Thursday, December 14, 2017

Santa Makes Frequent Stops to Pump after Consuming Cookies

There are a lot of trends and promises of "quick fixes" when it comes to breastfeeding and milk supply. Most of these "remedies" have absolutely no research to back them up, but (as with all good myths) there is some truth that has made them seem logical or even probable. Take lactation cookies for instance, the ingredients used in creating them have been promoted as galactagogues for years. Galactagogues are medications, herbs or foods that MAY help increase a woman's milk supply.

Some popular galactagogues include Fenugreek, Blessed Thistle and Fennel. It is important to note that recommendation of a galactagogue should only be made by a Lactation Consultant or Medical Professional.  A list of galactagogues and their effects can be found here.

The main frustration many lactation professionals have with the lactation cookie trend is the simplistic solution to low milk supply it offers. Most women can produce enough milk for their baby if they have a good latch, feed frequently and experience milk transfer during the feeding. The most effective way to increase milk supply is by removing milk from the breast regularly. Unfortunately, most moms will still have concerns about supply. Some of the expensive remedies prey on these concerns.

Supply can drop with the return of a menstrual cycle, if a person experiences extreme stress and with some forms of birth control. Not all low supply is merely perceived. When a breastfeeding woman is concerned about her supply, she needs to be evaluated by an IBCLC.

A mom may also receive reassurance from noticing the following:

  • Baby has 8-10 wet diapers every 24 hours
  • Mom's breasts feel lighter after a feeding
  • Baby is eating 10-12 times every 24 hours
  • Baby gains 4-7 oz weekly
  • Baby is satisfied after nursing
  • Baby is alert when awake
  • Baby has good skin color and diapers are yellow and seedy
  • Mom can see and hear baby swallowing

There is good news for the entrepreneurs that have baked their way into the homes and hearts of families as well as those who consume the confectioneries. We already discussed how stress can affect milk supply and if sitting down and enjoying a warm oatmeal cookie relieves stress, it may help to combat the issue. Oatmeal is also a great source of iron. Anemia (low iron) can result in lower milk supply. Lastly, when we are enjoying our food, we release more oxytocin, a hormone associated with the "let-down."

We cannot ignore the placebo affect. Many moms feel like the cookies help, therefore, they do. Our minds are very convincing to our bodies.

Although there is no scientific evidence that consuming cookies boosts milk supply, there are many anecdotal findings. This is perhaps the most effective advertising boosting the sales of edibles.

So please, if you want a cookies, have a cookie, but if you are experiencing low supply see a Lactation Consultant. In fact, why not sit down and share a plate of cookies over a conversation and consultation.

Looking for a good recipe? Try this one this holiday season, and maybe deliver a plate to your neighbors.

Happy Holidays and Lavishing Lactation from Birthing, Bonding and Breastfeeding.

Wednesday, February 22, 2017

How Formula and Fear Ended My First Breastfeeding Journey

The year was 1997, and I entered the hospital where I was planning to birth my first baby. I had read all the books, taken the classes and prepared to the best of my ability for my impending birth. My rolling luggage contained all the supplies recommended by the Lamaze teacher and close friends. I had a well-thought out Birth Plan. In all honesty, my entire plan consisted of avoiding medications and birthing a baby. I assumed that the hospital staff would fill in any blanks I had forgotten to complete. My "water broke" at home, so the hospital policy stressed the importance of remaining in bed to avoid "severe infection." Since we had not discussed this in prenatal classes, I deferred to the attending nurse.

The contractions were as regular as the hands on a clock, which caused the staff to predict a "fast labor." The nurse approached me and explained that the labor could and should be hastened, so I could deliver my baby before the day was out. I excitedly agreed--not comprehending that I was consenting to Pitocin administration. Almost immediately, I was consumed with incredible pain and fear. My body was reacting in a way that seemed uncontrolled or understood by my mind. I was still trying to focus, but was not as successful as I had been the previous hours.

Again, I was approached with an option of "lessening the pain" and "taking the edge off." The nurse offered a visit from the anesthesiologist who would happily provide the epidural--resulting in a "pain free birth." I declined, not because I did not want the relief, but because I had predetermined my pain management goals.

A few hours of intense labor and my son joined us earth-side. I was holding my perfect little baby and, for a time, everything was well in my world. I cuddled and stared in awe until we slept. I felt completely as ease while my baby and I synchronized our breaths and adjusted to our surroundings.

The shattering news was delivered only a few, short hours later. A new nurse (who replaced my kind, supportive day nurse) brought the discovery to my attention. She entered my room and abruptly stated that my son was jaundiced! I looked at her in confusion because we had not discussed this diagnosis in my prenatal classes. I asked if he would be all right. She said that his numbers were at eleven and he needed formula. She also stated that since my seven pound baby was very large, formula was a necessity. I reluctantly explained that I desired to breastfeed. Her quick, rehearsed response was, "Do you want this baby to live, or do you want to breastfeed?" What a terrifying question to be presented with just hours postpartum. What is jaundice? Why is my baby's weight an issue? There were no explanations, just fear and accusations. I immediately consented to formula--considering the alternative that was provided.   I was extremely vigilant in offering a bottle, along with breastmilk for every feed, until I left the hospital. The following day, I was applauded for my baby's progress, which the nurse attributed to the formula. She discharged me with several containers of formula and admonished me to continue feeding formula to safeguard against tragic results.

