New Insights on Nipple Shields - La Leche League International

Jill Bergman004The importance of skin-to-skincontact for every newbornModern childbirth has become a medical condition requiringdelivery in a hospital with doctors and nurses in attendance.Our neonatal mortality rate has decreased in the last 200years, which is a wonderful thing. However, recent studies ofneuroscience of the newborn have shown that our moderncare may well be at some cost to the baby’s brain. What wenow know is that newborn brain development is dependenton mother’s presence!Inside mother the fetus is held warm and safe, loved andprotected by mother’s body. Sounds are muffled, and mom’sfamiliar heartbeat and voice reassure the baby. His heart rateand oxygen saturation are optimal. The moment of birth thenis a huge transition, but his development has prepared himfor this change. After the actual birth he is able to regulatehis systems because ideally he is held in the safe place thatmother’s chest provides.However, our modern care often takes the newborn into theworld of lights that are too bright for his sensitive eyes, loudsounds 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 hisadapting brain is that he is taken away from his mother, hisSAFE place. Separation from mother is highly stressful, andis enough to make a baby physiologically unstable. He feelsunsafe, his brain sends “danger” signals to the body. Hisbrain releases the stress hormone cortisol, which increasesthe heart rate and breathing in a basic “fight or flight”reaction. Somatostatin is also released and acts in the gut todecrease absorption of food and thus inhibit growth. Thesestress hormones will continue to affect the baby while he isseparated from mom. When returned to his mother, the stresshormones still take 30 minutes or even an hour to wash outof his system.Stephanie Wernbo and baby Alex courtesy of Sacha BlackburneThe separated baby will protest and cry to call for mom. Hisarms and legs will wave or jerk to get his mother to comeback. The crying can also open the foramen ovale, a flapbetween the two sides of the heart, thus restoring fetalToday• Issue 6 • 2011 | llli.org

Jill Bergman005Skin-to-skincontact will helpthe baby maintaina steady bodytemperature. If thebaby is cold, themother’s chest willheat up to warm herbaby, or to cool himif he is too hot.circulation, which now pumps deoxygenatedblood to the brain. This crying increases theheart rate and blood pressure in the baby’s brain,which can damage the tiny capillaries, maybeeven causing an intraventricular hemorrhage(IVH).All of this intense protest activity uses up vitalcalories that should be used for growth. If thebaby’s protest signals are not heeded, the babymay go into an energy-conserving defensemode, which lowers heart rate and temperaturefor prolonged survival. This state of “freeze”may look like the baby is asleep, but recentneuroscience research has shown that the babymay be firing pathways in the brain that in laterlife tend to increase anxiety. A final stage ofdefense is called “dissociation” in which thebaby essentially “tunes out.” This whole processreinforces emotional pathways in the baby’sbrain, 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 emotionaleffects. Adult mental health is based on infantmental health, and we know that caring forinfant mental health starts early, even in the firsthour after birth. This capacity of the newbornis new knowledge. Many babies cope fine awayfrom their mother, but for the more sensitive wewant to avoid the stress of separation in future.Obviously not all separated babies will haveproblems as adults, but all experience separationas stress.In summary, separation of the newborn babyfrom the mother is the primary cause of newbornstress. This can show itself in increased heartrate, blood pressure and decreased oxygensaturation in the blood. These physiologicaleffects of separation can lead to a cascade ofproblems and complications requiring moreintervention from the neonatal health system.Most of this could be avoided by the mindblowinglysimple practice of putting everynewborn baby naked onto mom’s bare chest,drying him and covering both of them. All of thenecessary newborn observations and tests canbe 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-skincontact?Skin-to-skin contact will help the baby maintaina 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 autonomicnervous systems (ANS) of the mother and babycoordinate to establish healthy and stable setpoints of blood pressure, temperature, heartrate and glucose. This allows the baby to “selfregulate”better when stressful events rock hisequilibrium. But until the baby has establishedthose set points he needs the “bufferingprotection of adult support.” In the absenceof this support, metabolic set points may notbe properly established and this can increaseproblems of hypertension, obesity and diabetesin later life.Many of you will be familiar with the “selfattachment”behavior of the newborn onmother’s chest in the first hour of life. The baby’ssmall movements on the mother’s chest in movinghis way to the nipple and touching it stimulatesa wonderful interaction of hormones in bothmother and baby’s brain and body as follows.The baby stimulates the mother’s breastand areola, and the mother’s ANS tells herhypothalamus and pituitary to release thehormone prolactin which causes the breastto start milk production. Note that it is thebehavior of the baby which ensures that milk willbe produced by the breast; the baby is in effectmaking his next meal! Prolactin is released in thebaby as well, which stimulates oligodendrocitecells, which make the myelin that will coat thenerves and speed up the sending of messages inthe brain,. The release of prolactin in the babyalso stimulates production of surfactant, whichhelps the newborn baby’s lungs to breathe better.Balboa BabyAdjustable SlingCarriers are used by parents to supporttheir babies in a variety of positions.While you attend to daily tasks, your babycan enjoy the closeness of your body. Formore information shop online at store.llli.orgor call 800-LALECHE.Balboa Babyshopping cartcoverSimple and fashionableproviding a clean &secure environmentfor babies. For moreinformation shop onlineat store.llli.org or call800-LALECHE.Baby K’tanCarriersllli.org | 2011 • Issue 6 •Today

Jill Bergman006Skin-to-skin contact at birthfor stabilization of EVERYnewborn is a simple yet profoundintervention, which increases thephysical, mental, emotional and socialstability and well-being of the baby.Oxytocin is well-known as the “lovehormone” and also for its action inthe Milk Ejection Reflex. Howeverit is also a neurotransmitter in thebrain, and is released primarily inresponse to skin-to-skin contact.In the mother’s brain the oxytocinsuppresses the cingulate gyrus,which is the fear centre of thebrain, thus making the motherfearless to protect her baby.Oxytocin release in the babystimulates the brain pathways forapproach, and the baby opens hiseyes and gazes at mother. This isthe beginning of the vital first bondthat is the foundation of all otherrelationships.The baby suckling also stimulatesthe release of cholecystokinin in themother, which acts on the amygdalato produce a sense of contentmentand well-being. In the baby thissame hormone not only producesa sense of calm, it also aids selfregulationof digestion.These three powerful hormoneshave thus worked in both motherand baby to wire neural circuitsfor a well-bonded, well-regulatedmother-infant pair. The basicbiological needs for warmth,nutrition and protection are thusprovided from the very beginning.This early bonding fires security inthe baby and instinctive protectionbehavior in the mother, and setsthe mother-baby pair on a courseof healthy development and securerelationships.Skin-to-skin contact at birth forstabilization of EVERY newborn is asimple yet profound intervention,which increases the physical,mental, emotional and socialstability and well-being of thebaby. This is every baby’s right.The number of hours of skin-toskincontact a baby receives in thefirst day of life has been shown toenhance his mother’s sensitivityto his cognitive development andemotional security even a year later.This also predicts the attachmentrelationship and social intelligence.Obviously if that early contact hasbeen missed it can be made uplater.These are just a few reasons foradjusting and modifying our healthcare practices to give every babythe best start. All of the above arevalid benefits for EVERY newbornbaby. For a fragile and sensitivepreterm baby, skin-to-skin contactat birth is even more important forstabilization and minimizing stress.If technology needs to be added, itshould be done on mother’s chest,the baby’s SAFE place.Summary of benefitsof skin-to-skincontact for babyPhysical: heart rate, breathingand temperature are better.Emotional: feels safe so lessstress and crying.Mental: better sleep and brainwiring for development.Breastfeeding: gainsweight, home sooner.For Parents:less stress, better bonding.ResourcesAmodio DM, Master SL, YeeCM, Taylor SE. Neurocognitivecomponents of the behavioralinhibition and activation systems:Implications for theories of selfregulation.Psychophysiology2008;45:11-1.Schore AN. The effects of earlyrelational trauma on right braindevelopment, affect regulation,and infant mental health. InfantMental Health Journal 2001;22(1-2):201-69.Carter CS, Altemus M, ChrousosGP. Neuroendocrine and emotionalchanges in the post-partum period.In: Russell JA, Douglas AJ, Windle RJ,Ingram CD, editors. The MaternalBrain. 133:241-9. ed. 2001.241-9.Ross HE, Young LJ. Oxytocin andthe neural mechanisms regulatingsocial cognition and affiliativebehavior. Front Neuroendocrinol2009 Oct;30(4):534-47.Bigelow AE, Littlejohn M, BergmanN, McDonald C. The relationbetween early mother-infant skinto-skincontact and later maternalsensitivity in South African mothersof low birth weight infants. InfantMental Health Journal 2010May;31(3):358-77.More details on the neuroscienceof newborns can be found in HoldYour Premie. A workbook on skin- toskincontact for parents of prematurebabies and in the DVD “Holdyour Prem” available from www.kangaroomothercare.com.You can also read more aboutresearch on skin-to-skin contacton this Web site.Today• Issue 6 • 2011 | llli.org

