the mysteries of parenthood.

How do you know your baby is doing OK? Is it normal to have a baby feeding frequently every evening? How can it be normal to poop so much? When is spitting up too much? What will I do if there is an emergency? Will I even recognise there is actually an emergency? What if I don't speak Japanese well (or at all)? Where can I find the help I need? How long before life returns to "normal" and I can "get things done" again? Why am I so forgetful now, even though before the baby arrived I was a highly competent and organised business professional? These are just a some of the things that might run through your mind.

And to top it off, all this occurs while you are recovering physically, emotionally and mentally from your birth, possibly replaying the experience over and over in your mind, adjusting to living with interrupted sleep and hormones that are in flux, and being totally responsible for this new little person, 24/7. Learning to breastfeed, learning to recognise your baby's signals, getting to know your baby's needs and how to satisfy them, dealing with the nights, coordinating feeding, changing, sleeping, eating meals yourself, maintaining yourself, your relationship with your partner, your home...this intense on-the-job training happens when you may feel at your most vulnerable, and at times it is hard to pick out the exact bit of information you need from all the things you have heard, read and stored for future reference.

If we were all parenting our new babies in extended communities, we would probably have been exposed to little babies and the things they do while we were growing up. We might have some inner sense of "this is what babies do". In an extended family or community, other women may
be able to share their wisdom and experience when our babies are born, help us out with the myriad of tasks we are learning, and support us in a positive way as we learn to become mothers. But being in Japan, you may find yourself more isolated than if you were in your home country.

During pregnancy, most first-time mothers are focussed on the birth. It can be so all-consuming that we tend not to think about what comes after: we trust the next part will all come naturally, and look after itself. Compared to the birth, how hard could it be???

Before the baby arrives, many women say they are determined to keep some sense of routine and order after the baby is born (which explains the appeal of those books with carefully planned daily schedules). They start from the premise that being in control is essential to being a parent. "No baby is going to run my life!" Having a baby is the beginning of a life-long relationship. What other relationship in your life is based on "control"? Each baby is an individual, each wired differently, and a control-based one-size-fits-all approach to parenting can make life very stressful for a new mum. It is easy to think that because your baby doesn't do everything that the book says, or doesn't respond to the methods in a particular book, there is something wrong with your baby. Maybe there is something wrong with the book???

By not anticipating and preparing for the reality of life with a newborn and the changes that will arrive in your life, new motherhood can come as a massive shock. Before your baby arrives, read some books on gentle parenting, attend La Leche League meetings or join a new mothers group in your area where you can see mothers and babies in action and hear their stories, join online discussion forums where you can have your questions answered sensitively. Do this at a time when you are still able to think straight, and be open to different suggestions...you never know what might work for you in the future! These links are just somewhere to start to help lessen the new mother shock, and then after the birth these same places may be able to offer you support as you adjust to your new life as a mother.

Our babies truly benefit from us being flexible, spontaneous and open to new ideas as we learn to be their parents. If we listen to our babies, and watch them, and grow and learn with them, our lives can be so enriched, and sometimes just a little less stressful!

Making milk is easy!

Download the flyer "Making milk is easy! 10 steps to make plenty of milk " from the Massachusetts Breastfeeding Coalition - available in English, Spanish, Portuguese, Italian & French.

Epidurals and breastfeeding

There is more and more evidence that breastfeeding is affected by birth practices, particularly the epidurals mothers receive during labor.

Epidural use is not all that common in Japanese hospitals, but if there was a survey done on the non-Japanese mothers' use of epidurals, the rates would definitely be higher than for the local mothers.

This video gives an interesting discussion of the situation being seen in North American hospitals where epidural use is much more common. The doctor describes how babies born to mothers who have had epidurals during labor are having more difficulties getting breastfeeding started. Their behaviour is affected by the medications. They are usually sleepier, may have disorganised sucking patterns and are often subject to other kinds of interventions, as are their mothers.

One thing to note is that the comments she makes about the medications passing into the mother's colostrum are not supported by the evidence. Dr Thomas Hale who specialises in pharmacology and lactation, reports that the fentanyl transfer from epidural anesthesia during labor into mother's milk is poor and probably clinically unimportant. The milk is not the concern: more important is the effect of the epidural on the baby during labor, and the different breastfeeding behaviours being observed when compared with babies whose mothers had unmedicated births.

I think what this all means is that all mothers should be informed of the potential risks of epidurals and other birth interventions, and if possible you should take childbirth classes here or in your local area to learn about resources for coping with labor. Read some good birth books and ask lots of questions.

