T oday - La Leche League International

[08] 

Mothers’ Stories 

[08] Motherly LLLove 

[09] Answering 

Questions 

[12] Breastfeeding 

An Ailing Child 

[22] 

New Insights on 

Nipple Shields 

[25] 

Celebrating 

The New Baby 

T 

oday 

[14] Lovely, Comfortable and 

Right 

![16, 28] 

LLL News 

[18] 

Uplift of 

Our Series Meetings 

[26] 

Breastfeeding 

In The News 

[28] 

Donors Making 

A Difference 

[19] 

What’s Cooking 

Vegan 

[21] 

Your Letters

Issue 6 | 2011 | Volume 6 | Number 6 © 2011, 

La Leche League International, Inc. 

Managing Editor | Barbara Higham 

Contributing Editors | Kathy Abbott, Johanna 

Horton, Barbara Mullins, Lesley Robinson 

Review Board | Barbara Emanuel, Gwen Gotsch, 

Carol Kolar, Kathleen Whitfield 

Art Director | Ronnelito Larracas 

Cover Photo | shutterstock.com 

Advertising Manager | ReNata Bauder 

Web Development | Dave Davis, Shelly Stanley 

Acceptance of paid advertisements does not 

constitute an LLLI endorsement of the product 

advertised. LLLI does not require advertisers 

to carry product liability insurance. 

Mailing Lists: 

LLLI sometimes makes its mailing list of members 

available to reputable outside groups. If you prefer 

not to receive these mailings, notify LLLI. 

La Leche League International fully supports 

the WHO (World Health Organization) International 

Code of Marketing of Breastmilk Substitutes. 

LLLI Board of Directors, (2009, 2010) 

Skin to Skin 

When my first baby was born he failed to breathe straightaway and was rushed 

away from me to a neonatal intensive care unit so that we were apart for the first 

few hours of his life. When we were reunited, my baby was already dressed and 

when I first attempted to put him to my breast there was very little in the way of 

direct contact between us because we were both fully clothed. Perhaps this, as 

well as a difficult birth, partly accounts for the difficulties we encountered with 

breastfeeding. Felix fought the breast and it was weeks before he eventually got 

the hang of nursing well. In the lead article, Jill Bergman examines the importance 

of skin-to-skin contact between a newborn baby and his mother and how this 

simple practice can often avoid the stress of separation and promote physical 

and emotional health, as well as facilitating breastfeeding. 

Naomi Stadlen’s article illustrates how La Leche League Series Meetings give 

breastfeeding mothers a safe place to acknowledge their difficulties and how this 

mother-to-mother sharing can really raise our spirits, regardless of whether we 

find solutions to the questions we brought to the meeting. 

In this spring issue, Gina Kruml examines how we might celebrate the arrival of a 

new baby and Nancy Mohrbacher shares new insights on nipple shields. 

We take a look at what exciting things are happening in LLL globally and four 

mothers share their breastfeeding stories and tell about the support they found 

from other mothers through LLL. 

“What’s Cooking” takes a look at vegan cookery and gives us three easy recipes 

that make up a healthy, green and delicious meal. 

Mothers sharing their experiences to help one another is LLL’s particular 

strength. Please help us to spread this support around the world through 

Breastfeeding Today by writing to editorbt@llli.org 

Breastfeeding Today is published by La Leche League 

International Inc., 957 N. Plum Grove Road, Schaumburg, IL. 

60173 USA. Telephone 847-519-7730 

(9 AM to 5 PM Central Time). Visit our Web site at llli.org. 

Canadian subscribers should contact LLL Canada at 

PO Box 700, Winchester, ON K0C 2K0, Canada, or 

go to www.lalecheleaguecanada.ca with any questions about 

subscriptions. 

Barbara Higham | editorbt@llli.org 

Barbara is a La Leche League Leader, managing editor of Breastfeeding Today and co-editor 

of LLLGB’s Breastfeeding Matters. She lives in the spa town of Ilkley, West Yorkshire in the 

north of England with Simon and their children, Felix (12), Edgar (9) and Amelia (5).

Jill Bergman 

004 

The importance of skin-to-skin 

contact for every newborn 

Modern childbirth has become a medical condition requiring 

delivery in a hospital with doctors and nurses in attendance. 

Our neonatal mortality rate has decreased in the last 200 

years, which is a wonderful thing. However, recent studies of 

neuroscience of the newborn have shown that our modern 

care may well be at some cost to the baby’s brain. What we 

now know is that newborn brain development is dependent 

on mother’s presence! 

Inside mother the fetus is held warm and safe, loved and 

protected by mother’s body. Sounds are muffled, and mom’s 

familiar heartbeat and voice reassure the baby. His heart rate 

and oxygen saturation are optimal. The moment of birth then 

is a huge transition, but his development has prepared him 

for this change. After the actual birth he is able to regulate 

his systems because ideally he is held in the safe place that 

mother’s chest provides. 

However, our modern care often takes the newborn into the 

world of lights that are too bright for his sensitive eyes, loud 

sounds that he cannot block out, and strange new smells. 

Often a newborn is taken and weighed on a cold scale, 

or bathed or routinely suctioned. But worst of all for his 

adapting brain is that he is taken away from his mother, his 

SAFE place. Separation from mother is highly stressful, and 

is enough to make a baby physiologically unstable. He feels 

unsafe, his brain sends “danger” signals to the body. His 

brain releases the stress hormone cortisol, which increases 

the heart rate and breathing in a basic “fight or flight” 

reaction. Somatostatin is also released and acts in the gut to 

decrease absorption of food and thus inhibit growth. These 

stress hormones will continue to affect the baby while he is 

separated from mom. When returned to his mother, the stress 

hormones still take 30 minutes or even an hour to wash out 

of his system. 

Stephanie Wernbo and baby Alex courtesy of Sacha Blackburne 

The separated baby will protest and cry to call for mom. His 

arms and legs will wave or jerk to get his mother to come 

back. The crying can also open the foramen ovale, a flap 

between the two sides of the heart, thus restoring fetal 

T 


• Issue 6 • 2011 | llli.org

Jill Bergman 

005 

Skin-to-skin 

contact will help 

the baby maintain 

a steady body 

temperature. If the 

baby is cold, the 

mother’s chest will 

heat up to warm her 

baby, or to cool him 

if he is too hot. 

circulation, which now pumps deoxygenated 

blood to the brain. This crying increases the 

heart rate and blood pressure in the baby’s brain, 

which can damage the tiny capillaries, maybe 

even causing an intraventricular hemorrhage 

(IVH). 

All of this intense protest activity uses up vital 

calories that should be used for growth. If the 

baby’s protest signals are not heeded, the baby 

may go into an energy-conserving defense 

mode, which lowers heart rate and temperature 

for prolonged survival. This state of “freeze” 

may look like the baby is asleep, but recent 

neuroscience research has shown that the baby 

may be firing pathways in the brain that in later 

life tend to increase anxiety. A final stage of 

defense is called “dissociation” in which the 

baby essentially “tunes out.” This whole process 

reinforces emotional pathways in the baby’s 

brain, laying down wiring adapted to cope with 

“a dangerous world, where nobody loves me.” 

Too much time spent in this state of distress, 

away from mother, can have lasting emotional 

effects. Adult mental health is based on infant 

mental health, and we know that caring for 

infant mental health starts early, even in the first 

hour after birth. This capacity of the newborn 

is new knowledge. Many babies cope fine away 

from their mother, but for the more sensitive we 

want to avoid the stress of separation in future. 

Obviously not all separated babies will have 

problems as adults, but all experience separation 

as stress. 

In summary, separation of the newborn baby 

from the mother is the primary cause of newborn 

stress. This can show itself in increased heart 

rate, blood pressure and decreased oxygen 

saturation in the blood. These physiological 

effects of separation can lead to a cascade of 

problems and complications requiring more 

intervention from the neonatal health system. 

Most of this could be avoided by the mindblowingly 

simple practice of putting every 

newborn baby naked onto mom’s bare chest, 

drying him and covering both of them. All of the 

necessary newborn observations and tests can 

be done while leaving the baby in his SAFE place. 

This alternative to separation-stress is called 

“skin-to-skin contact.” 

So what are the positive effects of skinto-skin 

contact 

Skin-to-skin contact will help the baby maintain 

a steady body temperature. If the baby is cold, 

the mother’s chest will heat up to warm her baby, 

or to cool him if he is too hot. The autonomic 

nervous systems (ANS) of the mother and baby 

coordinate to establish healthy and stable set 

points of blood pressure, temperature, heart 

rate and glucose. This allows the baby to “selfregulate” 

better when stressful events rock his 

equilibrium. But until the baby has established 

those set points he needs the “buffering 

protection of adult support.” In the absence 

of this support, metabolic set points may not 

be properly established and this can increase 

problems of hypertension, obesity and diabetes 

in later life. 

Many of you will be familiar with the “selfattachment” 

behavior of the newborn on 

mother’s chest in the first hour of life. The baby’s 

small movements on the mother’s chest in moving 

his way to the nipple and touching it stimulates 

a wonderful interaction of hormones in both 

mother and baby’s brain and body as follows. 

