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1. Pregnancy & Birth, 2. The Infant

World Breastfeeding Week 2014: Parent Support Deserts in the USA

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By Rita Brhel, Editor of Attached Family magazine, API’s Publications Coordinator

World Breastfeeding Week 2014What 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
  • Babywearing International
  • Holistic Moms Network
  • International Association of Infant Massage
  • International Cesarean Awareness Network
  • La Leche League International
  • Pathways Connect

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 rita@attachmentparenting.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:

Alabama

  • Undersupported Key Communities: Mobile, Montgomery (capital)
  • Notable Communities: Huntsville-Madison

Alaska

  • Undersupported Key Communities: Anchorage, Juneau (capital)

Arizona

  • Unsupported Key Communities: Chandler, Gilbert, Mesa, Peoria, Tempe, Scottsdale, Surprise
  • Undersupported Key Communities: Tucson
  • Notable Communities: Phoenix (capital)

Arkansas

  • Notable Communities: Little Rock (capital), Searcy

California

  • 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

Colorado

  • Unsupported Key Communities: Westminster
  • Undersupported Key Communities: Arvada, Aurora, Boulder, Centennial, Colorado Springs, Fort Collins, Lakewood, Pueblo, Thornton
  • Notable Communities: Denver (capital), Parker

Connecticut

  • Unsupported Key Communities: Hartford (capital), Stamford
  • Undersupported Key Communities: Bridgeport, Greenwich-Stamford, New Haven, Southington-New Britain, Waterbury

Delaware

  • Unsupported Key Communities: Dover (capital)

Florida

  • Unsupported Key Communities: Cape Coral, Coral Springs, Hialeah, Miami Gardens, Palm Bay, Pembroke Pines, Pompano Beach, Port St. Lucie, St. Petersburg
  • Undersupported Key Communities: Clearwater, Fort Lauderdale, Gainesville, Hollywood, Miami, Miramar, Orlando, Tallahassee (capital), Tampa
  • Notable Communities: Jacksonville

Georgia

  • Undersupported Key Communities: Athens, Augusta, Columbus, Savannah
  • Notable Communities: Atlanta (capital)

Hawaii

  • Undersupported Key Communities: Honolulu (capital)

Idaho

  • Undersupported Key Communities: Boise (capital)

Illinois

  • Unsupported Key Communities: Elgin, Joliet
  • Undersupported Key Communities: Aurora-Montgomery-Oswego, Peoria, Rockford, Springfield (capital)
  • Notable Communities: Chicago, Naperville

Indiana

  • Undersupported Key Communities: Evansville, Fort Wayne, Indianapolis (capital), South Bend

Iowa

  • Unsupported Key Communities: Cedar Rapids
  • Undersupported Key Communities: Cedar Falls-Waterloo, Quad Cities
  • Notable Communities: Des Moines (capital)

Kansas

  • Unsupported Key Communities: Olathe, Overland Park, Wichita
  • Undersupported Key Communities: Kansa City, Lenexa-Shawnee

Kentucky

  • Unsupported Key Communities: Frankfort (capital)
  • Undersupported Key Communities: Lexington
  • Notable Communities: Louisville

Louisiana

  • Unsupported Key Communities: Shreveport
  • Undersupported Key Communities: Baton Rouge (capital), Lafayette, New Orleans

Maine

  • Unsupported Key Communities: Augusta (capital)

Maryland

  • Undersupported Key Communities: Annapolis (capital), Baltimore, Washington D.C. (nation’s capital)

Massachusetts

  • Unsupported Key Communities: Cambridge, Lowell
  • Undersupported Key Communities: Boston (capital), Worchester

Michigan

  • Unsupported Key Communities: Flint, Sterling Heights
  • Undersupported Key Communities: Ann Arbor, Downriver, Grand Rapids, Lansing (capital), Warren
  • Notable Communities: Detroit, Saginaw