NB_issue1_09.qxd:06Nov_DecNBƒ.qxd 4/16/09 1:23 PM Page 19Mothers’ Stories009Answeringhis first joke. I remember the lows—thenipple pain; feeling overwhelmed byQuestionsOliver’s needs. But the hundreds ofnormal days, the thousands of warm,enjoyable but unmemorable feeds, fadeinto a blur.Attending LLL meetings and hearingabout other mothers’ breastfeeding andAnuja Kotari, Mumbai, parenting India experiences The have initial days beenin hospital gave mebrilliant. Over the past a two taste and of how a half our breastfeedingyears I have gained so journey much from would the be, when I heard theAnuja found mothers family I had have met following through question LLL. and commentsa lot of questions They’ve about suggested tips for from specific my near situations,changed some ofones, “Is he gettingbreastfeeding when her baby enoughmy attitudesmilk?” “Give him more. Icompletely, and given me true empathy.was born and finding La Leche think he is not done yet.”Their experiences have helped me toLeague helped her to answerSisters Diane and Jamie and their babiesrecognize the truth in the phrase “thisthem … too shall pass.” This has Yasmin, really helped my local meLa Leche about League it, just the basics, and thoughtto enjoy the good bits and Leader, cope whom with the I have been that in my touch baby and I would figure it outlackadaisical attitude toward breastfeedingduring my pregnancy camePhoto of Anuja Kotari and Ansh courtesy of A. Kotarirocky periods. I would with like for to over say a year a now, if it gave were me meant to be.from a lack of knowledge; knowledgeparticularly warm thankWhen I was expecting my baby, theyouconfidenceto my localthat breastmilk I didn’t and talk to LLL my has husband very good about information it (thank on goodness) When Ansh that was my about sister two learned monthsLeaders Ruth, Suzanne, and Barbara for much or have him read anything about from a book and passed on to me.Ansh, the only thing that worried only breastmilk was required by my how to check whether your baby is old, he went on a nursing strike.their listening ears, helpful information, it either. I remember him being very When my daughter was born, I hadme was my forthcoming and, of course, labor. their friendship. baby for his first six months.shockedWewhen lategainingin theweightpregnancyappropriatelyI someandcomplications,He just wouldandnotitdrinktookandsevenBreastfeeding was something live in an extended family announced so you that my I would local Leader be exclusively has always been days for my would milk start to come crying in—seven loudly when longII had taken for Joanne granted Whistler and I can imagine how it is listening feeding to the baby; generous we would with her not time beto help days in which put him my to husband my breast. and Talking I were tobelieved that everyWest YorkshiremotherGreatcouldBritain12 different opinions using each day! bottles guide if all me went through well. this information. I vigorously Yasmin reading put about me at ease breastfeeding.she wasdo it—why worry about it? But This can really get frustrating rememberAdapted from a story in LLLGB’s Breastfeedingat he was Yasmin not too also happy suggested about reading Our The LLL so Leader, supportive Jeanette, and was gave awesome,lotssuddenly, one Matters day, you become a times when I don’t have it. answers. Looking back Womanly now, both Art of of us Breastfeeding, should providing which of us helpful with much information. needed She support washave read a lot more and given a lot and encouragement. She even came tomother and are supposed to take It was a little difficult to convince is a must have for all new moms. It empathic and encouraged me tomore thought to the subject.visit me at my house because I was too illcare of this fragile little one who is the different members ofMymysister andanswersI weresonotmanybreastfed.queries nottoonlyleave. And,be patient,of course,sayingI calledthismywouldsister.pass.totally dependent on you. This can family initially but, as Our the months mom says regarding it just breastfeeding was notbut those At that point His fussiness I was determined lasted for to about breastfeed.tworeally be very scary when you haveabsolutely no experience.can Seeing weeks what but a positive did pass. experience itpassed, they saw the results something of you many did then. other So, small we queries had thatmy breastfeeding, when never Ansh really was been disturb around you when any breastfeedingcaring for your was for my sister made me all the moremothers. little We one. were never taught eager to nurse my own child. I am sogaining weight appropriately.about it in school, and no one ever glad that I did.talked to us about it. I believe that my My 11-month-old daughter, Madison,A Gift fromMy SisterLLL has very goodinformation on howto check whether yourbaby is gaining weightErin.appropriately and my localLeader has always beengenerous with her timeto help guide me throughthis information.My younger sister, Jaime, has alwaysbeen one to learn a lot by reading. Sowhen she was pregnant, Jaime read andlearned a lot about breastfeeding. Shejoined a La Leche League Group in herarea and established a wonderful breastfeedingrelationship with her daughter,When I became pregnant a monthafter Erin was born, I asked Jaime aboutbreastfeeding. She told me severalpositives about it and told me to lookup the number of my local LLL Group.She didn’t push information on me. Inher quiet way, she just recommended Iread about it and decide for myself. Iattended one LLL meeting late in mypregnancy. I didn’t read a whole lotFor information on the benefits of co-sleepingplease go to www.armsreach.com(800) 954-9353 or (805) 278-2559ARM’S REACH CONCEPTS, I NC© 2004 Arm's Reach Concepts,Inc. ARM'S REACH, CO-SLEEPER,Mother & Child Logo and all other trademarks are stringently protected.All rights reserved.Patents pending.“I am pleased to recommend Arm’s Reachas a wonderful nighttime attachment tool.”Dr. Wm. P. Sears,Author “The Baby Book: Nighttime Parenting”Baby sleeps snugly and safelyalongside adult bedConverts to free-standing bassinet or changing tableThe MiniJust 20"x34"of floor space<strong>New</strong>bornto 23 lbs.Award-winningFit PregnancyandParentingIssue 1, 2009 • NEW BEGINNINGS 19llli.org | 2011 • Issue 6 •Today

Mothers’ Stories014Lovely, Comfortable and Right!Andrea Baughan, Berkshire, UKI have three wonderful childrenwhom I breastfed. They are agedseven, four and two. Joe, theyoungest, is still breastfeeding.I have learned more aboutbreastfeeding with each baby. Myattitude towards breastfeedinghas changed as my knowledge andexperience have grown. I wish Iknew then what I know now!With Emily, the eldest, I hadamazing prenatal support frommidwives who were very probreastfeeding.Even so, some ofthe information they gave me Inow know was not the best forsupporting breastfeeding mums.At the time I remember thinkinghow odd it was that feeds weresupposed to be limited to 15minutes each side. I did, of course,buy a notebook and carefullyrecord each feed, the length, theside and so on. Thank goodnessthere weren’t iPhone applicationsaround then! Obviously if it ishelpful for some to use technologysuch as spreadsheets or iPhoneapplications for this purpose thenI am all for it, but for me all thisrecord keeping was one more thingto worry about.I attended a lovely group a fewtimes in Bournemouth, where Ispoke to one of the Leaders whosuggested I just watch Emily andlet her feed for as long as shewanted rather than timing her.This felt more natural and allowingEmily to come off in her own timestarted to give me a lot moreconfidence. It also inspired me toread more information from LaLeche League.By the time Lola was born,I had been reading up andlearning about feeding on cueand was much more confidentabout breastfeeding. I threw mynotebook away! She went straighton to the breast and stayed therepretty much for the next two and ahalf years! I was more relaxed andprobably enjoyed feeding more as Iwas worrying less.When I was pregnant with JoeI started to train as a peersupporter with the local hospital.I came across some of researcherDr. Suzanne Colson’s work* andit was so inspiring, refreshing andhelpful—mums looked so muchhappier and relaxed when sittingwith their babies skin to skin.The ideas within her work aboutbiological nurturing I found to bevery useful when supporting mumswho were worried about feeding orwho had had a difficult time givingbirth and whose confidence hadbeen shaken, for example, if birthhad not progressed as anticipatedor hoped for.Joe was born in May 2008 andwhen he was two weeks old wewere lucky enough to attend aconference at which Dr. SuzanneColson was speaking. During herfascinating talk, I started off sittingupright with Joe held in my armsand as I watched her presentationI found myself gradually slidingdown my seat into more of a“biological nurturing” positionand holding Joe against my bodyso that all of his body was incontact with mine. It felt lovely,comfortable and “right”.The value of keeping your babyskin-to-skin was not so widelyadvised by health workers whenI had my first baby and, to behonest, I feel guilty sometimesthat Lola and Joe had more ofthis experience than Emily did.After Emily’s birth it took me awhile to stop listening to friendsand relatives who meant wellbut who had no experience ofbreastfeeding or a more “attachedstyle” of parenting. I carried onlistening politely but learned waysto continue to parent happily andto find support and families whoshared similar ideas. I realized thatbreastfeeding on cue and for aslong as we both wanted to carryon was the choice for me. Emilyfed until she was about 20 monthsold.With all three children, even awriggling toddler if I am lucky, Ienjoy the warmth and closenessof snuggling up and lots of mostdefinitely public displays ofaffection. To me this is a wonderfulPhoto © shutterstock.comextension and natural progressionof the biological nurturingapproach.* Ochert, A “Biological NurturingOr Laid Back Breastfeeding”Breastfeeding Today issue 5 2010http://viewer.zmags.com/publication/94fb8af9#/94fb8af9/6Colson, S An Introduction toBiological Nurturing: <strong>New</strong> Angles onBreastfeedingRead extracts from the book herehttp://viewer.zmags.com/publication/94fb8af9#/94fb8af9/8Today• Issue 6 • 2011 | llli.org

