neonatal health

Mamas on Bedrest: (Breast) Milk-It Does a Body Good!

August 4th, 2015

wbw2015-logo-m2Hello Mamas!

It’s August and that means it’s National Breastfeeding Month here in the United States, and August 1-7, 2015 is World Breastfeeding Week! There is a lot of hubbub about breastfeeding in the US news. Advocates encourage women to reap the benefits of breastfeeding for themselves and their babies, while those less “enthusiastic” about public breastfeeding press for a more austere approach to this timeless practice.

Breastfeeding is a completely natural event and most all animal species breastfeed their young. Mamas of most species will breastfeed their young until the young are mature enough to eat adult food, then breastfeeding stops and the offspring eats with the rest of the pack/herd. Animals get everything nutrient and immune defense they need from their mamas.

Young animals do have an advantage over human infants, though. While most young animals will become mature enough to stop nursing in a matter of months, human infants, if nursed to the extent that nature intended, would nurse for up to 5 years! So I understand it when some mamas say that they don’t want to nurse that long. Breastmilk is a remarkable substance. When a mama breastfeeds, her body miraculously creates breastmilk with just the right nutrient balance, just the right consistency and just the right amount for the growing infant. In fact, as the infant grows, the consistency, composition and amount of breastmilk changes to meet the needs of the growing infant. And while developing the skill and finesse needed to breastfeed with ease does often take some practice, once mastered, mama and baby are free to go without the hassle of worrying about carrying bottles, formula, or worrying about keeping the breastmilk fresh or warming it up for baby to drink.

So when women tell me that they don’t want to breastfeed, I have to admit, I am always a bit taken aback; They want to forgo all those nutrients, all that convenience, all the immune system and developmental benefits…? But we all have to remember, It is a mama’s right to decide what is the best way for her to feed her baby. Yet it is my sincere hope that every woman will at least attempt to breastfeed her infant-even if only for a few weeks-in order to give her baby this most beneficial nourishment.

Why am I such a strong proponent of breastfeeding? Because of its benefits for both mamas and babies.

Research suggests that breastfed babies have lower risks of:

  • Asthma
  • Childhood leukemia
  • Childhood obesity
  • Ear infections
  • Eczema (atopic dermatitis)
  • Diarrhea and vomiting
  • Lower respiratory infections
  • Necrotizing (nek-roh-TEYE-zing) enterocolitis (en-TUR-oh-coh-lyt-iss), a disease that affects the gastrointestinal tract in pre-term infants
  • Sudden infant death syndrome (SIDS)
  • Type 2 diabetes

But the benefits don’t stop there. Breastfeeding also has significant benefits for mamas! Breastfeeding leads to a lower risks of :

  • Type 2 diabetes
  • Certain types of breast cancer
  • Ovarian cancer
  • In some women, breastfeeding speeds pregnancy weight loss
  • Breastfeeding has been associated with reduced rates of Post Partum Depression

While almost all research sources, The American Academy of Pediatrics, The American Academy of Family Practice, The US Centers for Disease Control and Prevention, The World Health Organization and many other national and international organizations recommend breastfeeding exclusively for at least 6 months, but preferably for one year, again, every woman has to make the decision that is best for her and her baby. So that women can make informed decisions, here are some resources about breastfeeding.

Resources

La Leche League

The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies

WomensHealth.gov

The American Academy of Pediatrics

The American Academy of Family Practice

Mamas on Bedrest: Want a Smarter Baby? Breastfeed!

March 30th, 2015

nursing infantGood Monday Morning, Mamas!!

According to a recent study done by Brazilian Researchers published in The Lancet Global Health, “Breast-fed babies may be smarter, better educated and richer as adults”. This article so intrigued me that I had to read through and see just what the researchers saw as the determining factors.

According to the Medline report and the actual publication, Brazilian researchers followed enrolled and started following 5914 neonates who were breastfeeding to gather information about IQ and breastfeeding duration. The data was analyzed between June of 2012 and February 2013.  3493 participants remained from the original study group. The researchers found that the durations of total breastfeeding (in months) and predominantly breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with higher IQ, higher educational attainment, and higher income. Babies who were breastfed for 12 months or more were found to have higher IQ scores, more years of education, and higher monthly incomes than did those who were breastfed for less than 1 month. So based on these findings, the researchers concluded that “Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.”

While the results of this study are in line with many other studies, the article has aroused some criticism. Dr. David Mendez, a neonatologist at Miami Children’s Hospital, said “Parents should not take the message from this study that ‘if you do not breast-feed, your child will not be a successful adult.'” The researchers found that it was duration of breastfeeding that was key. It did not depend on the infants’ families being wealthy or on the parents being highly educated, outcomes in the infants still showed breastfed babies were more successful and those who were breastfed longer were more successful.

