Wednesday, December 17, 2014

Should I Circumcise My Son? The Pros and Cons of Infant Circumcision



New to the subject of infant circumcision and the benefits of the prepuce ('foreskin')? The following are resources others have found useful when looking into the subject for the first time. They are meant to be a starting point in a deeper investigation and further research for expecting parents today.

Functions of the Foreskin: http://www.drmomma.org/2009/09/functions-of-foreskin-purposes-of.html

Intact vs. Circumcised: A Significant Difference in the Adult Penis: http://www.drmomma.org/2011/08/intact-or-circumcised-significant.html 

Why did circumcision start as we now know it in the U.S.? Hear from some original doctors on the matter: http://www.savingsons.org/2012/07/circumcision-to-reduce-mens-sexual.html

Faith Considerations on Circumcision (if this matters to an individual - resources by/for Jews, Christians, and Muslims): http://www.drmomma.org/2011/01/faith-considerations-on-circumcision.html

Peer reviewed research (studies published in medical journals): http://www.drmomma.org/2007/01/circumcision-studies.html

Are there medical benefits to circumcision? Read national medical statements from around the world: http://www.drmomma.org/2014/08/medical-organization-position.html

Physicians' thoughts within the medical field today: FB.com/IntactCare

Well researched books written on the subject: http://astore.amazon.com/savingsons.org-20

Dr. Ryan McAllister's Georgetown video lecture, Elephant in the Hospital (also included on DVD in the info pack below): http://vimeo.com/26130057

Dr. Christopher Guest's video, Circumcision: The Whole Story: http://youtu.be/SeAXantm4tE

Intact Care: http://www.drmomma.org/2009/06/how-to-care-for-intact-penis-protect.html
Circumcision Care: http://www.nocirc.org/publish/pamphlet5.html

The two most common forms of circumcision in North American today: 

Gomco: http://www.savingsons.org/2011/01/neonatal-circumcision-video-for.html

Plastibell: http://www.drmomma.org/2009/08/plastibell-infant-circumcision.html [Note that the Plastibell is the type of circumcision most often referred to as a 'no-cutting' or 'no-blood' method.]

Outcome Statistics: Circumcised and Intact: http://www.drmomma.org/2010/01/cut-vs-intact-outcome-statistics.html

Men speak on the subject: https://www.facebook.com/media/set/?set=a.487363627949430.115346.166998263319303
Over 250,000 men are restoring some of what was lost to circumcision. It improves sex in a wide variety of ways. Google 'foreskin restoration' and check out any of these resources: http://www.savingsons.org/2009/10/foreskin-restoration.html

8 articles published at Psychology Today: http://www.savingsons.org/2011/10/psychology-today-circumcision-series.html

For those with older sons who were circumcised: 
Public Page: FB.com/FutureSons 
Private Discussion Group: FB.com/groups/FutureSons
Related items from others with circumcised sons: http://www.drmomma.org/2010/05/i-circumcised-my-son-healing-from.html 

What does this have to do with WOMEN? 
SexAsNatureIntendedIt.com
Book by same title: http://astore.amazon.com/savingsons.org-20

How Male Circumcision Impacts Your Love Life: http://www.drmomma.org/2009/10/how-male-circumcision-impacts-your-love.html

Women's Health and Male Circumcision Resource List: http://www.drmomma.org/2009/07/how-male-circumcision-impacts-women.html

50 Reasons to Leave it Alone: http://www.drmomma.org/2010/11/50-reasons-to-leave-it-alone.html 

The Info Pack (includes a DVD with several videos and 80 pages of materials) or "Expecting?" New parent packets (materials without the DVDs or full articles): http://www.savingsons.org/p/info-pack.html

Informational items: http://www.savingsons.org/p/info-cards.html

Questions? 

Email DrMomma.org@gmail.com at any time. We have several clinicians who volunteer their time to field questions, and if we're not able to answer, we'll seek out a place to go for further information.

If you find these resources to be of use, please help support Saving Our Sons and the work done through this effort. We continue solely by volunteers' time and generosity. See current needs at: http://www.savingsons.org/p/sponsor-son-waiting-list.html or give directly: https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=G6VLETWSGSR22


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Monday, November 10, 2014

Birth Spacing: Research Shows 3-5 Years Optimal for Mother and Baby Health

As reported by the Catalyst Consortium

Two Years - The Former Invisible Norm

For many years, family planning experts generally agreed that at least a twenty-four month, or two-year, birth interval is important for infant, child and maternal health. Studies have shown that birth intervals less than two years are associated with adverse perinatal and maternal outcomes. Despite this knowledge, few governments, or international health organizations have birth spacing policies or programs.

Although birth spacing is at the heart of reproductive health/family planning, it is rarely addressed directly. In short, the two-year recommendation for birth spacing is an "invisible norm." A review of over one thousand abstracts from the health and development literature revealed that few programs address birth spacing for its health benefits. As a result, the health benefits of adequately spacing births are often left out from client education materials and provider training manuals. In the few countries that have birth spacing programs the terms "birth spacing" and "family planning" are incorrectly used as synonyms.

New Findings on the Optimal Birth Interval

Research on optimal birth spacing collected and commissioned by CATALYST has confirmed the long-held notion that the highest risks for adverse health outcomes for children and mothers often occur with the shortest birth intervals. In addition, the new research shows that there is substantially more health benefit gained from lengthening the birth interval beyond the previously recommended two years to a three to five year birth interval. The new research shows there is an optimal interval for birth spacing - a period associated with the lowest risks for adverse health outcomes - and that optimal interval is three to five years. Based on these groundbreaking new research findings, CATALYST and the Optimal Birth Spacing Champions has taken the position that the previous two year guidelines need to be revised to be: Three to Five Years for Optimal Birth Spacing.

The new research on optimal birth spacing comes from large retrospective cross sectional analyses that statistically controlled for potentially confounding socio-demographic and biological variables. Shea Rutstein examined the association between birth intervals and neonatal, infant and child health and nutritional outcomes using Demographic and Health Survey (DHS) data from fifteen developing countries in Africa, Latin America and Asia. Agustin Conde-Agudelo examined the association between birth intervals and perinatal, maternal, and adolescent health outcomes, using a database of over two million pregnancies in eighteen countries in Latin America and the Caribbean. Bao Ping Zhu examined the association between birth intervals and perinatal health in two U.S. States and between two racial groups. Their findings indicate that spacing births for three to five years has the greatest positive health impact on perinatal, neonatal, infant, child, maternal, and adolescent maternal health in both developing and developed countries. The findings ( Graphs: One and Two ) indicate that the lowest risks for fetal death, pre-term delivery, small for gestational age, neonatal death, and low birth weight occur when births are spaced from three to five years. The lowest risk for maternal morbidity and mortality also occur at three to five year birth intervals.

Graph One:


Graph Two:


CATALYST has crafted the graph Optimal Birth Spacing Interval: Maternal- Perinatal Risks to illustrate the recommended optimal birth spacing interval. Research findings on the association of birth intervals and maternal and perinatal health were plotted on an eighty- month timeline. As Figure 1 shows:

  • The current recommendation of two years is too close to the high risk period for both mother and child; 
  • Most researchers, but not all, identify the period of lowest risk for adverse health outcomes from between 27 to 60 months;
  • Risks for the mother starts climbing at 60 months and becomes statistically significant at 69 months. 

