Parenting with Patience by Judy Arnall details three steps parents can take to ease the process of moving away from using punishments to practicing positive discipline.
API: Tell us about your book.
Judy: Parenting With Patience normalizes parent and child anger, and proposes a simple three-step model to manage frustration and improve relationships. The book walks parents through a single incident of deliberate disobedience — because that is when most parents feel angry and really want to punish, whether they believe in it or not! — and shows how the three simple steps work. The three steps are:
The parent gets calm first through timeout for the parent, not the child.
The parent helps get the child calm through time-in.
The parent and child work through the issue with collaborative problem-solving and time together.
Throughout the three steps, the book describes the three kinds of stresses every person faces, and the effects on brain development, as well as the five parenting styles, and the eight benefits and eight challenges of each temperament characteristic — yes, there are challenges to parenting an “easy” child.
The book also has a cut-out section of 70 calm-down tools useful for parents and children in the moment of anger. It has a massive section on what children are capable of socially, physically, emotionally and cognitively from babies to teens so that parents have realistic expectations for their children. It is full of practical tools of “what to do” and statements of “what to say” in the
moment of anger — for playgroup altercations, sibling anger, toddler tantrums, teen anger, school-aged attitude, partner anger and our own anger. It gives suggestions on how to word assertive “I-statements.”
The bonus is that anyone can read it in a day.
API: What inspired you to write the book?
Judy: When I wrote Discipline Without Distress, people loved the book because of its focus on guiding behavior of babies to teens with truly non-punitive strategies — not only no spanking or other physical punishments but also no timeouts, logical consequences or taking away possessions. It was translated into five languages. As a mom of five children who are now ages 13 to 23 — three currently at university — and a parent educator for the past 17 years, I discovered a lot of tips and tricks to help make family life more fun, caring and connected while getting through the daily grind. Although I never was a spanker, I did use timeouts and logical consequences and eventually dropped all of these punishments by the time my oldest son was 10. I was facilitating parent groups and compiled a lot of parent ideas for gaining cooperation into the Discipline Without Distress book.
The problem was that the parents and I found that positive discipline was fine with a calm brain — anyone could do it when calm — but it was much harder to do with a stressed and angry brain, even when one truly believed in non-punitive, gentle discipline.
I was also single parenting at the time, because my partner was away at work a lot. I thought that a companion book about Parenting With Patience, loaded with ideas about handling stress, would be beneficial to parents because anger is a normal, healthy emotion. I found that parents were most at a loss in handling their children’s anger — at all ages, from toddlers to teens — respectfully and assertively in a way so that both of them win.
Helping children manage their anger without punishment is critical, because it determines their adult life success in jobs, relationships and happiness.
API: How will this book benefit other families?
Judy: Even if parents just take the first step, which is getting ourselves calm enough to think logically rather than emotionally, then family life will improve. The book provides at least 70 things to do in order to get calm.
The book also busts several parenting myths, such as that parents have to deal with things in the moment or toddlers will forget. Parents can take 30 minutes to calm down before they do anything and many strategies can be done with little children underfoot. Toddlers can remember what happened.
A critical section of the book outlines what ages children can do certain things. Parents feel they have to come down hard on the toddler years or behaviors will snowball by the teen years. Again, not true. Brain development is on their side in the later years.
Many “discipline” issues can be resolved with parent knowledge of appropriate development and adjustment of age-appropriate expectations.
API: Is there any special message you have for parents who feel that spanking is an appropriate discipline method for children?
Judy: I totally understand spanking. I felt the urge to spank from the anger arising when my kids deliberately disobeyed me. Non-parents just don’t understand how angry parents can feel with their offspring’s misbehavior.
Anger is a very normal and useful emotion. When we understand that spanking is most often a reaction of our anger, rather than a tool to teach — because we know logically that research shows it doesn’t work in the long run — then we can practice taking a timeout for ourselves a little bit every day. We can replace spanking with collaborative problem-solving if we are calm and help our children get calm first.
The more we do a habit, the more the habits become what we do. The payoff comes when we enjoy our beautiful results: Children who care about us, talk to us, have fun with us and listen to us — as we do for them.
Judy: Attachment Parenting International is a much-needed organization to promote healthy child upbringing and provide support for parents for their choices.
When the Internet was born, a few like-minded parents and I started Attachment Parenting Canada (APCA) two years after API was founded. Canada is a very progressive country, parenting-wise, and most of the health organizations align with API’s Eight Principles of Parenting. We feel that API’s Eight Principles of Parenting are a wonderful framework to guide parenting decisions, and they are inclusive enough for everyone who has a desire to be a little more skilled in their parenting. No parent is perfect, and we can all work within API’s Eight Principles of Parenting.
Judy: Every new day is a gift for us to begin again. Patience takes practice, and we can gain more by taking little baby steps. We can’t change the past, but we can start today. Every time we refrain from yelling is a gift for our children. Children are very forgiving, and you will love the fun, laughter, caring and joy of the school-aged and teen years if you drop punishments and begin collaborative problem-solving with them.
First, let’s deal with our frustration. This book will show you how.
API: Where can people find more information about your book or your work?
Chapter 15: How Parents Can Prevent Conflicts by Modifying Themselves
Chapter 16: The Other Parents of Your Children
Our discussions happen on GoodReads, so don’t hesitate to join in the conversation. We read a chapter a week. Sometimes you can’t get through the chapter and yet you’ll find you’ll still be able to participate in the conversation. So come join the other 500+ members who are already part of the conversation!
There are 500+ members waiting to read and discuss AP-oriented books with you. Are you already one of those members? If not, what are you waiting for?! Join the club at API’s online book club held through GoodReads.
For Siblings Without Rivalry, we will be reading chapters one to three in November. The topics for these chapters will be:
How This Book Came to Be
Chapter 1: Brothers and Sisters — Past and Present
Chapter 2: Not Til the Bad Feelings Come Out…
Chapter 3: The Perils of Comparisons
For Parent Effectiveness Training, we’ll be reading Chapters 10 to 12. The topics for these chapters will be on:
Chapter 10: Parental Power – Necessary or Justified?
Chapter 11: The “No-Lose” Method for Resolving Conflicts
Chapter 12: Parents’ Fears and Concerns About the “No-Lose” Method
Our discussions happen on GoodReads, so don’t hesitate to join in the conversation. We read a chapter a week and sometimes you can’t get through the chapter and yet you’ll find you’ll still be able to participate in the conversation. So come join the other 500+ members who are already part of the conversation!
Have you joined the API Reads movement? If not, now is your time to do so. We are still reading Parenting from the Inside Out by Daniel J. Siegel, MD, and Mary Hartzell, MEd for the general audience and for those with children under the school-age years. We will also be reading Parent Effectiveness Training by Dr. Thomas Gordon for those with children who are in the school-age years and above.
