The Motherwear Breastfeeding Blog

WHO announces a big change in breastfeeding recommendation for HIV positive mothers.

On the eve of World AIDS Day, the World Health Organization has released updated recommendations on preventing mother-to-child transmission of HIV.  And the news for breastfeeding is really big.

You may recall that HIV can be transmitted from mother to child during pregnancy, childbirth, and breastfeeding.  In the developing world this has been a major source of new infections. 

For this reason, it's been the recommendation that women who are HIV positive not breastfeed, as long as formula feeding is "acceptable, feasible, affordable, sustainable and safe."

Many women in developing countries don't have access to clean water, much less the resources to purchase formula, and not breastfeeding puts their infants at a high risk of death and disease.  In one recent study of 14 developing countries, not breastfeeding resulted in over 325 deaths per 1,000 births compared to 35 deaths per 1,000 births among breastfed babies. 

That's why breastfeeding, even though it may mean that a child becomes infected with HIV, is considered safer than not breastfeeding in much of the developing world.  Both feeding options carry significant risks, but a child is far likelier to die early in life if he is not breastfed. 

So, until today, the recommendation has been that women in developing countries feed their babies breastmilk substitutes only if it is "acceptable, feasible, affordable, sustainable and safe."  Otherwise, exclusive breastfeeding is recommended during the first six months of life, to be discontinued as soon as is feasible thereafter.

This has been a really difficult recommendation to follow, for several reasons.  Exclusive breastfeeding (considered the safest method) is relatively rare.  Weaning from exclusive breastfeeding to no breastfeeding at six months, as you can imagine, is extremely difficult.  And women face significant stigma when not breastfeeding.  Unlike in the U.S., many developing countries never lost the "breastfeeding culture," and not breastfeeding is considered a give away that a woman is HIV positive.

But recent research has shown that when HIV positive mothers take antiretroviral drugs while breastfeeding, it reduces the risk of transmission dramatically.  Access to ARVs has increased significantly in recent years.  Accordingly, the WHO has changed its recommendation:

WHO now recommends that breastfeeding continue until the infant is 12 months of age, provided the HIV-positive mother or baby is taking ARVs during that period. This will reduce the risk of HIV transmission and improve the infant's chance of survival.

"In the new recommendations, we are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers, when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.

National health authorities are encouraged by WHO to identify the most appropriate infant feeding practice (either breastfeeding with ARVs or the use of infant formula) for their communities. The selected practice should then be promoted as the single standard of care.

I think that this is really good news for mothers, babies, and the tradition of breastfeeding.

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Free webinar on supporting nursing mothers during flu season.

The International Lactation Consultants Association (ILCA) is offering a free webinar on breastfeeding during flu season for anyone who works with nursing mothers in hospital settings.  The webinar is tomorrow, December 1st, from 2:00 to 3:30 pm EST, and will feature a talk by Katherine Shealy of the CDC. 

The webinar is designed for lactation consultants, educators, and other health professionals who work with breastfeeding mothers and babies in hospital settings. The information will help you assist hospitals and birthing facilities with establishing protocols that can support breastfeeding families during flu season.

Topics include:
• Infection control measures to reduce the transmission of H1N1 in the hospital setting
• Mechanisms of transmission of 2009 H1N1 to the newborn
• Caring for breastfeeding newborns of mothers with suspected/confirmed 2009 H1N1
• Recommendations for flu vaccines (seasonal and H1N1) in pregnant and breastfeeding women
• Promoting the importance of breastfeeding during flu season
• Role of IBCLCs in establishing and implementing protocols that support breastfeeding
• Resources available from ILCA, CDC, and other organizations

Space is limited. Reserve your Webinar seat now. Equipment needed: a computer and a telephone. To learn more, contact ILCA toll-free at 1-888-ILCA-IS-U or (919) 861-5577.

Stem cells in breastmilk may help a child "fulfill its genetic destiny"

It's been known for some time that breastmilk contains stem cells, but new research suggests that there are three types of stem cells present in breastmilk, and hints at a role they may play in the development of muscle and bone tissue.

The Independent reports:

Dr Mark Cregan, medical director at the Swiss healthcare and baby equipment company Medela, believes the existence of stem cells means breast milk could help a child "fulfil its genetic destiny", with a mother's mammary glands taking over from her placenta to guide infant development once her child is born.

