“Mothers deserve better”: An interview with Dr. Christie Del Castillo-Hegyi

Dr. Christie Del Castillo-Hegyi, MD, is a mother – and a physician- on a mission. Since she began her blog and Facebook page a few months ago, she’s become a hero to over 10,000 parents who have experienced insufficient milk or delayed lactogenesis II (the process of breastmilk “coming in” after birth). She has been tirelessly advocating for better safeguards for breastfeeding mothers, and fighting against the dogma that insists that supplementation is detrimental to a baby’s health. 

I’m honored to bring you this interview with Dr. Del Castillo-Hegyi. Her opinions are controversial, and I really admire her bravery, and how she’s turned a negative personal experience into a plea for change. Before we make blanket recommendations that force women to weigh their gut instinct against the fear of recriminations from medical professionals and hospital staff, it’s essential that we look at ALL the research- without bias, without blinders, without fear. 

– The FFF

“Mothers Deserve Better”:

An Interview with Christie Del Castillo-Hegyi, MD.

FFF: Your blog and Facebook page are called “Insufficient Breastfeeding Dangers”. What are the dangers of insufficient feeding in a newborn, exactly?

CDCH: The known potential effects of insufficient feeding are dehydration, low glucose, elevated bilirubin (jaundice) and high sodium.  All in all, those laboratory markers make up the syndrome of starvation.  Dehydration, if extreme enough, can cause decreased circulating blood volume, low blood pressure, and decreased circulation to the brain.  This can cause brain injury and even death.  In animal studies, thirty minutes of loss of circulation to the brain can cause widespread brain cell death.

 

Extreme dehydration results in hypernatremia, or high sodium, because as a baby loses water, the sodium will become concentrated.  Their brains can experience contraction similar to dehydrated fruit, which upon re-expansion through rehydration, can result in brain swelling and irreversible brain injury.  It has been documented in the literature that hypernatremic dehydration can result in brain swelling, brain hemorrhage, seizures and even death.

 

It is not clear how long a child can tolerate exclusive colostrum-feeding before they develop hypoglycemia.  I have had one mother whose child seemed dissatisfied from exclusive colostrum-feeding for only one day and was found hypoglycemic by the second day.  It is difficult to know what the typical time to developing hypoglycemia of an average exclusively breastfeeding child because glucose is not routinely checked in babies without a diabetic mother or other traditional risk factors.  Hypoglycemia eventually happens to all babies if they do not receive enough milk through breastfeeding either due to poor supply or poor latch.  EVERY article in the known medical literature that has studied newborn hypoglycemia shows evidence of harm in the form of abnormal MRI findings and decreased long-term cognitive outcomes.  A low glucose is typically cited as a glucose level of less than 45, even though some newborns may exhibit few signs of distress even at this level.  Signs of a hypoglycemic newborn is agitation, frantic feeding, inconsolable crying or lethargy.

 

Lastly, insufficient feeding can result in a third dangerous condition, called hyperbilirubinemia or jaundice.  A bilirubin of greater than 15 is considered abnormal in the literature and has been associated in multiple studies around the world with a higher risk of autism relative to newborns who don’t experience high bilirubin levels.  One study refuted these findings and it came from the Kaiser system, which is a Baby-Friendly hospital, where exclusive breastfeeding from birth is encouraged.  They produced a study that was well-done but was thousands-fold smaller in size that the largest study, which showed a positive correlation, in Denmark, where they studied the ENTIRE newborn population over 10 years, which included over 700,000 newborns.  The Denmark study found a 67% higher risk of autism in jaundiced newborns.

 

That being said, I don’t want to worry every mom whose child had jaundice.  Not every jaundiced newborn has a level above 15.  Also, not every child who develops a level above 15 will develop autism.  Autism is still a genetic disease.  I believe babies who are born with a lot of autism genetics, as predicted by having lots of scientists, mathematicians and engineers in their families, who experience a physiologic insult, such as lack of oxygen to the brain and jaundice (both demonstrated in the literature to be associated with autism) may go on to have the disabling condition of autistic spectrum disorder.

FFF: What sparked your interest in this issue?

CDCH: My newborn son developed hypernatremic jaundice and dehydration because I was assured by the breastfeeding manuals that there is always enough milk in the breast as long as I keep breastfeeding.  I was told that, “he would be hungry” and that my “latch was perfect” by our lactation consultant the day we left the hospital.  No one ever told me it was possible for a child to become dehydrated and unconscious because there was not enough milk present.  We were told to count the diapers but how wet is a wet diaper?

 

My son lost 15% by the third day, the day after discharge and my pediatrician must not have calculated the percent lost because he gave us the option of continuing to breastfeed and to wait for the 4th or 5th day.  I realized when I was watching my son get an IV that what I did must be common and that other mothers must be experiencing this horror too.  I thought, “What must my son’s brain injury look like and why hadn’t I heard of this before?”  Three-and-a-half years later, I found out what his brain injury looked like.

 

What I saw with my own physician- and mother-eyes was the slow torture of a newborn child.  Babies who are asked to endure hours of frantic feeding without compensation of milk, otherwise known as “cluster feeding,” are experiencing agony.  No textbook, lactation consultant or physician will ever convince me otherwise.  To this day, the description of what I saw is embedded in every breastfeeding manual as normal and vital for the stimulation of milk production.  We are systematically telling new mothers to ignore their child’s hunger cues by telling them there is ALWAYS enough colostrum and by scaring them into withholding formula even when a newborn needs it.  THAT is why newborn dehydration will never go away with simply increasing breastfeeding support and follow-up appointments.  Unless a mother is given the knowledge about the potential harms of insufficient feeding and the right to feed her own baby, newborns will continue to experience these complications and be hospitalized for it every day.

FFF: When you began researching the topic, was there anything that surprised or shocked you?quotescover-JPG-66

CDCH: I began researching the topic shortly after receiving our son’s formal diagnosis of autism, which was February, 2014.  I first studied jaundice and autism and was surprised that there were so many studies that linked the two conditions, because I had never heard of the risk factor listed in the patient literature on autism.  I wondered why a modifiable risk factor would not be heavily attacked in the face of an epidemic.  I believe it is because it is linked to breastfeeding.

