Science & Sensibility

Breastfeeding Solutions; Quick Tips for the Most Common Nursing Challenges by Nancy Mohrbacher, IBCLC, FILCA is a recently published book, (April 2013) designed  for breastfeeding mothers.  This book is small and lightweight, measuring just 5 x 7 inches, with 202 pages, including appendices, which makes it practically pocket sized and easy to throw in a diaper bag or read while nursing a little one.  There is also an e-book version available as well.

The book is divided in to 7 chapters, and includes a short and concise resource list at the back, along with some brief citations referred to in the book.  The chapters have simple titles such as “Nipple Pain” or “Night Feedings” making it easy to find the information a mother might be looking for.  Each chapter is divided into the typical challenges that mothers might be dealing with under that particular topic.  With a clear, easy to read large font for each section,  the pages are well designed and simple, making it a breeze for a tired and sleep-deprived mother or partner to find exactly what information s/he needs. Occasional, basic, black and white line drawings reinforce the information provided in the text.  The language used throughout the book consists of common terms and is easy to read and understand. I really liked how Nancy reassures the reader with her writing style, that the while the mother or baby may be experiencing some struggles, that things can be fixed and will get better.   In many places throughout, the author lets us know that if things do not improve that the mother should seek out help from an appropriately skilled expert, with her first recommendation being an international board-certified lactation consultant (IBCLC).

Right from the start, Nancy encourages and explains laid back breastfeeding positions for the mother-baby dyad, sharing why these positions makes so much sense for the mother and baby who are just starting to breastfeed.  She even references and provides a link for a short video on this from Suzanne Colson. In several places in the text, Nancy encourages readers to refer to a linked video to reinforce the information provided in the book.

Nancy emphasizes throughout the book that mothers can follow their instincts and will know what to do, but problems can arise and that help is available. She uses some of the same vocabulary that I use when teaching breastfeeding classes, such as “breast sandwich” to help mothers understand getting a deep latch. When discussing weight gain in breastfed babies, Nancy references the WHO exclusively breastfed growth charts as the appropriate guide for how baby is doing.  This is good to know information when a mother will be discussing weight gain with the baby’s provider.

Important information is repeated throughout the book, so a mother who has opened the book to find specific information will not miss key points such as “drained breasts make milk faster, full breasts make milk slower” even if she never turns to the “Milk Supply Issues” chapter.

One of my favorite sections was Nancy’s accurate explanation of breastfeeding norms for the newborn.  Reassurance that cluster feedings, having night and day time mixed up, frequency and length of feedings in the first six weeks really go along way to reassure the new mother that her baby is normal and doing what normal newborns do.  She also shares information about the volume of milk a baby can expect to need as she grows. Every pregnant woman or new mom should read this section, so they don’t wonder if things are normal in their sleep-deprived state.

The old foremilk-hindmilk discussion is squashed as Nancy explains how fat molecules are released from the milk ducts as the feed progresses, but reassures mothers that this is not something to be concerned about.  When a mother feeds on demand and offers both breasts over the course of a day, the baby will be provided with adequate breastmilk that contains everything needed.

There is a great section on going back to work and maintaining supply, along with how to make a pumping session most effective. There are even tips on choosing the right pump for your pumping needs.  I loved the information and drawings included for making sure that your pump has the proper sized phalanges (or nipple tunnels as they are called in the book) for each woman’s nipples, as I frequently see women who have poor fitting phalanges, making pumping so much more uncomfortable.

Nancy shares several different strategies for solving the common problems, so women have many things to try and includes a section for each topic called “If these strategies don’t work” with even *more* information and other things to consider. There are also little sidebars with “Myth and Reality” nuggets scattered throughout the book.  Women are provided with current evidence based information for best breastfeeding practices.