For the mother-child dyad, the data supporting an optimal birth interval window spans from 27 to 69 months. However, as a public health recommendation, it is safer to create a buffer of nine months at each end of the interval window (27 + 9 = 36 and 69 - 9 = 60). Based on these findings CATALYST, the OBSI Champions and USAID have recommended a 36-60 month or a 3-5 year window as the optimal birth spacing interval.


New Findings on the Determinants of Birth Spacing Behaviors

In order to better understand the larger social, cultural, religious, institutional and structural influences on birth spacing behaviors, CATALYST has gathered qualitative data through focus group discussions in four countries: Peru, Bolivia, India and Pakistan. Over 1,000 respondents participated in the focus groups. In 2003, CATALYST will conduct OBSI focus groups in Egypt. Results from the series will help CATALYST form a more comprehensive research base for new birth spacing programming.

OBSI Reports and Technical Papers

CATALYST has commissioned several studies by Dr. Agustin Conde-Agudelo, Consultant to the World Health Organization, and the Pan American Health Organization. These are presented in Optimal Birth Spacing: New Research from Latin America on the Association of Birth Intervals and Perinatal, Maternal and Adolescent Health (2002). The document is available in English and Spanish.

Other useful reports on optimal birth spacing include:

Birth Spacing: Research Update 2002 USAID.

Birth Spacing: A Call to Action 2002 USAID.

Three to Five Saves Lives, Population Reports, Volume XXX, Number 3, Series L, Number 13 Summer 2002 Population Information Program, Johns Hopkins University.

Espeut, Donna Spacing Births, Saving Lives: Ways to Turn the Latest Birth Spacing Recommendation into Results, 2002 ORC Macro, Child Survival Technical Support Project.

The following list provides a short bibliography of some of the recent studies in optimal birth spacing interval:

2000

Conde-Agudelo, A. and J. Belizan. Maternal mortality and morbidity associated with interpregnancy interval: A cross sectional study. British Medical Journal (321): 1255-1259.1998

2002

Conde-Agudelo, A. Analysis of the Association Between Maternal Age and Adverse Pregnancy Outcomes. Unpublished.

2002

Conde-Agudelo, A. Analysis of the Maternal-Perinatal Morbidity and Mortality Associated with Inter-Pregnancy Intervals Following a Miscarriage in Women and Adolescents. Unpublished.

2002

Conde-Agudelo, A. Maternal Sociodemographic and Obstetric Factors Associated with Short Birth Intervals in Women in Adolescents. Unpublished.

2000

Fuentes-Afflick, E., N.A. Hessol. Interpregnancy interval and the risk of premature infants. Obstetrics and Gynecology 95: 383-90.

2000

Rafalimanana, H. and C. Westoff. Potential effects on fertility and child health and survival of birth-spacing preferences in Sub-Saharan Africa. Studies in Family Planning 31 (2): 99-110.

2002

Jansen, W.H. D. Frick, and R. Mason. The "X" factor in birth spacers: age and parity in demand for birth-spacing in 15 developing countries. Paper Presented at the Population Association of America. May, 2002.

2002

Rutstein, S. Effect of birth intervals on mortality and health: multivariate cross-country analyses. Unpublished Data from Measure/DHS+ Macro International, Inc. Calverton Maryland.

2000

Skjaerven, R. et al. The interval between pregnancies and the risk of preeclampsia. New England Journal of Medicine 346 (1): 33-38.

2001

Zhu, B.P. et al. Effect of interval between pregnancies on perinatal outcomes among white and black women. American Journal of Obstetrics and Gynecology (185): 1403-10.

1999

Zhu, B.P. et al. Effect of the interval between pregnancies on perinatal outcomes. The New England Journal of Medicine (340): 589-94.


Related Reading: 

Your Children's Future Successes May Depend on Birth Spacing

Women Risk Premature Birth if Second Pregnancy Occurs Too Quickly

Why I Waited 3 Years Between Pregnancies (Natural Mama)

Birth Order and Intelligence [A 3 year minimum between pregnancies]

Making the Case for Space: A Birth Spacing Opinion

Deep Nutrition: Why Your Genes Need Traditional Food (information included on spacing of pregnancies and how the nutrient stores impact health of a baby already born and a new baby on the way)

The Nourishing Traditions Book of Baby & Child Care

~~~~

Saturday, November 01, 2014

Car Seats: Rear Facing Background Basics

By Hakan Svensson
Read more from Svensson at CarSeat.se

Image courtesy of De Su Mama

Children who sit rear facing in a car seat cut the risk for death or injury dramatically. But why is rear facing so much better and where did the idea come from?

There are three main reasons why rear facing is so much better. First is the outstanding protection of a child’s head, neck and spine in frontal collision - which accounts for roughly 80% of accidents. Second is superior protection in side collisions. A rear facing child is pushed further into the car seat where it’s well protected. Third is a social reason, rear facing car seats often work better because driver/passenger can more easily communicate with the child.

You will notice Sweden mentioned often regarding car seat safety, especially when discussing rear facing use. The Swedes started rear facing long before other countries and have led research in the area for the past 40+ years. Swedish car seats are also different, with virtually all seats allowing children to sit rear facing up to 25 kg. (55 lbs), one of the highest rear facing limits in the world. Rear facing past 12 months is yet unheard of for many parents in other nations, while many are just now learning of the huge safety benefits. And all the while, rear facing car seats are a Swedish invention, with children here having used them standardly since the 1960s.


It was a Swedish professor, the now legendary Bertil Aldman, who came up with the idea of rear facing car seats in the early 1960s. Professor Aldman took his inspiration from the seats the Gemini mission astronauts used for take-off and landing, specially moulded to distribute the forces over the whole back. He was watching a TV program with the astronauts in the Gemini space capsule and noticed they were laying on their back, in opposite direction of acceleration. No one back then imagined how revolutionary Aldman’s research would become. He is now well known internationally and is credited with saving thousands of children’s lives. Read more here about Aldman and his 'crazy idea' of how to keep children ultra-safe in cars.


Many ask about rear facing and the benefits -- is it really that much safer? Are the benefits real? Are lives actually saved? From 1992 through June 1997, only 9 children properly restrained rear-facing died in motor vehicle crashes in Sweden, and all of these involved catastrophic crashes with severe intrusion and few other survivors. Looking at statistics in Sweden, where the recommendation is for children to sit rear facing until age 4, it is obvious to see what a huge difference the simple concept of rear facing really make.

Professor Aldman is legendary for his research, but it is Thomas Turbell who is called the 'Father of rear facing' for his work at the highly regarded crash test facility VTI in Sweden.  There are over a million rear-facing seats in use in Sweden, and we do not know of any cases where a child in a rear-facing car seat has been seriously injured in a frontal collision. Swedish accident research has shown that rearward facing children’s car seats reduce serious injuries by 92%, while the forward-facing seats only reduce injury by 60%.

In the last few years, the rest of Europe (and rest of the world) has also become aware of this. A number of cases are known in which children have been totally paralyzed as a result of neck injuries while using forward-facing seats. The idea of rear facing is very simple: children, not only babies, have weak neck and bone muscles which are well protected while rear facing. Volvo explained this very well in one sentence: In the event of a front-end collision, the whole of the child’s back takes the strain of the impact, not its much more vulnerable neck.

Image courtesy of CarSeatBlog.com

To learn more about rear facing, first take a look at the history behind it and how the Swedes have been been rear facing children for the past 40+ years with amazing results. Read more details about the safety benefits and why Extended Rear Facing (rear facing past 24 months) or ERF is superior compared to forward facing. Learn about safety of different positions in the vehicle and also if Isofix/LATCH really make a difference.


Related Reading:

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

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 

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

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

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

Car Seats Photo Album on Facebook: https://www.facebook.com/media/set/?set=a.10150914937212671.414158.202794322670