For Parenting from the Inside Out, in the month of October we will be finishing up the book by reading chapters 7-9. The topics for these chapters will be:
Chapter 7 – How We Keep It Together and How We Fall Apart
Chapter 8 – How We Disconnect and Reconnect: Rupture and Repair
Chapter 9 – How We Develop Mindsight: Compassion and Reflective Dialogues
Chapter 5 – How to Listen to Kids Too Young to Talk Much
Chapter 6 – How to Talk So Kids Will Listen to You
Chapter 7 – Putting I-Messages to Work
Chapter 8 – Changing Unacceptable Behavior by Changing the Environment
Chapter 9 – Inevitable Parent-Child Conflicts: Who Should Win?
Our discussions happen on GoodReads, so don’t hesitate to join in the conversation. We read a chapter a week, and sometimes you can’t get through the chapter and yet you’ll find you’ll still be able to participate in the conversation. So come join the other 500+ members who are already part of the conversation!
By Julie Artz, originally published in Summer 2008 issue of API’s newsletter
I’ve interviewed some big names in my writing life, so I was surprised at how nervous I felt at the prospect of interviewing Attachment Parenting International’s co-founders, Barbara Nicholson and Lysa Parker, about the organization’s beginnings, their book on Attachment Parenting (AP), and the challenges of founding and running a not-for-profit organization.
My anxiety couldn’t have been more displaced. Barbara and Lysa, despite their high-profile positions within Attachment Parenting International (API), are a delight to interview and tell an amazing story of how two young mothers–who were also special education teachers–went from having, as Barbara put it, “our own little support group,” to founding a global not-for-profit organization with the vision of helping parents achieve a more compassionate relationship with their children through AP.
JULIE: How did you two meet?
LYSA: Let’s begin at the beginning. Barbara and I met at a La Leche League (LLL) meeting in Nashville, Tennessee, USA, in 1980. She had just moved from Texas, USA, and was a LLL leader applicant. We started talking and found out we had a lot in common. We were both special education teachers, and our husbands were singers/songwriters. Both our husbands were from Texas, so they knew some of the same people. That’s how our friendship began. Because of our friendship, Barbara shared with me what she learned through LLL and was a great support.
I remember worrying about whether or not AP was right when I was a new mother. What if it’s not right? What if I damaged my child? Because we didn’t know anyone who had kids who were APed. It helps to know someone personally who’s been there. Even moms today in our API circles want to talk to people who have raised children this way.
BARBARA: The founders of LLL are seven mothers with an average of about five children each and that was one little light at the end of the tunnel–witnessing generations of their families continuing on with what their mothers started. I always tell my boys, “I’m learning on the job,” but at least you see me reading, trying, and that’s all I ask of you is to keep trying and growing. It is wonderful to see so many of our API and LLL friends becoming grandparents and watching their adult children parent in such loving ways. We feel very confident that our sons will be great parents, too!
LYSA: In 1985, we moved to Alabama, USA, due to my husband’s new work. I became a LLL leader in 1986 and went back to teaching in 1990. It was a real culture shock for me, because I’d gone from this world of loving, caring mothers surrounded by babies and young children where everybody is nurturing toward their children and each other. I found myself stuck in a portable classroom with rambunctious seventh- and eighth-grade students with learning disabilities. Many were emotionally disturbed; they were already initiating for gangs, and one student was already a father. I remember looking in their folders and seeing the problems they had in kindergarten and wondering why no one intervened–believing in my heart that AP could have prevented so many of these problems.
BARBARA: I remember thinking as my children got older, “I can’t imagine going back in the classroom knowing what I know.” I would feel like I wasn’t really serving the students if I didn’t promote AP.
I see prevention as the answer. Maybe 10-15% of these special education children had a true learning disability, and the rest of them just needed someone to sit and hold them and read to them and give them attention. Even in the late 1970s when I was teaching, it was hard to find a parent who was taking the time to give their children special attention. Parents wanted the teachers to take care of that for them, and when the children got home from school, they sat in front of the television. And this was surburban America, not high-risk or inner-city schools; it was a middle-class area, not poor.
Dr. Isabelle Fox (a member of API’s Advisory Board) has been telling us very similar stories. She started her practice in the late 1950s, worked through the 1990s, and the shift in the culture that she has seen during that time is profound. When she was first a young therapist, the mother usually stayed home with the children. So if something went wrong with a child, the mother could give the therapist information about the background of the child or what might have led to fears or anxieties. In the present day, Dr. Fox said the mothers don’t know what goes on in the child’s life, because they’re in substitute care with many changing caregivers. If it was a nanny, which is what she recommends for substitute care, at least it would be one stable caregiver who would know the child well. But in most situations, it’s not one stable caregiver; it’s a constant rotation, even in the best daycare situation.
JULIE: When did you realize you wanted to found API?
BARBARA: We were reading these great books, like High Risk: Children without a Conscience by Ken Magid. We actually met him later; he was a real catalyst. Then we read For Your Own Good by Alice Miller. All of a sudden, light bulbs were going on about why parents were having such a hard time learning about positive discipline with their own children: because most of us had not been parented that way. You are so deeply imprinted by the way you were treated as a child. Reactions people think of as instinctual would not be the normal reaction if you’d been raised lovingly. That was a huge “ah ha” moment for us.
I subscribed to a journal published by the National Association of Parents and Professionals for Safe Alternatives in Childbirth (NAPPSAC), and the publishers, Lee and David Stewart, had reviewed Alice Miller’s book. So there was this explosion of ideas in the late 1980s. We knew about AP from Dr. William Sears and LLL, but then you have these psychologists giving us the cultural overlay: the punishing culture we live in, that parents only knew what they learned as they were raised.
LYSA: If we had learned about Attachment Theory in college, we didn’t remember, so we’d go to the library and it was like a treasure hunt. We found out about Dr. John Bowlby (known as the “Father of Attachment Theory”) and Dr. James Clark Moloney.
“Attachment Parenting is in many ways the practical application of my father’s [John Bowlby] theory.” ~ Sir Richard Bowlby Bt, Attached at the Heart
Meet Sir Richard Bowlby Bt, advocate, lecturer, member of API’s Advisory Board and speaker at the 2014 API Conference on September 27 at Notre Dame University in South Bend, Indiana, USA. Richard Bowlby, the son of Dr. John Bowlby who first developed Attachment Theory, worked as a scientific photographer in various medical research institutions where he produced visual aids for communicating research findings.
He retired in 1999 to promote a wider understanding of Attachment Theory to healthcare practitioners and interested lay people. His present concern is the psychological impact on babies and toddlers being cared for by unfamiliar people in day care who do not develop long-term secondary attachment bonds to one caregiver. He also gives lectures to a wide range of health care professionals using video material and personal insights to promote a much broader understanding of his father’s work on attachment theory. He focuses on wider audiences using video material to help communicate the emotional significance of Attachment Theory, a potentially dry academic subject with very personally challenging significance.
He supports a range of organizations that address various attachment issues and is seeking ways to help the general public benefit from a better understanding of childhood attachment relationships. His eventual goal is to find ways of “crossing the species barrier” between academics and the general public, to liberate the professional knowledge of Attachment Theory into the population at large. He is developing a broader knowledge of associated subjects, especially the emerging research about the role of fathers and the long-term significance of their early relationships with their children.