I took my bundle of joy and bundle of formula and left the hospital. I religiously offered a bottle of formula several times a day to prevent whatever condition would develop without it. I was too afraid of putting my baby at risk to exclusively breastfeed. I never spoke of my breastfeeding journey with friends. I was too embarrassed about them knowing I almost put my baby's life in danger by my "selfish" desire to breastfeed.

My six week check up resulted in more congratulatory remarks about my baby's development. When asked about feeding, I responded with a pro-formula remark since I understood there was a "danger" associated with exclusive breastfeeding. My schedule of formula feeding was positively reinforced and I conceded that my pediatrician was favorable of formula feeding.

At six weeks, when my baby experienced "frequency days," I was convinced that my milk was insufficient to satisfy my baby. I increased the amount of formula, not realizing that in doing so, I was signaling my body to actually slow milk production. By now the free samples had disappeared and I was investing hundreds of dollars into a breastmilk substitute. I read all the propaganda and purchased the most attractive cans that touted a closeness to breastmilk. Once again, my ignorance won out. I invested in a product that was trying its best to mimic the fluid I had in abundance.

My breastfeeding journey ended so much sooner than I desired. I had a personal goal of nourishing my outside of the womb just as I had for nine months. No one questioned how my body could grow a baby for forty weeks. No one questioned if I was providing adequate nutrition in utero. No one questioned how my body sustained life, but outside of the womb, apparently, my body failed miserably at the task. I questioned everything about my parenting choices. I felt like a failure because I was pronounced a failure. Perception is reality.

My second child made her debut twenty-two months later--at a Baby Friendly designated hospital. My labor plan was supported and within a few hours, I held my daughter skin-to-skin and was breastfeeding. I was prepared to defend my choice this time. I had researched the AAP jaundice guidelines and realized that jaundice was a common condition due to extra red blood cells and I understood what numbers would constitute a legitimate concern. I was ready to confront the fear--but the fear never came. I also anticipated being judged for "giving only breastmilk" to my large baby. After all, she was about the same size as her brother at birth. The judgement never came. My little girl was weighed, her diapers were counted and I was encouraged to "keep up the good work." The following day, an IBCLC visited me to ask how breastfeeding felt and if I was experiencing any pain. She requested that I allow her to observe a feeding session. My little girl latched, sucked and fed for several minutes. The session was used to educate me on signs of milk transfer and recognizing swallows.

The following day, I left the hospital with my bundle of joy and bundle of confidence. I was equipped with knowledge and confidence. I knew my body was capable of nourishing my baby. I knew I could provide milk for my offspring just as every mammal does. I was not going to be bullied or scared into making a choice that I did not agree with. I was older, bolder and more educated.

The combination of advocating for myself and a hospital that supported breastfeeding made my dreams a reality. Breastfeeding continued until her first birthday--and a breastfeeding advocate was born.

My third child presented some feeding challenges. We worked through issues with an IBCLC and each problem I encountered was resolved with a solution that allowed me to continue my breastfeeding relationship. When the issue of jaundice surfaced this time, I supplemented for twenty-four hours with my own expressed breastmilk. I was surprised that this little girl trumped her brother in size. Her birth weight prompted the nurse to advice breastfeeding "every chance I got." A quote that was not followed up with any severe warnings or fear mongering. My hospital stay consisted of small snacks, skin-to-skin holds and frequent feeding. My baby and I were only separated when I showered (at which time she transferred from my chest to her father's). I could not help but contrast this scenario with my first birth. I wondered what that event would have looked like had I been knowledgeable and supported.

Yes, hindsight it 50-50, but I hope foresight can be as well. We have come a long way in our birth and breastfeeding practices. The Baby Friendly Hospital Initiative has laid some great ground-work and provided a foundation for providing in-hospital breastfeeding support. The initiatives, protocols, policies--all aided by skilled and educated health professionals are helping to bring instinct and the biological norms back into the highly medicated and routinely intrusive process of hospital birth.

For those who find themselves where I was as a first-time mom, let me offer you the information and support I so desperately needed. First, you need to know you are amazing. You are, after all, capable of making a person! Your body is a super-factory that is able to create the most intricate life form known. Simultaneously, your body is preparing the perfect nourishment for its creation. What a spectacular system you are equipped with.

Secondly, know that you will face adversaries in your quest to breastfeed. There are people who have made a point to question your ability. I am both saddened and angered that instead of celebrating the power and strength of a woman, some choose to undermine and minimize the uniqueness of our gender. I suppose there are many reasons for the skepticism. Some sabotage breastfeeding for a profit, some out of ignorance and a few from habit. Old wives' tales are difficult to shake.

Here are a few reassuring points you need to commit to memory.

