Mad at Medela

I hate pumping. But it's a necessary evil for mums who are working, or who are unable to breastfeed their babies directly at every feed. I have never used a Medela breast pump. I tried it once and didn't like it, so didn't buy it. In the end, I bought an Ameda Lactaline, which cost a fraction of the price, but was lighter, and worked better.

After more than 6 years of breastfeeding, I am on to my second Ameda pump. When my first broke down a few years ago because I had dropped it on the floor one too many times, I was almost seduced by the Medela Pump in Style. I had heard and read great reviews about it. And the bag was cute too. But the price-tag was off-putting. And it was as heavy as a brick. I decided to stick with the devil I knew.

After reading this article on the problems with Medela, I am so glad I stuck with Ameda. Ignoring all of Medela's WHO Code violations (which I already find offensive), the idea that theirs is an open system with no way of ensuring that the milk is isolated and kept clean and uncontaminated, is sick-inducing. Based on this fact alone, I would encourage nursing mums to stay away from Medela pumps. (This does not apply to the Medela Symphony, which is a hospital grade pump, and since it is to be shared, has to be a closed system.)

I am not necessarily recommending Ameda, which has served me faithfully. My favorite method of expression are my hands. They are free, and you don't need to wash pump parts. More on hand expression another time.

World Breastfeeding Week 2009 (1 - 7 Aug 2009)

It's World Breastfeeding Week (WBW) once again. This year's theme is "Breastfeeding: A Vital Emergency Response. Are You Ready?" More information can be found on the World Breastfeeding Week website.

I don't really want to talk about event, and themes...I just thought it would be an opportunity to share some brief thoughts on breastfeeding. Earlier this year, I trained as a breastfeeding counsellor and currently I am a volunteer counsellor with a breastfeeding counselling hotline. Even though I have 4.5yrs of breastfeeding experience and have read widely on the subject, it's been a wonderful learning experience for me. And hopefully, I've helped a few mums along the way...

I receive many different types of calls. One of the most common (and painful) stories I hear from new mums is that they don't have enough milk for their babies. Many are exhausted, and suffering from post-natal blues. The apparent lack of milk affects their confidence terribly and makes them question if they are good mothers.

The lack of milk may or may not be real. If it's real, it frequently is due to poor breastfeeding management in the early post-partum period. The best way to ensure a good supply of milk is to drain the breast frequently and effectively, i.e. newborns need to nurse at least 8 - 12 times in a 24 hour period, or every 2 - 3 hours on average. A breast that is suckled sends signals to the brain to release hormones that are involved in milk production. So that when the baby is put to the breast more frequently, the breast starts to increase its production of milk and the baby gets more milk.

Unfortunately, this natural feedback mechanism is often not allowed to work. In hospitals, even those that claim to be breastfeeding friendly, a well-meaning but misguided nurse may encourage the mother to rest and leave the care of the baby to the nursing staff. As the baby is not allowed to nurse on the breast, the body does not receive critical information to jumpstart milk production. For mothers who are genetically blessed with an ample supply anyway, this may not be a problem. But for many mothers, this is the start of a series of problems that can make breastfeeding a very painful journey. A journey that many mothers decide not to complete.

The mother who thinks she doesn't have enough milk, may be tempted to give her baby formula, which then encourages the baby to drink less from the breast, which will in turn produce less milk. It is a vicious cycle.

If the young infant is fed through a bottle and artificial nipples, problems are compounded, as some babies develop a preference for artificial nipples. The mechanism for feeding from a breast is very different from the mechanism for feeding from an artificial nipple (which is generally why breastfed babies have better jaw development). And, even if the mother expresses her milk to feed to her baby through a bottle, a breast pump is not as good as a baby in emptying the breast. Expressing milk on a permanent basis is also very tiring for the mother, and she may be tempted to skip pumping sessions (especially at night). All these factors lead to dwindling milk supplies.

Fortunately, it is often possible to help these mothers achieve a full milk supply. However, it can be a very tiring process, depending on how far down the cycle the mother is. Strategies include getting the mother to nurse her baby more frequently, to ensure that her baby is actively drinking and not just mouthing at the nipple (i.e. milk is being removed from the breast), to pump after nursing sessions to ensure the breast is fully drained, getting the mother to rest, relax, eat and drink well. Often, a mother may have a lot of milk, but because she is stressed, the breast is not able to eject the milk. Finally, we may recommend herbal remedies, such as fenugreek, or medication, such as domperidone. Herbal remedies will not work if the mother is not able to drain her breasts frequently and effectively. Medication can be very effective. But it should only be used as a last resort, if other strategies have not worked very well.

