Tuesday, 26 February 2013

Triumphant Tuesday: Breastfeeding with Inverted Nipples

About 10 per cent of women have inverted nipples. Mothers often cite inverted nipples as a reason to abandon breastfeeding. However the reality is that such mothers could still breastfeed; Babies feed on areolas, not nipples. Inverted nipples can however, make latching more problematic. The areola of women with inverted nipples tends to be very firm. If this breast tissue doesn’t flex when baby attempts to latch, the baby can find it difficult to get a large enough mouthful to latch properly. How can mothers overcome this dilemma? After enduring much heartache, Brianna, a mother of two, finally found the solution.



“Breastfeeding the first time around was a one of the toughest things I had ever experienced. My son was born early and experienced some complications. He was not breathing well and his blood oxygen saturation level (meaning how well oxygen was being absorbed into his blood) was low. Due to these complications I was not able to nurse him right after delivery and had to wait several hours until the doctor and nurses were able to get his levels up. 

Once I was able to nurse I found out that, because of the way my nipples were inverted, my son would have difficulty latching on. It was important that I get some nutrients into him some way, so the nurse gave me a medical-grade breast pump. I syringed the breast milk from the bottle into my son’s mouth each feeding for the first few days after his birth. Then the process began of working on latching and sucking. 

I started going to lactation meetings with the hospital’s lactation nurse. Every three to four hours I pumped my milk, syringe-fed my baby, and then cleaned the necessary parts of the pump. At this point I was at my wits end. I felt helpless, I felt defeated, and mostly I felt like a failure. I would put my son down in his crib and go to my room and cry. It was a constant struggle every feeding, but I knew I couldn't give up. It is so important for a baby to get at least 6 months of breastfeeding to build up their immune system. It is a huge bonding experience for a mother to be able to provide for her infant. Also, I had chosen to stay at home after my son was born so money was tight; I really needed to save the money that would have otherwise been spent on formula. 

It wasn't until between month 3 and 4 when I finally felt like my baby and I were a team working together to meet his needs. I was finally able to get him to latch! I did this using a nipple shield. I felt such a rewarding feeling knowing that we were finally able to enjoy the times of feeding. There were some other struggles along the way, but none as hard as those first few months. 


I applaud any woman who chooses to breastfeed and sticks with it. We are faced with many walls to hurdle over and much temptation to give in to formula. Whether it be the distracted baby who is more interested in what’s going on around them then nursing (this usually happens between 4 and 5 months) or the difficulty of scheduling outings between feeding time, because there isn't much support in the public for nursing mothers. To those of you new mothers who are thinking about nursing and aren't sure - go for it! You will never regret trying. There are ways to make it work whether it be support and advice from other nursing mothers/ family members, the support group La Lecha, reading material (I like "New Mother's Guide to Breastfeeding" put out by the American Academy of Pediatrics) or a combination of all three. 

This second time around I went into breastfeeding my daughter feeling like a PRO! With all of my gained experience and the wisdom of what to expect we have breezed through many of the obstacles that can trip up a breastfeeding mother. Good Luck breastfeeding moms and keep up the good work!”



Get your own Bingo Card here.

Email me with your story.

Monday, 25 February 2013

Formula Feeding and Obesity


A little while ago I posted an article titled, ‘It’s Just Baby Fat’, in which I ridiculed a grotesque toy doll that came armed with a toy bottle. I linked the baby’s obese frame with the suggestion that it was formula fed. 


The response to this post was overwhelmingly one of contemptuous anger (really? One of my posts?! Never!)

Likewise, this mock health advertisement which I posted on The Alpha Parent Facebook page was greeted with similar disdain:


So I’d like to add some facts and stats to support my ‘formula fed babies as fatties’ stance:

Here's the deal: during the first 6 to 8 weeks of life there is little difference in growth (gain in weight and length) between breast- and formula-fed babies. However, from about 2 months of age formula-fed infants gain weight and length more rapidly than breast-fed infants (Ziegler 2006Singhal 2007; Rebhan 2009Larnkjaer et al 2009Durmuş et al 2011Rose et al 2012). Numerous studies have shown that by the end of the first year breastfed babies are leaner than formula-fed babies (Lande et al 2005Tantracheewathorn 2005Oddy et al 2006; Scholtens 2008Stuebe 2009; Van Rossem 2011Mindru and Moraru 2012Arenz et al 2004; Mayer-Davis et al 2006; Plagemann and Harder 2011). Scientists suggest that the rapid weight gain among formula fed babies likely represents fat mass gain (Wells et al.,2007; Karaolis-Danckert et al., 2006).

Now, you’ve no doubt heard the DFF (Defensive Formula Feeder) often-regurgitated defence to these statistics: “Line up some school kids and you won’t be able to tell whose been breastfed and whose been formula-fed”. However, I beg to differ - we can make a pretty good bet, and science agrees. In a 2008 study, researchers looked at school entry data of 14,412 children aged 4.5–7 years in southern Germany. After adjusting for a large number of potential confounding variables, mean BMI was significantly reduced in children who had been breastfed versus the formula-fed (Beyerlein et al 2008). Another, even more recent study, showed that the effects of prior breastfeeding on protecting from obesity were particularly significant at ages 6 to 13 years (Crume et al 2012). Similar results were reported from 2 to 14 year old children in the National Longitudinal Survey of Youth (Li et al 2005).

