Thursday
Mar152012
Is 6 Months of Exclusive Breastfeeding Unrealistic and Idealistic?
Thursday, March 15, 2012
Health authorities around the world, including the World Health Organization, Health Canada, and the Centres for Disease Control and Prevention (CDC), all recommend exclusive breastfeeding for the first six months of a baby's life. In Canada, the recommendation reads:
In the United States, the American Academy of Pediatrics recently released a new policy statement on breastfeeding that reaffirmed its recommendation of six months of exclusive breastfeeding and also added that [emphasis mine]:
Then yesterday, the British Medical Journal released a summary of a qualitative study suggesting that the "advice to breastfeed exclusively for 6 months may be 'unhelpful' and too idealistic", noting the great deal of pressure that is put on mothers to meet this ideal, despite the fact that very few mothers actually meet this target.
The mothers quoted in this study seemed to take the breastfeeding recommendations personally. That didn't surprise me, because I see that every day. Any promotion of breastfeeding, any discussion of limiting formula advertising, leads to cries of "but formula saved my baby's life" and "why can't people mind their own business and stop judging other moms". To some extent, I understand that. As I've said before, I think there is too much pressure to breastfeed and not enough support for breastfeeding. That said, I don't think the way to resolve that issue is to downplay the recommendations.
Instead, I think we need to recognize that no one is a perfect parent and, as Dr. Yoni Freedhoff often says, "it's about the healthiest life you can enjoy, not the healthiest life you can tolerate."
The objection to the breastfeeding recommendation in particular is perplexing because there are many health-related recommendations that most people do not live up to. While we may recognize that we are not achieving the ideal state on some of these other health issues, most people do not feel personally insulted by the recommendations.
Health-related recommendations are not designed to make people guilty. They are designed to give people an understanding of what to strive for, if they want to choose the healthiest route. They are also designed to help ensure that sufficient societal support is in place to help people meet those recommendations.
When schools are developing physical education curriculum or designing school lunch programs, they should take nutrition and exercise recommendations into consideration. When public health systems or health insurance companies are designing coverage of things like lactation consultants and breast pumps, they should take the breastfeeding recommendations into consideration. When people are advocating for reasonable rest periods between shifts at work, the exercise and sleep recommendations should be considered. When people are advocating for maternity leave, breastfeeding recommendations should be taken into consideration.
Gina from the Feminist Breeder wrote a great post on that this week, outlining why breastfeeding needs to be considered a public health issue and not simply a lifestyle choice. It isn't to put more pressure on individual women. Instead, it is to create more support for breastfeeding so that there is less pressure on individual women. The type of support that is needed, so that no mother experiences the types of things described in the Hoyden About Town post Gone too far?
No one is perfect. We know that. We are all human and all have limitations, physical, emotional, and otherwise. That doesn't mean that the recommendations should change. It simply means that we need to set our own goals vis-a-vis those recommendations and be realistic with ourselves. Just because you don't manage to eat seven to eight servings of fruits and vegetables every day, isn't a reason to change the recommendation or to protest initiatives designed to make fresh fruits and vegetables more accessible to people.
I didn't manage to breastfeed my first child exclusively for six months. I had to supplement with formula for a while and we started solids a month early. But with my second child, I managed to breastfeed exclusively for six months with no difficulty whatsoever. But if the recommendations were not there at all or if they were vague, then I may have made choices that compromised my child's health for no reason at all.
Do I feel guilty for not breastfeeding my son exclusively for six months? No. I did the best that I could, in that situation, with the information and support that I had available. Ultimately, that is all that I ask of myself on any health issue.
Do I look down on moms who formula feed? No, I don't. Their choices don't concern me. I just want every mom who wants to breastfeed (that is 95% of Canadian moms) to be supported in that decision with quality support and barriers removed. That is all that I ask.
Exclusive breastfeeding is recommended for the first six months of life for healthy term infants, as breast milk is the best food for optimal growth. Infants should be introduced to nutrient-rich, solid foods with particular attention to iron at six months with continued breastfeeding for up to two years and beyond.
In the United States, the American Academy of Pediatrics recently released a new policy statement on breastfeeding that reaffirmed its recommendation of six months of exclusive breastfeeding and also added that [emphasis mine]:
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.