What those critical to the study did point out is that it does take time and effort to breastfeed. Parents who are dedicated to breastfeeding and mamas who have a strong support while they breastfeed are going to be more successful. Moreover, they are more likely to be invested in the overall development of their child, making choices and exhibiting habits that nurture their child and guide them in more positive behaviors. They caution people against thinking that breastfeeding alone will give a child an advantage. However, the more its studied, the more we can see that breastfeeding does in fact lead to numerous benefits-for infants as well as for their mamas. Here are some of the benefits:

  • Breastfed infants are getting high quantities of saturated fatty acids (of which breastmilk is composed) and which the infant brain preferentially uses for growth and development
  • Breastmilk contains important immunologic factors that are passed from mama to baby so that babies are protected from many dangerous diseases while they are growing and being immunized.
  • Breastmilk is always ready; perfect amount, at perfect temperature. No need for bottles, or additional time to mix or prepare
  • Breastfeeding is economical. No additional costs to the family
  • Breastfeeding provides additional “skin to skin” time for mama and baby and numerous studies have shown that skin to skin, cuddling and closeness improves growth and development in infants
  • Breastfeeding has been shown to help some mothers lose the pregnancy weight
  • Breastfeeding is linked to reduced rates of breast cancer in mothers.

With all of these benefits and more, one would think that Breastfeeding would be a “no brainer” (pun intended!!). However, Breastfeeding is still somewhat controversial here in the United States, despite all the scientific evidence for its benefit, the “Breast is Best” campaigns and the recommendations from the American Academy of Family Physicians and the American Academy of Pediatricians. According to the US Centers for Disease Control and Prevention, only 79% of American mamas initiate breastfeeding at birth, and at 6 months that number drops to somewhere around 27%. At 12 months, a mere 12% of mamas are still breastfeeding their babies. Barriers to breastfeeding include:

  • Difficulty latching on
  • Lack of support from parnter/familly
  • Painful/sore nipples
  • Insufficient milk supply
  • Mother returns to work/limited ability to pump.

Many of these barriers are being addressed. “Baby Friendly Hospitals”(1) are allowing more time for mamas and babies to bond right after birth and during the hospital stay. Mothers are encouraged to breastfeed and lactation consultants are available to assist with any logistical difficulties. Lactation consultants are also available to answer questions partners or family members may have, and to educate the family on the benefits of breastfeeding and their important role in supporting mama.

Public breastfeeding is not widely accepted in the United States and many states, cities and local areas have laws/restrictions about how and where mothers may feed their infants. Breastfeeding advocates are working to have many of these laws and rules overturned, but face an uphill battle in some areas. Legislation has been passed in many states requiring employers to provide “pumping breaks” for breastfeeding mamas, as well as quiet, private and comfortable areas in which mamas can pump. These are all works in progress.

We cannot ignore the fact that up until the turn of the 20th century, everyone was breastfed. While the wealthy or nobility may have had “wet nurses” (other, often poor or servant lactating women breastfed their babies), all babies were breastfed until they were old enough to eat mashed table foods or cereals. It’s how we as a species survived. It has worked for centuries. Why is it suddenly “passe”?

I am sure that this article will continue to spark controversy. However, I hope that we don’t lose fact of the basic principle: babies were meant to be breastfed by their mothers. The physiology of a woman’s breast, and the milk that she makes is specifically designed to feed her infants regardless of the size of her breast tissue. Most infants can breastfeed unless they have a physical anomaly prohibiting them from doing so, and this is rare. Even in such cases, if mothers can pump, the infant can still reap the benefits in breastmilk. In mothers who have difficulties, with support, education and guidance, most all mamas who want to breast feed, can. The data is in and yes, Breast is best-for infants and quite possibly for the adults they will become!

 

 

References

1. Prof Cesar G Victora, PhD, Dr Bernardo Lessa Horta, PhDcorrespondenceemail, Christian Loret de Mola, PhD, Luciana Quevedo, PhD, Ricardo Tavares Pinheiro, PhD, Denise P Gigante, PhD, Helen Gonçalves, PhD, Fernando C Barros, PhD. “Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil” The Lancet Global Health. Volume 3, No. 4, e199–e205, April 2015 (Released online March 17, 2015).

2. The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding (i) and the International Code of Marketing of Breast-milk Substitutes (ii). 

 

 

 

 

 

Mamas on Bedrest: Going Home Without Your Baby

December 8th, 2014
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Me and my daughter the day after her birth. Kangaroo (skin to skin) care is very beneficial to preemies helping them learn to regulate their body temperatures, soothing and comforting them and helping mamas and babies to bond.

