2019 Lactation Conferences and How to Afford to Attend Them (Bonus: registration links at the end of the article)

Be sure to scroll to the end of the article for links to the 2019 conferences

As we welcome in the New Year, we welcome new opportunities for education in 2019. The line up of lactation and perinatal conferences is extremely encouraging, but can also be overwhelming and could even break the bank. With so many amazing options, how does one choose which conferences to attend? I hope to break down the process and help everyone with considerations for this daunting task. Let's take a moment to consider some of the major factors that influence decisions and how we can navigate the waters.

The main considerations when selecting which educational opportunity to attend include: cost, location, date, speaker line-up and networking opportunities. Many attendees also make decisions based on who the conference will benefit, or the reputation of the organization hosting the event. Audiences may also select a conference if it provides Continuing Education Units or CEUs to attendees.

I usually attend several low-cost, high-quality, local conferences and one or two international conferences annually. How do I make my dollars stretch and afford me these amazing opportunities? I follow these suggestions:

Get a good value
With conference prices ranging from $65 to almost $1,000, a conference budget is essential. Some of the lower-priced conferences provide a great value with access to amazing speakers. Attendees may miss out on a few perks when attending a smaller conferences. For instance, meals may not be provided, there may not be huge exhibits with all the new gadgets and technology (along with a mirage of free promotional gifts), but if you already have enough canvass bags to fill a closet, you aren't sacrificing much, so I encourage you to take advantage of these steep discounts and amazing deals. Lower prices may also mean fewer speakers or only local speakers. Don't let this persuade you not to attend. Every local area has access to amazing speakers and it is more the quality of the speakers--not the quantity. I have sat in an audience hoping for a lecture to continue all day only to discover the time cut short to allow for additional topics.

Stay local
There are so many reasons to support local organizations. You can network with colleagues while supporting the efforts of those in your area. You will save on travel, hotel and meal expenses. Building bridges and collaborating with the locals are essentials in the perinatal world. You may discover great referrals, businesses and programs right in your own backyard. I always look forward to reunions with my community connections. We are able to move forward together after a rejuvenating event.

Register early
most conferences offer an early bird rate. If organizers can get people to sign up early, they can use the funds to promote the event and pay for expenses they incur early on in the planning stages. Some of these early bird rates offer hundreds of dollars off the regular registration price. Keep in mind, many events also charge a substantial fee for those who procrastinate and register late. Pay close attention to cut-off dates, the early bird really does get the worm.

Volunteer
Some conferences seek additional help in the planning or production phases. Ask the organizers if there are any volunteer opportunities that may result in registration discounts. Bartering with service can be a creative way to earn your ticket and get to know those attending the conference. If you are an extrovert, you will not only benefit from the work, but truly enjoy yourself.

Join the organization 
Most events are hosted by an organization. if the host is a Breastfeeding Coalition, WIC Agency or La Leche League, they offer member discounts. Joining the organization will keep you up to date on their events and secure a discount all while supporting a good cause.

Become an Exhibitor
Conference organizers love the exhibitors. Exhibitors fund much of the event, and provide additional opportunities for the attendees. If you have items to sell, consider renting a booth and becoming an exhibitor. Some conferences offer discounts for exhibitors to attend the conference. You can reclaim your registration cost and promote your business at the same time. Don't have your own merchandise? Consider working for a company. I have hired representatives to tend my booth and often part of their compensation is registration to the event.

Submit an abstract
Do you have research you would like to share? Do you enjoy presenting? Are you eager to add to the knowledge of colleagues? Why not submit an abstract and venture out as a public speaker? You would be surprised to know how many people I know that present at in-services or staff meetings that never considered presenting in a conference setting. Many of these same individuals are now making the rounds and appear on conference flyers everywhere. Take the leap, this may be just the push you need to enter the circuit and share your knowledge and gift with the world.

Take advantage of group rates
Check to see if the conference offers a group discount. If they do, find some friends who would appreciate the information and organize a group to attend.