Then yesterday, the British Medical Journal released a summary of a qualitative study suggesting that the "advice to breastfeed exclusively for 6 months may be 'unhelpful' and too idealistic", noting the great deal of pressure that is put on mothers to meet this ideal, despite the fact that very few mothers actually meet this target.
When did we start taking recommendations so personally?
The mothers quoted in this study seemed to take the breastfeeding recommendations personally. That didn't surprise me, because I see that every day. Any promotion of breastfeeding, any discussion of limiting formula advertising, leads to cries of "but formula saved my baby's life" and "why can't people mind their own business and stop judging other moms". To some extent, I understand that. As I've said before, I think there is too much pressure to breastfeed and not enough support for breastfeeding. That said, I don't think the way to resolve that issue is to downplay the recommendations.
Instead, I think we need to recognize that no one is a perfect parent and, as Dr. Yoni Freedhoff often says, "it's about the healthiest life you can enjoy, not the healthiest life you can tolerate."
The objection to the breastfeeding recommendation in particular is perplexing because there are many health-related recommendations that most people do not live up to. While we may recognize that we are not achieving the ideal state on some of these other health issues, most people do not feel personally insulted by the recommendations.
Do these statements bother you?
Recommendations Help Solidify Support
Health-related recommendations are not designed to make people guilty. They are designed to give people an understanding of what to strive for, if they want to choose the healthiest route. They are also designed to help ensure that sufficient societal support is in place to help people meet those recommendations.
When schools are developing physical education curriculum or designing school lunch programs, they should take nutrition and exercise recommendations into consideration. When public health systems or health insurance companies are designing coverage of things like lactation consultants and breast pumps, they should take the breastfeeding recommendations into consideration. When people are advocating for reasonable rest periods between shifts at work, the exercise and sleep recommendations should be considered. When people are advocating for maternity leave, breastfeeding recommendations should be taken into consideration.
Gina from the Feminist Breeder wrote a great post on that this week, outlining why breastfeeding needs to be considered a public health issue and not simply a lifestyle choice. It isn't to put more pressure on individual women. Instead, it is to create more support for breastfeeding so that there is less pressure on individual women. The type of support that is needed, so that no mother experiences the types of things described in the Hoyden About Town post Gone too far?
Don't Ask for Lesser Recommendations, Ask Less of Yourself
No one is perfect. We know that. We are all human and all have limitations, physical, emotional, and otherwise. That doesn't mean that the recommendations should change. It simply means that we need to set our own goals vis-a-vis those recommendations and be realistic with ourselves. Just because you don't manage to eat seven to eight servings of fruits and vegetables every day, isn't a reason to change the recommendation or to protest initiatives designed to make fresh fruits and vegetables more accessible to people.
I didn't manage to breastfeed my first child exclusively for six months. I had to supplement with formula for a while and we started solids a month early. But with my second child, I managed to breastfeed exclusively for six months with no difficulty whatsoever. But if the recommendations were not there at all or if they were vague, then I may have made choices that compromised my child's health for no reason at all.
Do I feel guilty for not breastfeeding my son exclusively for six months? No. I did the best that I could, in that situation, with the information and support that I had available. Ultimately, that is all that I ask of myself on any health issue.
Do I look down on moms who formula feed? No, I don't. Their choices don't concern me. I just want every mom who wants to breastfeed (that is 95% of Canadian moms) to be supported in that decision with quality support and barriers removed. That is all that I ask.
Reader Comments (118)
I recall reading something saying that breastfed babies in developed countries consume more breastmilk than those in developing countries and have a somewhat lower need for complementary foods, but I don't have the time to hunt up that info. I am supposed to be homeschooling my kids and they are running wild instead.
Taking the WHO at their word, though, I can see how there would be pressure put on people to get baby eating solids very quickly. It sounds like a recipe for frustration for me. I always just did one or two meals of cereal until baby could be on mashed table foods. My current 8 month old gags and vomits when he eats anything with more texture than a puree, I can't even fork mash sweet potato, so he is progressing to solids much more slowly than my others.
Becky's comments agree with the general sentiment from early childhood nurses and what I was told when mine were little. Mothers were hounded as hard to get enough solids into their babies as they were vilified for giving said solids early.
