Feeding Your Baby—When Supplementing Saves Breastfeeding and Lives

Jody Segrave-Daly, RN, MS, IBCLC

Mothers are taught that it’s rare to not produce enough milk to exclusively breastfeed in nearly every breastfeeding book, mommy group and hospital breastfeeding class. The truth is, we have limited studies that provide an accurate percentage of the number of mothers who can produce enough milk for their baby for the recommended 6 months. Although actual rates of failed milk production are unknown, there are estimates that range from 5-15 percent or more. 

  • Dr. Marianne Neifert, Clinical Professor of Pediatrics at the University of Colorado Denver School of Medicine, who co-authored a 1990 study of 319 breastfeeding women found 15 percent of the women were unable to produce sufficient milk by three weeks after delivery.
  • Data from the Infant Feeding Practices Study (IFPS) II, a study of U.S. women, showed that one in eight women experienced early, undesired weaning from disrupted lactation due to physiologic reasons. According to the study, pain, difficulty with latch and insufficient breast milk supply were the most common reasons for early weaning.
  • Dr. Shannon Kelleher talks about these staggering numbers in her publication,  “Biological underpinnings of breastfeeding challenges: the role of genetics, diet, and environment on lactation physiology,” where she says the prevalence of lactation insufficiency may be much higher, as 40–50% of women in the US and 60–90% of women internationally cite “not producing enough milk” or that their baby was “not satisfied with breast milk” as the primary reasons for weaning prior to 6 months.

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How I Learned That Fed is Best

by Jen Gamarano

I hate to admit it, but before I got pregnant, and even when I was pregnant, I was already a judgmental mom. I started watching documentaries about natural birth and breastfeeding years before I even entertained the idea of having children because it fascinated me. Women’s bodies are amazing. We are capable of growing, birthing, and feeding a brand new life and I was on board for doing all of it naturally because biology is perfect and I was made to do this – or so I thought. I looked at moms who opted for epidurals and thought “If only they knew about natural birth and how amazing it is”, or those who formula fed and thought  “How sad” because breast milk is magical and formula will never be able to measure up. I hate to admit these things, but I have to admit them so you know just how much this journey has changed me.

Our birth plan was simple – deliver at the birth center with our doula and midwife, stay there for four hours, go home, breastfeed forever, be happy. I’m lucky to have had a fairly short labor of nine hours, but afterwards was nothing like I’d imagined. I ended up transferring to the hospital to repair a third degree tear. Lovely, I know.

We started to breastfeed at the hospital, and it hurt like they all said it would. L. had trouble latching but he was still nursing so I just tried to be patient. I had a rough first few days as my body tried to balance out hormones. I was shaky, hot, sweaty, mad, sad, and all-around miserable. I called the midwife who told me this was normal and advised me to stay in bed and “breastfeed, breastfeed, breastfeed”. So I did. The next day, my son started crying like crazy when I tried to latch him, and refused to nurse for a full 24 hours. The pediatrician told us to supplement with formula and I gave in because I felt sick, tired, and good lord, I wasn’t going to starve my child.

“The next day, my son started crying like crazy when I tried to latch him, and refused to nurse for a full 24 hours.The pediatrician told us to supplement with formula and I gave in because I felt sick, tired, and good lord, I wasn’t going to starve my child.”

When he finally started to latch again, it was clear that I didn’t have enough for him. He would get sleepy after only a few minutes of nursing, sleep for a few minutes, and then wake up crying and wanted to eat again. I spent a couple days feeding him every 15 minutes and didn’t wear a shirt or see anyone during that time. I met with a lactation consultant who listed a whole slew of things that could potentially be wrong with him. I also learned that I had an infection on my nipple and he developed thrush, which made all of this infinitely more complicated and painful. I was still determined to breastfeed, so we saw two lactation specialists, an ENT and Osteopath to evaluate the little guy, and I tried every natural remedy in the book. I took supplements and tinctures, drank dark beer, pumped multiple times in an hour, saw another lactation specialist, ate almonds, stayed hydrated, pumped, nursed, pumped, nursed, until I just couldn’t do it anymore. I got to the point where I just said without emotion “tried it” whenever someone gave me advice to increase my supply. I was exhausted. I woke up to pump every morning and sobbed because I would only get dribbles and my baby just wasn’t getting that ever so magical breast milk despite all my best efforts.

I’ve heard so many different opinions about my son and I on our journey that I don’t think I can definitively say what the root cause of all of this was. The opinion that made me feel the most at ease was from our ENT who flat out said that not every baby is a fit for every breast. Until then, I’d been conditioned to think that since I was a woman, breast feeding would be the most natural thing I’ve ever done. I forgot in all of this that all humans are different and that’s part of the beauty of life. I had to stop blaming my baby, and I had to stop blaming myself for “failing” at this. I had to give up the notion that this was, in fact, a failure, because it wasn’t.