See if your employer has educational funds
Many jobs encourage education and have funds set aside for their employees. Check with your employer to see if there are any applicable programs that can sponsor your education. Even if your company does not pay for the conference, some will allow you to attend on work time if the training will benefit your place of employment.

Save on travel and accommodations
While not directly related to registration fees, you can save enough on travel to justify the expense of attending your favorite conferences. Booking airfare early, using airline points or taking advantage of sales can help to reduce travel costs. Shop around for your hotel. Oftentimes, you can find your own hotel or airbnb cheaper than the accommodations recommended by the conference organizers. You can also find roommates to share the expense. If you do decide to stay at the hotel hosting, try going to the hotel site directly rather than the through the link provided on the conference registration page. Look for discounts, such as AAA or AARP offered by the hotel. You also may be able to get a discount by calling the front desk and asking for any specials. There may be unadvertised discounts for those who sign up for their rewards program. It never hurts to ask.

Stay home
Want to really save on travel? Attend one of the several conferences offered online. Many "virtual conferences" are available throughout the year and this option affords audiences to hear from international speakers live or recorded. Many of the conferences grant access to the talks for several weeks or months. You don't even need to get dressed for this option. Grab a cup of coffee, stay in your PJs and earn your CEUs from your own home.

Start a savings account
Is there a conferences on your bucket list or in a destination location that you really want to visit? Maybe there is a a speaker presenting this year that you have waited your entire career to meet in person--don't despair, prepare. Like the saying goes, "How do you eat an elephant? One bite at a time." Do the math and figure out how much you must set aside weekly or monthly to attend the conference of your dreams. You can also ask friends and family to contribute in lieu of birthday or holiday gifts. Put a contribution jar on the counter and decorate it with motivational words or pictures. Skip the Starbucks and other luxuries in order to feed your jar. It will surprise you how quickly you meet your goal.

Keep receipts
Every little bit helps. If you remember to keep all your receipts, you can claim the expenses on your tax returns annually. Don't be shocked at the end of the year when you add up how much you spent on education. I am proud to invest in my own education, and feel it is the responsible thing to do. As I travel across the nation speaking and teaching the Certified Lactation Educator Training (CLE) to Public Health Agencies, birth professionals and breastfeeding advocates, I know I am equipped with the latest, most up-to-date evidence-based information available because I sought the best teachers and researchers to learn from.

I greatly appreciate those willing to plan and prepare amazing opportunities that benefit me and all other advocates and professionals. I have included links that may help you schedule your conference calendar for 2019. Many of the conferences below are favorites that I attend annually. I also included those that have been recommended to me or have been posted on social media. Please make us aware of additional conferences by posting in the comments. I know WIC and La Leche League has state or regional conferences and would love to have readers share information on those shared as well.

Most of the events listed below are specific to lactation. Some of the larger conferences that include breastfeeding elements have also been included. Some main conferences (such as ABM) are noticeably absent. Only the organizations that had announced their 2019 conferences at the time I composed this article were included. I plan to post conference updates in the comments section when they are announced. Make sure to follow this blog.

Which ones will I see you at in 2019? Maybe we can share a room or register as a group!

Looking forward to 2019 and all the new information we will learn together!

Healthy Children Project January 16-18, 2019 Deerfield Beach, FL $450 California Breastfeeding Summit  January 29-31, 2019  Anaheim, CA $300