The mothers I speak to are usually very encouraged by the fact that they can do something to make things right again. Often, I can hear their spirits lifted. But because it can involve quite hard work, I know that not all will last the course. Some are angry that they had been ill-advised. And, often, I am angry too.

There's a lot of advice on breastfeeding going out to new mums and mums to be. At the top of my list is always this: Supply = Demand. As long as you abide by this principle, you will always have enough milk for you baby.

Happy Breastfeeding!

World Breastfeeding Week 2008

It's World Breastfeeding Week (WBW) this week ( 1-7 Aug 08). This year's theme, "Mother Support: Going for Gold", is something I believe very strongly in.  

It is not enough to say that breastmilk is the perfect source of nourishment for infants and young children ("the gold standard" so to speak), mothers must be given support so that they are in the best position to make breastfeeding a reality for their children.  

Support should not be confined to the first days in hospital with the hospital lactation consultant.  Many mothers give up breastfeeding shortly after returning home, due to a lack of awareness and information on optimal breastfeeding practices.  More needs to be done to help mothers sustain exclusive breastfeeding for at least 6 months post-partum, and to continue breastfeeding for two years and beyond (WHO guidelines). 

Through my breastfeeding experience, I have come to realise that support must come from a variety of sources.  Mothers must start to learn about breastfeeding before the baby is born.  It is a suprise to many that breastfeeding, though a very natural act, needs to be learnt.  As mothers, we should do as much as possible to learn about it so that we can give our children the best start in life.  In a similar vein, hospitals need to provide "practical instruction" on breastfeeding in the first few hours and days after the birth of the child.  Someone needs to physically show the mother what needs to be done.  Counselling needs to be available even after the mother returns home, as many problems arise in the weeks after delivery. 

Home support is also critical.  My husband and mother, who took care of me during my confinement month, were extremely supportive of my desire to breastfeed exclusively.  Never once did they suggest that we feed our baby formula.  In my exhausted and hormonally-driven emotional state, I think I might have given in had the idea been brought up.  Even then, I faced difficulties.  

Beyond this, we need to see more support at the workplace, and within the community. Working mothers must be able to regularly express milk in a conducive environment during the workday so that her baby can be fed.  She must certainly not have to use the toilet to express her milk.  We do not prepare our meals in the toilet, so why should it be OK to prepare her baby's meals there?  She must also be able to nurse her infant in public without being asked to cover-up.  How would you like to be told to eat under a blanket? Breastfeeding is not obscene.  In anycase, usually very little of the breast is exposed and you won't notice it unless you are trying hard to look, you leering pervert. 

The Singapore Chapter of the Breastfeeding Mothers' Support Group is celebrating WBW. More information is available at their website.  If you are a breastfeeding mother, please support their activities. If you are not, do take some time to learn about breastfeeding, and what you can do to help our mothers help our children get the best start in life. 

Give the baby a bottle?

According to my husband, I'm a breastfeeding fanatic. I don't think I'm extreme. I just believe that breastmilk is the best food for babies and that formula companies (and some doctors) have done many children a great disservice by trying to convince mums that formula is better than or as good as breastmilk (though nowadays they go about it much more subtly). But more on that some other time. 

My first baby was breastfed exclusively for 6 months. He has never had any formula. And had his first taste of regular cow's milk at around 18 months.  He continues to nurse and will continue to do so until he is ready to wean.  However, as I went back to work when he was about 3 months, he was fed expressed breastmilk (EBM) via the bottle while I was at work. 

My second baby is now 3 months old and is also exclusively breastfed.  I'm not returning to work for awhile, so there really hasn't been any need to introduce the bottle.  The one time we had to do it was when my hubby and I went for our first date 2 1/2 months after the baby arrived.  Baby didn't like it at all, and ingested only a tiny amount of EBM before falling asleep. 

Somehow the knowledge that my baby didn't like the bottle gives me great pleasure.  For some women, being able to give their baby a bottle represents freedom. Freedom to reclaim some part of their lives from the all consuming needs of the baby.  While I dearly miss my pilates classes, I don't feel ready to give my baby up to the artificial feeder, and to the knowledge that I can be replaced! I suppose, having experienced mommy-hood once before, I am all too aware of how quickly my baby will grow and learn to separate from me. My time with the baby now is so precious. The pilates classes can wait. The bottles can wait.