Breastfeeding has enjoyed an untouchable status in the medical community.  So much so that no part of it as outlined by the lactation community has been challenged by the physician community.  We assumed because it is associated with breastfeeding, what ever the guidelines are must be safe, despite evidence that many newborns on a daily basis get admitted for dehydration and jaundice from exclusive breastfeeding.  Unfortunately, any challenge is quickly met with an accusation that the individual is “anti-breastfeeding” or “pro-formula,” when in fact, perhaps it may simply be a challenge like mine, whose purpose is to keep the newborn safe from harm.  I am surprised by the lack of activism by the medical community to reduce or stop the incidence of a horrible, life-threatening and brain-threatening condition that can be prevented with informing mothers of these complications and a few bottles of formula to keep a child out of the hospital.

quotescover-JPG-42I was surprised to find out that we really haven’t exclusively breastfed from birth for millennia before the creation of formula.  If that were so, indigenous cultures that have no access to formula currently would be doing so nearly 100% of the time.  In fact, there is no evidence that we have widely exclusively breastfed from a single mother at all.  According to a review of the history of breastfeeding written by an IBCLC, lactation failure was first described in Egypt in 1550 B.C.  Wet nurses were often employed to feed newborns whose mother could not lactate.  There are modern day cultures where babies are breastfed by a community of mothers, not just one mother.  Also, the breastfeeding literature is rife with articles showing how problematically low exclusive breastfeeding from birth is all around the world because most cultures give what they call, “pre-lacteal feeds.”  These moms probably just call it “feeding.”  Moms all over the world recognize that their children may need more than what is coming out of the breast and they have populated their countries on the tenets of feeding their children what they need every day.  It wasn’t until the breastfeeding resurgence in the 1980’s and the codification of exclusive breastfeeding from birth through the Baby-Friendly Hospital Initiative of the World Health Organization written in 1992, that we started feeding newborns colostrum-only during the first days of life in the hospital.  This was written primarily to counteract the dangerous feeding of formula prepared with contaminated water to babies in the developing world, which was an important public health endeavor.  However, the guidelines to exclusively breastfeed for 6 months largely ignored the common possibility of insufficient milk production experienced by many mothers.  So feeding newborns without supplementation only began in the 1990’s.

Nurses who worked in the newborn nursery in the 1980’s account that newborns were supplemented from the first day of life with 2 ounces of formula.  Most newborns tolerated these feeds and did not vomit it as widely claimed by the lactation community.  I found that the newborn stomach at birth is not 5 cc, as claimed by the lactation community.  It is in fact roughly 20 cc’s or 2/3rds an ounce, as summarized by a review of 6 different articles looking at actual newborns.  This is also the static volume of a newborn stomach and may not account for peristalsis, which may allow a newborn to accommodate more.  I discovered that it is quite implausible that the stomach can grow 10 times its size in 2 days and that a one-day-old newborns can in fact drink 2 ounces in one meal without vomiting at all.

Many moms asked me, “How much weight CAN they lose?” and “What DOES my newborn need?”  I looked again to the literature looking for evidence showing the safety of weight loss in newborns and NOT A SINGLE ARTICLE showing that 10% weight loss over 10 days is safe in every newborn, which is the current standard of care.  This teaching has been accepted for decades now.  To answer the second question, I sought out what a one-day-old’s daily caloric requirement was and what the caloric content of colostrum is.  I found that a one-day-old’s caloric requirement is the same as that of a three-day-old’s, because they have the same organs and same activity all three days.  A one-day-old newborn needs 110 kcal/kg/day and colostrum has 60 kcal/100 mL.  I must have done this calculation by hand 20 times because I found that this resulted in a one-day-old needing 2.8 ounces of colostrum per pound per day .  A 7 lb child would need 19.6 oz of milk in one day.  I confirmed this finding because I gave my 5.5 lb twin girls free access to supplementation and they each took 2 oz every 3 hours on their first day, a total of 16 oz.  They only gained 1 oz! That leaves 15 oz going completely toward their metabolic activity.  For them, they required 2.7 oz/lb/day.

How much actual science and observation of actual babies and safety data was done to come up with the breastfeeding guidelines?  There are many articles that show that unlimited supplementation can reduce breastfeeding duration, which is why formula is withheld from babies, but none that showed this practice was safe for the baby’s brain in the long run.  We have no idea what threshold of weight loss is in fact safe for a baby’s brain, because it has not been studied.  While babies’ bodies can endure days of underfeeding, their brains cannot.  That is what I am asking the scientific community to study.

FFF: Do you think that medical professionals are afraid to say anything that could be construed as “anti-breastfeeding”? How have your peers responded to your work in this area?

CDCH: Yes, medical professionals are afraid to say anything contrary to what the lactation community accepts as true because they do not want to be perceived as “anti-breastfeeding” or “pro-formula.”  Being “pro-formula” or “formula-sponsored” is a common accusation that I receive despite all the “pro-breastfeeding” instruction that I provide.  People have assumed that if you are against any part of the breastfeeding prescription, you MUST be against breastfeeding.

I am absolutely pro-breastfeeding.  I am absolutely AGAINST starving a child to achieve it.  I have received quiet support from several of my peers, but mostly silence for the majority.  I believe colleagues who are silent are incredulous or shocked or afraid.  I can’t truly know.  I can understand it because I am a physician and we are taught to stick close to the pack.  I am literally running away from it.

Until there is data from a credible and impartial source like the CDC or the Joint Commission, I will not have the proof that the Baby-Friendly Hospital Initiative is causing long-lasting harm.  There is already plenty of harm that has resulted locked in the hearts of many mothers who experienced this trauma.  I hope moms from both our Facebook sites will be willing to help advocate for increased safety for newborns by submitting written and/or video testimony on how the BFHI harmed them and their child.

FFF: What sort of response have you received from publishing your blog and Facebook page? 

CDCH: Outrage from breastfeeding moms and opposition from most lactation consultants except for a loved few, two of which fully recognize the harms of insufficient feeding to baby’s and their moms.  However, the ones I live for are the responses from moms who say that this happened to them and their babies either were harmed, hospitalized or were luckily saved from harm by an independently minded mom, nurse or other individual that told them their baby was hungry and needed a bottle.  These moms write to thank me for validating what happened to them and for telling them that this was not their fault, that what they saw was real and that this should never happen to any mother and child.  I have received messages from moms experiencing what I describe in my letter in real time and I have helped those moms advocate for their child, even when their professionals were bullying them to keep withholding formula!  It’s crazy.  What are we doing to our newborns?