~~~~

Monday, October 27, 2014

Peaceful Parenting Pumpkin Contest


Have a pumpkin sitting around waiting for your artistic genius? Join us in this year's Peaceful Parenting Creative Pumpkin Contest! Paint it, carve it, stick a baby in it - tie it into gentle parenting in some fashion, and let your imagination take flight. Snap a photo and send to DrMomma.org@gmail.com with your first name. We'll add all entries here on Halloween for sharing and the winner (by number of 'likes') will receive a $20 gift credit toward any item(s) in the advocacy galleries of good stuff: http://www.drmomma.org/p/info-cards.html (breastfeeding, birth, babywearing, gentle parenting, intactivism, etc.). Thank you for raising awareness and planting seeds of gentle parenting information this Halloween!

Entries (click image to 'vote' by likes on FB): 




Sunday, October 26, 2014

Intact Care and No Retraction Agreement


The following intact care agreement was written by Jennifer Gardner and originally appeared at Mothers Against Circumcision. It has been edited slightly for sharing at DrMomma.org, with updates in care (i.e. water only to clean the genitals - no soap), advising physicians and terminology. Gardner shares that she, "Wrote this after my family and I moved from Michigan to Massachusetts. In taking my son to a new pediatrician for his four month check-up, I made the mistake of trusting the doctor to know not to retract the infant foreskin. I was wrong. He did - while I was standing right next to him. I then wrote up this agreement, which has been signed - and adhered to - by our current pediatrician. (It also helps that he's already "foreskin-friendly.") Many other parents of intact boys have since relayed their own stories, requesting a copy of the agreement."



To:_______________________
Healthcare provider/s of our son

From: ____________________
His Parents

In providing health care for the above named person, I agree to the following:

1. This boy is not circumcised. He was left intact, on purpose, by his parents at birth, who refused the operation at that time, as they feel that it is not a medically indicated procedure for infants. They intend to keep him intact, and are informed on the proper (and wary of the improper) care of the intact penis.

2. The proper care of the intact penis is to "leave it alone" (per Dr. Sears, Dr. Fleiss, Dr. Winckler, the AAP, among others). His parents do not retract his foreskin, as it is unnecessary, and likewise will not allow anyone else to do so either. Only a very small percentage of babies and young children have foreskin that is retractable. In the majority, the foreskin is firmly attached to the glans (head) of the penis in much the same way as the fingernail is attached to the finger, and DOES NOT retract.

Furthermore, any retraction of the foreskin before natural separation has occurred, as early as age three, but as late as early adulthood, can cause irreparable damage through bleeding and the formation of adhesions. The ONLY person who may retract our son's foreskin is our son himself, once natural separation has occurred.

3. There is NO reason whatsoever to touch our son's penis during an exam: Not "to see inside," not "out of curiosity," not "to break adhesions” (the attach points are synechiae, not adhesions), not "to see if the foreskin retracts," not "to clean it," etcetera. I therefore agree that I will not touch this child’s penis for any reason. If I genuinely have a concern about whether his urethral opening is "fine" I will bring this point up to his parents and they can decide if there needs to be anything done. If they do decide that it needs to be looked at, only THEY, not I, will touch his penis.

4. The intact penis needs no special care, such as "irrigation" or "loosening of the foreskin." His parents wipe the OUTSIDE with a wipe at diaper changes, or with warm water at bath time. Any "cleaning" other than the afore-mentioned can cause irritation, infection, and problems down the road. When his foreskin has naturally separated on its own, his parents will inform him of the proper care concerning retraction, and concerning cleaning; (i.e. to retract gently when showering, rinse with warm water, and replace.)

5. As our son's parents, we have written this document as a preventative measure only, in response to a previous negative experience. It is not meant to single out any one person, but is meant to relay our wishes and concerns to all health care providers who see our son.

I have read the above information. I understand what I have read, fully, and agree to what is written herein. I will adhere to the above information, and know that if I do not, it will be seen in the eyes of his parents as purposeful abuse toward our son. If I sign, I will receive a copy of this document. If I do not agree to all that is written here, this child will not be looked after by me for his medical care.

Signed,

 __________________________


Additional items at the Intact Care Resource Page.

Monday, September 22, 2014

Top 100 Names of the Year for Boys!



Expecting a beautiful little BOY? Congratulations! The fun is only just beginning as you search for the best name for your new little sweetheart. Some adore using popular names of the time, others desire a unique name of their own creation. But no matter which direction you go on his name, your perfectly made little baby will soon fill your life with wonder and delight - and your heart will never again be the same.

Included below are the 100 most popular names for boys in the United States this year, based on the Social Security Administration's latest statistics. Does your little one's name make the Top 100? We'd love to hear from you and know what name you chose. Drop a comment below, or join in the conversation any time on the Peaceful Parenting Facebook page, or private discussion group

And if you have questions about all things BOY, drop a note any time to SavingSons@gmail.com and our clinicians and volunteers will do their best to get you the resources you are seeking.

❤ Happy Babymoon! ❤

1. Noah
2. Liam
3. Jacob
4. Mason
5. William
6. Ethan
7. Michael
8. Alexander
9. Jayden
10. Daniel

11. Elijah
12. Aiden
13. James
14. Benjamin
15. Matthew
16. Jackson
17. Logan
18. David
19. Anthony
20. Joseph

21. Joshua
22. Andrew
23. Lucas
24. Gabriel
25. Samuel
26. Christopher
27. John
28. Dylan
29. Isaac
30. Ryan

31. Nathan
32. Carter
33. Caleb
34. Luke
35. Christian
36. Hunter
37. Henry
38. Owen
39. Landon
40. Jack

41. Wyatt
42. Jonathan
43. Eli
44. Isaiah
45. Sebastian
46. Jaxon
47. Julian
48. Brayden
49. Gavin
50. Levi

51. Aaron
52. Oliver
53. Jordan
54. Nicholas
55. Evan
56. Connor
57. Charles
58. Jeremiah
59. Cameron
60. Adrian

61. Thomas
62. Robert
63. Tyler
64. Colton
65. Austin
66. Jace
67. Angel
68. Dominic
69. Josiah
70. Brandon

71. Ayden
72. Kevin
73. Zachary
74. Parker
75. Blake
76. Jose
77. Chase
78. Grayson
79. Jason
80. Ian

81. Bentley
82. Adam
83. Xavier
84. Cooper
85. Justin
86. Nolan
87. Hudson
88. Easton
89. Jase
90. Carson

91. Nathaniel
92. Jaxson
93. Kayden
94. Brody
95. Lincoln
96. Luis
97. Tristan
98. Damian
99. Camden

Photograph by Clare Fisher

Related Reading: 