Minnesota

  • Undersupported Key Communities: Bloomington-Richfield, Rochester
  • Notable Communities: Duluth, Minneapolis-St. Paul (capital)

Mississippi

  • Notable Communities: Jackson (capital)

 Missouri

  • Unsupported Key Communities: Independence
  • Undersupported Key Communities: Columbia, Jefferson City (capital), Kansas City, Springfield
  • Notable Communities: St. Louis

Montana

  • Undersupported Key Communities: Billings, Helena (capital)

Nebraska

  • Undersupported Key Communities: Omaha
  • Notable Communities: Lincoln (capital)

Nevada

  • Unsupported Key Communities: Carson City (capital), Henderson, Reno
  • Notable Communities: Las Vegas

New Hampshire

  • Unsupported Key Communities: Manchester/Merrimack Valley
  • Undersupported Key Communities: Concord (capital)

 New Jersey

  • Unsupported Key Communities: Elizabeth, Patterson
  • Undersupported Key Communities: Trenton (capital)

New Mexico

  • Undersupported Key Communities: Albuquerque, Las Cruces, Santa Fe (capital)

New York

  • Unsupported Key Communities: Oyster Bay, Yonkers
  • Undersupported Key Communities: Albany (capital), Bronx, Brooklyn, Buffalo, New York City, Queens, Rochester, Staten Island, Syracuse
  • Notable Communities: Long Island, Manhattan

North Carolina

  • Undersupported Key Communities: Cary, Charlotte, Durham, Fayetteville, Greensboro, High Point, Raleigh (capital), Wilmington, Winston-Salem
  • Notable Communities: Greenville

North Dakota

  • Undersupported Key Communities: Bismarck (capital), Fargo

Ohio

  • Undersupported Key Communities: Akron, Cincinnati, Cleveland, Columbus (capital), Dayton, Toledo

 Oklahoma

  • Unsupported Key Communities: Broken Arrow
  • Undersupported Key Communities: Norman, Oklahoma City (capital), Tulsa

Oregon

  • Undersupported Key Communities: Eugene-Springfield, Gresham, Salem (capital)
  • Notable Communities: Portland

Pennsylvania

  • Unsupported Key Communities: Allentown
  • Undersupported Key Communities: Erie, Harrisburg (capital), Philadelphia
  • Notable Communities: Pittsburgh

Rhode Island

  • Undersupported Key Communities: Providence (capital)

South Carolina

  • Undersupported Key Communities: Charleston, Columbia (capital), Grand Strand

South Dakota

  • Unsupported Key Communities: Pierre (capital), Sioux Falls

Tennessee

  • Undersupported Key Communities: Chattanooga, Clarksville, Memphis, Murfreesboro
  • Notable Communities: Knoxville, Nashville (capital)

Texas

  • Unsupported Key Communities: Abilene, Beaumont, Brownsville, Carrollton, Grand Prairie, Laredo, Mesquite, Midland, Odessa, Richardson, Round Rock
  • Undersupported Key Communities: Amarillo, Arlington, Bryan-College Station, Corpus Christi, Dallas, Denton, El Paso, Fort Worth, Garland, Irving, Killeen, Lubbock, McAllen, Pasadena, Plano, Waco, Wichita Falls
  • Notable Communities: Austin (capital), Houston, McKinney, San Antonio

Utah

  • Unsupported Key Communities: Provo, West Valley City
  • Undersupported Key Communities: Salt Lake City (capital), West Jordan

Vermont

  • Undersupported Key Communities: Montpelier (capital)

Virginia

  • Unsupported Key Communities: Hampton, Newport News
  • Undersupported Key Communities: Alexandria-Arlington County, Chesapeake, Norfolk, Richmond (capital), Virginia Beach
  • Notable Communities: Fredericksburg

 Washington

  • Undersupported Key Communities: Bellevue, Everett, Kennewick-Pasco-Richland, Kent, Olympia (capital), Seattle, Spokane, Tacoma, Vancouver
  • Notable Communities: Port Angeles