Hello Mamas,

We all know bedrest is a beast, but we endure it with the ever pressing hope that at the end of the journey, we’ll end up with a healthy baby. Sometimes the journey ends up not quite how we expected. We deliver and our baby has to be taken into the neonatal intensive care unit (NICU) for special care. Even though all proceeds positively, it’s a tough pill to swallow that after the many weeks on bed rest, you actually have to leave the hospital without your baby. While most mamas on bedrest know that they have a higher than normal risk of delivering a premature infant, few are prepared for the feelings that ensue when they are discharged home from the hospital and their babies must remain. Many mamas describe a feeling of grief, a void and feeling like they didn’t really succeed in having a successful birth outcome. All of these are very valid feelings.

As a mama who had to leave the hospital without her baby, it was really hard to be wheeled down to the pick up circle in front of the hospital, all my personal items and flowers beside me, and no baby in my arms. And I was lucky. My daughter (a late phase preemie born at 36 w, 6d) only remained in the NICU for 5 days beyond my discharge. But it was still hard to walk into my house and to see her room all ready and to see the cradle and changing table in my room and for her not to be there. During those 5 days, I made the most of my time, created a routine with my husband and the order, quite frankly that feeling of control is what got me through.

Structure your days: Every day I got up, dressed and prepared a bag for the day full of snacks and supplies (breast pump tubing, bottles, breast pads, maxi pads and other personal items) and my husband would drive me to the hospital so I could be there by about 9 am. Once I arrived, I assumed most of my daughter’s care. I would weigh her, feed her, change her and weigh her again. Then I’d hold her and rock her, talking to her. My mother had come down to help out, so she would come to the hospital with me and we would take turns holding my daughter. While my mom held my daughter, I’d pump. I pumped every few hours and by the time she came home, we had enough stored breastmilk to take up nearly one quarter of our freezer. Occasionally during the day I’d take a nap in the rocker, but generally I hung out with my baby, holding her and caring for her as much as the nursing staff allowed. My husband would typically pick up my mom and I at about 7pm and he’d bring us home. I’d eat and pump and rest, my mom taking care of me, while my husband would go back to the hospital and hang out with my daughter until about midnight. We repeated this schedule daily until we brought my daughter home.

Now I am sure that many of you are thinking,

“Well that’s just fine for you. Your baby was only in the NICU 5 days beyond your discharge (10 days total). And you didn’t have any other children at home.” 

To this I say, “You are absolutely right!” But the point I want to make is that when your child is in the NICU, it’s stressful. Many mamas feel as if the nurses are bonding more with their babies than they are! Personally, I was kinda pissed at the nurses at first. They held my daughter before I did. Although they had whisked her by me when she was first born, the NICU nurses were the first people my daughter really  “saw”. I knew intellectually that they were doing the best possible for her, but frankly I was jealous. I wanted to be doing everything for her. I WAS HER MAMA!!! And as the days went on, and I was able to do more and more for her myself, those feelings of jealousy gave way to gratitude as I realized those nurses really were doing the best things for her at that time.

Get support: I live in Texas and my family lives in Massachusetts. My mom came down to visit and take care of me. It was a HUGE help. While she really didn’t do much (a few loads of laundry, made sure I ate, helped me move about comfortably), her presence meant more than I can say. She was there when we learned about a lot of my daughter’s lab tests. While most of them were negative and my daugther was progressing nicely, the anxiety that arose each time the neonatologist arrived was stiffling and each day that he said my daughter could not go home, mom was there to comfort me. Also, although I didn’t have other children at home, having my mother present would have enabled me to be with my daughter without having to worry about the care of my older children at home. Do what you can to have folks present to support you. Its invaluable!!!

Take Advantage of Available Services: Many hospitals offer a wide range of services to families with infants in the NICU (Social service consultations, assistance at home, getting medical devices and equipment for home if they are needed, counseling for parents if needed and so much more!). While I didn’t need many of the services offered, I did take advantage of the lactation consultations. My daughter had trouble breathing and that is why she was in the NICU in the first place. But she had difficulty breathing while nursing. The lactation consultant gave me tips on good positions in which to hold her comfortably, how to make sure enough of my breast was in her mouth to stimulate the milk let down reflex, and how to best help my daughter to be able to breathe while nursing.

Be present for all tests and ask questions about the results: There are a million and one tests done to make sure that your preemie is progressing and developing. As much as possible, BE PRESENT WHILE ALL OF THEM ARE ADMINISTERED!! There were a couple that they tried to tell me that I had to leave the room to have done. I refused. You have the right to refuse and be with your baby provided it poses no health risk to her or compromises the test. Speak up! And be sure to get full reports on all the tests and ask questions of the neonatologists when they do their rounds and present the test results to you.

Be patient: All babies go home. Some, like my daughter only spend a few days in the NICU. Other babies spend weeks to months. Whatever the duration of your baby’s hospital stay, know that they are getting the best possible care. And know that each day that they stay in the NICU is further preparing them to be home with you. One of the worst things that can happen is to get your baby home and for them to have some sort of complication that causes you to rush them back to the hospital. Be patient, allow the NICU staff to do what they do, and with time and grace, your little one will be home to stay!