Storage and Handling of Breast Milk

One of the best things about breast milk feeding is its flexibility in handling and storage.  Breast milk can be collected, refrigerated or frozen and used later as desired!  This allows us so much freedom… to share lunch with a friend, to have a relaxing massage, to spend a few hours shopping, etc., etc.!

All mothers should have information about the storage and handling of breast milk.  This is most easily described in a table format, so here it is:

Breast Milk	Room Temperature	Refrigerator at ≤ 39 degrees	Refrigerator Freezer	Deep Freezer
Fresh	Use within 4-6 hours	Use within 3-7 days	Use within 6 months	Use within 12 months
Frozen then thawed in refrigerator	Use within 4 hours	Use within 24 hours	Do not refreeze	Do not refreeze
Frozen then thawed in a warm water bath	Use right away	Use within 4 hours	Do not refreeze	Do not refreeze

Although the immunological composition of cold-stored milk will have been altered, it is still the next best thing to fresh breast milk for your baby.  In preparing bottles for feeding, many of us assume that milk must be warmed.  However, many babies actually enjoy chilled milk straight from the fridge!  Some prefer room temperature.  Others seem to like it slightly warmed.  To warm chilled milk, place the unopened container in a warm water bath (cup or bowl) for a few minutes.  Warning:  Because babies can be badly injured, please remember never to use a microwave to heat baby’s milk.

I have discussed how to collect breast milk (by hand and by pump) in a previous blog, so please select keywords “milk expression” or “collection” for more information.  BTW, I will be chatting very soon about introducing bottles to babies.  I hope this discussion on milk storage was helpful.  Please feel free to post any questions your may have by clicking on the comment link.  Happy milk storage!

Collection of Breast Milk for Storage

This topic came up at our Moms MoBap Morning meeting the other day.  Michelle and Crystal were wondering how and when to begin this process in preparation for their return to work.  

First of all, you can start collecting anytime after breast milk production is well established.  Many mothers begin around the third week after birth depending upon when they plan to return to work.  Expression of milk for storage should be done in the morning hours when we typically have more milk.  Always feed baby first so he gets what he needs.  It is important that you choose a time when things are quiet and you can relax.

1) Always wash your hands before you begin.

2) Expression may be done manually (by hand) or with a breast pump.

   A.  If you are expressing manually, choose a clean collection container with a wide opening (like a bowl or wide mouth jar).  Place your thumb on top and index finger below your breast.  Keeping your fingers apart, move them into place over your areola (the brown area surrounding your nipple) to about ½ inch behind where the nipple and areola meet.  Step 1, keeping your fingers in place and apart, push into your breast (toward your ribs).  Step 2, gently squeeze your fingers together as you roll them toward your nipple.  Do not slide your fingers over your skin.  Step 3, release the squeeze but keep your fingers in place.  Repeat these 3 steps over and over at a comfortably rapid pace.  Practice aiming your milk as it begins to stream into the collection container (you can see why a wide opening is helpful!).

   B.  If you are using a pump, be sure to adjust the suction control to its lowest setting.  Then, as you pump, turn it up gradually to the highest level that is comfortable.  If you are using a double electric pump, wrap your hands around the flanges as you hold them to your breasts.  This will help to maintain a good seal and allow you to massage your breasts with your thumbs.  This will increase your output.  Do not be concerned if only small amounts of milk are obtained at first.  Over time, your output will increase.

   C.  Helpful Hint:  For a mother whose baby often takes only one breast per feeding, expression may be done on one breast while baby feeds on the other.  This takes advantage of the natural milk ejection reflex where milk flows freely toward the nipple and can be easily collected.

Remember that expressing your milk should never hurt!

3)  Milk may be stored in various types of containers including polypropylene BPA-free bottles, polyethylene bags or glass.  There are containers available for purchase specifically designed for breast milk storage.  Here are some guidelines for storage:

   A. Freshly expressed milk can be kept at room temperature if it will be used within 4-6 hours.

   B.  It can be stored in the refrigerator and used within 7 days.

   C.  If it will be frozen, store it in portions of 1, 2 and 3 ounces.  Until you get an idea of how much baby will take in a feeding, you won’t have to waste milk left in the bottle.

   D.  Because milk expands when frozen, leave an air space between the milk and the top of the container.  We wouldn’t want it to burst and be spoiled!