So formula fed babies *are* fatties, not just now, but throughout life. Why?

There are several reasons why formula feeding is a recipe for obesity.

Reason #1 Species Specific

Milk is species specific. Breastmilk is lower in energy and protein and higher in fat than commercial formulas (see the table below). The protein intake of breastfed babies decreases with age and closely matches the requirements for protein during the early months of life, whereas the protein intake of formula-fed infants exceeds requirements after the first 1-2 months of life (Ziegler 2006). The omega 6/omega 3 ratio of formula also stimulates the growth of fat cells (Ailhaud et al., 2006). This is because cow’s milk (the major component in formula) is designed to build body mass. It encourages weight gain. This makes sense for an animal that will gain so much weight in its first year of life. The human growth rate, for example, is such that a newborn will double his weight in about 180 days, while a calf accomplishes this in only 47 days.

In other words, the composition of formula encourages too many fat cells to be produced (Hester et al 2012).  “Insulin-mediated glucose utilization shifts from skeletal muscle to fatty tissue” (Manco et al., 2011). This has “lasting effects on body composition” (Harvey et al., 2007). When extra fat cells are laid down, so the theory goes, they persist into adulthood where they can easily be filled with fat again, causing adult obesity (Taveras et al 2009). This explains why non-breastfed babies have a higher incident of glucose intolerance at 9.5 years (Veena et al 2011). 

Breastfeeding, on the other hand, has a protective effect on obesity by inducing lower plasma insulin levels, thereby decreasing fat storage and preventing excessive early adipocyte (fatty tissue) development (Oddy 2012).

Table from (Thompson 2012).

When you look at the above table, it's easy to become alarmed at the higher fat content of breastmilk - however, don't be fooled. The fat in breastmilk contains a completely different
concentration of long-chain polyunsaturated fatty acids (Shahkhalili et al., 2011). Also, when solids are introduced the fat composition changes dramatically. Intakes decline from around 50% of total energy in breastmilk to 30–35% of total energy (Thompson 2012).


Reason #2 Natural Vs Synthetic:

It should come as no surprise that whether your baby derives nourishment from a natural or synthetic source will impact on the way their body behaves. Unlike formula, breastmilk is alive and contains hundreds of non-nutritive components which studies have agreed “influence short and long-term patterns of growth through their regulation of nutrient use and metabolism” (Hamosh, 2001). For instance, did you know that the higher levels of LCPUFAs (long-chain polyunsaturated fatty acids) in breastmilk are associated with lower glucose levels in the skeletal muscle and reduced levels of pro-inflammatory cells (Das, 2002). Also, breast milk contains endocannabinoids! Nope, you didn't start hallucinating. This lactogen, which can cause the munchies (presumably to entice babies to feed), also regulates appetite, making them feel very full at the end of a feed. Consequently, they don't over-eat (Williams 2013). Formula lacks these compounds. What's more, longer durations and exclusivity of breastfeeding enhance these effects in a dose–response manner (Harder et al., 2005) with the lowest risk seen among those breastfed longest without formula supplementation (Arenz et al., 2004). Researchers have suggested that this link between the fatty acid profile of breastmilk and inflammation may be particularly important given the well-established links between systemic inflammation and the development of obesity (Thompson 2012Dandona et al., 2004; Yudkin, 2007).

Another positive of being natural is that “unlike formula, breastmilk composition varies between mothers, over the course of lactation, and during feeds, providing a mechanism through which the baby’s energy needs and feeding behaviors, such as frequency and duration of feeds, can directly influence weight gain during on-demand breastfeeding” (Thompson 2012). Your baby controls the quantity and consistency of their milk intake and your body provides a unique blend of micronutrients tailed specifically to your baby’s requirements. Under such conditions, it’s not hard to see why obesity is unlikely in breastfed babies.

Consider also that breast milk changes in composition during the feed (aka the fore/hind milk dichotomy). This mechanism actually helps a baby to know when he has had enough. Depending on how hungry he is the baby can choose to take in more or less of the rich hind milk, which comes at the end of the feed.

Reason #3 Mode of Delivery

This is perhaps the most commonly cited explanation for formula-fed babies proneness to obesity. Simply: breastfeeding puts your baby in the driving seat. He has full control over the amount of milk he takes (Fisher et al., 2000). Because he has to work hard to get the milk, he will stop when he has had enough. Consequently his stomach does not become overstretched.

Breastfeeding also promotes maternal feeding styles that are less controlling and more responsive to infant cues of hunger and satiety, thereby allowing infants greater self-regulation of energy intake (Taveras 2006). The contrary is true of formula fed babies, who are more prone to over-feeding and thus, to stomach-stretching (Ruowei Li et al 2012Brown and Lee 2012Fein and Grummer-Strawn 2010). For instance, six-week-old formula-fed infants consume 20–30% higher volumes per feed and, by 4 months, have fewer yet much larger feeds (Sievers et al., 2002). Differences in the volume consumed and the higher energy density of formula contribute to a whopping 15–23% higher total energy intake in formula-fed infants from 3 to 18 months (Thompson 2012). When a baby’s stomach is overstretched regularly, he becomes accustomed to this ‘full feeling’. He then expects this feeling each time he feeds and this often becomes the habit for life, leading to overeating (Lim 2009).

