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

Saturday, July 18, 2015

Breasts Plan to Breastfeed--Don't Let Them Down

I think advocates have exhausted the mantra that human milk is best for human babies, but breastfeeding does not exclusively benefit baby. I believe Mom is often left out of the equation. In fact, if breastfeeding were only about the baby's nutritional needs, than perhaps someday there could be an adequate substitute--but it isn't.
Approximately sixteen weeks into pregnancy, a mom is notified via tender mammary glands, that she is, indeed, expecting. Her body is starting the preparation for future breastfeeding. An amazing, complex factory has commenced production of cells, aveoli, ductile work and Montgomery glands. There is even an increase in the pigmentation around the areola to create an obvious target for the baby once he arrives--make no mistake, the breasts are planning on breastfeeding.

Milk Synthesis explained

The attention given to every detail is absolutely mind boggling. The stage is set in precise detail. The breasts have prepared for breastfeeding like an athlete prepares for the Olympics. They are focused on their one job, and poised to perform. Imagine the disappointment when they are "letdown" postpartum. They never get to realize their full potential. Who is speaking up for the rights of the ta-tas? They have painstakingly prepared for this precise moment for nine consecutive months. Not only is is disappointing, it also poses serious health risks. Just like atrophy sets in when muscles cease to do what they were designed for, abandoning breastfeeding creates serious complications as well.

What happens when breasts are told, "You're Fired!" and are not chosen to fill the primary feeding position? Well, it isn't pretty.

Following birth, Mom's uterus is in need of some serious repair. The best way to return this muscle to it's pre-pregnancy shape is to contract the muscle--a phenomenon that is executed through breastfeeding. This is the most effective way to strengthen the muscle and reduce blood loss. Moms should plan on breastfeeding for a thorough workout, after all, they cannot walk into a 24 Hour Fitness and use the "uterus machine" to tone up.

Recovery continues as the baby continues to breastfeed. Mom may experience significant weight-loss as she burns more calories breastfeeding. The benefits do not stop when baby weans, they continue for a lifetime.

It is as though Baby says, "Mom, I need you to be around a very long time. I need your lap to sit on and your hand to hold...I need your advice when I'm a teen and in my adult years...I need your hugs on birthdays and every morning...I need your kisses on my scraped knee and broken heart...I need you at my wedding and at childbirth...I need you to be the grandmother to my children; and here's how I will make that happen--breastfeed me."

If Mom chooses to breastfeed, Baby will protect her from many immediate and future ailments. Breastfeeding moms experience a reduction in breast, uterine and ovarian cancer. Breastfeeding also lowers the risk of postmenopausal osteoporosis. Breastfeeding moms profit from the hormone Oxytocin, which helps to stabilize moods.

I hope we are encouraging women to listen to their bodies and listen to their babies. They should be entitled to receive all the advantages and bonding associated with breastfeeding. I know not everyone has the opportunity or freedom to select breastfeeding and they must rely on milk donations, supplements or a combination of both. I sympathize with them and understand their plight personally, but still want to convey for those who can, that they (not only their offspring) will reap the rewards.
Order your copy of the poster above

Breastfeeding is a relationship. A bond between Mother and Baby. A beautiful contract to support each other in health and well-being. Maybe breastfeeding and mothering isn't a thankless job after-all, maybe we just aren't making moms aware that their baby has a tremendous gift they want to give, but only by breastfeeding can it be received. Let's commit to empower moms and enable them to accept this life-giving gift.

Thursday, February 12, 2015

The Slippery Slope of Supplementing

There are a few pieces of education that can prevent unnecessary supplementation of formula or unintentional weaning. One problem is that many people misinterpret baby behavior. A baby communicates various ways. He uses body language, head movements, hand gestures and crying as forms of expression. The crying stage is usually what brings on the bottle.  A baby's cry brings full attention to the situation. The cry is annoying, upsetting and a "call to action." It was designed that way. If a baby just whispered, "Hello, up there, I'm over here and I need you." More often than not, the busy, distracted people around would not be aroused to take action. Since the cry demands a response, parents begin the ritual of calming baby. If the baby does not settle right away, parents will often resort to a bottle assuming that their baby is hungry. The bottle will elicit the suck reflex, making it difficult to cry. The baby also soothes by sucking so he continues to suck for comfort which reassures the parents that baby was indeed hungry. This sucking reflex is just that--a reflex. When we go to the doctor and he checks our patellar reflex with a hammer, if our leg spontaneously jerks forward, the doctor does not exclaim, "She wants to play soccer, see, just confirmed it!" That would be ridiculous, yet we use this reasoning when deciding that a baby needed supplements.