Breast milk is the only adult tissue where more than one type of stem cell has been discovered. That is very unique and implies a lot about the impressive bioactivity of breast milk and the consequential benefits to the breastfed infant," said Dr Cregan, who is speaking at Unicef's Baby Friendly Initiative conference this week. His research has isolated adult stem cells of epithelial (mammary) and immune origin, with "very preliminary evidence" that breast milk also contains stem cells that promotes the growth of muscle and bone tissue.

Dr Cregan said the discovery of immune stem cells was the "most exciting development", adding, "It's quite possible that immune cells in breast milk can survive digestion and end up in the infant's circulation. This has been shown to be occurring in animals, and so it would be unsurprising if this was also occurring in human infants.

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Giving thanks for the support you had with breastfeeding.

Earlier this week I encouraged everyone to provide feedback to their hospitals about your breastfeeding experiences.  While I mentioned both good and bad experiences, the emphasis was a bit more on the bad.

So I thought, during this week of giving thanks, that I'd balance things out by encouraging you to write to anyone who has made your breastfeeding experience better.  It might be a nurse or La Leche League Leader, but it might also be your husband or sister or best friend. 

I have a folder of cards (right) with letters of thanks from moms, and I love adding to it.  I'm not sharing this to brag, but more to show you that I, like everyone involved in breastfeeding support, take feedback very seriously.  The cards say, among other things:

"Without your support and knowledge, we would have given up in the first week."
"You helped make it the best experience it could have been."
"I am eternally grateful for your patience and help during some of the toughest days."
"May you be blessed in the way you have blessed so many others."
"Breastfeeding was really tough for me, but with your help I was able to succeed."
"We couldn't have made it this far without you."
"We'll never forget the night we barged into your clinic full of tears and thinking we might have to give up nursing!"
"These are true gifts that brought many moments of ease into the sometimes rocky transition into parenthood."

I've written a few of my own such letters, one to the midwife and doula who were there for my son's birth, and one to a doctor who went above and beyond for me. 

Have you?

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NPR's 'Tell Me More' talks about breastfeeding and African American moms

Breastfeeding has come up a number of times on the NPR show Tell Me More recently.  Enough times that I'm at higher risk of crashing my car while listening to the radio between the hours of 9 and 10 am.   

I've been wondering why the host, Michel Martin, has brought up the topic so frequently.  And of course I wondered if she'd breastfeed herself.  Though it's really none of my business.  Then I read her comment to this post: 

"I also loved breastfeeding...and with twins trust me there WAS no breastfeeding in public. can you imagine?! I'd have had to pull a blanket over my whole head. but it was hard. sometime I'll tell you the story of when I first got back to work and was sent on a reporting trip. I think I have forgiven the relevant parties for what happened next, but the fact that my heart rate is accelerating as I write this tells me: maybe not. here's a short version: nine hours, ice storm, small plane. and that's all I'll say about it. For now."

Any moms of twins who nursed and also pumped at work totally gets it.

Thanks to an email from a faithful reader, I learned that yesterday I missed a segment on why African American moms breastfeed at rates lower than other ethnic groups. 

One of the women Michel Martin interviewed is Kathi Barber, whom I interviewed for a podcast interview on African American moms and breastfeeding.  For a while it was the most popular download from our free iTunes store.  Kathi is the author of The Black Woman's Guide to Breastfeeding, and the founder of the African American Breastfeeding Alliance.  I finally got to meet Kathi this fall at an advisory board meeting for the breast cancer/breastmilk study I'm helping to recruit for.  She's awesome.

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Motherwear's winter line is here.

Motherwear's winter line of cozy, comfortable and stylish nursing clothes is here!

Some of my favorites are shown here, including the Audrey Ribbon Trim Cardigan (top left), the Timeless Dress (right), and the Aria Top (lower left).

The Cozy Cubs Pajamas are pretty cute, too!

Not sure how the nursing openings work?  Check out this page for a good visual explanation.

And don't forget:  a Motherwear gift certificate makes a great holiday gift.

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Had a good or bad experience in the hospital? Tell them!

