Hand Expression and Breast Massage

Thanks to everyone for your comments. I'm glad to get some dialog on this issue. Here is a video recommended by Dr. Smillie for the proper technique of hand expression and breast massage for building milk supply.

The thing that I liked best about Dr. Smillie's approach to lactation assistance, was that the whole thing was mother and baby-led. Of course the name of the conference was, "Baby-Led Breastfeeding." But I always felt uncomfortable being overly dictatorial when helping moms in the hospital. Like so many other things that went on there, it left the patients feeling like we were the experts and they couldn't be successful without us. That's great for making nurses feel good, but not so great for empowering women as mothers. Dr. Smillie (a pediatrician) was all about allowing mom and baby discover one another without the interference of 'professionals.' I loved her videos of babies discovering the breast for themselves, crawling up the belly towards the smell of milk, or making jerking movements down toward the nipple. Babies are so smart- we give them so little credit. I remember (with horror) the time I stood by and witnessed a nurse 'help' a mom and baby by grabbing the mom's breast, and the baby's head, and 'milking' them both for 15 minutes to 'facilitate' a feeding. I stood there somewhat in shock that this very invasive procedure would pass as assisting with breastfeeding (I always had a no touch policy about lactation assistance- but I would still verbally direct and frustrate the mothers). The mother of course learned nothing from this except that she would need the nurse the next time she wanted to feed her baby to hold her breast and her baby's head to 'make' them nurse. Dr. Smillie's approach centered more on asking questions, to help the mother discover for her self was should be done. She also advocated for time for the infant skin to skin with mother to discover the breast on their own. It's been a week now since the conference, and the more I think about the information, the more excited I get. I'm adding significant information to my lactation seminar for my students on practical nursing care, with more emphasis on patient-led dialog and less on nursing interventions. I can see very clearly that there are times when being the 'expert' can interfere with a new mother embracing her own power and autonomy. We don't want to create a patient who is dependent on our expertise, we want to support a mom who can go home and care for her infant with confidence.

Hand Expression? Who Knew?

At the breastfeeding conference I attended nearly a week ago, the speaker said something intriguing. In fact, it's taken me a week to process it- Hand expression as a means of boosting milk supply? It seems too simple to be true- and just about the one thing I didn't try. Could it really be so simple? I both want and don't want it to be true. After all the teas, galactogagues, and tinctures I poured down my gullet, it was never suggested that manual expression might be something to try. I also recently watched a friend suffer this same dreaded fate, and had very little to offer her in the way of practical support or suggestions. I only half-heartedly mentioned the usual offerings since none of them had worked for me. Has anyone out there used manual expression to boost milk supply? I'd love to hear some empirical evidence or personal narratives.

Breastfeeding, midwives, homebirth

Greatly enjoyed the conference yesterday by Dr. Christine Smilie on baby led breastfeeding. I purchased her CD to show to my classes, and the books, "Pushed" by Jennifer Block, and "Mother's Milk: Breastfeeding controversies in American culture" by Bernice Hausman. I look forward to reading them both. As is the case with most conferences, the best parts can be what happens between sessions.

I got to meet some of the local hospital-based CNMs. I was chewing the fat (as we Midwesterners say) with one of the local homebirth midwives when a CNM stopped by her booth to chat with us. It's always nice for me to see CNMs and CPMs getting along and being nice to one another. Sometimes I feel like a child of divorce since I consider CNMs and CPMs to be equal parents to my dream of being a birth advocate. I hate to see the two camps go at one another. Especially when I know they have more in common than they have differences. Anyway we all made introductions and had a nice chat. It made me realize there are just too few venues for midwives of all types to meet and greet in our city. That is why I love MANA so much. MANA (Midwives Alliance of North America) is having their conference next month and I can't wait to go. It will be in Monterey CA this year so the surroundings should be exquisite. MANA is one American organization that warmly welcomes midwives and birth advocates of all kinds and varieties (and trust me you see some of everything at their annual conference). Its an experience like no other. A lot of midwife organizations segregate by midwife type, but not MANA. Midwives have enough outside opposition without fighting against one another in my opinion, but that's what it's come to- unfortunately. I spent my morning viewing this video that aired a couple of days ago on the Today Show. It's an attack on homebirth (for which I am a staunch supporter) but in all fairness, it shows a bit of the other side as well. All in all it wasn't as bad as I thought it would be. But with ACOG nipping at our heels, we really should be kinder and gentler to one another.

Thanks to the Doulas of Greater Kansas City who put on a wonderful conference yesterday, with a really informative speaker. Lots of food for thought on how we approach lactation education with parents, and learned lots of new stuff. It gave me a new perspective that just as with birth we may be too interventive instead of allowing nature to work as it was intended.

How not to bathe a baby

http://www.youtube.com/watch?v=WATnDPSs3iI

If you click on the link and watch to accompanying video, it shows a baby being bathed in a hospital setting, right after birth. It is completely inhumane. The infant in brutalized without regard to its fears or pain. I used it in class yesterday to demonstrate two things.
One, how not to bathe a baby. The students were learning infant bathing techniques, and after showing the video I demonstrated a proper infant bath. The students had to return demonstrate later in the learning lab.
Two, how we do not as a matter of course treat infants as aware and sensitive beings. We treat them less than the rest of us, because they are small and lack language. I talked about how we 'casually abuse the neonate at every turn' and gave some examples. The bath video illustrated what I meant beautifully. I also took the opportunity to discuss birth from the neonates perspective and how we give no credence to the neonates experience of birth and difficult transition to extrauterine life.

