Saturday, August 16, 2014

Making More Milk: Breastfeeding, Supply and the Feedback Inhibitor of Lactation

By Danelle Frisbie © 2013


A common concern among new nursing mothers is milk supply. And while it is the case that very rarely does a mother carry a baby to term without also producing the milk this baby needs to thrive post-birth, the worry, "Am I making enough for my baby...?" is ubiquitous.

To maintain a full supply of human milk (and not much is needed in the early weeks or months of babyhood) a mother must drain her breasts often to create a demand. As simple and non-complex as it sounds, that is the very basic, fundamental rule of milk production: increased demand = increased supply.

This basic component of milk production in mammals is termed the Feedback Inhibitor of Lactation (FIL). In Breastfeeding Management for the Clinician: Using the Evidence, Marsha Walker explains, "FIL is an active whey protein that inhibits milk secretion as alveoli become distended and milk is not removed. Its concentration increases with longer periods of milk accumulation, down regulating milk production in a chemical feedback loop."

Unfortunately, when we decrease the demand from the body for milk production by supplementing or putting baby on a time clock (not as much milk is needed to feed baby when s/he is being filled with something else, or when longer intervals pass between feeds) then supply follows the drop in demand and decreases as well. A supplementing mom, or a mother who has been told she should only feed her baby every x number of hours, quickly finds that her milk supply dwindles, and she becomes frustrated and/or sad that breastfeeding "just isn't working out" for her and her baby.

Because of the FIL principle, when products are marketed specifically to mothers who are already breastfeeding their babies, or those who plan to nurse and wish to succeed in doing so, it is an irresponsible and hurtful move to push such items on women already concerned about their babies' wellbeing and their milk supply. Instead, we would empower the next generation of nursing (and pumping) moms, and see more happy, healthy, well-fed babies by understanding and appreciating the FIL process, and encouraging mothers to always listen to their little ones and feed on cue. And in cases where we wish to increase or build milk supply, we must make moves to nurse (and/or pump with a hospital grade pump) completely to empty, at frequent intervals.

When women elect to birth and breastfeed their babies, the female body is a powerfully wonderful, working organism - one which overcomes all kinds of roadblocks along the way. Yet we must provide our bodies with the feedback they need to fulfill what they were designed to do; and in the case of breastfeeding and milk supply, it is all about demand.


Reference:

1) Walker M: Influence of the maternal anatomy and physiology on lactation. In Breastfeeding Management for the Clinician: Using the Evidence. Sudbury, Massachusetts: Jones and Bartlett Publishers; 2006:51-82.


Related Reading:

Breastfeeding Made Simple (book)

The Baby Bond (book with excellent research on breastfeeding, among other topics)

Your Baby's Signs of Hunger (article)

Lactation Cookies: Increasing Milk Supply (article)

Nursing Mother, Working Mother (book)

Balancing Breastfeeding (article)

Making More Milk (book)

The Politics of Breastfeeding: When Breasts are Bad for Business (book)

Formula For Disaster (film)

Using Formula Like 'Similac for Supplementation' Decreases Milk Supply (article)

Breastfeeding Advocacy and Formula Feeding Guilt (article)

Helpful Breastfeeding Books

Breastfeeding Resource Page

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Friday, August 15, 2014

Medical Organization Position Statements on Circumcision


No national medical organization recommends the routine genital cutting of infants without medically justified need for such surgery to take place. Infant circumcision is clearly spoken against in many nations, regardless of babies' sex (female, male, intersex) and is not supported for all babies in any nation, even those that otherwise stem from within a cutting culture.

What follows are current medical position statements from organizations across the globe today. Full statements are readily available via online searches. When we recognize that no national medical organization recommends routine infant circumcision, it becomes clear that such things should not be funded with tax payer dollars (Medicaid and similar programs), covered by health insurance (genital cutting of infants is not performed as a health treatment), or pushed upon unknowing parents by any medical staff who stands to financially gain from performing unnecessary genital surgery upon a non-consenting human being.


The above informational cards and more are free for download and printing,


Related Reading: 

Peer reviewed published research on circumcision and the functions of the foreskin: http://www.drmomma.org/2007/01/circumcision-studies.html


On the ethics of registered nurses assisting in forced infant circumcision: http://www.drmomma.org/2014/04/on-ethics-of-registered-nurses.html


The Medical Benefits of Infant Circumcision: http://www.drmomma.org/2013/05/the-medical-benefits-of-infant.html


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Monday, August 11, 2014

Child injured in car accident when belt moved behind her back


On August 6th, loving father, Jonah Fults, shared a photo of his daughter and the following description of what occurred when she moved her seatbelt behind her shoulder (instead of keeping it across her chest). It is a powerful reminder to all parents, and children who are using belts, to be sure they are used correctly. Many older children (out of car seats) are prone to moving the chest strap behind them "because it is uncomfortable," but this, or worse, is too often the result.