We got photocopies of a book of Dr. Moloney’s from Susan Switzer, an LLL leader in Georgia, USA. Dr. Moloney was a psychiatrist who had been sent to Okinawa right after World War II as part of a team processing folks who had suffered greatly during the war. He found that, in spite of everything that had happened to them, they had happy dispositions. They weren’t bitter but were resilient, kind, calm, and it piqued his curiosity. He observed them, and what he found was that their parenting created a culture of compassion. Moloney called it “permissive parenting” at the time, where the child is the sole occupation of the mother for the first two years, then the siblings become part of the care of the child. Okinawan parents were very respectful of the children, contrary to what he had observed in the United States. He came back to the United States to work with the Cornelian Corner (a group of progressive pediatricians at Wayne State University) and started teaching American parents how to parent like the Okinawans. Even though the program wasn’t considered a success, it ultimately had its influence through Moloney’s association with LLL International.
So then we started scheming: What can we do? We wanted to start an organization.
BARBARA: So we wrote a letter to Dr. Elliot Barker, who founded the Canadian Society for the Prevention of Cruelty to Children (CSPCC), asking if we could found an American chapter. He had given a talk at a LLL conference that was
reprinted in Mothering (magazine). The day I moved into this house, October 1, 1992, we got the phone plugged in and it rang. It was Dr. Barker calling from Canada. I had to go hide in a closet and try to sound professional. I dropped everything to talk to him, while people were carrying in boxes downstairs. I thought he was going to tell me how to join, but actually he told us if he had it to do over again, he would do so much more than just publishing Empathic Parenting (the CSPCC’s quarterly journal published from 1978-2003). He mentored us from then on and told us to use a grassroots approach. It will start slow and it will build, he said, but that’s what’s going to change the culture.
LYSA: Dr. Barker emphasized having a strong mission and a strong vision, because he’d seen organizations get watered down over time and ultimately fold because they didn’t stay true to their mission. He wrote letters to important people asking them to send letters of endorsement, which they did, and suggested forming a strong advisory board of well-known experts. Thanks to Dr. Barker, we believe we found our spiritual calling: He made us feel that this is what
we were meant to do.
Our very first website was created in 1995 by a computer lab teacher at my school. This website became the open door to parents around the world. In 1997, we were contacted by some AP moms in Seattle, Washington, USA, who wanted to start an API group. We asked them to help us pioneer the support group model for us, which they agreed to take on, and they helped us come up with our very first support group materials.
BARBARA: About that time, we hired our first employee: fellow LLL Leader Zan Buckner, who started out just doing filing and then helped us so much with our early materials. We had a wonderful group of LLL friends who wanted to expand their horizons. They were excellent parenting resources. At the conferences, you could really expand on the philosophy of LLL and move into AP, and that’s where we heard so many fantastic speakers. So many LLL leaders were ready to do more, so they joined us.
Our first LLL conference as co-founders of API was in Indianapolis, Indiana, USA, with our exhibit that looked like a science fair project: a cardboard, three-sided exhibit with magazine cutouts. We’ll always be school teachers at heart!
API returns to Indiana…Make plans to attend the 2014 API Conference on September 26 at Notre Dame University in South Bend, Indiana! Registration is only $75 for a day packed with AP speakers and fun family activities
One of the founders of LLL, and their new executive director was there. They were so supportive of what we were doing. Since then, we have met every founder, and they have all said they wish they could have done what we were doing–expand their mission into parenting. There wouldn’t be API without the experience of breastfeeding our babies–learning to trust our bodies and ourselves as parents. Some of us were the first generation in several generations to breastfeed.
JULIE: Can you talk a little bit about the struggles of founding a not-for-profit?
LYSA: Every time we’ve gotten to the point where we were about to give up because we didn’t have enough money or resources or we were burned out, someone or something has come along and helped us out. What we’re going through right now is proof of that. If it’s meant to be, it will survive. It’s a constant miracle in our lives to see how API keeps hanging in there.
To us, it’s so important and nourishing to hear from parents and professionals. We’ve talked to people who knew John Bowlby, and they’ve said he would be proud of what we’re doing. His quote that I love is: “If a community cares for its children, it must cherish its parents.” He held support groups for parents when he was practicing medicine at the Tavistock Clinic in London. What an inspiration!
JULIE: And in 2007, you turned over API’s day-to-day operations to a small volunteer staff to work on a book about Attachment Parenting.
LYSA: The book, Attached at the Heart, is a culmination of the last 20 or more years since we had our first conversations about wanting to help children and parents. In our book, we paint the big picture and give the reader the reasons why AP is important, as well as the principles and the research to support those reasons. We’re different than most parenting books; we want to give parents the researched information and empower them to make their own informed decisions.
BARBARA: The other important message of our book is the title: Attached at the Heart. We want people to trust their heart when all else fails. When it’s the middle of the night and the baby’s crying, and the pediatrician and the mother-in-law have both said to let the baby cry, we want parents to trust their instincts. Instead of worrying, “Is my baby going to be messed up if I hold her for 15 more minutes?”, we want them to trust their heart. Mothers wouldn’t be in a cold
sweat or crying when their children were hurting, if they instinctively knew to always default to the most loving, connected thing to do.
We really wanted to have something about nurturing, or connection, in the title to capture all of these philosophical concepts we’ve been talking about.
JULIE: A lot of the philosophies you’ve discussed fault what you called a “punishing culture.” How do you go about changing culture to something more AP-focused?
LYSA: You can’t change generations of behaviors in one generation, but you can begin the change. So often, AP is blamed for troubles in a relationship or with children. But really, it has to do with the individual and collective experiences we bring to a relationship. You’ve got to raise your consciousness about yourself so that you’re more conscious with your children. Our children are grown now, but we’re still working on this with them and will be with our grandchildren.
BARBARA: Sometimes we hear of parents who say their own parents stayed together for the children, but did not work on the issues in their marriage. The children were so emotionally damaged, because they had absorbed the dysfunction in their family. They had been given a horrible model for a healthy relationship. We’re proud that our book and our organization emphasize how important it is for couples to model positive, loving interactions and ideally to work on their issues as a couple before they become parents.
LYSA: In the last 15 years, we can say without a doubt that we have seen the cultural shift begin, and AP is becoming more mainstream. It’s reflected in the media with celebrity parents in magazines wearing their babies, talking about breastfeeding and cosleeping; in television and movies where babies are worn in slings or carriers are a normal part of the scenery or with plots that include issues that are AP-oriented. AP businesses have popped up all over the Internet;
people from all over the world contact AP for advice and resources.
BARBARA: We dream of the day when the term “Attachment Parenting” is just “parenting,” and our organization isn’t needed anymore! Until then, we hope the parents who are out there setting such a good example in their communities will continue to nurture their children and each other, family by family creating a more compassionate world.
This is an exciting month for API Reads in which you, the reader, get to choose which direction you’ll go in your reading.