Research has shown that differences in intake between breast and formula fed babies persist well after solid foods are introduced (Dewey, 2009). Each additional 100 kcal/day that formula fed babies consume at 4 months is associated with 46% higher odds of them becoming overweight at 3 years and 25% higher odds at 5 years (Ong et al., 2006). These facts add credence to the hypothesis that breastfed babies better match intake to energy needs while their formula fed counterparts seem unable to compensate for the intake of solids with lower formula intake (Wasser et al., 2011).

Reason #4 Leptin and Ghrelin

Interestingly, researchers have asserted that: “The presence of hormonal differences between breast- and formula-fed infants provides evidence that feeding type has a metabolic effect in infants” (Thompson 2012). Let's explore this statement further.

The hormonal composition of breastmilk plays an important role in the neural programming of appetite, not just in short-term regulation of infant weight gain, but also in long-term programming of the complex pathways linking the hypothalamus, gastrointestinal tract, and fatty tissues (Agostini, 2005; Savino et al., 2009; Bartok and Ventura, 2009).

Table from (Thompson 2012).

The hormones Leptin and Ghrelin are key players in ‘programming’ the human appetite and nutritional preferences. Leptin is the hormone responsible for making us feel full. The levels of leptin in breastmilk become more plentiful as the baby reaches the rich hindmilk (Savino et al., 2009). When ingested during the suckling period Leptin is absorbed by the baby's immature stomach exerting certain biological effects. These include: facilitating the normal maturation of tissues and signalling pathways involved in metabolic processes; programing appetite by providing hunger and satiety cues; discouraging excessive fat storage; and improvement in insulin sensitivity (Agostoni 2005Savino and Liguori 2006Palou and Picó 2009Vickers and Sloboda 2012Thompson 2012).

The other hormone in this duo - Ghrelin - is produced by the stomach and functions as a hunger signal. Formula fed babies have higher ghrelin levels which links formula feeding to increased appetite. (Savino et al., 2009).

These findings are in line with other studies which maintain that neonatal nutrition influences endocrinology more readily than genetics (Zegher et al 2012).

On that note, we move onto the cousin of Leptin and Ghrelin...

Reason #5 Growth Hormone

It’s time for a mini science lesson.

Growth hormone is basically the hormone that controls when your adipose (fat) tissues release fatty acids to be metabolized by the rest of your body. A person with low growth hormone has a ‘low metabolism’ as it is understood in the popular sense (i.e. the common rant: “I’m fat because I have a low metabolism”). The inverse is also true: high levels of growth hormone lead to an increased basal metabolic rate (Liu et al 2007). 

So if growth hormone controls the release of fat from your fat tissues, what controls the release of growth hormone? My friends, let me introduce you to IGF-1 (Insulin-like growth factor 1), a group of hormones in the blood that come from the liver. 

Perhaps unsurprisingly, nutrition is the strongest drive of this system, and throughout the whole of evolution IGFs have been the mediators of the control of tissue growth in relation to how much nutrition you have.

Okay, but where do formula fed babies come into this?

Higher basal insulin levels and prolonged insulin response accompany formula-feeding as early as the first week of life (Lucas et al., 1981). The higher protein content of formula – as much as 50–80% higher than in breastmilk - drives up the baby’s IGF-1 secretion (Hoppe et al., 2004Chellakooty et al 2006Ziegler 2006Koletzko et al 2009Larnkjaer et al 2009), as illustrated in this chart:


However this increase of IGF-1 has a dramatic consequence. It re-sets the pituitary so that 7 years later children who were formula fed have a lower IGF-1 level, as illustrated here:


Those with a low IGF-1 have the highest BMI (Body Mass Index) many, many years later. In other words, their growth hormone levels are depressed (Scacchi et al 1999).

Conversely, as you can see in the above charts, breastfed babies have lower levels of IGF as babies, but at 7 to 8 years they have higher levels of IGF-1 (Martin et al 2005; Savino and Lupica 2006). This suggests that during the breastfeeding period, the lower IGF-1 levels have reset the hypothalamic/pituitary axis to a higher responsiveness to increased growth hormone as an inference (Larnkjaer et al 2009Michaelsen et al 2012).

These findings are in line with other studies which maintain that being breastfed for between 13 and 25 weeks is associated with a 38 percent reduction in the risk of obesity at nine-years of age, while being breastfed for 26 weeks or more is associated with a 51 percent reduction in the risk of obesity at nine-years of age (McCrory and Layte 2012; Gillman et al 2001Mayer-Davis et al 2006Weyermann et al 2006Abraham et al 2012).

What About Environment?

Everything I have discussed above is married with the environment in which it occurs - and that environment is usually one of abundant over-nutrition. Formula fed babies have the worst of both worlds. They are physiologically disadvantaged due to all the factors explored above, and they are environmentally disadvantaged by a culture which is out of sync with nutritional health.