The allergy connection to this is significant. Not giving solids before 6 months was justified on the basis of the size of the holes in the gut of small babies. It was NOT based on any evidence that said holes actually made allergies more likely. Recent research suggests that exposure to foods before those holes close up reduce allergies, so restricting small babies' diets is more likely to contribute to allergies than minimise them.
Either way, these mother shaming rules are based on flimsy evidence at best. Our current best guess is not a reason to dictate how all children must be fed. I found the whole thing condescending and unreasonable. Having said that, it's not like ti changes much once we reach adulthood. Nutritional advice is equally poorly grounded in research and prone to fads for adults as it is for babies.
You know, this and your comment above about being told you COULD NOT get in-person help without a fee make me think that your midwife and other practitioners were uninformed or outright lying. That does happen--when I toured the hospital while pregnant, the tour guide told us (big group of expectant parents) to refuse the lactation consultants, calling them "breastfeeding Nazis who will assault you. The truth is that a baby HAS to eat within 4 hours of being born, so just let the nurses give it formula so you can rest." I contacted the hospital about this next day, and they were horrified and later got back to me saying they had put this tour guide on unpaid leave pending investigation. When I gave birth in that hospital, in fact the LC was quite pleasant and gentle.
Great article! It's amazing that you posted this on the very day when I had planned to write an article (which, for complex reasons, I have not yet written) about how it really is not that difficult to breastfeed while working outside the home, motivated by "The Tyranny of Breast-Feeding" in the March issue of Harper's Magazine, whose author argues that the whole idea of breastfeeding is A PLOT TO KEEP WOMEN DOWN!!! Her argument is ludicrous (supported by outdated LLL publications instead of the current ones, very selective searching of the Internet, etc.) but I think a lot of people do believe that exclusive breastfeeding is literally impossible if you go back to work--I heard that idea a number of times when my son was a baby--so I wanted to address that and explain that in my own experience it really was pretty easy to pump (and much less uncomfortable than I expected!) and then during the hours I was with my baby, it was fantastically easier to breastfeed him than to muck about with bottles! I do plan to write that article soon, and now I will be able to link to yours (and Feminist Breeder's--thanks for that great link!) and not have to spell out a lot of what I was going to say about the public health recommendations vs. individual mothers' needs.
I'm glad I came back to your site today! I haven't looked at it in months for some reason. I should subscribe!
Wow. That is awful. The lactation consultants where I gave birth were lovely, but I too had to fight past a know-it-all formula-pushing nurse to get to them.
In my understanding, while studies on allergies point toward a 4-6 months ideal "window" for solids introduction, there is evidence of increased GI infections if baby has solids before six months. Personally, I wish they would encourage watching signs of readiness, which are often present around 5-6 months of age, and also promote good food safety practices. There's evidence in favor of "about six months," but not evidence in favor of it as a firm, unbending limit.
It's possible. I can't read minds, so I don't know what the individual motivations were. But I gave birth in an incredibly breastfeeding-positive hospital. At no point was my son ever offered a bottle. He was born, checked over by a specialist (slight complication, no big whoop), and then immediately put on my chest. The time between him being inside and then on me was under five minutes. My midwife and the nurses stayed with us for a little while to see if I was getting the hang of breastfeeding. After I was discharged, on her home visits, the midwife helped with latch (not as an LC, but rather as a general baby-practitioner). So I have trouble seeing them as pro-formula or otherwise deliberately trying to sabotage me.
But I was unable to find in-person, on-demand help that didn't cost money. I have a co-worker who had a baby less than a year before mine was born and she paid to consult with an LC. Different midwife, different hospital, different doctor, and she didn't find any in-person on-demand help for free either. So maybe Ottawa is just the one place where there's a fee?
You have to pay out of pocket to see a LC or breastfeeding counselor here. (Victoria, BC) You have to have a referral to see one of two doctors who specialize in breastfeeding here ... though you can see the other one without referral.