  1. Your baby is not born "starving." Although food is often withheld from the laboring woman, the baby's access to nourishment is not interrupted in the womb.
  2. Baby's are not born with an "empty" stomach. There is research on how much fluid a baby's empty stomach can hold and malicious people are using that information to question a woman's ability to satisfy her newborn. Remember, baby's gauge is not on "empty" at birth.
  3. Mammals have milk for their offspring and instinctively nurse. Visit any zoo, wild animal park, pet store, etc. and ask to see the resident "lactation consultant." You will be met with blank stares and confusion. Mammals have been feeding their newborns for generations.
  4. Babies have very tiny tummies. They are born with a desire to suck and suck they will. The more frequently the better. Because the suck reflex exists, if a baby is placed on the breast, he will often begin feeding spontaneously. The baby that is fed frequently, will be satisfied and signal (through hormones and biology) for the mother's breasts to make more milk. 
  5. Moms have thick, rich milk the first few days that is full of protective factors and concentrated nutrients. This milk also has a mild laxative effect that encourages the expelling of meconium and reduces the risk of jaundice.
  6. Since babies have tiny tummies and moms have small amounts of colostrum, the baby can eat constantly and not get overfed.  In fact, when the baby is satisfied, the suck will change from active eating to pacifying--another way a newborn instinctively stops himself from eating to the point of discomfort. 
  7. The best way to make milk is by removing milk. Early, frequent feeds is the key. If a mom and baby are separated at birth, mom should remove milk manually or with a pump within six hours of delivery.
  8. For full-term, healthy newborns, breastmilk intake is not measured. It is preferred to allow mom and baby and partner time to recover and bond. Measuring intake is not necessary since there are more favorable ways to ensure milk transfer.
  9. Babies should have one wet diaper for every twenty-four hours of life until around day six, when they will begin having 8-10 wet diapers daily. 
  10. Initial weight loss is common. Babies should return to birth weight by two weeks of age. It is important to get a good weight at discharge or the first week of life to make certain baby is gaining weight. 

Christy Jo Hendricks, IBCLC, invented the Lactation Lanyard to remind mothers that their milk supply is the standard for feeding, NOT the formula bottles.

The first few days after delivery is mostly about bonding, recovery and feeding. Most women who can birth can also breastfeed. It is the way a mammals body works. There are conditions (like the ones I had after delivering my third child) that require intervention and support.

Warning signs can include:

  • No, or little diaper output
  • Discontent, inconsolable infant
  • Continued weight loss
  • Signs of dehydration
  • High billirubin
  • Constant feeding without satisfaction
The breastfeeding mother may show warning signs:
  • Little or no change in her breasts during pregnancy
  • Breasts that do not feel softer after a feeding
  • Pain while breastfeeding
  • Diagnosis of retained placenta
The above is not an exhaustive list nor is it a list of reasons to abandon the breastfeeding path. These are, however, a few reasons to involve an IBCLC in your journey. Occasionally, temporary supplementation is necessary or even long-term supplementation, but a lactation professional can advise you on how much more milk is needed and what kind of supplementation is available.

Data shows that most moms want to breastfeed. Who are we to downplay their desires. We should do all we can to support the goals of women in our society, who, after all, are creating society. To effortlessly dismiss a woman's goal of providing human milk to her newborn or to sabotage her goals with fear and false information is disgraceful.

I have spoken with many women who feel robbed of the breastfeeding experience and others that are angry that they did not have the support or education that would have resolved their issues. The groups that are preying on these women to gain followers or instigate more anger and resentment are indeed deplorable. I hope we can see our government, communities, families, health agencies and medical professionals working to support breastfeeding and empower moms rather than stripping them of their goals and power.

Monday, February 13, 2017

Breastfeeding Truths Come Under Attack--IBCLC Fights Back

I have comfortably watched from the sidelines as an ER doctor in Arkansas and one of her cohorts have taken a strange position in regards to breastfeeding. As far as I could tell from her blogs and postings, the doctor and her son suffered an unnecessary tragedy related to insufficient milk transfer right after delivery. No one accurately diagnosed her condition of retained placenta or evaluated the infant for milk transfer and growth. The consequences were dire. The infant did not thrive and the mother may have felt helpless and frightened. I have empathy for her. I share in her frustration. I am angered that the medical professionals and system let her down. What I do not understand is why she isn't lashing out at them. Why doesn't she insist on more observation, better care of moms in the postpartum period, regular assessments of the dyad. She stresses that she wanted to breastfeed, so it seems that it would be logical to take a pro-breastfeeding stand and help others that come after her avoid the same fate. Instead, she is working tirelessly to destroy the Baby Friendly Hospital Initiative, discredit the American Academy of Pediatricians, slander La Leche League International, and question the advice of Academy of Breastfeeding Medicine. The list of her antagonists goes on and on. Her message is destructive. Not only is she pedaling false information, she is also seeking ways to gain notoriety and attention by attacking pillars in the lactation community as well as stellar programs that exist to support and educate families.

Well, I have finally come in her cross-hairs and can no longer sit idly by.  Perhaps I should have spoken up sooner, but I truly felt the anger and accusations she was spewing would be her own downfall. I am responding now because I need to share truth and light in order to dispel shadows and doubt, besides, It is time for me to continue my campaign of evidence-based education backed by references and research.

When my product was recently mentioned in her blog, my first instinct was to ignore the post and focus on helping families. In fact, I would not have conceived this post if the complaints had just been aired on her editorial page. I know my product is well-respected by professionals and health organizations. I know it contains sound advice, backed by science. Unfortunately, I fell compelled to to respond now because a misled individual has gone to great lengths to discredit my work and the evidence behind it. She submitted a claim to the US Consumer Product Safety Commission accusing my product of leading to her son's starvation. Her reasoning is faulty to say the least. I am sharing the Open Letter I sent in response to the ridiculous and almost scandalous complaint she submitted. Let's end her tirade once and for all. Let's call out those who pretend to support breastfeeding but try to sabotage its success. Let's expose lies and half-truth.We cannot embrace "alternative truths" when it comes to infant feeding and public health. There is so much more I could say, but for now I will share my response to an invalid complaint about a powerful visual and important teaching tool that is empowering moms around the world.