No. 10344and prostateNo. 10343with love.been fulfi led.No. 10341completed.sti l loved.entirely.baby.Reflux Disease.No. 10342eatingthe stomach)or spi ting-upseveral breathsweight percentileinfectionsasthmahabitsand night.the pain is gone.nurse:more easily.milk flow a bit.<strong>New</strong> items atGlobaLLL015store.llli.orgBreastfeeding AnswersMade Simple: A Guide forHelping Mothersby Nancy MohrbacherBalboa Baby Nursing PillowDeveloped with lactation consultantsand medical professionals, the BalboaBaby® Nursing Pillow makes nursingeasier and more comfortable.LLLI Information Sheets (Tear-Off)*provide easy-to-read, and research-basedmothering topics/information for new moms. (50 sheets per pad)*Available in Spanish, and will be available in additional languages soon!Vitamin D,Your Baby, & You(Click here)Safe Sleep forBreastfeeding Babies(Click here)What is Reflux?(Click here)What about Weaning(Click here)Breastfeeding Tips(Click here)Tips for BreastfeedingTwins(Click here)Establishing YourMilk Supply(Click here) English/SpanishA Guide to PumpingYour Milk(Click here)Inceasing YourMilk Supply(Click here)Breastfeeding AfterCesarean Birth(Click here)Vitamin D,Your Baby,and YouIt is a known fac that humanmilk is the superior infant food.Human milk is the most completenutritionaly, immunologicaly,and is the only food designedspecificaly for your baby.Given that it is expected to be“perfect,” you may be confusedabout why your baby’s doctoris encouraging you to giveyour breastfed baby vitamin Dsupplements.In 2008, the American Academyof Pediatrics (AAP) amendedits recommendation regardingvitamin D supplementation ofinfants and children. The currentrecommendation reads: “Asupplement of 400 IU/day ofvitamin D should begin within thefirst few days of life and continuethroughout childhood. Anybreastfeeding infant, regardlessof whether he or she is beingsupplemented with formula,should be supplemented with400 IU of vitamin D.” (Pediatrics2008; 122(5):1142-52)© October 2010, La Leche League InternationalWhy is vitamin D important?Vitamin D is a key nutrient in the maintenanceof bone health in children and adults. Becausevitamin D is e sential for promoting calciumabsorption in the body, vitamin D deficiencyis marked by such conditions as rickets (inchildren), osteomalacia (in adults), and canlead to osteoporosis if left unchecked longterm.While researchers are sti l working toprove a cause-and-e fect relationship betweenlow levels of vitamin D and other health i sues,anecdotal and epidemiological (trackingthe o cu rence of a disease or condition ina population over time) co relations havebeen found between vitamin D insufficiency/deficiency and the fo lowing:• Cancers; specifica ly of the colon, breast,• Hypertension (due to calcium’s role in theregulation of blood pre sure)• Diabetes (both type I and type I); insulinresistance/pre-diabetes may also be related tovitamin D insufficiency• Multiple sclerosis, rheumatoid arthritis, andother autoimmune conditions957 North Plum Grove Road • Schaumburg IL 60173 USA847.519.7730 • fax 847.969.0460 • 800-LALECHEI spend a lot of time outside.Surely I’m not deficient invitamin D.This informational sheet may not be reproduced in any mannerwithout written permi sion from La Leche League International.Sleeping with ourbabies is an instinctas old as motherhooditself. Ye today, someauthorities say it’srisky. What are thefacts?who smoke and share a bed with wriggle and ye l if she did!) Hertheir infant also increase the risk, sl ep cycles tend to synchronizeregardle s of where or when the with his, often increasing sl epparent smokes. One in five SIDS time and lowering stre s for both.deaths o curs in daycare. 3Unfortunately, some mothers,mistakenly believing their bed isa SIDS risk, move to a couch orrecliner with the baby – a muchisn’t SIDS. It almost always involves greate risk than the bed they left. 7either prone (face-down) sl epingor a baby becoming wedged, forinstance in a couch 4 o recliner.Sharing sl ep with an adult who “A l bedsharing,” “a l babies,” andsmokes or is impaired by drugs “a l bed partners” are no the same,(SIDS, Crib Death, or Cot Death) or alcohol is risky. Using pi lows, just as “a l drivers” are no theis the unexpected and unexplainable props, or soft bedding to “help the same. Anything that interferes withdeath of a baby. The highest risk baby sl ep” increases risks. 5 When a breastf eding puts a baby at higheris during the first six months. The breastf eding mother sl eps in bed risk. 8 There is no known increasedgreatest SIDS risk factors are with her baby, she tends to curve her risk when a sober, non-smoking,smoking during your pregnancy and body around her baby in a “cuddle breastf eding mother sl eps with herplacing your baby face-down for curl” that eps the infant at breast baby on a safe surface.sl ep. 1 Formula-fed children have level and k eps her from ro lingdouble the risk of SIDS. 2 Parents onto him. 6 (And of course he wouldSudden Infant DeathSyndromeThere are a few factors that have an impacton the vitamin D content of a mother’s milk.Most significantly, the vitamin D status ofthe mother during pregnancy and lactationimpacts the vitamin D status of the baby atbirth, as we l as mother’s ability to transfervitamin D via her milk. In 2003, data releasedby the Thrasher Research Fund/US NationalInstitutes of Health reported that 81% ofwomen of childbearing age have insufficientlevels of vitamin D. While there is sti l someuncertainty abou the optimal level of vitaminD for adults, there is recent agreementamong the medical community that vitamin Dinsufficiency is represented by a blood level ofle s than 32 ng/mL. Those with blood levelsbelow 20 ng/mL are considered deficient invitamin D. How has vitamin D insufficiencyreached epidemic proportions?We as a population have heeded the warningsof the medical community and limited ourunprotected exposure to the sun. The use ofsunscreen, while important in the protectionagainst skin cancer, blocks the rays of the sunthat are nece sary for our bodies to convertsunlight into vitamin D through the skin.© October 2010, La Leche League InternationalFor more informationli.orgSu focation“Cuddle Curl”957 North Plum Grove Road • Schaumburg IL 60173 USA847.519.7730 • fax 847.969.0460 • 800-LALECHESafe Sleep for Breastfeeding BabiesHere’s what our babies have always “expected” at night:During sleep, babies “expect”… What you can doATTENTIVE, SOBER ADULTS. Even in your sl ep, you normaly know whereBe aware of your and your partner’s condition. A baby should never sl epyour baby is just as you know where your bed edge is. Alcohol and certainwith young children or anyone who is compromised.medications alter awarene s during sl ep and increase the risk of su focation. 9CLEAN AIR. A smoking parent greatly increases the risk of SIDS. (Smokingduring pregnancy increases risk even more.)BACK- SL EPING. Stomach-sl eping on a flat, horizontal surface increases therisk of su focation and SIDS 1 unle s the surface is a parent’s chest.k ep your baby in a separate space within arm’s reach.10If you or your partner smokes at a l, bed-share only for f edings. Otherwise,This takes care of itself. Breastf eding babies who sl ep with their mothersdon’t ro l onto their stomachs.Eliminate gaps – betw en bed and wa l and betw en bed and rail – that couldtrap your baby’s face. Avoid ma tre ses and couches that ro l your babytightly against you, or any surface too soft for your baby to lift his head fromA GAP-FR E SURFACE and reasonable airspace, to avoid su focation risk. 12 if he’s face-down. No pi lows or props for the baby. Light blankets wi l “tent”over you both, leaving plenty of air for your baby. Pu ting the ma tre s on thefloor eliminates many risks.The breastfed baby heads toward your breast and stays out of trouble.BREASTF EDING. Bo tle-f eding behaviors increase su focation risk. 13Bo tle-fed babies don’t orien this way, and their mothers aren’t as sensitiveBreastf eding to sl ep is normal and healthy.to their own sl ep position. If your baby isn’t at least partly breastfed, it’ssafer for him to sl ep separately, always within arm’s reach.If you don’t breastf ed, have your baby sl ep face-up within arm’s reach on aHUMAN MILK. Formula-fed babies are more than twice as likely to die ofseparate surface. For help with breastf eding, ca l La Leche League. There areSIDS. Su focation and othe risks rise with formula-f eding as we l. 14often surprisingly simple solutions to what may f e like big problems.FR EDOM OF MOVEMENT. A swaddled baby can’t protect his airway, changehis position, reach his mother, suck on his hands, o regulate his temperature,Don’t swaddle your baby.sl ep state, or appetite normaly. Swaddling increases the risk of both SIDSand su focation. 15, 16About Weaning:This informational sheet may not be reproduced in any mannerwithout wri ten permi sion from La Leche League International.Because BreastfeedingIs More Than MilkIdea ly, the breastfeedingrelationship wi l continue until thebaby outgrows the need© October 2010, La Leche League International957 North Plum Grove Road • Schaumburg IL 60173 USA847.519.7730 • fax 847.969.0460 • 800-LALECHEFor more informationBreastfeeding addre ses numerous needsin the baby and toddler including, but notlimited to: hunger, thirst, nutrition, skin-toskincontact, touch, eye contact, engagement,love, mother-baby bonding, comfort, security,safety, warmth, a tention, connection, quiet,centering, relaxation and suckle The need forcomfort suckling or non-nutritive sucklingmay last for several years as witne sed by theuse of bo tles, thumbs and pacifiers by manytoddlers and preschoolers. Each weaning isas unique as your baby or toddler and yourfamily’s circumstances. And it is for this reasonthat La Leche League International emphasizesthat weaning should be done gradua ly and other than nursing. The baby’s father, themother’s partner, and other family memberscan be a great help during this time.Weaning is a process that beginswith the first introduction of asubstance other than breast milkli.orgchild wi l insist on nursing, what a baby needsIn American culture, the word “weaning” Abrupt weaning is the most difficult for bothmost during weaning is rea surance that he isis usua ly a sociated with something we the mother and the baby and should beare giving up. However, weaning is no the avoided if at a l po sible. Serious drawbacksce sation of breastfeeding, but rather the of abrupt weaning include physical discomfortaddition of other foods to the breastfeeding and potential health complications for the The practical details of a planned weaningchild. Rather than an event, weaning is a mother. Because breastfeeding is a source wi l depend upon the age of the child. Alwaysproce s that can last days, weeks, months of comfort and closene s as we l as food, an consult your doctor about wha to give youror years. When we talk about breastfeeding abrupt weaning may be emotionaly traumatic baby in place of mother’s milk. For the veryand natural weaning, we are talking about for the baby. A planned gradual weaning is young baby, weaning involves finding anfulfi lment or satisfaction. Natural weaning preferable because it a lows a mother to slowly appropriate substitute for mother’s milk ando curs when your baby’s need for nursing has substitute other kinds of extra loving a tention then replacing breastfeeding with bo tles. Ifand a fection to compensate for the closene s the baby is close to a year old, already eatingthey shared while nursing. Eliminating one other foods, and drinking we l from a cup,daily feeding every two or three days a lows a mother may be able to forgo the bo tlethe mother’s milk supply to decrease slowly,with li tle or no fu lne s and discomfort.Since nursing takes care of a wide variety ofFor the younger baby, the first concern duringneeds, the most e fective way to lead babiesweaning is nutrition, since breastfeeding isthrough weaning is to gue s a curately whatfirst and foremost a method o feeding thatthe child’s cu rent most pre sing needs are If a mother te ls her doctor that she’d like to also provides closene s and comfort. In orderand then mee those needs with something continue nursing or be given time to wean to gradua ly wean a young baby, substitute aThe optimal approach toweaning matches the needs andrequirements of the child.Avoid abrupt weaning wheneverpossibleWhen abrupt weaning isrecommended for medical reasonsGastroesophageal refluxis the medical term formilk and stomach acidbackwashing out of thestomach into the throat.Reflux is also ca led wetburps or spitting-up.gradua ly, alternatives can usua lybe found. For example, if a drug thatis prescribed for a mother is foundto be one of the few drugs that areincompatible with breastfeeding, thedoctor may be able to substituteanother drug if he knows the motherwants to continue nursing. Sometimesa recommended course of medicaltreatment or specific procedure canbe modified or delayed. La LecheLeague Leaders have information onthe compatibility of specific drugswith breastfeeding. Even when amother mus take a drug that isincompatible with breastfeeding,she sti l has the option of continuingto expre s her milk and returningto breastfeeding after treatment isThe baby also has special needsduring an abrupt weaning. The baby’sdoctor should be consulted aboutwhat foods to substitute for mother’smilk, which may vary dependingon the baby’s age. The baby wi l also needlots of extra holding and focused a tentionfrom loving family members. Although manymothers feel the urge to distance themselvesfrom their babies while weaning for fear theThis informational sheet may not be reproduced in any mannerwithout wri ten permi sion from La Leche League International.What is Reflux?The valve betweenthe stomach and theesophagus is onlysupposed to open whenyour baby swa lows orburps. Reflux happenswhen the valve doesn’tclose tightly or opensfor no reason.Any baby on thisspectrum can benefitfrom the ideas in thispublication.1. Most babies have o casional© October 2010, La Leche League InternationalPlanned Weaning of a Younger BabyFor more informationli.org957 North Plum Grove Road • Schaumburg IL 60173 USA847.519.7730 • fax 847.969.0460 • 800-LALECHEBreastfeeding your baby with gastroesophageal reflux.If your baby experiences any ofthese problems, please discu sthem with your doctor so youcan work together and preventthem from becoming serious.• Spi ting up large quantitiesvery frequently or hours after• Vomiting (more forceful thanspi ting-up and usua ly emptying• Painful crying after wet burps• Crying, fu sing or arching theneck and back during feeding• Baby seems reluctant to nurse• She may have poor weight gainor pu ls away from the breastuntil the pain is gone.• Unusual eating pa terns, constantfeeding or feeding only when sleepy• Noisy breathing or congestion• Many babies with reflux find that • Use breastfeeding positions that• Breath-holding spe ls, skippingbreastmilk is soothing on their sore don’t put pre sure on the baby’sthroats. Breastmilk helps wash the stomach. When her tummy is beingEnglish (Stomach + Esophagus• Frequent gagging, coughing, acid back down into the stomach. squeezed, the milk comes back up+ Backwash) = Latinchoking or sneezing(Gastroesophageal Reflux)• She may nurse constantly a l day• Poor weight gain, fa ling to a lower• Use breastfeeding positions thatkeep your baby’s head higher than• She may want to nurse after every her stomach. She may also prefer to• Frequent throat infections, red wet burp or spit-up.keep he right ear up. This keeps thethroat, colds, ear congestion or• She may gain a lot of weight until top of the stomach higher than themilk in her stomach.• Any serious respiratory problems• If your baby chokes during the letdown,try positions that let her facesuch as bronchitis, pneumonia,episodes of reflux every day. Thisyour body, not the ceiling. Theseis perfectly normal and doesn’t • Breath that sme ls sour/acidicpositions a low her to release theusua ly cause any problems for thebreast and let some milk dribble out• Frequent hi cupping and burping• This baby wi l probably behave in of her mouth when the flow is too• Waking suddenly with painful ways that confuse her mother. When fast. You can also try taking her o fcrying, unusua ly poor sleeping she is hungry her tummy wants food, for a few seconds and pre sing youramounts after every meal. You andbut if her throat is sore from acid breast with your palm to slow theyour doctor wi l wan to watch yourshe might not want the milk to touchbaby carefu ly for signs of trouble.her throat. She is confused and isWhen a baby has acid backwashing• Encourage your baby to nursenot sure whether to eat or not.from the stomach into thefrequently and take sma l amountsesophagus, this can cause throat • She may fu s and act hungry but at a time. Overfi ling her stomachproblems when the stomach acidpain. The pain can range from minor refuse to eat until she is starving. makes the milk come back up easier.burns the delicate lining of theto severe. It may last for a fewthroat or airway or the baby can’t• She may eat very fast, but stop • Nursing at one breast per feedingminutes or a l day.gain enough weight. This is ca ledafter only a few minutes.can help your baby avoid overfi lingher stomach. It also helps her get a• She may become afraid of eating.balance o foremilk from the front of• She may eat be ter when she is the breast and hindmilk from deepersleepy because she feels le s pain. in the breast. Both are important2. Some babies spit up large3. Some babies experienceReflux SymptomsWhen a baby has throatpain, it can a fect nursing.Pa tern #1 Babies with refluxwho nurse for comfort:Pa tern #2 Babies withreflux who feel pain when theyThis informational sheet may not be reproduced in any mannerwithout written permi sion from La Leche League International.Tips that minimize refluxepisodes:For more informationllli.orgdo you want to be a midwife?Paths to Becoming a Midwife, Getting An Education, 4th EditionAre you thinking about becoming a midwife, but you’re not sure what kind of midwife youshould be, or what training options would be best for you?Paths to Becoming a Midwife:Getting an Educationis designed to help you answer these questions and sift through thevarious options available to aspiring midwives in the United States.The fourth edition of this book includes several new articles on the various midwiferyphilosophies, new information on becoming an apprentice, dozens of recently updatedarticles, and a current directory of morethan 150 schools, programs and other resources.midwiferytoday.com/products/C614PM.htmPaper, 274 pages C614PM $32.95 + S&HTel: (541) 344-7438 (800) 743-0974 US/CANFax: (541) 344-1422 E-mail: orders@midwiferytoday.comwww.midwiferytoday.comllli.org | 2011 • Issue 6 •Today