You're right, Becky. Readiness is one factor, http://www.kellymom.com/nutrition/solids/delay-solids.html" rel="nofollow">open gut is another factor. Evidence shows that the gut closes sometime between four and six months and there isn't an easy way to check if your baby's gut has closed or not. Personally, I think it is worth doing everything possible to exclusively breastfeed for six months. But if it isn't possible, and the baby is close to six months, I would certainly opt for introducing solids rather than introducing formula. When I was no longer able to pump enough to meet my son's needs, we started him on some banana. If he was out of milk and mama wasn't home from work yet, he got a bit of mashed up banana.
I gave birth at the Ottawa General with both of my children. With the first one, I saw the lactation consultant at the hospital before we were discharged. That made me eligible for out patient appointments with the lactation consultants at the general for as long as needed and fully covered under medicare. But if I hadn't see the lactation consultant before being discharged, I wouldn't have been able to use their services and would have had to go to a private IBCLC and pay the fee.
That said, there are free weekly drop-in clinics (not on demand, but good if you don't need urgent advice on something) with lactation consultants through the City of Ottawa (on the Ottawa side) and through the CLSCs (on the Gatineau side). With my daughter, I went to the weekly IBCLC clinic at our local CLSC to weigh my daughter (she was slow gaining weight and we needed to keep an eye on it) and could have used that opportunity to get any additional support I needed. I saw her giving wonderful advice to other moms, but I simply didn't have the need.
There are also LLL meetings (several different groups in Ottawa that meet different nights of the week and different weeks of the month) and Milkface has a breastfeeding drop-in too.
As I mentioned above, the best option for me for on-demand free advice was through online forums. I had access to IBCLCs and CLCs in an online environment, as well as the support of other moms who were going through the same thing. It was wonderful.
As it happens, most insurances and WIC supply reasonably good quality breast pumps. So, it's the rare woman who should have a problem pumping because of the cost of a pump. I'll also point out that formula (even the cheapest forms) cost money - when I did the calculations the first time I had to make the choice, it came out slightly cheaper to pump - even though I was actually RENTING the pump!
The issue of workplace accommodations is far more serious. But, watering down the recommendations won't help that. On the contrary, strong recommendations make it more likely and possible to change that situation.
I get so mad when I hear about people like your midwife. It's SUCH a stupid thing to say, and midwives, or all people should know better.
I'm glad you got through that.
If someone is interested in how many people have exclusively BF to at least 6 months, I have. In fact, except for my eldest, who had her first food at just short of 5 months because she was grabbing the fork out of our hands and sticking it to her mouth, the rest of my kids have averaged between 7 and 10 months for their first food. They just weren't interested prior to that time. They all were receiving at least 2 meals by 12 months. (I have 5 children). None of them liked pureed food, so they needed food that could be chopped up and picked up.
For me breastfeeding exclusively to 6 months was the best choice. No preparing of formula and washing bottles. It was not easy at first - even BF takes practice (and some relieving hydrogel breast discs - untill the body's used to it). I liked it because it felt natural and right, not because of any recommendations. My mum did things very differently and I don't feel compromized because of that. BF a personal choice but I'm all for it (and I am sure if babies had voice the polls would be pretty clear!!).
Great post and comparison Annie. I think it makes clear just how important the reccomendations are while at the same time showing how the issue is muddied by our biases and emotions. I'm not offended by the reccomendations to BF for six months but the exercise reccomendation makes me feel judged and frustrated..."when, when do I have time!?!" Its all about perspective!
"People do NOT regularly go around asking ... “I see you are eating a burger, are you going to make sure to get your servings of fruits and veggies too?...
Nobody asks that, but as soon as you get pregnant, people think it is their business to ask you and tell you all about infant feeding."
My family is vegetarian - me, my husband, and our two children. My youngest child has NEVER had meat. When this becomes known, it doesn't seem to matter how well (or not at all) someone knows us, the inevitable next question is something along the lines of, "is that even healthy?" or "what do you do for protein" or "how can you force your beliefs on your kids?" or "what do your kids do at parties?" and on & on.
When it comes to food and children, everyone has an opinion. When it comes to things outside of general knowledge or comfort zone, everyone has an opinion.
The best you can do is be educated about and confident in your choices. Things like the food pyramid, exercise guidelines, and breastfeeding recommendations are just that - guides. They take solid evidence and boil it down to easy-to-understand and follow "rules" to help people make educated decisions about their choices.