For those who desire to see the "complaint" so you can understand my thorough frustration and confusion of why she projects blame on a teaching tool (that was not even widely marketed during the time she experienced) her for her child's condition, well, please refer to the claim she submitted here:

Now for my complete response:

US Consumer Product Safety Commission
Attn: Clearinghouse
4330 East West Highway
Bethesda, MD 20814-4408

January 29, 2017

Dear US Consumer Product Safety Commission and Reviewers:
I appreciate and respect the authority of your office and understand the gravity used in evaluating the safety of products. I recently received a notification that an invention I manufacture and market, the Lactation Lanyard, has been mentioned in a complaint. I am writing to clarify the utility of the product, the evidence that supports its use, and the fallacious nature of the accusations launched against this important teaching tool.

I understand that the complaint has been published and a response from myself or my company is not required, but I would be remiss if I did not respond to the false accusations directed at my product. I assure you that this is not an anonymous complaint by a “concerned citizen” but rather a spiteful person searching for an outlet for her anger and frustration.  I feel compelled to address the complaint and expose the misleading (and selective) information that the author of the submission provided on your form.

The individual who submitted the claim against my product has suffered a personal tragedy (as documented in her submission and on social media) and is trying desperately to find someone or something to blame for her circumstances.
She has gone to great lengths to skew information, and now I fear she has stooped to using your office to submit a frivolous complaint in an effort to execute a personal vendetta against lactation professionals. She has been making these claims on social media and appears frustrated that they have not been taken seriously by a wide audience.

Allow me to share some background information. The person who submitted the claim is part of an organization called “Fed is Best.” Her counterpart wrote a blog post attempting to discredit my lanyards and the established research that validates their utility. This new complaint issued to the Safety Commission appears to be yet another effort to grow an audience for their blog which recently featured complaints about the Lactation Lanyard. The picture of the Lactation Lanyard was removed from the editorial when I threatened a cease and desist letter. Even in the poorly written narrative, the author admits that the stomach capacity of a newborn is unknown, which is not entirely accurate. I am frustrated that this individual continues to spout misleading information in hopes of winning people over to her cause. In this case, the means definitely do not justify the ends. 
Blog by Jody Segrave-Daly, RN, IBCLC

Allow me to address each aspect of her accusations systematically. I believe once the scientific evidence is reviewed, it will be clear that there is absolutely no basis for her claims, and her complaint to the Commission will be disregarded.
First, the Product Detail section on the US Consumer Product Safety Commission report contains false information. The submitter states,

“The lactation lanyard and keychain are visual tools used to convince mothers that their newborns are not in need of supplemental feeding. It claims a newborn stomach size of 5-7 mL when in fact the scientific data has shown it is 20 mL. This is leading to dangerous newborn starvation and brain injury…”

My product is indeed a visual tool that shows the approximate intake of a newborn at day one and at day three, based on the anatomy and physiology of human newborns. The card attached to the lanyard also states that a newborn should be fed frequently and that the stomach grows as milk supply increases. The product comes with an instruction card and website address where we offer additional resources.  The lanyard in no way communicates that a mother should never supplement; that is a medical decision to be undertaken by the patient and her medical, nursing and lactation team. In reference to the last statement in the Product Detail, a visual aid cannot lead to starvation or brain injury; neglect and withholding nourishment can, and we would never condone anything remotely associated with that advice.

The complaint stresses the stomach size on day one. Immediately following birth, families are usually followed by a health professional whether a physician or medical staff in a hospital, or a midwife at a home birth or birth center. Families are cared for and educated by qualified staff who assess a baby for anything out of the ordinary. Knowing many hospitals and birth centers utilize the lanyards encourages me that these professionals share in the belief that breastmilk is the appropriate and sufficient nutrition for newborns, and will advise a family if supplementation becomes necessary. Dyads are closely monitored by health professionals during the postpartum stay, and surveys include tracking weight and output regularly.

The first 24 hours postpartum is mostly about rest and recovery. Newborns take in small quantities of milk during each feed. The exact amount measurable in milliliters is a moot point. When a mother is feeding from her breast, there is no need to use a feeding device and measure intake. Health care professionals have many ways to assess milk transfer, including documenting diaper count. Even though I will share references for the approximate capacity of a newborn on day one, the reality is we are not actually measuring 5-7 mL and feeding with a syringe, but rather feeding at the breast and ensuring milk transfer is occurring. The measurement of 5-7 mL thus reflects the stomach size and not the exact amount of milk transferred.

I am completely bewildered by the author’s paragraph on the Incident Details of the report. It is highly concerning that a Health Care Professional (stated in the submitters report and on her bio), would draw such utterly unscientific conclusions regarding a simple product. The author states:

Lanyards “…prevent them from supplementing newborns who are crying inconsolably for milk when there is not enough. The most recent scientific data shows that in fact, the newborn stomach size is 20 mL using ultrasound and autopsy…these…are leading to accidental newborn starvation and its complications, namely severe dehydration, hypernatremia, hypoglycemia and excessive jaundice which are all know causes of brain injury and permanent disability”

Again, there is not now, nor would there ever be a recommendation to “prevent them from supplementing newborns who are crying inconsolably for milk when there is not enough.” That would not only be barbaric, but unprofessional and dangerous. I will not justify the author’s accusation with further answers.

To address the author’s assertion about the newborn’s stomach capacity, there have been numerous studies performed a variety of ways that give approximations of a newborn’s stomach capacity, but all offer margins of error. There are no perfect studies, and each resource reiterates that the capacity is an estimate.

I will address the three resources the author cited as her evidence of the dangers of the Lactation Lanyard. I believe it will shed light on the situation and reveal the nature of her complaint.