This journey made me bake myself an entire humble pie and eat every last crumb. I started to look at breastfeeding and motherhood from a much different perspective. I came to terms with the fact that feeding my baby formula and the tiny bit of breast milk I did have was infinitely better than having a baby that couldn’t thrive and a sobbing mommy. I became grateful that I live in a time where formula exists to provide nourishment to my child.

“I became grateful that I live in a time where formula exists to provide nourishment to my child.”

Every mom out there is incredible. I’m proud of moms who breastfeed exclusively. I’m proud of moms who use formula. I’m proud of moms who do both. I’m proud of moms who have natural birth. I’m proud of moms who use modern medicine to take away the horrible pain. I’m proud of every mom who chooses to do the best thing for her baby and herself. The sisterhood of motherhood is incredible and I’m grateful to be a part of it and share my story.


HOW YOU CAN SUPPORT FED IS BEST

There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:

  1. Join the Fed is Best Volunteer group to help us reach Obstetric Health Providers to advocate for counseling of new mothers on the importance of safe infant feeding.
  2. Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies and 100% of your donations go toward these operational costs. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
  3. Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
  4. Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write them about feeding complications your child may have experienced.
  5. Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
  6. Write your local elected officials about what is happening to newborn babies in hospitals and ask for legal protection of newborn babies from underfeeding and of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
  7. Send us your stories. Share with us your successes, your struggles and every thing in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
  8. Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child.  Your messages of support keep us all going.

Donate to Fed is Best

Thank you so much from the Founders of the Fed is Best Foundation!

 

 

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I Was Able To Breastfeed My Third Baby Thanks To The Fed Is Best Foundation

During my pregnancy, I began reading the Fed Is Best Foundation’s feeding educational resources and prednisone dose pack pertaining to breastfeeding and combo feeding. I didn’t have  successful breastfeeding experiences with my previous children and wanted to try one more time. I went into labor when I was 37 weeks pregnant. My labor progressed extremely quickly. By the time we got to the hospital almost an hour later, it was already too late to set up an epidural. I struggled for hours with laboring and pushing, and both my daughter and I were profoundly exhausted after delivery.

Before I gave birth, I had studied the HUNGRY educational resource flyer for exclusive breastfeeding. My goal was to prevent inadequate weight gain with this baby. After my daughter was born, she was not interested in nursing, and I was worried because she was tiny. Thanks to Fed is Best feeding plan, I felt confident in letting my husband do the first feed with a bottle. I wanted her father to feed her so she could get some strength to nurse later and so I could rest. I loved watching him feed her as I recovered. About two hours later, I tried to breastfeed her again and she had the energy to stay latched and nursed. I was so happy she was breastfeeding! Continue reading

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Response to Baby-Friendly USA Regarding Rates of Hyperbilirubinemia Among Exclusively Breastfed Newborns

Christie del Castillo-Hegyi, M.D. and Jody Segrave-Daly, RN, IBCLC

We at the Fed Is Best Foundation give mothers across the globe a platform to tell their stories about how their babies suffered needlessly because they were denied information and supplementation for their hungry babies while under the care of the Baby-Friendly Hospital Initiative/WHO Ten Steps to Successful Breastfeeding protocol. Our Foundation has grown rapidly and demands significantly more time than we currently have because we are a 100% volunteer organization.  We are inundated with messages from mothers, health professionals and media on a daily basis. We try very hard to prioritize what we can do collectively, every single day. Our first priority is to respond to mothers in crisis who contact us needing assistance on how to safely feed their distressed breastfed baby because they were not educated on appropriate supplementation. Baby Friendly USA (BFUSA) found time to critique our interpretation of studies and written materials, so we were forced to take time away from mothers to update written materials and clarify our interpretations. Our goal is to be completely transparent and we have provided our detailed response below with corrections and clarifications given publicly available published data. If there have been errors in interpretation of published information, then we go back to the original published data to provide better data for the public, which we have done below. We believe we have a responsibility to inform parents, the public, medical insurance companies and BFHI hospitals about the risks of exclusive breastfeeding when insufficient. We believe parents deserve to know that the BFHI has an exclusive breastfeeding (EBF) threshold mandate to meet if the hospital wants to remain credentialed. The mandate results in tens of thousands of newborn admissions every year in the U.S. alone, which we chronicle on our page. For the safety of infants across the globe, we will continue to provide education on how to recognize serious complications of exclusive breastfeeding and how every parent can prevent them.