   E.  Milk should be stored in the bottom and back of the freezer, never on the door.

Michelle and Crystal, I hope this helps.  Next week I will chat about handling of stored breast milk, so keep an eye out!

On the Issue of sleep

Published recently in the journal Pediatrics, researchers report that they found no difference in the amount of sleep a mother receives whether she is breastfeeding or formula feeding her baby.  In their study, 80 new mothers were monitored electronically over a ten-week period beginning at 2 weeks post-partum.  Additionally, the mothers completed daily diaries.  Researchers measured total sleep and time awake, sleep quality, fatigue and daytime sleepiness.  In addition to finding no difference in the amount of sleep, the researchers found no difference in fatigue or daytime sleepiness.

The fact is many of us have long believed that breastfeeding mothers get as much sleep (if not a little more) and perhaps a better quality of sleep than their formula feeding counterparts.  One reason may be that when we breastfeed, the hormone relaxin is stimulated and released from our brain.  Relaxin helps us to feel more relaxed.  So, we tend to fall asleep very easily after feedings, nature’s way of encouraging rest for a new mom.  Furthermore, little effort is required to bring baby to breast when he awakens for a feeding.  And the milk is already warm and waiting!   No formula mixing, warming, etc. is necessary.  More time to sleep!  Finally, breastfed babies tend not to over-feed or take in large amounts of air during feedings, so they are not prone to the discomforts of stomach distention and aerophagia commonly seen in formula / bottle-fed infants.  In the event you’d like to read more, I have added a couple of links to more information about the study.  However, please don’t lose valuable sleep over this.  Remember the old adage “sleep when your baby sleeps” and you should be fine!

Happy Sleeping!

http://bit.ly/b7y2Up

http://reut.rs/bFj4eX

Duration of Early Feedings

In previous blogs, I have addressed recommendations regarding breastfeeding frequency in the early hours and days after birth. However, mothers may wonder how long feedings should last. So, here are a few words on early, in-hospital feeding duration.
During the first few days after delivery and before the transitional milk comes in, it is important that mothers allow their babies to feed at breast for as long as baby indicates a desire to do so. This is, of course, providing that mom is physically and emotionally comfortable. In the distant past, it was thought that limiting an infant’s feeding time at breast would prevent nipple soreness. This is NOT the case!!! As long as an infant is attached correctly and there is little or no discomfort for mom, unlimited feedings may take place without the risk of soreness.
Frequent, unlimited feeding at breast is advantageous to both mother and baby. For mother, frequent, unlimited feeding promotes milk production, rest and relaxation as she progresses through early post-partum. Unlimited feeding may also prevent painful breast engorgement as her transitional milk comes in. For baby, this allows plenty of practice in transferring milk BEFORE he has to handle the larger volumes. Furthermore, baby receives more colostrum (lots more swallowing), gains weight faster, stabilizes body temperature and blood sugar levels, expels more meconium, develops less jaundice, etc, etc.
In summary, if breastfeeding is comfortable for mom, and baby is swallowing at the breast, length of feedings need not be a concern.

Your Baby has a Fuel Gauge!

In a previous blog we talked about BABY watching VS CLOCK watching to determine baby’s readiness to feed.   A full-term newborn will exhibit hunger cues by flexing her arms, tightening her little hands into fists, turning her head and pulling her fists to her mouth.  Her whole body becomes tense and she produces sweet short vocal “yaps” to alert us to the fact that she is ready to feed.  These are early signs of hunger and would be the best time to put her to breast.  Late signs of hunger include a scowled forehead, facial tension and crying or screaming in “alarm” of the fact that she is hungry.

 So, how do we know when baby has had enough milk?  As baby continues to feed at the breast and her tummy begins to fill, her body should become increasingly more relaxed.  Arms lose their flexion and release to extension.  Fists open.  Scowled forehead disappears and baby’s face and mouth become more relaxed.  She may, in fact, “fall” off the breast.  Now, here’s the trick.  If, when you raise then release her arm, she tenses it and wiggles or roots, she probably needs to feed a little more.  However, if her arm flops down to her body (as if she were a rag doll), and this is repeated two or three times, chances are good that her tank is full!  Now it’s time to rest.  I’ll bet you didn’t know your baby came with a fuel gauge!

In the News...Again!