The author confidently states that the “most recent scientific data shows that in fact…” But she neglects to mention that the “new” scientific data is a review of six previous studies. The studies cited were from 1920, 1987, 1988, 1992, 1997, 2000, 2001. Thus, even though the article was written in 2013, it was based on research from as early as 1920. Dr. Nils Bergman, the author of the article cited as documentation for the 20 mL stomach capacity, arrived at that volume based on an average. It is also important to mention that not all stomachs were measured right at birth. The author’s conclusion stated the need for shorter intervals in feeding since a newborn has a small stomach capacity.  I do not believe Dr. Bergman would approve of his research being used to justify a greater volume of feeds since his research centers on promoting frequent feeding, skin-to-skin and Kangaroo Mother Care. The point made in the article is regarding feeding intervals, it is not focusing on stomach capacity.

The abstract clearly proclaims, “There is insufficient evidence on optimal neonatal feeding intervals, with a wide range of practices. The stomach capacity could determine feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or after birth. Six articles were found, suggesting a stomach capacity of 20 mL at birth.”

Dr. Nils Bergman’s brilliant work is worth reviewing Bergman, Nils J. "Neonatal Stomach Volume and Physiology Suggest Feeding at 1-h Intervals." Acta Paediatrica 102.8 (2013): 773-77. Web.

The following studies suggest a stomach capacity of approximately 5-7 mL.

Hanson, L., Korotkonva, M., The Importance of Colostrum, Breastfeeding May Boost baby’s Own Immune System. (2002). Pediatric Infectious Disease Jour; 21:816-821

Silverman, W.A.: Dunham’s Premature infants 3rd Edition. Paul B. Hoeber, Inc., Medical Division of Harper and Brothers. New York. 1961. Pp. 143-144

Scammon, R.E. and Doyle, L.O.: Observations on the capacity of the stomach in the first ten days of postnatal life. Am. J. Dis. Child. 20:516-538, 1920

Spangler, A., Randenberg, A., Brenner, M., Howette, M., (2008). Belly Models as Teaching Tools: What is Their Utility? Journal of Human Lactation. May 2008, vol 24; no 2

These studies demonstrate that there is plenty of scientific research that can be found supporting the 5-7 mL stomach capacity reference. There are also many studies that suggest that a newborn can hold a larger volume of fluid. I concur that this is certainly a possibility. What a newborn can consume and what a newborn should consume is also worth mentioning. Newborns, along with the general population, have physiological capacity and an anatomical capacity.

Even if a newborn’s stomach can hold more (as in the case of the autopsied newborns where the procedure to measure stomach capacity took a measurement when the stomachs began to bulge), it does not necessarily mean it SHOULD hold more. Nutritionists promote small, frequent meals as the ideal eating pattern for humans, a practice that seems to naturally begin at birth.

It also stands to reason that if women have small amounts of colostrum on day one, the baby must need small amounts of colostrum on day one. All of the emphasis on research and science laboratory studies is important, but it is equally important to consider the anthropology and biological norm of infant feeding.

The Lactation Lanyards have many uses, including supporting the evidence that newborns consume small amounts of colostrum. This information empowers mothers and gives them a more accurate consumption goal than the 2 oz. formula bottles distributed in many hospitals. If families are not shown the volume for an average feed on day one, they are apt to consider the formula bottle as the standard of feeding rather than the anatomy of the infant.

Even though research has validated the small stomach capacity of a newborn, perhaps the most compelling argument for educating families on the infant’s stomach capacity is corroboration by the most trusted health care agencies and organizations in the United States.  The following agencies accept the information shared on the Lactation Lanyards.

The Academy of Breastfeeding Medicine documents infant’s intake in the first 24 hours to be between 2-10 mL per feed.  BREASTFEEDING MEDICINE Volume 4, Number 3, 2009 © Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2009.9991

American Academy of Pediatrics Section on Breastfeeding documents a newborns intake on days 1-2 will be between 5-10 mL

American Pregnancy Association: “It is normal to make only 1-4 teaspoons of colostrum per day.”

The support of professional organizations and well-documented research has spawned the development and spread of this valuable teaching tool. Many pharmaceutical companies have similar products to our Lactation Lanyard (see below), yet I did not see any reports on these products.  I am surprised to be personally targeted; it appears that the author’s complaint may be with me personally rather than truly concerned about a product I created. Why have none of these other teaching tools been reported?

The first picture is of the Lactation Lanyard, the following pictures are samples of other very similar items. 


The Lactation Lanyard is a portable teaching tool used by health professionals, perinatal professionals, public health educators and breastfeeding advocates. Lactation Lanyards come equipped with double-sided colostrum card and informational card. It also displays the website which provides additional education and resources.
 Belly Beads
Baby Bellies Pocket Keychain

Many items are also sold internationally

Baby Bellies Display

Cascade Health Care Products

Colostrum the Gold Standard Visual Aid

Many educational pamphlets and posters are available from companies that support health facilities. A few examples are provided below.

These complaints seems to stem from the offense the author takes regarding breastfeeding promotion and public health advocacy in regards to breastfeeding supporter. I am assuming that she is unaware that the formula companies also use the same research to educate families about the infant’s small stomach. 