Oral Habilitation of the Breastfeeding Dyad: A Master Class for the IBCLC February 7-9, 2019 Oahu, HI $550

iLactation   March 6-May 6, 2019 Online Edwardsville Region Breastfeeding Task Force Lighting the Way to Breastfeeding Success Fairview Heights, IL March 7, 2019 $100 Emory Regional Perinatal Center & Emory Division of Neonatology Annual Conference  March 11-12, 2019 Atlanta, GA $345 Ohio Lactation Consultant Assoc Breastfest March 15-16, 2019 Dublin, OH Australian Breastfeeding Association Breastfeeding: Supplying the Evidence March 11-16, 2019 Brisbane, Sydney, Melbourne & Perth $255 31st Annual LC in Private Practice Workshop March 15-17, 2019 Pennsylvania, PA $575 Breastfeeding and Feminism International Conference March 20 –22, 2019 Chapel Hill, NC $350 Nursing Mother's Council of BACE March 25, 2019 Boxborough, MA $80 Northwest Georgia Breastfeeding Coalition March 27, 2019 Dalton, GA $115 NY Statewide Breastfeeding Coalition Conference March 28, 2019 Troy, NY $80 San Joaquin County Breastfeeding Coalition March 29, 2019 Stockton, CA $129

GOLD Lactation Online Conference April 1-June 3, 2019 Online $225 National WIC Association April 7-10, 2019 Baltimore, MD $485 Lamaze International April 11-13, 2019 Philadelphia, PA $475 Human Milk Banking Assn of North American Symposium HMBANA April 12-13, 2019  Chicago, IL $250 Oral Habilitation of the Breastfeeding Dyad: A Master Class for the IBCLC April 14-16, 2019 Sleepy Hallow, NY $635 Alaska Breastfeeding Coalition Conference April 26-27, 2019 Anchorage, AK  La Leche League of Minnesota/Dakotas April 26, 2019 St. Paul, MN $160 Lactation Consultants Great Britain April 26-27, 2019 Daventry, Northamptonshire

Baystate Log Cabin Breastfeeding Conference May 2-3, 2019 Holyoke, MA FREE American College of Obstetricians and Gynecologists (ACOG) May 3-6, 2019 Nashville, TN Black Mothers' Breastfeeding Association May 8-10, 2019 Detroit, MI $249 United States Lactation Consultant Association (USLCA) May 16-18, 2019 Scottsdale, AZ $875

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) June 8-12, 2019 Atlanta, GA $749 United States Breastfeeding Committee (USBC) June 14-15, 2019 Bethesda, MD Childbirth & Postpartum Professional Association June 20-23, 2019 Atlanta, GA FREE with $65 annual Membership

International Lactation Consultant Association (ILCA) July 24-27, 2019 Atlanta, GA

Reaching Our Sisters Everywhere August 21-23, 2019 Atlanta, GA College of Medicine Dept of OB/GYN August 28, 2019 Omaha, NE

Appalachian Breastfeeding Network Annual Conference  October 11-12, 2019 Kingsport, TN Canadian Lactation Consultant Association (CLCA) October 25-27, 2019 Vancouver, Canada

Massachusetts Lactation Consultant Association November 2, 2019 Boston, MA $130 Southeastern Lactation Consultant Association (SELCA) Conference November 9-10, 2019    Atlanta, GA UNICEF/Baby Friendly Hospital Initiative Conference November 28-29, 2019 Glasgow

Is there a conference missing from our list? Please add it, along with a registration link, in the comments section. We will be updating the list regularly.

If we do not meet at a conference, I hope you will consider joining me for a three-day intensive lactation education training. 21.25 L-Cerps are awarded by IBLCE. Find out more about the CLE training at https://www.birthingandbreastfeeding.com/certified-lactation-educatortrade.html

One way or another, hoping to connect in 2019,

Christy Jo Hendricks, IBCLC

Birthing, Bonding & Breastfeeding

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.

Breastfeeding Moms Have a Target on Their Breasts

The national increase in breastfeeding rates has caused the formula companies to stand up and take notice.  What is great news for moms, babies and society could prove disastrous for formula companies and their stock holders--unless they can grab part of the growing market.  