During infancy, babies' bodies try to adapt to their environment. The endocrine system is part of that adaptation. Assume you are a formula fed baby. If you are trying to adapt to an environment of high protein intake (formula) that is driving your IGF-1, your IGF-I levels will feed back and suppress the central control, re-setting this control under the assumption that you will always have a high protein intake. So you come out of this high protein exposure with a pituitary that has been re-set down.

With all these factors in mind, we see how formula fed babies have the odds stacked against them from the start. However when studies are published which show that feeding a human infant with artificially modified bovine milk (i.e. formula) leads to obesity, formula feeders are up in arms. “Correlation does not equal causation!” they chant. This is a lazy get-out clause used to denounce scientific evidence. The dialogue often goes like this:

Science: "Formula feeding increases a child's risk of becoming obese".
Formula feeder: "No. My child was formula fed and they're not fat".
Science: "Scientific studies have shown that children who were formula fed are statistically more likely to become obese. The increase in formula use correlates with the parallel increase in obesity".
Formula feeder: "It's not formula feeding that is responsible for the rise in obesity - it's people eating too much fattening food!"
Science: (Trump card time) "Formula feeding manipulates a baby's biological makeup, priming their body's receptiveness to putting on weight."

So yes, whilst it is technically the consumption of fattening food that causes an individual to become obese - it is the way their body craves the food and then processes it, that leads to this obesity. These mechanisms are set in infancy. In other words, formula feeding provokes long-term vulnerability to obesity, not only by shaping eating behaviours and responses to satiety cues, but also through hormonal programming.

Indeed, these metabolic and physiological processes have a more central role in obesity than social trends. Whilst it’s true that breastfeeding mothers are statistically more likely to be higher educated, afford healthier food, and make better food choices for their families - these factors don’t negate the bioactive factors inherent in breast and formula feeding. In light of the scientific evidence it is impossible to deny the dynamic interplay of groups of hormones with cellular chemistry, protein composition and appetite regulation mechanisms, all of which expose the true nature of formula feeding as an instrument of sabotage in the fight against obesity.

Loved it? Pin it!

Tuesday, 19 February 2013

Triumphant Tuesday: The Veteran Breastfeeder

Once commonplace, an experienced breastfeeding mother is now a rare commodity. This is a great shame as there is much we can learn from the veteran breastfeeder. Contrary to common assumption, most experienced breastfeeding mothers have not had it ‘lucky’. Rather, their success is a product of persistence, dedication, bravery and stamina.

This week’s triumphant mom had three babies, all exclusively breastfed, all self-weaned. She endured traumatic births, judgemental relatives, formula pushing medical staff, mastitis, having to pump during office meetings, a jaundiced baby, a dairy intolerant baby, and a lip-tied baby. She is now a lactation consultant. This is her story.


I had my first son when I was 21. It was a traumatic birth (all natural, just a little stuck and in stress) and he ended up in the NICU for 3 days. Being a young, first time mom, I had said I would "try" to breastfeed. The NICU staff only let me in every 3 hours to feed my baby and provided me with a pump for in between, so I pumped, and pumped and pumped. and nothing. not even a drop. It was a good thing I had read about breastfeeding while pregnant and knew it was normal for the milk to trickle at this point, so I persevered and pumped and fed my little baby who was all hooked up to wires, every chance I got.  

A bond like no other

Once I tried breastfeeding, I realized it is something that can never be replaced between a mother and a child.  I loved the feeling of being able to nourish my child with my own body, an extension of developing the baby inside of the womb.  I became very interested in all the health benefits and research about breast milk and decided I could never give my child an inferior start.

Ruthless relatives

However my family, friends, and "in-laws" all had a negative view of breastfeeding. My friends, all around the age of 21, could not understand why I would want to "ruin my boobs" or be "so tied down", we obviously had different priorities.  My own father was very uncomfortable and would comment that I "whipped my boob out" or that it’s "time to get the kid off the tit" and ordered for me to leave the room completely when I needed to nurse.  This made me feel very uncomfortable, but I honoured his wishes. As I practiced and got more discrete I was able to get up the gumption to nurse where ever I wanted, even at the Mall with no cover by 1 month old! 

My in-laws had similar prejudice and were worried that their son would "not be able to bond with the baby" if I did not allow him to have a bottle.  My mother-in -law even went as far to buy a can of formula for "when he is at their house". I made sure he was never alone at their house because of that!

I exclusively breastfed my first born until 4 months when we introduced rice cereal (hey, it was 9 years ago, and I know better now) and continued nursing with not one drop of formula for 18 months when he self-weaned. I also worked full time, but was able to bring him to work with me until the time he weaned.

Baby #2

My next son was born when I was 25, by then my partner and I had married.  I knew I would breastfeed this child without a doubt. His labor was induced 10 days after his due date because my amniotic fluid was low. I ended up with an emergency c-section, as he was breach and we unsuccessfully tried aversion twice.  After the surgery I begged to hold my baby and the nurses insisted I had to get some feeling back before I was allowed to hold him.  My husband knew how important it was to "get the baby to the boob within an hour" after delivery and so he propped our son at the breast in the recovery room for him to nurse.  