Saving Our Sons public community page 






~~~~

Top 100 Names of the Year for Girls!



Expecting a gorgeous little GIRL? Congratulations! The fun is only just beginning as you search for the best name for your new little sweetheart. Some adore using popular names of the time, others desire a unique name of their own creation. But no matter which direction you go on her name, your perfectly made little baby will soon fill your life with wonder and delight - and your heart will never again be the same.

Included below are the 100 most popular names for girls in the United States this year, based on the Social Security Administration's latest statistics. Does your little one's name make the Top 100? We'd love to hear from you and know what name you chose. Drop a comment below, or join in the conversation any time on the Peaceful Parenting Facebook page, or private discussion group

And if you have questions about all things GIRL, drop a note any time to DrMomma.org@gmail.com and our clinicians and volunteers will do their best to get you the resources you are seeking.

❤ Happy Babymoon! ❤

1. Sophia 
2. Emma 
3. Olivia 
4. Isabella 
5. Ava 
6. Mia 
7. Emily 
8. Abigail 
9. Madison 
10. Elizabeth 

11. Charlotte 
12. Avery 
13. Sofia 
14. Chloe 
15. Ella 
16. Harper 
17. Amelia 
18. Aubrey 
19. Addison 
20. Evelyn 

21. Natalie 
22. Grace 
23. Hannah 
24. Zoey 
25. Victoria 
26. Lillian 
27. Lily 
28. Brooklyn 
29. Samantha 
30. Layla 

31. Zoe 
32. Audrey 
33. Leah 
34. Allison 
35. Anna 
36. Aaliyah 
37. Savannah 
38. Gabriella 
39. Camila 
40. Aria 

41. Kaylee 
42. Scarlett 
43. Hailey 
44. Arianna 
45. Riley 
46. Alexis 
47. Nevaeh 
48. Sarah 
49. Claire 
50. Sadie 

51. Peyton 
52. Aubree 
53. Serenity 
54. Ariana 
55. Genesis 
56. Penelope 
57. Alyssa 
58. Bella 
59. Taylor 
60. Alexa 

61. Kylie 
62. Mackenzie 
63. Caroline 
64. Kennedy 
65. Autumn 
66. Lucy 
67. Ashley 
68. Madelyn 
69. Violet 
70. Stella 

71. Brianna 
72. Maya 
73. Skylar 
74. Ellie 
75. Julia 
76. Sophie 
77. Katherine 
78. Mila 
79. Khloe 
80. Paisley 

81. Annabelle 
82. Alexandra 
83. Nora 
84. Melanie 
85. London 
86. Gianna 
87. Naomi 
88. Eva 
89. Faith 
90. Madeline 

91. Lauren 
92. Nicole 
93. Ruby 
94. Makayla 
95. Kayla 
96. Lydia 
97. Piper 
98. Sydney 
99. Jocelyn 

Photograph by Kelly Brown

Related Reading:

One Regret: Thoughts on ear piercing

Raising Daughters: Good books on girl culture

The Great List of Things I Can't Do Because I Only Have Daughters (Mike Reynolds)

Female Genital Cutting (attitudes and misconceptions)

History of Female Circumcision in the United States

~~~~

Saturday, August 30, 2014

Breastfeeding Myths

By Jack Newman, MD, FRCPC, IBCLC
Revised by Edith Kernerman, IBCLC
Photographs by Peaceful Parenting readers. Have a myth-debunking photo to share? Email with your name to DrMomma.org@gmail.com
Read more from Dr. Newman at Breastfeeding Inc. and the International Breastfeeding Centre site, as well as in his published texts.


There are so very many 'booby traps' for nursing mothers today. Myths and misconception are rampant across many of our sub-cultures, and misunderstanding when it comes to lactation and mother/baby-nutrition is so ubiquitous that even medical professionals commonly dish out poor advice to new moms. Here, Dr. Newman responds to many of the myths alive and present in our world today - those that commonly hinder a mother's breastfeeding relationship with her baby.

1. Many women do not produce enough milk. Not true! The vast majority of women produce more than enough milk. Indeed, an overabundance of milk is common. Most babies that gain too slowly, or lose weight, do so not because the mother does not have enough milk, but because the baby does not get the milk that the mother has. The usual reason that the baby does not get the milk that is available is that he is poorly latched onto the breast. This is why it is so important that the mother be shown, on the first day, how to latch a baby on properly, by someone who knows what they are doing.

2. It is normal for breastfeeding to hurt. Not true! Though some tenderness during the first few days is relatively common, this should be a temporary situation that lasts only a few days and should never be so bad that the mother dreads breastfeeding. Any pain that is more than mild is abnormal and is almost always due to the baby latching on poorly. Any nipple pain that is not getting better by day three or four or lasts beyond five or six days should not be ignored. A new onset of pain when things have been going well for a while may be due to a yeast infection of the nipples. Limiting feeding time does not prevent soreness. Taking the baby off the breast for the nipples to heal should be a last resort only. (See Information Sheet Sore Nipples).


3. There is no (not enough) milk during the first three or four days after birth. Not true! It often seems like that because the baby is not latched on properly and therefore is unable to get the milk that is available. When there is not a lot of milk (as there is not, normally, in the first few days), the baby must be well latched on in order to get the milk. This accounts for "but he's been on the breast for 2 hours and is still hungry when I take him off". By not latching on well, the baby is unable to get the mother's first milk, called colostrum. Anyone who suggests you pump your milk to know how much colostrum there is, does not understand breastfeeding, and should be politely ignored. Once the mother's milk is abundant, a baby can latch on poorly and still may get plenty of milk, though good latching from the beginning, even in if the milk is abundant, prevents problems later on.

4. A baby should be on the breast 20 (10, 15, 7.6) minutes on each side. Not true! However, a distinction needs to be made between "being on the breast" and "breastfeeding". If a baby is actually drinking for most of 15-20 minutes on the first side, he may not want to take the second side at all. If he drinks only a minute on the first side, and then nibbles or sleeps, and does the same on the other, no amount of time will be enough. The baby will breastfeed better and longer if he is latched on properly. He can also be helped to breastfeed better and longer if the mother compresses the breast to keep the flow of milk going, once he no longer drinks on his own (Information Sheet Breast Compression). Thus it is obvious that the rule of thumb that "the baby gets 90% of the milk in the breast in the first 10 minutes" is equally hopelessly wrong. To see how to know a baby is getting milk see the videos at nbci.ca.


5. A breastfeeding baby needs extra water in hot weather. Not true! Breastmilk contains all the water a baby needs.

6. Breastfeeding babies need extra vitamin D. Not true! Everyone needs vitamin D. Formula has it added at the factory. But the baby is born with a liver full of vitamin D, and breastmilk does have some vitamin D. Outside exposure allows the baby to get the rest of his vitamin D requirements from ultraviolet light even in winter. The baby does not need a lot of outside exposure and does not need outside exposure every day. Vitamin D is a fat soluble vitamin and is stored in the body. In some circumstances (for example, if the mother herself was vitamin D deficient during the pregnancy) it may be prudent to supplement the baby with vitamin D. Exposing the baby to sunlight through a closed window does not work to get the baby more vitamin D.

