Global Strategy For And Young Feeding

No more than 35% of worldwide are exclusively breastfed during the first four months of life; complementary feeding frequently begins too early or too late, and foods are often nutritionally inadequate and unsafe. Malnourished children who survive are more frequently sick and suffer the life-long consequences of impaired development.

Rising incidences of overweight and obesity in children are also a matter of serious concern. Because poor feeding practices are a major threat to social and economic development, they are among the most serious obstacles to attaining and maintaining health that face this age group. Exclusive is when a baby is only fed and is not fed other liquids or solids. Summary of Current Breastfeeding Rates for Canada 2011/2012: Initiation = 89% Exclusive Breastfeeding for 4 months = 50% + Exclusive Breastfeeding at 6 months = 26%

Trends: • 89%, breastfed their baby in 2011/2012, 85% in 2003. Canada’s rate was higher than that of the United States, 77%, but lower than the rate in Norway, 95%, and Australia, 92%. • Exclusive Breastfeeding for 6 months + increased to 26% in 2011–2012, compared with 17% in 2003. Over half of breastfed exclusively for four months (or more); up from 42% in 2003 (see graph below) http://www.statcan.gc.ca/pub/82-624-x/2013001/article/11879/c-g/c-g-01- eng.htm

• The most common reasons cited for stopping breastfeeding before six months were “not enough breast milk” and “difficulty with breastfeeding technique” in 2011– 2012. James Akre, The Problem with Breastfeeding, 2006:

“Since the collaborative reanalysis of individual data on breast cancer and breastfeeding (op. cit., Lancet, 2002,360(9328)203-10), I have been a guest speaker to five USA-based travelling student groups and one Swiss class, or about 130 people in all. Students were 18 to 26 years of age, more than 90% female, and many were preparing for careers in health. I used these occasions to ask the following question:

“Can anyone tell me about a link between breastfeeding and breast cancer?

“With the exception of one student, who said she thought that women who breastfed were at increased risk of breast cancer, no one had the slightest notion in this regard. I then used this jaw-dropping (theirs not mine) teaching moment to do two things: provide a summary of the facts of the matter and suggest it was worth pondering how a group that was so well-educated, informed, health-conscious and overwhelmingly female had arrived at adulthood totally ignorant of this vital aspect of reproductive health.” Health Canada says:

Exclusive breastfeeding1 is recommended for the first six months of life for healthy term infants, as breast milk is the best food for optimal growth. Infants should be introduced to nutrient-rich, solid foods with particular attention to iron [3] at six months with continued breastfeeding for up to two years and beyond [4].

1 Exclusive breastfeeding, based on the WHO definition [5], refers to the practice of feeding only breast milk (including expressed breast milk) and allows the baby to receive vitamins, minerals or medicine. Water, breast milk substitutes, other liquids and solid foods are excluded.

http://www.hc-sc.gc.ca/fn-an/nutrition/child-enfant/infant-nourisson/excl_bf_dur-dur_am_excl_e.html I AM ANGRY

TAX PAYER PRACTITIONER WOMAN

ESPECIALLY AS A FEMINIST Don’t We Have the Right/Duty/Obligation to Know?

What most experts don’t know: • Breastfeeding is not supposed to hurt • Skin to skin stabilizes unstable infants, preemies • Skin to skin raises blood sugar, regulates heart and breathing rates • The normal breastfed baby does not need any kind of supplement • That there are new WHO Growth charts (almost 10 yrs old now) • Effects of formula on Diabetes type 1, Allergies, Asthma, Eczema • A little bit can hurt • Correlation between bottle-feeding and sleep apnoea • The critical importance of skin to skin care • That formula is in the top 3 risk factors for S.I.D.S. • Dr. Chandra’s work: Allergies asthma eczema • The iron in baby cereals is poorly absorbed

CBC documentary, 2006, www.cbc.ca www.WHO.org Hanson, Lars, Immunobiology of Human Milk, Hale Publishing, 2004 Palmer, Brian, www.brianpalmerdds.com Bergman, Nils, www.kangaroomotercare.com Smith, Linda, Presentation at INFACT Conference, 2005, Toronto, Canada http://www.who.int/child-adolescent-health/NUTRITION/global_strategy.htm What Else Do They Not Know?