Welcome to November's Carnival of Breastfeeding!  This month's theme is breastfeeding experiences in the hospital.  Be sure to check out the links to other contributors' posts at the bottom of this one.

I'm going to take a different angle on this topic.  I want to focus on the importance of giving feedback to hospitals about our breastfeeding experiences. 

Why?  Recent data from the CDC shows that only 8.1 percent of hospitals follow practices known to increase exclusive breastfeeding rates.  Mothers who deliver in hospitals that follow these practices are six times more likely to achieve their intention to exclusively breastfeed.  Another study found mothers who delivered in hospitals that followed only one of these practices were 13 times less likely to be exclusively breastfeeding at six weeks.  

But many of you don't need data to prove this - you've lived it.  And some of your stories published on this blog are perfect examples: "They said the latch was fine," "You'll never be able to nurse".

I strongly believe that we need better, evidence-based support for breastfeeding in our hospitals.  I also believe that practices can change, and that as mothers we have an important role to play in bringing about that change.  Here are a few things I think you should know about hospitals:

1) Most hospitals act like businesses.  You are their customers.  Most of us have choices about where we have our babies, and hospitals know that.  They want you to hire them to help you deliver your baby, and they should know if they are falling short in an area that is important to mothers.  If they're doing a good job, they should know that, too.

2) Hospital staff are trying to do the right thing.  None of them come to work with the intention of sabotaging your breastfeeding experience.  They just sometimes don't know what the right thing is, or they don't have the skills to make it happen.  Or maybe they lack the communication skill to convey it appropriately.  All of that can be changed.

3) Most importantly, your feedback matters - a lot.  Hospitals track patient satisfaction, and these measures are taken very seriously.  A single letter from a mother can lead to a change in policies and retraining of staff.  A letter with positive comments strengthens the convictions that people are doing the right thing.

Here are a few tips for providing your feedback to a hospital:

1)  Explain who you are and why you're writing.

2)  Tell your story, as clearly and factually as you can.  Include statements you recall from different people involved, and specific things that contributed to the good or bad experience you had.

3)  Explain what you think and/or feel about what happened.

4)  Tell the hospital what you would like to happen next (a written reply, a reevaluation of a policy, etc.).  You may want to reference evidence-based practices for support of breastfeeding, like the Ten Steps to Successful Breastfeeding, or the Baby Friendly certification.

5)  Be as respectful as you can, without sacrificing any relevant information.

6)  Send your letter to the director of maternity/childbirth, the CEO, and (importantly) to risk management.

If you're feeling intimidated by the institution, or if you're worried about offending someone in a small community, remember that there is always a way of respectfully expressing your dissatisfaction without sacrificing the truth.  Think it was too long ago to matter?  It could be that nothing has changed since then, and you'll be helping other mothers avoid a bad experience.  Or you may hear back that things have changed for the better.  Either way, it's worth it.

Here are some other great posts from carnival contributors (updated throughout the day):

• Breastfeeding 1-2-3: "Breastfeeding experiences in the hospital"
• The Milk Mama: "Newborns, Nursing, and Hospital(ity)"
• Momma's Angel: "My Hospital Experience in Norway"
• Whozat & Shrike: "The Nipple Intervention"

Some recent celebrity quotes about breastfeeding

A number of celebrities have been talking about breastfeeding recently - and not only about weight loss!  I thought I'd share a few recent quotes:

"They're not very big, my boobs, so they just became normal size.  I loved it!  I felt very Woman.  When you're had a slightly androgynous body your whole life, having breasts is a nice feeling."  - Nicole Kidman

"I love ABC, they really look out for breastfeeding mothers.  We have I think eight nursing and pumping mothers on our show this season so there are pump stations everywhere.”  - Rachel Griffiths (Brothers and Sisters)

“They do say breastfeeding is nature’s lipo.” - Ana Ortiz (Ugly Betty)

“With my daughter — obviously the doctor made sure that everything was okay — but I didn’t do all of the procedures they recommend right away. I did the least amount that was necessary that was still healthy, so that my daughter would be able to latch right away.” - Kelly Rutherford (Gossip Girl)

“I know it’s a cliché, but I was eating just ridiculous amounts of food but still losing weight.  I think I should just keep breastfeeding until she’s 18.” - Allyson Hannigan (How I Met Your Mother)

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New Zealand launches breastfeeding campaign with new posters.