7. A mother should wash her nipples each time before feeding the baby. Not true! Formula feeding requires careful attention to cleanliness because formula not only does not protect the baby against infection, but also is actually a good breeding ground for bacteria and can also be easily contaminated. On the other hand, breastmilk protects the baby against infection. Washing nipples before each feeding makes breastfeeding unnecessarily complicated and washes away protective oils from the nipple.

8. Pumping is a good way of knowing how much milk the mother has. Not true! How much milk can be pumped depends on many factors, including the mother's stress level. The baby who breastfeeds well can get much more milk than his mother can pump. Pumping only tells you have much you can pump.

9. Breastmilk does not contain enough iron for the baby's needs. Not true! Breastmilk contains just enough iron for the baby's needs. If the baby is full term he will get enough iron from breastmilk to last him at least the first six months. Formulas contain too much iron, but this quantity may be necessary to ensure the baby absorbs enough to prevent iron deficiency. The iron in formula is poorly absorbed, and the baby poops out most of it. Generally, there is no need to add other foods to breastmilk before about 6 months of age.

10. It is easier to bottle feed than to breastfeed. Not true! Or, this should not be true. However, breastfeeding is made difficult because women often do not receive the help they should to get started properly. A poor start can indeed make breastfeeding difficult. But a poor start can also be overcome. Breastfeeding is often more difficult at first, due to a poor start, but usually becomes easier later.


11. Breastfeeding ties the mother down. Not true! But it depends how you look at it. A baby can be breastfed anywhere, anytime, and thus breastfeeding is liberating for the mother. No need to drag around bottles or formula. No need to worry about where to warm up the milk. No need to worry about sterility. No need to worry about how your baby is, because he is with you.

12. There is no way to know how much breastmilk the baby is getting. Not true! There is no easy way to measure how much the baby is getting, but this does not mean that you cannot know if the baby is getting enough. The best way to know is that the baby actually drinks at the breast for several minutes at each feeding (open mouth wide—pause—close mouth type of suck). Other ways also help show that the baby is getting plenty (Information Sheet Is my Baby Getting Enough Milk?). Also see the videos at nbci.ca.

13. Modern formulas are almost the same as breastmilk. Not true! The same claim was made in 1900 and before. Modern formulas are only superficially similar to breastmilk. Every correction of a deficiency in formulas is advertised as an advance. Fundamentally, formulas are inexact copies based on outdated and incomplete knowledge of what breastmilk is. Formulas contain no antibodies, no living cells, no enzymes, no hormones. They contain much more aluminum, manganese, cadmium, lead and iron than breastmilk. They contain significantly more protein than breastmilk. The proteins and fats are fundamentally different from those in breastmilk. Formulas do not vary from the beginning of the feed to the end of the feed, or from day 1 to day 7 to day 30, or from woman to woman, or from baby to baby. Your breastmilk is made as required to suit your baby. Formulas are made to suit every baby, and thus no baby. Formulas succeed only at making babies grow well, usually, but there is more to breastfeeding than nutrients.

14. If the mother has an infection she should stop breastfeeding. Not true! With very, very few exceptions, the mother’s continuing to breastfeed will actually protect the baby. By the time the mother has fever (or cough, vomiting, diarrhea, rash, etc) she has already given the baby the infection, since she has been infectious for several days before she even knew she was sick. The baby's best protection against getting the infection is for the mother to continue breastfeeding. If the baby does get sick, he will be less sick if the mother continues breastfeeding. Besides, maybe it was the baby who gave the infection to the mother, but the baby did not show signs of illness because he was breastfeeding. Also, breast infections, including breast abscess, though painful, are not reasons to stop breastfeeding. Indeed, the infection is likely to settle more quickly if the mother continues breastfeeding on the affected side. (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).


15. If the baby has diarrhea or vomiting, the mother should stop breastfeeding. Not true! The best medicine for a baby's gut infection is breastfeeding. Stop other foods for a short time, but continue breastfeeding. Breastmilk is the only fluid your baby requires when he has diarrhea and/or vomiting, except under exceptional circumstances. The push to use "oral rehydrating solutions" is mainly a push by the formula manufacturers (who also make oral rehydrating solutions) to make even more money. The baby is comforted by the breastfeeding, and the mother is comforted by the baby's breastfeeding. (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).

16. If the mother is taking medicine she should not breastfeed. Not true! There are very very few medicines that a mother cannot take safely while breastfeeding. A very small amount of most medicines appears in the milk, but usually in such small quantities that there is no concern. If a medicine is truly of concern, there are usually equally effective, alternative medicines that are safe. The risks of artificial feeding for both the mother and the baby must be taken into account when weighing if breastfeeding should be continued (Information Sheets Breastfeeding and Medication and Breastfeeding and Illness).

17. A breastfeeding mother has to be obsessive about what she eats. Not true! A breastfeeding mother should try to eat a balanced diet, but neither needs to eat any special foods nor avoid certain foods. A breastfeeding mother does not need to drink milk in order to make milk. A breastfeeding mother does not need to avoid spicy foods, garlic, cabbage or alcohol. A breastfeeding mother should eat a normal healthful diet. Although there are situations when something the mother eats may affect the baby, this is unusual. Most commonly, "colic", "gassiness" and crying can be improved by changing breastfeeding techniques, rather than changing the mother's diet. (Information Sheet Colic in the Breastfed Baby).

18. A breastfeeding mother has to eat more in order to make enough milk. Not true! Women on even very low calorie diets usually make enough milk, at least until the mother's calorie intake becomes critically low for a prolonged period of time. Generally, the baby will get what he needs. Some women worry that if they eat poorly for a few days this also will affect their milk. There is no need for concern. Such variations will not affect milk supply or quality. It is commonly said that women need to eat 500 extra calories a day in order to breastfeed. This is not true. Some women do eat more when they breastfeed, but others do not, and some even eat less, without any harm done to the mother or baby or the milk supply. The mother should eat a balanced diet dictated by her appetite. Rules about eating just make breastfeeding unnecessarily complicated.

19. A breastfeeding mother has to drink lots of fluids. Not true! The mother should drink according to her thirst. Some mothers feel they are thirsty all the time, but many others do not drink more than usual. The mother's body knows if she needs more fluids, and tells her by making her feel thirsty. Do not believe that you have to drink at least a certain number of glasses a day. Rules about drinking just make breastfeeding unnecessarily complicated.


20. A mother who smokes is better not to breastfeed. Not true! A mother who cannot stop smoking should breastfeed. Breastfeeding has been shown to decrease the negative effects of cigarette smoke on the baby's lungs, for example. Breastfeeding confers great health benefits on both mother and baby. It would be better if the mother not smoke, but if she cannot stop or cut down, then it is better she smoke and breastfeed than smoke and formula feed.

21. A mother should not drink alcohol while breastfeeding. Not true! Reasonable alcohol intake should not be discouraged at all. As is the case with most drugs, very little alcohol comes out in the milk. The mother can take some alcohol and continue breastfeeding as she normally does. Prohibiting alcohol is another way we make life unnecessarily restrictive for breastfeeding mothers.