The book closes with a lovely chapter on weaning, sharing ideas on how to decide when the time is right and how to make it easy on both mother and child.  The entire book is non-judgmental, acknowledges that there can be challenges and offers encouragement and information in a non-biased manner and easy to read style that will provide support and answers to the most common concerns facing breastfeeding mothers today.  This book would be a great accompaniment to a breastfeeding class, and lactation consultants,  childbirth educators, doulas, midwives and doctors that work with breastfeeding families will want a few copies to put in their lending libraries for new moms to borrow.

About Nancy Mohrbacher

Nancy Mohrbacher, IBCLC, FILCA, is author of the books for breastfeeding specialists, Breastfeeding Answers Made Simple (BAMS) and its BAMS Pocket Guide Edition.  She is co-author (with Julie Stock) of all three editions of  The Breastfeeding Answer Book, a research-based counseling guide for lactation professionals, which has sold more than 130,000 copies worldwide. She is also co-author (with Kathleen Kendall-Tackett) of the popular book for parents, Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers.  Nancy has written for many publications and speaks at breastfeeding conferences around the world. Contact Nancy by email: nancymohrbacher@gmail.com

 

 

 

Sharon Muza Babies, Book Reviews, Breastfeeding, Childbirth Education, Healthy Birth Practices, Healthy Care Practices, Infant Attachment, Newborns, Parenting an Infant, Uncategorized book review, breastfeeding, Childbirth Education, doulas, how to breastfeeding, lactation consultants, lactation support, midwives, Nancy Morhbacher, problems with breastfeeding, Sharon Muza

I taught hospital based childbirth classes for 6 years prior to changing gears and teaching independently in my community.  Teaching evidence-based information and current best practice in my hospital class always left me feeling anxious and on edge.  Eventually, I made the decision to hang out my own shingle, and after just a few of my “own” classes, I knew I had definitely made the right choice for me.

If you have ever struggled with the same challenge, are considering what your teaching options are or feel alone in your attempts to cover the best evidence in your hospital classes, then Lamaze International has a free webinar for you that you won’t want to miss. 

Kathryn Konrad, MS, RNC-OB, LCCE, FACCE will be leading a webinar, “How to Teach Evidence-Based Childbirth Classes and Still Keep Your Job” on Wednesday, May 22, 1:00-2:15 PM EST.

Childbirth educators including RNs, LPNs lactation consultants, midwives, doulas and others who teach childbirth education in a hospital setting may find it challenging to push for safe and healthy birth outcomes. The purpose of this webinar is to examine the conflicts that may arise when hospital-based childbirth educators teach evidence-based content that is in conflict or inconsistent with hospital and/or provider policies and practices, and to investigate strategies for promoting best practices.

After attending this webinar, learners will be able to:

• Identify potential conflicts of interest when teaching childbirth education classes in a hospital setting;

• Describe strategies for empowering pregnant women to advocate for their preferences regarding evidence-based maternity care and;

• Develop strategies for promoting evidence-based birth practices within a hospital setting.

Contact hours are available.  This program has been planned by Lamaze International for 1.1 hours of CNE credit. To earn credit, attendees must register for the event, attend the entire 75 minute webinar, and complete an online evaluation within the specified time period.  This program has also been approved for 1.0 Lamaze contact hours.  See the registration page for more details.  You do not have to be a Lamaze member to attend the webinar, but you are asked to create a profile in order to register.

This is a great opportunity to learn how to be successful as a hospital based childbirth educator and navigate some of the challenges that occur when you teach for a hospital.  You will not want to miss this webinar scheduled for tomorrow.  Make some time in your schedule, and register now!  Come back and share your thoughts in our comments section on the topic and your experiences as a hospital based childbirth educator.  I know the discussion will be lively.

Kathryn Konrad has educational experience overseeing the development and presentation of childbirth, breastfeeding and parenting classes in both hospital and community settings.  Currently she is an instructor at The University of Oklahoma College of Nursing.  She received a Bachelors of Science degree from the University of Central Oklahoma in 2000 and a Masters of Science degree with an emphasis in Nursing Education from The University of Oklahoma Health Sciences Center in 2008.  She has been Lamaze Certified Childbirth Educator since 2006, an RNC-OB since 2005 and a labor and birth nurse since 2000.  She was inducted as a Fellow in the Academy of Certified Childbirth Educators in 2011. She offers workshops on evidence-based labor support for nurses and nursing students.