What I feel most disappointed about is the lack of response I have received from the Executive Committee of American Academy of Pediatrics who I have been trying to contact for at least 6 months.  No response from the organization that is supposed to protect our newborns.  So I decided to inform the public on my own.  At first I was afraid.  Now I am not.

FFF: Have you endured any personal or professional attacks due to asking these tough questions about our current protocol for early breastfeeding?

CDCH: Tons.  People on the internet can act with cruelty because they don’t have to suffer any consequences.  I try not to let it get to me because I know it comes from a place that is likely sincere like mine, a mother trying to protect her newborn from harm.  Some mothers perceive my ideas as harmful, likely because the thought of starving your child is so horrible, I get the most harsh messages from breastfeeding moms, often moms whose children developed pathological weight loss.  I haven’t received too many challenges from physicians though, interestingly enough.  At least among my colleagues on Facebook, I have received supportive messages.

FFF: In an ideal world, how do you think hospitals could alter their procedures to better protect babies and mothers from the dangers of insufficient breastfeeding?

CDCH: These are my core recommendations:

1) Instructional videos on manual expression to check for the presence of colostrum.  Mom should also be instructed on listening for swallows to detect transfer of milk.

 

2) Pre- and post-breastfeeding weights to ensure transfer of milk and identify newborns at risk for underfeeding.

 

3) Calculation of the 7% weight loss threshold at delivery so that a mother knows when supplementation may be needed, which can be posted in her room.  The most critical clinical data an exclusively breastfeeding mom needs to know is the percent weight loss of her child.

 

4) Universal informed consent and thorough counseling on the possibility of underfeeding and jaundice due to delayed or failed lactogenesis and giving mothers permission to supplement their child if they go under the weight limit at home using a baby scale. Mothers must know the signs of a newborn in distress including hours of feeding continuously, crying after unlatching, and not sleeping. Most of all, a mother should be advised to check her supply by hand-expression or pumping to ensure that her child is in fact getting fed.  If little milk is present, she should be given permission ahead of time to supplement by syringe with next-day follow-up with a pediatrician and lactation consultant to assess the effectiveness of technique and transfer of milk if such an event arises.

5) Uniform daily bilirubin (abnormal total bilirubin > 14) and glucose checks (abnormal glucose < 45) for exclusively breastfed infants who are losing weight or who have any degree of jaundice.  Both these values are critical to detect physiology that can cause brain injury.

6) Twice daily weight checks in the hospital and at home until lactogenesis and consistent milk transfer has been established with a mother-baby dyad.  These can be plotted before discharge to predict the expected weight loss the day after discharge if mother’s milk does not come in.  A mother can check the weight at home and supplement if the child reaches the weight loss threshold.

7) Detailed instructions on supplementation only after nursing to continue the stimulation needed for milk production.  Supplementation should be a choice and be accepted and supported by the medical community as a patient right.  A mother has the right to feed her child above all goals the medical community has for her.

8) A breastfeeding safety checklist to reduce medical error in the care of a mother and exclusively breastfed newborn.

 

Lastly, my advice for new mothers at home is to have an experienced parent around for the first week to help.  Parents need sleep and they don’t get much in the postpartum period.  Additionally, experienced parents know the look and sound of a child who is hungry or in distress.  The child’s wishes should be honored.  I believe in the human rights of a newborn to be fed what they need because following the alternative can lead to what my son experienced.

FFF: Your page grows in popularity every day. Have you been surprised at how many mothers have been affected by this issue?

CDCH: I am not surprised by how many mothers have experienced this issue.  Mothers have been experiencing this for 2 decades now since exclusive breastfeeding from birth has been the mandate.  This is the first that the experience is being made public because mothers have been uniformly shamed for having their child go through this.

Even now, people still post comments that blame me for not knowing, for not producing enough milk, for not seeking out enough help when the entire teaching by the lactation community prevents a mother from knowing this is possible and the standard of care does not detect what is coming out of a mother’s breast.  We have been taught to abandon responding to a baby’s cry in order to achieve exclusive breastfeeding and rely instead on weight checks and bilirubin levels to determine “medical necessity” for supplementation.

What are we doing with our newborns?  What are we doing to our mothers?  It breaks my heart every day the things mothers have told me about inadvertently starving their newborns.  They all sought help and all followed the instruction of their providers while seeing that there was something wrong with their child.  But they were told breastfeeding is always enough as long as your child is producing diapers.  What we are doing is NOT enough. These are the most well-intentioned and motivated mothers who do this. They read parenting books, attend classes and follow their doctor’s orders like I did.  I was in the hospital for a whole 48 hours while my son was receiving nothing for me!  Then I was at my pediatrician’s office the next day, at a lactation consultant’s office the day after and in the hospital by that evening.

Mothers are being led astray by the current breastfeeding dogma and being led to hospitalize their precious babies.  These mothers deserve better.

Vist Dr. Del Castillo-Hegyi’s Facebook page for more information: https://www.facebook.com/insufficientbreastfeedingdangers?fref=ts

 

 

FFF Friday: “No one told me about the possibility of this not working…”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so. 

There’s a lot that bothers me about the way breastfeeding is presented to women (which I suppose is, erm, rather obvious), but the whole “only 1-5% of mothers can’t breastfeed” is definitely near the top. Not only is this statistic based on limited, shaky research, it is also completely misleading. Lou Gehrig’s Disease (ALS) affects .002% of the population, and there are telethons for it (as there should be, of course). Women with lactation failure are ignored, ridiculed, and told it’s all in their heads. I’m certainly not comparing ALS with lactation failure (please) but merely making the same point Lisa Watson of Bottle Babies did in her brilliant post about this issue: 1-5% of women is nothing to scoff at. 

As Karly writes in her beautiful, raw post below, “This was my baby and my body, and I knew them both best.”. It’s odd to me that this same sort of rhetoric is used to justify so much of the natural birth movement, but it is turned on it’s head when the subject is breastfeeding. Maybe some of us need to take a long hard look at our own hypocrisy, as feminists and maternal health advocates. 

Happy Friday, fearless ones,

The FFF

***

Karly’s Story

Now that my breastfeeding journey is coming to a close, I feel I finally have the emotional stability to tell my story. I never thought I would be writing something like this when Olivia was only 7 weeks old, but you know the saying, “the best laid plans are laid to waste.” And for me, this was no exception.

