On Thursday evening January 17, 2013 I attended a lecture at the New York Academy of Medicine. The title was Our Bodies, Our Nature: Breastfeeding & Maternal Ideology in mid-20th Century America.

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This was presented by Jessica Martucci, PhD.  She is an historian and gender studies professor. This lecture was from her research on the history of breastfeeding and environmental contaminants.  She is also writing a book called Back to the Breast: Natural Motherhood and Breastfeeding in the 20th Century.

Breastfeeding research always interests me. What piqued my interest in attending this lecture was Ms. Martucci’s seeming attack on La Leche League. The descirption on the announcement has this quote:

“In 1972, the international breastfeeding support organization La Leche League published a pamphlet titled “DDT and Mother’s Milk,” which addressed the problem of tainted breast milk.  “Many mothers have wondered whether they should discontinue nursing their babies,” they wrote, adding “The answer is ‘No.'”  As much as the League wished the issue of DDT and other toxins in milk would just go away, environmental contaminants have been a persistent issue in scienitific and popular discussions of breastfeeding.”

Now perhaps I was wrong. I went to the lecture with an open mind.

The presentation was interesting. She paralleled the resurgence of breastfeeding with the contamination of the environment. She also discussed her concept of Natural Mothering. She somewhat spoke on it’s impact on feminism.

She pointed out two environmental researchers who had been breastfeeding while doing research on environmental contaminants and had their own milk tested. Glenda Daniel made the decision to discontinue breastfeeding her daughter sometime around 1980. She then discussed Florence Williams, a science writer, who in 2005 wrote an article for the New York Times titled Toxic Milk. Ms. Williams decided to continue to breastfeed her daughter despite the environmental contaminants. She wanted to know why these two women made different decisions with nearly the same data. I found two big missings in this parallel. One big missing was Sandra Steingraber, the ecologist and author, who also continued to breastfeed her children knowing the environmental impact.

The other big missing in my opinion is that we know much more about human milk than we did thirty years ago. Perhaps Ms. Daniel did not understand what she was giving to her daughter in terms of immunity and long term protection from diabetes, cancers, obesity while she was breastfeeding her.

She also chose to show examples of prominent women in the natural motherhood movement who had breastfeeding failure. She highlighted the experience of Eleanor Agnew from her book Back From The Land. Ms. Agnew had two terrible bouts of mastitis and discontinued breastfeeding.

Ms. Martucci seemd to have a subtle, but palpable dislike for La Leche League and breastfeeding. I could not call her on it for it’s subtlety nor would it be my place. She referred to the organization as The League.

This was not the forum to ask her about her personal life. I wanted to know if she is a mother, if so, did she breastfeed? I wanted to know if she was breastfed herself. I wanted to know what her birth experience was like.

My big question during the Q & A was “How many babies have died as a result of being nursed from polluted breasts?”  While Ms. Martucci said that data has not been collected the was a resounding “None” from the audience.

The great thing about the evening was that the audience was peppered with physicians and scientists who spoke of the importance of breastfeeding despite the environment.

The big take home was that we need to act to clean up our polluted world.

To Pump or Not to Pump

March 25, 2012

When I was pregnant with Phoebe is 1995 I took a birthing class and a breastfeeding class. In week six of the birthing class the teacher brought in a guest – a woman who rents breast pumps. The businesswoman made it clear that if a person was to be breastfeeding she would need a good quality pump.

Phoebe and I struggled for a few days but got the hang of nursing and all was well. The pediatricians were impressed with her weight gain and were nearly shocked I was exclusively breastfeeding. Looming in the back of my mind was that little voice of the woman “you need a breast pump, you need a breast pump.”

After about four weeks I found a local pharmacy that rented pumps and plopped down my $212.32 for a two-month rental with all of the supplies. I brought it home and it sat on the kitchen table.  Rob came home that evening and saw the new appliance in the kitchen and said, I see you got the pump.