Starvation jaundice (hyperbilirubinemia) of the newborn is defined as abnormally high bilirubin in a newborn who loses >8-10% weight. It is caused by insufficient elimination of bilirubin due to insufficient caloric intake from exclusive breastfeeding in the first week of life. This well-established phenomenon has been discussed by neonatologist Dr. Lawrence Gartner, who is listed as a Director on the Baby-Friendly USA website, in a lecture given to lactation consultants (not just physicians and nurses as stated by BFUSA) at a 2013 California Breastfeeding Conference, previously posted on their website. This public lecture was provided to educate lactation consultants regarding dangerous levels of jaundice that can occur in previously healthy breastfed babies that result from inadequate intake of calories from exclusive breastfeeding. Under Fair Use laws, dissemination of educational material for non-profit educational purposes is protected and we were subsequently asked to post the full lecture by Dr. Gartner via email. The Academy of Breastfeeding Medicine jaundice protocol acknowledges that exclusively breastfed newborns are at higher risk of hyperbilirubinemia from insufficient milk intake (“suboptimal intake”) and excessive weight loss. The vast majority of newborn hyperbilirubinemia is caused by starvation jaundice. Their protocol also states that 98% of kernicterus, or the most severe form of brain injury from jaundice, occurs in breastfed newborns. Nearly all of starvation jaundice can be prevented with timely and adequate supplementation. Nearly all newborns with starvation jaundice show signs of poor feeding including excessive crying and frequent, unsatisfied nursing or lethargy before they develop levels of hyperbilirubinemia that result in impaired brain development. While BFUSA has not previously denied the increased risk of hyperbilirubinemia in breastfed newborns, they have not routinely disclosed them to parents or subscribing hospitals, which has the unfortunate effect of causing hospitalizations that would have been prevented by supplementing a crying underfed newborn. Unfortunately, many parents and health professionals are taught that the signs of poor feeding including crying and hours of unsatisfied nursing are normal, widely known as the “Second Night Syndrome.” These unfortunately are also the earliest signs of other complications like acute bilirubin encephalopathy, kernicterus, hypernatremic dehydration and hypoglycemia, all known causes of brain injury and permanent disability, which can occur if those signs are overlooked as normal and supplementation is avoided in order to meet the goal of exclusive breastfeeding.

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My Body, My Breast: Stop Asking Me How I’m Feeding My Baby

by Sarah Cunningham

As a new mom who did not successfully breastfeed, I have so often felt like a lesser mother over the past 9 months, self-conscious whenever someone has asked me, “Are you still breastfeeding?” Or, my favorite follow-up question, “Oh no, what happened!?” I have heard so many references to breastfeeding that at times I have felt as though mothering is breastfeeding– and because I am not doing so, I must certainly be less of a mom.

Like for many others, the “breast is best” mantra-turned-guilt-trip started for me before my daughter was even born. In my last group prenatal meeting, one woman said she planned to feed her baby formula, but felt like the healthcare community would only give her information on breastfeeding.

After a deafening silence, the lactation consultant said, “that’s because we now know that breast milk is better.” And as if that icy tidbit wasn’t enough, she went on to caution, “I will just warn you that this is a very pro-breastfeeding area.” I swallowed hard, internalizing this information as a non-negotiable item, like so many women must do.

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Jillian Johnson: My Message To Parents During World Breastfeeding Week

By Jillian Johnson

It took all of the courage I had to put aside the debilitating amount of guilt I carried for five long years to tell sildenafil cost—his birth, the first days of his life and how he died. In fact, I still don’t know where I found that courage, but I am convinced Landon gave me the strength. I wasn’t prepared for the intense scrutiny my story received. I was utterly shocked because people came out of nowhere to discredit my story with a vengeance, but I quickly learned how to be gracious in such a vulnerable time.

After all, nothing anyone could say to me could hurt me more than the death of my newborn baby.

I can remember a very specific time, when I was sitting in the waiting room of the hospital and Landon was on life support. My dad was there with me and we were talking about Landon’s prognosis and I won’t ever forget him telling me what a special little boy he was and that he would do great things. I couldn’t quite wrap my head around what his words meant because Landon was most likely going to pass away, and my dad was talking about how he’s going to do great things. I never dreamed that his death would change the lives of so many people across the globe. Continue reading

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My Lactation Consultant Slapped My Nipple And Called My Nipple Shield A Cheater

I’d heard pretty much since starting puberty that breast is best. It’s in movies, books, social media, health class, and even in my own family. So, you can imagine my surprise to be sitting across from a very concerned doctor with a starving infant hearing that my breast milk wasn’t enough.