I’ll start out by saying that I truly believed that because I so deeply wanted to breastfeed, that I could just do it. I embraced the La Leche League belief system that all woman could breastfeed and that very few woman had actual supply issues that kept them from doing so. I threw out all the free formula I got in the mail, didn’t register for any non-Medela bottles on my baby registry, and did my share of breastfeeding classes, book reading, and research. I told everyone I knew that I wanted to breastfeed for accountability. I was so excited to partake in something so “natural.” I didn’t realize that there was much more to it than a willing heart and a pair of boobs.

My breast feeding journey didn’t start out the way I had planned, and since becoming a parent, I realize that not much does follow the way of our intentions! When Olivia was born, she had accelerated  breathing and was immediately whisked to the far side of my delivery room for monitoring. After she settled down, I was able to spend 10 minutes with her before she was taken to the transitional nursery for 5 hours. I desperately had wanted to nurse her right away, because that’s what everyone says you’re supposed to do to establish a good breastfeeding relationship. I was a little worried I wasn’t able to, but my maternal instinct was already rearing its head and all I was truly concerned about was her being healthy. When I was finally able to spend time with her, it was 10pm and there were no nurses around to help me. I buzzed my less than helpful and attentive nurse and she showed me the football hold and told me that Olivia wasn’t really nursing and couldn’t I tell? “See,” she said, “her cheek muscles aren’t really moving and you can’t hear any swallowing.” I was already starting to feel awful about my abilities to properly nurse. She told me a lactation consultant would come around the next day.

Around 11am the next day, a LC arrived and spent a reasonable amount of time with me. She ascertained that Olivia didn’t have tongue tie (good news) but that she had a high palette, which made it difficult for her to latch because her mouth was so small, and I have slightly retracting nipples.  She gave me a nipple shield and it seemed that Olivia was able to finally grab on to something. I tried nursing all day and it “seemed” to be going well, but I couldn’t really tell.

The next morning the pediatrician made his appearance and when we told him that Olivia wasn’t really producing that many diapers, he was concerned. He suggested supplementing with a 1/2 ounce of formula to prevent her from being dehydrated. I had to suck back my tears until he left. I was devastated. All the books and websites and avid breast feeders had “warned” me this might happen, and to not give in. When my newly on-shift nurse arrived, I cried with her. She was super understanding and reminded me that I needed to make sure Olivia was taken care of.

This was the first time I realized that a commitment to breast feeding can sometimes jeopardize your child’s health. If I hadn’t decided right then to make sure my child’s health came before my desire to only breastfeed, Olivia could have ended up hospitalized for dehydration (and I know this happens because I’ve heard first-hand about it). This is by no means a judgment on people who decide to take a different route than I did when listening to their doctor. However, I personally, could not justify it.

To abate my fears, my nurse showed me how to supplement the formula with a syringe and straw, so that Olivia would still practice her breast feeding skills and not be at risk for nipple confusion. She wouldn’t even notice what was happening. But I did- and no matter what I told myself, I felt awful. I hadn’t wanted to even touch formula, and here I was, supplementing in the first 30 hours of Olivia’s life. I felt inadequate and crippled. Everyone had told me that babies stomachs were the size of marbles and that the small amount of colostrum I had would surely be enough. But it wasn’t, so what was wrong with me? I had pumped what little colostrum I could relinquish, and it was about a 1/4 ounce (less than 8ML). It almost made me feel worse to actually see how little I had.

Everyone assured me that my milk would come in over the weekend, days 3-4, and not to worry.  I kept up hope, but still worried. As soon as it came in, I could stop supplementing. When I got home, the syringe and straw didn’t feel so easy anymore. It was near impossible to get it into Olivia’s mouth where she would do all the work and suck the formula out. After a few attempts, we started just squirting it directly into her mouth. I cried every time I had to attempt the syringe because she would unlatch when I accidentally poked her in the mouth. When she got frustrated she would bob her head and grab at my breasts, ripping off the nipple shield. I don’t think I’ve cried so much as I did those 4 days at home. The worst part was, I would nurse for an hour+ each time, and she would cry and root after each session because she was still hungry.

As the weekend ended, I knew something was amiss. There had been no change in my breasts at all- no engorgement, no let down sensations, no happy baby at the end of a marathon nursing session: only a hormonal wreck of a first-time mom who realized that her breasts were letting her down.

I signed up for a breast feeding workshop and was elated at the thought of some help and encouragement. The LC weighed Olivia before and after a 40 minute feeding and I was horrified to learn she had only taken in a 1/2 ounce in all that time. Add to it the fact that she had lost 9 ounces of her birth weight and had not gained any back in a week, meant I left the workshop in tears. My husband was so encouraging, but let me know that breast feeding was something I may have to just let go of. I wasn’t ready to hear it and sobbed the entire way to the health food store, where I purchased Fenugreek and Blessed Thistle supplements in hopes of increasing my supply. We committed that day to supplementing after every feeding to get Olivia’s weight up to par. Prior to that I fought every supplement because I had wanted to be enough for her alone.

When Olivia was 9 days old, we weighed her again at the Mother Baby Assessment Center in our hospital. She had only gained 1/2 an ounce in 2.5 days since we were last there. I was beginning to feel worse than a failure. I had been taking the supplements but wasn’t noticing much of a difference in Olivia’s satiation at the breast, or when I pumped.

The stress of even the idea that breastfeeding wouldn’t work was beginning to consume me. I spent hours on the internet trying to read other people’s stories of how they overcame supply issues, or how I could produce more. I couldn’t sleep well enough to feel rested, which I’m sure only made milk production worse. I knew that if I didn’t overcome this, I would be entering into postpartum depression. That day, I made a private appointment with a LC for the following Tuesday. But when I made it home, I didn’t even think I could make it that long. I wanted to quit, and quit right then. My husband wouldn’t let me, telling me he would be disappointed in me if I didn’t make it to my appointment, which was right around Olivia’s 2 week birthday. It hurt to hear him say that, because all I wanted was a way out. But I realize now that he didn’t want me to look back and regret quitting, but to do it when I was emotionally stable (as if that’s even possible in postpartum days!).