We are still reading Parenting from the Inside Out by Daniel J. Siegel, MD, and Mary Hartzell for the general audience and for those with children under the school-age years. We will also be reading Parent Effectiveness Training by Thomas Gordon for those with children who are in the school-age years and above.
For Parenting from the Inside Out, we have read the Introduction, Chapter 1 and Chapter 2. For the month of September we will be reading Chapters 3 to 6. The topics for these chapters will be:
Chapter 3 – How We Feel: Emotion in Our Internal and Interpersonal Worlds
Chapter 4 – How We Communicate: Making Connections
Chapter 5 – How We Attach: Relationships Between Children and Parents
Chapter 6 – How We Make Sense of Our Lives: Adult Attachment
Chapter 3 – How to Listen So Kids Will Talk to You: The Language of Acceptance
Chapter 4 – Putting Your Active Listening Skill to Work
Our discussions happen on GoodReads, so don’t hesitate to join in the conversation. We read a chapter a week, and sometimes you can’t get through the chapter and yet may find that you will still be able to participate in the conversation. So come join the other 400+ members who are already part of the conversation!
By Rita Brhel, Editor of Attached Family magazine, API’s Publications Coordinator
What this year’s celebration of World Breastfeeding Week is really about—more than updating the status on breastfeeding acceptance or increasing understanding for mothers who are unable to breastfeed—is advocacy for parent support.
While the primary goal of Attachment Parenting International (API) is to raise awareness of the importance of a secure parent-child attachment, the organization’s overarching strategy is to provide research-backed information in an environment of respect, empathy and compassion in order to support parents in making decisions for their families and to create support environments in their communities. API extends beyond attachment education, also promoting the best practices in all aspects of parenting from pregnancy and childbirth to infant feeding and nurturing touch to sleep and discipline to personal balance and self-improvement through such innovative programs as API Support Groups, the API Reads book club and the Journal of Attachment Parenting, just to name a few.
API is a parent support organization made up of parents located around the world with a deep desire to support other parents.
Parent Support Deserts
In this spirit, API created the Parent Support Deserts project through which we mapped gaps in local parent support opportunities specific to Attachment Parenting (AP). The goals of this multi-layered project are to identify communities, regions and nations in need of conscious-minded parent support and to encourage collaboration among like-minded organizations to address these gaps.
The first part of the project was identifying key nations of the world that we feel would ideally have organized, like-minded parent support options available. We focused on developed countries, because societal advance encourages separation from the natural world, including biologically instinctual ways of living and relating to one another, as is reflected in family structure and mainstream parenting philosophies. Industrialized nations lead the world in ideas and developing, and less-industrialized and underdeveloped nations tend look to these societies for guidance. We used the World Bank’s list of Developed Countries and Territories. All of the nations included in the project are defined as high-income economies as determined by Gross National Product, per-capita income, level of industrialization, widespread technological infrastructure and high standards of living.
The second part of the project was identifying key parent support organizations. We were looking for representative organizations with local support groups or classes with an approach to parent support that closely matches that of API—advocating for conscious, informed parenting choices that challenge the status quo:
Attachment Parenting International
Holistic Moms Network
International Association of Infant Massage
International Cesarean Awareness Network
La Leche League International
API recognizes that there are myriad local parent support opportunities in many communities that are not affiliated with these key parent support organizations, such as peer counselors, professionals, groups and classes available through hospitals, clinics, faith-based organizations, schools, etc. and that some of these may be quality, AP-minded programs. We appreciate this and welcome these independent programs to nominate themselves for inclusion in the Parent Support Deserts project through firstname.lastname@example.org.
We have a bias toward local support groups because the research validates the importance of a parenting support network. This may be provided through family, friends, coworkers and others in an informal way, but a community of like-minded parents is an empowering environment for parents learning about and growing in their parenting approach.
It is to be noted that not all communities identified as having a parent support option may have an active local support group at any one time, as some local leaders hold groups while others, depending on their own life stage or lack of interest from the community, opt not to lead a group but to remain available for one-on-one support. What was important in mapping communities was identifying those with an active parent support leader affiliated with one of the key parent support organizations who is either leading a group or class, or is available to provide support in this way should the interest from parents arise.
It is also to be noted that local support groups or classes unaffiliated with API may provide varying degrees of AP education that may or may not be aligned with API’s Eight Principles of Parenting. However, each of these representative organizations promote an environment that empowers parents in finding their own path for intentional parenting.
The third part of the project is dissecting each nation into both parent support deserts as well as oases. The first nation we are focusing on is the United States.
Future steps include cross-examining data according to risk factors such as areas with low breastfeeding rates, high infant mortality, high Cesarean rates and other aspects of public health, as well as creating maps to illustrate parent support deserts and oases, and inviting discussion among the AP community in how to address gaps in parent support.
Infant-Feeding Parent Support Deserts
Local parent support for breastfeeding has grown at an astonishing rate since La Leche League (LLL) International was founded in Illinois, USA, in 1956. LLL groups are located worldwide in nearly all developed nations as well as other less-developed countries. LLL has expanded its resources as cultures have evolved with technology and the changing roles for mothers, assisting mothers in providing breast milk to their infants whether through exclusive or partial breastfeeding or pumping as needed.
As research pours in on the benefits of breast milk and breastfeeding, evidence continues to point toward AP practices, such as using fewer interventions during childbirth, avoiding early mother-baby separation, rooming-in at the hospital, breastfeeding on demand, interpreting pre-cry hunger signals, encouraging skin-to-skin contact, room sharing, discouraging cry-it-out sleep training, helping the father in supporting the mother, and others. As a result, the vast support network that many communities now have for breastfeeding mothers—from a breastfeeding-friendly medical community to lactation consultants and peer counselors to doulas and childbirth educators and parent educators trained in lactation support—tend to direct breastfeeding mothers toward Attachment Parenting.
By contrast, there are few organized AP-minded support opportunities for mothers who are unable to or choose not to breastfeed or feed expressed breast milk. Formula-feeding parents are relatively on their own in terms of finding support that rightly points them in the direction of Attachment Parenting, as this choice or necessity to bottle-feed exclusively is seen less as part of the relationship context and more solely a nutritive option—though certainly we know, and research in sensitive responsiveness is finding, the behaviors surrounding bottle feeding are as much a part of the parent-child relationship as is breastfeeding. Unlike breastfeeding support, formula-feeding support is much less cohesive, with some information sources putting forth questionable science regarding formula versus breastfeeding benefits.
This gap in support provides an opportunity for API Support Groups and other like-minded organizations to offer acceptance, validation and support in AP practices to non-breastfeeding mothers. One program in the United States that does this is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), putting as much attention on formula-feeding mothers as those who choose to breastfeed.
For this introductory look at the Parent Support Deserts project, we examined locations of parent support groups in terms of infant-feeding in the Attachment Parenting context. We focused on LLL for breastfeeding support and API for both breastfeeding and formula-feeding support. Specifically, we were looking at:
Unsupported Key Communities = Communities of 100,000 or more, or state capitals, without either an LLL or an API presence.
Undersupported Key Communities = Communities of 100,000 or more, or state capitals, with either an LLL or an API presence, but not both.