• Swaddling is not good for baby, in fact it may be harmful • Babies never need formula (milk bank anyone?)

• When a baby self weans—even as early as at 6 months, the baby still does not need formula • Babies never need to take a bottle—and yes can still “go out”

(cup anyone?)

• A baby not sleeping through the night is normal even at 4 months, 7 months, 15 months, 20 months, etc – its critical for a newborn So, What Is The Problem?

“How is it that, for what is a universal fundamental defining characteristic of our entire species - the nurturing and nutritional strategy called breastfeeding - we daily encounter so much variety, indeed so much divergence, in basic how-to-do-it principles?” -James Akre BREAST IS BEST

…but you are on your own (jim really doing edith’s work )

“The super-short answer to that question rests with each of us in terms of our world view of contemporary history and how little the collective we appear to have learned in, say, the past hundred years.” Chatelaine Onstad, K. Breastfeeding Sucks. Nov 2006

JUST BECAUSE …

I refer to breastfeeding as the norm I am branded a breastfeeding Nazi

I demand women be allowed to breastfeed anywhere they have permission to be present, I am imposing my beliefs on society

I want better visibility and no softening of ad campaigns, I am branded a breastfeeding bully

Many LLL meetings have some older babies breastfeeding, they are branded fundamentalists THE ISSUE

THE CRUELTY OF BREAST IS BEST (not enough) GOOD TRAINING

(WHOSE RESPONSIBILITY IS IT?)

• IBLCE (and IBCLCs) • NURSING COLLEGE (and nurses) • RNAO registered nurses association of Ontario • MEDICAL SCHOOLS (and doctors) • MIDWIFERY COLLEGES (and ) • COURSES (and ) • (public health nurses) • The “EXPERTS”? (book writers, the conference speakers, the editors of JOURNALS) • Journal of Human Lactation? • THE MEDIA??? I AM ANGRY

PRACTITIONER How Bad Is The Training?

• Many IBCLCs, nurses, MWs, Docs, HCPs who do not even know the first thing about latching

• Of the observers who have visited us in our clinic, a majority of them still think a baby should be fed 8-12x/24hrs (not an evidence-based practice or concept)

• And even more of them teach 5-10 min/side (again, no evidence)

• Countless moms getting nipple shields

• Hindmilk/foremilk every where! Case Study of an IBCLC

• Got her IBCLC about a year or so ago • Came to our clinic requesting more in-depth training than what she had (I give her credit for at least recognizing that she needed to know more) • A few months of observation • Months of following me around learning hands-on/hands-off techniques of latching, compressions, etc. • Followed Jack and others in our clinic for months Remember, she came to our clinic already having sat the exam • Finally ready to take histories (we thought) and help mothers by pointing out what is working and not working in the latch • One of the first times I stood back to listen to what she would say to a mother: She tells the mother that it is time to offer the other side because 5 minutes has passed! Had a mother with a 6-month old, breastfeeding exclusively, just starting to introduce solids (the LC needed my opinion on the case). So, she told the mother: “It’s now time to start introducing a bottle of formula” The LC was wondering what type of bottle to recommend! Is This Kind Of IBCLC Unique?

• Unfortunately, no

• Have had a few LLL leaders come to me knowing they are not ready to work with moms until they get decent training

• Have had a number of IBCLCs tell me they just wanted to pass the exam so they could get hired at a BF clinic and then get trained on the job. Scary IBCLC Case?

- IBCLC needs a consult from a “specialist” in lactation -she has a “very difficult” case requiring a home visit - a “regular” IBCLC is not enough.

What was this special situation?

The LC says “This mother has really sore nipples when she latches the baby on, but it gets better as the feeding goes on. And, when I latch the baby the same thing happens—so, it obviously can’t be the latch”

Huh??????? Scary IBCLC Case? con’t…

• I asked the LC what kind of latch she uses and she says she makes sure baby is deeply on the breast and the nose and chin are touching the breast as tightly as she can make it

• Is this LC for Real?!!! And this needs a highly trained IBCLC? No!! This needs a properly trained IBCLC—adjust the latch AND fix the training!!

• BY THE WAY, SHE WORKS IN A TORONTO BF CLINIC Another Scary IBCLC?