Ideally, staff in the hospital or clinic should be well versed in how to help mothers and babies get breastfeeding off to the best possible start...lots of skin to skin contact with baby on mum's chest, keep mother and baby together at all times, give baby time to come to the breast, if baby is having trouble, you might need to express some of your colostrum and feed it by syringe or spoon, very sleepy babies may need to be woken for feeds and gently encouraged to continue feeding for long enough and so on. Unfortunately, we cannot control what level of skill the staff have, nor how supportive the hospital or clinic will be of breastfeeding.

The best idea then, is to learn as much as possible about breastfeeding during pregnancy. Mothers-to-be can attend La Leche League meetings, both parents can take classes here if they are available in your area, so everyone knows what to expect with normal breastfeeding, and can recognise if things are going well or not after your baby arrives.

For a more technical review of epidurals and breastfeeding see here where the author states "There is evidence to show that epidural anesthesia probably does diminish the neonate's early ability to suckle. " A recent breastfeeding journal article concludes "women and their clinicians may feel that sufficient evidence has accumulated to justify offering extra support to establish breastfeeding if women have received high doses of analgesics in labour."

Make sure you get the support you and your baby need.

Baby poop

Eeeeew, yucky topic, I know, but it is amazing how people have had so little exposure to this natural function that they don't know what is normal, and baby comes along, and panic sets in.
Newborn babies first pass meconium, a thick blackish tarry poop, which is very sticky. It has been collecting in the baby's gut in utero. Often the hospital or clinic staff change those diapers/nappies, but sometimes it is Dad's job, lucky guy.

As baby takes in more breastmilk, the poop will become lighter, first becoming a greenish colour after a day or so, then becoming more yellowish, as baby gets more milk. By about Day 5 you should see baby with more copious stooling patterns, and the poop will be mustardy coloured and LIQUID. The poop will sometimes have curdy bits that look like cottage cheese, sometimes it will be more watery, and sometimes it may even have a greenish tinge to it. None of these things are cause for concern.

How many times a day do we expect babies to poop? When they are very little, they should be going several times a day, and the number of poops is pretty reliable as an indicator of whether baby is drinking enough breastmilk or not. If things are going well with breastfeding, you may see between 2 and 5 poops every day, sometimes more. If your baby is less than a month old and not stooling at least twice a day, it could be an indicator that baby is not getting enough breastmilk, and you should have someone observe your breastfeeding to be sure baby is actually transferring milk during the time spent at the breast. Lots of parents take their babies to the doctor at this point, wondering what to do about constipation.

Breastfed babies RARELY ever get constipated. In the first couple of weeks, if they are not stooling, it generally means they need more frequent and effective breastfeeding. More calories makes more poop. It is amazing how many doctors suggest using Q tips to get baby to poop. It is such a dangerous practice, and parents often go home and use that method each day to get baby to poop. A baby who doesn't poop should first be checked to be sure your baby is breastfeeding frequently and well.

Let's just repeat this: More calories more poop. Isn't it more important that your baby is getting enough breastmilk rather than focussing on getting the poop to come out?

Breastfeed at least 8-10 times a day, even more if you are worried. If you have been told by the hospital or clinic to breastfeed only 5 or 10 minutes per breast (a common practice in Japan), it is very likely this is contributing to your baby's shortfall of calories.

Breastfeed longer and as effectively as possible on one side first. Be sure you hear baby swallowing. Finish the first breast first before offering the other side. If baby is sleepy, you can burp or change him to help him wake up enough to take the other side.

For more details about poop colour, see Dr Jay Gordon's page

The final thing is, parents wonder when the baby will start to do more formed bowel movements. These start when baby begins solid foods. So enjoy the less odorous breastmilk poop while you can, because once babies are on solids, then everyone within a large radius knows when someone has done a poop...!!

Self-soothing solitary sleep

Sounds cold and lonely doesn't it?

What do you like to do to before you sleep? Apart from the obvious...which for new parents may not even top the list...as the weather gets colder, maybe you like to have a cup of something warm and soothing, a chat and a cuddle with your partner, a bit of a read, maybe even a massage...that sounds like a nice way to ease ourselves into the world of sleep, doesn't it? And it feels good!

Why then do we want our little babies to learn to sleep alone and without human contact from a young age, when we all know how nice the alternative feels? Is it fear that keeps us from being warm, loving and gentle with our babies as they transition to sleep, just as we are with our partners? Is it so important to "teach" our babies self-soothing solitary sleep, when as adults they most likely will not be interested in sleeping like that all?

Breastfeeding, rocking, patting, cuddling, stories, massage...these are the things babies love to do to help make that transition into sleep. Even your dog is happy when he gets stroked and cuddled. What are we really doing to our own human babies with sleep schools, sleep management programs, controlled crying and strict schedules, avoiding eye contact, avoiding human contact, ignoring cries and imposing arbitrary sleep times and expectations?