Jonah writes:
I'm posting a picture of my precious little Firecracker Demi who was hurt last Friday in a car accident. I want people to understand the importance of the correct utilization of a car seat. She put her shoulder belt behind her back. This low speed accident happened in a neighborhood close to the house that they left. So 'I'm just going right down the road' is no excuse! We all have done it. She went forward, and hit the seat or the door. She has an orbital bone fracture. We will know soon if surgery is required to keep her eye muscles working properly. Her brother was fine in a car seat on the other side. Please people, protect our little ones. This is the scariest thing I've ever been through. Head injuries are for real!

Related reading:

Common Car Seat Errors: http://www.drmomma.org/2010/02/common-car-seat-errors.html

Do You Use Your Car Seat Correctly? http://www.drmomma.org/2010/02/do-you-use-your-carseat-correctly.html

Car Seats Are For CARS: http://www.mothering.com/green-living/car-seats-are-for-cars

Safety: Rear-Facing As Long As Possible: http://www.drmomma.org/2009/11/car-seat-safety-rear-facing-as-long-as.html

Carseats lower oxygen levels in newborns (use only in the car when driving): http://www.drmomma.org/2010/02/aap-car-seats-lower-oxygen-levels-of.html

Rear-Face Car Seat Facing Still Beneficial http://www.drmomma.org/2009/07/rear-facing-car-seats-beneficial-after.html

AAP Healthy Children Car Seat Guidelines: http://www.healthychildren.org/english/safety-prevention/on-the-go/pages/car-safety-seats-information-for-families.aspx

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Thursday, July 24, 2014

Circumcision: Never Assume Parental Knowledge

By Jen Sugarbaker
names in this story have been changed to protect identies


I have a story of circumcision regret, not for my own son, but for a baby I did not save.

My brother Jim, and his girlfriend, Carrie, gave birth to a beautiful, premature baby boy. They live in the Northeast, and I live in the Southwest, but I communicate with Carrie frequently over Facebook as our boys are about the same age. When their son, Evan, was born a month and a half premature and placed in the NICU, I never even thought to talk with Carrie about circumcision. I just assumed that because her son was so small and fragile, she would not want to do anything to hurt him. I also knew that she was aware that my own son is intact, and that she would follow my lead.

I was shocked when my mother called and told me that my new nephew had been cut, only a few weeks after birth.

I learned an important lesson that day: if you know someone who is expecting, or has recently had a baby, TALK TO THEM about the dangers of circumcision and the benefits of keeping children intact. Never underestimate the other parent's naivety on the subject, or the powerful pressure a mother may be under from her partner, her family, or her medical providers to circumcise.

I wish now that I had spoken up for my nephew, and I refuse to let another opportunity like that pass me by. Please, do the same and speak up whenever you have the chance to do so.


Hear from additional parents who are keeping future sons intact, and those who have worked through circumcision regret: http://www.drmomma.org/2010/05/i-circumcised-my-son-healing-from.html

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Saturday, July 12, 2014

Press Release: More than 200 Jewish Leaders Will Bless Intact Jewish Boys


At this Brit Shalom, the parents washed their son’s feet (Brit Rechitzah) as a symbolic sign of Jewish covenant and welcoming, rather than circumcising him. Other aspects of the service involved honoring of the parents and grandparents and giving the son his Hebrew name.

The movement to welcome newborn Jewish boys into Jewish life without the surgery of circumcision has reached a milestone—over 200 officiants are now available to perform the peaceful welcoming ceremony. Over 120 of these are rabbis. Many of these officiants are members of the Reform, Humanistic, Renewal, and Reconstructionist Jewish movements. Not all of the officiants on the list are opposed to circumcision, but some are. Several Rabbis on the list have intact grandsons, some have intact adopted sons.

While most celebrants are Rabbis and Cantors a variety of other Jewish Leaders are available to lead these rituals. Other celebrants include professors of Jewish Studies, Synagogue leaders, leaders of Jewish retreats, and Rabbinical students in a variety of Jewish movements.

Called brit shalom  (Hebrew for covenant of peace), this alternative naming ceremony corresponds with traditional brit milah welcoming ceremony, except that there is no cutting of the baby. “They’re especially happy ceremonies, for that reason,” says Mark Reiss, M.D.

For 14 years, Dr. Reiss, has been recruiting celebrants of brit shalom for his web page. He estimates that an annual 300-500 boys are welcomed into the Jewish community with brit shalom ceremonies in the United States. Most U.S. states, several Canadian provinces, and other countries are represented on Dr. Reiss’ celebrants list. Twelve of the celebrants are in Israel, where a young Jewish Intactivist movement is budding (intactivist = intact + activist).