Monday, in the online addition of the journal Archives of Disease in Childhood, a team of researchers from the University of Crete in Heraklion, Greece,  reported finding significantly fewer incidences of infections and hospitalizations in children exclusively human milk-fed for the first 6 months of life.  Many other studies have had similar findings.  However, it is important for us to hear it again and again and again.

Certainly, Greek mothers need to hear it.  In 2000, while visiting Greece, I felt privileged to have been invited to attend a La Leche League meeting held in the suburbs of Athens.  The leaders of the group explained to me that breastfeeding rates were very low in Greece at the time and that it was a challenge to educate the public.  So, I am very glad to hear that this research has come out of a Greek university.

On the subject of the La Leche League meeting, it was really wonderful to see all those Greek mothers and babies gathered in support of what was best for their babies.  The meeting was conducted in Greek.  However, much to my surprise, I was able to understand most of what was being discussed!!  I guess breastfeeding is a universal “language”.  It certainly was not all Greek to me!!!  

Check out this link to WebMD for the story http://bit.ly/agRVmU

Protection Against Overweight and Obesity

Last week, Michelle Obama spoke about the importance of human milk feeding of infants in reducing the incidence of obesity. Several people have asked me exactly how breastfeeding confers this protective effect.

Researchers have found that there is a difference in intestinal flora (bacteria) and pH between breastfed and formula-fed infants. The breastfed infant gut has a lower pH with a higher level of healthy bacteria and fewer disease-causing organisms. The formula-fed infant gut has a higher pH which inhibits the growth of healthy bacteria and enables disease-causing bacteria to grow. Therefore, formula feeding predisposes the infant intestine to the development of long-term, low-grade inflammation, a condition associated with a number of health challenges including overweight and obesity. Because breast milk controls inflammation, it helps to protect infants and children from the development of childhood and adult obesity.

Breastfeeding in the News Again!

Everyone knows that breastfeeding is best for human babies. However, the fact that breastfeeding is best for human mother’s receives far less attention. A study published in the September 9th issue of The American Journal of Medicine finds that women who breastfed exclusively for at least one month were at a much lower risk of developing type II diabetes than those who gave birth but did not breastfeed. Type II diabetes is a major public health concern here in the US. If breastfeeding for at least one month could decrease the incidence of type II diabetes, then legislation and public health policy needs to reflect it. If you have a familial history of type II diabetes, this research will be particularly interesting to you. Here’s the link to information about this new study: http://www.reuters.com/article/idUSTRE6893Z320100910

Calling All Babies – Expressing the Need for Colostrum

As some of you know, I am a strong advocate of the veterinary model of healthcare management when it comes to birth and early infant feeding, regardless of one’s species! Anyone who breeds cows, horses or other mammals will tell you how important it is for a newborn to receive colostrum, a mother’s very first milk. Loaded with antibodies, colostrum protects an infant from harmful environmental bacteria and viruses. To this end, farmers who raise cattle will immediately coax a newborn calf to its mother, skin-to-skin with her udder. Knowing the serious health consequences of not receiving species-specific colostrum as soon as possible after birth, veterinarians and zoologists will take extraordinary measures (like milk expression and alternative feeding methods) to ensure that a newborn receives its mother’s first milk. In the animal world, it is well-recognized that health, and even survival, is greatly influenced by receipt of this amazing liquid. Although artificial baby milks may be formulated for some species, illness and healthcare costs are significantly higher for those that must be “hand raised” (formula fed).

Human infants are no different. Infants not having received colostrum are four times more likely to become ill and require hospitalization during the first year of life than their human-milk-fed counterparts. Often called baby’s “first immunization,” colostrum provides passive immunity to a newborn because it is so rich in antibodies. In addition to immune factors, colostrum has an amazing ability to stabilize blood sugar levels, far better than formula. This is extremely important to a newborn infant, especially those who may have had a stressful birth, been born prematurely or delivered by a diabetic mother.

Like farmers and veterinarians, We too can ensure that our babies receive colostrum as soon as possible after birth. In cases where baby can be placed directly at the breast, skin-to-skin after birth, we certainly should do so. If not, let’s hand express and spoon- or syringe-feed this liquid gold to our newborns (see blog on hand expression). Our babies deserve the very best, so let’s let advocate for them by behaving like a bunch of animals!