• Very prominent LC in my city has told a few mothers (I know of 8 in the last 3 years) that they will never be able to breastfeed, that they should call their husbands to pick up formula, and she told one to call husband back and remind him to get some bottles too.

• This same LC claims she teaches an asymmetric latch and yet teaches the mothers to scoop and bring the nose around right into the breast

• She told one mother too that she is torturing both herself and her baby Is the problem only with LCs?

Unfortunately, NO!! And What About These “Informed” Doctors?

• Recommending starting cereals at 4 months with a healthy well-gaining exclusively breastfed baby (against the recommendations of WHO, CPS, AAP, Health Canada )

• Recommending prune juice in a 2-week old baby

• Recommending Vaseline be put on sore nipples More Doc Talk

• Telling mother her baby is too fat on her breastmilk and will never crawl, so she should put baby on a diet (that kid is now 20 yrs old, tall and slim— about 5’6, 124 lbs)

• Put baby beside the window to treat jaundice

• Give baby vitamin D for jaundice a case from a colleague...

Less than 24hrs Mom was sleeping Baby asleep beside in bassinette in hospital room Mother awoke to missing baby Went to look for her baby Found baby at nurses station being given a bottle of formula (obviously without the mother’s consent or knowledge)

Nurse’s explanation: it is important you get sleep, you didn’t hear baby wake up, I thought I would feed your baby for you so you could recover from the birth Even more doc talk…

• Give baby a bottle of formula because 4 ounces of formula is better for slow weight gain than 4 ounces of breastmilk • Baby taken off the breast because mother had to go on cephalexin for mastitis—mother told to pump and dump Dr William Sears’ Website

IS BABY LATCHING ON AND SUCKING EFFICIENTLY? HOW TO TELL Latch-on and sucking checklist:

Baby's ears are wiggling. During active sucking and swallowing the muscles in front of baby's ears move, indicating a strong and efficient suck that uses the entire lower jaw. Dr William Sears’ Website

Mom's position (the cradle hold) Sitting-upright in an armchair or rocking chair is the easiest position for breastfeeding. You can also sit up in bed, but make sure that your back, shoulders, and knees are well-supported. You'll need several pillows. Place one or more pillows behind your lower back, and/or shoulders so that you are comfortable and relaxed.

If you're in bed, put pillows under your knees.

You'll need at least one pillow in your lap to bring baby up to the level of your breast, and another under the arm that will support your baby as he breastfeeds.

If you are sitting in a chair, use a foot stool or something else to raise your lap so you don't have to strain or lean over to get baby closer to your breast.

Why all the fuss about your comfort? Once baby is latched-on, you're going to be stuck in this position for 20 to 30 minutes. You don't want to be all knotted up when baby finally falls asleep in your arms. Dr William Sears’ Website

Be patient, relax, and use these checkpoints to evaluate whether baby has a good latch: Mother should be relaxed, with baby well supported in her arms. If you end up sitting hunched over during feedings and have a tired, sore back when you're done, you probably need another pillow in your lap to get baby up to breast height. Lean back into the pillows behind you and be sure you're bringing baby to the breast, not the breast to baby. Use an additional pillow to support the elbow of the arm that is holding the baby. There are also breastfeeding pillows you can purchase that keep baby's body aligned, yet raised to breast level. This is helpful for first-time moms who are overwhelmed with positioning baby's body and getting baby to latch-on correctly. Make sure baby sucks the , not just the nipple. Your baby's gums should bypass the base of the nipple and take in at least a one-inch radius of the areola as he latches on. If baby is sucking on only the nipple, your nipples will be sore after just one or two feeding and miserable after many more. Another reason it is so important that baby compress the areola is that the milk sinuses (the reservoirs for milk) are located beneath the areola. If these sinuses are not compressed, your baby will not get enough milk. Babies should suck , not nipples. Baby's top and bottom lip should be turned out (everted). When baby takes the breast with mouth open wide, he'll have a "fish mouth" look as he nurses. If his bottom lip is pulled inward instead of outward, use the index finger of the hand that is supporting the breast to pull out that lower lip. (You may need a helper to take a peek under the breast and do this for you while baby is latched-on.) Martha Sears, who logged 18 years of breastfeeding 8 children dubs this technique the lower lip flip. This lower lip flip may be all that's needed to keep baby from tight-mouthing your nipple. Baby's chin should be pressed into the breast with his nose resting on the breast, as well. You will notice that baby is able to breathe out the sides of his nose, even when pressed against your breast. Babies are designed that way. If your baby struggles, pull baby's bottom closer to you, or use your thumb to press gently on the breast to make an airway. Dr William Sears’ Website