The New Zealand Ministry of Health has launched a new national breastfeeding promotion campaign with some great posters, radio spots, social media, a DVD update, and photo competition.

I thought you'd like to see some of the posters.  They all depict mothers of different ethnicities nursing in public.  You can see the rest of them here.  The new videos, are available on You Tube here.

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A "milk's up" sign.

A breastfeeding group in Massachusetts is proposing a hand signal women could use to express support of mothers breastfeeding in public.

You can see a video explanation here (fast forward to 3:00 for the signal), but the essence is a combination of the "thumbs up" sign and the sign for milk (opening and closing of the hand).

Do you do anything when you see another mom nursing in public?  Smile?  Stop and say something?  And what do you think of this signal?

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What should our national breastfeeding goals be? Time to comment on the Healthy People 2020 goals.

Every ten years since 1979, the U.S. Department of Health and Human Services has set "Healthy People" objectives.  These objectives for a kind of public health agenda for the country, and are used to assess the progress of some government sponsored public health programs.

Healthy People 2010 set goals of 75% breastfeeding in the early postpartum period, 50% at six months, and 25% at one year.  There are other goals for exclusive breastfeeding, too.

I explored the Healthy People website, looking for information on how far we've progressed toward these goals.  The 2008 data on "any breastfeeding" show us falling short of the 75% goal by 4 percentage points.  Not too bad, and maybe by 2010 we'll actually make it. 

It gets more interesting when you look at breastfeeding rates by ethnicity.  Some ethnic groups are surpassing the goal significantly.   Specifically, Asian/Pacific Islander, Latina, and American Indian/Alaska Native moms are exceeding the targets (with rates of 86%, 79% and 80%, respectively).  White mothers may meet the target by 2010, since their breastfeeding rate in 2008 was 74%.  The breastfeeding rate of African American moms has increased significantly in recent years, but is still lower, at 51%. (See my podcast interview for a discussion of African American moms and breastfeeding).  And disparities by education persist. 

While we're making progress, we have a lot further to go when it comes to exclusive breastfeeding.  The goal for exclusive breastfeeding to six months was 17%, but the actual rate in 2008 was 10%. 

The Healthy People 2020 goals are now in development, and the draft objectives have been opened up to public comment.  I'm planning to comment on the need for a focus on disparities between different demographic groups, based on income, age, and race, for example.  A few years ago I wrote about some of these stark disparities here. 

You can comment here.  The public comment period is open until December 31st.

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Fall clearance sale at Motherwear

Motherwear has a great clearance sale going on right now, with lots of items marked down to make way for the winter styles.

To the right is the popular keyhole tee, marked down from $29.00 to $13.95.  A long sleeved version is on sale for $19.95.

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New York Times: "Breastfeed the Baby, Love the Calorie Burn"

I'm always surprised to find articles about breastfeeding in the New York Times, but I was shocked when I realized that I know the mother and baby whose picture is prominently displayed at the top!  We met a little while back at a breastfeeding group I run, and I think she had some of the most sensible comments in the piece.

The article states:

That breast-feeding gives mothers an edge shedding baby weight has long been suspected. But lately, a parade of celebrities has attributed their postpartum slimming to nursing, bringing this age-old topic back into the spotlight. Adding to the conversation is a large study that suggests that weight loss through breast-feeding is not a myth.

...Is it any wonder that some new mothers are quietly thrilled at the calorie cushion that breast-feeding provides? “Nobody wants to admit they are doing it for themselves, or ‘I’m doing it to help myself look hot again,’ ” said Jesse Comer, from Portland, Ore., [not the mother I met] whose main motivation to breast-feed was her baby’s health. “It’s tough to admit to other people that everything isn’t about the baby.” But Ms. Comer, like many mothers interviewed for this article, “felt like until the weight was off, I wouldn’t feel myself.”

For those incredibly shrinking women, the time they nurse is precious not only for its skin-on-skin cuddling, but also for the Get Out of Dieting Jail Free card that comes with it.

But does breast-feeding actually speed weight loss in postpartum women? It depends.