I'm not offended when people ask me why we're vegetarian, or make mistaken assumptions like I'm depriving my children. I take it as a moment to educate, share my experience, and in doing so, become more confident in my decision making.
I think the breastfeeding recommendation is wonderful. It will further help to emphasize breastfeeding as a normal & natural & healthy way to feed babies and will hopefully help bring greater confidence to mothers who want to breastfeed, and lead to more support for those who do choose to follow the guidelines to reach that goal.
[...] baby and herself, and should be able to feed and nuture her baby without judgement from others. PhD in Parenting wrote a brilliant piece recently on the new APA’s new statement that breastfeeding is a public health issue and not [...]
I'm not sure those polls would be clear at all. I think they would reflect the diversity of human beings. I have one child who was never enamoured by breastfeeding, and I'm sure if we could have asked him, he'd have thanked the Powers That Be when I finally stopped torturing him with the breast (at 4 months). The other two were totally down with breastfeeding - despite the fact that my body never got used to it.
Babies are no more homogenous than the rest of society, and I simply don't understand the obsession with the One True Path.
I think this nicely represents the diversity of kids. My eldest was grabbing for food before 4 months. He was eating sandwiches by 6 months. The next one wasn't really interested in solid food before 7 or 8 months, despite my best efforts. The youngest started solids just after 4 months. They all now have different palates, and that seems entirely reasonable to me. How did feeding children become a battleground? Why have we allowed this?
The time it takes to pump and/or breastfeed is time taken away from something else- like one's job. If women should breast feed and/or supply breast milk for six months, then there should be policies in place to give women the time to do that. Maternity leave should either be longer or there should be a workplace policies for time-off to pump/nurse once you are back at the job.
Those who say breastfeeding is free (compared to formula) may not have considered the cost of time. I exclusively breastfed my child for 18 months. I could do that because I have a flexible and well-paying job with supportive colleagues and boss and my own private office. But I am deeply sympathetic of those who do not have the means, flexibility, or resources to do this. In total, if I count all the time I spent pumping or nursing, it amounts to almost 2 months (~46 days) of the first 18 months of my daughter's life.
I realize for a lot of women that pumping at work is a challenge and I agree that rules are needed to protect breastfeeding in the workplace.
That said, I don't think it always needs to be time away from the job or a "concession" as a lot of people see it. My colleagues spent more time on smoke breaks than I spent pumping. Plus, depending on the job, some women can combine pumping with work (I pumped hands-free and could continue researching, reading reports, responding to e-mails and so on while pumping).
It really does depend on the nature of the job and, to some extent, the seniority of the woman. But for me, breastfeeding never meant time away from my job.
When it comes to breastfeeding recommendations, I feel that the support component is critical. If you actually look at the study itself, that's what it found. The recommendation to exclusively breastfeed for 6 months may be unrealistic when mothers don't have adequate support, which is often.
The problem with the current situation in regards to breastfeeding, in my view, is that we're great at telling people what they should do, but we're not always so good at actually helping them do it. This is exacerbated by the fact that few mothers in the first days and weeks after giving birth are in a position to do a lot of research and legwork. On top of that, many individual health care practitioners aren't up-to-speed on the recommendations and information in their own fields. Doctors and nurses can be quick to recommend formula supplementation, or to downplay the risks of nipple confusion and the like. It's no wonder that mothers are overwhelmed and confused, when the medical community can't even all get on the same page.
If few mothers are meeting the recommendation to exclusively breastfeed for six months, then that's a sign that something's wrong. Maybe that does mean we need to review the way that we issue recommendations. Not because it's unrealistic to breastfeed exclusively for six months (I did it), but because the current message doesn't seem to be having the intended impact. We need to make sure that our public health recommendations are delivered in a way that's accessible to the people we're trying to reach, and we need to make sure that they're backed by adequate support and information.
I'm not sure what you mean when you say, "So if La Leche League is really as good as people say they are, why don’t we have grants to give low income women access to them?" La Leche League Leaders are volunteers who are available for telephone and email support to anyone regardless of their income. They are volunteers, you don't have to pay them to call for help or to attend their meetings. If a group isn't available in one's area, well, again, they are volunteers, and maybe nobody in that area has started a group. However, I think you can still call a Leader via the national hotline, or call whichever group is closest to you. So, all women, regardless of income, have access to them.