Formula companies, like most thriving companies, strive to make a profit and constantly plot how to increase their earning. Some companies do this in conscionable ways while others are not so scrupulous--allowing visions of profit to cloud their judgement, they tend to concentrate on profit regardless of quality or health implications. Any assumption that these companies have the best interest of baby in mind is ludicrous. They continue to use the cheapest ingredients (corn syrup, vegetable oil, sucrose, etc) to allow for greater income--the bottom line, their loyalty is to their stock holders and wallets, which leads to many of their marketing strategies. 

The earlier a company can obtain a loyal customer the better.  Many ads and products vie for the prenatal shopper. Brand loyalty can begin with a selection of prenatal vitamins or supplements.  Many pregnant women are succumbing to the offers of registering for baby formula for baby showers and collecting coupons before they even deliver a baby.    

Formula companies previously used more passive marketing techniques such as offering free feeding advice on warm lines, suggesting formula for moms on the go, or offering quality gifts to new moms; but the days of subtleties are over.  The breastfeeding market has become too large to ignore, so "if you can't beat them, market to them." 

Formula advertisers are the kings of spin.  Moms have switched to formula after the huge marketing campaign announcing that breastfed babies need a Vitamin D supplement since breast milk does not contain the sunshine vitamin.  Of course, none of the ads reveal that breast milk was not meant to contain Vitamin D, which ideally comes from the sun. Since formula contains it, mothers began to question whether or not their milk was complete--the marketing strategy paid off, consumers were either purchasing formula containing Vitamin D or the Vitamin D supplements (manufactures by Enfamil) that state clearly on the box, "Essential for all Breastfed Infants." Of course the box top boasts, the "brand recommended by Pediatricians."

Perhaps the most disturbing trend in formula marketing occurred this month with the release of a new product directly targeting and undermining breastfeeding moms.  The May 11, 2013, release of a Similac for Supplementation confirms the company is desperately trying to increase its customer base.  This blatant attempt to sabotage the breastfeeding relationship is outrageous.  This new product states, "for breastfeeding moms who choose to introduce formula" compared to the other formulas which are only for "formula moms who choose to introduce formula?" This is a pathetic bid for the breastfeeding audience.  Unfortunately, it could just work, especially since this message is being perpetuated by a new study released two days later in Pediatrics.  The article's release date (occurring the same week this formula hit the shelves) is highly suspect.  It may seem like a conspiracy theory, but as well-equipped as the strategists are, the timing is not a coincidence and neither is the correlation between Abbott and the co-author of the study, who was previously employed by the maker of Similac.

The timing could not have been better orchestrated. It would be interesting to see if an advertisement for Similac ran in some of the major papers who posted the flawed supplementation study.

Formula companies seem to have an uncanny way of acquiring prestigious spokespeople for free. First, the doctors in the hospitals, now researchers for Pediatrics. No wonder the companies boast billions in profit annually, they have inside help.

The flawed, and poorly-constructed study published by Pediatrics sent the media on a sharing frenzy. The article made its way into nearly every large newspaper with headlines proclaiming that formula helps to breastfeed (an oxymoron exemplified).  Similac, Enfamil, and other artificial human milk companies could not have been handed a better gift. Few editors critiqued or even read the study prior to plastering the headlines across front pages.  The study, released online May 13, 2013, and published in Pediatrics, consisted of forty subjects-- an anemic sample size. The conclusion, after confirming that  15 of 19 mothers were still breastfeeding at 3 months, compared to 8 of 19 in the control group--a difference of 7 babies--was that babies given formula continue to breastfeed at higher rates. Not only was the study not supported by a clear hypothesis, the subjects were not homogeneous.

The clear conflict of interest was also document by a disclosure statement by the co-author, who "served as a paid consultant for Abbot Nutrition, Mead-Johnson, Nestle SA and Pifzer Consumer Products." Obviously, he must have a bias towards the necessity of formula to serve as a consultant for these companies. In fact, a more responsible study could have centered around supplementation with donor milk, if marketing formula was not one of the goals of this study. Pediatrics and its peer review council will surely continue to come under fire for publishing such an insult to true research. They acted in an irresponsible and unethical manner by endorsing this premature study. Although much of the damage has irreversibly been done, there are several rebuttals and informative articles being shared that are well thought out and deserve recognition   It is unfortunate indeed that newspaper editors will not be publishing any of them.  Dr. Alison Stuebe a member of Breasfeeding Medicine provides a response to the published study. Dr. Jack Newman added valuable insight to the study by posting his own commentary. 