West Virginia

  • Undersupported Key Communities: Charleston (capital)

Wisconsin

  • Undersupported Key Communities: Kenosha, Madison (capital), Milwaukee
  • Notable Communities: Green Bay, Oshkosh

Wyoming

  • Undersupported Key Communities: Cheyenne (capital)
You can read more in the double "Voices of Breastfeeding" issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members--and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.
You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.
1. Pregnancy & Birth, 2. The Infant

World Breastfeeding Week 2014: When Breastfeeding Doesn’t Work

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By Lisa Lord, Assistant Editor of Attached Family magazine

World Breastfeeding Week 2014When 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.”

Common Complications

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.

Moving On

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.”

You can read more in the double "Voices of Breastfeeding" issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members--and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.
You can read more in the double “Voices of Breastfeeding” issue of Attached Family magazine, in which we take a look at the cultural explosion of breastfeeding advocacy as well as the challenges still to overcome in supporting new parents with infant feeding. The magazine is free to API members–and membership in API is free! Visit www.attachmentparenting.org to access your free issue or join API.

 

2. The Infant

Pumping for Stay-at-Home Moms

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By Sonya Fehér, leader for South Austin API (Texas, USA) and blogger at MamaTrue.com

pumping for stay-at-home momsIf we’re staying at home to be with our babies full-time, we don’t have to pump milk or offer bottles. We can delay extended separations until our children are older, take our babies with us to run errands, go to appointments, or when we meet friends. And most of the time, we do. We spread out activities, so we can avoid taking Baby in and out of the car for multiple stops. We keep the volume low on the car stereo. We prioritize what we need to get at the grocery and find ways to entertain or distract Baby, so that we can get everything on the list. And we likely plan it all around when Baby may take a nap. That’s what stay-at-home moms do.

What differs for attached moms is that we are likely also sleeping with or near our babies during the night, wearing them during the day, and nursing them every hour or so. Being an Attachment Parenting (AP) stay-at-home mom is an intense 24-hours-a-day/365-days-a-year job.

Why Stay-at-Home Breastfeeding Mothers Pump

While all of the mothers that I interviewed agreed that breastmilk from the breast is best, AP stay-at-home moms have many reasons to pump: Continue reading Pumping for Stay-at-Home Moms →

2. The Infant, 3. The Toddler

Breastfeeding and Working, an Illustration

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By Amber Lewis, staff writer for The Attached Family

Pumping breastmilkThe first painful hurdle I was to face as a mother was the need to return to work. After a three-month crash course in Attachment Parenting (AP), my daughter and I were well bonded, so going back to work broke my heart. I have to admit it still does — every day that I spend more time working for a paycheck than I do building a relationship with my daughter, I cry a little privately.

I have tried to make the best of this hurdle called work, and in spite of day after day away from my daughter, we are still very much an attached family. When I am home, we use attachment skills that help us best keep and build a good relationship with our daughter, including:

  • Breastfeeding — Even though my daughter is more than two years old, I still pump twice a day at work. We will practice self-weaning, because I know she needs to nurse. It’s no longer as much of a nutritional need as a psychological need that allows us to reconnect after work and to say good bye without words in the morning.
  • Cosleeping — We have a family bed. Even though we have experimented with moving our daughter into her own room, we know she’s not ready for that yet and so we allow her to lead the way, at least for the mean time.
  • Prioritizing — Our daughter is our number-one priority. While we like to have a clean and organized house, this is not always the case. Things frequently get left out or put away in a rush to maximize our time together. I am a stay-at-home mom when I’m home. We take however long we need for library story time, trips to the park in the summer, family walks, crafts, learning, religious study, and anything else I would do if I were a stay-at-home mom.