Day after day, Phoebe and I developed our routine. We both loved nursing and she grew so beautifully. Rob loved watching her nurse and saw how happy she was. When I thought she was nursing too much he is the one who pointed out how happy we both were at these moments.

About two weeks after I rent the contraption I realize I have spent this money and I had better use the thing. Phoebe lay asleep on the bed off the kitchen and as I watched her I set up the machine and began to pump. It was fascinating to watch my milk flow out of my breasts into the bottles. After about ten or fifteen minutes I had collected about three quarters of an ounce. I placed it in the refrigerator so Rob could feed it to her in the next day or so. After all, shouldn’t I let him get involved in this parenting adventure.  Why should I be the only one to bond with our little girl?

That night Rob came through the door beaming as usual to see us at the end of the day. He was followed by a thunderstorm that rattled our little house. The lights flashed off and on and off.  The electricity was out.   My mind went directly to the fridge where my precious liquid gold sat on a wire shelf. Rob, the electricity! My milk! You must feed it to her now before it goes bad! I ran to the kitchen ran the bottle under hot water and handed it to Rob with a hungry wiggly Phoebe in his arms. She started to root on his chest. He placed the bottle in her mouth she looked in his trusted eyes as if to say: What the hell are you doing?  I stared at them and my breasts began to tingle. They struggled, both looking betrayed.

Give me that bottle, I said. I unscrewed the nipple and poured the milk down the drain. Let me hold her. I latched her on and we all melted into the normal little family we knew. Is it okay if I don’t pump? I asked Rob. Of course, I never asked you to. I don’t need to feed her to feel connected. 

The next day Phoebe and I drove to the pharmacy and returned the pump and she never had a bottle.

It is important to know that Phoebe and I were rarely separated in the first year of her life. Well, in her case we were rarely separated for the first few years of her life.

Chloe, my second baby also never had a bottle.

Finn, my third baby was born slightly early and had a severe tongue-tie and lost a full pound by his third day of life.  On day six I rented a pump and for 24 hours I pumped my left breast and fed him the milk. In all, he had about three bottles. When he was about nine months old I left him for a few hours and left behind some milk. Rob said he through it across the room and he didn’t really need it.

That is my story about bottles and breast pumps.

Now I want to address the general population.

For many women a pump is an important tool to continue breastfeeding. Just as my story was unique to my situation, so it is for all moms. In 1995 there were not on-line mothers groups. The moms I met were face to face and the conversations about feedings were that – conversations, two- or three-way discussions. These days moms go to their on-line community and read posts. In many ways these forums are great but they can also be scary and mis-informative.

A recent trend I notice is that moms believe if they do not start pumping right away they will not get enough milk. Another trend is that it is important to have a freezer full of milk. All of this work puts so much pressure on new moms and takes away from the time spent face to face with her baby. It also throws off the balance of her milk supply.

Why do you need to pump?

There are different scenarios where a mom really should pump.

If a mom is directed by her doctor to supplement her baby then this mom should use a hospital grade pump to express her milk. This is so that she has a supplement for her baby and it also will help to establish her milk supply.

If a mom and baby are separated it is important for the mom to pump her milk to again establish her milk supply and/or prevent engorgement.

These days many women work outside of the home. In this case pumping her milk assures she has milk to feed her baby while they are apart.  If the mom is one to three days ahead of her supply she can keep her milk in the refrigerator. There really is no need to have a freezer full of milk.  The idea is to nurse your baby when you are with him and to pump when you are separated.

Some moms would like to have a stash of milk so that she can leave her baby in the care of someone else occasionally. In these situations it is truly fine to keep a bottle or two a week in the mix.

For some moms it truly is nearly impossible to pump while at work. Pumping at home after feedings is one way to save milk for this time. Other moms find they use either donor milk or formula as a supplement. If a mom is not 100% breastfeeding it does not mean she is not breastfeeding. There seems to be this idea that breastfeeding is an all or nothing proposition. It is not. When you are with your baby you nurse your baby.