22. A mother who bleeds from her nipples should not breastfeed. Not true! Though blood makes the baby spit up more, and the blood may even show up in his bowel movements, this is not a reason to stop breastfeeding the baby. Nipples that are painful and bleeding are not worse than nipples that are painful and not bleeding. It is the pain the mother is having that is the problem. This nipple pain can often be helped considerably. Get help. (Information Sheet Sore Nipples and Vasospasm and Raynaud’s Phenomenon). Sometimes mothers have bleeding from the nipples that is obviously coming from inside the breast and is not usually associated with pain. This often occurs in the first few days after birth and settles within a few days. The mother should not stop breastfeeding for this. If bleeding does not stop soon, the source of the problem needs to be investigated, but the mother should keep breastfeeding.

23. A woman who has had breast augmentation surgery cannot breastfeed. Not true! Most do very well. There is no evidence that breastfeeding with silicone implants is harmful to the baby. Occasionally this operation is done through the areola. These women do have often have problems with milk supply, as does any woman who has an incision around the areolar line.

24. A woman who has had breast reduction surgery cannot breastfeed. Not true! Breast reduction surgery does often decrease the mother's capacity to produce milk, but since many mothers produce more than enough milk, some mothers who have had breast reduction surgery sometimes can breastfeed exclusively. In such a situation, the establishment of breastfeeding should be done with special care to the principles mentioned in the Information Sheet Breastfeeding—Starting Out Right. However, if the mother seems not to produce enough, she can still breastfeed, supplementing with a lactation aid (so that artificial nipples do not interfere with breastfeeding). See Information Sheet Lactation Aid.

25. Premature babies need to learn to take bottles before they can start breastfeeding. Not true! Premature babies are less stressed by breastfeeding than by bottle feeding. A baby as small as 1200 grams and even smaller can start at the breast as soon as he is stable, though he may not latch on for several weeks. Still, he is learning and he is being held which is important for his wellbeing and his mother's. Actually, weight or gestational age do not matter as much as the baby's readiness to suck, as determined by his making sucking movements. There is no more reason to give bottles to premature babies than to full term babies. When supplementation is truly required there are ways to supplement without using artificial nipples.

26. Babies with cleft lip and/or palate cannot breastfeed. Not true! Some do very well. Babies with a cleft lip only usually manage fine. But many babies with cleft palate do indeed find it very difficult to latch on. There is no doubt, however, that if breastfeeding is not even tried, for sure the baby won’t breastfeed. The baby's ability to breastfeed does not always seem to depend on the severity of the cleft. Breastfeeding should be started, as much as possible, using the principles of proper establishment of breastfeeding. (Information Sheet Breastfeeding—Starting Out Right). If bottles are given, they will undermine the baby's ability to breastfeed. If the baby needs to be fed, but is not latching on, a cup can and should be used in preference to a bottle. Finger feeding occasionally is successful in babies with cleft lip/palate, but not usually (See Information Sheet Finger and Cup Feeding).

27. Women with small breasts produce less milk than those with large breasts. Nonsense!


28. Breastfeeding women cannot take the birth control pill. Not true! The question is not about exposure to female hormones, to which the baby is exposed anyway through breastfeeding. The baby gets only a tiny bit more from the pill. However, some women who take the pill, even the progestin only pill, find that their milk supply decreases. Estrogen-containing pills are more likely to decrease the milk supply. Because so many women produce more than enough, this sometimes does not matter, but sometimes it does even in the presence of an abundant supply, and the baby becomes fussy and is not satisfied by breastfeeding. Babies respond to the rate of flow of milk, not what's "in the breast", so that even a very good milk supply may seem to cause the baby who is used to faster flow to be fussy. Stopping the pill often brings things back to normal. If possible, women who are breastfeeding should avoid the pill, or at least wait until the baby is taking other foods (usually around 6 months of age). Even if the baby is older, the milk supply may decrease significantly. If the pill must be used, it is preferable to use the progestin only pill (without estrogen).

29. Breastfeeding babies need other types of milk after six months. Not true! Breastmilk gives the baby everything there is in other milks and more. Babies older than six months should be started on solids mainly so that they learn how to eat and so that they begin to get another source of iron, which by 7-9 months, is not supplied in sufficient quantities from breastmilk alone. Thus cow's milk or formula will not be necessary as long as the baby is breastfeeding. However, if the mother wishes to give milk after 6 months, there is no reason that the baby cannot get cow's or goat’s milk, as long as the baby is still breastfeeding a few times a day, and is also getting a wide variety of solid foods in more than minimal amounts. Most babies older than six months who have never had formula will not accept it because of the taste.

30. Women with flat or inverted nipples cannot breastfeed. Not true! Babies do not breastfeed on nipples, they breastfeed on the breast. Though it may be easier for a baby to latch on to a breast with a prominent nipple, it is not necessary for nipples to stick out. A proper start will usually prevent problems and mothers with any shaped nipples can breastfeed perfectly adequately. In the past, a nipple shield was frequently suggested to get the baby to take the breast. This gadget should not be used, especially in the first two weeks! Though it may seem a solution, its use can result in poor feeding and severe weight loss, and makes it even more difficult to get the baby to take the breast. (See Information Sheet Finger and Cup Feeding). If the baby does not take the breast at first, with proper help, he will often take the breast later. Breasts also change in the first few weeks, and as long as the mother maintains a good milk supply, the baby will usually latch on by 8 weeks of age no matter what, but get help and the baby may latch on before. See Information Sheet When a Baby Does not yet Latch.


31. A woman who becomes pregnant must stop breastfeeding. Not true! If the mother and child desire, breastfeeding can continue. Some continue breastfeeding the older child even after delivery of the new baby. Many women do decide to stop breastfeeding when they become pregnant because their nipples are sore, or for other reasons, but there is no rush or medical necessity to do so. In fact, there are often good reasons to continue. The milk supply will likely decrease during pregnancy, but if the baby is taking other foods, this is not a usually a problem. However, some babies will stop breastfeeding if the milk supply is low.

32. A baby with diarrhea should not breastfeed. Not true! The best treatment for a gut infection (gastroenteritis) is breastfeeding. Furthermore, it is very unusual for the baby to require fluids other than breastmilk. If lactose intolerance is a problem, the baby can receive lactase drops, available without prescription, just before or after the feeding, but this is rarely necessary in breastfeeding babies. Get information on its use from the clinic. In any case, lactose intolerance due to gastroenteritis will disappear with time. Lactose free formula is not better than breastfeeding. Breastfeeding is better than any formula.

33. Babies will stay on the breast for two hours because they like to suck. Not true! Babies need and like to suck, but how much do they need? Most babies who stay at the breast for such a long time are probably hungry, even though they may be gaining well. Being on the breast is not the same as drinking at the breast. Latching the baby better onto the breast allows the baby to breastfeed more effectively, and thus spend more time actually drinking. You can also help the baby to drink more by expressing milk into his mouth when he no longer swallows on his own (See Information Sheet Breast Compression). Babies younger than 5-6 weeks often fall asleep at the breast because the flow of milk is slow, not necessarily because they have had enough to eat. See videos at nbci.ca.