LLL <strong>New</strong>s01611MonthMonth10GlobaLLLLLL Abu DhabiKirsty LarmourWhen expats come to live in AbuDhabi they’re often not sure whatto expect. How does this relativelyconservative Muslim city live withthe many cultures and peoplewithin its confines? One pressingquestion for moms and moms-tobeis how easy and acceptable isbreastfeeding here?It’s a huge relief to many mumsto find that the Koran mentionsbreastfeeding should continue fortwo years. But where are all thebreastfeeding ladies? Are theyhidden away in the bathrooms?Are there feeding rooms that youcan’t find? Is there some secretcode? Do the local ladies hide theirbabies under the folds of theirabayas? Well, the answer to thelast question is sometimes yes! Butthe Abu Dhabi La Leche Leaguegroup set out to show the mothersof Abu Dhabi that nursing yourbaby is really okay anywhere andeverywhere.We launched a campaign tofind willing models—ladies whowould be prepared to breastfeeddiscreetly in public, out andabout around Abu Dhabi—andthe models and their beautifulbabies of all ages came, and wephotographed them—in parks, incoffee shops, in malls, in hotels,inside, outside—all over the city ofAbu Dhabi.The fruit of all this hard work isthe “La Leche League of Abu DhabiBreastfeeding Awareness Calendar,”which will not only help to raisefunds, but we hope will adornthose coffee shop and hotel walls,and be seen in doctor’s waitingrooms, hospitals, schools, nurseries,gyms and cafés to show that theseplaces are breastfeeding friendly,and to show that as long as youare respectful of the conservativenature of the city, you can, shouldand are welcome to breastfeed allover Abu Dhabi.All photography for the projectwas done by Kirsty Larmour (www.kirstylarmour.com) who has beenlucky enough to receive wonderfulsupport from LLL in Hong Kongand Guangzhou, China, as wellas Abu Dhabi, when nursing herown two daughters. More photoscan be seen on her blog at www.kirstylarmourblog.comMonth12Today• Issue 6 • 2011 | llli.org

A look at what is happeningin LLL around the worldLLL Belgique, associationd’accompagnement à l’allaitementLLL <strong>New</strong>s017LLL USAThe Surgeon General’s Call to Action toSupport Breastfeedingwww.lllbelgique.orgChristina De SchepperFrench-speakers around the world might liketo know about LLL Belgium’s new brochure thatthey can download from the Web site, entitled“Allaitement maternel, chacun son chemin!”which loosely translates as “Breastfeeding, toeach his own path!” Mothers and health careprofessionals are very enthusiastic about it, as itis concise while offering quite an array of basicuseful breastfeeding information in a respectfulway that empowers the mother to make informedchoices.Rejoignez-nous sur Facebook!www.facebook.com/group.php?v=app_2373072738&ref=nf&gid=336043462215#!/group.php?v=wall&ref=nf&gid=336043462215L LLGBThe Surgeon General’s Call to Action to SupportBreastfeeding outlines steps that can be taken toremove some of the obstacles faced by womenwho want to breastfeed their babies.LLL CanadaL’allaitement maternelChacun son chemin !ous embarquez pourVun voyage riche endécouvertes : la vie avecvotre enfant. Ce guide vouspropose des indicationssuccinctes, que votreexpérience avec votre bébéet d’autres ressources(sites, publications,rencontres avec d’autresparents…) complèteront etenrichiront.Nous vous souhaitons beaucoupde bonheur avec votre enfant.La Leche Leaguewww.lllbelgique.orgYou can find ithere: http://www.lllbelgique.org/pdf/LLL003-10brochure_pdfversion.pdfNote that everyphoto illustration is a real-life image taken andsubmitted by families for a photo contest. Nostudio set-ups!See also a newmagnet withbreastmilkconservationguidelines:http://www.lllbelgique.org/livres-allaitementparentalite.phphttp://www.lllgbbooks.co.uk/product/446/Pack-of-8-Postcards/default.aspxBeautiful mother and baby postcards availablenow for sale from LLLGB. FREE postage andpacking worldwide. Selling at £2.50 for eightcards, with four of each design per pack. Thedesigns are the front cover of The WomanlyArt of Breastfeeding 8th edition 2010 LLLIPinter & Martin, featuring Bronwyn Millar anddaughter Ruby, and a cover painting ©CassiePearson age 13 of LLLGB’s bi-monthly magazine,Breastfeeding Matters.This is the 30 second PSA spot we producedfeaturing Sitara Hewitt from Little Mosque onthe Prarie for the La Leche League Canadacampaign “Because breastfeeding isn’t alwayseasy, we’re here to help”L LLIEver heard of a little thingcalled Facebook? We’re so onit. And you can “like” us there.We tweet – lots.Follow us now!(continue on page 28 )llli.org | 2011 • Issue 6 •Today