Sharon Muza Childbirth Education, Continuing Education, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Lamaze International, Maternity Care, Medical Interventions, Uncategorized, Webinars Childbirth Education, Continuing Education, continuing education for nurses, Evidence Based Medicine, hospitals, Kathryn Konrad, Lamaze International, Lamaze webinars, Sharon Muza, Webinars

Childbirth Connection’s Listening to Mothers Initiative just released the Listening to Mothers III (LTMIII) results late last week.  For the third time in the past 11 years, this organization has gone out and queried women on a variety of topics related to pregnancy, birth, postpartum and breastfeeding.  They have questioned thousands of women to accurately assess how the actual experiences hold up against what we know to be best practice and evidence based maternity care. I have relied on the past two survey results frequently during my professional career in maternal health and am thrilled to have the new survey results now available.

I thought it would be interesting to run some of the LTMIII results through the filter of Lamaze International’s Healthy Birth Practices.  The Healthy Birth Practices were most recently updated by Lamaze in 2009, and consist of six simple, evidence based practices that greatly contribute to keeping birth safe and healthy for mothers and babies. Each easy to remember practice has its own short video that parents can watch that talks about that specific care practice and safe alternatives.  Additionally, each Healthy Birth Practice has an accompanying Practice Paper with all the citations for the peer-reviewed, gold standard research that supports that particular practice.

Some useful links and information upfront

Listening to Mothers I

Listening to Mothers II

New!  Listening to Mothers III

Survey Questionnaire 

Major Study Findings

Interesting facts before we get started

While the LTMIII survey only looked at 2400 women,  please be aware that one percentage point change in results would represent approximately 40,000 mother/baby pairs, based on a US birth rate of around 4 million births a year.

35% of women had not intended to be pregnant at the time of this pregnancy, including 5% who stated that they had never intended to become pregnant at all.

52% of those planning to get pregnant did have a preconception meeting with a health care provider, (which could be viewed as a wonderful time to determine if this health care provider might be a good match for their maternity care needs.)

85% of women based their maternity care provider on insurance requirements or restrictions.

78% of women worked with an obstetrician (this has dropped over the course of the three studies.)

9% of women worked with a family practice doctor

8% of women worked with a midwife who practiced in a hospital, as one of the requirements of the study was that the mother was having a hospital birth.

The average length of time spent actually in a prenatal appointment, with health care provider or their nurse was 32 minutes.  (OB: 31 min, Family Practice/MW 35 min.) I was pleasantly surprised that it was this long, I expected less.

Over the course of the three studies, the cesarean rate of study participants went up, (24% to 31%), the VBAC rate went down and labor augmentation was cut in half from 53% to 26%.  More women used nitrous oxide for pain relief during their labor in the most recent study (6%, up from 2% in the first study)

30% of the women chose not to ask a question that they wanted answered at least once during their prenatal appointments.

Overall, women were unable to make choices in line with the Healthy Birth Practices, and did not know that deviating from these practices was not evidence based and resulted in increased interventions.

Let’s see how things stack up

Healthy Birth Practice 1: Let Labor Begin on Its Own

Research shows that in the absence of medical issues, mothers, babies and labors do best when labor starts spontaneously on its own. The final few weeks of pregnancy are vital for the putting the “finishing touches” on baby and helping to make the transition to life on the outside as smooth as possible.