Notable Communities = Communities of any population with both an API and LLL presence as well as other Attachment Parenting-minded support.
Key communities have a population of at least 100,000 or are state capital cities, because of these communities’ population density and centrality to policymaking and lawmaking.
We recognize that families in less-populated areas are as much in need of support. The Parent Support Desert project has found that LLL’s distribution worldwide and within the United States includes both urban and rural population centers, making LLL unique among like-minded organizations. API considers LLL to be an important partner in the Attachment Parenting movement, not only because of its representative size, reach and longevity but also because the parenting support provided in addition to breastfeeding education is directly in line with that promoted by API.
While this list is in flux, following are state reports of API’s Parent Support Deserts specific to Attachment Parenting infant-feeding support in the United States as spring 2014:
Notable Communities: Little Rock (capital), Searcy
Unsupported Key Communities: Anaheim, Carlsbad, Chula Vista, Concord, Corona, Costa Mesa, Daly City, Downey, El Cajon, El Monte, Escondido, Fontana, Fullerton, Garden Grove, Hayward, Huntington Beach, Inglewood, Moreno Valley, Norwalk, Ontario, Palmdale, Pomona, Rancho Cucamonga, Rialto, Richmond, Riverside, Salinas, San Bernardino, Santa Clara, Santa Maria, Sunnyvale, Torrance, Vallejo, Victorville
Undersupported Key Communities: Bakersfield, Burbank-Glendale, Elk Grove, Fairfield, Fremont, Humboldt, Lancaster/Antelope Valley, Marin, Modesto, Oakland-Berkeley, Oceanside, Oxnard, Pasadena, Pittsburgh-Antioch, Roseville-Citrus Heights, San Jose, Santa Clarita, Santa Rosa, Simi Valley, Stockton, Temecula-Murrieta, Thousand Oaks, Tulare-Visalia, Ventura, West Covina
Notable Communities: Long Beach, Los Angeles, Monterey, Sacramento (capital), San Diego, San Francisco, Santa Ana/Orange County
Unsupported Key Communities: Westminster
Undersupported Key Communities: Arvada, Aurora, Boulder, Centennial, Colorado Springs, Fort Collins, Lakewood, Pueblo, Thornton
By Rita Brhel, Editor of Attached Family magazine, API’s Publications Coordinator
I am very much a breastfeeding advocate, but I hesitate to vilify formula. I myself have bottle-fed two of my three babies with some formula. As a WIC Breastfeeding Peer Counselor, I work with women who exclusively breastfeed but also many women who struggle with low milk supply or, for other reasons, prefer to feed some formula in addition to breastfeeding or pumping.
While formula is unable to replicate much of the components in breast milk, formula has been able to save countless infant lives. We are fortunate to live in a time when we have a breast milk substitute that, while not the same as breast milk, is a viable infant food. Certainly, less than a century ago this was not the case.
The Birth of Formula
While breastfeeding was at one time the primary way to feed infants, breast milk substitutes were not a concept new to the 20th century, when formula’s approval increased so drastically.
Babies who were unable to breastfeed in the 19th century primarily received cow milk as substitution, according to Samuel Fomon in his article “Infant Feeding in the 20th Century: Formula and Beikost,” published in 2001 in The Journal of Nutrition, with cereal and other solids introduced to older infants.
Although evaporated milk was first marketed in 1858, its use was short lived because of the fear of it leading to scurvy. Powdered formula was available commercially by the late 1800s, but it was out of reach financially for many families. However, cow milk was not an ideal substitute: Major improvements in sanitation, dairying practices and milk handling didn’t occur until 1900—not to mention that sterile rubber nipples and the home icebox, precursor to the refrigerator, weren’t widely available until 1912.
Beginning in the 1920s, parents were directed to supplement their formula-fed infants with fruit juices to combat scurvy and cod liver oil to protect against rickets, two medical conditions caused by deficiencies of vitamins C and D, respectively. By the mid-1920s, formula prepared with evaporated milk dramatically improved upon the low digestibility and bacterial contamination of previous breast milk substitutes.
In the 1930s, the common breast milk substitute was prepared at home using either evaporated milk or fresh cow milk mixed with water and corn syrup as a carbohydrate. The advantage of evaporated milk was its vitamin D fortification. In either instance, the infant was supplemented with orange juice.
Breastfeeding rates dropped quickly during the 1940s when women were entering the workforce during World War II, according to Kathryn Davis, a historian of the era. After the war, coinciding with improved mass communications through printing methods, radio and television, formula use was so successfully marketed as superior to breastfeeding that breastfeeding rates declined to nearly nonexistent. This continued for several decades. Even as late as 1970, Fomon explained that fewer than 25% of mothers in the United States were initiating breastfeeding, and of those who breastfed, only 14% were still breastfeeding at two months of age. Nearly all infants were weaned, either to formula or cow milk, by four to six months. The loss of breastfeeding benefits aside, formula use had its limitations.
The Development of Formula
In the 1950s, the medical community began to address several issues with infant formula use: the tendency for infants to become dehydrated during illness, low content of iron resulting in high rates of iron deficiency, intestinal blood loss associated with fresh cow milk, low content of essential fatty acids and the continued problems with scurvy.
It was during this decade that concentrated liquid formula was developed, which was more affordable than powdered formula, and it reigned until 1970, when powdered and ready-to-feed formula use increased with the returned popularity of breastfeeding, since many breastfeeding mothers chose to supplement with formula.
Formula quality improved dramatically in the 1950s when a vitamin B6 deficiency among formula-fed infants was corrected. Iron-fortified formula was introduced in 1959, and in 1962, the formula base was changed to better match the protein ratio in breast milk. By the late 1960s, less than 10% of infants were fed home-prepared formula, greatly improving the nutrition and health among the formula-fed infant population. In the 1970s, formula was further improved in response to chloride deficiency in formula-fed infants.
Still, iron deficiency among formula-fed infants was a common occurrence through 1980, when mothers were delaying introduction of cow milk to beyond six months of age and when cereal’s iron fortification process was improved to increase absorption.
That infants can develop an allergy to cow milk was known early on. In fact, a soy formula was first developed in 1929. It regularly caused malodorous diarrhea and ulceration in the diaper area. A meat-based formula and a formula made with casein hydrolysate, a cow milk derivative, were also offered to sensitive infants. These early special formulas were not fortified with vitamins because it was believed at that time that these could include allergens. Not surprisingly, the medical community in the 1950s and 1960s reported several deficiencies in infants fed these special formulas, particularly vitamin K and iodine deficiencies, leading to goiters. An improved, fortified soy formula was developed in the 1960s. By the 1990s, more than 20% of formula-fed infants were receiving soy formula.
Early Introduction to Solids
From at least the 1940s through the 1970s, most infants were weaned from formula to cow milk at four to six months of age, although it was increasingly recognized that feeding cow milk predisposed infants to dehydration during illness as well as led to iron deficiency; the thought was that cereal would mediate these effects of cow milk consumption in infants and that water was a suitable supplement during times of illness, in addition to cow milk being fed as the nutrition base. The driving motivator for transitioning infants to cow milk so quickly was that cow milk was considerably less expensive and required no preparation compared to formula. It was also widely believed by parents that infants who were able to tolerate solids sooner were developing better—the “early independence” factor—something that Fomon noted.