Pressure to formula feed

This baby ended up jaundiced and had to stay under light therapy for 3 days. He could only come out every 2-3 hours to nurse.  The hospital staff encouraged me to give him formula to help his billirubin levels come down. They were polite but persistent.  At every shift change, every nurse, every feeding, I was asked if I would consider the formula. I refused and said I would just nurse him more. After 5 days in the hospital his levels were finally safe and we were discharged.  

Dairy-intolerance

He was my fussiest baby and I couldn't understand why. At about 4 weeks old I realized he was sensitive to something I was eating and started an elimination diet - not an easy task, especially when I discovered it was dairy he was reacting to. It was now that I realized how many dairy products we consumed in our household!  Cheese was definitely the hardest food to eliminate.  We did find a cheddar flavored tofu that worked as a substitute, but it was not the same! I continued to avoid dairy for the next year and nursed him until he self-weaned at 17 months.  I introduced homemade cereals and purees at 6 months but kept breast milk his main nutrition.

Baby #3

My last, and current nursling was going to be a breeze.  I was 29 years old and had encountered everything I would with 3+ years of nursing already, right? Wrong.  I had a scheduled c-section due to the previous and the hospital’s policy against VBACs, plus I had developed severe gestational diabetes and it was important to make sure my and the baby's glucose were at safe levels after birth.  My baby girl was brought to me sooner than I had expected and she latched right on. 

Lip-tied

Baby and I were happy, until a few days later when blisters started to develop on my nipples.  I knew what a correct latch should feel like and it just didn't feel right. Baby girl was lip tied and not able to flange which crushed my nipples raw.  She too seemed fussy and I was worried she was not getting enough since she could not latch right.  

Stealth supplementation

The hospital night nurse gave my baby formula from a cup, without my consent. My daughter then slept for about 4 hours which meant that I slept too.  I felt betrayed! Let down. And bad for my baby girl.  I trusted the nurses to care for my baby while I rested between feedings. When I woke from that 4 hour stretch of sleep I immediately called for the nurse to bring my baby girl back to me. When I realized we had slept through 2 feedings I asked how and the nurse whispered to me that she had "cup fed her a little formula, she was a hungry girl" I started crying, and sobbing, and stuttering, unable to explain why I was so upset the nurse wrote it off as hormones.  I put my baby to the breast and calmed down and called for the Lactation Consultant and my midwife. They were both irate and agreed that it was not a decision for the nurse to make. I then diverted my attention to focusing on getting a better latch and healing my skin.  

Formula pushing pead

Weeks of painful latch and cringing at feeding time, finally stretched her lip enough and toughened up my nipples to make it bearable to breastfeed. She had lost 1 full pound before we left the hospital and the pediatrician strongly encouraged a supplement of formula. He actually wrote on her prescription pad a note to me explaining when and how much formula to give.  I read it and told the Dr that I was not comfortable with that recommendation.  The pediatrician asked me to keep an open mind.  I asked him to do the same.  I knew that once my milk came in my baby would gain.   We agreed on weight checks for her every 2-3 days until she was back up to birth weight.

Mastitis

By 2 months old my baby who weighed 8 lbs 10 oz at birth had doubled her weight.  My milk came in with a vengeance this time and swelled up to my armpits with melon sized knots keeping me from even putting my arms down.  I suffered from one clogged duct after another and had my first case of Mastitis. I was shocked. Over 4 years of nursing and I had never encountered that; I thought I was in the clear.  Boy was I wrong, Mastitis does not discriminate.  I felt achy all over, sick, feverish, and just like I had the flu accompanied by a red, swollen, streaky breast.  I used antibiotics and nursed as much as my baby would.  It was excruciating to latch and about the first 2 minutes were almost unbearable.  Once I got through letdown, I was able to massage my breast and encourage my baby girl to keep going! After 2 days on the antibiotics and 3 days of pain, the infection started to clear up.

Pumping at work

By this time I had discovered baby led weaning and introduced solids to her when she was almost 7 months old, again keeping breastmilk as her main source of nutrition.  I worked full time out of the home and was not able to bring my daughter with me. Despite the tedious hours I pumped diligently and my daughter never received anything but breast milk while momma was at work. I pumped in the car, in restrooms while away at trainings, and in front of a whole staff meeting, because that was where the outlet was available! You could say my modesty has gone out the window. 


My baby girl is now 17 months old and I plan to let her self-wean, hopefully past the age of 2 years!

I have since become a Certified Lactation Consultant through my work and counsel breastfeeding mothers every day.  I will never say it was easy - it was emotional, painful, and much hard work, but I would not trade my breastfeeding experiences for the world.

Any mother who does not try breastfeeding is missing out on a one-of-a-kind experience.  I also feel bad for the child because I believe that even if breastfeeding is not right for every mother, it is what is right for every baby.


Get your own Bingo Card here.

Email me with your story.

Tuesday, 12 February 2013

Triumphant Tuesday: Breastfeeding a Sick Premature Baby

Breast milk is a complex living, morphing, dynamic substance. It contains live cells that protect babies from infection, and these are are even more important for premature babies. Preemies have a lower immune function than term babies. Also ironically, the very interventions used to save the lives of prem babies make them even more vulnerable to infection, such as intravenous lines, blood tests and intubation tubes.

With these concerns in mind, it would seem feasible to assume that medical professionals, families and communities would encourage and facilitate the breastfeeding of premature babies. However this is sadly not the case, as Megan's story illustrates.