PS. "Self-soothing solitary-sleeping babies" is a phrase which appears in Pinky McKay's new book, Sleeping like a Baby She is not an advocate of the practice!

Understanding your baby's signals

This week a woman was on Oprah who says she made the amazing discovery that babies communicate their needs with a primitive form of language.

This news is not really so amazing if you speak to experienced mothers. So many mothers are being encouraged to fix strict schedules and set boundaries and limits, to show the baby who is "in control", that they are depriving themselves of the special opportunity to listen to their baby, and to learn who he/she really is. Communciation between mother and baby does not need to be verbal: in fact one argument suggests that if you are waiting for baby to verbalise (even in that primitive language) then you have missed a whole lot of non-verbal signals that can tell you the same sorts of information, giving you a chance to respond earlier. Baby is hungry or tired or lonely or in pain...a mother who is listening notices these differences, and learns to respond in the way that best meets her baby's needs. Learning to listen to your own baby's cues can actually help you have an easier life as a parent.

Take feeding cues as an example. How do you know your baby is hungry? Generally the answer parents give is that the baby cries, but in fact, if you wait till then, you have missed those non-verbal cues. Crying is the last sign of hunger.

But don't babies breastfeed "on demand"? We imagine this "demand" to feed will be made in a "demanding" way....like "I want my dinner and I want it RIGHT NOW! WAH! WAH! WAH!" But if you respond sooner, before baby cries, breastfeeding will definitely go more smoothly.

Studies of crying in babies have found that the baby’s breathing, oxygen concentration, heart rate and blood pressure are all affected negatively by crying. Cortisol, a stress hormone, is elevated and baby’s sucking pattern becomes disorganized. The tongue is pulled up into the mouth during crying, whereas breastfeeding requires the tongue down and forward. With all this stress, baby takes longer to settle for a feed.

What about the “good” baby, who sleeps well and doesn’t make “demands?” “Good” babies may not get enough milk, inadvertently, because their mothers are waiting for them to cry! Crying is metabolically taxing for baby, and without enough food, baby may not have the energy to cry.

So what to look out for? Mouthing movements, sucking hands, rooting or other increased activity, even with the eyes shut, all indicate baby will be receptive to feeding. When parents recognize and respond quickly to these early hunger signs, babies don’t need to become really“demanding”and state their needs unequivocally!

What is La Leche League?

La Leche League (LLL) groups around the world run discussion meetings for mothers, generally once a month, which cover all aspects of breastfeeding, from getting started right through until weaning. At LLL meetings, you can bring your babies, your stories and experiences, and also your questions. You can make friends with other like-minded mothers, and get heaps of up-to-date and relevant information on breastfeeding whatever the stage of your baby.

LLL was founded 50 years ago by a group of seven mothers who were breastfeeding at a time when few people were supportive of it. They quickly found that there were many other mothers like them, who knew breastfeeding was best for them and their babies but no one had much information on it. So the network of mothers supporting other mothers grew and grew, and now LLL groups are in over 60 countries of the world!

The Leaders at the meetings are all volunteers, experienced breastfeeding mothers themselves who have completed the training required to become accredited and run a group. Groups are supported entirely by the memberships they sell. You don't have to be a member to attend a meeting or to call a Leader for support, but by joining, you help to keep the library stocked, to ensure that LLL is here for future mothers, and that the Leaders can receive further education and materials to offer the best help they can to mothers.

In Japan we have the following English speaking groups.
Tokyo: Tokyo Central and Tokyo West
There are English speaking Leaders available to help mothers in Sendai, Wakkanai (northern Hokkaido), Atsugi, Yokota and Okinawa.
Japanese groups and Leaders can be found through their website.

If you are a breastfeeding mother and would like to learn more about how to become a LLL Leader and start groups in your area, LLL International has a website where you can get that information. Of course it also carries heaps of breastfeeding and parenting resources, and there are interactive discussion forums where parents can ask breastfeeding questions too.

getting started

Choosing a doctor, hospital, clinic or midwife who is supportive of breastfeeding is important. As Dr Jack Newman points out, they all say they are supportive, but his article tells you what to look out for. The challenge for mothers like you in Japan is to find somewhere that truly values breastfeeding, does not separate mothers and babies after birth, and does not suggest bottles of glucose water or infant formula as a quick fix at the first sign of a breastfeeding problem. Discuss breastfeeding and hospital policies with your caregiver during pregnancy, and find out if they are willing to be flexible, and perhaps "bend the rules" for you. Asking the tricky questions now might save a lot of heartache later.

This list of 10 questions for all pregnant mothers is very useful, so you have some idea about the right questions to ask about your birth and breastfeeding!