I'm sure my students all thought that a lecture on caring for normal newborns would be "Cuddles and Hugs 101." Now they know different.

Unnatural Causes

I've been previewing "Unnatural Causes" http://www.unnaturalcauses.org. This is a video series on the social determinants of health. I'm previewing it for my October class. Most of my students think of health in very simple terms. They tend to think of health as being mainly self-determined, whether or not one exercises, or smokes, or consumes a healthy diet, etc. I want to give them a broader picture of the role of education, economics, housing, social policy, municipal prioritization, market forces, federal state and local political will, societal violence, family structure, culture and so many other factors that impact health that are outside of individual control. This series does an excellent job of presenting a realistic if bleak picture. I can't wait to dialog with my students about these issues and of course how they trickle down to impact maternal, infant, and child health.
I acquired my copy of the video when I attended my monthly Health Commission meeting. I am a Health Commissioner for the city of Kansas City MO, where we discuss issues related citizen health and the city policies that impact it. Good work is done by the commission, and while it has no money to throw at problems, it does have the force of political will in it's recommendations to the city council (that does hold the purse strings). The Health Commission has had a key role in changing the status of the city to virtually smoke free. I spread my time between the women, infant, health committee and the minority health committee, depending on which projects and priorities appeal to me.
All of this is shaping my ideas about my own role in public health in my community. I once thought being a front line clinician was the key to effecting change. Once I was doing it, I saw the gross limitations of delivering care one patient at a time. Then I thought, setting policy was the great savior of humanity until I encountered bureaucracies. Now I try my hand at education with a look to the future of broadening my role in activism. This video series is an excellent tool for creating dialog around vital issues.

Hannibal Regional Hospital is Baby Friendly!

Yesterday I made the four hour drive to and from Hannibal MO to participate in the celebration for the their Baby Friendly designation. It was easily worth 8 hours on the road. What a victory to relish! I traveled with Charlene and Mary Grace, two veteran lactation consultants here in the KC area. Charlene and I are both on the Missouri Breastfeeding Committee and Greater KC Breastfeeding Committee. I also serve on the Kansas Breastfeeding Committee. As a crowd gathered in the lobby of the hospital I couldn't help but think, that most of those gathered probably didn't understand the long term consequences of what was happening here. Baby Friendly sounds so warm and fuzzy, that most folks don't realize the long term implications of making such cultural changes in a facility. There was a brief ceremony presenting the plague with the media and all the administrative bigwigs present. Afterwards, us traveling dignitaries were given a tour of the maternity care unit. (It was actually a large, attractive fairly new facility). My favorite part of the day came next. We were treated to a powerpoint presentation from the lactation consultant about the facility's 5 year journey to Baby Friendly. It was a long and tumultuous journey to say the least. Afterwards we attended a reception. This was my second favorite part. I put on my advocate hat, and sat at a table with the hospital administrators and talked with them about how this small designation is going to impact the health of their community for years to come. I wanted them to know what a big deal this was, and not just 'another certificate'. I talked about my thesis topic: the impact of lactation on infant mortality rates in the African American community. They asked lots of questions about breastfeeeding, birth practices, and cultural competency. I actually had a great time. On the car ride home Charlene said it was the best day she's had in a long time- and I would have to agree!
Thanks Hannibal Regional Hospital for showing the SHOW ME state how it's done!

Hey Kansas- Got Milk?

It's official. Missouri has it's first 'Baby-Friendly Hospital' a designation assigned by the World Health Organization for hospitals that meet it's 10 criteria for supporting lactation. The hospital is in Hannibal MO (yes, that town of Tom Sawyer and Huckleberry Finn fame). I will be traveling there tomorrow for the day (about 3 hours from KC) to be a part of the celebration planned to recognize this momentous occasion. I'm so excited. A barrier has been broken. Neither state of Kansas or Missouri had a baby friendly hospital (or a mother friendly one either- a designation from CIMS (Coalition to Improve Maternity Services) for natural birth support). It was often a topic of discussion when attending my Kansas or Missouri breastfeeding committee meetings, and Kansas City breastfeeding committee meetings. It will be nice to be surrounded by my bi- state-wide breastfeeding advocates to celebrate this occasion, and to brainstorm ways to make it happen closer to home.

The hospital in Hannibal has successfully completed these 10 steps:

The Ten Steps To Successful BreastfeedingThe BFHI promotes, protects, and supports breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals, as outlined by UNICEF/WHO. The steps for the United States are:
1 - Maintain a written breastfeeding policy that is routinely communicated to all health care staff.
2 - Train all health care staff in skills necessary to implement this policy.
3 - Inform all pregnant women about the benefits and management of breastfeeding.
4 - Help mothers initiate breastfeeding within one hour of birth.
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6 - Give infants no food or drink other than breastmilk, unless medically indicated.
7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8 - Encourage unrestricted breastfeeding.
9 - Give no pacifiers or artificial nipples to breastfeeding infants.
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

PS: For American hospitals number 6 is the bug-a-boo. Most hospitals are absolutely dependent on the free formula they recieve from formula companies, and the free diaper bags full of free formula given to patients. Most hospitals can't see giving this up to qualify for the designation. Of course, the short-sightedness of this view of things is, if you truly support and maintain lactation, you won't need the free formula.