I reached out to a La Leche League leader in my area, who pretty much verbally vomited the same things I had read in the Womanly Art of Breastfeeding: very few woman have supply issues, just keep putting the baby to the breast, don’t supplement, feed on demand. She made me feel worse than I already did, because if “most woman don’t have issues,” then either something was wrong with me or I wasn’t trying hard enough. She couldn’t really say much when I told her that Olivia wasn’t even producing enough diapers- the tell tale sign that babies are getting enough breast milk.

I’m proud to say I made it to my appointment! I have to admit, I went with the intention of quitting as soon as it was over. The LC could tell I was on the verge of losing it. We nursed and weighed Olivia again and this time she took in 1 ounce, instead of 1/2 like the week before. Obviously, Olivia was growing and was only going to need more, and even this clearly wasn’t enough. The LC looked at me and told me that any milk Olivia got was good. It didn’t matter if I could exclusively breastfeed or not. She told me if all I could handle was nursing 1x per day then pumping, that was ok. She said it was my baby, not hers, and she wasn’t going to tell me to do something I couldn’t. She diagnosed me with a lactogenesis disorder, or a milk production problem.  She gave me a way out and made me feel like I could finally let go.

After that appointment, I felt a weight lifted. This WAS my baby and my body, and I knew them both best. I knew there was something wrong with my milk production, no matter what any La Leche League leader told me (which, coincidentally was to nurse EVERY HOUR. That’s not even humanly possibly as a new mother, and especially not emotionally possible for the wreck that I was at the time). Because the stress of exclusively breastfeeding was gone since I knew it wasn’t possible, I moved to only pumping.

Even then, I would pump 5-6x per day and still only get 5-6 ounces for the entire day, less than a quarter of what Olivia still needed. I started to walk down the road of depression again when my milk supply wouldn’t increase, no matter how frequently I pumped or how much fenugreek I took. Pumping made me feel almost embarrassed in a way, watching my ugly, not quite working nipples be tortured into giving up droplets of breast milk. When I found blood in my preciously stored milk (which is completely normal and not harmful for baby), I decided my days of breastfeeding/pumping were done. It was like the blood signified everything I was willing to put aside to just make it work- and it made me feel horrible. So I packed up my pump, bottles, and flanges. I put them out of sight and don’t plan on looking at any of it for a long while. It’s all over.

Formula feeding was never the issue for me. I don’t think its poison or that it contributes to obesity. If it was truly unsafe, it wouldn’t be on our shelves. It really wasn’t even about Olivia. I was mostly thinking about myself and what breast feeding was for ME. My sweet baby doesn’t care how I got the liquid in her bottle, only that I love her enough to give it to her when she needs it. And let’s be honest- when she’s in kindergarten I’m not going to be looking back and constantly thinking about how I couldn’t really breast feed. I needed a little more perspective.

The real issue is that I was truly uninformed about breast feeding. True, most women can breast feed in some form- but it’s not true that most women can exclusively breast feed. Many women have supply issues. Once I started having issues, all my girlfriends started coming out with the problems they had as well. Where were they all when I was standing on my soapbox, proclaiming my imminent success as a breast feeder, while secretly judging people who gave up? And on top of it, I had major guilt about all the breast feeding supplies we’d spent money on that would be useless to me. We had JUST bought a $250 breast pump! No one told me about the possibility of this not working! As my husband puts it, the books I read on breast feeding were selling something: an idea that sounds perfect, but that is rarely ever obtained. I dealt with feeling duped and stupid because I bought into it.

I ran the gauntlet of feelings the last 7 weeks. Emotionally, I had times of resenting my new baby, my body, and my husband. Physically, I was exhausted and bitter at my anatomy. I went through the stages of grief: denial, in that I never thought it could be happening to me; anger and bargaining with God; shameful depression; and finally today, acceptance.

I wanted to finish this post as I let my milk dry up. The physical pain is what I wanted from the beginning- to signal an imminent, successful breast feeding journey. Instead it’s a bittersweet end to something that I need to move on from. I started writing this in the throes of my post partum hormones. Now, 5 weeks later, I’m finishing it. When I went back to read what I started, tears started streaming down my face as I remembered the anguish I was feeling. I never want to feel that way again, and am so glad I am on my way to accepting God’s plan for motherhood, even though I’m still a little sad about it now and then.  I can finally put down the breast pump and spend time with my Olivia.

***

Have a story you’d like to share? Email me at formulafeeders@gmail.com.

 

Can breastfeeding concerns be overcome with support? Depends on what “support” means

Guess what? Women are having trouble meeting their breastfeeding goals.

Contain your excitement.

Apparently, this is news to the American Academy of Pediatrics, and every major news outlet in North America. The study causing such shock and awe came out this Monday in the journal Pediatrics. Researchers used self-reported data (i.e., interviews) from 532 first-time moms giving birth at a particular medical center (can’t find where, and due to geographical differences in levels of breastfeeding support and acceptance, I think this is vital information that at least one of the articles could have shared with us). The women were asked prenatally about their breastfeeding intentions and concerns, and then re-interviewed at 3, 7, 14, 30 and 60 days postpartum. According to Reuters:

During those interviews, women raised 49 unique breastfeeding concerns, a total of 4,179 times. The most common ones included general difficulty with infant feeding at the breast – such as an infant being fussy or refusing to breastfeed – nipple or breast pain and not producing enough milk.

 

Between 20 and 50 percent of mothers stopped breastfeeding altogether or added formula to the mix sooner than they had planned to do when they were pregnant.

 

Of the 354 women who were planning to exclusively breastfeed for at least two months, for example, 166 started giving their babies formula between one and two months.

 

And of 406 women who had planned to at least partially breastfeed for two months, 86 stopped before then.

Given these results, the study authors come to the conclusion:

Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity concerns occurring within the first 14 days postpartum. (Source: Pediatrics)

 

The headlines, as usual, were both amusing and infuriating. “Nursing Troubles May Prompt New Moms to Give Up Sooner”. “Early breastfeeding challenges make women quit.” “Some moms discontinue breastfeeding within two months die to nursing difficulties”. And my personal favorite, “95% of breastfeeding problems are reversible.”

One might easily blame the media for their usual skewering of the science to make for a juicier headline, but one can hardly blame them when the experts giving interviews about this study say things like, “It’s a shame that those early problems can be the difference between a baby only getting breast milk for a few days and going on to have a positive breastfeeding relationship for a year or longer… If we are able to provide mothers with adequate support, 95 percent of all breastfeeding problems are reversible.”