Skin-to-Skin Kangaroo Care – Yet Another Amazing Story!

You all HAVE to see this video clip featured on the TODAY show this morning. An amazing story you cannot miss! Here’s the link
Parenting on Today Show - Premature infant stirs to life after two hours of kangaroo care
It is yet another testament to the value of skin to skin contact for all babies!

Hand Expression of Milk

Over the course of my career I have been privileged to observe hundreds of mothers happily breastfeeding their infants AFTER having had early and/or significant challenges with breastfeeding. In other words, breastfeeding doesn’t always get off to an easy start. However, with expert clinical assistance, time, patience and determination, most breastfeeding issues can be resolved. In the interim, expression of mother’s milk may be necessary to ensure a baby’s receipt of breast milk. When a baby is unable to or has trouble with attachment (or latching), it’s highly recommended that the mother begin pumping with a hospital-grade electric pump as soon as possible after birth. Pumping technology has advanced to the point that mothers can maintain a milk supply for months and even years. However, manual (hand) expression is still considered to be the most effective means of expressing colostrum, mother’s very important first milk. Hand expression of milk may also be helpful later when managing breast engorgement (another discussion for another day). Using the thumb and index finger in a systematic method of breast compression, we are often able to collect significant amounts of this thick, rich colostral milk for our babies. Spoons, syringes, feeding tubes or even tiny cups may be used for feeding this liquid gold to our little ones. I have included this link for step-by-step instruction of hand expression of colostrum, which you may find extremely helpful:

Hand Expression Video - Stanford University

Whether or not hand expression becomes necessary in the early days of breastfeeding, I recommend that all breastfeeding mothers develop the propensity to perform this handy maneuver. You never know when your breasts will express their need for some relief! Happy expressing!

“Cah, Cah”…Evaluating for Transfer of Mother’s Milk

One of the best ways to evaluate an infant’s feeding at the breast is to observe for swallowing. During the first few minutes at breast (after your transitional milk has come in), your baby should exhibit a suck/swallow ratio of about one-to-two sucks per swallow. This means that you should see one or two jaw excursions (sucks) followed by a deep draw (chin drops and mouth pauses in an open position) then the sound of a swallow may be heard (a quick, gentle “cah” sound). Swallowing may also be felt by resting a finger gently on baby’s throat while he is feeding. Remember, a good attachment to the breast is important. There should be a wide gape of baby’s mouth around your breast. His lips should be flanged outward with a good seal between your breast tissue and his lips. No air spaces should be seen and milk should not run out from the corners of his mouth. So listen and count those “cah’s.” They eventually turn into coo’s! Relax and enjoy your baby’s feeding!

Tick, Toc, Tick, Toc: Must we always watch the clock?

We talk about how human infants should feed every two to three hours in the early weeks and months, and certainly that is true. However, once effective breastfeeding is well-established and baby is gaining weight nicely without intervention, it may be time to kick back and relax. What’s wrong with letting baby dictate how often he wants to eat as long as he is thriving? A baby who begins to get hungry will exhibit early hunger “cues.” Examples of early hunger cues include upper body movement, hand-to-mouth behaviors, rapid eye movement during sleep, etc. Late signs of hunger include fussing and crying. So, sit back, put your feet up and let your baby do the talking. Tick, Toc, Tick, Toc…perhaps we shouldn’t watch the clock!

The Value of Skin-to-Skin Contact

Did you know that placing your baby skin-to-skin on your chest, especially while you are resting, is more than just a sweet snuggle time? Skin-to-skin positioning (also known as kangaroo care) not only facilitates milk production and the release of the maternal hormone oxytocin (the mothering hormone), but also has an effect on your baby’s physiology. Holding your baby skin-to-skin (no fabric between you) actually regulates his body temperature, respirations and heart rate. Research in this area is absolutely fascinating! For example, a mother’s breast temperature actually rises in order to warm and lowers in order to cool her baby when he has direct skin-to-skin contact with his mother. His breathing becomes relaxed, and his heart rate becomes regular. Talk about a mother’s ability to provide for her baby! Here’s another fascinating example: in two separate case studies, pre-term twins were placed simultaneously skin-to-skin with their mother, each against one of her breasts. Remarkably, each breast (in all four cases) responded individually to the thermal needs of the infant on that particular breast by raising and lowering its temperature independently of the other. So, let’s not underestimate the power of our breasts. Food, warmth and security… all in a soft, beautiful package! What more could our babies want?