34. Babies need to know how to take a bottle. Therefore a bottle should always be introduced before the baby refuses to take one. Not true! Though many mothers decide to introduce a bottle for various reasons, there is no reason a baby must learn how to use one. Indeed, there is no great advantage in a baby's taking a bottle. Since Canadian women are supposed to receive 52 weeks maternity leave, the baby can start eating solids after 6 months, well before the mother goes back to her outside work. The baby can even take fluids or solids that are quite liquid off a spoon. The baby can start learning how to drink from a cup right from birth or older, and though it may take several weeks for the older baby to learn to use it efficiently, he will learn. If the mother is going to introduce a bottle, it is better she wait until the baby has been breastfeeding well for 4-6 weeks, and then give it only occasionally. Sometimes, however, babies who take the bottle well at 6 weeks, refuse it at 3 or 4 months even if they have been getting bottles regularly (smart babies). Do not worry, and proceed as above with solids and spoon. Giving a bottle when breastfeeding is not going well is not a good idea and usually makes the breastfeeding even more difficult. For your sake and the baby's do not try to "starve the baby into submission." Get help.


35. If a mother has surgery, she has to wait a day before restarting breastfeeding. Not true! The mother can breastfeed immediately after surgery, as soon as she is awake and up to it. Neither the medications used during anaesthesia, nor pain medications nor antibiotics used after surgery require the mother to interrupt breastfeeding, except under exceptional circumstances. Enlightened hospitals will accommodate breastfeeding mothers and babies when either the mother or the baby needs to be admitted to the hospital, so that breastfeeding can continue. Many rules that restrict breastfeeding are more for the convenience of staff than for the benefit of mothers and babies.

36. Breastfeeding twins is too difficult to manage. Not true! Breastfeeding twins is easier than bottle feeding twins, if breastfeeding is going well. This is why it is so important that a special effort should be made to get breastfeeding started right when the mother has had twins (See Information Sheets Breastfeeding—Starting Out Right and The Importance of Skin to Skin Contact). Some women have breastfed triplets exclusively. This obviously takes a lot of work and time, but twins and triplets take a lot of work and time no matter how the infants are fed.

37. Women whose breasts do not enlarge or enlarge only a little during pregnancy, will not produce enough milk. Not true! There are a very few women who cannot produce enough milk (though they can continue to breastfeed by supplementing with a lactation aid). Some of these women say that their breasts did not enlarge during pregnancy. However, the vast majority of women whose breasts do not seem to enlarge during pregnancy produce more than enough milk.

38. A mother whose breasts do not seem full has little milk in the breast. Not true! Breasts do not have to feel full to produce plenty of milk. It is normal that a breastfeeding woman's breasts feel less full as her body adjusts to her baby's milk intake. This can happen suddenly and may occur as early as two weeks after birth or even earlier. The breast is never "empty" and also produces milk as the baby breastfeeds. Is the baby getting milk from the breast? That’s what’s important, not how full the breast feels. Look skeptically upon anyone who squeezes your breasts to make a determination of milk sufficiency or insufficiency. See videos at nbci.ca.

39. Breastfeeding in public is not decent. Not true! It is the humiliation and harassment of mothers who are breastfeeding their babies that is not decent. Women who are trying to do the best for their babies should not be forced by other people's hang-ups or lack of understanding to stay home or feed their babies in public washrooms. Those who are offended need only avert their eyes. Children will not be damaged psychologically by seeing a woman breastfeeding. On the contrary, they might learn something important, beautiful and fascinating. They might even learn that breasts are not only for selling beer. Other women who have left their babies at home to be bottle fed when they went out might be encouraged to bring the baby with them the next time.

40. Breastfeeding a child until 3 or 4 years of age is abnormal and bad for the child, causing an over-dependent relationship between mother and child. Not true! Breastfeeding for 2-4 years was the rule in most cultures since the beginning of human time on this planet. Only in the last 100 years or so has breastfeeding been seen as something to be limited. Children breastfeed into the third year are not overly dependent. On the contrary, they tend to be very secure and thus more independent. They themselves will make the step to stop breastfeeding (with gentle encouragement from the mother), and thus will be secure in their accomplishment.

41. If the baby is off the breast for a few days (weeks), the mother should not restart breastfeeding because the milk sours. Not true! The milk is as good as it ever was. Breastmilk in the breast is not milk or formula in a bottle.


42. After exercise a mother should not breastfeed. Not true! There is absolutely no reason why a mother would not be able to breastfeed after exercising. The study that purported to show that babies were fussy feeding after mother exercising was poorly done and contradicts the everyday experience of millions of mothers.

43. A breastfeeding mother cannot get a permanent or dye her hair. Not true! I have no idea where this comes from.

44. Breastfeeding is blamed for everything. True! Family, health professionals, neighbours, friends and taxi drivers will blame breastfeeding if the mother is tired, nervous, weepy, sick, has pain in her knees, has difficulty sleeping, is always sleepy, feels dizzy, is anemic, has a relapse of her arthritis (migraines, or any chronic problem) complains of hair loss, change of vision, ringing in the ears or itchy skin. Breastfeeding will be blamed as the cause of marriage problems and the other children acting up. Breastfeeding is to blame when the mortgage rates go up and the economy is faltering. And whenever there is something that does not fit the "picture book" life, the mother will be advised by everyone that it will be better if she stops breastfeeding.

45. Breastfeeding mothers cannot breastfeed if they have had X-rays. Not true! Regular X-rays such as a chest X-ray or dental X-rays do not affect the milk or the baby and the mother may breastfeed without concern. Mammograms are harder to read when the mother is lactating, but can be done and the mother should not stop breastfeeding just to get this done. Furthermore, there are other ways of investigating a breast lump. Newer imaging methods such as CT scan and MRI scans are of no concern, even if contrast is used. And special X-rays using contrast media? As long as no radioactive isotope is used there is no concern and the mother should not stop even for one feed. Herein are included studies such as intravenous pyelogram, lymphangiogram, venogram, arteriogram, myelogram, etc. What about studies using radioactive nucleotides (bone scans, lung scans, etc.)? The baby will get a little radioactive nucleotide. However, as we often do these very same tests on children, even small babies, and the potential loss of benefits if the mother stops breastfeeding are considerable, the mother should, in my opinion, continue breastfeeding. If you feel you must stop for a period of time, express milk in advance so that the baby can be fed your milk and not formula. After two half lives, 75% of the compound will be out of your body. This is surely waiting long enough (the half life of technetium, which is used in most radioactive scans is only six hours, so that 12 hours after the injection, 75% of it will be out of your body). The exception is the thyroid scan using I131. This test must be avoided in breastfeeding mothers. There are many ways of evaluating the thyroid, and only very occasionally does a thyroid scan truly have to be done. If the scan must be done, doing it with I123 requires the mother to stop breastfeeding for 12 to 24 hours only depending on the dose. Check first before taking the radioactive iodine—the test can wait until you know for sure. In many cases where the scan must be done, it can be put off for several months. Incidentally, lung scans with radioactive contrast no longer is the best test to rule out a lung clot. CT scan is now the preferred test to prove or disprove the diagnosis. [See also Information Sheet Breastfeeding and Medications)

46. Breastfeeding mothers' milk can "dry up" just like that. Not true! Or if this can occur, it must be a rare occurrence. Aside from day-to-day and morning-to-evening variations, milk production does not change suddenly. There are changes which occur which may make it seem as if milk production is suddenly much less:

An increase in the needs of the baby, the so-called growth spurt. If this is the reason for the seemingly insufficient milk, a few days of more frequent breastfeeding will bring things back to normal. Try compressing the breast with your hand to help the baby get milk (Information Sheet Breast Compression). A change in the baby's behaviour. At about five to six weeks of age, more or less, babies who would fall asleep at the breast when the flow of milk slowed down, tend to start pulling at the breast or crying when the milk flow slows. The milk has not dried up, but the baby has changed. Try using breast compression to help the baby get more milk. See the website nbci.ca for videos on how to latch a baby on, how to know the baby is getting milk, how to use compression. The mother's breasts do not seem full or are soft. It is normal after a few weeks for the mother no longer to have engorgement, or even fullness of the breasts. As long as the baby is drinking at the breast, do not be concerned (Information sheet Is My Baby Getting Enough Milk?). The baby breastfeeds less well. This is often due to the baby being given bottles or pacifiers and thus learning an inappropriate way of breastfeeding.