So, what’s my issue? I think the study is fine. Sort of a no-brainer, considering they could’ve came to the same conclusion years ago had they just listened to moms instead of insisting we just needed more convincing of the benefits of breastfeeding, and we’d all magically lactate to the satisfaction of the World Health Organization. But the quote above (from Laurie Nommsen-Rivers, one of the study authors) makes me wonder if the results of the study are being taken in the wrong context.

The focus is on moms not getting enough support –  something that I 100% agree needs to be focused on. Like, yesterday. But where the experts quoted in these articles and I part ways is on what type of support is needed. This passage from NPR illustrates my point:

The researchers didn’t do physical exams of the moms and babies, so they don’t know what was happening for sure. But they speculate that some of the first-time mothers may have misread the babies’ cues, mistaking fussiness for hunger, for instance, or thinking the babies weren’t getting enough milk when they’re doing just fine…

 

Once again, the assumption is that women are wrong about their bodies, and about their babies. The study authors surmise that access to lactation consultants in the first week postpartum, after hospital discharge, will be the solution to many of these problems. Again, I absolutely agree that this is a great start. And yet – reading through the scores of FFF Friday stories, I have to wonder… is this really going to make a difference, given the current state of our breastfeeding culture? How many LCs have we all seen, cumulatively? How many were bullied or shamed by medical professionals? How many of us have been told our babies were fine, only to end up in the ER with a dehydrated infant? How many of us were told – by professional lactation consultants and pediatricians – that every woman can breastfeed, and that we should just keep on nursing and it will all work out?

Looking at this study, this is what I see: a ton of women are claiming to have pain, trouble latching, and concerns that their babies aren’t getting enough milk. NPR also reports that the group with the least amount of reported problems was comprised mostly of women under 30, and women of Hispanic origin. That begs for further research, doesn’t it? Could age and legitimate lactation failure be associated? What about race/ethnicity? Are there conditions more prevalent in older, non-Hispanic populations that are also associated with breastfeeding problems?

And this is what I also see: We have an opportunity – no, a responsibility- to look at the type of support these women are getting. Is it truly evidence-based? Or is it based on dogma; on the belief that “95% of breastfeeding problems are reversible”? (By the way, I am super curious about the research backing up that claim.) Are the individuals giving the support truly listening to the mothers, examining them, considering the delicate balance of hormones necessary for lactation, or the effect of emotional or physical trauma around birth on a woman’s ability to withstand latching pain or her infant’s cries? Is there nuance? Are these mothers being seen, or are they being treated as uniform breasts, needing to be “handled” so that they can fulfill their duty of providing exclusive breastmilk for 6 months?

I’m not knocking a study that advocates for more support for moms. I simply want us to open up the discussion, rather than going in circles, with the same researchers and the same experts telling us the same things – if mothers only knew better. If they could only be taught to recognize their babies’ cues. If they would only listen to us. 

I think it’s time they listened to us, instead. Which brings me to what I’d really like to see from this study: a follow-up where they ask the women who “failed” to meet breastfeeding recommendations what they think would have helped them reach their goals. Because without that piece, I really don’t think we can get very far.

 

FFF Friday: “I didn’t have the confidence or the mental clarity to stand up for myself.”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so.

All I can say about Amy’s story, below, is THIS. THIS is why breastfeeding support must be secondary to supporting moms, full stop. THIS is why the medical community and the breastfeeding advocacy machine is failing us. THIS is why there are “defensive formula feeders” peppering message boards, attempting to share their truths, and being accused of making up stories and scaring other women out of nursing. THIS is why women are getting angry and fighting back. THIS is why people are starting to think the pendulum has swung so far and so hard that it’s bonked us all in the head and made us stupid. This. This. And THIS.

Read on, rage on, and don’t stop reading and raging until the world stops acting like a petulant child and realizes that new mothers are being trampled on, right and left; that women are being told that they don’t know their own bodies; that we’ve completely missed the forest for the trees.

Happy Friday, fearless ones,

The FFF

***

Amy’s Story

My sweet, healthy, formula-fed little boy is now one year old. For the first seven months of his life, I supplemented his formula with whatever small amount of breastmilk I could muster through insane efforts.

Looking back, I know that exclusive breastfeeding was never going to work for us. I have two conditions that interfere with milk production: insufficient glandular tissue (aka hypoplastic breasts), and hypothyroidism. But none of the dozen or so professionals I turned to for help during my son’s first weeks  – midwives, doulas, nurses, doctors, lactation consultants – listened to me carefully enough to tell me that exclusive breastfeeding was probably not a realistic goal, given my medical profile. Instead, they repeated the mantra that might be helpful to many but is infuriating to me (and is also untrue): “Exclusive breastfeeding is always possible if you work hard enough, and working hard at it is always the right choice.”

My first inkling that we would have nursing problems came early in my pregnancy. I had many of the typical symptoms (nausea, heartburn, exhaustion), but I wasn’t experiencing any breast changes. At every checkup, I told the nurse, midwife or doctor that I wasn’t feeling any swelling, tenderness, size increase…nothing. And each time I mentioned it, I got one of two responses: either “I’m sure it’s nothing” or “You MUST be having at least SOME changes”. I’m not sure which of those was worse – the total dismissal of my concerns, or the claim that I was not an accurate reporter of my own symptoms. No one told me that my lack of symptoms might be a sign of insufficient glandular tissue, a condition that can seriously hinder milk production. I can only imagine how much easier my first weeks of parenthood would have been if someone had just said to me, while I was pregnant, “Why don’t you give breastfeeding your best shot, and we’ll give you all the support we can. But just so you know, some women whose breasts don’t change during pregnancy have IGT and can’t produce as much milk as their babies need, but they can still be great moms.” But it seems that everyone is too convinced of the infallibility of breastfeeding, and too convinced that unmotivated women will give up at the first hint of trouble, to say anything like that.