41% of all women surveyed attempted a medical (involved a care provider) induction and of those induced, 74% were successful, (the woman went into labor) for an overall medically induced labor rate of 31%

Reasons why women were induced

• 44% were full term
• 19% wanted to get the pregnancy over
• 11% wanted to control the timing of birth
• 16% were induced for a large baby (note: the average weight of these babies induced for suspected macrosomia was 7 lbs 15 ounces.)
• 18% were induced for being “overdue” (note: the average gestational age of those babies induced for being overdue was 39.9 weeks)
• 18% were induced for a maternal health problem

Interestingly, 26% of women had their due date changed toward the end of their pregnancy; 66% of those were given an earlier due date and 34% were given a later one.

68% of women had a late third trimester ultrasound to estimate fetal weight

Healthy Birth Practice 2: Walk, Move Around and Change Positions in Labor

Women with the ability to move and change positions are able to use this movement to help cope with the pain of labor.  Access to water in the form of a shower or tub can be a valuable coping technique.  Having access to intermittent fetal monitoring or telemetry movements can facilitate movement and promote labor progress for many women.

Only 43% of women walked around after being admitted to the hospital in labor

40% of women used position changes and movement for non-pharmacological pain relief

Healthy Birth Practice 3: Bring a Loved One, Friend or Doula for Continuous Support

Many women will thrive in labor if surrounded by a caring, supportive birth team.  Adding a skilled birth doula to the team has been shown in many studies to improve the outcome of birth and reduce interventions and cesareans.  While more and more birthing women are aware of a doula, many are still not having one in attendance at their birth.

99% of mothers had at least one support person present, (most often this was a partner, then a family member or friend)

6% women used a doula

75% of mothers were aware of what a doula does and of those 75% who knew, 27% would have liked a doula supporting them at their birth.

Healthy Birth Practice 4: Avoid Interventions That are Not Medically Necessary 

Although research shows that routine and unnecessary interference in the natural process of labor and birth is not likely to be beneficial—and may indeed be harmful—most U.S. births today are intervention-intensive.

98% of the women had at least one ultrasound during pregnancy and 70% had three or more over the course of their pregnancy

68% of women had a late third trimester ultrasound to estimate fetal weight.

83% of women had some type of pain medication

67% had an epidural or spinal, and 92% of those who did reported this to be “very helpful” or “somewhat helpful.”

62% of women surveyed had an IV during labor

51% of women had one or more vaginal exams in labor. (I was surprised at this, I would have suspected higher)

47% had bladder (Foley) catheters

31% of women had a labor augmented with pitocin

50% of birthing women had their labor either induced or augmented with pitocin

20% had their membranes ruptured artificially (AROM)  after labor began

36% of women had their labor started or augmented by AROM

1% of women requested and had a maternal request cesarean for non-medical reasons

40% of women drank fluids during their labor

21% of the women ate during labor

85% of women birthing vaginally did so without forceps or vacuum

87% of women responding had at least one of the five big interventions (attempted labor induction, epidural, pitocin augmentation, assisted delivery with vacuum or forceps or cesarean.

60% of the women had at least two of the above five interventions listed above

Healthy Birth Practice 5: Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

Women push most effectively when permitted to push in the positions that feel best for them.  Allowing the baby to “labor down” even after reaching full dilation until moms feel the urge to push can help women to push a baby out quicker and under their own steam.  Pushing in positions that allow the pelvis to open as much as possible and making space by getting the sacrum out of the way can help promote descent during pushing.

68% of women surveyed birthed on their backs

23% birthed in a semi-sitting position

8% gave birth in a position off their back, either side-lying, squat or hands & knees

Healthy Birth Practice 6: Keep Mother and Baby Together; Its Best for Mother, Baby and Breastfeeding

Experts now recommend that right after birth, a healthy newborn should be placed skin-to-skin on the mother’s abdomen or chest and should be dried and covered with warm blankets. Any care that needs to be done immediately after birth can be done with your baby skin-to-skin on your chest.  This early time together promotes breastfeeding, helps stabilize the newborn’s temperature and blood sugar and also offers a unique chance for high levels of natural oxytocin that promote bonding and help with immediate postpartum bleeding.