A large formula manufacturer, Gerber, states:

“Your baby’s tummy is tiny at birth—the size of a marble—and grows to the size of an egg around day 10. Many babies eat a lot quickly, so spit-up is common, and often the result of overeating or air entering the stomach during feeding. ‘Happy spitters’ spit up one to two mouthfuls during, or shortly after, each feeding and show no sign of discomfort.
As your baby’s stomach grows and her digestive system matures, the rate and frequency of spit-up will decrease. Your baby will likely outgrow spitting up around the time he can sit up, but it can continue through the first year in some babies.” (

Below are two samples of parent education provided by Similac, one of the top three formula manufacturers in the United States.

 If the author desires to take on the Lactation Lanyards, she must also work to discredit the American Nurses Association, Department of Women’s Health, AAP, ABM, Public Health Agencies, WIC, La Leche League, hospitals, formula companies and many educational institutions. There are a plethora of products and information sheets that she will need to prove provide “unsafe information.” We believe we are in good company and do not feel threatened by the baseless rhetoric being directed at our teaching tool.

In addition to Dr. Nils Bergman’s research, the author of the complaint offered two additional pieces to justify her submission to the Product Safety Commission. One such documentation, I will not address as it is her own blog about her story—hardly evidence-based research. The second is equally subjective, but I will address it as I feel it may be the main reason for her witch hunt.

The submitter shares a story about her son. It appears that she experienced a personal tragedy. The narrative on the report to Commission mirrors the story she shares across social media. Her story clearly states that she was followed by a lactation consultant and a pediatrician following the hospital birth of her son. She explains the feelings she encountered on day four, when she realized she had been starving her baby. There is not one mention of my lanyard in her story. There is not one reference to its use in leading to dehydration. The second part of her story reveals that she was diagnosed with retained placenta, a condition that results in inhibiting milk production (along with other complications). It is pertinent to note that it would not matter if her baby’s stomach capacity was 5 mL or 30 mL, the newborn was experiencing weight loss and dehydration due to little or no milk transfer, not because he had a small stomach. There is absolutely no parallel that can be drawn between our product and her baby’s consequences.  I can only speculate how she must have felt allowing her child to go hungry. She may have been failed by her medical team and may have ignored her own instincts—but whatever led to her withholding food from her newborn is in no way associated with a lanyard. She will have to come to grips with her own feelings and emotions. As a doctor, she is no doubt aware that complications and poor outcomes occur in spite of the best available care. Sometimes, there is not one to blame.

I can respect the concerns this individual shares. As a medical doctor working in an emergency room, she undoubtedly faces many difficult situations and hopes to avoid others going through what she experienced. I only hope she channels her energy in a positive, honest way. I question her lack of scientific evidence and knee-jerk reaction to attack those she perceives led to his condition—the science just does not back up her accusations.

According to the About Section on the Fed is Best Foundation’s Facebook page, “Christie del Castillo-Hegyi, M.D investigates the real-life breastfeeding stories of mothers through social media and holds the largest collection of breastfeeding stories in existence on her Facebook page.” I have no idea if her claims are true, but I do know she solicits stories from her followers that include “unacceptable outcomes” from breastfeeding and requests they sign her petition to “Protect Newborns from Brain Injury Caused by Insufficient Breast Milk Intake.”
 Her hobby of collecting stories has apparently caused her to put metaphoric rhetoric above science. She is creating her own truth—a very dangerous practice.

I believe I have done due diligence in refuting the complaint issued against the Lactation Lanyard. Not only did the submitter not prove the lanyards to be a safety concern, she used your organization and submission process to pursue a vendetta as publicly as possible. She has wasted everyone’s time engaging is this dispute.

I personally feel that Dr. Castillo-Hegyi acted irresponsibly in abusing the Public Safety Commission Office by submitting an unfounded, frivolous complaint. She has selfishly added to the demands of your office and consumed a considerable amount of my time in her efforts at self-promotion. I understand from the description on your website that this complaint should have never reached your office.
The U.S. Consumer Product Safety Commission (CPSC) is an independent federal regulatory agency that was created in 1972 by Congress in the Consumer Product Safety Act. In that law, Congress directed the Commission to "protect the public against unreasonable risks of injuries and deaths associated with consumer products."

From the statement on the complaint form, the submission was regarding information and how one individual was able to twist it to her perception. Your office handles complaints about a product. If your office is now in the business of handling complaints about information shared, then perhaps it is time for me to issue a counter-complaint about Dr. Castillo-Hegyi who apparently is offering fear-based education and is negligent in respecting the policy statements of her medical professional associations that recommend exclusive breastfeeding for the first six months as the optimal feeding advice.

In closing, I realize the US Consumer Product Safety Commission receives numerous complaints and must take each one seriously. However, I was disappointed that there does not seem to be an independent investigation prior to publishing complaints. A quick Internet search would have verified our tool has not been responsible for any harm and promotes the same information shared by our US health agencies.

I can sympathize with the doctor’s predicament, and her desire to find a cause for her son’s condition, but I do not respect her accusations against a product that promotes breastfeeding and supports every major health organization’s recommendations (WHO, CDC, AAP, ACOG and many more).
While the physician submitting a complaint was undoubtedly beside herself when her child became ill, my Lanyards cannot be faulted.

The author of the complaint shares her personal story as validation that the Lactation Lanyards caused dehydration in her infant. Let me reiterate: the Lanyards come equipped with a double-sided instruction card that explains that an infant’s stomach grows rapidly and babies must be fed frequently.