In the 1960s, there was also the notion that whole cow milk would lead to obesity in infants, so some pediatricians were recommending feeding skim milk instead. Infants subjected to this practice consumed enormous amounts of milk and often lost skin folds, indicative of using their own body fat stores to stave off starvation.
While solid foods were to be introduced by four to six months of age in the 1930s, pediatricians were recommending solids to be started by two months in the 1950s, with some advising cereal by two to three days and strained vegetables by 10 days! In the 1960s, the guideline was to feed cereals by one month of age. The first baby foods developed at this time also had salt, monosodium glutamate (MSG), sugar and modified food starches added to improve taste and texture per adult taste standards.
The 1970s brought great change in infant-feeding views when the practices of feeding skim milk and putting food additives in baby foods discontinued. In addition, cereal introduction was recommended to be delayed until four months because earlier consumption was found to contribute to overeating habits. There was also research showing that iron deficiency during the first few years of life led to delayed cognitive development.
Comeback of a Breastfeeding Culture
The 1970s marked a turning point for infant feeding in other ways. This decade is when recommendations were first issued to defer introduction of cow milk to infants. This immediately resulted in infants being fed formula longer. In 1971, 20% of 6-month-old infants were formula-fed, whereas more than 50% of 6-month-old infants were on formula by 1980. The current recommendation that all infants are to either be breastfed or formula-fed until 12 months, when cow milk can be introduced, was issued in 1992.
At the same time, the U.S. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was providing free formula to low-income families, those most at risk of weaning infants to cow milk before six months of age. What started out as a very small anti-hunger program in the 1970s grew to be a major influence on infant feeding by the late 1980s. By the mid-1990s, 1.99 million infants were being served by WIC, representing about 47% of live births. For years, WIC was considered only a program through which to receive free formula; over time, however, WIC has become a major influence in improving breastfeeding rates among at-risk populations as well.
The 1970s saw an explosion of information about the components of breast milk as well as the non-nutritive benefits of breastfeeding. This spurred research as well as medical interest, leading to the creation of a new profession: lactation services in the form of lactation consultants, breastfeeding educators and peer counselors. Support of breastfeeding, and the accompanying Attachment Parenting movement, has expanded ever since.
Fomon commented that the increase in breastfeeding in the 1970s was global among industrial nations and arose in response to the public rather than the medical community, although he wasn’t certain why. He speculated that the sudden popularity in breastfeeding may have been in part due to negative publicity directed at the formula industry, which was accused of interfering with breastfeeding in less-developed nations as a marketing strategy. As its response to the public awareness campaign, the formula industry began efforts to better promote breastfeeding.
It is to be noted that La Leche League International, founded in 1956 in Illinois, USA, and considered to be the most influential organization in terms of breastfeeding support, was greatly expanding internationally during the 1970s. Today, the general recommendation is to breastfeed or formula-feed infants exclusively for at least six months before introducing solids and to continue breastfeeding or feeding formula until 12 months before introducing cow milk. Breastfeeding may continue beyond the first birthday for as long as is mutually desired by mother and baby, and the World Health Organization recommends breastfeeding until at least two years of age. Research on the benefits of breastfeeding infants is broad, while research on breastfeeding toddlers is growing.
According to the “Breastfeeding Report Card—United States, 2013” distributed by the U.S. Centers for Disease Control and Prevention, American breastfeeding rates are notable: 77% of all infants begin life breastfeeding, skin-to-skin contact and rooming-in are both on the rise, support is increasing in the workforce as well as at child care centers, and 49% of babies are being breastfed at six months and 27% at 12 months. Formula is still a significant part of the picture, with 62% of breastfed infants receiving some formula at three months and 84% of breastfed infants getting some formula at six months.
A lot has improved in our knowledge of infant nutrition during the past century. Today, the medical community embraces breastfeeding as well as appropriate infant development, and the formulas available are able to provide mothers with the ability to feed a safe, adequate breast milk substitute if needed. While very few mothers are entirely unable to breastfeed, many mothers rely on formula to some extent to be able to breastfeed their infants at all, a trend that is slowly changing as breastfeeding support expands. But there will always be babies who need a breast milk substitute. Fortunately, formula today is worth falling back on.
A mother on a mission can do amazing things, especially when working with an equally passionate parent support advocate.
Nancy Mohrbacher, a La Leche League (LLL) leader in Chicago, Illinois, USA, said it was a mother in her group who gave birth to an idea that has become the Mothers’ Milk Bank of the Western Great Lakes—one of a number of milk banks sprouting up around the world to serve mothers who are unable to breastfeed exclusively but no longer want to settle for formula.
“We need more milk banks to save more lives,” said Mohrbacher, IBCLC, FILCA, author of Breastfeeding Answers Made Simple, and chair of the board of directors for the now-developing Mothers’ Milk Bank. “And this seems to be an idea whose time has come because many are springing up all over.”
The mother in Mohrbacher’s LLL group gave birth to a preterm boy, and the hospital staff insisted that he receive formula because he was too weak to exclusively nurse. The mother knew about the lifesaving and life-giving properties of breast milk, and she knew about the potential negative outcomes of feeding formula to a preterm baby. She told Mohrbacher that she would have preferred to feed her baby donor breast milk.
This mother went on to ask Mohrbacher to help her start a milk bank for the Chicago and Wisconsin areas—a region with one of the highest infant mortality rates in the United States and for which a formal recommendation was made by the Wisconsin Neonatal Perinatal Quality Collaboration that low-birth-weight babies be fed pasteurized donor breast milk, rather than formula, when the mother’s own milk is not available.
For those families who have healthy babies, but for some reason the mother was unable to breastfeed, milk banks can meet their needs as well, provided that critically ill and preterm infants have been helped first.
The preterm baby in Mohrbacher’s group had a milder condition than other babies who are admitted to hospital neonatal intensive care units for care, and he is now nursing well despite formula supplementation. But for very preterm or more severely ill babies, anything other than human milk can cause serious health problems, like necrotizing enterocolitis (NEC), which occurs when a part of a baby’s intestines becomes inflamed and dies. The treatments for NEC account for 19% of all newborn health care costs. When NEC requires surgery, half of the babies treated die, and many of those who survive suffer from lifelong disabilities. Breast milk helps prevent NEC.
According to a 2009 study (Quigley, M. et al. “Formula milk versus donor breast milk for feeding preterm or low birth weight infants”), small preterm babies fed infant formula are two-and-a-half times more likely to develop NEC than those fed pasteurized donor human milk. The components unique to human milk prevent the inflammation that causes NEC, among other complications. Even partial human milk feedings are much less likely to cause a baby to become seriously ill.
“Human milk is preventative medicine for these babies,” Mohrbacher said.