47% of mothers responding had their baby in their arms within the first hour

40% of mother-baby pairs were not skin to skin when they were first held

33% of all babies were with hospital staff the first hour

60% of mother-baby pairs roomed in together

18% of babies spent time in the NICU

25% of babies spent their days with mom and their nights in the nursery

49% of mothers who stated that they intended to exclusively breastfeed were given formula samples or offers.

29% of newborns were supplemented with water or formula during the hospital stay

Summary

After reading through the LTMIII report, I found myself discouraged by the current results.  It was clear that women were making choices and/or being informed by their care providers to choose practices that have long been known to create a cascade of interventions, do not improve outcomes for mothers or babies and are not evidence based.  For the majority of the women who responded to this survey, the Healthy Care Practices are still a pipe dream and not a reality in their hospitals and with their current providers.  I know change comes slowly, and it can take years for protocols to catch up with the evidence but frankly, after reading the summary of how things did or did not change over the course of the three studies I was still shocked.

Have you had a chance to go through the study yet?  What were your thoughts?  Anything surprise you?  Can you share a bright point that you noticed?

Join us later this week as I examine what the LTMIII survey had to say about childbirth education and how women are receiving pregnancy and birth information and from where.

 

 

 

 

Sharon Muza Breastfeeding, Cesarean Birth, Childbirth Education, Doula Care, Epidural Analgesia, Evidence Based Medicine, Healthy Birth Practices, Healthy Care Practices, Lamaze International, Maternal Quality Improvement, Maternity Care, Medical Interventions, Midwifery, New Research, Newborns, News about Pregnancy, Research, Transforming Maternity Care, Uncategorized Childbirth Connection, Healthy Birth Practices, Lamaze International, Listening to Mothers III, Listening to Mothers surveys, research, Sharon Muza

Childbirth Connection has just released the Listening to Mothers III study today, and will holding a press conference shortly to share the results.  I plan to listen in and read the study thoroughly to see what the mothers have to say!  Look for a complete post early next week evaluating the current state of pregnancy care, labor, birth postpartum and breastfeeding and how it stacks up to Lamaze International’s Six Healthy Birth Practices.  In the meantime, consider joining the press conference, or reading this new study.  You can also check out the previous two LTM studies to see if things have changed.

Listening to Mothers I

Listening to Mothers II

New!  Listening to Mothers III

Sharon Muza Babies, Cesarean Birth, Childbirth Education, Depression, Healthcare Reform, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternal Quality Improvement, Maternity Care, Medical Interventions, New Research, Research Childbirth Connection, Healthy Birth Practices, Healthy Care Practices, lamaze, Listening to Mothers, research, Sharon Muza

Press time update: Over the course of my research on Monday 4/22/13, I noticed that by the end of the day, Milkscreen’s main website no longer shows links to the Breastfeeding Assesment Calculator. The Facebook page for this product has also been removed.  An email received from the company confirms that the product has been removed from the website and retailers have been instructed to pull the product from the shelves. I can only speculate that this is due to pressure from social media. ~ Deena

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I recently became aware of a new product, the Milkscreen Breastfeeding Assessment Calculator by Upspring Baby, designed to help new breastfeeding mothers be more confident in their breastfeeding abilities. This product tells them whether their milk supply is “low, normal or high” and how they can correct problems.  

This product assumes that many mothers are worried about having a low milk supply and therefore this product will reassure mothers that they are normal. To use this product, a mother must pump her milk. Additionally, this product assumes that pumping breastmilk will yield the same quantity as when a baby nurses.  We know: what a mother pumps is not indicative of what she may be producing to feed her baby. 

From the product description: 

“The Milkscreen Assessment home test determines daily breast milk supply. It was created to address the common concern many moms have: how much breast milk do I make and is that enough for my baby? Milkscreen Assessment gives mom confidence to keep breastfeeding by telling her how much breast milk she makes and how that relates to baby’s growth, identifying possible breastfeeding issues and providing recommendations on how to overcome these issues.”