Night Time Feedings

New mothers usually want to know if they should wake their baby for night time feedings. The answer is dependent upon several things. First of all, if your baby is under two weeks of age, you will want to remove milk from your breasts every two to three hours. This will assist in establishing a good milk supply and keep you comfortable. Most full-term babies wake to feed at this frequency anyway, so it works out well for both. Babies who were born a little earlier than expected, may need to be aroused for their feedings in order to gain weight. A two- to three-hour interval works well. Once your baby is nursing effectively, stooling and voiding within normal limits, and gaining weight, it’s acceptable to allow for longer intervals between feedings, especially at night. So, if your breasts can tolerate a wee bit of fullness, I say go for it, and let baby sleep. Enjoy your ZZZ’s.

Fussing and Crying

Recently, I attended a professional conference addressing gastro-esophageal reflux in infants. I must say that the discussion brought back the passion (and empathy) I feel for the issue of excessive fussing and crying in infants. During the late 1990’s and early 2000’s, I was privileged to work with Dr Anthony Kulczycki of The Washington University School of Medicine, Division of Allergy and Immunology. Together, we explored the role of a certain cow milk protein in the incidence of infantile colic. We studied breast-fed and formula-fed infants alike. I became fairly skilled at assessing and managing excessive fussing and crying in the breast-fed infant.

I bring this topic to the table, because when a breastfeeding baby is ‘colicky,’ the practice of continued breastfeeding is placed at great risk. Most mothers jump to the conclusion that their baby is either hungry or ‘allergic’ to something they are eating. Some mothers discontinue their efforts to breastfeed in favor of formula feeding, which usually doesn’t help. In fact, formula feeding may worsen the symptoms. Other mothers starve themselves in an effort to avoid every food that has ever been implicated in producing gas or fussiness in babies. This usually doesn’t work either.

A baby’s excessive and sustained fussing and crying cannot be taken lightly. This can cause serious upheaval in any household. Breastfeeding may not seem to work. Parents are exhausted. Babies are at risk of being shaken (yes, even the best of parents can snap under these conditions). And, a mother’s gift for nurturing and protecting her baby is crushed by feelings of worthlessness and frustration.

If you have a baby that is fussing and crying to the point of concern, please don’t try to treat this yourself. Get help. Pick up the phone and call us. Here at MoBap, our team of lactation specialists is fully equipped to assist you in a systematic evaluation of the situation. We are genuinely happy to help, and you can always call me on the phone for another opinion! Whatever you do…don’t stop breastfeeding without first seeking help!!!

One-Breast vs Two-Breast Feedings

I am often asked whether one breast or two breasts should be offered per feeding. This is a tricky question, and every mother/infant couplet should be considered individually. However, in the first couple of weeks after birth, a mother’s breasts may be somewhat engorged (normal fullness) as they begin to regulate milk production. Offering both breasts per feeding allows each breast some relief of pressure, and therefore comfort for mother. Later, after the initial couple of weeks, one-breast feedings may serve to balance the intake of fore-milk and hind-milk (a discussion all in its own).

Indicators of Adequate Infant Intake

New mothers often wonder how they can tell if their baby is getting enough milk. Fortunately there are several indicators that can be used to determine the adequacy of baby’s milk intake.

First and foremost is weight gain. Most babies lose some weight in the days following birth. However, once a mother’s transitional milk comes in, her baby should begin to gain. By two weeks of age, she should expect to see a return to birth weight. Breastfed infants typically gain between four and eight ounces per week thereafter.

Stool output and urination is another important means of gauging adequate intake. An infant who is receiving adequate amounts of milk (and therefore enough calories for growth) will stool at least three times in every 24-hour period by the time he is five or so days of age. Often the stool is yellow in color and has a pasty or watery consistency. Tiny white seeds or curds may often be seen. Wet diapers are important as well, but are only an indicator of hydration, not caloric intake. So, while at least five wet diapers in every 24-hour period is expected (and certainly encouraging), stool output is the most reassuring indicator of adequate intake by an infant under six weeks of age.

Your Breasts (and you) Need to Arrive Alive!