The baby stimulates the mother’s breast 

and areola, and the mother’s ANS tells her 

hypothalamus and pituitary to release the 

hormone prolactin which causes the breast 

to start milk production. Note that it is the 

behavior of the baby which ensures that milk will 

be produced by the breast; the baby is in effect 

making his next meal! Prolactin is released in the 

baby as well, which stimulates oligodendrocite 

cells, which make the myelin that will coat the 

nerves and speed up the sending of messages in 

the brain,. The release of prolactin in the baby 

also stimulates production of surfactant, which 

helps the newborn baby’s lungs to breathe better. 

llli.org | 2011 • Issue 6 • 

T 

oday

Jill Bergman 

006 

Skin-to-skin contact at birth 

for stabilization of EVERY 

newborn is a simple yet profound 

intervention, which increases the 

physical, mental, emotional and social 

stability and well-being of the baby. 

Oxytocin is well-known as the “love 

hormone” and also for its action in 

the Milk Ejection Reflex. However 

it is also a neurotransmitter in the 

brain, and is released primarily in 

response to skin-to-skin contact. 

In the mother’s brain the oxytocin 

suppresses the cingulate gyrus, 

which is the fear centre of the 

brain, thus making the mother 

fearless to protect her baby. 

Oxytocin release in the baby 

stimulates the brain pathways for 

approach, and the baby opens his 

eyes and gazes at mother. This is 

the beginning of the vital first bond 

that is the foundation of all other 

relationships. 

The baby suckling also stimulates 

the release of cholecystokinin in the 

mother, which acts on the amygdala 

to produce a sense of contentment 

and well-being. In the baby this 

same hormone not only produces 

a sense of calm, it also aids selfregulation 

of digestion. 

These three powerful hormones 

have thus worked in both mother 

and baby to wire neural circuits 

for a well-bonded, well-regulated 

mother-infant pair. The basic 

biological needs for warmth, 

nutrition and protection are thus 

provided from the very beginning. 

This early bonding fires security in 

the baby and instinctive protection 

behavior in the mother, and sets 

the mother-baby pair on a course 

of healthy development and secure 

relationships. 

Skin-to-skin contact at birth for 

stabilization of EVERY newborn is a 

simple yet profound intervention, 

which increases the physical, 

mental, emotional and social 

stability and well-being of the 

baby. This is every baby’s right. 

The number of hours of skin-toskin 

contact a baby receives in the 

first day of life has been shown to 

enhance his mother’s sensitivity 

to his cognitive development and 

emotional security even a year later. 

This also predicts the attachment 

relationship and social intelligence. 

Obviously if that early contact has 

been missed it can be made up 

later. 

These are just a few reasons for 

adjusting and modifying our health 

care practices to give every baby 

the best start. All of the above are 

valid benefits for EVERY newborn 

baby. For a fragile and sensitive 

preterm baby, skin-to-skin contact 

at birth is even more important for 

stabilization and minimizing stress. 

If technology needs to be added, it 

should be done on mother’s chest, 

the baby’s SAFE place. 

Summary of benefits 

of skin-to-skin 

contact for baby 

Physical: heart rate, breathing 

and temperature are better. 

Emotional: feels safe so less 

stress and crying. 

Mental: better sleep and brain 

wiring for development. 

Breastfeeding: gains 

weight, home sooner. 

For Parents: 

less stress, better bonding. 

Resources 

Amodio DM, Master SL, Yee 

CM, Taylor SE. Neurocognitive 

components of the behavioral 

inhibition and activation systems: 

Implications for theories of selfregulation. 

Psychophysiology 

2008;45:11-1. 

Schore AN. The effects of early 

relational trauma on right brain 

development, affect regulation, 

and infant mental health. Infant 

Mental Health Journal 2001;22(1- 

2):201-69. 

Carter CS, Altemus M, Chrousos 

GP. Neuroendocrine and emotional 

changes in the post-partum period. 

In: Russell JA, Douglas AJ, Windle RJ, 

Ingram CD, editors. The Maternal 

Brain. 133:241-9. ed. 2001. 

241-9. 

Ross HE, Young LJ. Oxytocin and 

the neural mechanisms regulating 

social cognition and affiliative 

behavior. Front Neuroendocrinol 

2009 Oct;30(4):534-47. 

Bigelow AE, Littlejohn M, Bergman 

N, McDonald C. The relation 

between early mother-infant skinto-skin 

contact and later maternal 

sensitivity in South African mothers 

of low birth weight infants. Infant 

Mental Health Journal 2010 

May;31(3):358-77. 

More details on the neuroscience 

of newborns can be found in Hold 

Your Premie. A workbook on skin- toskin 

contact for parents of premature 

babies and in the DVD “Hold 

your Prem” available from www. 

kangaroomothercare.com. 

You can also read more about 

research on skin-to-skin contact 

on this Web site. 

T 




008 

LLL is about women 

supporting women 

through all aspects 

of motherhood. 

Photo Anna and Trena courtesy of Trena Prewitt 

Motherly 

LLLove 

Trena Prewitt, Florissant, Missouri, USA 

Trena went to her first La Leche League 

meeting when she was expecting her first 

baby … 

When I first found out I was pregnant, I knew 

I wanted to breastfeed. I had no idea if I was 

breastfed and found out that I wasn’t. I didn’t 

know of anyone in my family who breastfed 

and had only two friends who had tried it. 

For some reason, I knew it was important 

and that I was going to do it. A wise friend, 

20 years my senior, advised me to attend a 

La Leche League meeting before my baby’s 

arrival. Each month came and went without 

my getting around to it. Two weeks before 

my daughter was due, my husband’s friend’s 

mother called and told him that it would be a 

good idea for me to attend her LLL meeting. 

It turned out she was a Leader at the local 

group. So, with my husband’s support, I 

finally went to a meeting. I must say, walking 

in that door was one of the best parenting 

decisions I have ever made. 

Instantly I was in a group of women who 

shared the same goal as I did. Each month I 

attended a meeting was another month that I 

was a nursing mother. It became a celebration 

to be able to walk in the door because I knew 

that I was still providing my daughter with the 

best milk in the world. 

In the beginning, I asked many questions and 

seemed always to have a new situation arising 

with regard to breastfeeding my daughter. 

But as each month went by, my hand stopped 

rising to ask a question. Instead, I sat 

back and listened as new moms asked the 

questions I once had. And now, I was able 

to help. Giving back and being able to help 

a new mother has been such a rewarding 

experience. 

With motherhood came a change in my social 

life. I no longer had the energy to go out 

with my old group of girl friends because 

their nights started so late. It was hard to 

get together on the weekends because I 

really wanted that time with my husband 

and daughter. I would have felt isolated as 

a new mother had I not been attending 

the meetings. I knew that at least once a 

month, sometimes twice if I attended an Enrichment 

Meeting, I had my girl time. Even though it consisted 

of sitting at the local children’s resale shop talking 

about engorgement, breast pumps and low milk 

supply, it was my time. 

One mother in particular, Anna, taught me what 

LLL was really about. LLL is not just about women 

supporting women with breastfeeding issues. LLL 

is about women supporting women through all 

aspects of motherhood. With my first daughter, Anna 

answered breastfeeding questions that I had during 

the first few weeks. At one point, she asked how 

everything else was going for us. I mentioned that 

my daughter was up all night and hard to calm. Anna 

recommended a good book from the LLL library and 

even dropped off her copy so I could read it. That 

really helped. With the arrival of my second daughter, 

Anna was there once again. She showed up at my 

door with muffins, two dinners, dessert and a fresh 

loaf of bread. The food was much appreciated. Anna 

and a few other mothers, whom I got to know very 

well by attending meeting after meeting, really made 

the arrival of my second daughter special. They did 

more for me as a new mother than anyone else. LLL 

mothers know that each child is special. 

These caring mothers are exactly what LLL is all 

about. I am so thankful for their friendship over 

these last two years. I only hope that I can return the 

favor to a new mom some day. 

T 




009 

Answering 

Questions 

Anuja Kotari, Mumbai, India 

Anuja found her family had 

a lot of questions about 

breastfeeding when her baby 

was born and finding La Leche 

League helped her to answer 

them … 

When I was expecting my baby, 

Ansh, the only thing that worried 

me was my forthcoming labor. 

Breastfeeding was something 

I had taken for granted and I 

believed that every mother could 

do it—why worry about it But 

suddenly, one day, you become a 

mother and are supposed to take 

care of this fragile little one who is 

totally dependent on you. This can 

really be very scary when you have 

absolutely no experience. 

LLL has very good 

information on how 

to check whether your 

baby is gaining weight 

appropriately and my local 

Leader has always been 

generous with her time 

to help guide me through 

this information. 

The initial days in hospital gave me 

a taste of how our breastfeeding 

journey would be, when I heard the 

following question and comments 

from my near ones, “Is he getting 

enough milk” “Give him more. I 

think he is not done yet.” 

Yasmin, my local La Leche League 

Leader, whom I have been in touch 

with for over a year now, gave me 

the confidence that breastmilk and 

only breastmilk was required by my 

baby for his first six months. We 

live in an extended family so you 

can imagine how it is listening to 

12 different opinions each day! 

This can really get frustrating at 

times when I don’t have answers. 

It was a little difficult to convince 

the different members of my 

family initially but, as the months 

passed, they saw the results of 

my breastfeeding, when Ansh was 

gaining weight appropriately. 

Photo of Anuja Kotari and Ansh courtesy of A. Kotari 

LLL has very good information on 

how to check whether your baby is 

gaining weight appropriately and 

my local Leader has always been 

generous with her time to help 

guide me through this information. 

Yasmin also suggested reading The 

Womanly Art of Breastfeeding, which 

is a must have for all new moms. It 

answers so many queries not only 

regarding breastfeeding but those 

many other small queries that can 

disturb you when caring for your 

little one. 

When Ansh was about two months 

old, he went on a nursing strike. 