Tips for Successful Pumping at Work:

  • Start early and pump often — My breasts are fullest in the morning, so I usually pump twice in the morning. I began pumping even before I returned to work, at night for the last six weeks I was on maternity leave, my daughter would nurse on one side while I pumped on the other, it was the best thing I did to build up my supply. By the time I returned to work, I was a pumping pro and had a freezer full of milk.
  • Put pumping on your to-do list — I was the only pumping mother in my department, so if I didn’t decide to pump, no one noticed or cared. I added it to my to-do list and set an alarm with the exact time I would pump every day. My breasts got used to the schedule, and if I missed a pumping session, I could feel it. Once I set it as a priority, people knew it was important to me and they respected that.
  • Be honest and open — If your boss wants to know why you are leaving and what you are doing, be honest. Using the word “breast” in a sentence at work makes people uncomfortable and I used that to my advantage. If my boss needed to know where I had been, I told him I was pumping breastmilk. If I was using a bathroom instead of a nursing room and a busybody needed to know what that funny noise was coming from the stall, I told them it was a breast pump. Anyone who wants to make a big deal about it will usually be too embarrassed at hearing the “b” word, they will immediately back down and none of those people ever mentioned it again to me.

What Fathers Can Do:

  • Provide support — Remind your wife that she can do continue nursing and working at the same time, because you believe in her.
  • Help out — Your wife is helping to take care of financial obligations, so you should help take care of home obligations. A little cleaning goes a long way in the heart of a working mom.
  • Be patient — Your wife feels the stress of working and still wants to be a wonderful mother. Those two things tend to compete for her time, so she can and probably will lose it every once and a while. Be quick to forgive and forget those frazzled moments.
  • Encourage weekend relaxation — When your wife has a free moment, encourage her to rest or help her so she can catch up on her favorite hobby. A little rest and relaxation can go a long way to preventing those frazzled moments in the point above.

Breastfeeding and Extended Separations

The most challenging time of me was around the time my daughter turned 18 months. I am a Navy reservist and was required to serve my two-week training across the country. We didn’t have the money to fly my husband and daughter back with me, so we set about finding other ways to stay attached.

I began researching everything I could find about nursing while apart. The best information was from a few moms whose travel for work kept them apart from their babies two or three days. I was left with one question as my departure date loomed ever closer: Would my daughter want to continue our nursing relationship when I returned?

Everything I knew about breastfeeding led me to believe it was beneficial for as long as possible, so I made two decisions:

  1. We would nurse up until the moment before I left for the airport. During our last nursing session, I would try to explain to her about my leaving and where I was going and that we would nurse again when I got home.
  2. I would pump throughout the two weeks. So, if she did want to nurse again once I returned, she could.

These decisions I made concerning breastfeeding were just a couple of ways we stayed attached. Here is what I found key to keeping attached with my daughter over the distance:

  • Video conferencing and lots of phone calls.
  • Help from Grandma and aunts. This was especially important, not only for giving my husband breaks, but in a pinch, their extra love and attention filled in a bit for my absence. Every time my mother-in-law came over, my daughter was ecstatic. It was as if she needs a woman’s love, and Grandma filled that need for the two weeks.

The decision to pump, with the hope we could continue our breastfeeding relationship, was not one without consequence. Pumps are great and they can do a good job in a pinch, but without a baby to fully empty my breasts, I developed a short bout of mastitis halfway through the two weeks.

My supply did drop, mostly because I was sleeping through the night, so I had to adjust that schedule. Instead of ignoring when my full breasts woke me up during the night, I took the cue and got the pump out. Showers became another tool to help me keep up my supply and fight further infection; using warm water and massaging the milk ducts became a twice-daily routine.

While it was a very stressful and exhausting two weeks, it was well worth all the effort. My daughter immediately nursed after we were reunited at the airport.

It doesn’t matter if you are across town for the day or across the globe for the week, you can successfully continue breastfeeding and AP with a little extra work and dedication. The best part of my time apart was seeing my husband and daughter at the airport when I returned — my daughter squealed with such delight and held on to me so tight, and then that first nursing session after my return was like heaven.