This description may play directly into a mother’s fear that she isn’t making enough breastmilk for her baby. 

From the product box:

“Problem: About 50% of moms stop breastfeeding because they are concerned they don’t make enough milk for their baby. Solution: Milkscreen Calculator”

How do we know that this percentage is accurate? 

The company does not cite a source for this statement. Moms cease to breastfeed for many reasons, including, but not limited to; going back to work, pain while breastfeeding and personal preference. 

The real data on low milk supply

 An estimated 5% to 15% of all mothers experience either primary or secondary lactogenesis failure, with the actual numbers being unknown. 

Hypoplasia or Insufficient Glandular Tissue is a rare condition that some women may have. and it needs a clinical diagnosis to confirm. Many women with this condition supplement with donated breastmilk or formula while continuing to breastfeed.

I believe that the Milkscreen Calculator doesn’t help to eliminate low production worries, as advertised. I believe that it promotes this fear! 

How does Milkscreen test the breastmilk?

After scouring their website, I am not able to find any information on what nutrients they are testing for or what testing procedures they use because they don’t actually test the breastmilk! A mother doesn’t send the breastmilk to their lab for testing. A mother fills out a questionnaire and enters the amount of milk pumped in three pumping sessions, one hour apart. Milkscreen looks at a mother’s production level as “low, normal, or high” and gives her results and recommendations as to what to do if she’s having a problem, and then makes suggestions as to their other products she might like to purchase. 

From Milkscreen’s FAQ: 

How accurate is this test?

Milkscreen Assessment is modeled after a scientific paper, published in a peer-reviewed journal, and interpretation and recommendations provided in report are based on published scientific literature found in our list of references. However, each woman will respond differently to pumping breast milk. If a woman gets a result that shows low production, it’s possible that pumping was not as efficient for her as feeding at the breast.  In this case, the report will suggest to explore this possibility with a Lactation Consultant.

When I took a look through their references list, I was unable to find the paper they referred to.. They do offer useful citations and background information, but nothing supports the need or usefulness of this product.

From the video with breastfeeding expert Dr. Landers:

“This test is based on data that are normative. Hundreds of mothers have had very special calculations of daily milk supply. Our test takes an estimated amount of breastmilk supply over a shorter period of time and lets a mother know if she’s low, normal or high. Milkscreen calculator is an estimate of the day’s milk production, but in a scientifically studied, peer reviewed paper it’s actually a good approximation….. This test is an accurate estimate of daily milk supply…. It is the growth of the baby that is the most important thing. Gives mom an idea of whether baby’s weight gain is low, normal or high. (Uses the WHO growth chart)”

If the growth of the baby is “the most important thing” why don’t we weigh and measure the baby. That would tell us if the breastmilk supply is adequate.

This product oversimplifies the issue of low milk supply. “Low, normal or high,” doesn’t give a mother any real data to go on.

How do others test* for nutritional quality of breastmilk?

The Mayo Clinic provides us with some insight as to how breastmilk is tested and what it is tested for. They use thin-layer chromatography (TLC)/colorimetry/spectrophotometry (SP)/other methodologies as appropriate. With their testing, they use samples that are 4-5ml of breastmilk.

From the Mayo Clinic:

“The nutritional content of breast milk changes considerably from day 1 to day 36 postpartum. Subsequent to that time the nutritional content is considered to be stable.

Measured nutritional components are glucose, lactose, triglyceride, and protein. Deficiency of any of the measured or calculated parameters is suggestive of decreased nutritional quality of human breast milk.”

Mayo Clinic, Breast Milk Nutritional Analysis

“Several different methods are used in the analysis of human breast milk. The sample is analyzed for triglycerides using an enzymatic method. One aliquot of breast milk is tested for total protein using biuret reagent and titration methodology and for measurement of glucose using a glucose oxidase method. A second aliquot of breast milk is pre-incubated with beta-galactosidase and glucose is measured. Lactose is calculated using results obtained by the methods listed above.”