Naomi Stadlen018Uplift of Our Series MeetingsNaomi Stadlen, London, UKMothers often write to say howthey feel at their first La LecheLeague Series Meeting, that theyhave “come home.” I am movedevery time I read one of theseaccounts. My own experience wasdifferent. It was over 20 yearsago now. The meeting was quitenear my home, but I arrived late.I squeezed into a space nearthe back and tried to follow thediscussion.It’s importantto have a placewhere one canspeak honestly.Series Meetingsgive breastfeedingmothers a safe placeto acknowledgedifficulties.I had loved breastfeeding, and itseemed to me that everyone wascomplaining how difficult it was.The Leader was doing her bestto offer solutions to some of theproblems that mothers raised. Butevery time she made a suggestion,mothers would raise even moreproblems. I think that, because Ihad missed the beginning of themeeting, I wasn’t in tune with itsflow.Also I was the only mother therewithout a baby. My children wereall at school. I had already trainedwith the National Childbirth Trustas a breastfeeding counselor.However, I learned about La LecheLeague from Jean Waldman, wholived locally. During the 1970s,she was one of the motherswho started LLLGB. I met herin 1988, and she suggested Iconsider becoming a La LecheLeague Leader. She recommendedthat I start by coming to SeriesMeetings, which she said she founduplifting. After my first meeting,I explained to Jean that I hadn’tbeen uplifted. She laughed andinvited me to the next meeting,which she was leading herself.So, one month later, I set outagain. It was a cold, rainy, windhowlingmorning, and this time thevenue was a long way from whereI lived. “Why am I doing this?” Ithought, struggling to open myLondon A–Z under my wind-shakenumbrella. I was in an unfamiliar partof London and it took me a longtime to locate the venue. However,this time, I was there from thebeginning, and the discussionmade perfect sense to me.The sitting-room of the hostess’sflat soon filled up with mothers,many as cold and wind-blown asI was. All complained, sometimesbitterly, that it was so hard to be amother. One mother put it vividly:“Even the ticket collector at mylocal station, all dressed up in hisuniform, seems to have more pridein himself than I do. Yet his jobisn’t half as responsible as mine.But I don’t feel that.”I noticed that Jean didn’t tell herto feel any differently. She didn’toffer any advice, any solutions,or even comfort. She simplythanked each mother for speaking,and moved on to the next one.By doing this, she had left eachmother with the dignity of herstatement. She was receiving andaccepting everything that motherssaid to her.However, it wasn’t until the endof the meeting that I saw howeffective this was. Collectively,Photo © veer.commothers’ complaints added up toa very gloomy picture. Jean hadn’tchanged that. So I was extremelysurprised that, when we all got upto go, and mothers dressed theirbabies to go back to the situationsthey had just been complainingabout, I could hear a lot of laughterand cheerful voices. I myself feltlighter and more energetic. Whatmagic transformation had just takenplace?There are many ways to leadmeetings, and the Leader at myfirst meeting had given mothersplenty of valuable informationabout breastfeeding. But I wascompletely inspired by Jean. Icould see the wisdom of hergenerous kind of listening. Shedidn’t offer solutions to problems,perhaps because they were notrequests for specific information.Yet her whole demeanor and wayof talking expressed her love forbreastfeeding and also her trust ineach mother. I determined to trainto be a Leader myself.It’s important to have a placewhere one can speak honestly.Series Meetings give breastfeedingmothers a safe place toacknowledge difficulties. No oneis going to tell her she is “makinga rod for her own back” [ie thatshe is doing something that islikely to cause problems for her inthe future]. This is a frequent butcompletely heartless comment tomake to a breastfeeding mother.Many mothers don’t like to tellother people how tired they feelin case they get that response. AtLa Leche League meetings, mostmothers are tired, and everyoneknows it is in a good cause. A tiredbreastfeeding mother is given therespect she deserves.Now I know exactly why motherssay of our meetings that they feelthey have “come home.”Naomi Stadlen and Anthony havethree children and one grandson.Naomi became a La Leche LeagueLeader in 1990, and co-leads theCentral London Group, LLLGB. Sheruns Mothers Talking, discussiongroups for mothers in London. Herbook, What Mothers Do—EspeciallyWhen It Looks Like Nothing, hasbeen published by Piatkus (GB)and Tarcher/Penguin (USA) and isavailable from www.lllgbbooks.co.ukToday• Issue 6 • 2011 | llli.org

What’s Cooking019VeganTeresa PitmanMy daughter, Lisa has been a vegan mostof her life. We learned early on that meat,dairy products and eggs caused her digestiveproblems. At first, I cooked separate meals forher while making more traditional foods for therest of the family. Eventually one of my sonsand I became vegan as well, and the othersin our family eat vegan meals when we aretogether. We’ve found it to be a very healthy,fairly inexpensive, environmentally sound way toeat that also helps us achieve our goals of notcausing suffering to animals.Kale Avocado Salad(Lisa’s recipe)1. Tear up the leaves from a bunch of kale intobite-sized pieces and place in a large bowl.2. Add a Tbsp of olive oil, the juice of half alemon and a tsp of sea salt.3. Massage everything together for a coupleof minutes (the kale should change texture tobecome almost wilted).4. Peel and pit an avocado (or two). Mash theavocado flesh into the kale, to coat the leaves.5. Top with half a red pepper, julienned and afinely chopped scallion.MethodSpray a 4-quart saucepan with non-stick cookingspray, then add the apples, sweet potatoes, waterand salt. Cover and cook for about 20 minutesover low heat, stirring often. Then turn the heatup a bit and add more water if needed and cook,stirring often, for another 20 minutes. Add otheringredients and mash thoroughly.(I think this could also be cooked in a crockpot.)photos courtesy Lisa PitmanLisa now has a blog at www.vegancookbookcritic.blogspot.com featuring photos, recipes andcookbook reviews. Here are three vegan recipesthat make up an easy and delicious meal.This is also good without the avocado.Ginger Mashed Sweet Potatoesand Apples(Recipe by Isa Chandra Moskowitz from Appetitefor Reduction. Excerpted by arrangement withDa Capo Lifelong, a member of the PerseusBooks Group. Copyright (c) 2010.)Ingredients2 apples, peeled and cut into 1/2 inch chunks2 pounds of sweet potatoes cut into 1/2 inchchunks1/4 cup water1/4 tsp salt1 Tbsp agave nectar1/4 tsp cinnamon1/2 tsp freshly grated gingerForty-Clove Chickpeas and Broccoli(also from Appetite for Reduction)Ingredients1 pound of broccoli cut into large spears,stems chopped into 1/2 pieces10 cloves of garlic, smashed1 15-ounce can of chickpeas, drained and rinsed2 tsp olive oil1/4tsp salt2 tsp lemon zest11/2 tsp dried oregano1 cup vegetable brothMethodPreheat 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 inoven and bake for about 30 minutes, turningonce. Remove from oven and add the vegetablebroth. Use a spatula to scrape the bottom ofthe pan to get any tasty bits and to stir up theingredients again, and put back in the oven foranother 15 minutes. Your whole house will smellgarlicky and amazing.photo © shutterstock.comllli.org | 2011 • Issue 6 •Today

What’s Cooking020Some commonquestions andanswers aboutbeing veganWhere do you get your protein?Most foods have some protein inthem—even vegetables. Beans, nuts,seeds and mushrooms are all goodsources of protein. Wheat gluten is alsooften made into “imitation meats” and ishigh in protein. Tofu, tempeh and nondairymilks can also add more protein toa vegan diet. The reality is that most ofus get more protein than we really need.What about Vitamin B12? This isthe one nutrient that is hard to getin a vegan diet, but it is readily availableas a supplement or is added to foodssuch as nutritional yeast.Is a vegan diet expensive?It can be if you buy a lot of processedvegan foods, such as veggie burgers,but the basics of vegan eating—beans,vegetables, whole grains, fruits, nutsand seeds—are generally significantlyless expensive than meats and dairyproducts. A commitment to vegan eatingalso keeps you out of most fast foodrestaurants—another saving!Is a vegan diet adequate forpregnant and breastfeedingmothers? With planning and attentionto meeting your nutritional needs, avegan diet can supply all you need duringpregnancy and lactation. And mother’smilk is the perfect food for the veganbaby!“What’s Cooking” is edited by LLLLeader Lesley Robinson. She lives inOttawa, Canada with husband, Mark. Herthree grown children have flown the nest.Send your recipes and photos please toeditorbt@llli.orgLLLI Cookbook SetFor a limited time, buy the most popular LLLIcookbooks at a bargain price! The set of WholeFoods for the Whole Family, Whole Foods from the WholeWorld, Whole Foods for Kids to Cook, and Whole Foodsfor Babies and Toddlers will satisfy every craving fordelicious and nutritious meals and snacks!LLLI LogoPins$7.50 ea. | Green, #10296 | Blue,#10298 | Orange, #10300LLLI (metal) logo lapel pin with military clutchbacking. Size is .75” and comes in a 1 1/8”square clear acrylic gift box.photo © shutterstock.comToday• Issue 6 • 2011 | llli.orgGreat Giftfor LLL Leaders,Members, Supportersand Friends!

Letters PageYour Letters021Photo ©shutterstock.comSTAR LETTERIn The NightI recentlygave birth to abeautiful littlegirl and we had arough start withbreastfeedingin the firstfew weeks.My husband was so supportive throughout.He was even inspired to write a poem abouthow wonderful breastfeeding is and it actuallyencouraged me to keep going.The title is 4 A.M. because he wrote it one nightwhen I was having a hard time getting my baby tolatch on properly. I was upset and my baby wasupset but my husband kept reminding me howgreat breastfeeding is to keep me going. It mademe realize that now might be hard but if we workat it then it will get better.Lisa Bakowski, Raleigh, North Carolina, USA4 A.M.by Adam BakowskiArms flailingChild wailingKeep it togetherThe benefits last foreverYour neck, back and wrists are soreThis feels so much like a grueling choreYou find yourself in awkward positionsSometimes in the most embarrassing conditions365 days is the goalOne day these antibodies may fight off a coldThe reasons are manyFocus to keep your routine steadyThe bond this providesEliminates the dividesMother and child embraced as oneThe love and compassion have just begunThe Big Brother When my daughter, Hannahwas born a few months ago, I had expectedto be tandem feeding as Thomas (now almostthree) was still having a very short breastfeedonce every week or two. We had discussed howlittle babies need to feed lots and how he wouldhave to share. When he came to meet his newsister in the hospital and I fed her (after theintroductions), he said, “Hannah’s having milkfrom mummy, I used to have milk from mummywhen I was a baby.” He hasn’t asked to breastfeedsince, which both surprised and pleased me.The photo of the three of us is not a veryflattering one of me, but I’ve included it as itshows me trying my best to include my son,which I feel is very important, while nursing mynew baby.Gillian Mabbitt, <strong>New</strong>castle, UKTips on Helping <strong>New</strong> Moms Yesterday atour La Leche League Series Meeting mothersshared what they thought were helpful thingspeople could do for a mother who has just had ababy. These were three I particularly liked.“Putting a cup of tea where Ican reach it.”“Cutting my food up into bitesizedportions and seasoning itappropriately.”“Telling me, ’Well done, youare doing a really good job.”Marion Jones, Derbyshire, UKPhoto of Gillian Mabbitt, Hannah & ThomasPlease send your letters and photosto editorbt@llli.orgprizeA for thestar letter!The star letter for Issue 7,2011, will receive the new 8thedition of The Womanly Art ofBreastfeeding!BreastfeedingBasics 20-minute DVDthat discusses gettingbreastfeeding off to theright start, positioning,latch-on, the suckling reflex,let-down technique,and more.BreastfeedingComprehensive135-minute DVD thatdiscusses the benefits ofbreastfeeding, positioning,latch-on, the suckling reflex,let-down technique, howthe breast makes milk, foremilk and hind milk, medications and humanmilk, problems and solutions, breastfeedingand special situations, maximizing supply, afather’s role, attachment parenting, weaning,politics and the law, and more.BreastfeedingIntensive 45-minuteDVD– discusses thebenefits of breastfeeding,positioning, latch-on, thesuckling reflex, let-downtechnique, how thebreast makes milk, fore milk and hind milk,medications and human milk, and more.llli.org | 2011 • Issue 6 •Today