Some moms like to include her partner or other family member with the feedings. Many moms find this helpful while others prefer help with other aspects of her mothering this new baby. A couple of things to keep in mind: be sure it does not complicate the feedings and not feeding a baby does not preclude bonding.

What kinds of pumps are there?

There are many pumps on the market. It seems everyone wants to get in the game. As a new parent it is important to watch out for marketing. New parents are one of the most heavily targeted markets.

Read reviews, real reviews, not just a couple of posts on forums. And watch for paid advertising. Not all pumps are created equal. Just because a pump costs more than others, it does not mean it works better or even as well.

If you need to pump in the early weeks it is important to rent a hospital grade pump.

If you have an established supply and you are working outside of the home on a regular basis you may need a rental pump or a good quality double electric pump.

Look at the size of the motor. Are you paying for technology? Or quality?

If you just need the occasional bottle often a smaller pump or a hand pump can work well. And do not forget your hand. Learning to hand express is a great gift. You do not need to rely on electricity or batteries. Hand expression is something all moms should know how to do.

Here is a quick tutorial:

You take the pads of your thumb and middle finger and place them just on the inner edge of your areola.

You put pressure as though you are going to touch your rib cage.

Then, imagine there is ink on your thumb – you roll your thumb towards your nipple as though you would make a thumbprint – not a smudge.

Repeat.

If you do not have milk flowing you can massage your breast toward the nipple.

You repeat until you have expressed  enough milk for your particular needs of the moment.

The best place to practice is in the shower. Sometimes you will find a “sweet spot” where you get a nice continuous flow.

When should one pump?

If breastfeeding is going well there is no need to pump right away. Allow time for you and your baby master this art. Let your baby and your body flow into a nice equilibrium. You can wait several weeks to introduce a pump and expressed milk.

If there are hiccups in your situation pumping may be indicated.

When to pump varies from person to person. There is no one size fits all prescription.  If you are not sure contact an International Board Certified Lactation Consultant (IBCLC) or a La Leche League Leader.

Infant feeding can be complicated or it can be smooth. It is important to find your way. Feel free to share it on your forums but please, please put a disclaimer that this is your unique experience.