Everyone must also learn to appreciate and respect the fact that a woman's body and baby communicate through a series of events. Baby does at times need more milk and he must communicate this. The infant will "place his order" by frequently visiting the breast. He even tells his mother's body that he is not satisfied. He fusses, grunts, pulls his head back and arches his back. This arrangement convinces the mom's body to step up production. Many professionals used to refer to these stages as "growth spurts," until it was shown that growth does not necessarily coincide with the frequent breastfeeding. More recently, the feeding frenzies are being called, "frequency days." However they are labeled, they do occur and are necessary for regulating milk supply.

The body is amazing. It does not have to store all the milk the baby needs per day or week. It creates milk made to order. If a baby needs more, he expresses his desire and the breast-feeder complies.  Herein lies the problem. If a baby is given a bottle during these moments of frustration, it communicates with the woman's body, "Never mind, seems like baby is satisfied, it was a false alarm." The mom's body has no reason to produce more. The next time baby models the same behavior, parents may respond with the same solution. The baby will often take more from the bottle and if the supplement is formula, the ingredients are more difficult to digest and this "heavy" meal may encourage baby to sleep longer. A longer nap will also communicate to Mom's body that baby doesn't eat as frequently and she doesn't need to make milk as often. Next. the mom will notice a definite decline in milk, convincing her to supplement even more. Unfortunately, this unintentional weaning happens too often. Disappointed moms feel as though they were broken and could not effectively breastfeed. They think they were starving their newborn because he appeared unsatisfied with her milk, not knowing that this protesting was the exact recipe for increasing milk supply. If moms were encouraged to trust their amazing bodies and constantly put baby to breast so he could effectively communicate his needs and that the body would respond to meet those needs, we would see women empowered rather than defeated.

The good news is that the woman's body still wants to feed and meet the needs of her baby. The situation can be reversed. Mom must put baby to breast every time baby will nuzzle, suck, cuddle or nurse from the breast. It is also a good idea to practice skin-to-skin and get oxytocin freely flowing. Without this contact, the mother's body is persuaded that the baby is getting fed elsewhere and it needs to shut down production.

If breastfeeding has stopped completely, contact an IBCLC to help with re-lactation. Lactation Consultants can also help the mother who needs to supplement by sharing ways to continue the breastfeeding relationship and instruct on how much supplementation is necessary.

Interested in becoming a Certified Lactation Educator (CLE) and sharing evidence-based education with others? Sign up for an upcoming training on the Birthing, Bonding and Breastfeeding website.

Saturday, October 25, 2014

Attack Formula Companies--Not Formula Feeders

It's here, another way to stop breastfeeding advocates and create a wedge between breastfeeders and formula-feeders. Blogs like, "I Don't Breastfeed and It's None of Your Business" exist to stir up emotions and create conflict. The problem I see with these posts and other seemingly anti-breastfeeding rants, is that they attempt to silence breastfeeding advocates, and encourage acceptance of formula "as is." The posts almost imply "leave my formula alone!"

But, alas, the formula companies had to do something fast to protect their market shares. There is a new battle on the forefront from both breastfeeding and formula-feeding families, it is a campaign worth of bipartisan support--improve formula ingredients and demand the manufactures use higher quality products in their manufacturing and eliminate harmful ingredients (like corn syrup solids and dangerous chemicals). Some countries do not even allow corn syrup solids in their infant foods, but in the United States we have them in spades. If formula companies can move the focus off of their companies to "nosy, judgmental, holier-than-thou, breastfeeders," well, then, they win. They strive to have a product that no one will oppose--an ambition I plan to thwart.
Similac formula in the US

Formula label in Australia

Enfamil ProSobee in the US

I have NEVER attacked a formula-feeder (and for those curious, I was one), but I definitely support breastmilk, and believe moms who must supplement deserve a better option than the ones currently on the market. If we, as a society, strive to protect babies and families who need supplements, we can affect great change. I do not know of one formula-feeding mom who does not want the best for her infant, and she has chosen the only option available to her. Unfortunately, the best alternative is not good enough. Formula companies use taglines such as, "Closer than ever to breastmilk," but in reality, that can refer to the color of the fluid or a myriad of other conditions. Formula is missing many key ingredients, some of which cannot be replicated.

Let's face it, we live in a world of ever-changing technology, Purchase a new state-of-the-art phone or computer and walk out the door of the electronics store only to discover your new purchase is already being replaced by another model. Markets are consumer driven. Companies make what sells and they are constantly fighting for the market. Since we are not demanding better quality from infant foods, no one is striving to make improvements. We cannot be ignorant of the strategies formula companies use--if they can keep breastfeeding moms fighting formula-feeding moms, no one will think to fight THEM. If we demand better ingredients, formula companies lose money. If we make banked-donor milk available, formula companies lose money, if we support breastfeeding and provide support to families, formula companies lose money--follow the money.