As a service to breastfeeding mothers, and a way to expose the flawed research Birthing, Bonding and Breastfeeding conducted a survey asking mothers to respond if they were able to exclusively breastfed without formula supplementation. Within 24 hours over 340 moms confirmed their breastfeeding relationship was protected by choosing not to supplement.  Maybe from this result we could conclude that 99% women who use Facebook exclusively breastfeed. As ridiculous as this statistic is, it shows the parallel to how numbers can be manipulated and the erroneous conclusions which were drawn from the Pediatrics study.

Formula companies are missing out on a large portion of the infant-feeding market. Breastfeeding moms stay vigilant.  If you desire to breastfeed exclusively, the evidence is overwhelming in support of avoiding supplementation.  Babies are born to breastfeed and the protecting the relationship by keeping Mom and Baby together is the best practice for success.  Women who need additional support or medical advice should consult with their breastfeeding-friendly physician, Lactation Consultant and Peer Support Groups.

Editor's Note: I hope we can promote the message that moms do indeed have the milk they need when their babies are born. Products and flawed studies continue to undermine instinct and nature. We need to dispose of the idea that milk will "come in" or that mother's around day 3...engorgement does not have to happen, and if any more milk were available on day one, theoretically the baby could overfeed since all he wants to do is suck! We don't need to "wait" for anything. Just keep the dyad together and all the "issues" can resolve themselves.

Biochemistry of Human Milk

Biochemistry is the study of the structure, composition, and chemical reactions of substances in living systems. Biochemistry emerged as a separate discipline when scientists combined biology with organic, inorganic, or physical chemistry and began to study such topics as how living things obtain energy from food, the chemical basis of heredity, and what fundamental changes occur in disease. Biochemistry includes the sciences of molecular biology; immunochemistry; neurochemistry; and bioinorganic, bioorganic, and biophysical chemistry.

With the broad definition of biochemistry, it is obvious that a blog cannot do human milk justice, but I do have some points to share. I have been fascinated with this topic since I began my work in lactation.  In fact, one of my early projects was creating a visual that would allow parents to see in a snap shot how unique breastmilk is. I had seen a list of basic ingredients found in breastmilk compared to those in artificial human milk (formula).  I commenced to build a 3D image of my understanding and the "Lego Stack or Brick Building Block" emerged from my work.  I invented this tool back in 2001 and it has traveled across the US and is used in California WIC instructional material.  I am including a picture of the handout that accompanies the curriculum here, but the idea is to use a set of large building blocks (or duplo legos) and place one "ingredient" on top of the other as the properties of the ingredients are discussed.  At the end of the demo, the breastmilk stack dwarfs the formula stack.  It leaves quite the impression.

Since I created this simple illustration, I have learned so much more about breastmilk's composition.  I wish I could share my entire PowerPoint on Human Milk for Human Babies, but I will do my best to highlight some of the information.  One main  point is that human milk is species-specific.  Just a comparison of different mammals and their milk composition verifies this statement.  If we were to be fair and pick the mammal whose milk has many of the same ingredient percentages as humans, we would most likely be giving our infants donkey or cat milk.  I can't imagine having cat farms of lactating felines to feed our infants, but really, what's the difference between that and cattle farms?  Just a little regression to point out the humor in our loyalty to cow's milk formula.  