After my son was born, it was obvious that I had been right to worry. Despite near-constant skin-to-skin cuddling and frequent attempts at nursing, by the time he was 3 days old, he was not in good shape. He had turned orange, he had lost more than 10% of his weight, he wasn’t peeing or pooping at all, he was passing uric acid crystals (a sign of dehydration), and he would latch onto my breasts but wouldn’t swallow. And I knew it was because I had no milk for him. He desperately needed formula. I went to CVS at 6 AM in a state of panic and tried to buy formula there, but they keep it in a locked cabinet (as if I didn’t already feel like a criminal), and anyway I didn’t know what kind to buy or what to do with it once I bought it. So instead, I walked out, empty-handed and sobbing. There were many friends I could have called at the crack of dawn for breastfeeding support, but I couldn’t think of anyone to call for formula-feeding support. I had no idea what to do, and I was terrified for my hungry, dehydrated baby. My sweet husband was out-of-state for an exam he couldn’t reschedule, and he convinced me to go back to the maternity floor of the hospital where I’d given birth and ask the nurses there for help. I took a cab to the hospital, and a kind nurse – who wasn’t technically allowed to help me because I wasn’t a patient anymore – gave me some liquid formula, which got us through that scary day.

The following weeks were a blur of friends and professionals telling me to just try harder. Talking to them was like talking to customer service representatives working out of an overseas call center, reading off a piece of paper, and not knowing how to deviate from that script. I began every conversation with “I don’t have enough milk.” The reply was always some version of “Oh, I’m sure you do! What makes you think you don’t?” And then I’d have to list all the ways I knew I didn’t have enough milk: my baby was losing weight, he wasn’t peeing or pooping, he was agitated, he had a depressed fontanel, he was latching well but not swallowing at all, my breasts hadn’t changed, when I squeezed my breasts almost nothing came out. It broke my heart every time I had to repeat that list. But, just like the customer service people reading off a script, they were ready with their automatic (and completely unhelpful) responses: Weigh him before and after you nurse him, you’ll see that he really IS getting enough. (Tried it a few times. He got a bit less than an ounce at each feed – about a quarter of what he needed.) Try nursing more often. (I was nursing constantly.) Drink more water. (I was drinking as much as I possibly could.) Take fenugreek. (Not an option; it’s not safe for people who have peanut allergies, which I do.) Pump every time you nurse. (I pumped for 10-20 minutes 8-10 times a day…and never got more than about 3 ounces a day. It breaks my heart to think about those hours I could have spent holding my newborn. Or sleeping.) They didn’t always say it in this many words, but it was clear that they all wanted me to buy the mantra: “Exclusive breastfeeding is always possible if you work hard enough, and working hard at it is always the right choice.” It didn’t seem to occur to them that I might be part of the 5% of women who just can’t produce enough milk.

My baby and I settled into a routine of nurse, then supplement with 2 ounces of pumped milk and formula, then pump for later – every 2-3 hours, around the clock, often while the two of us were home alone. As the weeks went by and my supply didn’t improve (despite customer service’s promises), we added more interventions. With each new step, customer service promised that THIS would be the one that would finally make it work. I took Domperidone; it didn’t make any difference. I used a Supplemental Nursing System; it didn’t help and it drove me completely nuts. When my son was about 2 months old, I stopped asking for help. In my vulnerable state, I just couldn’t deal with any more conversations with people who wouldn’t listen to me or believe me.

And even though they wouldn’t or couldn’t hear me, I was spending a lot of time in the company of nursing moms, and I knew that my body just wasn’t doing what theirs were. Listening to the conversations of nursing moms felt like the days in high school when I showed up unprepared for a test in a class I didn’t understand. I would walk out of the test knowing that I hadn’t written enough on my paper to even get a passing grade. I would hear my classmates discussing what they’d written for each specific question and I wouldn’t even understand the words they were using. That’s how I felt – and, a year later, sometimes still feel – listening to women talking about the breastfeeding secrets that are normal to most nursing moms, but that I never experienced: their discomfort when their milk first came in, the feeling of their breasts filling with milk between feeds, the feeling of a let-down, waking up with milk-soaked pajamas, needing to wear nursing pads for leakage, storing and freezing pumped milk (I couldn’t pump enough in a day for even one full feed), losing weight quickly because their baby was sucking out all their calories (salt, meet wound). I was nursing all day long, but for me, none of those things ever happened. I knew with certainty that there was something different about my body, and I was frustrated that all the professionals insisted I was normal, but I was an exhausted brand-new mom and I didn’t have the confidence or the mental clarity to stand up for myself.

As the months went on and I emerged from my new-parent fog and re-entered my old brain and body, I began to clarify the story that customer service couldn’t or wouldn’t listen to. I realized that while everyone I had talked to had asked if I had any underlying medical conditions (one of the questions on their script), they had no response when I told them about my hypothyroidism; they didn’t tell me that there’s a high correlation between thyroid conditions and lactation failure. They asked about breast changes during pregnancy (another scripted question), but didn’t tell me that women whose breasts don’t change during pregnancy often deal with very low milk supply. Maybe they didn’t know these things about thyroid conditions and breast changes, or maybe they did know but they kept it from me because they were worried the knowledge might lead me to – gasp – quit breastfeeding.

My husband and I hope to have more children. Now I know that exclusive breastfeeding isn’t a realistic goal for me. I’ll try to give my next baby as much breastmilk as my body can produce, but I won’t pump, take pills, or tape tubes to my breasts. I’ll give my baby formula at the first sign that he or she needs it. If I need support from a professional, I hope I can find one who is able to listen. And in the meantime, I’ll continue to tell my pregnant friends that I am the person they can call in the middle of the night for formula-feeding support.

***

 We may not have much power, but the power we do have is in our words. Speak up. Email me your story at formulafeeders@gmail.com.

Study says: Breastfeeding problems aren’t serious. And are probably your fault, anyway.

One of the most interesting interviews I did in my research for Bottled Up was with a physician who had studied breastfeeding-related neonatal hypernatremia (severe dehydration leading to electrolyte imbalance). We discussed the fact that these days, this condition is typically caught early and can be treated successfully. But the doctor also cautioned that while the prognosis wasn’t usually dire in terms of long-term health (thanks to modern medicine), we shouldn’t forget about the emotional and financial effects on the parents. He worried about a first time mom, trying to do the best for her child, who ends up seeing that baby hospitalized – sometimes for weeks- due to what she might perceive as her own failure to nourish him adequately.