He just would not drink and 

would start crying loudly when I 

put him to my breast. Talking to 

Yasmin put me at ease as she was 

so supportive and gave me lots 

of helpful information. She was 

empathic and encouraged me to 

be patient, saying this would pass. 

His fussiness lasted for about two 

weeks but it did pass. 


T 



010 

Myths about breastfeeding abound. When Ansh turned six months, I 

was bombarded with questions such as, “Is your milk enough for him” 

I am so happy to have found reliable information from LLL that guided 

me through starting solids while continuing to breastfeed. I know so 

much about breastfeeding now, yet hunger to know more. 

Now Ansh is over 12 months old and the question I’m most often 

asked is, “How long do you think you will continue breastfeeding, now 

he doesn’t need it” Well, who are they to decide whether he needs it 

or not I think I need to breastfeed my baby as much as Ansh needs 

to breastfeed. It is so calming for us both. I wonder how life will be 

without breastfeeding him. For my baby and me breastfeeding has been 

so special. 

Increasing your Milk Supply outlines the process of milk 

production and what a new mother can expect as her body adjusts. 

Also addresses how to measure intake, factors that contribute to a low 

milk supply, and more. 

http://store.llli.org/public/profile/418 

About Weaning: Because Breastfeeding Is More Than Milk 

LLLI 2010 Addresses the common questions parents have from the 

first introduction of food other than breast milk, all the way through to 

the end of nursing, taking into account individual family’s needs. 


Introducing Complementary Foods to Your Breastfed Baby 

LLLI 2008 New information sheet provides an overview of when and 

how to start feeding baby complementary foods, and examples of ideal 

solids with which to begin. Pad of 50 tear-off sheets. http://store.llli. 

org/public/profile/326 

T 




012 

Breastfeeding 

An Ailing Child 

since she was two weeks old) and 

although her pressures are checked 

every six months they are not 

as high as SWS patients usually 

suffer. I attribute all of this to the 

prolonged breastfeeding. 

Photo of Tinee Luparelli and Gianna courtesy of Sacha Blackburne 

Tinee Luparelli, Bermuda 

Tinee believes that 

breastfeeding her daughter 

gave her the best possible 

start in life. 

Gianna was born with a rare 

congenital neurological and 

skin disorder known as Sturge 

Weber Syndrome (SWS) and 

Nevus of Ota (NoO) (a blue 

hyperpigmentation that presents 

on the face). I had never heard 

of SWS or NoO, but these terms 

quickly became a part of my 

vocabulary. The SWS included 

ailments such as glaucoma (often 

leading to blindness), mental and 

growth retardation and seizures. 

Needless to say I was horrified. 

Although I was considering 

breastfeeding prior to her birth, 

these diagnoses greatly influenced 

my decision to ensure that she got 

the benefits of the antibodies and 

nutrients my milk would provide. 

Our breastfeeding journey started 

with a challenge. The day she 

was born I fed her from my left 

breast and when I went to switch 

her to the right we discovered it 

was engorged and Gianna would 

not latch onto it. The lactation 

consultant advised me to pump 

my milk and feed her from a 

spoon until we were 

able to establish 

a breastfeeding 

relationship several 

days later. I was 

determined to 

breastfeed and I 

never let anyone 

discourage me from 

obtaining that goal. 

The day Gianna 

turned a month 

old she came 

down with a fever and, after a 

spinal tap, was diagnosed with a 

respiratory syncytial virus (RSV) 

and hospitalized in the NICU for 

four days. I never left her side and 

breastfed her; I refused the offer 

for her to have formula, as I felt 

it was essential that she have the 

beneficial antibodies and nutrients 

in my milk. 

We returned to our home in 

Bermuda when she was four 

months old and I had to return to 

work almost immediately. Putting 

her in day care was a concern 

because Gianna would not take 

a bottle. She did not even use 

a pacifier. She only wanted my 

breast. I was fortunate enough 

to find a caregiver who had the 

patience to use a spoon to feed 

her. I also used a sippy cup, which 

she seemed to take to without too 

much difficulty. Another problem 

was that pumping was not easy for 

me—I never took to the pump—I 

had a hospital-grade one, but 

couldn’t relax enough to get more 

than a few ounces at a time, and 

many days I only sent about eight 

ounces to nursery. My pumping 

difficulties were compounded by 

the fact that my office did not 

have a suitable place to pump. 

They suggested the bathroom, but 

I declined as I would not prepare 

my own meals in a bathroom and I 

was not about to prep hers there 

either. Instead I opted to give up 

my lunch break (nibbling a snack 

at my desk instead) so that I could 

leave work earlier. In addition, I 

journeyed home (not far from work) 

on my coffee break (combining two 

15-minute breaks as one) to pump. 

I took fenugreek, which I found 

increased my supply. I left work 

about 3:45 each afternoon to 

collect Gianna from the sitter and 

often breastfed her in the car 

before we left as she was so hungry. 

Gianna seemed to feed almost 

nonstop from the time I picked her 

up until she went to sleep. It was 

exhausting but worth it. 

Initially I had only intended to 

breastfeed for six months, but the 

doctors and I quickly determined 

that it was easier to perform many 

of the required intrusive tests if 

I was breastfeeding her at the 

same time. The neurologist also 

felt that breastfeeding for 18 

months would be beneficial to her 

brain development. Gianna’s SWS 

and NoO require us to travel to 

the Children’s Hospital in Boston 

every six months for her to be 

assessed by a team of doctors, 

which includes a neurologist, 

opthamologist, geneticist, 

dermatologist, gastroenterologist 

and glaucoma specialist. The 

physicians are amazed she does 

not have the typical severity of the 

ailments people with SWS have. 

Her brain functions are normal and 

her development is ahead of the 

curve with no growth or mental 

retardation. She does occasionally 

suffer with petit mal seizures, but 

fortunately has only had two brief 

grand mal seizures in her life. She 

was diagnosed with glaucoma at 

birth (and has been wearing glasses 

When she was 30 months she 

breastfed mainly during the night 

or if she was unwell. We continued 

this routine until she was five years 

and four months old. We stopped 

when she started primary school 

and because I required major 

surgery. Although I myself was not 

breastfed and family and friends 

could not understand my desire to 

do so at all, let alone for so long, I 

made the conscious decision to do 

what I felt was most beneficial for 

my daughter. 

I hope that by sharing our story I 

can inspire and encourage other 

breastfeeding families to persevere, 

for as long as they feel they need 

to do so. 

A Guide to Pumping Your 

Milk LLLI 2009 

Tear-off sheet provides information 

for breastfeeding mothers who find 

themselves in situations in which 

it seems necessary for them to 

pump their milk. Common reasons 

mothers use breast pumps and the 

considerations that might make 

one type of pump preferable over 

another are discussed. http://store. 

llli.org/public/profile/381 

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014 

Lovely, Comfortable and Right! 

Andrea Baughan, Berkshire, UK 

I have three wonderful children 

whom I breastfed. They are aged 

seven, four and two. Joe, the 

youngest, is still breastfeeding. 

I have learned more about 

breastfeeding with each baby. My 

attitude towards breastfeeding 

has changed as my knowledge and 

experience have grown. I wish I 

knew then what I know now! 

With Emily, the eldest, I had 

amazing prenatal support from 

midwives who were very probreastfeeding. 

Even so, some of 

the information they gave me I 

now know was not the best for 

supporting breastfeeding mums. 

At the time I remember thinking 

how odd it was that feeds were 

supposed to be limited to 15 

minutes each side. I did, of course, 

buy a notebook and carefully 

record each feed, the length, the 

side and so on. Thank goodness 

there weren’t iPhone applications 

around then! Obviously if it is 

helpful for some to use technology 

such as spreadsheets or iPhone 

applications for this purpose then 

I am all for it, but for me all this 

record keeping was one more thing 

to worry about. 

I attended a lovely group a few 

times in Bournemouth, where I 

spoke to one of the Leaders who 

suggested I just watch Emily and 

let her feed for as long as she 

wanted rather than timing her. 

This felt more natural and allowing 

Emily to come off in her own time 

started to give me a lot more 

confidence. It also inspired me to 

read more information from La 

Leche League. 

By the time Lola was born, 

I had been reading up and 

learning about feeding on cue 

and was much more confident 

about breastfeeding. I threw my 

notebook away! She went straight 

on to the breast and stayed there 

pretty much for the next two and a 

half years! I was more relaxed and 

probably enjoyed feeding more as I 

was worrying less. 

When I was pregnant with Joe 

I started to train as a peer 

supporter with the local hospital. 

I came across some of researcher 

Dr. Suzanne Colson’s work* and 

it was so inspiring, refreshing and 

helpful—mums looked so much 

happier and relaxed when sitting 

with their babies skin to skin. 

The ideas within her work about 

biological nurturing I found to be 

very useful when supporting mums 

who were worried about feeding or 

who had had a difficult time giving 

birth and whose confidence had 

been shaken, for example, if birth 

had not progressed as anticipated 

or hoped for. 

Joe was born in May 2008 and 

when he was two weeks old we 

were lucky enough to attend a 

conference at which Dr. Suzanne 

Colson was speaking. During her 

fascinating talk, I started off sitting 

upright with Joe held in my arms 

and as I watched her presentation 

I found myself gradually sliding 

down my seat into more of a 

“biological nurturing” position 

and holding Joe against my body 

so that all of his body was in 

contact with mine. It felt lovely, 

comfortable and “right”. 

The value of keeping your baby 

skin-to-skin was not so widely 

advised by health workers when 

I had my first baby and, to be 

honest, I feel guilty sometimes 

that Lola and Joe had more of 

this experience than Emily did. 