You hear baby swallowing. During the first few days after birth, baby may suck 5 to 10 times before you hear a swallow. That's because colostrum comes in small amounts. You may have to listen carefully to notice swallows. After your milk has "come in," swallowing will be obvious. After the baby's initial sucking has triggered the milk ejection reflex, you should hear a swallow after every suck or two. This active sucking and swallowing should continue for five to ten minutes on each breast. WHERE DO WE FAIL?

CONFLICTING AND CONTRADICTORY ADVICE

NOT ENOUGH MOTHERS FORMULA GOOD QUIT MARKETING TRAINING

LACK OF FUNDING FROM GOV’T And the mothers?

Are they blameless?

What happens when your accountant screws up?

Your lawyer?

Your cardiologist?

Why are we expected to be experts at everything? Are we? Should we be? I AM ANGRY

TAX PAYER PRACTITIONER We Have Done Our Marketing

• High initiation rates

• In Canada we are looking at around 80-95% overall, with Toronto somewhere between 84-94%

(statistics are scant and this is a culmination of many) Breastfeeding Rates in Canada

Recent Canadian statistics show that while almost 75% of mothers begin breastfeeding in hospital, only 60% and 30% are still exclusively breastfeeding at 3 and 6 months, respectively (Health Canada, 1996). By 9 months, only 18% of mothers still breastfed in a Vancouver cohort (Williams et al., 1996). Breastfeeding trends vary across the provinces; rates are higher in the west and drop off from Quebec to the east (Health Canada, 1996). “Breastfeeding in the first hour of life could save almost one million babies’ lives each year.”

Press Release, 26 March 2006. Department of International Development http://www.dfid.gov.uk/. from www.infactcanada .ca Summary of the International Code and Relevant Subsequent Resolutions of the World Health Assembly:

• No advertising of artificial infant feeding products to the general public. • No free product samples to pregnant women, new mothers or their families. • Information and educational materials must explain the benefits of breastfeeding, the health hazards associated with bottle- feeding, and the costs of using . No promotion through health care facilities. The health care system may not be used to provide free samples to mothers or the promotion of products, such as product displays, posters, distribution of promotional booklets, flyers or the use of product logos. Company/sales employees may not use the health care system for product promotion. No gifts or samples to health care workers. Product information to health care workers must be factual and scientific. No free or low-cost supplies of infant formulas, bottles or nipples to maternity wards, hospitals or any part of the health care system. • Labelling of products must clearly state: the superiority of breastfeeding; that products should be used only on the advice of a health care worker; the instructions for appropriate preparation; and warn about the hazards of inappropriate preparation. No nutrition and health claims may be used, nor pictures or text which idealize artificial feeding.

• Exclusive breastfeeding for six months as a global public health recommendation with continued breastfeeding for up to two years of age or beyond and the addition of complementary foods from the age of six months.

• Complementary foods may not be marketed in ways that undermine exclusive and sustained breastfeeding. Financial sponsorship from infant formula and infant foods companies creates conflict of interest for professionals working in infant and young child nutrition, especially with regard to the Baby- Friendly Hospital Initiative. FROM: Growingkids.co.uk

For years, we've heard the saying, "breast is best" when it comes to feeding infants. Most experts agree, but many mothers cannot, or would prefer not to breastfeed, instead choosing a commercially prepared baby formula as their child's primary source of nutrition. Babies grow and develop well on formula, which has become more nutritionally complete through the years. I AM ANGRY

TAX PAYER PRACTITIONER WOMAN

ESPECIALLY AS A FEMINIST -GLOBAL STRATEGY FOR INFANT AND YOUNG CHILD FEEDING

Women, in turn, have the right to proper nutrition, to decide how to feed their children, and to full information and appropriate conditions that will enable them to carry out their decisions. These rights are not yet realized in many environments. AND WHY AS A FEMINIST?