Bye Bye Breast Burka

March 23, 2011

Some of you have seen this but it bears showing from time to time: Katherine, a new mom, called me to discuss her milk supply. She was concerned with keeping up the demand of her baby. Then she asked me other breastfeeding questions. She was not sure how to nurse Sadie outside of her house. She thought it was because she needed her “special pillow.” The truth is she doesn’t know how because few women really breastfeed in public anymore. There was an orangutan at a zoo in Boston. The zookeepers mated her and she became pregnant. Ms. Orangutan had been raised in captivity. She had not lived among sister orangutans so she did not know what to do with her baby when he was born – the baby orangutan died. The second time around the zookeepers asked volunteers from the local chapter of La Leche League to nurse their babies in front of the primate.  When the second baby was born the primate placed her baby in her arms backwards but with some guidance from the staff quickly learned to feed and care for her baby. This is how we learn. We observe the behavior of others. When I was a pregnant with my first baby I had met a few breastfeeding mothers along the way including my sister-in-law. I took a breastfeeding class to learn as much as I could before my baby arrived. When Phoebe was born she was placed in my arms and we nursed for the first time for about twenty minutes. And then we nursed  – a lot. I felt awkward. I fumbled to unlatch my nursing bras, some of which were too big, some of which were too tight and one that broke. I bought dowdy nursing clothes. I wore button shirts. I still felt awkward. Phoebe was born on a hot summer day.  I am a gregarious person. I am best chatting with a group. As a new mother I felt isolated. I hungered for company That summer we had a few social events – a wedding, an engagement party – “showing off our baby” weekends. I noticed that wherever I went the host always had a “nice air conditioned room with a comfy chair” for me to go and nurse Phoebe. And Phoebe nursed all the time. I was even isolated in my socialization. Sandra, my brother’s wife had recommended attending a La Leche League meeting. The meetings had been a great resource for her as a new mom. I found the meetings helpful but even more important were the lunch dates after the meetings. Phoebe and I joined other nursing moms monthly at the Thruway Diner. We always sat at the big round table in the center of the bustling eatery. Six to ten moms and their babies smack in the middle of business suits, ties, skirts and silk blouses. This is where I learned to nurse out and about with confidence. I watched the moms with older babies. I saw unspoken communication between them. I saw how a baby might start to wiggle a bit and like Houdini the mom had unhooked her bra, lifted her shirt and latched the baby in seconds flat. It looked effortless and it also looked like there was a baby in her arms – no breasts hanging out, no cover ups – simply a babe in arms. I wanted to be like them. I wanted to feel that assured. I wanted to look that smooth and at ease. As I expressed my envy at their mastery they all assured me that they too had been awkward. They encouraged me to nurse Phoebe in front of a mirror and I did. I grew confident in my ability to nurse Phoebe whenever she needed.  At the next social gathering Phoebe started rooting and I said to Rob, “I am going to nurse her here.” He put his arm around me and kept talking. From there I declined offers for the “air conditioned room with a comfy chair.” I eventually became a La Leche League leader and then lactation consultant. I gave birth to two more children. I nursed them all over the place: the bus, the subway, Saks, Barnes & Noble, fancy restaurants, diners.  Usually no one except other mother’s knew I was nursing. I was not hiding behind anything just nursing my babies. When my youngest child, Finn, was about 6 months old I was at the pediatrician’s office for a well check up. In the waiting area were two new moms discussing a new product they had just discovered – “The Hooter Hider” one of them said in an embarrassed giggle. Then I started seeing breastfeeding covers everywhere. This was the antithesis of the Thruway Diner experience. A baby begins to fuss, the mother searches her bag for the cover, the baby fusses more, the mother opens the cover, ties it around her, by now the baby is wailing, the mom fumbles with the cover and the baby, the baby kicks about, perhaps not wishing to be under a tent. Now everyone knows what is going on under the fabric. How challenging this makes everything. Breastfeeding by its very nature is designed to be simple. We have complicated it. We have made it shameful and difficult.  Like the orangutan new moms today have no real life positive breastfeeding images. Courtney, another new mom, asked me a question about nursing in public. I asked her, “ Do you have any friends who are breastfeeding?” “Yes,” she replied. “So go hang out with them, learn from them,” I offered. “They use a cover or expressed milk in a bottle.” she answered. “Go to the thruway diner!!!” I want to scream. But that was another time, another place. I walk down the street and look into the windows of Victoria’s Secret, American Apparel and Abercrombie + Fitch – this is our provocative world yet we must put a tent around us to feed our babies? We flaunt our breasts to sell products. Breasts are sexy – until they become functional. Then we hide them. A few years ago I could spot a breastfeeding mom because I had a keen eye and I had been there. Nowadays anyone can tell a breastfeeding mom – she is the one hiding behind the overpriced piece of calico. Scan 121940003

Ban The Breast Burka

February 23, 2011

Katherine, a new mom, called me to discuss her milk supply. She was concerned with keeping up the demand of her baby. Then she asked me other breastfeeding questions. She was not sure how to nurse Sadie outside of her house. She thought it was because she needed her “special pillow.” The truth is she doesn’t know how because few women really breastfeed in public anymore.

There was an orangutan at a zoo in Boston. The zookeepers mated her and she became pregnant. Ms. Orangutan had been raised in captivity. She had not lived among sister orangutans so she did not know what to do with her baby when he was born – the baby orangutan died.

The second time around the zookeepers asked volunteers from the local chapter of La Leche League to nurse their babies in front of the primate.  When the second baby was born the primate placed her baby in her arms backwards but with some guidance from the staff quickly learned to feed and care for her baby.