Tips for Successful Pumping during Work-Related Travel:

  • Bring your best pump — I asked for a second breast pump for my birthday and now I have a pump used only for travel. It stays cleaner and pumps a little more efficiently than the one I use every workday.
  • Bring lots of photos — This will help you pump more milk and stay connected to your baby. If you have a video phone, take pictures with it to play back while you pump.
  • Bring lots of batteries — Don’t expect to find a nursing room everywhere you go, especially on a plane. I bring enough batteries to last to whole trip just in case.
  • Bring a nursing wrap — If you can’t find a bathroom suitable to pump, you can sit in your car or find a secluded chair, cover up, and get to pumping.
  • Keep your lactation consulant’s number handy — I actually made an appointment just to discuss my plans with my OB/GYN before I left. When I got mastitis, I called her office and got some tips to get over it without medicine and a sympathetic ear, which helps when you are on the verge of tears with two very full and painful breasts.
  • Keep at it — The first two or three days will be the most difficult. Your body is adjusting to a new type of nursing and it can be hard to get a rhythm going, but once you get a schedule of pumping that works for you, things get easier. Mental attitude will go along way here. If you believe you can keep at this, you can and you’ll overcome any obstacle that gets in your way.
  • Stay hydrated — Drink lots of water to keep your supply up. I usually don’t drink anything but soy milk as far as dairy goes, but I found that whole milk actually helped increase my supply dramatically. So, the days I was gone, I drank two glasses each morning.
  • Bring lanolin cream — Invest in a couple tubes of lanolin cream, and don’t be shy when administering it. Pumps can be hard on nipples.
2. The Infant

From Fear to Breastfeeding

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By Grace Zell, staff writer for The Attached Family

To breastfeed or bottle-nurse?When I was pregnant for the first time, I wasn’t sure what I would do and I was actually a little afraid of committing to breastfeeding and being my child’s sole source of sustenance.

After my son was born, I decided to combine breastfeeding and bottle-nursing. I was ready with a breast pump, sterilized bottles, and formula. My son was a very alert and agitated infant, and he awakened every hour during the night in the beginning. Bottle-nursing gave me the ability to sleep for a four-hour shift while my husband took over. I had planned to fill the bottles with breast milk, but my son was such a high-needs infant that I fell behind with pumping and, after about three weeks, gave up completely and used formula in his bottles.

An Early End to Breastfeeding

I had been unable to get my son to latch on for nursing and did not get very nurturing support from the lactation staff at our hospital. They had led me to believe that I wouldn’t be able to pump and bottle-nurse. (I have since seen women who pumped for several months without their baby actually nursing and a woman who got her infant to latch on after about three unsuccessful weeks of trying.) Continue reading From Fear to Breastfeeding →

2. The Infant

The Basics of Bottle Nursing

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By Barbara Nicholson & Lysa Parker, API co-founders, reprinted with permission from Attached at the Heart ©, available through the API Store

Bottle nursingWe have been contacted by many parents and caregivers who want to incorporate the most loving behaviors into their feeding practices with their babies. Our culture often supports practices that create disconnection from our children. For instance, some parents have shared with us that they were given baby gear to encourage a “hands off “ style of parenting, including devices to prop a baby bottle so the baby does not have to be held during feedings. An Attachment Parenting International Support Group meeting may be the first place where a parent hears how important it is that babies be fed in the arms of a loved one.

API developed guidelines for bottle-feeding with a unique viewpoint. Because we encourage all parents to look at their parenting choices through the lens of attachment, we have coined the term “bottle nursing” because it reflects breastfeeding behaviors and has tremendous advantages to the parent or other caregiver and baby. These recommendations are applicable to infants who are bottle-fed breast milk, formula, or a combination.

To simulate breastfeeding, parents hold the baby in the crook of the arm, positioning the bottle alongside the breast. This position places the baby’s face and cheek in contact with the parent’s arm, and this skin-to-skin contact helps parent and baby feel more connected. Holding the baby during feeds also helps to prevent the baby from developing “flat-head syndrome,” or plagiocephaly, which can happen when a child is left on a flat surface too frequently. When a baby drinks from a propped bottle, mother and baby also miss an important opportunity to strengthen their emotional connection. Propping the bottle can also be a choking hazard.