The size of the infant’s stomach is a moot point. No matter how small a newborn’s stomach size is, if a mother is not producing any milk due to retained placenta, the baby will become dehydrated. It is my professional opinion as an International Board Certified Lactation Consultant (IBCLC), that this scenario occurred due to insufficient milk transfer due to low milk supply. The diagnosis of retained placenta is of utmost concern. I am perplexed that a family doctor would try to blame a three dimensional teaching tool on her child’s condition. She shares the rest of her story (most likely what lead to low milk supply) here:

This complaint appears to be an attempt to promote her blog and discredit science for personal gain and notoriety using the US Consumer Product Safety Commission platform. I am sorry your office was summoned for this purpose.

Thank you for your diligence in accepting complaints and rebuttals in an effort to improve safety for everyone.

Normalizing Breastfeeding through Education and Support,

Christy Jo Hendricks, IBCLC, RLC, CLE, CCCE, CD(DONA)

Medical professionals, health agencies, lactation consultants--should always assess the needs of the dyad. When supplementation is necessary or desired, a medical team should provide evidence-based, scientific information. We cannot neglect families by pretending to know what is best for their situation, nor should we use fear to force persuade them to breastfeed or formula feed. Human milk will always have benefits for humans--it was designed that way. Each mammal produces species-specific milk for their offspring. We must empower women who desire to breastfeed and support them to the full extent. 

Thursday, October 13, 2016

Saying Goodbye before You Have a Chance to Say Hello

Pregnancy and Infant Loss Awareness

By contributing writer Samantha Johnson

When I was a freshman in college, my job as the “Community Life Committee President,” was to provide our housing community with fun activities and coffee “support stations” during midterms and finals. I worked alongside a wonderful, kind and generous lady who lived with her husband in the married campus housing right across from my apartment. I still remember the day she told the staff she was expecting a baby. We were all so surprised and overjoyed for her. Then, what seemed like only a few days later, she shared the news that they suffered a miscarriage. I was in complete disbelief. I had no idea that one in four women experience miscarriage. I had no idea that one day, I would also experience the raw, indescribable pain of pregnancy loss.

October 15 is Pregnancy and Infant Loss Awareness Day. It is meant to inform and provide resources for those who have lost a child due to miscarriage, eptopic pregnancy, molar pregnancy, stillbirths, birth defects, SIDS, and other causes.

  • An estimated 500,000 miscarriages happen each year;
  • 1 in every 148 babies are stillborn; and
  • 3 in every 1000 babies die shortly after birth.

Knowing the prevalence of pregnancy and infant loss does not lessen the pain, but navigating grief alongside others can be incredibly healing. There are a number of support groups you can join if this has been your experience.

Support groups for those who have experienced pregnancy or infant loss

  • AfterTalk is an online grief support site offering inspirational stories, poems and quotes, and forums on the grieving process.  The site offers grief advice by Dr. Neimeyer, an expert in grief and bereavement.

  • The On Coming Alive Project is a collection of true stories featuring men and women who are coping and “coming alive” after loss or other tragedies. Stories also include overcoming and living through abuse, depression, anxiety, rape, and other circumstances. They encourage journaling through grief and offer a Facebook support group.

  • MISS Foundation is an international community of compassion and hope for grieving families. MISS provides immediate and ongoing support to grieving families as well as training and referrals for certified Compassionate Bereavement Care Providers.

How you can support someone who has suffered loss

I remember feeling the most grief after my miscarriage when I would think of mine and my spouse’s parents. Even though I had lost the pregnancy at 8 weeks, we had already told them the news we were expecting. The thought that their hearts were also broken and that there was nothing they could say or do to help “fix” this was the most empty, devastating feeling. If you know someone who is going through loss, there really is nothing you can do to make it better, but there are a few things you can do to provide support.

1. Listen

It’s not always about what you can say to make the situation easier, but how well you listen. As difficult as it may be, that can be the most helpful thing you can offer. The loss of a child is incredibly shocking, and some cope by sorting through their feelings out loud.

"We quickly find there are no words to describe the experience of losing a child. For those who have not lost a child, no explanation will do. For those who have, no explanation is necessary" ~ Mary Lingle

2. Know What to Say: “Comfort IN, dump OUT”

When the opportunity comes to offer some comforting words, remember “Comfort IN, dump OUT.” In this visual, the parents are in the innermost circle, since the loss hits them the hardest. Next is their family, friends, acquaintances, etc. Let's say you are a friend. The news of the loss is completely devastating to you, and you need to talk about it. Be sure to do your “dumping” to someone further out in the circle than you are. Never say to the parents, “This hurts me so much.” Always say words that bring comfort to those who are hurting.

Trying to find a positive aspect in the situation can almost be as hurtful because it can make light of the situation. Never say, “At least you didn't tell everyone about the pregnancy,” or “At least it happened early,” or “At least you have other children.” Instead, you can say, “I'm so sorry.” “What is a good night for me to bring you some homemade dinner?” “I am here for you if you need to talk.”

3. Participate in Preserving the Child’s Memory

Many parents, especially mothers, also want the memory of their child to live on even if the child never met anyone on this earth. You can provide support by encouraging their efforts. Join them in a Walk to Remember, plant a tree in the child’s memory, create a memory box, and don’t be afraid to mention the child’s name in conversation. Acts like these can show you care and help the grieving parent to feel they are not alone.

Finding beauty in pain

Through the fiery trial of infant loss, beautiful refinement can occur as we seek help and support and embrace the process of grief.