“The celebrants include rabbis, cantors and other lay leaders, who need not reject circumcision themselves, but want to accommodate parents who do. New celebrants are always welcome,” says Dr. Reiss.


Jewish parents including Natalie BivasMoshe RothenbergDiane TargovnikMichael S. KimmelSara Rockwell and Shawn Stark have written about their experiences holding a Brit Shalom and raising intact Jewish sons.


Those who wish to contact Dr. Reiss to request an officiant, to add their name to the list of celebrants, or to learn more about brit shalom may do so by phone (415) 647-2687 or by email at mdreissmd@gmail.com.


Monday, July 07, 2014

Misled Regret: The Unwanted Circumcision of My Son During Hypospadias Repair

By Ashley Focht © 2014

I was 26 when I gave birth to my first son. As any first time mom, I was worried and researching things for my baby's sake. I knew that I would breastfeed, and I was weary about vaccinations, but felt backed into a corner because I knew he would go to public school and I was not sure how to maneuver exemptions. Prior to my son's birth, circumcision was brought up once and both his father and I said yes, of course we will circumcise - that is just what you do, after all.

At birth our son had a few issues, but nothing major and the pending circumcision surgery was far from my mind. The pediatrician on call said our son may have hypospadias (where the urethra is not on the head of the penis) and that he would require surgical correction as a result. The next day, my OB came in and said he wasn't entirely positive if this was the case, but that we should ask yet another pediatrician about it. He then added that if we did not get a definitive diagnosis he could still perform the circumcision within 30 days from my son's birth. [Editor's note: If hypospadias is suspected at birth, circumcision will not be immediately performed because the assumption in many U.S. hospitals is that it will be done when corrective surgery under anesthesia is done, and that the foreskin will be used in the hypo/chordee repair.]

We had a new pediatrician the next day, who gave the same diagnosis. We went home and were told to call a urologist around 4-6 months. From the time we were home to the first appointment with the urologist, my son had no complications. He did have a short foreskin, and as he grew we were able to see how the urethra was not at the head of the penis, but not far off from its normal location. We could also see a curve to his penis. The urologist confirmed that he also had chordee. He told us that both aspects of our son's penis could be corrected with the use of his foreskin. The surgery was scheduled for 2 months out.

The night before surgery, he came down with his first illness and the appointment had to be cancelled. Around this time I became friends with two intactivists, each with an intact son. As we became friends and talked more, my husband and I questioned whether the surgery, and ultimately the circumcision that came with it, were necessary. We finally researched and felt so sick knowing that we were ready and willing to do this to our son. But what about his condition?

The urologist drilled it into our heads that he would not only have trouble urinating, but also could see complications in fertility. We wanted what was best for our son. Our pediatrician told us we should go ahead with it, and a second consult with the urologist gave me a false hope that he would try to not use our son's foreskin in reconstruction. He assured us that if it wasn't necessary to circumcise and use the foreskin for the hypospadias and chordee correction, he would tell us, but that our son's penile curvature was to such a degree that he always recommended surgical correction. We felt backed into a corner. Would our son hate us if we had the surgery? Would he hate us if we didn't? 

We scheduled again.

We backed out.

We scheduled a third time with much pressure in both directions all around us...

I really went into it thinking that I had expressed to the doctor how badly I did not want him circumcised, and I really believed our son would come out of everything with, at the very least, a repaired foreskin. Surely this physician would honor our wishes for our son as we'd expressed them all along.

The day came, and I held my son as they gave him medicine to calm him down. I watched as a nurse carried his limp body back into the OR.

I waited for 3 hours.

And then I finally saw him -- sweaty and sleeping, tubes and IVs still attached. I held him and cried as the doctor told me there wasn't enough foreskin to save and he had to be circumcised, but that everything "went great."

In that moment I hated myself. I wanted to take it all back. Deep down I knew I was making the wrong decision, and I still made it. He was bandaged up and had to have a tube coming out of his new urethra for a few days. Everything was covered, so the severity of it had not hit us just yet. We took our son back to get the bandages removed and make sure everything was healing well. When we returned home and did the first diaper change we really saw it...

We both cried. We had seen our son normal and intact for 18 months, and now we saw this.

It never got easier. Every single diaper change is a kick in the stomach -- a reminder of how I didn't stand up for my son, how I let everyone else make a decision that I knew in my gut was the wrong one. I just hope that when the time comes he will understand that his Dad and I only wanted what was best for him, that we went into thinking that the good of the surgery would outweigh the possible evil. If nothing else, I just hope he remembers how much we love him.

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Read more from parents who have regretfully had one or more son circumcised, and are keeping future sons intact at: http://www.drmomma.org/2010/05/i-circumcised-my-son-healing-from.html


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