My son Liam was born prematurely at 29 weeks due to my water breaking.  He weighed 1330 grams at birth and was not stable enough to be held for more than a minute at a time.  He was too little to be directly breastfed but the nurses and doctors encouraged me to pump.  

On death's door


7 days after he was born, Liam became critically ill.  My husband and I had to rush to the hospital at 4 a.m. as the staff were not sure if Liam was going to make it.  The nurses later told us it was like a 9.5 out of 10 on the severity scale.  Liam had to be temporarily paralyzed and intubated for 72 hours. He bled into his lungs and eyes as a result (this was in addition to the blood that was already in his brain.)

When I was told that my son might not survive I felt a cocktail of emotions: disbelief, confusion, helplessness and terror. We live an hour from the hospital so it was the longest drive of our lives.  I remember going to the parking lot and being scared to go into the hospital and face the reality.  It was the only time my husband and I have held hands.  I worried how I was going to tell everyone.  He is the first grandchild on both sides and meant the world to everyone not just us.  There were so many people pulling for him, I was horrified how it would impact on everyone.

Starved of touch

Fortunately, he pulled through but as a consequence we could not hold him until he was three weeks old.  If he was touched, he became distressed and stopped breathing.  Even after the three week period, he could only be held once a day for no more than an hour for about a month.  I'm not bringing this up because I want others to feel bad for us.  There is no reason for pity; we are one of the lucky ones.  I bring this up because I feel the lack of contact in the first 6 to 8 weeks was difficult for my supply.

Top-ups

In order to keep up my supply I pumped every 3 hours around the clock while my son was in the hospital ( a total of 65 days.)  Due to his illness, he was only eating 25ml max a feed so I was able to build up a stock pile.  When he was 50 days old or so we were able to practice breastfeeding and eventually I was allowed to feed him 3 times a day via breast with top-ups of expressed breastmilk after.  Breastfeeding tired him out so the doctors mandated the top-ups.  

When Liam came home I was told to work-up to breast only with a combination of breastfeeding with breastmilk top-ups.  This was quite difficult as Liam would become very sleepy. Our routine would be breast, he would fall asleep, wake-up and scream because he was still hungry, feed him again and repeat for 1/2 hour.  Then I would pump for another 1/2 hour while I topped him up (to maintain my supply as he wasn't taking a full feed.)  This process would take at least an hour only to start-over again.  Sometimes I was so tired and frustrated I cried with him.  I didn't quit though because everything I read about breastmilk made me want to keep going.

Family flack

My family gave me some flack at first.  Both my husband and I were formula feed babies so our families didn't really understand.  They teased me about feeding him and asked me if I will be in Time magazine too when my son is older.  I told them of course not, Time is American.  I will be in MacCleans (this is the Canadian equivalent).  

People in general often told me that he was too small and not getting enough to eat. The nurses at that Well Baby clinic were always telling me I should be doing something it. I was pressured to introduce solids earlier to “help him sleep through the night” and help him gain weight. It was hard but I did not cave.

Unhelpful doctor

As he grew he was eating more and going through my stock pile of breast milk.  I held off at first hoping it was a growth spurt but when I was almost out of milk I panicked.  I asked my doctor what I could do for low supply, he said formula.  When I stated that was not acceptable and asked him about domperidone, he said he didn't prescribe it because it's for nausea not milk supply.  Fair enough, his practice, not mine.  However, I was not going to let this break me.  I called the lactation consultant I met at the hospital, our local health unit and several others looking for someone to help (I live in a small town with no La Leche League and limited resources).  After several hours of calls I finally found someone who would prescribe domperidone.  

Domperidone

I took the prescription for 6 weeks and then was able to wean myself off and get my son completely on the breast with no top-ups. He started on solids at 6 months corrected (wanted to maintain his virgin gut).  He gains weight slowly; he only weighs 16 lbs now but I never gave up despite comments that I should because it was too hard or that he wasn't gaining enough.

Now he is a very happy and healthy baby and I think it is largely due to the breastmilk. These days I happily feed him in front of my family and they proudly tell others that I breastfeed him.



Get your own Bingo Card here.

Email me with your story.

Monday, 11 February 2013

Feminist Children's Books: Part Two

Here's another ten liberating children's books to tickle your feminist fancy (First, catch up on part one here).

Pippi Longstocking
Astrid Lindgren


Pippi is spunky adventurous nine-year-old girl with freckles, pigtails and trademark ‘longstockings’. Some may refer to her as a tomboy. I prefer to describe her as daring and playful with a hint of smartarse. What’s more, she’s random in an intriguing and entertaining sense - she lives with a horse, a monkey, and a big suitcase of gold coins.

This book is a treasury of her various antics, which include, organising an expedition, ‘dancing with burglars’, and ‘playing tag with the police’. Her cheeky enthusiasm is contagious. One can’t help but smile when reading of her adventures. Her witty remarks are simple yet sarcastic, the kind only a child can make unscathed. For instance, when the police say she must go to school otherwise she won’t know what the capital of Portugal is, Pippi replies, “If you’re so desperately anxious to know what the capital of Portugal is, then by all means write a letter to Portugal and ask them!” The humorous narrative is complimented by delicious illustrations which combine an eclectic mix of fabrics and childlike pencil drawings with ripped newspaper. I’m not sure who would be entertained most by this book – girls, boys, or indeed their parents.