This is how we learn. We observe the behavior of others. When I was a pregnant with my first baby I had met a few breastfeeding mothers along the way including my sister-in-law. I took a breastfeeding class to learn as much as I could before my baby arrived.

When Phoebe was born she was placed in my arms and we nursed for the first time for about twenty minutes. And then we nursed  – a lot. I felt awkward. I fumbled to unlatch my nursing bras, some of which were too big, some of which were too tight and one that broke. I bought dowdy nursing clothes. I wore button shirts. I still felt awkward. Phoebe was born on a hot summer day.  I am a gregarious person. I am best chatting with a group. As a new mother I felt isolated. I hungered for company

That summer we had a few social events – a wedding, an engagement party – “showing off our baby” weekends. I noticed that wherever I went the host always had a “nice air conditioned room with a comfy chair” for me to go and nurse Phoebe. And Phoebe nursed all the time. I was even isolated in my socialization.

Sandra, my brother’s wife had recommended attending a La Leche League meeting. The meetings had been a great resource for her as a new mom. I found the meetings helpful but even more important were the lunch dates after the meetings. Phoebe and I joined other nursing moms monthly at the Thruway Diner. We always sat at the big round table in the center of the bustling eatery. Six to ten moms and their babies smack in the middle of business suits, ties, skirts and silk blouses.

This is where I learned to nurse out and about with confidence. I watched the moms with older babies. I saw unspoken communication between them. I saw how a baby might start to wiggle a bit and like Houdini the mom had unhooked her bra, lifted her shirt and latched the baby in seconds flat. It looked effortless and it also looked like there was a baby in her arms – no breasts hanging out, no cover ups – simply a babe in arms. I wanted to be like them. I wanted to feel that assured. I wanted to look that smooth and at ease. As I expressed my envy at their mastery they all assured me that they too had been awkward. They encouraged me to nurse Phoebe in front of a mirror and I did. I grew confident in my ability to nurse Phoebe whenever she needed.  At the next social gathering Phoebe started rooting and I said to Rob, “I am going to nurse her here.” He put his arm around me and kept talking. From there I declined offers for the “air conditioned room with a comfy chair.”

I eventually became a La Leche League leader and then lactation consultant. I gave birth to two more children. I nursed them all over the place: the bus, the subway, Saks, Barnes & Noble, fancy restaurants, diners.  Usually no one except other mother’s knew I was nursing. I was not hiding behind anything just nursing my babies.

When my youngest child, Finn, was about 6 months old I was at the pediatrician’s office for a well check up. In the waiting area were two new moms discussing a new product they had just discovered – “The Hooter Hider” one of them said in an embarrassed giggle. Then I started seeing breastfeeding covers everywhere. This was the antithesis of the Thruway Diner experience. A baby begins to fuss, the mother searches her bag for the cover, the baby fusses more, the mother opens the cover, ties it around her, by now the baby is wailing, the mom fumbles with the cover and the baby, the baby kicks about, perhaps not wishing to be under a tent. Now everyone knows what is going on under the fabric.

How challenging this makes everything. Breastfeeding by its very nature is designed to be simple. We have complicated it. We have made it shameful and difficult.  Like the orangutan new moms today have no real life positive breastfeeding images.

Courtney, another new mom, asked me a question about nursing in public. I asked her,

“ Do you have any friends who are breastfeeding?”

“Yes,” she replied.

“So go hang out with them, learn from them,” I offered.

“They use a cover or expressed milk in a bottle.” she answered.

“Go to the thruway diner!!!” I want to scream. But that was another time, another place.

I walk down the street and look into the windows of Victoria’s Secret, American Apparel and Abercrombie + Fitch – this is our provocative world yet we must put a tent around us to feed our babies? We flaunt our breasts to sell products. Breasts are sexy – until they become functional. Then we hide them.

A few years ago I could spot a breastfeeding mom because I had a keen eye and I had been there. Nowadays anyone can tell a breastfeeding mom – she is the one hiding behind the overpriced piece of calico.