Please don’t pump and drive!!! Yes, we’ve all been warned about texting, talking on the phone, applying make-up, etc. while driving. Well, here’s another one for you!

Now that we have hands-free pumping options, it doesn’t mean we shouldn’t use good sense. Sure, those of us who are in a hurry to get to work would have loved to nurse before we left the house. But, unfortunately no one may have told the baby. Or perhaps you slept through the alarm. At any rate, imagine the look on the police officer’s face when you try to explain that the milk was overflowing the bottle and you let go of the wheel to turn off your breast pump. Or worse yet, that you aren’t drunk. Instead, the release of the hormone relaxin made you feel so relaxed and sleepy that you began swerving from lane to lane! Your breasts (and you) need to arrive alive.For your safety and the safety of others on the road, please don’t pump and drive! Pumping really can wait a few minutes until you reach your destination! :-)

Inverted Nipples

Today, an expectant mother asked me what she could do to prepare her breasts for breastfeeding. This is a common question, so I thought I might address it here with our group.

The most important thing a mother can do is to check to be sure she doesn’t have inverted nipples. Inverted nipples are those that retract (telescope in to the breast tissue) when the areola (brown area behind the nipple) is gently pinched together. The condition makes it difficult for a baby to latch correctly. If identified during pregnancy, treatment can be very effective in reducing the degree of retraction and facilitating an early attachment of infant to breast. So, if a mother thinks her nipples might be inverted, she can ask her doctor to check or call our lactation office for a recommendation.

Breasts: Small Versus Large

Breasts come in all shapes and sizes. Many women are led to believe that the size of one’s breasts will determine their ability to produce milk. Not true. Most of us are blessed with an ample amount of mammary (glandular) tissue that is responsible for making milk. Our mammary glands make up only a portion of our breast tissue. The rest is adipose (fat) tissue and is the greatest contributor to breast size. Women with large breasts will not necessarily make any more milk than those with small breasts. So, don’t let your breast size be your guide. Remember, breasts may be small…but they will be mighty!!!

Getting Started: The First Few Days

In many cases, the first few days of breastfeeding a newborn are quite different from what most of us have read or learned about breastfeeding. For example, we are told that a full-term baby will want to nurse about every two to three hours in the first few weeks. This is true. However, the first few days may throw us for a loop! Day one:Baby is often sleepy and may not awaken easily for feedings. This can be related to his tummy being filled with amniotic fluid (especially if born by cesarean) or by the store of fluids and nutrients transferred to baby in the days and hours just before birth. Day two:Baby is more awake and alert. His store of nutrients may now be depleting, and now he wants to nurse every hour! These are called “cluster feedings” and are baby’s way of letting mom’s breasts know that he will soon be ready for larger volumes. These frequent feedings not only help mom’s uterus to stay nicely contracted, but also allow baby to practice suckling before the voluminous transitional milk comes in. Days three to five: Mom’s transitional milk is coming in. Her breasts may change (blood and milk engorgement) and baby must re-learn how to latch to these “new” breasts. He must refine the way he suckles in order to handle the increased flow of milk. It is usually at this point that feedings begin to occur more consistently at two- to three-hour intervals. After the first few days, things begin to settle into more of a routine. Still there will be many more changes to adapt to. Life with a new baby can be challenging, yet wonderful. Just remember to eat, drink and sleep when baby sleeps, and let everything else go to pot!

I Think I Can, I Think I Can

Have you ever read the children’s book about the little engine that could? It is an inspiring story about the value of positive thinking and self-empowerment. When we are expecting our first baby, many of us feel worried about breastfeeding. This is completely normal, especially if we are going to be working mothers. In our culture of communication technology and information overload, expectant mothers often hear only about problems associated with breastfeeding. Unfortunately, that’s what people talk and write about. They may not hear the scores of wonderful, successful breastfeeding stories (yes, even for working mothers)! In most cases, especially when there are expert clinical resources, women and their babies do quite well with breastfeeding. One thing to remember is that, as women, our bodies are built for growing, birthing and breastfeeding babies. So let’s not forget that! Yes, indeed, I think you can, I think YOU can!