Nancy Mohrbacher022<strong>New</strong> <strong>Insights</strong> on Nipple ShieldsIf you’ve ever used a nipple shield—or knowsomeone who has—you’ve probably receivedconflicting advice about its use. Most nippleshields are made of silicone and consist of a thin“brim” that covers all or part of the areola (thepigmented area around the nipple) and a firmer,protruding “tip” that fits over the nipple. Whena baby breastfeeds with a shield in place, milkflows through the holes in its tip. Nipple shieldsare one breastfeeding tool many mothers loveto hate, in part because of their inability to getconsistent answers to questions such as thefollowing: When is a nipple shield an appropriatetool? Should a mother using a nipple shieldexpress milk after feedings to safeguard hermilk production? Should weaning from theshield 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. Duringrecent decades, the pendulum has swung toboth extremes. After a time of nipple shieldsbeing given out freely in hospitals after birth,their use was strongly discouraged (Mohrbacher& Stock, 1996; <strong>New</strong>man & Pitman, 2006).However, both research and case reportssuggest that in some situations, nipple shieldscan 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 pretermbabies who slipped off the nipple during pausesor fell asleep early in feedings suckled longerand took more milk when a nipple shield wasused (Meier et al., 2000). All of the 34 babiesin this study who used the shield took more milkdirectly from the breast, with a mean increase of14.4 ml (about a half-ounce), suckled for longerbursts and stayed awake at the breast longer.Photo of Athena courtesy Sacha BlackburneThe length of time these preemies used theshield varied, with a mean of 32.5 days. Onaverage, the mothers used the shield for about24% of their time breastfeeding. The babieswho were previously unable to transfer milkwithout the shield used it longer than the babieswho took some milk from the breast alone.There was no association between the lengthof time the shield was used and duration ofbreastfeeding. The reason the shield helps somepreemies is not yet fully understood, but somethink its firmer tip may push deeper into thebaby’s mouth, triggering more active suckling(Hurst & Meier, 2010).Today• Issue 6 • 2011 | llli.org

Nancy Mohrbacher023In one US retrospective telephonesurvey, 202 breastfeeding mothersreported using nipple shields forthe 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 withflat or inverted nipples is havingdifficulty taking the breast, the tipof the nipple shield can providethe firm feeling deep in his moutha baby is looking for. Problemslike this may be more likely forthese mothers when bottles and/or pacifiers (dummies) have alteredbaby’s expectations (Wilson-Clay& Hoover, 2008). For this samereason, a shield may help a newborntake an engorged breast or helptransition a reluctant bottle-feedingbaby to the breast (Wilson-Clay,1996). For mothers with damagednipples, temporary use of a nippleshield may provide just enoughpain relief to avoid interruptingbreastfeeding. For the baby withhigh muscle tone or tongue-tie,the firm shield can help push thebreast past a retracted or humpedtongue to trigger active suckling(Genna, Fram, & Sandora, 2008).With some breastfeeding problems,using a nipple shield can allow thebaby to feed directly from thebreast, simplifying a mother’s life byminimizing the need to express hermilk and feed it to her baby anotherway.That said, however, wheneverpossible it is always better to try tosolve a problem first by improvingbreastfeeding dynamics ratherthan by using a nipple shield. AnAmother can feel at ease aboutusing the shield as long as ithelps the baby breastfeed moreeffectively. In general, as the babymatures, his coordination increases,and as he develops more practice andpositive associations at the breast,the easier it will be to wean himfrom the shield.inappropriate use of a nipple shieldwould be for a supporter to offer itas the first solution to a problem oras an alternative to spending timehelping a mother make adjustmentsin how she puts her baby to thebreast.Do Mothers Using NippleShields Need to ExpressMilk after Breastfeeding?Originally, mothers using a nippleshield were told to express milkafter feedings because one studyfound reduced milk transfer whenthe shield was used. This 1980UK study found that thick nippleshields altered babies’ sucklingpatterns and the babies took lessmilk from the breast (Woolridge,Baum, & Drewett, 1980). Thebabies using the thick, rubber nippleshields took 58% less milk, andthose using the thinner latex nippleshields took 22% less milk thanwhen the babies took the breastalone. However, the babies in thestudy had been breastfeeding wellwithout the shield, and the changein suckling may have been simplybecause the shield was unfamiliar.<strong>New</strong>er research suggests that inmost cases expressing after feedingsmay not be necessary. A 2009study charted weight gain in 54babies who were breastfeeding witha nipple shield and whose motherswere not expressing milk afterfeedings. The researchers found nostatistically significant differencein weight gain at two weeks, onemonth, and two months betweenbabies using a nipple shield andthose breastfeeding without one(Chertok, 2009). In Selecting andUsing Breastfeeding Tools 2009,US lactation consultant CatherineWatson Genna wrote:“Many LCs encourage mothersusing a nipple shield to pump. Ioriginally followed the ‘party line’and encouraged mothers to expressmilk while using a nipple shield butsoon found that some motherswere developing uncomfortable[oversupply] and recurrent pluggedducts (Genna, 2009, p. 57).”Genna now individualizesher suggestions to mothers,encouraging them to watchtheir baby for signs of activebreastfeeding, satisfactionafterwards, normal energy levelsand stool output. If the baby seemssleepier than usual, has fewer thanfour stools per day before six weeksof age, or seems unsettled, she mayrecommend the mother express milkand supplement her baby with it.In some situations, expressing afterfeedings may make sense, such asthe mother whose milk productionis low or the mother who is unsureher baby is draining her breastseffectively. Regular weight checksare a good idea until it is obviousmilk expression is not needed. Afterfeedings with a shield, other signsof milk transfer that a mother cannote between weight checks areseeing milk in its tip and a decreasein breast fullness.When and How Should aMother Wean from aNipple Shield?The right time to wean from theshield depends partly on the reasonit was used. For example, when ashield is used to help a baby whohas been bottle-feeding recognizethe breast as a source of milk, itmay only be helpful for one feeding.But if a mother and baby have beenstruggling with breastfeeding forsome time and the baby considersthe breast a source of frustration, alonger time of easier breastfeedingto build positive associationsmay be better. The preterm babyusing the nipple shield to improvebreastfeeding effectiveness mayneed to grow and mature forseveral weeks before he can feedwell without the shield. In thestudy of preterm babies mentionedpreviously, the preemies who tookmore milk with the shield continuedto do so on average until theyreached their full-term correctedage of about 40 weeks (Meier etal., 2000). If a nipple shield helpsincrease milk intake at the breast, itmakes sense to use it as long as thisis the case.llli.org | 2011 • Issue 6 •Today

Nancy Mohrbacher024In the survey of 202 mothersmentioned previously, 67%eventually weaned from the shieldand breastfed without it, with thelength of shield use ranging fromone day to five months and a medianduration of two weeks (Powers &Tapia, 2004). Of the 33% whoused the shield for the duration ofbreastfeeding, 11% said the babywould have breastfed without itat any time but continued using itbecause breastfeeding felt morecomfortable with it. One motherused the nipple shield for theentire 15 months she and her babybreastfed.When the time seems right to weanfrom the shield, the mother maystart by breastfeeding with theshield. When milk ejection (let-down)occurs and the baby is swallowingmilk, try removing the shield quicklyand putting the baby immediatelyback to the breast. If the baby takesthe breast, the mother can use thisstrategy whenever needed to movefrom shield to bare breast. Usually, asthe baby becomes more coordinatedand more practiced (in my personalexperience this often happens atabout five to six weeks of age), theshield will be needed at fewer andfewer feedings.If this strategy doesn’t work, themother may continue using theshield at all feedings and try again afew days later when she and her babyare feeling relaxed, perhaps at a timewhen the baby is not too hungry(Mohrbacher, 2010). I suggest themother always strive to keep thebreast a pleasant place for her baby.If the baby is unwilling to breastfeedwithout the shield, it is best to avoidpushing the issue at every feedingbecause this can make the breasta battleground and lead to morefeeding problems.Although it was once recommendedto wean a baby from a nipple shieldby gradually cutting off the tip of theshield until it is gone, this strategy isnot recommended for the ultra-thinsilicone shields used today. This isbecause when cut, silicone has sharpedges that can irritate the baby’smouth.A mother can feel at ease aboutusing the shield as long as it helpsthe baby breastfeed more effectively.In general, as the baby matures, hiscoordination increases, and as hedevelops more practice and positiveassociations at the breast, the easierit will be to wean him from the shield.A baby may need the shield for onefeeding, a few feedings, a few days,a few weeks, or very rarely, a fewmonths. If the baby is unable orunwilling to breastfeed without theshield, chances are the problem thatcaused the baby to need the nippleshield in the first place is not yetcompletely resolved. A mother whowants to wean from the shield shouldtake her cues from her baby but keeptrying to offer the breast without theshield every few days.Nancy Mohrbacher, IBCLC, FILCAis an active La Leche League Leaderin the Chicago suburbs and for tenyears maintained a large privatelactation practice there, where sheworked with thousands of families.She is coauthor (with KathleenKendall-Tackett) of BreastfeedingMade Simple: Seven Natural Laws forNursing Mothers, coauthor of all threeeditions of LLLI’s The BreastfeedingAnswer Book, and author of the newbook, Breastfeeding Answers MadeSimple: A Guide for Helping Mothers.She is a full-time employee of AmedaBreastfeeding Products, which makesand sells nipple shields. Nancy offersbreastfeeding updates and culturalcommentary on her blog atwww.NancyMohrbacher.comReferencesBodley, V., & Powers, D. (1996).Long-term nipple shield use--apositive perspective. J Hum Lact,12(4), 301-304.Brigham, M. (1996). Mothers’reports of the outcome of nippleshield use. J Hum Lact, 12(4),291-297.Chertok, I. R. (2009).Reexamination of ultra-thinnipple shield use, infant growthand maternal satisfaction. J ClinNurs, 18(21), 2949-2955.Clum, D., & Primomo, J. (1996).Use of a silicone nipple shieldwith premature infants. J HumLact, 12(4), 287-290.Elliott, C. (1996). Using asilicone nipple shield to assist ababy unable to latch. J Hum Lact,12(4), 309-313.Genna, C. W. (2009). Selectingand Using Breastfeeding Tools:improving care and outcomes.Amarillo, TX: Hale Publishing.Genna, C. W., Fram, J. L., &Sandora, L. (2008). Neurologicalissues and breastfeeding. In C. W.Genna (Ed.), Supporting suckingskills in breastfeeding infants (pp.253-303). Boston, MA: Jonesand Bartlett.Hurst, N. M., & Meier, P. P.(2010). Breastfeeding thepreterm infant. In J. Riordan(Ed.), Breastfeeding and humanlactation (4th ed., pp. 425-470). Boston, MA: Jones andBartlett.Meier, P. P., Brown, L. P., Hurst,N. M., Spatz, D. L., Engstrom, J.L., Borucki, L. C., et al. (2000).Nipple shields for preterminfants: effect on milk transferand duration of breastfeeding. JHum Lact, 16(2), 106-114; quiz129-131.Mohrbacher, N. (2010).Breastfeeding Answers MadeSimple: A Guide for HelpingMothers. Amarillo, TX: HalePublishing.Mohrbacher, N., & Stock, J.(1996). The Breastfeeding AnswerBook (2nd ed.). Schaumburg, IL:La Leche League International.<strong>New</strong>man, J., & Pitman, T. (2006).The Ultimate Breastfeeding Bookof Answers. <strong>New</strong> York, <strong>New</strong> York:Three Rivers Press.Powers, D., & Tapia, V. B.(2004). Women’s experiencesusing a nipple shield. J Hum Lact,20(3), 327-334.Sealy, C. N. (1996). Rethinkingthe use of nipple shields. J HumLact, 12(4), 299-300.Wilson-Clay, B. (1996). Clinicaluse of silicone nipple shields. JHum Lact, 12(4), 279-285.Wilson-Clay, B., & Hoover,K. (2008). The BreastfeedingAtlas (4th ed.). Manchaca, TX:Lact<strong>New</strong>s Press.Woodworth, M., & Frank, E.(1996). Transitioning to thebreast at six weeks: use of anipple shield. J Hum Lact, 12(4),305-307.Woolridge, M. W., Baum, J. D., &Drewett, R. F. (1980). Effect ofa traditional and of a new nippleshield on sucking patterns andmilk flow. Early Hum Dev, 4(4),357-364.Nipple Shields Tear-Offhttp://store.llli.org/public/profile/163Nipple Shields Tear-Offhttp://www.lllgbbooks.co.uk/product/122/nipple_shields_-_pad_of_50/default.aspxToday• Issue 6 • 2011 | llli.org