Perhaps Elisabeth Kubler-Ross said it best:

‎"The most beautiful people are those who have known defeat, suffering, struggle, loss... and who have found their way out of the depths. These people have an appreciation, a sensitivity and an understanding of life that fills them with compassion, gentleness, and a deep, loving concern. Beautiful people do not just happen"

Friends, family members, and parents can also rest in the hope that time can heal this pain and that hope can be restored to some extent. Since my miscarriage, I still have moments of grief. I will never forget January 8th, the day we were told our baby had no heartbeat. I will always wonder what life would have been like had the pregnancy lasted. Three years later, I gave birth to my beautiful rainbow baby. Although he could never replace the child I lost, he is a reminder that something beautiful can come after a terrible storm.

Informational Resources


Saturday, October 8, 2016

When Natural Disasters Strike, Breastfeeding Matters

Hurricane Katrina
Earthquakes, floods, tornadoes, fires. Recent years have seen their share of natural disasters and emergencies which will only continue to occur with the passing of time. Even now, a State of Emergency has been declared for Hurricane Matthew, and heightened seismic activity at the Salton Sea has prompted scientists to warn of the elevated risk for “The Big One” at San Andreas fault.
Disasters and emergencies, while incredibly devastating, invoke a sense of camaraderie as people from all walks of life and differing backgrounds join together to help; to donate. While the intention is good, the protocol of infant feeding during natural disasters in particular needs dire improvement. This problem springboards from the lack of education on the importance of breastfeeding as a whole.
Hurricane Katrina shelter
Residents wait in line at the Superdome for shelter
during Hurricane Katrina. Image source:
Major health and aid agencies have come to a general consensus on how infant feeding issues should be addressed during disasters. They agree that the use of formula should only occur when mothers have weaned and relactation is not possible, or when the baby has lost its mother and wet nursing is not an option. They agree that ongoing support and assistance is necessary in such a case to limit the risks associated with artificial feeding, and that the distribution of breastmilk substitutes should be tightly controlled, carefully monitored and only provided to babies with a clear need.  
UNICEF, WHO, and the International Red Cross are active in alerting non-government organizations of the need to support breastfeeding and to be extremely careful in the distribution of breastmilk substitutes. Despite their efforts, and despite these guidelines, infant formula and bottles continue to be distributed unnecessarily during disaster situations.
During emergency situations, the cleanest, safest food is human milk.
Myth: Mothers who are under stress cannot breastfeed.

Fact: Mothers will continue to lactate in times of stress but will need adequate support.

Myth: If a mother is malnourished, she either cannot breastfeed or the milk she produces is poor quality.

Fact: Malnourished mothers or mothers with illnesses CAN provide healthy and safe milk for their babies.

The Problem with Formula Donations During Emergencies

One of the biggest tragedies during Hurricane Katrina was that almost no breastfeeding mothers were found. One-third of Louisiana’s population was displaced, which was about 1,300,000 people, and more than 100,000 evacuees remained in shelters more than one month later.

The distribution of formula and bottles by aid workers during this time disregarded the importance of clean water and utensils to make feeding infants possible and safe, and the more time that passed, the higher the risks for infant mortality continued to climb.

According to the American Academy of Pediatrics, in any given emergency, clean drinking water and a sterile environment may be inaccessible. Even in a potentially less catastrophic emergency, such as being trapped in gridlock for several hours, access to water to make formula as well as the ability to clean and sterilize bottles or feeding utensils is not possible. Infants need to be fed every 2 to 3 hours. When disaster strikes, reality hits, and panic can ensue.

The WHO states that artificially fed babies have a 1300 percent increased risk of death from diarrhoeal disease as compared to babies that are breastfed. The WHO adds that babies who are artificially fed are inherently more vulnerable to disease because they do not receive the disease-fighting antibodies that are in breastmilk.

“In past emergencies, 12–75% of all babies have died, so any factor that increases disease transmission and reduces the ability of babies to withstand disease may well result in their death.” - World Health Organization

At the time of Hurricane Katrina, information was not readily available to support optimal infant nutrition; rescue workers were not trained in breastfeeding support and management. Overall, the distribution of formula discouraged breastfeeding, decreased mothers’ confidence, and increased the risk of infection, illness, and death.

The Clear Advantages of Breastfeeding During an Emergency

  • Provides comfort and relieves maternal anxiety
  • Protects against infectious diseases
  • Readily available
  • Nutritionally perfect
  • Perfect temperature
  • Fights Illness

The Disadvantages of Formula-Feeding During an Emergency

  • It may not be readily available
  • May become contaminated
  • Water mixed with powdered formula may be contaminated
  • There may be no means of refrigeration to preserve it
  • There may be no method to sterilize feeding utensils

While some strides have been made to educate about the importance of breastfeeding during disasters, the lack of normalcy is still present in our society and more efforts should be made to instill it in mothers, aid workers, and government agencies collectively. Milksharing or local donations of expressed milk should be a mainstream option to feed infants in dire cases.

Future natural disasters are inevitable and will continue to have a devastating effect on the economy and well-being of families. Protecting, promoting, and supporting breastfeeding during these natural disasters will help prevent long-term health and developmental problems that may occur as a result of alternative feeding methods. Encouraging breastfeeding will also lessen the economic blow, as the overall cost of the disaster is significantly reduced for both the families and societies affected. It is an investment that will pay for itself in more ways than one, several times over.

Contributing author: Samantha Johnson is a freelance writer, blogger, wife, and breastfeeding mom. Her Bachelor of Arts degree in journalism from California Baptist University has led to more than six years of full-time writing experience and countless exciting opportunities. Aside from writing, her passions include drawing, painting, iced coffee, reaching her goals, balancing life's priorities, and encouraging others. You can visit her blog at