"Why are so many women taking normal biological struggles with breastfeeding so personally? Why is something that is so beyond our control seen to reflect our worth as mothers and, by extension, as people?"
I think you touched on why mothers feel internal guilt/pressure: because it is biological, and because we are mammals. Unfortunately, the way we live now sets us up w/ many barriers to breastfeeding, from hospital practices at birth to mothers working away from their babies to lack of family/friends who have nursed. We know, instinctively on a more primitive level, that it's what we are supposed to do. But just because it's biologically normal doesn't mean it comes naturally for us nowadays, which is unfortunate. I think it is amazing though how we have the deep biological longing to nurse: it was just instinct for me to put my first baby to breast when she cried. So to not be able to achieve that longing to nurse your baby, it could very well be a mourning process in which mothers go through feelings of guilt and taking it personally, as a part of that mourning process.
you know, my OB never asked me if i was planning to breastfeed. it was not something that was everybody's business. just as my doc doesn't ask me if i'm eating the proper number of veggies daily, neither does my OB ask about breastfeeding. and in fact, my ped's office have nurses who seem to just assume you're no longer nursing by about 4 months. i only know the guidelines because i sought them out, read, attended LLL meetings... the only person who presented the guidelines on it to me was my bradley childbirth class instructor.
Yes, I like the "about six months" guideline, along with watching readiness signs. And when it comes down to it, if baby will grab food and put it into his own mouth, that seems a pretty good indicator of readiness!
i don't think it's an obsession; it's just biology. Mammal babies nurse from their mothers because it's their instinct. Sure, they sometimes have trouble. But it doesn't mean they don't want to nurse if they are having difficulties. Infants don't even have the brain development appropriate to making a choice like that... which, I assume, is why they don't have a "voice" as infants. :)
I can only speak for my own experiences, but my baby hated the bottle. Breastfeeding is tricky to get right, and if the baby suckles incorrectly, this can be very painful. The only 'voice' my baby had as a newborn was a loud one, every time she got hungary (every one to two hours day or night). It seemed to be a life-or-death matter to her, so instinct is likely why feeding is so important to babies. It's all about survival regardless of whether it's mama's homebrand or the milk bottle!
I've heard the "given medication without permission", and the reality is that it is extremely hard to overcome that, especially when all the medical advice coming at you is negative and with your medical care being actively against it for the first few days. Keep in mind that at the time this practice was common, most pediatricians also strongly discouraged (to put it mildly) nursing.
As for the medication bit, there are a large number of medications that are most definitely NOT compatible with nursing. So, don't assume that the folks who say this didn't know what they were doing. The people I know about who said this knew exactly what they were talking about.
And, maybe you got lucky. I got similar advice from a lactation consultant - at a point where the pediatrician was ready to admit the baby into the hospital if we couldn't get something going. And, in fact it was my pediatrician who pushed me to combo feed - and suggested some ways to do it that would be most likely to be the most helpful. My only other useful suggestion came from a friend who is not an LC, but is quite smart about these things.
Ultimately, it worked out quite well- by 6 weeks I was able to go back to nursing exclusively. But, it didn't happen easily.
I've heard this story, and seen it play out a number of times.
Many "lactivitsts" can be incredibly doctrinaire about the issue of combo feeding. It frustrates me because it is so counter-productive.
PAID MATERNITY LEAVE! Hello? - Doesn't that seem like the obvious answer? Many other countries do it with great results, and USA with all it's talk on FAMILY VALUES can too. Pumping at work sucks. :-)
Really interesting article, the main difference however between the recommendation to bf and the others is that the baby doesn't have a choice how it's fed, whereas if you drink too much, don't exercise or eat your veg then the consequences lie with you. That's why there's so much heat around the bf recommendations because if you don't do it then there is an implication that you've done something bad for your baby, and this is where the challenge of breastfeeding advocacy lies and why there needs to be more focus on support availability than just the headline messages of breast is best.