WHERE IS THE WOOL?

(read: but I want to be a good mother!)

How did bottle companies infiltrate?

Are they not liable to tell us the truth?

Slave of the pump

Baby cereals

How did this happen?

The other paraphernalia

The cost, the burden, the necessity? WHY ELSE?

• Bad information to the public • Lack of media involvement • One-sided media • Lack of government foresight • Little funding for women’s issues (LHIN system in my province doesn’t even have breastfeeding on their radar) • Lack of support for what is normal WHERE DO WE FAIL?

CONFLICTING AND CONTRADICTORY ADVICE

NOT ENOUGH MOTHERS FORMULA GOOD MARKETING TRAINING QUIT

LACK OF FUNDING FROM GOV’T FROM A WEBSITE

In the hospital I was very aware of all the 'breastfeeding art' on the walls as well as the endless 'breast is best' posters and signs and probably the most disturbing thing was a notice in the bottle preparation area which listed 'Acceptable Excuses for Supplementation'. I was a bit horrified and possibly a bit smug when I looked down at my peaceful baby all full up on the formula while most of the other babies in the ward seemed to scream their heads off night and day.

-www.breastisbestunless.com FROM: BREASTIBESTUNLESS.COM

Bottle feeding has been absolutely wonderful for our family. My partner and I have split the care of our babies 50/50 from the day they were born. I believe my two sons are incredibly lucky to have had this. And when I see the state of new mothers around me I know that I am indeed very lucky also. Both our boys have thrived from day one and were sleeping through the night by 6 weeks. FROM: BREASTISBESTUNLESS.COM

I have become increasingly annoyed at the propaganda surrounding breastfeeding. I understand why breastfeeding should be encouraged in the third world but nearly all the claimed benefits of breastfeeding do not hold up to inspection. I get very angry when I read information put out to the public claiming that bottle fed babies are more likely to be beaten, to die of cot death, to be overweight and most offensive of all is the statement that breastfed babies have higher intelligence. Not only are these statements scientifically incorrect they are incredibly damaging to those women who, by choice or necessity, are bottle feeding their children. In these modern times we rely on many modern conveniences to improve our lives. If a woman wishes to bottle feed her baby it should be hailed as a legitimate choice. I have been told by both an obstetrician and a pediatrician that formula is nutritionally equal to breast milk.

From Nursing Spectrum, 2006

LaShawn Darien’s choice not to breastfeed may have been made for her. Minutes after giving birth to her son Michael in 1988, a nurse asked, “What type of formula would you prefer?” recalls Darien. Had Darien had support, she would have made a different choice. “I do know that I would have breastfed,” she says “Breastfeeding is a behaviour which shapes and sculpts the brain, and that brain shaping stays for life. Skin-to-skin contact is what the newborn requires in order for the brain to be shaped in the best possible way, and breastfeeding in the fullest sense is not about eating, but about brain growth, and the development of good relationships. -Howard Shore Any other form of care is experienced by the newborn as separation, and prolonged separation causes permanent harm to babies’ brains.” –Nils Bergman

Health Promotion Agency for Northern Ireland, Press Release, 17 May 2005, All-island breastfeeding conference highlights significant health impact of breastfeeding. -Nils Bergman, H Shore Formula Marketing

• WHO CODE: INTERNATIONAL CODE OF MARKETING OF BREASTMILK SUBSTITUTES (Canada is a signatory)

• INNOCENTI DECLARATION

• IBFAN

• INFACT CANADA: www.infactcanada.ca

• Global Strategies on Infant Feeding

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Newborn Issues

Congratulations on your new arrival! For many people, becoming a parent is one of the most exciting and rewarding experiences in life. But many first-time parents admit that they are unsure about what they need to do to properly care for and ensure the health of their new baby.

In this section, I will review the common newborn issues by offering some basic and important baby care tips from birth through the first several weeks of life.

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(over 3000 names to choose from)

Enter our contest and win a toddler prize pack from Fisher Price valued at over $150!

Welcome to the “Help Your Toddler Grow” Microsite. Here parents can receive helpful tips in all of the developmental areas of their toddler’s life. Ahhh docs...