The birth control pill may decrease your milk supply. Think about stopping the pill or changing to a progesterone only pill. Or use other methods. Other drugs that can decrease milk supply are pseudoephedrine (Sudafed), some antihistamines, and perhaps diuretics.

If the baby truly seems not to be getting enough, get help, but do not introduce a bottle that may only make things worse. If absolutely necessary, the baby can be supplemented, using a lactation aid that will not interfere with breastfeeding, or by cup if the baby will not take the aid. However, lots can be done before giving supplements. Get help. Try compressing the breast with your hand to help the baby get milk (Information Sheet Breast Compression).

47. Physicians know a lot about breastfeeding. Not true! Obviously, there are exceptions. However, very few physicians trained in North America or Western Europe learned anything at all about breastfeeding in medical school. Even fewer learned about the practical aspects of helping mothers start breastfeeding and helping them maintain breastfeeding. After medical school, most of the information physicians get regarding infant feeding comes from formula company representatives or advertisements.

48. Pediatricians, at least, know a lot about breastfeeding. Not true! Obviously, there are exceptions. However, in their post-medical school training (residency), most pediatricians learned nothing formally about breastfeeding, and what they picked up in passing was often wrong. To many trainees in pediatrics, breastfeeding is seen as an "obstacle to the good medical care" of hospitalized babies.


49. Formula company literature and formula samples do not influence how long a mother breastfeeds. Really? So why do the formula companies work so hard to make sure that new mothers are given these samples, their company's samples? Are these samples and the literature given out to encourage breastfeeding? Do formula companies take on the cost of the samples and booklets so that mothers will be encouraged to breastfeed longer? The companies often argue that, if the mother does give formula, they want the mother to use their brand. But in competing with each other, the formula companies also compete with breastfeeding. Did you believe that argument when the cigarette companies used it?

50. Breastmilk given with formula may cause problems for the baby. Not true! Most breastfeeding mothers do not need to use formula and when problems arise that seem to require artificial milk, often the problems can be resolved without resorting to formula. However, when the baby may require formula, there is no reason that breastmilk and formula cannot be given together.

51. Babies who are breastfed on cue are likely to be "colicky." Not true! "Colicky" breastfed babies often gain weight very quickly and sometimes are feeding frequently. However, many are colicky not because they are feeding frequently, but because they do not take the breastmilk as well as they should. Typically, the baby drinks very well for the first few minutes, then nibbles or sleeps. When the baby is offered the other side, he will drink well again for a short while and then nibble or sleep. The baby will fill up with relatively low fat milk and thus feed frequently. The taking in of mostly low fat milk may also result in gas, crying and explosive watery bowel movements. The mother can urge the baby to breastfeed longer on the first side, and thus get more high fat milk, by compressing the breast once the baby sucks but does not drink. (Information Sheets Colic in the Breastfed Baby and Breast Compression). Also see videos at nbci.ca

52. Mothers who receive immunizations (tetanus, rubella, hepatitis B, hepatitis A, etc.) should stop breastfeeding for 24 hours (3 days, 2 weeks). Not true! Why should they? There is no risk for the baby, and he may even benefit. The rare exception is the baby who has an immune deficiency. In that case the mother should not receive an immunization with a weakened live virus (e.g. oral, but not injectable polio, or measles, mumps, rubella) even if the baby is being fed artificially.

53. There is no such thing as nipple confusion. Not true! The baby is not confused, though, the baby knows exactly what he wants. A baby who is getting slow flow from the breast and then gets rapid flow from a bottle will figure that one out pretty quickly. A baby who has had only the breast for three or four months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

Questions? First look at the website nbci.ca or drjacknewman.com. If the information you need is not there, go to Contact Us and give us the information listed there in your email. Information is also available in Dr. Jack Newman’s Guide to Breastfeeding, and/or our DVD, Dr. Jack Newman’s Visual Guide to Breastfeeding (available in French or with subtitles in Spanish, Portuguese and Italian); and/or The Latch Book and Other Keys to Breastfeeding Success; and/or L-eat Latch and Transfer Tool; and/or the GamePlan for Protecting and Supporting Breastfeeding in the First 24 Hours of Life and Beyond.

To make an appointment online with our clinic please visit www.nbci.ca. If you do not have easy access to email or internet, you may phone (416) 498-0002.



Helpful Breastfeeding Books for Nursing Mothers and Mothers-to-Be 

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Dr. Jack Newman graduated from the University of Toronto medical school in 1970, interning at the Vancouver General Hospital. He did his training in pediatrics in Quebec City and then at the Hospital for Sick Children in Toronto from 1977-1981 to become a Fellow of the Royal College of Physicians of Canada in 1981 as well as Board Certified by the AAP in 1981. He has worked as a physician in Central America, New Zealand and as a pediatrician in South Africa (in the Transkei). He founded the first hospital based breastfeeding clinic in Canada in 1984. He has been a consultant for UNICEF for the Baby Friendly Hospital Initiative, evaluating the first candidate hospitals in Gabon, the Ivory Coast and Canada.

Dr. Newman was a staff pediatrician at the Hospital for Sick Children emergency department from 1983 to 1992, and was, for a period of time, the acting chief of the emergency services. However, once the breastfeeding clinic started functioning, it took more and more of his time and he eventually worked full time helping mothers and babies succeed with breastfeeding. He now works at the Newman Breastfeeding Clinic and Institute based at the Canadian College of Naturopathic Medicine in Toronto.

Dr. Newman has several publications on breastfeeding, and in 2000 published, along with Teresa Pitman, a help guide for professionals and mothers on breastfeeding, called, Dr. Jack Newman's Guide to Breastfeeding, (revised editions: 2003, 2005, 2009), and The Ultimate Breastfeeding Book of Answers, (revised edition: 2006). The book has been translated into French, Indonesian, Japanese, Spanish and Italian. In 2006, Dr. Newman, along with Teresa Pitman, published The Latch and Other Keys to Breastfeeding Success (Hale Publishing) and was translated into French. He has also, along with Edith Kernerman, developed a DVD as a teaching tool for health professionals and mothers. It is available in English and French. As well, it is subtitled in Spanish, Portuguese and Italian.

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