After Emily’s birth it took me a 

while to stop listening to friends 

and relatives who meant well 

but who had no experience of 

breastfeeding or a more “attached 

style” of parenting. I carried on 

listening politely but learned ways 

to continue to parent happily and 

to find support and families who 

shared similar ideas. I realized that 

breastfeeding on cue and for as 

long as we both wanted to carry 

on was the choice for me. Emily 

fed until she was about 20 months 

old. 

With all three children, even a 

wriggling toddler if I am lucky, I 

enjoy the warmth and closeness 

of snuggling up and lots of most 

definitely public displays of 

affection. To me this is a wonderful 

Photo © shutterstock.com 

extension and natural progression 

of the biological nurturing 

approach. 

* Ochert, A “Biological Nurturing 

Or Laid Back Breastfeeding” 

Breastfeeding Today issue 5 2010 

http://viewer.zmags.com/publicati 

on/94fb8af9#/94fb8af9/6 

Colson, S An Introduction to 

Biological Nurturing: New Angles on 

Breastfeeding 

Read extracts from the book here 

http://viewer.zmags.com/publicati 

on/94fb8af9#/94fb8af9/8 

T 



016 

LLL Abu Dhabi 

Kirsty Larmour 

When expats come to live in Abu 

Dhabi they’re often not sure what 

to expect. How does this relatively 

conservative Muslim city live with 

the many cultures and people 

within its confines One pressing 

question for moms and moms-tobe 

is how easy and acceptable is 

breastfeeding here 

It’s a huge relief to many mums 

to find that the Koran mentions 

breastfeeding should continue for 

two years. But where are all the 

breastfeeding ladies Are they 

hidden away in the bathrooms 

Are there feeding rooms that you 

can’t find Is there some secret 

code Do the local ladies hide their 

babies under the folds of their 

abayas Well, the answer to the 

last question is sometimes yes! But 

the Abu Dhabi La Leche League 

group set out to show the mothers 

of Abu Dhabi that nursing your 

baby is really okay anywhere and 

everywhere. 

We launched a campaign to 

find willing models—ladies who 

would be prepared to breastfeed 

discreetly in public, out and 

about around Abu Dhabi—and 

the models and their beautiful 

babies of all ages came, and we 

photographed them—in parks, in 

coffee shops, in malls, in hotels, 

inside, outside—all over the city of 

Abu Dhabi. 

The fruit of all this hard work is 

the “La Leche League of Abu Dhabi 

Breastfeeding Awareness Calendar,” 

which will not only help to raise 

funds, but we hope will adorn 

those coffee shop and hotel walls, 

and be seen in doctor’s waiting 

rooms, hospitals, schools, nurseries, 

gyms and cafés to show that these 

places are breastfeeding friendly, 

and to show that as long as you 

are respectful of the conservative 

nature of the city, you can, should 

and are welcome to breastfeed all 

over Abu Dhabi. 

All photography for the project 

was done by Kirsty Larmour (www. 

kirstylarmour.com) who has been 

lucky enough to receive wonderful 

support from LLL in Hong Kong 

and Guangzhou, China, as well 

as Abu Dhabi, when nursing her 

own two daughters. More photos 

can be seen on her blog at www. 

kirstylarmourblog.com 

T 



A look at what is happening 

in LLL around the world 

LLL Belgique, association 

d’accompagnement à l’allaitement 

017 

LLL USA 

The Surgeon General’s Call to Action to 

Support Breastfeeding 

www.lllbelgique.org 

Christina De Schepper 

French-speakers around the world might like 

to know about LLL Belgium’s new brochure that 

they can download from the Web site, entitled 

“Allaitement maternel, chacun son chemin!” 

which loosely translates as “Breastfeeding, to 

each his own path!” Mothers and health care 

professionals are very enthusiastic about it, as it 

is concise while offering quite an array of basic 

useful breastfeeding information in a respectful 

way that empowers the mother to make informed 

choices. 

You can find it 

here: http://www. 

lllbelgique.org/pdf/ 

LLL003-10brochure_ 

pdfversion.pdf 

Rejoignez-nous sur Facebook! 

www.facebook.com/group.phpv=app_237307 

2738&ref=nf&gid=336043462215#!/group.ph 

pv=wall&ref=nf&gid=336043462215 

L LLGB 

http://www.lllgbbooks.co.uk/product/446/ 

Pack-of-8-Postcards/default.aspx 

Beautiful mother and baby postcards available 

now for sale from LLLGB. FREE postage and 

packing worldwide. Selling at £2.50 for eight 

cards, with four of each design per pack.  The 

designs are the front cover of The Womanly 

Art of Breastfeeding 8th edition 2010 LLLI 

Pinter & Martin, featuring Bronwyn Millar and 

daughter Ruby, and a cover painting ©Cassie 

Pearson age 13 of LLLGB’s bi-monthly magazine, 

Breastfeeding Matters. 

The Surgeon General’s Call to Action to Support 

Breastfeeding outlines steps that can be taken to 

remove some of the obstacles faced by women 

who want to breastfeed their babies. 

LLL Canada 

This is the 30 second PSA spot we produced 

featuring Sitara Hewitt from Little Mosque on 

the Prarie for the La Leche League Canada 

campaign “Because breastfeeding isn’t always 

easy, we’re here to help” 

L LLI 

Ever heard of a little thing called Facebook 

We’re so on it. And you can “like” us there. 

Note that every 

photo illustration is a real-life image taken and 

submitted by families for a photo contest. No 

studio set-ups! 

We tweet – lots. 

Follow us now! 

See also a new 

magnet with 

breastmilk 

conservation 

guidelines: 

http://www.lllbelgique. 

org/livres-allaitementparentalite.php 


T 


Naomi Stadlen 

018 

Uplift of Our Series Meetings 

Naomi Stadlen, London, UK 

Mothers often write to say how 

they feel at their first La Leche 

League Series Meeting, that they 

have “come home.” I am moved 

every time I read one of these 

accounts. My own experience was 

different. It was over 20 years 

ago now. The meeting was quite 

near my home, but I arrived late. 

I squeezed into a space near 

the back and tried to follow the 

discussion. 

It’s important 

to have a place 

where one can 

speak honestly. 

Series Meetings 

give breastfeeding 

mothers a safe place 

to acknowledge 

difficulties. 

I had loved breastfeeding, and it 

seemed to me that everyone was 

complaining how difficult it was. 

The Leader was doing her best 

to offer solutions to some of the 

problems that mothers raised. But 

every time she made a suggestion, 

mothers would raise even more 

problems. I think that, because I 

had missed the beginning of the 

meeting, I wasn’t in tune with its 

flow. 

Also I was the only mother there 

without a baby. My children were 

all at school. I had already trained 

with the National Childbirth Trust 

as a breastfeeding counselor. 

However, I learned about La Leche 

League from Jean Waldman, who 

lived locally. During the 1970s, 

she was one of the mothers 

who started LLLGB. I met her 

in 1988, and she suggested I 

consider becoming a La Leche 

League Leader. She recommended 

that I start by coming to Series 

Meetings, which she said she found 

uplifting. After my first meeting, 

I explained to Jean that I hadn’t 

been uplifted. She laughed and 

invited me to the next meeting, 

which she was leading herself. 

So, one month later, I set out 

again. It was a cold, rainy, windhowling 

morning, and this time the 

venue was a long way from where 

I lived. “Why am I doing this” I 

thought, struggling to open my 

London A–Z under my wind-shaken 

umbrella. I was in an unfamiliar part 

of London and it took me a long 

time to locate the venue. However, 

this time, I was there from the 

beginning, and the discussion 

made perfect sense to me. 

The sitting-room of the hostess’s 

flat soon filled up with mothers, 

many as cold and wind-blown as 

I was. All complained, sometimes 

bitterly, that it was so hard to be a 

mother. One mother put it vividly: 

“Even the ticket collector at my 

local station, all dressed up in his 

uniform, seems to have more pride 

in himself than I do. Yet his job 

isn’t half as responsible as mine. 

But I don’t feel that.” 

I noticed that Jean didn’t tell her 

to feel any differently. She didn’t 

offer any advice, any solutions, 

or even comfort. She simply 

thanked each mother for speaking, 

and moved on to the next one. 

By doing this, she had left each 

mother with the dignity of her 

statement. She was receiving and 

accepting everything that mothers 

said to her. 

However, it wasn’t until the end 

of the meeting that I saw how 

effective this was. Collectively, 

Photo © veer.com 

mothers’ complaints added up to 

a very gloomy picture. Jean hadn’t 

changed that. So I was extremely 

surprised that, when we all got up 

to go, and mothers dressed their 

babies to go back to the situations 

they had just been complaining 

about, I could hear a lot of laughter 

and cheerful voices. I myself felt 

lighter and more energetic. What 

magic transformation had just taken 

place 

There are many ways to lead 

meetings, and the Leader at my 

first meeting had given mothers 

plenty of valuable information 

about breastfeeding. But I was 

completely inspired by Jean. I 

could see the wisdom of her 

generous kind of listening. She 

didn’t offer solutions to problems, 

perhaps because they were not 

requests for specific information. 

Yet her whole demeanor and way 

of talking expressed her love for 

breastfeeding and also her trust in 

each mother. I determined to train 

to be a Leader myself. 

It’s important to have a place 

where one can speak honestly. 

Series Meetings give breastfeeding 

mothers a safe place to 

acknowledge difficulties. No one 

is going to tell her she is “making 

a rod for her own back” [ie that 

she is doing something that is 

likely to cause problems for her in 

the future]. This is a frequent but 

completely heartless comment to 

make to a breastfeeding mother. 