My 3 yr old and 2 year old cannot have dairy/soy, or will get diarrhea w/ mucus/blood. So long as I avoid the two products, both children tolerate breast milk with ZERO problem. Both children tested negative to cow and soy protein allergy via a skin test. Pediatrician is telling me that breast milk is inadequate, and children need nutramigen formula until age 3. Ped says this is a lactose issue. HELP- What is wrong w/ my kids?

But don’t we need formula?

Yes! We do. Just as we need other medications like insulin and asthma pumps.

“…and return formula use to what it is at its base: an emergency nutrition intervention to prevent starvation and death.” -James Akre, 2006 James Akre, The Problem with Breastfeeding

“But you see, what I would really like more people to know about are the life-long health and developmental implications for millions of BABIES the world over of the routine corruption of:

- the cellular matrix, including their guts and brains

- their eyes and ears

- their renal, respiratory and cardiovascular systems

- the very essence of their tissues, organs and organ systems

by....

- the everyday non-emergency use of infant formula that’s supposedly flawless in every way nutritionally “adequate”, perfectly” clean, correctly mixed and lovingly fed.” James Akre, The Problem with Breastfeeding

“And what I would also really like more people to know about are the short- and longer-term implications of routine artificial feeding for the health of many millions of WOMEN, including increased risk of: - pregnancy - postpartum hemorrhaging - iron-deficiency anemia - hip fractures and osteoporosis - breast, uterine and ovarian cancer - quite possibly diabetes. WHERE DO WE FAIL?

Society Support CONFLICTING AND network CONTRADICTORY ADVICE

NOT ENOUGH MOTHERS FORMULA GOOD MARKETING TRAINING QUIT

LACK OF FUNDING FROM GOV’T Ontario (Canada) Government

• LHIN system

– We are not even on their 5-year radar

• Hospitals

– No BF program ever considered for NYGH’s multimillion dollar renovation

– Closures all over the province, more to be expected

– Conflicting contradictory advice—nurses are not trained

• Ministry of Health

– Not a single department is responsible for Breastfeeding. Notes from a nurse

• You must keep my name out of it

• No one can know I am coming to your clinic to observe

• On the day I come I will not remind you which clinic I work at

• We just don’t have the training

• I know it is meaningless but what are we supposed to do? If we don’t write down how long the baby is on the breast we will not be doing our job Society/Mother’s Support Network

Very significant reasons mothers continue or quit Research is all over the place: 20-80% determining factor

Even more important to get daddy/partner and grandmothers (both) onside. What About The Women Who Choose Not To Breastfeed…

Fine—AND let’s give women the info, the correct info.

So that they are GENUINELY informed

• Then support their choice by teaching:

– Formula is not the only option

– What about donor milk? (HMBANA)

– How to use the supplement in a safe way

– How to minimize the harmful effects

– How to use a cup and avoid bottles

Then, ACCEPT their genuinely informed choice

And insist on BFI to raise standards of all baby care So, What About That Conflicting Contradictory Advice?

Just how bad is it?

• No evidence to support feeding baby every 2-3-4 hrs, or 8-12x in 24 hrs.— yet almost every book recommends this

• No evidence/research on % wt loss—yet every hospital has a policy on this

• Evidence shows that the fastest liquid that raises blood glucose level is colostrum, formula is 4th on the list, yet almost every hospital has formula as the number one action on their protocols

• Evidence shows that the nipple must be placed at the junction of the hard and soft palate—therefore the nose must be away from the breast—yet, almost every clinic in Ontario has practitioners that teach a scoop latch— even though they say it’s asymmetric. No evidence

• There is no evidence supporting the safety of giving formula to a baby in the first week of life. NONE

• Even elemental formulas—

• In fact, we don’t even know if what they say is in them or not in them really is or isn’t!!

• There is no evidence to support the safety of giving a baby a bottle in the first week of life. NONE

• There is no evidence to support the separation of healthy mother and healthy baby. NONE What is the point of charting?

Do weEdith glean Kernerman, anything IBCLC, RLC from these charts? (C) 2006 We don’t know…

• How many diapers a normal baby is really supposed to have in the first week of life

• What a normal blood sugar is in the neonate

• How often a baby needs to eat

• How much a baby needs to eat

• What a baby is exactly eating at any given time (it’s not like Donna Geddes or Chin Tat Lai are beside us 24/7!) a case... Have twins. They are 5 weeks old now and 7.5 lbs. Both boys will open wide and then just shut their mouths. I have been going to lactation specialists at frequent hospital visits.