I’ve been thinking about this interview since I read several articles yesterday, detailing a new study about the same condition. According to the Guardian (“Breastfeeding problems rarely lead to serious illness, study says“), a new paper on neonatal hypernatraemia found that “Very few babies become dehydrated and seriously ill because they are not getting enough milk from breastfeeding…Dr Sam Oddie and colleagues found only 62 cases from May 2009 to June 2010, a prevalence of seven in every 100,000 live births… the babies were admitted to hospital, mostly because of weight loss, and some were intravenously fed…However, all were discharged within two days to two weeks having gained weight and none had long-term damage.”

Seem like good news, right? Put on the Def Leopard, because we’re about to start headbanging.

Source: http://www.yaindie.com/2012/12/banging-your-head-against-wall-is-it.html

Banging-my-head-against-the-wall Problem #1: 

Okay. So, correct me if I’m wrong, but having a 2-week-old newborn in the hospital hooked up to an IV for a week or two isn’t considered serious? And as for long-term effects – these babies were born between 2009-2010. The study is not available online, so I don’t know what the details are in terms of how the researchers followed up with the subjects… but considering studies on breastfeeding and intelligence have tested kids at the age of 8, I think one could fairly say the jury is still out on this sample of 4 and 5-year-old kids. And how were they assessed in terms of long-term effects? Psychological? Emotional? Physical?

With all the focus on mother-child interaction in the first days, and the effect of fatty acids on brain development, the superiority of breastmilk in the first weeks… doesn’t it seem a little ironic that we’re so quick to dismiss a condition which a) separates parents from babies through NICU stays and b) starves/dehydrates a child in those same “fundamental” weeks?

I understand that we’re talking small numbers here – 7 in every 100, 000 is admittedly a reassuring statistic. But while we’re talking about that figure… what exactly does it mean?

Banging-my-head-against-the-wall Problem #2:

First, without access to the study, I can’t tell you if this statistic means 7 in 100,000 of ALL LIVE BIRTHS – meaning EBF, formula-fed and mixed-fed infants, inclusive. The UK has lower breastfeeding rates than many countries, so if this was the number of babies in all live births, it doesn’t mean anything substantial. What we need to know is the number of babies admitted who were exclusively breastfed before we can start making statements about breastfeeding, milk supply, and what needs to happen to avoid this risk.

Banging-my-head-against-the-wall Problem #3: 

Even if this study did look only at EBF babies, there are major limitations in what we can fairly assess from the data.  We can’t know how many women can adequately produce milk so that their babies aren’t at risk, because most people would supplement before it got to the point of hospitalization. What the researchers did discover is that the babies hospitalized could nearly all breastfeed successfully:

Almost every baby is capable of breastfeeding, Oddie said. “In only a few cases were there special features of the baby that made it likely that there would be a severe feeding problem. [One of the babies, for instance, was found to have a cleft palate.] Normally all babies can get established with breastfeeding with the right support.”

Again, I’m a little confused. If there were only a few cases of this condition, what exactly is a “few” of a few? Of the seven babies hospitalized in a group of 100,000, does that mean one of them had a “special feature” which created a feeding problem? Was it a statistically significant number?

Then, the Deputy Manager of UNICEF’s Baby Friendly Initiative weighed in:

Anne Woods, deputy programme manager for Unicef’s Baby Friendly Initiative (BFI)…said the number of babies who could not feed was negligible and only a very small percentage – about 1% – of women would struggle to make enough milk. “The numbers who breastfeed in this country do not reflect the numbers who could breastfeed if they had effective support,” she said.

Where there are problems, she added, “it fundamentally boils down to the fact that the baby is not attached to the breast effectively. The whole of the baby’s mouth has to make contact and draw the breast tissue into the mouth.”

But because we have a bottle-feeding culture in the UK, she said, some women do not realise this and “try to bottle-feed with their breast”, so the baby takes only the nipple and does not get enough milk.

The other problem is when babies do not feed often enough. After a difficult labour or pain relief, the baby may be sleepy. There is also an expectation she said, that a baby will feed and then sleep.

Ah, right. It’s the mom’s fault. Who cares that this study proves – hell, even suggests – nothing about the true incidence of physiological lactation failure. The researchers are talking about the baby’s ability to feed, not the mother’s ability to produce milk. That doesn’t stop Anne Woods from hurling the 1% (the lowest number bandied about regarding lactation failure, by the way – she could’ve at least given us a break and used the higher end of the oft-cited 1-5% assumption figure) statistic at moms who’re already feeling like failures for landing their babies in the hospital. And of course, the mom probably can’t be bothered to feed as frequently as needed – not that it’s entirely her fault, since the formula companies have convinced her that her breast is actually…wait for it… a bottle!

Banging-my-head-against-the-wall Problem #4: 

I know, I’m being snarky. And I do appreciate that the lead researcher of this study, Sam Oddie, emphasized the need for better breastfeeding management and support. I’m fully on board with that. But I’m also concerned about what Dr. Oddie was saying back in 2009, when he embarked on his study:

Dr Sam Oddie, a consultant in the neonatal unit at Bradford Royal Infirmary, who is leading the study, said: ‘Once we understand the scale of the problem we can work out what to do about it – how to spot it, and how to act on it. But as far as I’m concerned the answer isn’t more formula feeding, but increased support for breastfeeding from the outset in the form of counsellors.” (Marie Claire, 2009).

I don’t disagree with him, necessarily, but going in to a study on hypernatraemia with a strong desire to avoid formula supplementation – even if that ended up being the best course of treatment – implies a certain degree of bias.

One could argue that there’s no harm in a study like this making the news; it will bring attention to those experiencing early breastfeeding problems and perhaps make medical professionals take them more seriously. But as we’ve seen so many times, these studies have a way of creeping into the breastfeeding canon and being misused as “truth” to back up future claims. I can already see Dr. Oddie’s quotes as being taken out of context, being used as “proof” that “all babies can breastfeed” and that the risk of inadequate feeding isn’t all that serious (so there’s never a need to supplement, even if your formula-pushing pediatrician tells you that there is).

Still think I’m overreacting? Here are the headlines from the other two major news sources covering the study:

Most mothers who struggle to breastfeed WILL be providing enough milk for their babies, say experts (The Daily Mail)

Dehydration risks from breastfeeding are ‘negligible’, study finds (The Telegraph)

Would you like me to move over and make a little space for you on the wall? Come on over. Bring some Metallica, and wear a helmet.

 

Read more about neonatal hypernatraemia:

http://fn.bmj.com/content/87/3/F158.full http://pediatrics.aappublications.org/content/116/3/e343.full

 

 

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