Celebrating The <strong>New</strong> BabyGina Kruml, RN, BSN, IBCLC, LLL LeaderDo you remember the days when planning a babyshower meant one big question: “Games, or nogames?” These days though, with the arrival ofsprinkles, mother showers, mother blessings, andpregnancy parties, there is a wider variety of waysto celebrate.* When planning a celebration for anexpectant mother, or to celebrate the arrival ofa new baby, if you want to think outside the box,rest assured, plenty of possibilities abound!Every child isspecial, and hisarrival deservescelebration.may want to be practical by giving a gift card, andsomeone may be knitting something special forthe baby.Feature Article025incorporated into the festivities. This can beas simple as bringing up breastfeeding as atopic of conversation. Just as many motherswill enjoy telling their birth stories at the party,many mothers will also enjoy the chance totell breastfeeding stories. If the expectantmother approves, you might want to make anappropriately shaped and decorated “breastcake” as part of the party food. Try to avoiddecorations, party games and gift wrapping thatinclude baby bottles and pacifiers. As useful asthese items might be sometimes, it makes onewonder, where are all the baby decorations withbaby bears, rabbits and kittens that are nursing?As a guest, giving a gift of The Womanly Art ofBreastfeeding or a similar book might be the mosthelpful thing you can do for a new mother.Photo of Gina Kruml courtesy of Ashley Elicio PhotographyEvery child is special, and his arrival deservescelebration. But what if the parents alreadyhave everything they need for the new baby?By calling the celebration a “sprinkle,” youcan indicate that opening presents will not bethe focus of the party. Or, if you’re throwing a“mother shower,” you could arrange a differentway for people to help the new mother. Letguests know when they RSVP that instead ofbringing a gift, they could bring a frozen meal, orcheck their calendars for a date when they couldbring supper for the family. Marcia Claessonfondly remembers attending a baby shower wherethe hostess suggested everyone bring a favoritechildhood book. The mother may even suggesta charity she would like to help in honor of thenew baby. Of course, these choices should bepresented as options, not as demands. Someguests might still want to pitch in together tobuy a big ticket item from a baby registry, othersGames are still a popular choice at showers.I always liked the “Guess how many?” game.This is, of course, referring to the number oftoilet paper squares it takes to go around theexpectant mother’s belly. It’s the most fun ifguests don’t know the secret, and guesses rangefrom two to 132. Games might be a good option,for example, if it is a couples shower, but toomany games can get in the way of spontaneousconversation. Too much time spent doing penciland paper competitions and guessing howmany jelly beans in the jar can make a party feelsomewhat superficial. If the main purpose ofgames is to start conversation and make peoplefeel welcome, surely a good hostess can do thison her own.Rather than concentrating on games and openingpresents, you may want to incorporate a morepersonal or spiritual aspect into the celebration.Be sure to talk with the mother ahead of timeabout what would be most meaningful, and inaccordance with her beliefs. Prayer, songs, orplanting a tree together in honor of the babymight all be special for her. A “mother blessing”might typically include more mother-centeredactivities, such as a belly casting, or painting withhenna. The guests might work on making a quilttogether, or each write a wish for the baby ona leaf to tie to a tree. Each guest might bring abead to add to a necklace string for the motherto wear during the baby’s birth. The mother canalso be encouraged during the birth by a planto support her with a telephone tree and prayerchain when the big day arrives. Each guest canbe given a candle at the party, to be lit when thephone call comes.When planning a baby shower or similarcelebration, a mother who will be breastfeedingmight appreciate some celebration of this to beWhatever way you find to support, encourageand celebrate the journey of a new mother, knowthat you are making a positive contributionto her and the new baby. By including herpreferences and beliefs, you can make thecelebration more meaningful. You can also setthe stage for the guests to continue to supporther after she has the new baby, which especiallyin this day and age is desperately needed.Remember, you don’t have to go to greatexpense, or plan out every moment to make ahappy memory for the new mother.* Maser, S. Blessingways: A Guide to Mother-Centered Baby Showers—Celebrating Pregnancy,Birth and Motherhood Moondance Pr.2004Gina Kruml, RN, BSN, IBCLC and LLL Leader ismother to Sophia, Ambrose, Maria and Victor inSierra Vista, AZ, USA.http://store.llli.org/publicsearch?q=Baby+Carriers&s=GoBuy gifts for a newmom from the LLLIstore!http://store.llli.org/public/profile/488llli.org | 2011 • Issue 6 •Today

Breastfeeding In The <strong>New</strong>s026Breastfeeding In The <strong>New</strong>sLeche League GB’s responseto the article reported inthe British Medical Journal,January 2011When WHO recommended this policy it wasbased on a systematic review of 3,000 studieson infant feeding. The article the British MedicalJournal 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.fullsuggesting that babies need solids earlier thansix months of age, is not a new research studyor a systematic review of all available evidence.Three of the four authors of this research havedeclared an association with the baby feedingindustry.http://www.facebook.com/note.php?note_id=192479987445666&id=136580916400946La Leche League has been providingbreastfeeding information and support toparents for over fifty years. We support the viewof The World Health Organisation (WHO), TheDepartment of Health (DH), and other eminentorganisations, that infants should be exclusivelybreastfed for around the first six months oflife to achieve optimal growth, developmentand health. Thereafter, to meet their evolvingnutritional requirements, infants should receiveappropriate complementary foods alongsidecontinued breastfeeding.There is clear scientific evidence thatbreastfeeding protects both the short and longterm health of mothers and babies. It reducesthe risk of infections such as gastroenteritisand 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 andcancer in mothers is lessened and it reducesthe risk of postnatal depression and neglect.With the current risk of swine flu, exclusivebreastfeeding reduces the risk of the babycatching secondary infections, which could beserious enough to need hospital admission.• The BMJ article says that delaying introducingsolid food may increase the risk of irondeficiency anaemia (IDA)Breastmilk supplies all the essential nutrientsa baby needs for around the first six monthsof life. There isn’t a lot of iron in breastmilkbecause there isn’t supposed to be. It is morecompletely absorbed by a baby than the kind informula, baby cereal or supplements. Breastmilkcontains a protein that binds to any extra ironthat the baby doesn’t use because too muchiron can end up feeding the wrong kind ofbacteria in his intestines and this can result indiarrhoea/constipation or even microscopicbleeding. Formula fed babies can have too muchiron in their intestines, which causes theseproblems and ends up reducing their overalliron.Photo: © Veer.comIf a baby is started on solids before he is readyiron stores can drop. Some fruits and vegetablescan bind with iron before the baby has a chanceto use it. These foods are often low in iron andso are simply replacing the perfect food forbabies with ones with fewer nutrients.To help ensure a breastfed baby has a goodsupply of iron, women can look at their dietduring pregnancy and ask that the umbilicalcord is not cut before it stops pulsating as thisadds to his iron supply.• The BMJ article says that delaying introducingsolids may increase the risk of coeliac diseaseCoeliac disease is associated with the earlyintroduction of gluten, which is found in cereals.Currently available evidence on the timing ofthe introduction of gluten into the infant dietis insufficient to support any recommendationsand a study suggesting this should be at fourmonths is considered by many to be flawed.There is evidence suggesting that not beingbreastfed at the time gluten is introduced intothe diet is associated with an increased risk ofsubsequently developing coeliac disease.• The article says that delaying introducingsolids may increase food allergiesToday• Issue 6 • 2011 | llli.org