Hospital Breastfeeding Practices

April 2010, The Joint Commission (an organization that accredits more than 17,000 top notch hospitals and health care facilities in the United States) established a new set of evidence-based core measures for quality in perinatal care. Included in these core measures is a requirement that hospitals strive to increase exclusive breast milk feeding of infants from birth to discharge. This means that in order to be accredited, hospitals will have to be more cautious about their use of formula in breastfeeding babies. Here at MoBap, we take breastfeeding very seriously (and yes, we are accredited by The Joint Commission).

If any breastfeeding baby may need supplementation, their mothers are encouraged to pump or hand-express their own milk for use as a supplement. We have state-of-the-art, hospital-grade breast pumps for use by any mother that may need one while she is here. Our goal is that every breastfeeding infant receives as much of his own mother’s milk as possible before anything else is given. A Lactation Consultant visits every breastfeeding mother everyday that she is here, providing support and encouragement and addressing any questions or concerns that these mothers may have. We are very proud of our more than 85 percent breastfeeding rate and will continue to provide the very best for our breastfeeding families. We believe The Joint Commission will be quite pleased with our breastfeeding practices and other core measures of quality in perinatal care!

Health Care Reform

As we all know, Health Care Reform is under way. Regardless of how we feel about it in general, there are some specifics that you, as breastfeeding mothers and advocates, might be interested in discussing. President Obama’s signing of the Patient Protection and Affordable Care Act (also known as Health Care Reform) will positively impact those of us who are employed and breastfeeding. The Act states that employers must provide “reasonable break time” and a private place (not a bathroom) for employees to express breast milk for their children up to one year of age. This is great news! The law became effective immediately upon signing, and the Department of Labor is working quickly to establish rules for enforcement. Unfortunately, employers are not required to pay employees for the time spent expressing milk. Nor are employers with fewer than 50 employees required to provide breaks for this purpose if it would cause “undue hardship” for their business. Nevertheless, this gives us legal rights with regards to breastfeeding and returning to work. So, ladies, let’s gear up (great pumps are available for working moms) and discuss options with our employers!

Economic Benefits of Breastfeeding

Breastfeeding is in the news again! A new study published this week in the journal, Pediatrics, deserves some discussion. Researchers from the Cambridge Health Alliance and Harvard Medical School did a pediatric cost analysis comparing current costs to projected costs if families were able to exclusively breastfeed their babies for at least six months. They found that if 90 percent of U.S. families complied with the medical recommendations to breastfeed exclusively for six months, the U.S.would save $13 billion per year and prevent more than 911 deaths (mostly infants). This comes as no surprise to those of us in breastfeeding circles. We’ve known the economic benefits of breastfeeding for a long time as similar studies have indicated in the past. Still, we are thrilled to see public acknowledgment of such magnitude. The authors of this new study conclude that current U.S. breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. So, ladies and gents, let’s keep up the good work in providing the very best for our babies (and pocket books)!

Baby Slings

In the news, throughout the last few days, there has been a lot of discussion about the safety of infant carrier slings. Since many breastfeeding mothers choose to wear their babies, I thought this might be a good topic of discussion.

Baby wearing is customary in many cultures around the world. Wraps, ties, slings and front packs are just a few examples of baby-wearing attire. These allow for comfortable, hands-free infant or baby carrying. Carriers are often worn therapeutically as well. I wore my colicky (refluxing) baby upright for the first three months of her life. It was the only way I could keep her comfortable and get anything done around the house! 

So, wraps and slings may be helpful, but are they safe? The key to safety is proper positioning. Very young infants and those born days or weeks earlier than their due date, are at a significantly greater risk of suffocation when their bodies are slumped over excessively, with their chins pressed against their chests. The issue here is airway constriction. This can occur in car seats as well as infant carriers. That’s why our pre-term babies receive car seat checks before they are discharged. 

Regardless of carrier type, an infant should have freedom to extend his neck and head. Bag-like slings do not allow for easy head extension. Upright carriers can be both easy and safe, but often need to be removed for breastfeeding. Oblong fabric wraps are designed for multiple positions, allowing most babies to ride safely (when positioned properly) and are great for discrete breastfeeding in public. Babies have been worn for thousands of years. It would be unfortunate if parents altogether stopped wearing their babies. So let’s learn to do it safely! I am thankful that the government and media have called attention to this problem. In fact, KMOV-TV did an interview with one of our pediatricians, Dr. Kelly Ross, who happens to be a good friend. In the interview, she explains more about the issue. Here’s the link if you are interested.