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?

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.

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.

To supplement or not?

Some doctors are not as supportive of breastfeeding as you would wish. If you are having problems, and the doctor advises supplementing with formula without really investigating how and why breastfeeding is not going as well as it should, you may like to check out the information from the Academy of Breastfeeding Medicine. These are protocols written by doctors for doctors on important topics like supplementation (in English and Japanese) based on protecting the breastfeeding relationship. You might even consider sharing the information with your doctor.

Of course your doctor wants to see your baby growing and thriving, but in Japan the supplements are too often a quick-fix solution. Somewhat surprisingly, supplements are routinely offered at many hospitals if a mother complains she is too tired and wants to sleep after the birth. This is just bad practice. Everyone is tired after having a baby...but you learn to breastfeed by breastfeeding, not by having someone else take care of your baby and feed supplements. Then the mothers complain they don't have enough milk, but your breasts don't continue to produce milk if you don't use it! This is known as the "use it or lose it" principle.

Supplementation with formula changes the gut flora in the baby, and can seriously affect your baby's health both now and in the future (allergies, diabetes, ear infections...the list is very long) so it is not something that should be approached lightly. Supplementing with the mother's own milk is always a better first choice, and if supplementation is indicated, mothers need good advice and support on how to express and use their own milk. "Just one bottle won't hurt "...or will it?

To increase your baby's breastmilk intake, also see Dr. Jack Newman's recommendations and contact a local Lactation Consultant or your local La Leche League Leader.