Breastfeeding In The <strong>New</strong>s027A baby’s insides are designed to be ready forsolid food once his outside has developedenough for him to eat it on his own. If offeredtoo soon he will automatically thrust it back outto protect his digestive tract. La Leche Leaguesuggests mothers look for cues that their baby isready, 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. Ababy’s digestive tract needs to be mature beforestarting solids so the lining of his intestines issealed against allergens (allergy producers). Ifgiven solids too early allergens can slip throughthe intestinal wall into the blood stream and thebaby produces antibodies against them, whichcan result in allergies such as eczema.At around six months a baby starts producingadult-type enzymes, which we need to breakdown food for digestion. If he has solids beforehe can digest them properly it can cause tummyproblems and the nutrients will not be fullyutilised.Trials are being undertaken to test if babies witha family history of true allergy might be helpedby earlier introduction of certain foods but, asa rule, the majority of babies are less likely tohave an allergic reaction to foods by around sixmonths.• The article suggests that introducing newtastes at an earlier age may increase acceptanceof leafy green vegetables and encourage healthyeating later in lifeThis is purely speculative. Breastmilk preparesa baby for family food as it changes in flavourdepending on the mother’s diet and so exposesthe baby to various tastes from birth onwards.In fact research shows that formula-fed babiesoften don’t accept new tastes as willingly asbreastfed babies. What a baby prefers to eatwill be dependent on many things and willchange as he grows. Some mothers have foundthat if a baby was encouraged to eat a food hehad shown a particular aversion to it caused anegative reaction, perhaps showing that babiesinstinctively know what to refuse. If offered arange of healthy foods babies tend to take whatthey need.• The article says that delayed introduction tosolid foods may be linked to increased obesityThis is in total conflict with the studies showingthat early introduction, particularly of sugaryfoods, is an important factor behind the obesityepidemic and can lead to babies being overfed.Breastfeeding helps a baby to regulate his ownappetite so that when he starts solids he may bebetter able to avoid over eating.La Leche League GB knows that women alreadyreceive conflicting advice and information onmany aspects of childcare and that this reporthas caused concern and confusion amongstparents wondering what to do for the best fortheir children. Babies’ individual developmentvaries and parents are best placed to look forsigns that their baby may be ready for solid food,around six months of age.While we recognise that it is important to ensurethat recommendations are based on the bestavailable evidence, and are regularly reviewed,we continue to believe that breastmilk provideseverything a baby needs up to around six monthsof age and that to introduce other foods beforea baby is ready is not beneficial … Read theentire press release here: http://www.facebook.com/note.php?note_id=192479987445666&id=136580916400946You can read the UNICEF UK response to mediareports questioning the recommendation tointroduce solid food to babies at six monthshere: http://www.babyfriendly.org.uk/items/item_detail.asp?item=680Analysis. Six months of exclusive breastfeeding:how good is the evidence? http://www.bmj.com/content/342/bmj.c5955.full/reply#bmj_el_248392http://store.llli.org/public/profile/326Andhttp://www.lllgbbooks.co.uk/product/442/Starting-Solid-Food-Introducing-your-baby-tofamily-meals/default.aspxInternationalBreastfeeding bagIt’s made from 100% recycled materials,is hand washable, and is gusseted formaxium space. Use it again and again forgroceries, to tote personal items, andto show your support for breastfeedingmothers around the world! Measures13x13x5.Bonding with your Brilliant& Beautiful Baby throughInfant MassageShows parents a loving way tocommunicate with their baby. This45-minute DVD is a wonderfulintroduction to infant massage,providing detailed chaptersdevoted to each part of the body,demonstrations, and examples ofparents practicing these techniqueson their babies.llli.org | 2011 • Issue 6 •Today

Donors Making A Difference028Letters of Appreciationfor donations of The WomanlyArt of BreastfeedingLLL <strong>New</strong>s (continued from page 17)La Leche League Great BritainTen <strong>New</strong> Groups Projectdiscussions. One Leader Applicantsaid, “The opportunity to role playthe meeting situation was hugelyhelpful. I felt encouraged andpleased about the things I did welland was given constructive ways toimprove.”Thanks to the generosity ofLa Leche League Internationaldonors this past year, we wereable to send complimentarycopies of the newest edition ofThe Womanly Art of Breastfeedingto baby-friendly hospitals,birthing centers, lactationconsultants, and libraries, alongwith many pregnant and nursingmothers. Here are two letters ofappreciation we received:We were so excited to receiveyour generous donation of20 copies of The Womanly Artof Breastfeeding to the MiamiMaternity Center. We areoverwhelmed with gratitude. Wedecided to add most of them toour lending library so that thegreatest number of mothers canbenefit. At this moment, all buttwo copies are checked out. Inaddition to pregnant and nursingmothers, the books have alsobeen checked out by severalstudent midwives who are passingthe information along, as well. Wehave also given two copies awayso far to two of our teenagedclients.You have our sincere thanks forthis amazing gift.Miami Maternity Center,Miami, Florida, USAParkland’s Women & Infants’Specialty Health (WISH) divisionis grateful for your support! Isend sincere thanks for yourrecent, in-kind donation of copiesof the newest edition of TheWomanly Art of Breastfeeding.With one of the most activeobstetrics programs in thecountry, Parkland is committedto supporting and encouragingnew mothers to breastfeedtheir babies. We wholeheartedlyunderstand the importance ofhealthy development of infantswhen they are breastfed.Thanks to your generosity,Parkland will be able to continueits mission and educate pregnantand nursing mothers about thebenefits of breastfeeding.Parkland Foundation,Dallas, TX, USAIn 2009 the United Kingdom’sDepartment of Health awarded LaLeche League Great Britain (LLLGB) with a three-year grant insupport of their “Ten <strong>New</strong> Groups”Project of recruiting and training20 mothers for La Leche League(LLL) leadership and setting upten new LLL groups in areas wheremother-to-mother breastfeedingsupport was not available.During the first phase of theproject, appropriate resources weredeveloped, project areas identifiedand LLL Leaders recruited to runworkshops and support the LeaderApplicants (trainees).LLL Awareness Days were held toattract local mothers and discussleadership with them.In 2010, in Phase 2 of the project,mothers started their applicationsand attended workshops. For somemothers, this has introduced themto the LLL mother-to-mother groupexperience, as well as developingthe skills Leaders need to provideeffective support and leadIn Phase 3 of the project, it isanticipated that the remainingLeader Applicants will be accreditedand new LLL groups formed. Theproject will then be evaluatedfrom all perspectives including themothers who will receive support.At this time, four new Leaders havebeen accredited and three new LLLgroups were formed in Liverpool,Preston and St Neots – providingkey centers for LLL support in partsof the country where no Leadersor groups previously existed. Onesuch mother, attending her firstLLL meeting in Liverpool, expressedher delight at having an LLL groupin her community: she enjoyed“meeting like-minded mums,” itwas “friendly and welcoming.”Another mother observed that theLeader “is developing a strong andsupportive group.”To learn more about LLLGB’s“Ten <strong>New</strong> Groups” Project, visithttp://www.laleche.org.uk/pages/about/10newgroups.htmSpecial thanks to Alison Parkes,Project Training Coordinator, whocontributed to this article.Today• Issue 5 • 2010 | llli.org

NB_issue1_09.qxd:06Nov_DecNBƒ.qxd 4/16/09 1:23 PM Page 19his first joke. I remember the lows—thenipple pain; feeling overwhelmed byOliver’s needs. But the hundreds ofnormal days, the thousands of warm,enjoyable but unmemorable feeds, fadeinto a blur.Attending LLL meetings and hearingabout other mothers’ breastfeeding andparenting experiences have beenbrilliant. Over the past two and a halfyears I have gained so much from themothers I have met through LLL.They’ve suggested tips for specific situations,changed some of my attitudescompletely, and given me true empathy.Their experiences have helped me torecognize the truth in the phrase “thistoo shall pass.” This has really helped meto enjoy the good bits and cope with therocky periods. I would like to say aparticularly warm thank you to my localLeaders Ruth, Suzanne, and Barbara fortheir listening ears, helpful information,and, of course, their friendship.Joanne WhistlerWest Yorkshire Great BritainAdapted from a story in LLLGB’s BreastfeedingMattersA Gift fromMy Sisterabout it, just the basics, and thoughtthat my baby and I would figure it outif it were meant to be.I didn’t talk to my husband about itmuch or have him read anything aboutit either. I remember him being veryshocked when late in the pregnancy Iannounced that I would be exclusivelyfeeding the baby; we would not beusing bottles if all went well. Iremember he was not too happy aboutit. Looking back now, both of us shouldhave read a lot more and given a lotmore thought to the subject.My sister and I were not breastfed.Our mom says it just was notsomething you did then. So, we hadnever really been around any breastfeedingmothers. We were never taughtabout it in school, and no one evertalked to us about it. I believe that mySisters Diane and Jamie and their babieslackadaisical attitude toward breastfeedingduring my pregnancy camefrom a lack of knowledge; knowledge(thank goodness) that my sister learnedfrom a book and passed on to me.When my daughter was born, I hadsome complications, and it took sevendays for my milk to come in—seven longdays in which my husband and I werevigorously reading about breastfeeding.Our LLL Leader, Jeanette, was awesome,providing us with much needed supportand encouragement. She even came tovisit me at my house because I was too illto leave. And, of course, I called my sister.At that point I was determined to breastfeed.Seeing what a positive experience itwas for my sister made me all the moreeager to nurse my own child. I am soglad that I did.My 11-month-old daughter, Madison,My younger sister, Jaime, has alwaysbeen one to learn a lot by reading. Sowhen she was pregnant, Jaime read andlearned a lot about breastfeeding. Shejoined a La Leche League Group in herarea and established a wonderful breastfeedingrelationship with her daughter,Erin.When I became pregnant a monthafter Erin was born, I asked Jaime aboutbreastfeeding. She told me severalpositives about it and told me to lookup the number of my local LLL Group.She didn’t push information on me. Inher quiet way, she just recommended Iread about it and decide for myself. Iattended one LLL meeting late in mypregnancy. I didn’t read a whole lotBaby sleeps snugly and safelyalongside adult bedConverts to free-standing bassinet or changing tableFor information on the benefits of co-sleepingplease go to www.armsreach.com(800) 954-9353 or (805) 278-2559ARM’S REACH CONCEPTS, I NC© 2004 Arm's Reach Concepts,Inc. ARM'S REACH, CO-SLEEPER,Mother & Child Logo and all other trademarks are stringently protected.All rights reserved.Patents pending.“I am pleased to recommend Arm’s Reachas a wonderful nighttime attachment tool.”Dr. Wm. P. Sears,Author “The Baby Book: Nighttime Parenting”The MiniJust 20"x34"of floor space<strong>New</strong>bornto 23 lbs.Award-winningFit PregnancyandParentingIssue 1, 2009 • NEW BEGINNINGS 19

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