As an IBCLC and Public Health Educator, I have asked moms the question about why they are not breastfeeding and have heard a plethora of reasons. I have heard they were having difficulty and had no help; needed to return to wok and did not have a pump; were undergoing cancer treatment, which is contraindicated to breastfeeding; were getting ridiculed by family or partner; did not want to; and many more responses. Fortunately, I asked, because in asking I was able to learn their reasons and help them overcome some of their obstacles. I was also able to find supplements that worked for them, offer education and support, or just sit with them and helped them cry. When we show compassion, empathy, sincerity and love, people understand we genuinely care.

I am convinced this entire argument is less about the asking and more about how we ask; and, to be fair, it also has something to do with how the question is received. Take time to ask, but more importantly take time to listen.

Let me paint a different scenario on how formula-feeders have used their conditions to promote breastfeeding. I have worked with or consulted for over a dozen women with cancer or going through treatments,and they are using their struggles to educate and advocate. They honestly do not mind talking about why they cannot breastfeed and why their babies deserve better options than what is currently on the market. They use their conditions as an opportunity to shed light on how limited their feeding choices are. They advocate for more breastmilk banks (like blood banks), some even share their story publicly. I personally, love that approach.
Collecting donor milk for her baby to give while undergoing iodine treatment for thyroid cancer

No one should ever feel shamed or attacked for their feeding choice, but no one should feel silenced for sharing truth either. This is not a battle among mothers, this is a battle against large conglomerates that are forcing society to accept the status quo. Be nice, share evidence-based information, and stay sensitive. Seems simple.

Saturday, December 28, 2013

Teaching Breastfeeding through Simple Analogies

We have to realize how vague our breastfeeding descriptions are to those who are unfamiliar with "normal breastfeeding behavior." Statements like, "babies breastfeed often" or "expect baby to wake frequently" can be misinterpreted based on the mom's expectations and definitions of the terms. The more specific lactation educators and consultants can be, the more successful moms will be. I try to use one of the "7 Laws of the Teacher": Teach from the Known to the Unknown.

Analogies can bring education to the forefront and help new parents relate to breastfeeding in a tangible way. I have shared these analogies or "advertisements" over the past year, but thought I would gather a few of them up and share them in one blog. I hope these analogies help others to educate on breastfeeding and convey the message that breastfeeding is the standard infant feeding practice.

I often describe breastfeeding anatomy and philology with house-hold items moms are familiar with. They may not have studied pictures of Dr. Coopers's Anatomy of the Breast, or read Dr. Hartman's research on the Mammary gland, but they have handled a bottle of glue.

Different posters convey the same message.  Having a variety of presentations can help reach the visual or auditory learner.  Some people like a quick, easy-to-read visual, while others prefer more detail. Advertisers state that a message must be seen at least ten times by an individual before it is "recognized." I think many educators can relate to this statistic.  I often feel like I am saying the same thing over and over again.
Unfortunately, some moms have been told that something is "wrong" with their breasts.  It is easy to blame a vulnerable, hormonal postpartum mom for difficult latch issues.  I like to remind moms that the baby doesn't come out of the womb, look at her breasts and announce, "those aren't like the ones I've seen in magazines." Babies have no basis for comparison.  There is a huge variation of nipples across the land and this could be a problem if babies were meant to "nipple" feed, fortunately for all the nipple challenged mommies out there, babies "breast" feed. I tell moms that nipples are like snowflakes--there are no two exactly alike. 

Anatomy concerns span from nipple formation to breast size. This is an easy description of "cup" size that everyone can relate to. 
Once moms gain the confidence that they will have what it takes to breastfeed, the next obstacle is milk supply. If I had a nickle for every time I heard the statement, "your milk hasn't come in," I would be a millionaire. 

I remind mothers that even though their meals were withheld from them, the baby had a steady supply of nutrient.  I sometimes joke that if they had been at the Home Town Buffet all day, they wouldn't be hungry right away either.  I encourage them to practice skin-to-skin, nuzzling, cuddling and offering the breast; but not be be discouraged if the baby is not ferociously hungry or "crawling to the breast right away.  In fact, the Breast Crawl has been documented to take up to 90 minutes to spontaneously occur. 

I invented the Lactation Lanyards as teaching tools to help with bedside education.  Seeing a formula bottle gives the impression that the baby should consume the amount in the container.  It is empowering to show a mom an accurate size of the newborn's stomach capacity.  The Lactation Lanyards are available from the Birthing, Bonding and Breastfeeding Store. 

Once a mom understands that her body is not only capable of growing her baby, it is also capable of 
nurturing her baby, the next obstacle is often overcoming any difficulties.  Prevention is key.  The first preventative step is not giving into the recommendation to bottle feed, or offer "just one bottle."
What about the accurately diagnosed "insufficient mammary tissue" or complications from breast surgery. What are those moms to do?  We have set the options as "breast or bottle" rather than "breast AND bottle." Some is still better than none, and this analogy points to that truth. 