Many mothers don’t like to tell 

other people how tired they feel 

in case they get that response. At 

La Leche League meetings, most 

mothers are tired, and everyone 

knows it is in a good cause. A tired 

breastfeeding mother is given the 

respect she deserves. 

Now I know exactly why mothers 

say of our meetings that they feel 

they have “come home.” 

Naomi Stadlen and Anthony have 

three children and one grandson. 

Naomi became a La Leche League 

Leader in 1990, and co-leads the 

Central London Group, LLLGB. She 

runs Mothers Talking, discussion 

groups for mothers in London. Her 

book, What Mothers Do—Especially 

When It Looks Like Nothing, has 

been published by Piatkus (GB) 

and Tarcher/Penguin (USA) and is 

available from www.lllgbbooks.co.uk 

T 




019 

Vegan 

Teresa Pitman 

My daughter, Lisa has been a vegan most 

of her life. We learned early on that meat, 

dairy products and eggs caused her digestive 

problems. At first, I cooked separate meals for 

her while making more traditional foods for the 

rest of the family. Eventually one of my sons 

and I became vegan as well, and the others 

in our family eat vegan meals when we are 

together. We’ve found it to be a very healthy, 

fairly inexpensive, environmentally sound way to 

eat that also helps us achieve our goals of not 

causing suffering to animals. 

Kale Avocado Salad 

(Lisa’s recipe) 

1. Tear up the leaves from a bunch of kale into 

bite-sized pieces and place in a large bowl. 

2. Add a Tbsp of olive oil, the juice of half a 

lemon and a tsp of sea salt. 

3. Massage everything together for a couple 

of minutes (the kale should change texture to 

become almost wilted). 

4. Peel and pit an avocado (or two). Mash the 

avocado flesh into the kale, to coat the leaves. 

5. Top with half a red pepper, julienned and a 

finely chopped scallion. 

Method 

Spray a 4-quart saucepan with non-stick cooking 

spray, then add the apples, sweet potatoes, water 

and salt. Cover and cook for about 20 minutes 

over low heat, stirring often. Then turn the heat 

up a bit and add more water if needed and cook, 

stirring often, for another 20 minutes. Add other 

ingredients and mash thoroughly. 

(I think this could also be cooked in a crockpot.) 

photos courtesy Lisa Pitman 

Lisa now has a blog at www.vegancookbookcritic. 

blogspot.com featuring photos, recipes and 

cookbook reviews. Here are three vegan recipes 

that make up an easy and delicious meal. 

This is also good without the avocado. 

Ginger Mashed Sweet Potatoes 

and Apples 

(Recipe by Isa Chandra Moskowitz from Appetite 

for Reduction. Excerpted by arrangement with 

Da Capo Lifelong, a member of the Perseus 

Books Group. Copyright (c) 2010.) 

Ingredients 

2 apples, peeled and cut into 1/2 inch chunks 

2 pounds of sweet potatoes cut into 1/2 inch 

chunks 

1/4 cup water 

1/4 tsp salt 

1 Tbsp agave nectar 

1/4 tsp cinnamon 

1/2 tsp freshly grated ginger 

Forty-Clove Chickpeas and Broccoli 

(also from Appetite for Reduction) 

Ingredients 

1 pound of broccoli cut into large spears, 

stems chopped into 1/2 pieces 

10 cloves of garlic, smashed 

1 15-ounce can of chickpeas, drained and rinsed 

2 tsp olive oil 

1/4tsp salt 

2 tsp lemon zest 

11/2 tsp dried oregano 

1 cup vegetable broth 

Method 

Preheat oven to 400 degrees F. Place onion, 

garlic and chickpeas in 9 by 13 inch baking pan. 

Drizzle with the oil and toss to coat. Add salt, 

lemon zest and oregano and toss again. Put in 

oven and bake for about 30 minutes, turning 

once. Remove from oven and add the vegetable 

broth. Use a spatula to scrape the bottom of 

the pan to get any tasty bits and to stir up the 

ingredients again, and put back in the oven for 

another 15 minutes. Your whole house will smell 

garlicky and amazing. 

photo © shutterstock.com 


T 



020 

Some common 

questions and 

answers about 

being vegan 

Where do you get your protein 

Most foods have some protein in 

them—even vegetables. Beans, nuts, 

seeds and mushrooms are all good 

sources of protein. Wheat gluten is also 

often made into “imitation meats” and is 

high in protein. Tofu, tempeh and nondairy 

milks can also add more protein to 

a vegan diet. The reality is that most of 

us get more protein than we really need. 

Is a vegan diet expensive 

It can be if you buy a lot of processed 

vegan foods, such as veggie burgers, 

but the basics of vegan eating—beans, 

vegetables, whole grains, fruits, nuts 

and seeds—are generally significantly 

less expensive than meats and dairy 

products. A commitment to vegan eating 

also keeps you out of most fast food 

restaurants—another saving! 

Is a vegan diet adequate for 

pregnant and breastfeeding 

mothers With planning and attention 

to meeting your nutritional needs, a 

vegan diet can supply all you need during 

pregnancy and lactation. And mother’s 

milk is the perfect food for the vegan 

baby! 

“What’s Cooking” is edited by LLL 

Leader Lesley Robinson. She lives in 

Ottawa, Canada with husband, Mark. Her 

three grown children have flown the nest. 

Send your recipes and photos please to 

editorbt@llli.org 

What about Vitamin B12 This is 

the one nutrient that is hard to get 

in a vegan diet, but it is readily available 

as a supplement or is added to foods 

such as nutritional yeast. 

photo © shutterstock.com 

T 



Letters Page 

Your Letters 

021 

Photo ©shutterstock.com 

STAR LETTER 

In The Night 

I recently 

gave birth to a 

beautiful little 

girl and we had a 

rough start with 

breastfeeding 

in the first 

few weeks. 

My husband was so supportive throughout. 

He was even inspired to write a poem about 

how wonderful breastfeeding is and it actually 

encouraged me to keep going. 

The title is 4 A.M. because he wrote it one night 

when I was having a hard time getting my baby to 

latch on properly. I was upset and my baby was 

upset but my husband kept reminding me how 

great breastfeeding is to keep me going. It made 

me realize that now might be hard but if we work 

at it then it will get better. 

Lisa Bakowski, Raleigh, North Carolina, USA 

4 A.M. 

by Adam Bakowski 

Arms flailing 

Child wailing 

Keep it together 

The benefits last forever 

Your neck, back and wrists are sore 

This feels so much like a grueling chore 

You find yourself in awkward positions 

Sometimes in the most embarrassing conditions 

365 days is the goal 

One day these antibodies may fight off a cold 

The reasons are many 

Focus to keep your routine steady 

The bond this provides 

Eliminates the divides 

Mother and child embraced as one 

The love and compassion have just begun 

The Big Brother When my daughter, Hannah 

was born a few months ago, I had expected 

to be tandem feeding as Thomas (now almost 

three) was still having a very short breastfeed 

once every week or two. We had discussed how 

little babies need to feed lots and how he would 

have to share. When he came to meet his new 

sister in the hospital and I fed her (after the 

introductions), he said, “Hannah’s having milk 

from mummy, I used to have milk from mummy 

when I was a baby.” He hasn’t asked to breastfeed 

since, which both surprised and pleased me. 

The photo of the three of us is not a very 

flattering one of me, but I’ve included it as it 

shows me trying my best to include my son, 

which I feel is very important, while nursing my 

new baby. 

Gillian Mabbitt, Newcastle, UK 

Tips on Helping New Moms Yesterday at 

our La Leche League Series Meeting mothers 

shared what they thought were helpful things 

people could do for a mother who has just had a 

baby. These were three I particularly liked. 

“Putting a cup of tea where I 

can reach it.” 

“Cutting my food up into bitesized 

portions and seasoning it 

appropriately.” 

“Telling me, ’Well done, you 

are doing a really good job.” 

Marion Jones, Derbyshire, UK 

Photo of Gillian Mabbitt, Hannah & Thomas 

Please send your letters and photos 

to editorbt@llli.org 


T 


Nancy Mohrbacher 

022 

New Insights on Nipple Shields 

If you’ve ever used a nipple shield—or know 

someone who has—you’ve probably received 

conflicting advice about its use. Most nipple 

shields are made of silicone and consist of a thin 

“brim” that covers all or part of the areola (the 

pigmented area around the nipple) and a firmer, 

protruding “tip” that fits over the nipple. When 

a baby breastfeeds with a shield in place, milk 

flows through the holes in its tip. Nipple shields 

are one breastfeeding tool many mothers love 

to hate, in part because of their inability to get 

consistent answers to questions such as the 

following: When is a nipple shield an appropriate 

tool Should a mother using a nipple shield 

express milk after feedings to safeguard her 

milk production Should weaning from the 

shield always occur as soon as possible Luckily, 

research has provided us with some answers. 

When Can Nipple Shields Help 

Like any breastfeeding tool or technique, 

nipple shields can be used or misused. During 

recent decades, the pendulum has swung to 

both extremes. After a time of nipple shields 

being given out freely in hospitals after birth, 

their use was strongly discouraged (Mohrbacher 

& Stock, 1996; Newman & Pitman, 2006). 

However, both research and case reports 

suggest that in some situations, nipple shields 

can help preserve breastfeeding (Bodley 

& Powers, 1996; Brigham, 1996; Clum & 

Primomo, 1996; Elliott, 1996; Sealy, 1996; 

Wilson-Clay, 1996; Woodworth & Frank, 

1996). The key is to use them wisely. 