Pirate Girl
Cornelia Funke


The story begins with a crew of boozy, menacing pirate men - the stereotypical sort that “make the knees of honest seafaring folk shake like jelly”. One day they decided to rob a ship – a ship that they should have left well alone. On board was a little girl called Molly. The pirates took her as hostage and made her peel potatoes and clean boots.

But Molly was resilient, intelligent and resourceful. She had a plan. Every night while the pirates were drunk and arsing about, she wrote secret messages and popped them into empty bottles (there were plenty lying around thanks to the pirates' alcoholic tendencies). When the pirates were safely snoring in their bunks, she tossed the bottles into the sea. Then... (fake drum role)...someone receives the bottles and comes to Molly’s rescue. That someone is ‘Barbarous Bertha’, Molly’s mother and the most dangerous of all pirates! She arrives with style, sailing in a grand ship heaving with strong pirate women of every shape and size. The matriarchal crew of pirate women give the pirate men a good seeing to (in the retributive sense), reducing them to potato peeling, boot cleaning submissives.




You Can’t Scare a Princess!
Gillian Rogerson and Sarah McIntyre


Pirates tend to be a popular theme in children’s books (no shit!), and this appears to be particularly so when the book has a feminist twist. ‘You Can’t Scare A Princess’ is another book from the pirate genre with a side helping of ‘princess parody’.

Princess Spaghetti (so called after her pasta-shaped hair presumably) lives in what I can only describe as a parallel universe full of candy-themed islands. Her castle is a giant pink cupcake (it looks like a breast to be honest). Whilst the combination of ‘pink’ and ‘cupcake’ and ‘princess’ are enough to make any feminist roll their eyes out of their sockets, fear not. They appear to act as a smokescreen behind which lurks a brave and resourceful girl.

After her father is kidnapped by pirates, said baddies make Princess Spaghetti help them find a treasure chest that is hidden somewhere in her kingdom. During their search it becomes apparent that the princess is more fearless than the pirate folk, and quick-witted to boot. She navigates treacherous terrain whilst the pirates bumble along behind her. When they finally reach the treasure chest...(spoiler alert)... they discover that another pirate has already stolen the treasure! The pirates are not happy by this at all. Cue a pitiful man-child crying spree. “I want my mummy!” one of them bawls. The accompanying illustration depicts Princess Spaghetti with an unfazed and bemused expression. This leads us to the climax of the book, which is a little random and less satisfying than the build up would lead us to expect. Basically the princess befriends the pirates and introduces them to the delights of rollerskating. Stockholm syndrome anyone?




Sophie and the Shadow Woods
Linda Chapman and Lee Weatherly


On her tenth birthday, Sophie Smith's life changes forever. As the new guardian of a magic gateway in the mysterious Shadow Woods, her mission is to stop the mischievous creatures that live there from entering our world. But disaster strikes when the Goblin King steals the key to the gateway... Sounds all very David Bowie to me.

In this six book character-led series aimed at 7+ girls, modern day heroine Sophie has to call upon all her strength and skills to defeat various creatures. Think: tween Harry Potter. Sophie is brave, resilient and sharp-witted. She is an inspiring example of the fact that girls should not be dismissed as the ‘weaker sex’ (as Sophie’s Grandad often does in the story). Aptly the book's tagline is ‘Only one girl can save the world’. Unfortunately, the 'Bratz'-style illustrations don't do her justice. In some illustrations she could even be wearing make-up.

Contrast this with the official website's description of Sophie as ‘a tomboy through and through’ which ironically I also don’t think is helpful. Strong, independent females should not attract masculine labels. Apparently Sophie lives in jeans and t-shirts and enjoys action films, sports, bikes, skateboards and dreaming of becoming a stuntwoman in films. Fair enough, but it gets predictable... She dislikes ‘girly things’ and is understandably wound-up when her grandfather does 'boy stuff' with her brother and leaves her out.

Evidently the writing could be criticised as lazy; for instance, it appears nonsensical that Sophie is highly talented on one hand (skilled at Taekwondo and skateboarding) yet on the other hand she is clumsy in giving away secrets to the enemy, and losing things. However I believe this dichotomy adds depth and humanity to the character. ‘Perfect’ characters can have a contemptuous effect on children’s self-esteem. That Sophie has flaws does not damage her rightful place as a role model for girls and boys alike. The realism and humanity of Sophie’s character balances perfectly with the fantastical nature of her adventures. Also, the spotlight on relationships with friends and family is well-pitched, and the book is littered with genuine laugh out loud moments. You'll wish you were 7 again.




I Know a Rhino
Charles Fuge


"I Know a Rhino" is simple board book about a child's imaginary world of play. Beautiful illustrations, overflowing with character, add to the dynamics of the plot. The central child character is designed so androgynously that they could be either male or female. For the most part, they wear jeans and a tshirt. However they have long hair and in one illustration can be seen in a pink fairy outfit. Gender is not mentioned in the text. It was only when I carried out my own research that I discovered the central character is in fact, a girl.