Also had a specialist over here. Not a thing works.

Both boys will do this about 2/3 of the time.

I am also having a nervous breakdown - frustration, yelling, crying. I successfully breastfed my other girl and boy, now 2 and 4. What will make them latch when I keep trying it for up to 20 minutes?? Some times they latch immediately!!

What am I doing wrong??

The specialist has had poor training—that is what is wrong!! Good Latch

• Asymmetric • Wide open mouth • Deep latch • Nipple points to the roof • More areola covered with the lower jaw • Chin in • Nose away • Baby angled slightly away from the mother More letters and case studies…

In case you are interested…. Where do we go from here?

• The problem needs to be fixed on so many levels it is almost overwhelming…

• But not impossible!!

• Province of Québec

– BFHI and BFI legislated by their Government

– 185,000 grant for the Goldfarb BF Clinic

– Better education (though far from perfect)

• WHO Code

– Unethical marketing out!!! So, what is it going to take?

• Get angry!

• Get REALLY ANGRY!!

• IT’S YOUR (TAXPAYER) MONEY!!!

• YOUR HEALTHCARE DOLLARS!!!!

• YOUR BODIES!! OUR BODIES!!

• YOUR BABIES’ LIVES

• OUR CHILDREN’S LIVES!! What to do?

• Lobby the Government for:

– BFHI/BFI to become legislated throughout your region/province/state/ country

– For a government supported educational facility (yes, like nbci) that provides university-level consistent, up-to-date and evidence-based information and teaching

– For funding for IBCLCs

– For regulation of the IBCLC

• Join/support your local professional organization (OLCA/CLCA/ILCA)

• OBC/BCC Ten Steps to Successful Breastfeeding

Every facility providing maternity services and care for newborn infants should follow these ten steps to successful breastfeeding. 1. Have a written breastfeeding policy that is routinely communicated to all health care staff. 2. Train all health care staff in skills necessary to implement this policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within a half-hour of birth. 5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants. 6. Give newborn infants no food or drink other than breastmilk unless medically indicated. 7. Practice rooming-in—allow mothers and infants to remain together—24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. The Seven Point Plan For The Protection, Promotion And Support Of Breastfeeding In Community Health Services

1. Have a written breastfeeding policy that is routinely communicated to all staff and volunteers.

2. Train all health care providers in the knowledge and skills necessary to implement the breastfeeding policy.

3. Inform pregnant women and their families about the benefits and management of breastfeeding.

4. Support mothers to establish and maintain exclusive breastfeeding to six months.

5. Encourage sustained breastfeeding beyond six months with appropriate introduction of complementary foods.

6. Provide a welcoming atmosphere for breastfeeding families.

7. Promote collaboration between health care providers, breastfeeding support groups and the local community. What else to lobby Gov’t for?

– Insist on funding for breastfeeding clinics

– Insist too that IBCLCs are to be covered under a government and private insurance health plan

– Insist on legislation requiring everyone who deals with new mothers to have direct, supervised, hands-on training by a recertified and approved IBCLC : including nurses, midwives, paediatricians, family doctors, naturopathic doctors, doulas (in other words, BFI) What to do as an IBCLC?

• Lobby IBLCE for:

– More standardized teaching and programs

– Raised standards for the basic IBCLC certification requiring mentoring with an approved IBCLC

– Create a higher credential on par with a post-graduate degree

– Clinical evaluations with certification What else to do as an IBCLC?

• Learn how to identify when the case is beyond you

• Avoid absolutes—there are almost always exceptions

• Remember, there may be an answer you don’t know or—

• Never be afraid to say: “I don’t know”

• Refer!!!!! You may actually be wrong!!! How Long do We Want to Continue to Torture women? Do we stop our breastfeeding promotion NO!!!!!! Do we allow for even lower standards? I don’t think so!!! INFACT Canada Newsletter Spring 2003

Ask anyone in the breastfeeding community and they'll tell you, with great enthusiasm, about the tremendous benefits of breastfeeding. Breastfed babies are healthier, smarter and even smell better than formula fed babies. In this comparative paradigm it's natural to say, "Breast is Best." Unfortunately, in doing so we actually open the door to establishing formula feeding as the norm.