Breastmilk, unlike formula is a living organism.  When one looks at breastmilk under a microscope there is plenty of movement.  Contrast that with formula, where the petri dish reveals a stagnant state.  Formula is dead.  It cannot change to meet the needs of a particular infant.  It does not change during a feed.  In fact, the first drop given to an infant at day one is mirrored in the last drop he receives at one year.  Formula companies are now trying to market this change by creating "stage formulas", another gimmick for marketing. (I recently saw a formula ad that stated, "now, one step closer to breastmilk."  Here is a way to put that claim in perspective, stand at attention, move one step to the right and then declare, "I am now one step closer to China"--not anywhere near China, mind you, but able to make an honest statement, providing your geography is correct.  We have to all be aware of the claims marketing experts are making and be ready to expose the propaganda being used).


There are many articles that are well cited available for purchase.  These are the scholarly articles that appeal to the medical professionals and are written in journal language.  A few such articles are found at
http://www.ajcn.org/content/42/6/1299.abstract
http://www.springerlink.com/content/q33725u6p1530587/
http://www.ncbi.nlm.nih.gov/pubmed/6475139
http://www.askdrsears.com/html/2/t020800.asp


No study on milk composition is complete without mention of Marsha Walker's "Just One Bottle" paper  http://www.massbfc.org/formula/bottle.html
For those wanting some basic information on the biochemistry of human milk in order to be prepared for possible questions on the IBCLC Exam, every candidate should be familiar with the following facts:

• Colostrum is high in protein, fat-soluble vitamins (A and E), minerals, and immunoglobulins. (antibodies that pass from the mother to the baby and provide passive immunity for the baby. Passive immunity protects the baby from a wide variety of bacterial and viral illnesses). 
• Two to four days after birth, colostrum will be replaced by transitional milk in the full-term infant.
• Colostrum's primary function is protective due to high immunological factors
• Colostrum coats the sterile gut and protects from pathogens
• Colostrum is lower in fat than mature milk
• Secretory immunoglobulin A (SIgA) is highest in colostrum
• Colostrum creates a laxative effect aiding in the elimination of bilirubin (reducing jaundice)
• Transitional milk occurs after colostrum and lasts for approximately two weeks. The content of transitional milk includes high levels of fat, lactose, water-soluble vitamins, and contains more calories than colostrum.
• Mature milk is the final milk that is produced. 85-90% is water, which is necessary to maintain hydration of the infant. The other 10-15% is comprised of carbohydrates, proteins, and fats which are necessary for both growth and energy. There are two types of mature milk: foremilk and hind-milk.
• Human milk is higher in whey protein (cow's milk is higher in casein)
• Human milk has the lowest total protein 
• Human milk has 19 amino acids (for development)
• Human milk has over 40 identified enzymes (aid in digestion)
• Human milk is highest in lactose (carbohydrate) of all mammals (humans have the largest brain of all mammals at birth)
• There is not much iron in human milk, but infants are born with a large physiologic stores (enough to last 6 months).  These stores are laid down the last trimester, so if an infant went to term, there is likely enough iron to avoid any supplements.  Also, infants absorb 50% of the iron found in breastmilk, but only 4% of the iron in formula and cereals, so it is misleading to point out that formula has more iron since it is not readily available to the infant.  

Obviously, I could go on and on.  In fact, more ingredients are discovered in breastmilk annually. As money is put into lactation research, this list will most definitely be expounded on.  I liken it to our space explorations and discoveries.  I remember in elementary school learning about the Milky Way as the only galaxy and now as I study with my children I am reminded that new planets, stars, other galaxies--have all recently been discovered and what we thought was an exhaustive list of space was actually very anemic compared to recent finding through exploration.  Stay tuned in to research and attend conferences where newly published information is presented.  This is fascinating stuff!  

Humans are obviously made to breastfeed.  Mom's milk is perfect for her individual infant(s).  My new tagline is, "designed to breastfeed." Isn't it nice when we do what we are designed to do?  I recently tried to hammer a nail with a heel of my shoe--it worked, but when I used a small hammer, it was much more effective.

Christy Jo Hendricks, IBCLC, Doula

http://www.birthingandbreastfeeding.com/