Exclusively breastfeeding for six months is possible for 95% of women (unless you have a physiological problem like insufficient glandular tissue). However, it isn't easy. You simply have to ask yourself how important this issue is to you and then make it happen. If other things take priority, so be it. Own your decision, don't blame others. I am mother to 19 month old twins you are still breastfed on demand when I am home. I work full time as an attorney with a busy law practice. Pumping was hard but I stuck it out. Did I have to give up some things to make it happen (like my going out for lunch)? Absolutely. Did I have to pump in the car on the way to meetings. Yeah. I told myself from the very beginning that I would not let ANYTHING get in the way of providing breastmilk to my babies. Over time it has gotten easier and while I still sometimes wish I could cook dinner without having to stop and nurse my kids, I know this phase will not last forever.
Beautiful = ) that you are not angry, defensive, or feel guilty, but rather grateful and thankful; it shows a beautiful heart.
"Is it a pain in the neck if you are back to work? OH YES. A huge pain in the neck. But doable,"
Such a broad statement. After being home with all my previous babies I started a job, at a hospital no less, when my last daughter was 10 months old. I'd exclusively breastfed her for 6 months and was still nursing her when I went to work. When I started my job at the hospital, I thought for sure they'd be supportive of breastfeeding/pumping. Imagine my shock when I was told I needed to pump on my 15 minute break, that I might not always get to take due to patient needs, because afterall I got the same breaks as everyone else and needed to figure it out. And my further astonishment when I learned the "pumping room" at my hospital was a teeny windowless closet where they stored all the cases of formula for the nursery. There was a chair over in the corner, surrounded by brown boxes that towered over my head, where I was to sit and pump. By the time I got all my patients situated enough to run to the break-room to get my pump, take the elevator to a different floor and walk to the pump room (closet!), my 15 minutes was up before I even got my pump out of the bag. I was doomed and after a few weeks of 12.5 hour shifts my milk supply diminished. Thankfully I'd been pumping for our local milk bank before going to work and I was able to use the milk I had stored for my own baby, instead of donating it to the milk bank, to get her to a year of mamas milk.
Every situation is different and certainly not every employer is so accommodating to make pumping "doable".
My midwives definitely asked me about how I was planning to feed my baby, and my ped asked me about how I was feeding my baby once the baby was born.
And, my regular physician asks me about diet and exercise. Why on earth shouldn't they? Diet and exercise are part of good health, and my doctor's concern should be helping me to stay healthy.
My breastfeeding, my diet and my exercise aren't everybody's business, but they certainly are my doctors' business.
Yes, you can always call any Leader for FREE help over the phone even if you do not have a Leader/group near you. There are also mother-to-mother forums on LLL's website that are moderated by Leaders. We are volunteers with our own families and many of us also have jobs outside the home. So we do the best we can to help the women who call us.
it actually sounds like she sought out help from various available sources, which is just being smart rather than getting "lucky." although having access to these kinds of resources may be the luck of the draw based on where one lives. i had to drive a half hour to LLL meetings, but i did it anyway because they helped me.
"I can’t remember the last time a physician spoke to me about the amount of exercise I should receive or how many vegetables I should eat, but I clearly remember being asked at every wellness visit how I was feeding my baby and how often."
I think that not inquiring what the baby eats would be an unreasonable omission from a check-up. The baby, who is growing at an astonishing rate (perhaps tripling in weight in the first year) has no resource but the parent, no option but what the parent provides. What, how much, and how often a baby eats is a considerable influence on his or her health, yet the baby can't directly tell you or the doctor if s/he has issues. If you are concerned about your own diet, you are free to ask your doctor, consult a nutritionist, surf the internet, etc.; and in any case, your health, size, and habits are well established now that you're an adult. An adult's annual physical and a baby's well visit *should* differ.
If your doctor isn't asking you about your diet and exercise levels, you might consider switching. A doctor who only medicates health issues as they arise rather than trying to identify and prevent risks is not a doctor you want in charge of your health.
I don't think I've ever had a physical in which I haven't been asked questions about my lifestyle and diet.