My baby gained only 7 ounces in 1 month.

I wanted to breastfeed because I wanted to do what was absolutely best for my son, no questions asked. But before he was born, the intense pressure to exclusively breast feed was causing anxiety attacks, frequently. I have flat nipples but I was assured breast feeding would be no problem.

Then I had my beautiful baby boy. We immediately had issues with breastfeeding. One lactation consultant slapped my nipple trying to get it to poke out and called the nipple shield a “cheater”. So I didn’t use one after that. We were not allowed to give him a pacifier. It was four days of pure buy cialis

I was told over and over my body would produce enough milk for my baby and to just keep breastfeeding.

We went home and it wasn’t much better. So, every time I held him he’d cry, and then I’d cry because I’d have to feed him. I began dreading my child. No parent should have to dread their child. Continue reading

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Fed is Best Foundation Response to U.S. Delegation Actions at the World Health Assembly

Jody Segrave-Daly, RN, IBCLC and Christie del Castillo-Hegyi, M.D.

The Fed is Best Foundation is dedicated to ensuring safe infant feeding for every single child, a goal that can be achieved with exclusive breastfeeding, combination feeding, exclusive formula feeding and tube-feeding. We have no political affiliation. We support all mothers to help their infant thrive with safe, sufficient and sustainable feeding in order to protect their health and optimize brain development. Recent news has broken about the U.S. delegation at the 71st World Health Assembly opposing the first draft of the Infant and Young Child Feeding resolution. We have provided a line-by-line break down of the first draft of the resolution, which was set to be proposed by delegates from Ecuador, as well as the proposed draft submitted by the U.S. delegation along with our interpretation of the lines that the U.S. delegates opposed.

In an editorial published in the New York Post, two pediatricians, Dr. Alma Golden and Dr. Brett Giroir,  who were key members of the U.S. delegation attending the 71st World Health Assembly, wrote about the rationale for the U.S. opposition of the first draft:

As pediatricians, US representatives at this year’s World Health Assembly in Geneva and supporters of breastfeeding throughout our professional careers, we were shocked to read recent headlines, in the New York Times and elsewhere, claiming that the administration has somehow called into question the importance of breastfeeding for infants.

The administration fully endorses breastfeeding, and the agencies where we work — Health and Human Services and USAID — communicate this unequivocally…We don’t just affirm these priorities in formal conference rooms in Geneva. For years, the US government…has invested millions of dollars to promote breastfeeding both at home and abroad.

All of which is to say: Breastfeeding wasn’t in dispute in Geneva. Rather, we raised objections to an early draft of the resolution we eventually supported, which made references to a controversial 2016 guidance document. The underlying policy goal of this guidance is unsupported by US nutrition guidelines and inconsistent with the practice of most families in our country…

In particular, the guidance recommends that countries impose stringent new regulations on the marketing of any commercially produced foods suggested for children between 6 months and 3 years old. Such restrictions, in our view, prevent parents from having access to all the factual information they might need. The guidance even advocates for the prohibition of free samples of formula — including in countries and conflict zones where supplies of formula could help save babies’ lives.

Most important, there are good and valid reasons, both medical and personal, why some mothers cannot breastfeed, or choose not to breastfeed exclusively. This is particularly true in situations where displacement, other trauma or malnutrition have made it impossible for mothers to breastfeed their children, and these babies’ lives are at risk without formula or other nutritional supplementation. Parents in these dire situations need all the information and choices available.

The issue of child malnutrition occurring in war torn countries has been reported on by CNN reporter Gayle Lemmon in her article, “Don’t make babies rely on breast milk in war zones,” where she interviewed members of Doctors Without Borders who reported taking care of many infants suffering from severe malnutrition as a result of the strict restrictions of the World Health Organization and UNICEF on formula donations.

‘Over the past couple of weeks we’ve seen an increase in the number of malnourished children needing treatment,” Doctors Without Borders’ Iraq country director Manuel Lannaud said in an interview released on the group’s Web site.

The surprising thing is that Lannaud and his colleagues at the humanitarian aid group didn’t place the blame for these underfed little ones just on war and the fact that the city was under siege. They also put the blame on other international organizations and policies that seek to do good.

“It isn’t a problem of access to food. The malnutrition we see here is primarily due to the scarcity of infant formula,” Lannaud wrote. “International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding … and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition.”

Doctors Without Borders says it agrees that breastfeeding promotion is a priority, but one that comes after dealing with the immediate crisis of a baby’s survival. Says Lannaud, if mothers “need formula, we give it to them.”