With the advances in medical technology, more preterm infants are able to survive outside the womb. Since premature delivery and medical complications can reduce a mother’s milk supply despite her best efforts, more donor human milk is needed. Despite the life-saving properties of breast milk, the price per ounce for donor milk ranges from $3.50 to $4.50, and a prescription is required. Part of the expense stems from the pasteurization process, which is essential for preterm babies, as any pathogens in the milk could make an already sick or unstable infant more ill.
“Because the cost of collecting, processing and distributing pasteurized donor human milk is so high, even selling milk at cost puts it out of reach financially for most families,” Mohrbacher said. “A healthy 1-month-old usually takes between 25 and 30 ounces per day. Preterm babies need far less milk, [but] the health risks of infant formula are much greater for them.”
In general, the cost of feeding a premature baby donor breast milk in the hospital is shifted to the hospital itself, government programs and insurance companies. After a critically ill baby leaves the hospital and a family can no longer afford pasteurized human milk, the charitable arm of a nonprofit milk bank will often reach out to supply these families with the milk that will protect their babies.
Mohrbacher and her coworkers have assembled a team of experts to find a facility, buy equipment and begin processing donor milk for their region. They estimate that they will need approximately $1 million to open their processing facility and establish the charitable arm of the milk bank. Within three years of opening, they predict, the $4.50 per ounce that hospitals pay for human milk will allow their bank to become financially self-sustaining.
As Mohrbacher and the Mothers’ Milk Bank prove, you do not have to be famous or rich or powerful to make a difference. Any caring individual, with proper help and funding, can establish a nonprofit milk bank. The Mothers’ Milk Bank are first and foremost a group of people who care about saving infants’ lives and are determined to help those infants survive and thrive.
By Lisa Lord, Assistant Editor of Attached Family magazine
When a woman makes the choice to breastfeed, she usually doesn’t anticipate that it won’t work. After all, we are told that almost everyone can breastfeed—and this is true: Lactation is a robust biological process that almost always works.
But though there are only a few medical conditions in which breastfeeding may be limited, there are many medical circumstances that can present lactation and feeding challenges. Mothers who wean early for medical reasons or who are never able to breastfeed at all suffer a loss and may experience a spectrum of emotions that range from disappointment, frustration and anger to guilt, sadness and grief to relief and acceptance.
Editor’s Note: The description of certain medical conditions and breastfeeding recommendations contained in this article are specific to individual cases. It is not advice. Contact your health care provider for medical advice on these or other conditions. Contact an International Board-Certified Lactation Consultant (IBCLC), La Leche League (LLL) Leader or another breastfeeding specialist for more information regarding breastfeeding concerns in your individual case.
A Heartrending Choice
Kim Barbaro of Warminster, Pennsylvania, USA, faced the difficult choice of weaning when she developed a breast abscess that required surgery. Her surgeon explained that the incision would be long and deep, extending into the areola, and would remain open for some time, requiring packing twice a day.
Kim says that while her doctor gave her facts about the surgery, she was also understanding and empathetic: “She absolutely left the decision up to me,” she said. “But she didn’t just talk about the medicine; she talked about the bonding and the quality of time and being a working mom, and that really pulled me to her. It was that level of compassion and understanding that made a gigantic difference.”
“At first I was just confused, definitely torn between two worlds,” Kim added. “I think one of the biggest things for me was that bonding piece [with the baby], because it is so strong, and I didn’t want to be without it. I finally felt like my body was doing what it was supposed to do.”
In the end, Kim decided to wean: “After I started really thinking about it and took the emotional piece out, I knew there was just no way,” she said.
During her recovery, her emotions swung from grief to guilt to resignation, Kim says: “I went through a period of just sadness at that time I was feeding with a bottle. Logically I knew I made the right decision—it was not going to be possible—but emotionally it was another world. I would bounce back and forth, and just when I would get emotional, I would try and tell myself I wasn’t being realistic. You have to convince yourself and get support for that.”
When a mother must wean immediately for medical reasons, support is essential. Mairéad Murphy, IBCLC and La Leche League Leader in Dunboyne, Co. Meath, Ireland, explained: “It’s important that such moms get help on a practical level, because they may need to do some expressing to avoid engorgement and mastitis. But they also need support just to come to terms with the whole thing. It is very much a process of loss and grieving, because this portrait they had of being a mother has changed drastically.”
Kim had planned on a natural labor and birth with midwives, but she ended up with a last-minute Cesarean section. Neither Kim’s birthing experience nor her breastfeeding experience turned out as she wanted.
“I had expectations about how my birth was going to go, and it didn’t go that way,” she said. “And if you go to breastfeeding class, and they tell you all of the benefits and how it is so superior to formula, then you do feel guilty [if you can’t breastfeed]. It’s that mother nurture instinct—you just want to provide.”
When Weaning is the Only Option
It was about the time of her daughter’s first birthday when Wendy Friedlander received the devastating diagnosis that she herself had a rare form of cancer that would require her not only to wean her daughter but to live apart from her for a year while she underwent chemotherapy treatment.
“That was the hardest conversation I ever had in my life,” said Wendy, who lives in New York City, USA. “I wept three boxes of tissues. The doctor literally told me I had to give up a year of my life to save the rest. I had a week before treatment started, before I knew I would have to wean. And it wasn’t just stopping the nursing, it was everything—the babywearing, the breastfeeding, the cosleeping.”
Daytime weaning was easier than expected, as her daughter filled up on hugs and smiles instead of nursing for comfort throughout the day. However, night weaning was more traumatic. In her blog post “Weaning Early,” Wendy wrote: “The night weaning was like ripping off a Band-Aid. Where I was the Band-Aid, and just like that, I was taken away, and it was up to my daughter and her father to get through those first milk-less nights.”
With her large supply of milk, it was imperative for Wendy to continue pumping regularly because a blocked duct could turn into a life-threatening infection. It was a difficult balancing act, removing enough milk to prevent problems while at the same time trying to decrease milk production, all while she was extremely ill from treatments and living apart from her family.
“Everything else seemed so big, weaning was just an aside,” Wendy wrote. “And yet, the pain and heartbreak were tremendous.”
Education and Support are Critical
Apart from genuine contraindications to breastfeeding, there are many medical conditions and circumstances that may affect breastfeeding. With the right diagnosis, information, intervention and support, some breastfeeding may be possible if desired by the mother. Sometimes temporary weaning is needed, or a mother may need to supplement with expressed milk or formula.
Medical professionals may act as barriers to breastfeeding at times: “There are some conditions where breastfeeding is contraindicated, and it’s quite right,” Murphy said. “And there is another group of conditions where mom is told not to breastfeed, and it’s not the truth.”
This is not a condemnation of physicians, most of whom are caring individuals who have the best interests of their patients at heart. However, crushing patient loads, the critical need for good outcomes and simple lack of the most up-to-date information on lactation may lead them to make recommendations that unnecessarily compromise breastfeeding. This underscores a mother’s need for self-education and support.