I wish they would change the recommendations on how much TV preschoolers should watch :-P I'm soooo not able to keep it within the suggested limits
But seriously, I'm glad that there is a recommendation out there that is based on research so that I at least know what I should be aiming for. And whilst I have a young baby and a 3 yr old who is not in any regular care outside the home, I can live with myself for letting him watch TV every day while I try to feed and settle the babe to sleep (the alternative is having the big one come and jump on the bed) or have an hour lying down with baby in the afternoon. I don't feel too bad about it because I know I'm doing the best I can with the resources I have available to me and this time in my life. And I know that when things settle down a bit, I'll be aiming to be closer to those recommendations.
For me personally, exclusive breastfeeding this second babe is the easy bit :-P But TV, excercise and diet for mum, dietary recommendations for toddlers... that's what I can't keep up with!
It's true that mammal babies nurse from their mothers instinctively. Also, mammal babies die if they aren't so good at it. My middle child would either have died or been chronically malnourished if the bottle hadn't been an option. Many children on the austism spectrum either can't breastfeed, or breastfeed very poorly, for example. It may well be biology, but biology is not kind to those who don't meet its expectations.
I think there is (or at least was) a sizable number of women in the US who did not qualify for WIC and who also did not have insurance that would cover a pump -- recent changes to health care law I belive have changed that, though all changes might not go into effect until 2012.
Paid maternity leave isn't a complete solution, at least not the way it has been implemented in Canada. When our son was born, my partner was unable to find a job that paid well enough to cover our bills. The "paid" maternity leave that I was receiving, didn't even cover our mortgage payment, nevermind food, utilities, clothing for the baby, and lactation consultants. I stayed home for 3 months with my son and 6 months with our daughter, because we simply couldn't afford for me to stay home longer than that, since I am the primary breadwinner in our family.
Whether women go back to work early because they want to, because they have to, or if they want to pump at work beyond the 12 months of maternity leave that are available, I think it is something that should be protected and supported in the workplace.
It hasn't been implemented all that well here, but it is still far above and beyond what is available in the United States.
I was a student with both my pregnancies. July 2008, and then December 2010. I graduated in April 2010. I have never received any sort of benefits of any kind. I don't qualify for any and I didn't qualify for CPP disability when I had hyperemesis with both because I haven't worked enough to pay into it.
If you are talking physiology, then you are probably right about your 95% figure. Otherwise, not close, I'm afraid. It's nice that you told yourself that would not let "anything" get in your way. But, do you realize that what you gave up does not come close to some of the things other women have to give up (like a job that they need in order to put food on the table.)
Not a complete solution, but a HUGE step in the right direction. Here in Ontario, we've also made BFing a human rights issue, so my understanding is that you can demand accommodations from your employer. Of course, even that can be a little iffy. For example, my employer really doesn't have the capability to support me pumping. The way our offices are laid out, there are absolutely no private spaces. I only work two days a week, though, so aside from a bit of soreness in the afternoons, it's not a big deal. But if I were in your situation, that could be a serious issue.
Sometimes however, I don't know if even the doctors know what they're talking about. I had a miscarriage and a D&C when my daughter was 19 months old. I asked every doctor and nurse I spoke with about medication and nursing my daughter. (I had a missed miscarriage and was choosing between the D&C and medication that might cause my body to miscarry "properly".) First I was told that I should pump and dump for 24 hours, which seemed manageable, then the anesthesiologist told me that I wouldn't have to stop nursing at all. Great! Then, while I was under (!) the surgical team decided that I should not nurse for 48 hours! Needless to say, my confidence in doctors' knowledge in this area is not strong. Every time I need medication I ask the doctor and the pharmacist, and they never seem that sure. The pharmacist always has to go dig out the product insert or some big book and look it up.
I guess my point in telling this story is to ask: Why is there no consensus? Why hasn't the medical community put together something easy to read and understand that indicates which medications are compatible with nursing? Why do my doctors always seem unsure when I ask?
Because it doesn't come up very often, probably. Or because not enough people see that as being a priority in the situations in which it does come up.
More likely because there is often not enough information to make a consensus possible. Especially in situations that are not so common. If you look at the available information on many drugs you will often see things like "insufficient data" regarding use in pregnancy or during nursing. Then you get situations where apparently some amount of the drug passes through the milk. Then the question becomes how safe / unsafe is it. And, most of the time, we don't know enough to say for sure.