The mothers who need it are those facing down life-and-death situations each day, often while caring for multiple children in the shadow of war. That giving infant formula to them is so controversial speaks to a policy tripwire few outside the humanitarian realm even know exists: global “breastfeeding first” policies.

The WHO breastfeeding policies are not without flaws and aggressive promotion of exclusive breastfeeding has resulted in harm, namely an epidemic of newborn hospitalizations for jaundice, dehydration and hypoglycemia, known causes of brain injury and developmental disability, in the U.S. and across the globe. In addition, there has been a rise in accidental suffocation of newborns, called Sudden Unexpected Postnatal Collapse, from prone positioning during to skin-to-skin care and breastfeeding, made worse by maternal exhaustion from 24/7 rooming-in, practices encouraged but the WHO Ten Steps and by Baby-Friendly policies. The promotion of exclusive breastfeeding from birth has contributed to an epidemic of neonatal jaundice in the developed and developing world, which has contributed to an epidemic of perinatal brain injury and cerebral palsy particularly in the developing world, where few health care resources are available to monitor and treat exclusive breastfeeding complications. Promoting exclusive breastfeeding from birth over the local, traditional practices of supplemented breastfeeding (with wet nursing, animal milk or sugar water) until the onset of copious milk production has discouraged a practice that breastfeeding mothers used to prevent hunger and starvation-related complications like jaundice, dehydration and hypoglycemia, which now are the leading causes of newborn rehospitalization in the world.

Incidence of severe neonatal jaundice (bilirubin ≥ 20 mg/dL) in Low- and Middle-Income countries. The data reported correspond to hospital statistics. [Greco, et al, Neonatology 2016;110:172-180]

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My Baby Was Starving – She Lost 17 Percent Of Her Body Weight While Exclusively Breastfeeding

My daughter was born after 14 hours of labor with no issues, in a baby friendly hospital, and with what all of the medical professionals assured me was a perfect latch. The nurses kept telling me she would fall asleep soon, that all newborns do, but she was up for 7 hours after birth, most of the hours latched onto me. By the next morning, my nipples were already raw. I had lanolin I had brought with me that I applied as much as I could, but my daughter was literally on my breast for 5 hour stretches. sildenafil over the counter, that I was doing a great thing by breastfeeding her, and we were sent home with no concerns being expressed, despite her 10 percent weight loss that I was told was normal. (This is not normal.)

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Cara continued to stay at my breast nonstop the next day and night. By day 4, she was finally stopping after 5 or so minutes and I assumed my milk must have come in. She also began to sleep much more, which I thought was because she was finally getting full.

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We had a weight check in later on that day with the lactation consultant. sildenafil citrate 100mg The LC told me I needed to get a pump, suggested a variety of measures to boost supply, and put me on a triple feeding schedule (breastfeed, give a bottle, pump and repeat). She said to not let her have any more than 20 ml of formula at a time or I would risk ruining my breastfeeding relationship. She also scheduled an appointment for me to come back the next day but never once told me that I should see my pediatrician for an urgent evaluation.  Continue reading

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Thank You to the American College of Obstetricians and Gynecologists for Supporting All Mothers

To the Leadership of the American College of Obstetricians and Gynecologists:

We want to thank Dr. Christopher Zahn, Vice President of Practice Activities for the American College of Obstetricians and Gynecologists for responding to our letter regarding safe support of breastfeeding in the newborn period and inclusive support of all mother’s informed infant feeding choices.

We thank you for endorsing that Obstetrician-Gynecologists and midwives provide counseling on when a mother should seek help regarding breastfeeding problems. We are encouraged by your support of providers maintaining knowledge and skills on normal breastfeeding physiology and management of breastfeeding complications, including anticipatory pre-hospital discharge feeding guidance for mothers on those matters. We, too, feel that providing mothers the tools to recognize safe and unsafe conditions in their infants during the course of breastfeeding is critical to providing safe and ethical breastfeeding support. Most of all, we are so grateful for ACOG’s recommendation that Obstetrician-Gynecologists and other obstetric care providers support each woman’s informed decision about what form of infant feeding is best for her child, whether it be exclusive breastfeeding, mixed feeding or formula feeding.  We, too, believe that mothers are uniquely qualified to determine what optimal nutrition looks like for her child depending on breast milk supply, anatomy, infant nutritional needs and the complex social, psychological and economic realities of the family unit. We, too, believe that supporting and respecting a mother’s safe infant feeding choices is paramount to fulfilling our core responsibilities as health providers.

Thank you for your continued support of mothers and their infants as well as the health providers that care for them.

Sincerely,

Christie del Castillo-Hegyi, MD and Jody Segrave-Daly, RN, IBCLC, Co-Founders and The Fed is Best Foundation

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