Last year, and epidemiological study of 36,000 Danish women found that the more a mother breast-feeds, the less weight she retains six months after birth. A few factors determined how much she lost: whether a woman was overweight before pregnancy, what she gained while expecting and duration of nursing, said Kathleen M. Rasmussen, an author of the study and a nutrition professor at Cornell.

So here's the thing about the guilt some of us feel when we experience weight loss with breastfeeding:  It may feel like it's about vanity, but it's actually about your health.  Numerous studies have shown that breastfeeding protects mothers against weight and metabolism related health problems, including diabetes, heart attack, coronary artery disease, obesity, and the high blood pressure, high cholesterol, and insulin resistance associated with metabolic syndrome.  Researchers attribute this to the weight loss and metabolism shifts that occur during breastfeeding.  Not burning off the weight - which your body added during pregnancy as a fuel source for breastfeeding whether you intended to breastfeed or not - puts you at a higher risk for these and other health problems.  So it's not just about fitting into your old clothes.  It's about your health.

Still feeling selfish for loving, as one of the stars of Ugly Betty put it, "nature's lipo?"  Just keep in mind this quote in the article from breastfeeding advocate Marsha Walker:  “We deserve it.  She ought to get into those skinny jeans after 9 months of pregnancy and 20 hours of labor. That’s what I tell mothers. Go for it.”

I know it doesn't work for everyone, and the article points that out.  My own observations:  Some women appear at a month as if they've never been pregnant, while others seem to have a huge appetite during breastfeeding and hold onto some of the weight until they wean.  Some mothers lose it gradually at first but lose more rapidly after the 6 month mark.  And some women struggle with the last few pounds until they wean, while others go well under their pre-pregnancy weight.  (This happened to me, and it wasn't pretty.  Between the hair loss, sleep deprivation, and extreme weight loss I looked a little like a prisoner of war.)  A few years ago I polled you (open with Explorer) on this topic, and I think the results show this, um, spread.

So, do you feel guilty for loving the calorie burn?

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Wordless Wednesday: Dorothea Lange photo "Migrant Mother," California, 1936

Source: Wikimedia Commons

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Join the November carnival: Breastfeeding experiences in the hospital

The theme for our next carnival of breastfeeding will be breastfeeding experiences in the hospital.  Here's your chance to join in!

Please send your submissions by November 16th.  The Carnival will be on November 23rd.  As usual, we'll be looking for posts that are:

- Well-written and grammatically correct
- Thoughtful and directly on point for the carnival subject
- Submitted by blogs that pertain to subjects of interest to our readers (breastfeeding, parenting, etc.)

If your post is selected for inclusion, you will be asked on the day of the carnival to edit your post to link back to each of the other participants in the carnival. Examples of past carnivals can be found here.

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Want to help in the fight against breast cancer? Post a flyer.

I've mentioned before that I help out with recruitment for a breast cancer study which uses breastmilk to identify molecular biomarkers for the development of cancer.

To participate, a mother has to be nursing, and have either had, or be expecting to have, a breast biopsy.  Mothers are sent a box to overnight mail their milk to the lab (at the study's expense) and receive $25 in thanks.  We've been helped a lot by the Avon Army of Women, but need to continue spreading the word.  If you think you may qualify, you can email Dr. Sarah Lenington.

If you don't qualify for the study, but would like to help out, please consider posting a flyer in your pediatrician's office, you OB or midwife's office, at your La Leche League meeting, or anywhere else you think nursing moms might see it.  You can download the flyer here, or you can email a request for hard copies from Dr. Sarah Lenington. 

More information about the study is at the study website.  Thanks for your help!

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Sesame Street breastfeeding clips

It's Sesame Street's 40th anniversary this week, and I thought I'd link back to posts I've done with breastfeeding videos from the show, just in case you missed any!

Sesame Street had it going on

Buffy nursing baby Cody

You're my baby (breastfeeding version)

Maria breastfeeds

I can't resist reposting this one of Buffy and Big Bird.  It's just too great.

Nipple creams in the Skin Deep database

I was recently playing around with the Environmental Working Group's Skin Deep database, checking to see exactly how bad my shampoo is for me, when I noticed that the database includes information on nipple creams.

Had any of you noticed that, or used the information to decide which one you use (if any)? 

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