For example, one study found that preterm 

babies who slipped off the nipple during pauses 

or fell asleep early in feedings suckled longer 

and took more milk when a nipple shield was 

used (Meier et al., 2000). All of the 34 babies 

in this study who used the shield took more milk 

directly from the breast, with a mean increase of 

14.4 ml (about a half-ounce), suckled for longer 

bursts and stayed awake at the breast longer. 

Photo of Athena courtesy Sacha Blackburne 

The length of time these preemies used the 

shield varied, with a mean of 32.5 days. On 

average, the mothers used the shield for about 

24% of their time breastfeeding. The babies 

who were previously unable to transfer milk 

without the shield used it longer than the babies 

who took some milk from the breast alone. 

There was no association between the length 

of time the shield was used and duration of 

breastfeeding. The reason the shield helps some 

preemies is not yet fully understood, but some 

think its firmer tip may push deeper into the 

baby’s mouth, triggering more active suckling 

(Hurst & Meier, 2010). 

T 



Nancy Mohrbacher 

023 

In one US retrospective telephone 

survey, 202 breastfeeding mothers 

reported using nipple shields for 

the following reasons (Powers & 

Tapia, 2004): 

✤✤ 

Flat or inverted nipples (62%) 

✤✤ 

Disorganized infant suck (43%) 

✤✤ 

Sore nipples (23%) 

✤✤ 

Engorgement (15%) 

✤✤ 

Prematurity (12%) 

✤✤ 

Tongue-tie (1%) 

When the baby of a mother with 

flat or inverted nipples is having 

difficulty taking the breast, the tip 

of the nipple shield can provide 

the firm feeling deep in his mouth 

a baby is looking for. Problems 

like this may be more likely for 

these mothers when bottles and/ 

or pacifiers (dummies) have altered 

baby’s expectations (Wilson-Clay 

& Hoover, 2008). For this same 

reason, a shield may help a newborn 

take an engorged breast or help 

transition a reluctant bottle-feeding 

baby to the breast (Wilson-Clay, 

1996). For mothers with damaged 

nipples, temporary use of a nipple 

shield may provide just enough 

pain relief to avoid interrupting 

breastfeeding. For the baby with 

high muscle tone or tongue-tie, 

the firm shield can help push the 

breast past a retracted or humped 

tongue to trigger active suckling 

(Genna, Fram, & Sandora, 2008). 

With some breastfeeding problems, 

using a nipple shield can allow the 

baby to feed directly from the 

breast, simplifying a mother’s life by 

minimizing the need to express her 

milk and feed it to her baby another 

way. 

That said, however, whenever 

possible it is always better to try to 

solve a problem first by improving 

breastfeeding dynamics rather 

than by using a nipple shield. An 

A 

mother can feel at ease about 

using the shield as long as it 

helps the baby breastfeed more 

effectively. In general, as the baby 

matures, his coordination increases, 

and as he develops more practice and 

positive associations at the breast, 

the easier it will be to wean him 

from the shield. 

inappropriate use of a nipple shield 

would be for a supporter to offer it 

as the first solution to a problem or 

as an alternative to spending time 

helping a mother make adjustments 

in how she puts her baby to the 

breast. 

Do Mothers Using Nipple 

Shields Need to Express 

Milk after Breastfeeding 

Originally, mothers using a nipple 

shield were told to express milk 

after feedings because one study 

found reduced milk transfer when 

the shield was used. This 1980 

UK study found that thick nipple 

shields altered babies’ suckling 

patterns and the babies took less 

milk from the breast (Woolridge, 

Baum, & Drewett, 1980). The 

babies using the thick, rubber nipple 

shields took 58% less milk, and 

those using the thinner latex nipple 

shields took 22% less milk than 

when the babies took the breast 

alone. However, the babies in the 

study had been breastfeeding well 

without the shield, and the change 

in suckling may have been simply 

because the shield was unfamiliar. 

Newer research suggests that in 

most cases expressing after feedings 

may not be necessary. A 2009 

study charted weight gain in 54 

babies who were breastfeeding with 

a nipple shield and whose mothers 

were not expressing milk after 

feedings. The researchers found no 

statistically significant difference 

in weight gain at two weeks, one 

month, and two months between 

babies using a nipple shield and 

those breastfeeding without one 

(Chertok, 2009). In Selecting and 

Using Breastfeeding Tools 2009, 

US lactation consultant Catherine 

Watson Genna wrote: 

“Many LCs encourage mothers 

using a nipple shield to pump. I 

originally followed the ‘party line’ 

and encouraged mothers to express 

milk while using a nipple shield but 

soon found that some mothers 

were developing uncomfortable 

[oversupply] and recurrent plugged 

ducts (Genna, 2009, p. 57).” 

Genna now individualizes 

her suggestions to mothers, 

encouraging them to watch 

their baby for signs of active 

breastfeeding, satisfaction 

afterwards, normal energy levels 

and stool output. If the baby seems 

sleepier than usual, has fewer than 

four stools per day before six weeks 

of age, or seems unsettled, she may 

recommend the mother express milk 

and supplement her baby with it. 

In some situations, expressing after 

feedings may make sense, such as 

the mother whose milk production 

is low or the mother who is unsure 

her baby is draining her breasts 

effectively. Regular weight checks 

are a good idea until it is obvious 

milk expression is not needed. After 

feedings with a shield, other signs 

of milk transfer that a mother can 

note between weight checks are 

seeing milk in its tip and a decrease 

in breast fullness. 

When and How Should a 

Mother Wean from a 

Nipple Shield 

The right time to wean from the 

shield depends partly on the reason 

it was used. For example, when a 

shield is used to help a baby who 

has been bottle-feeding recognize 

the breast as a source of milk, it 

may only be helpful for one feeding. 

But if a mother and baby have been 

struggling with breastfeeding for 

some time and the baby considers 

the breast a source of frustration, a 

longer time of easier breastfeeding 

to build positive associations 

may be better. The preterm baby 

using the nipple shield to improve 

breastfeeding effectiveness may 

need to grow and mature for 

several weeks before he can feed 

well without the shield. In the 

study of preterm babies mentioned 

previously, the preemies who took 

more milk with the shield continued 

to do so on average until they 

reached their full-term corrected 

age of about 40 weeks (Meier et 

al., 2000). If a nipple shield helps 

increase milk intake at the breast, it 

makes sense to use it as long as this 

is the case. 


T 


024 

In the survey of 202 mothers 

mentioned previously, 67% 

eventually weaned from the shield 

and breastfed without it, with the 

length of shield use ranging from 

one day to five months and a median 

duration of two weeks (Powers & 

Tapia, 2004). Of the 33% who 

used the shield for the duration of 

breastfeeding, 11% said the baby 

would have breastfed without it 

at any time but continued using it 

because breastfeeding felt more 

comfortable with it. One mother 

used the nipple shield for the 

entire 15 months she and her baby 

breastfed. 

When the time seems right to wean 

from the shield, the mother may 

start by breastfeeding with the 

shield. When milk ejection (let-down) 

occurs and the baby is swallowing 

milk, try removing the shield quickly 

and putting the baby immediately 

back to the breast. If the baby takes 

the breast, the mother can use this 

strategy whenever needed to move 

from shield to bare breast. Usually, as 

the baby becomes more coordinated 

and more practiced (in my personal 

experience this often happens at 

about five to six weeks of age), the 

shield will be needed at fewer and 

fewer feedings. 

If this strategy doesn’t work, the 

mother may continue using the 

shield at all feedings and try again a 

few days later when she and her baby 

are feeling relaxed, perhaps at a time 

when the baby is not too hungry 

(Mohrbacher, 2010). I suggest the 

mother always strive to keep the 

breast a pleasant place for her baby. 

If the baby is unwilling to breastfeed 

without the shield, it is best to avoid 

pushing the issue at every feeding 

because this can make the breast 

a battleground and lead to more 

feeding problems. 

Although it was once recommended 

to wean a baby from a nipple shield 

by gradually cutting off the tip of the 

shield until it is gone, this strategy is 

not recommended for the ultra-thin 

silicone shields used today. This is 

because when cut, silicone has sharp 

edges that can irritate the baby’s 

mouth. 

A mother can feel at ease about 

using the shield as long as it helps 

the baby breastfeed more effectively. 

In general, as the baby matures, his 

coordination increases, and as he 

develops more practice and positive 

associations at the breast, the easier 

it will be to wean him from the shield. 

A baby may need the shield for one 

feeding, a few feedings, a few days, 

a few weeks, or very rarely, a few 

months. If the baby is unable or 

unwilling to breastfeed without the 

shield, chances are the problem that 

caused the baby to need the nipple 

shield in the first place is not yet 

completely resolved. A mother who 

wants to wean from the shield should 

take her cues from her baby but keep 

trying to offer the breast without the 

shield every few days. 

Nancy Mohrbacher, IBCLC, FILCA 

is an active La Leche League Leader 

in the Chicago suburbs and for ten 

years maintained a large private 

lactation practice there, where she 

worked with thousands of families. 

She is coauthor (with Kathleen 

Kendall-Tackett) of Breastfeeding 

Made Simple: Seven Natural Laws for 

Nursing Mothers, coauthor of all three 

editions of LLLI’s The Breastfeeding 

Answer Book, and author of the new 

book, Breastfeeding Answers Made 

Simple: A Guide for Helping Mothers. 