*These tests are not FDA approved.

What is the rate of false positive / false negative results from the Milkscreen test?

An incorrect assessment can have a huge impact on the mother’s breastfeeding relationship. If a mother is led to believe falsely reassured that she is making enough milk, she may not seek appropriate help from a lactation consultant or other breastfeeding professional and her baby may suffer, Alternately, a mother may choose to supplement with formula when in fact, there was no issue or her supply could have been corrected with professional help.

Breastfeeding confidence 

In the video explaining the science behind Milkscreen, Dr. Landers states;  

“Anything we can do to help a new mom, especially a first time breastfeeding mom, to have confidence in her body’s ability to make milk and nourish her baby would be a huge, huge addition to our tools to help breastfeeding moms and babies. We know from clinical studies that moms stop breastfeeding because they think they don’t have enough breastmilk supply. It’s the mother’s perception of an inadequate supply and that she doesn’t know what she’s doing… Modern women don’t have confidence in that process (supply and demand). So one of the reasons this product is so important is that it is a huge confidence builder for the average mom.’

Phrases like  “they think they don’t have enough milk” and “mother’s perception of inadequate supply” or “doesn’t know what she is doing” reinforce the idea that women are not capable of being knowledgeable or confident about breastfeeding. 

Milkscreen Assessment also claims that if a mother has too much milk, she will likely have growth issues with her baby as well. They attribute this to the foremilk/hindmilk imbalance, including the problem of ‘loose stools’ with the infant.  Current research no longer supports the foremilk/hindmilk theory, and exclusively breastfed babies normally have loose, mustardy stool.  According to Kellymom.com, “Your breasts don’t “flip a switch” at some arbitrary point and start producing hindmilk instead of foremilk. Instead, think of the beginning of a nursing session as being like turning on a hot water faucet.” In other words, there is always fat in breastmilk but the quantity varies dependent upon how long baby nurses. Feeding from a relatively empty breast will yield a higher fat content in the milk. However, it’s the fat over the course of the day, not just in a single feeding which is important.

As educators and professionals, we know to refer a mother who is questioning her milk supply to seek help from a qualified lactation consultant or other breastfeeding professional.  Additionally, we can be sure that our breastfeeding and newborn care classes are evidence based, offer useful information and instill confidence in new mothers so they can start their breastfeeding relationship off on the right foot.  We also make sure that new mothers are aware of support groups and local resources that can help them if they run into problems and concerns. 

Lamaze’s Healthy Birth Practice #6: Keep Mother and Baby Together- It’s Best for Mother, Baby and Breastfeeding is a great resource for parents and includes a wonderful video for use in class. 

Resources and References:

 AAP Breastfeeding and the Use of Human Milk (2012) 

American Academy of Pediatrics, Adequacy of Milk Intake During Exclusive Breastfeeding: A Longitudinal Study, (2011)

Butte NF, Garza C, Smith EO, Nichols BL. Human milk intake and growth in exclusively breast-fed infants. J Pediatr. 1984 Feb;104(2):187-95.

Daly SEJ, DiRosso A, Owens RA, Hartmann PE. Degree of breast emptying explains changes in the fat content, but not fatty acid composition, of human milk. Exp Physiol 1993;78:741-55.

Highlights of, and thoughts regarding the AAP’s Policy Statement “Breastfeeding and the Use of Human Milk”

Hurst, N (2007) Recognizing and Treating Delayed or Failed Lactogenesis II, Journal of Midwifery & Women’s Health

“Hypoplasia/Insufficient Glandular Tissue.” KellyMom RSS. N.p., n.d. Web. 22 Apr. 2013.

 World Health Organization on Breastfeeding

Deena Blumenfeld Babies, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Healthy Care Practices, informed Consent, Newborns, Social Media breastfeeding, breastmilk, Childbirth Education, Deena Blumenfeld, guest post, Healthy Birth Practices, power of social media, Social Media