Breast isn't best - it's the normal way feed babies. As Diane Wiessenger wrote in her essay, Watch Your Language, "Because breastfeeding is the biological norm, breastfed babies are not "healthier"; artificially-fed babies are ill more often and more seriously. Breastfed babies do not "smell better"; artificial feeding results in abnormal and unpleasant odor that reflects problems in an infant's gut." Our Words Have An Effect

• "When we fail to describe the hazards of artificial feeding, we deprive mothers of crucial decision-making information.“

• …Rather than promoting the benefits of breastfeeding, we need to shift the emphasis to the dangers of formula feeding. INFACT CANADA:

• A good example of this is the consumer health warnings on cigarette packaging. Consumers are not advised that non-smokers have lower rates of heart disease and lung cancer and that non-smokers give birth to healthier, heavier full-term babies. The warnings on cigarette labels are very clear: • "Cigarettes cause cancer.“ "Cigarettes cause strokes." • "Cigarettes hurt babies. “ “Tobacco use during pregnancy increases the risk of preterm birth. Babies born preterm are at an increased risk of infant death, illness and disability."

• Similarly, formula manufacturers should be required to place warnings on their products that reflect the proven health risks: • "Formula fed babies are at a higher risk for asthma." • "Formula fed babies are at a higher risk for cancer, diabetes and cardiovascular disease.“ "Formula fed babies have lower I.Q.s." Wiessinger:

"Inverting reality becomes even more misleading when we use percentages, because the numbers change depending on what we choose as our standard. If B is 3/4 of A, then A is 4/3 of B. Choose A as the standard, and B is 25% less. Choose B as the standard, and A is 33 1/3% more. Thus, if an item costing 100 units is put on sale for "25% less" the price becomes 75 units. When the sale is over, and the item is marked back up, it must be marked up 33 1/3% to get the price up to 100. Those same figures appear in a recent study which found a "25% decrease" in breast cancer rates among women who were breastfed as infants. Restated using breastfed health as the norm, there was a 33-1/3% increase in breast cancer rates among women who were artificially fed. Imagine the different impact those two statements would have on the public." Wiessinger:

"We cannot expect to create a breastfeeding culture if we do not insist on a breastfeeding model of health in both our language and our literature."

"All of us within the profession want breastfeeding to be our biological reference point. We want it to be the cultural norm; we want human milk to be made available to all human babies, regardless of other circumstances," wrote Wiessinger. "A vital first step toward achieving those goals is within immediate reach of every one of us. All we have to do is…watch our language." * Wiessinger D. Watch Your Language! J of Human Lact 12: 1-4, 1996 So, what do we do?

We fix the breastfeeding information that is out there.

We get “experts” on the same page.

We insist on consistency of information and deep knowledge of current research and findings in our own clinics, on our units, within our collectives.

We fix the breastfeeding training of healthcare professionals.

We ask mothers to write letters and file complaints.

We insist on accountability.

We continue to dialogue. What else?

• Build bridges...stay positive

• Remember: we are all trying to help

• We all have good intentions

• Never question anyone else’s motives—no matter how questionable the practise Change the doublespeak

• Language-Dianne Wiessinger

• Actions—breastfeed everywhere, rally against inappropriate media representations of women (Calvin Klein jeans, David Bitton—whatever he is advertising)

• Insist on appropriate representations of women’s bodies—including baby’s at the breast And for ourselves?

We make a commitment to ourselves to only practice in a way which is evidence based—both research and experiential.

We practice in a way that supports BFI and the Code in every aspect and we insist that those around us do as well.

We practice within our own scope always assuming we know less than we do

We learn from others and listen to the mothers.

We continue to learn…always. Clinically...

• Keep our skills up to date- – Volunteer/work in a clinic at least 2-3x/yr – Attend lectures and conferences regularly

• Get involved with mothers—give talks at or attend talks – e.g.

• Keep in the know with mothers’ concerns – Participate in forums or discussion groups – i.e. answering emails BREASTFEEDING IS NORM