She is a full-time employee of Ameda 

Breastfeeding Products, which makes 

and sells nipple shields. Nancy offers 

breastfeeding updates and cultural 

commentary on her blog at 

www.NancyMohrbacher.com 

References 

Bodley, V., & Powers, D. (1996). 

Long-term nipple shield use--a 

positive perspective. J Hum Lact, 

12(4), 301-304. 

Brigham, M. (1996). Mothers’ 

reports of the outcome of nipple 

shield use. J Hum Lact, 12(4), 

291-297. 

Chertok, I. R. (2009). 

Reexamination of ultra-thin 

nipple shield use, infant growth 

and maternal satisfaction. J Clin 

Nurs, 18(21), 2949-2955. 

Clum, D., & Primomo, J. (1996). 

Use of a silicone nipple shield 

with premature infants. J Hum 

Lact, 12(4), 287-290. 

Elliott, C. (1996). Using a 

silicone nipple shield to assist a 

baby unable to latch. J Hum Lact, 

12(4), 309-313. 

Genna, C. W. (2009). Selecting 

and Using Breastfeeding Tools: 

improving care and outcomes. 

Amarillo, TX: Hale Publishing. 

Genna, C. W., Fram, J. L., & 

Sandora, L. (2008). Neurological 

issues and breastfeeding. In C. W. 

Genna (Ed.), Supporting sucking 

skills in breastfeeding infants (pp. 

253-303). Boston, MA: Jones 

and Bartlett. 

Hurst, N. M., & Meier, P. P. 

(2010). Breastfeeding the 

preterm infant. In J. Riordan 

(Ed.), Breastfeeding and human 

lactation (4th ed., pp. 425- 

470). Boston, MA: Jones and 

Bartlett. 

Meier, P. P., Brown, L. P., Hurst, 

N. M., Spatz, D. L., Engstrom, J. 

L., Borucki, L. C., et al. (2000). 

Nipple shields for preterm 

infants: effect on milk transfer 

and duration of breastfeeding. J 

Hum Lact, 16(2), 106-114; quiz 

129-131. 

Mohrbacher, N. (2010). 

Breastfeeding Answers Made 

Simple: A Guide for Helping 

Mothers. Amarillo, TX: Hale 

Publishing. 

Mohrbacher, N., & Stock, J. 

(1996). The Breastfeeding Answer 

Book (2nd ed.). Schaumburg, IL: 

La Leche League International. 

Newman, J., & Pitman, T. (2006). 

The Ultimate Breastfeeding Book 

of Answers. New York, New York: 

Three Rivers Press. 

Powers, D., & Tapia, V. B. 

(2004). Women’s experiences 

using a nipple shield. J Hum Lact, 

20(3), 327-334. 

Sealy, C. N. (1996). Rethinking 

the use of nipple shields. J Hum 

Lact, 12(4), 299-300. 

Wilson-Clay, B. (1996). Clinical 

use of silicone nipple shields. J 

Hum Lact, 12(4), 279-285. 

Wilson-Clay, B., & Hoover, 

K. (2008). The Breastfeeding 

Atlas (4th ed.). Manchaca, TX: 

LactNews Press. 

Woodworth, M., & Frank, E. 

(1996). Transitioning to the 

breast at six weeks: use of a 

nipple shield. J Hum Lact, 12(4), 

305-307. 

Woolridge, M. W., Baum, J. D., & 

Drewett, R. F. (1980). Effect of 

a traditional and of a new nipple 

shield on sucking patterns and 

milk flow. Early Hum Dev, 4(4), 

357-364. 

Nipple Shields Tear-Off 

http://store.llli.org/public/ 

profile/163 

Nipple Shields Tear-Off 

http://www.lllgbbooks.co.uk/ 

product/122/nipple_shields_-_ 

pad_of_50/default.aspx 

T 



Celebrating The New Baby 

Gina Kruml, RN, BSN, IBCLC, LLL Leader 

Do you remember the days when planning a baby 

shower meant one big question: “Games, or no 

games” These days though, with the arrival of 

sprinkles, mother showers, mother blessings, and 

pregnancy parties, there is a wider variety of ways 

to celebrate.* When planning a celebration for an 

expectant mother, or to celebrate the arrival of 

a new baby, if you want to think outside the box, 

rest assured, plenty of possibilities abound! 

Every child is 

special, and his 

arrival deserves 

celebration. 

may want to be practical by giving a gift card, and 

someone may be knitting something special for 

the baby. 

Feature Article 

025 

incorporated into the festivities. This can be 

as simple as bringing up breastfeeding as a 

topic of conversation. Just as many mothers 

will enjoy telling their birth stories at the party, 

many mothers will also enjoy the chance to 

tell breastfeeding stories. If the expectant 

mother approves, you might want to make an 

appropriately shaped and decorated “breast 

cake” as part of the party food. Try to avoid 

decorations, party games and gift wrapping that 

include baby bottles and pacifiers. As useful as 

these items might be sometimes, it makes one 

wonder, where are all the baby decorations with 

baby bears, rabbits and kittens that are nursing 

As a guest, giving a gift of The Womanly Art of 

Breastfeeding or a similar book might be the most 

helpful thing you can do for a new mother. 

Photo of Gina Kruml courtesy of Ashley Elicio Photography 

Every child is special, and his arrival deserves 

celebration. But what if the parents already 

have everything they need for the new baby 

By calling the celebration a “sprinkle,” you 

can indicate that opening presents will not be 

the focus of the party. Or, if you’re throwing a 

“mother shower,” you could arrange a different 

way for people to help the new mother. Let 

guests know when they RSVP that instead of 

bringing a gift, they could bring a frozen meal, or 

check their calendars for a date when they could 

bring supper for the family. Marcia Claesson 

fondly remembers attending a baby shower where 

the hostess suggested everyone bring a favorite 

childhood book. The mother may even suggest 

a charity she would like to help in honor of the 

new baby. Of course, these choices should be 

presented as options, not as demands. Some 

guests might still want to pitch in together to 

buy a big ticket item from a baby registry, others 

Games are still a popular choice at showers. 

I always liked the “Guess how many” game. 

This is, of course, referring to the number of 

toilet paper squares it takes to go around the 

expectant mother’s belly. It’s the most fun if 

guests don’t know the secret, and guesses range 

from two to 132. Games might be a good option, 

for example, if it is a couples shower, but too 

many games can get in the way of spontaneous 

conversation. Too much time spent doing pencil 

and paper competitions and guessing how 

many jelly beans in the jar can make a party feel 

somewhat superficial. If the main purpose of 

games is to start conversation and make people 

feel welcome, surely a good hostess can do this 

on her own. 

Rather than concentrating on games and opening 

presents, you may want to incorporate a more 

personal or spiritual aspect into the celebration. 

Be sure to talk with the mother ahead of time 

about what would be most meaningful, and in 

accordance with her beliefs. Prayer, songs, or 

planting a tree together in honor of the baby 

might all be special for her. A “mother blessing” 

might typically include more mother-centered 

activities, such as a belly casting, or painting with 

henna. The guests might work on making a quilt 

together, or each write a wish for the baby on 

a leaf to tie to a tree. Each guest might bring a 

bead to add to a necklace string for the mother 

to wear during the baby’s birth. The mother can 

also be encouraged during the birth by a plan 

to support her with a telephone tree and prayer 

chain when the big day arrives. Each guest can 

be given a candle at the party, to be lit when the 

phone call comes. 

When planning a baby shower or similar 

celebration, a mother who will be breastfeeding 

might appreciate some celebration of this to be 

Whatever way you find to support, encourage 

and celebrate the journey of a new mother, know 

that you are making a positive contribution 

to her and the new baby. By including her 

preferences and beliefs, you can make the 

celebration more meaningful. You can also set 

the stage for the guests to continue to support 

her after she has the new baby, which especially 

in this day and age is desperately needed. 

Remember, you don’t have to go to great 

expense, or plan out every moment to make a 

happy memory for the new mother. 

* Maser, S. Blessingways: A Guide to Mother- 

Centered Baby Showers—Celebrating Pregnancy, 

Birth and Motherhood Moondance Pr. 

2004 

Gina Kruml, RN, BSN, IBCLC and LLL Leader is 

mother to Sophia, Ambrose, Maria and Victor in 

Sierra Vista, AZ, USA. 

http://store.llli.org/ 

publicsearchq=Baby 

+Carriers&s=Go 

Buy gifts for a new 

mom from the LLLI 

store! 

http://store.llli.org/public/ 

profile/488 


T 


Breastfeeding In The News 

026 


Leche League GB’s response 

to the article reported in 

the British Medical Journal, 

January 2011 

When WHO recommended this policy it was 

based on a systematic review of 3,000 studies 

on infant feeding. The article the British Medical 

Journal published, Mary Fewtrell, David C Wilson, 

Ian Booth, Alan Lucas BMJ 342:doi:10.1136/ 

bmj.c5955 (Published 13 January 2011) 

http://www.bmj.com/content/342/bmj.c5955. 

full 

suggesting that babies need solids earlier than 

six months of age, is not a new research study 

or a systematic review of all available evidence. 

Three of the four authors of this research have 

declared an association with the baby feeding 

industry. 

http://www.facebook.com/note. 

phpnote_id=192479987445666& 

id=136580916400946 

La Leche League has been providing 

breastfeeding information and support to 

parents for over fifty years. We support the view 

of The World Health Organisation (WHO), The 

Department of Health (DH), and other eminent 

organisations, that infants should be exclusively 

breastfed for around the first six months of 

life to achieve optimal growth, development 

and health. Thereafter, to meet their evolving 

nutritional requirements, infants should receive 

appropriate complementary foods alongside 

continued breastfeeding. 