The eclectic range of adventures she enjoys with her various animal friends include a tea party with a rhino, playing in dirt with a pig, miming pop songs with an orangutan, administering medical care to a dragon, bathing with a giraffe, and so on. At the end of the book we discover the true identity of the animals – they are her stuffed toys.




Princess Pigsty
Cornelia Funke and Kerstin Meyer


Young princess Isabella has it all - but has had enough of it! She has had enough of being waited on hand and foot, of having to smile all the time, and of wearing beautiful dresses that she can't climb trees in. So when the king banishes her to the pigsty, his punishment backfires - Isabella's happier there than a pig in... well, you get the idea.

This amusing story about non-conformity challenges the widespread notion that all girls want to be princesses. In this narrative, the traditional life of a princess is presented as boring and restrictive. The quirky illustrations perfectly capture the sharp contrast between cheeky Isabella and her angelic sisters. When she is not hiding under the bed from an onslaught of hair straightners, Isabella can be seen throwing her crown out of the window in a rebellious strop.

After banishing her to the pigsty, the king finally realises that his attempts to shoehorn his daughter into the princess stereotype (“put on a pretty dress and comb your hair”) are perpetually in vain. Upon seeing her happiness and contentment as she wallows in the mud he finally accepts her as she is.





Maisy’s Fire Engine
Lucy Cousins


Children are never too young to be exposed to strong, female role models. In this simple board book feminism starts at toddlerhood. Maisy Mouse and her male side-kick, Cyril the squirrel, like to participate in a variety of activities. Today they are driving their fire engine. Maisy sits in the front and drives whilst Cyril rides in the seat behind. However when clumsy Cyril accidently sprays a cat with his water hose (the one attached to the fire engine you understand), the cat freaks out and climbs onto the roof of a random shed. Maisy to the rescue!

Cyril quivers in his boots as he watches Maisy perilously climb a ladder and rescue the grateful kitty. Needless to say, it’s refreshing to see a book aimed at very young children in which the main, most active character is female, and the more passive character is male. What’s more, the male character was the one to cause a scenario whereby someone needs saving – and our female heroine executes the rescue. Combine these elements with Lucy Cousin’s trademark bold, childlike illustrations and you’ve got a winner.



Lucia and the Light
Phyllis Root and Mary Grandpre


Inspired by Nordic lore, this atmospheric tale places the limelight on a courageous girl and her mission to save her family.

Lucia, her mother, and baby brother live in a small isolated cabin in the middle of nowhere. As the snows mount and the winds howl around their tiny home, their food supplies dwindle.

One morning, the sun does not rise. Darkness envelops Lucia's world and when the cow stops giving milk, the brave girl decides to go out into the world and bring the sun home again. She skis and trudges through ferocious snow storms in spite of adversity and fear. Grandpre's evocative, dimly lit acrylics capture the eerie mystery and shivery suspense of the adventure, as Lucia treks through spooky, starlit forests and finally finds the sun, held hostage by a band of wrinkly gruesome Hugh Hefneresque trolls.






Dolls House Fairy
Jane Ray


This is the second of Jane Ray’s books that I’ve had the pleasure to review. The first, ‘The Story of Christmas’, I featured in my article: “Images of Breastfeeding in Children’s Books”.

The pages of Dolls House Fairy feature Ray’s trademark gold enamels and eclectic use of textures. Rosy, a young girl and the star of the story, is in for a big surprise.

The narrative begins by painting a pretty unimaginative set-up: Rosy loved her dolls house. It was her favourite thing in the whole world because her dad had built it just for her. (Bear with me, there is some feminism in here, honest). She played for hours with her dolls house, making up games and stories for the dolls that lived there. Suddenly one day an unorthodox fairy with anarchic behavioural problems decided to move in (booom – there it is!)

This fairy was not called ‘Rose’ or ‘Petal’ or ‘Daisy’ or any such fairy-like name. This fairy was called ‘Thistle’ and she had the hair of Russell Brand, the dress sense of Rab C Nesbit and the manners of a builder with tourettes. She wasn’t like the sweet fairies in Rosie’s storybooks. She was funny and noisy and full of mischief. She bounced on the bed and drew on the walls. She spilt things and dropped things and scattered fairy dust everywhere.

Naturally, only Rosie could see Thistle the fairy - this plot twist lends itself to multiple interpretation possibilities. Does Thistle really exist, or is she Rosie’s imaginary friend? Or is Thistle Rosie’s alter ego? Or perhaps Thistle is a metaphor for PMS or riotgrrl style rage at the Patriarchy? So many questions.





The Pirate Queen
Terry Deary


Grace O’Malley is one badass pirate. In fact, she’s “the greatest pirate that ever lived”, and woe betide you forget it. As a child she saved her father’s life at the hands of English soldiers. Now, a grown woman, and the leader of a crew of male pirates, Grace faces the English again. They capture her, but instead of being hanged, she is sent to London – by royal command. What will happen to the Queen of the Pirates when she meets the Queen of England? Will her quick witts, knife skills and potty mouth be her saviour? The humour, illustrations and characters of this book are very-Blackadder, and Grace, although volatile, unsightly and perpetually angry, proves herself a lovable rouge. One of the best feminist books from the pirate genre.