Mihaela [last name withheld by request] had hepatitis B as a child but had no further problems with the condition for the rest of her teen and adult years. When she was 26 weeks pregnant, a blood test showed what her doctor called “pregnancy hepatitis.” Upon receiving this frightening news, she began having contractions. She spent the next seven weeks in the hospital on bed rest, taking medications for the hepatitis and to prevent further contractions.
“Later on, I learned that even if I had had hepatitis, the chances that the baby would have caught it were minimal,” Mihaela said. She also learned she might not have needed to take the medications she was on.
“I didn’t think to read about it myself. It’s a doctor’s responsibility, and if he doesn’t tell you and can’t self-educate, then you can’t protect yourself,” she added.
Her daughter was born at 34 weeks and was placed in an incubator almost immediately, so Mihaela didn’t have the chance to see her for several hours and didn’t hold her until the next day. Her doctor told Mihaela that she shouldn’t breastfeed because of the medications, and she was given pills to stop lactation.
“I was really sad because I imagined that I would be able to do that, but I didn’t have too much time to think about it [the doctor’s recommendation],” said Mihaela, who had assumed she might be able to begin nursing the baby after a day or two.
She and her daughter spent two weeks in the hospital, in separate rooms, until the baby was gaining weight steadily enough to go home. Looking back, she still feels regret and sadness.
“I feel it would have been much, much easier with breastfeeding,” Mihaela said. “I had moments when I was holding her, and she was close to me…breastfeeding would have complemented that.”
It was especially tough when her daughter would nuzzle her breasts, searching for a way to nurse, Mihaela said: “I would have to take her away from the proximity of the breast. It was really hard.”
If a mother requires medication, she may be told she shouldn’t breastfeed, advice based on resources doctors commonly use, such as the Physician’s Desk Reference or information from the drug manufacturers. According to La Leche League International (LLLI), these resources do not contain complete information about effects on breastfeeding, and very few medications are truly incompatible with breastfeeding. A more useful reference is Dr. Thomas Hale’s Medications and Mother’s Milk or LactMed, the U.S. National Institutes of Health’s Drugs and Lactation Database.
Before Wendy’s biopsy, she asked her anesthesiologist for a list of medications needed for the procedure, “and he didn’t want to give them to me, because he knew I wanted to know for myself when I could nurse my daughter again,” she said. The anesthesiologist told Wendy he would not do the procedure unless she agreed to wait 24 hours to nurse. In the end, Wendy did obtain the list of medicines and learned that she only had to wait eight hours to breastfeed.
There are a number of common conditions that generally should not hinder breastfeeding but often do.
Mastitis is an inflammation in the breast requiring frequent and thorough removal of milk, along with plenty of rest for the mother. “Empty breast, lots of rest,” recommends LLLI. Weaning is not required and may actually worsen the condition. If an antibiotic is needed, there are choices compatible with breastfeeding.
“But it’s still very common that a mother will go to her doctor with symptoms which may or may not be mastitis, and she is often told she needs antibiotics and she must wean in order to take them,” Murphy said. “Sometimes I find moms are told to wean for the duration of antibiotics, but this may be seven to 10 days, and for a very young baby, that may create difficulty getting back to the breast. Or a mother may have trouble keeping her milk supply up. Whereas if she was given the direction of getting into bed, feeding a lot, taking painkillers and so on, it may resolve quickly by itself.”
Many of the common causes of mastitis can be resolved with the help of a lactation consultant, and this is especially important if mastitis occurs more than once.
Jaundice, an excess of bilirubin in the infant’s blood, may cause him to be sleepy and less interested in eating. However, because bilirubin is excreted in stool, it’s critical for babies to continue feeding often to resolve the condition. Mothers may be encouraged to supplement with formula while continuing to breastfeed, which can interfere with milk production and baby’s interest in feeding. Rather than go down the route of giving formula, Murphy says mothers can be shown how to rouse a sleepy newborn, how to get him to take extra feeds and how to supplement if needed.
Once a mother begins supplementing with formula, she might not want to stop, because knowing the exact amount the baby is eating helps moms feel more confident, especially in the face of medical problems. It can be hard for a mother to regain trust in her ability to know that her baby is getting enough milk from breastfeeding.
“Sometimes I think with breastfeeding issues, if you could bottle confidence and give it to mom to drink, then everything would be sorted,” Murphy said. “We are so distanced from the knowledge of normal baby behavior. That lack of recognition causes a lot of problems.”
Deciding to Wean
Sometimes a mother may feel that weaning is the best option for her and her family.
“It all comes down to giving the mom information and letting her make a choice with her specific caregiver,“ Murphy said. “Lots of moms have a different path they are prepared to take with breastfeeding.”
When a mom decides to wean, a good lactation consultant or breastfeeding counselor will respect that and reassure her of the good she has done by breastfeeding up until that point.
“And it truly is good, no matter if she has breastfed for two days,” Murphy said.
Due to the stress and uncertainly caused by breastfeeding difficulties, weaning may bring great relief to an anxious mother. The day I (the author) brought my oldest son home from the hospital was the most stressful day of my life. Breastfeeding was not going well, possibly due to a related medical condition, and I was overwhelmed with worry. After well-intentioned but misguided advice from two counselors didn’t help resolve the issues, and after nine exhausting weeks of nursing, pumping and bottle feeding around the clock, I decided to wean. Though I felt tremendous grief and guilt, I was so relieved be free from the ongoing stress of breastfeeding. It was the right decision at the time—and it also fueled my determination to educate myself and get more support when my second child was born. Mothers who wean may appreciate tips on how to mother the baby in a way as close to breastfeeding as possible.
“Sometimes moms see the end of breastfeeding as the end to all that loveliness, but there are still important ways to enjoy the baby,” Murphy said.
Otherwise known as “bottle nursing,” a term coined by Attachment Parenting International founders Lysa Parker and Barbara Nicholson, authors of Attached at the Heart, mimicking breastfeeding behaviors when bottle-feeding include plenty of eye contact, snuggling at feeding times, skin-to-skin contact and feeding on demand. Mothers may also find bathing together and cosleeping helpful for establishing that initial bond with baby.
The process of making peace with weaning is different for every mother, and regret may linger.
“I only listened to one person,” Mihaela said. “I didn’t investigate the problem too much. What I would do is read more, ask more. If I had known more about how the baby would be affected, then probably I would have made other decisions.”
Kim had a strong support network of friends with a variety of breastfeeding experiences, friends who helped her come to terms with her experience.
“You have to say to yourself: This does not make or break your relationship with your child, this is not going to be the one and only bonding thing with your child,” she said.
Now a few years past her successful treatment, Wendy said, “It was a gift in so many ways in the end.”
She says her experience improved her relationships with everyone in her life, and it also left her daughter with a huge network of adults with whom she is very close, though the relatives caring for her daughter during Wendy’s illness didn’t always adhere to the same secure attachment-minded practices that Wendy did.
“In the end, it doesn’t matter because they loved her,” she said. “When it comes to a situation where you are low on reserves and low on support, there is only so much one person can do. Your children are getting served by love. That is the number-one thing that serves them.”
Connecting with our children for a more compassionate world.