There is clear scientific evidence that 

breastfeeding protects both the short and long 

term health of mothers and babies. It reduces 

the risk of infections such as gastroenteritis 

and respiratory, ear and urinary tract infections, 

particularly infections requiring hospitalisation, 

even in developed countries such as the UK. 

The risk of diabetes and obesity in children and 

cancer in mothers is lessened and it reduces 

the risk of postnatal depression and neglect. 

With the current risk of swine flu, exclusive 

breastfeeding reduces the risk of the baby 

catching secondary infections, which could be 

serious enough to need hospital admission. 

• The BMJ article says that delaying introducing 

solid food may increase the risk of iron 

deficiency anaemia (IDA) 

Breastmilk supplies all the essential nutrients 

a baby needs for around the first six months 

of life. There isn’t a lot of iron in breastmilk 

because there isn’t supposed to be. It is more 

completely absorbed by a baby than the kind in 

formula, baby cereal or supplements. Breastmilk 

contains a protein that binds to any extra iron 

that the baby doesn’t use because too much 

iron can end up feeding the wrong kind of 

bacteria in his intestines and this can result in 

diarrhoea/constipation or even microscopic 

bleeding. Formula fed babies can have too much 

iron in their intestines, which causes these 

problems and ends up reducing their overall 

iron. 

Photo: © Veer.com 

If a baby is started on solids before he is ready 

iron stores can drop. Some fruits and vegetables 

can bind with iron before the baby has a chance 

to use it. These foods are often low in iron and 

so are simply replacing the perfect food for 

babies with ones with fewer nutrients. 

To help ensure a breastfed baby has a good 

supply of iron, women can look at their diet 

during pregnancy and ask that the umbilical 

cord is not cut before it stops pulsating as this 

adds to his iron supply. 

• The BMJ article says that delaying introducing 

solids may increase the risk of coeliac disease 

Coeliac disease is associated with the early 

introduction of gluten, which is found in cereals. 

Currently available evidence on the timing of 

the introduction of gluten into the infant diet 

is insufficient to support any recommendations 

and a study suggesting this should be at four 

months is considered by many to be flawed. 

There is evidence suggesting that not being 

breastfed at the time gluten is introduced into 

the diet is associated with an increased risk of 

subsequently developing coeliac disease. 

• The article says that delaying introducing 

solids may increase food allergies 

T 




027 

A baby’s insides are designed to be ready for 

solid food once his outside has developed 

enough for him to eat it on his own. If offered 

too soon he will automatically thrust it back out 

to protect his digestive tract. La Leche League 

suggests mothers look for cues that their baby is 

ready, such as being able to sit up, pick up food, 

get it in his mouth and chew without choking, 

and that often happens around six months. A 

baby’s digestive tract needs to be mature before 

starting solids so the lining of his intestines is 

sealed against allergens (allergy producers). If 

given solids too early allergens can slip through 

the intestinal wall into the blood stream and the 

baby produces antibodies against them, which 

can result in allergies such as eczema. 

At around six months a baby starts producing 

adult-type enzymes, which we need to break 

down food for digestion. If he has solids before 

he can digest them properly it can cause tummy 

problems and the nutrients will not be fully 

utilised. 

Trials are being undertaken to test if babies with 

a family history of true allergy might be helped 

by earlier introduction of certain foods but, as 

a rule, the majority of babies are less likely to 

have an allergic reaction to foods by around six 

months. 

• The article suggests that introducing new 

tastes at an earlier age may increase acceptance 

of leafy green vegetables and encourage healthy 

eating later in life 

This is purely speculative. Breastmilk prepares 

a baby for family food as it changes in flavour 

depending on the mother’s diet and so exposes 

the baby to various tastes from birth onwards. 

In fact research shows that formula-fed babies 

often don’t accept new tastes as willingly as 

breastfed babies. What a baby prefers to eat 

will be dependent on many things and will 

change as he grows. Some mothers have found 

that if a baby was encouraged to eat a food he 

had shown a particular aversion to it caused a 

negative reaction, perhaps showing that babies 

instinctively know what to refuse. If offered a 

range of healthy foods babies tend to take what 

they need. 

• The article says that delayed introduction to 

solid foods may be linked to increased obesity 

This is in total conflict with the studies showing 

that early introduction, particularly of sugary 

foods, is an important factor behind the obesity 

epidemic and can lead to babies being overfed. 

Breastfeeding helps a baby to regulate his own 

appetite so that when he starts solids he may be 

better able to avoid over eating. 

La Leche League GB knows that women already 

receive conflicting advice and information on 

many aspects of childcare and that this report 

has caused concern and confusion amongst 

parents wondering what to do for the best for 

their children. Babies’ individual development 

varies and parents are best placed to look for 

signs that their baby may be ready for solid food, 

around six months of age. 

While we recognise that it is important to ensure 

that recommendations are based on the best 

available evidence, and are regularly reviewed, 

we continue to believe that breastmilk provides 

everything a baby needs up to around six months 

of age and that to introduce other foods before 

a baby is ready is not beneficial … Read the 

entire press release here: http://www.facebook. 

com/note.phpnote_id=192479987445666& 

id=136580916400946 

You can read the UNICEF UK response to media 

reports questioning the recommendation to 

introduce solid food to babies at six months 

here: http://www.babyfriendly.org.uk/items/ 

item_detail.aspitem=680 

Analysis. Six months of exclusive breastfeeding: 

how good is the evidence http://www.bmj. 

com/content/342/bmj.c5955.full/reply#bmj_ 

el_248392 


And 

http://www.lllgbbooks.co.uk/product/442/ 

Starting-Solid-Food-Introducing-your-baby-tofamily-meals/default.aspx 


T 


Donors Making A Difference 

028 

Letters of Appreciation 

for donations of The Womanly 

Art of Breastfeeding 

LLL News (continued from page 17) 

La Leche League Great Britain 

Ten New Groups Project 

discussions. One Leader Applicant 

said, “The opportunity to role play 

the meeting situation was hugely 

helpful. I felt encouraged and 

pleased about the things I did well 

and was given constructive ways to 

improve.” 

Thanks to the generosity of 

La Leche League International 

donors this past year, we were 

able to send complimentary 

copies of the newest edition of 

The Womanly Art of Breastfeeding 

to baby-friendly hospitals, 

birthing centers, lactation 

consultants, and libraries, along 

with many pregnant and nursing 

mothers. Here are two letters of 

appreciation we received: 

We were so excited to receive 

your generous donation of 

20 copies of The Womanly Art 

of Breastfeeding to the Miami 

Maternity Center. We are 

overwhelmed with gratitude. We 

decided to add most of them to 

our lending library so that the 

greatest number of mothers can 

benefit. At this moment, all but 

two copies are checked out. In 

addition to pregnant and nursing 

mothers, the books have also 

been checked out by several 

student midwives who are passing 

the information along, as well. We 

have also given two copies away 

so far to two of our teenaged 

clients. 

You have our sincere thanks for 

this amazing gift. 

Miami Maternity Center, 

Miami, Florida, USA 

Parkland’s Women & Infants’ 

Specialty Health (WISH) division 

is grateful for your support! I 

send sincere thanks for your 

recent, in-kind donation of copies 

of the newest edition of The 

Womanly Art of Breastfeeding. 

With one of the most active 

obstetrics programs in the 

country, Parkland is committed 

to supporting and encouraging 

new mothers to breastfeed 

their babies. We wholeheartedly 

understand the importance of 

healthy development of infants 

when they are breastfed. 

Thanks to your generosity, 

Parkland will be able to continue 

its mission and educate pregnant 

and nursing mothers about the 

benefits of breastfeeding. 

Parkland Foundation, 

Dallas, TX, USA 

In 2009 the United Kingdom’s 

Department of Health awarded La 

Leche League Great Britain (LLL 

GB) with a three-year grant in 

support of their “Ten New Groups” 

Project of recruiting and training 

20 mothers for La Leche League 

(LLL) leadership and setting up 

ten new LLL groups in areas where 

mother-to-mother breastfeeding 

support was not available. 

During the first phase of the 

project, appropriate resources were 

developed, project areas identified 

and LLL Leaders recruited to run 

workshops and support the Leader 

Applicants (trainees). 

LLL Awareness Days were held to 

attract local mothers and discuss 

leadership with them. 

In 2010, in Phase 2 of the project, 

mothers started their applications 

and attended workshops. For some 

mothers, this has introduced them 

to the LLL mother-to-mother group 

experience, as well as developing 

the skills Leaders need to provide 

effective support and lead 

In Phase 3 of the project, it is 

anticipated that the remaining 

Leader Applicants will be accredited 

and new LLL groups formed. The 

project will then be evaluated 

from all perspectives including the 

mothers who will receive support. 

At this time, four new Leaders have 

been accredited and three new LLL 

groups were formed in Liverpool, 

Preston and St Neots – providing 

key centers for LLL support in parts 

of the country where no Leaders 

or groups previously existed. One 

such mother, attending her first 

LLL meeting in Liverpool, expressed 

her delight at having an LLL group 

in her community: she enjoyed 

“meeting like-minded mums,” it 

was “friendly and welcoming.” 

Another mother observed that the 

Leader “is developing a strong and 

supportive group.” 

To learn more about LLLGB’s 

“Ten New Groups” Project, visit 

http://www.laleche.org.uk/pages/ 

about/10newgroups.htm 

Special thanks to Alison Parkes, 

Project Training Coordinator, who 

contributed to this article. 

T

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