I have many other posters and reminders about breastfeeding and breast milk.  I am working on my 2014 analogies.  Feel free to share misconceptions that frustrate you in the lactation field.  I may be able to make a visual to correct the erroneous advice. I hope you will join me on my Facebook Page: Birthing, Bonding and Breastfeeding and share some of the evidence-based information we post with others. Some of the posters are available for framing from the BBB Store

Happy New Year and let's work together to tackle myths and fears in 2014!

Friday, June 28, 2013

Milk Supply and Newborns—in Perfect Harmony

Lately, I have been trying to re-frame the way I think and talk about the first hours and days of breastfeeding a newborn. I came to the conclusion that if I truly believe that everything works in perfect harmony in nature, I needed to appreciate and understand the dyad’s relationship at birth prior to any attempt to "fix" the breastfeeding relationship. Once I removed any preconceived ideas and expectations and learned to appreciate the birth and postpartum period, I discovered that all mysteries dissolved. I believe (and research supports) the fact that the dyad thrives and survives through skin-to-skin contact. Since this is the optimal condition following delivery, the baby can begin to trigger the milk-producing hormone, prolactin; and milk-ejection hormone, oxytocin, just by “being in the right place at the right time.”

If the baby is separated from the mother, the mother’s body is somewhat confused and may even go through a "mourning" period. The stage was set to feed an infant when the placenta was delivered and the progesterone levels plummeted, but without the presence of a recipient, the mother’s body is not sure if milk is necessary or exactly how much is required. Without stimulation, the prolactin receptors are not laid down and milk production is in limbo.

In order for production to commence and maintenance to occur, baby must be allowed to set the pace. The infant is born with the life-saving skill of sucking. Without this inborn reflex, the baby would not survive. People have misinterpreted this reflex for generations. Some have diagnosed that the baby must still be hungry since the suck reflex is still present following a feeding session. This is no more correct than saying that a child must need a nap because he keeps blinking.

 The newborn’s suck is exactly paced and the mother’s milk compliments the demand. Since the newborn has a strong desire to suck, he may engage in this ritual with few breaks. Respecting this inborn reflex results in an appreciation for the infant's feeding pattern and mom's supply.

 Colostrum is very thick and is coaxed from the breast slowly; precisely the reason constant sucking is needed to extract the liquid gold. It is also crucial to the baby’s small stomach capacity that the fuel he is collecting is deposited in very small amounts. The consequences of a fast-flowing liquid filling the stomach with a few sucks would be catastrophic. A newborn would not be able to manage the volume if milk was plentiful immediately after delivery. Lactation experts and health professionals have used terms like "milk coming in" for years, when in reality, milk has the right consistency, right antibodies, right amount, right temperature, right availability on the right time table.

While the baby was in utero, he was fed on demand and was never left wanting. Now experiencing the extra-uterine life, he expects his needs to continue to be met. During labor and delivery, the baby had the advantage of the umbilical cord and a direct line to nutrition. Babies are not born famished--quite the contrary.  Babies are not always eager to eat immediately after delivery.  Often babies take one to two hours to find the breast and commence sucking.

Since babies have been regularly fed in the womb, they only need small amounts of colostrum to keep the gut lining coated to protect from disease and infection and some nourishment for caloric intake and to expel the excess red blood cells and prevent or treat jaundice. Drops of milk meet these needs. Constant sucking causes the "order to be placed" for more milk in the future. Constant sucking soothes and comforts the newborn. Constant sucking results in the right portions of nutrients to enter the digestive tract. Constant sucking makes the uterus contract and control postpartum bleeding in the postpartum woman. What a perfect relationship. Mom and Baby learning together…baby learning to suck, mom learning to respond. There is perfect harmony when we see the couple as one unit and allow nature to take its course.

In order to demonstrate this concept and provide a convenient tool for lactation educators, I invented Lactation Lanyards.  These teaching tools allow educators and nurses to provide on-the-go education.  I was familiar with the concept that newborns have a stomach capacity of approximately 5-7 ml at birth, the equivalent of a teaspoon, but to convey this message to new moms was challenging.  Now moms have an accurate visual to reinforce the message.  New moms often question their ability to produce enough milk, and seeing a two ounce bottle in an isolette increases their anxiety.  When moms are confronted with the Tiny Tummy Teaching Tool, they are immediately put at ease. The lanyards are equipped with a safety clasp and colorful bead depicting the infant's stomach capacity.  The Colostrum Card provides quick, accurate information about colostrum and its importance.  These tools are being used regularly in hospitals, WIC clinics and other perinatal programs.  They are available at