Try to make feeding time a special time of calm for both parent and child. Maintain eye contact while feeding when the baby is alert and interested, and switch positions from one side to another; these help strengthen the baby’s eye muscles. Talk softly and lovingly to baby at feeding times. Parents should respect their child’s hunger cues by avoiding feeding schedules. Following the child’s cues helps to strengthen the attachment relationship and shows the baby that his needs are understood.

“We take care of our foster babies as if they were our birth children in every way, except that they are bottle-fed. We hold them as much as we can; I war them in a sling all of the time when I am out in public, and we never take the car seat out of the car. We sleep in close proximity to them; we have a porta-crib next to our bed.

We feed them bottles but use a breastfeeding model, holding them close, never propping the bottle, changing sides for eye-hand coordination, demand-feeding, yet being careful not to overfeed them formula (which is not a concern with breastmilk).

We answer their needs as quickly as is humanly possible, helping them to feel as if they are the most precious beings on this earth.”

~Reedy Hickey, foster mother of 32 infants

Some mothers (or primary caregivers) who bottle nurse choose to follow the breastfeeding model closely so the baby associates feeding with being held; therefore, the mother is the primary person who feeds him while using the bottle. This approach to bottle-feeding produces many benefits for mother and child. The mother will have an opportunity to sit down, to have a special time to bond and rest, just as a breastfeeding mother would be “allowed” to do. A new mother sometimes needs this excuse to rest, instead of feeling that she must do all the housework or other tasks while letting someone else feed the baby. With this behavior, the baby benefits from the consistency of his mother’s presence while feeding and is able to gaze at her face, smell her scent, and feel secure in her arms. This enables their precious attachment relationship to deepen. A mother might say to a well-intentioned relative or friend who wants to feed the baby that this is their special bonding time and a rest time for Mom.

Sucking can remain a strong need well past the first year or two. Pacifiers, when used appropriately, can satisfy that need until the child outgrows it. Breastfeeding babies suck at the breast for comfort, so parents of bottle-fed babies can enrich their child’s experience by either holding the baby in the feeding position when giving a pacifier or simply holding and comforting an older child. These modifications increase close physical contact and bonding time and can make weaning from the pacifier a more natural and gradual process.

As the baby gets older and is able to hold his own bottle, the parent may be tempted to allow the baby to feed himself or to let him walk around with a bottle rather than providing the comfort the child is seeking. If a child doesn’t associate the bottle with being held or having undivided attention by the parent, he might use the bottle or a pacifier as a comfort tool, or “transitional object.” Toddlers who use the bottle, pacifier, or thumb for comfort – rather than being comforted by the parent – may have a much harder time giving up the bottle, pacifier, or thumb down the road. If they learn to come to their parent for comfort or cuddle time and perhaps a short time of sucking on their bottle or pacifier, eventually they will prefer the cuddle and gradually wean from the transitional object, much like a breastfeeding toddler weans from the breast.

In the case of a baby or child who must be separated from their parents during part of the day, it is important that the parent evaluate how important a pacifier or other transitional object is for the security of the child. In some cases, it would be cruel to forbid the use of these comforts, so parents must use their best judgment.

1. Pregnancy & Birth, 2. The Infant, Special Circumstances: Multiples, Adoption & Special Needs

Traci’s Story: Developing an Appreciation for Bottle-feeding

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By Traci Singree, leader of API of Stark County, Ohio

**Originally published in the Spring 2007 annual New Baby issue of The Journal of API

Traci and baby
Traci and baby

Before my children, I was career driven, working in retail management, which meant no family time at holiday or summer get-togethers because I was always working! And I loved it! I met my husband right out of college. We were together for about five years before we got married. In 1995, we were wed. I continued my course of 12-hour days, sometimes 6-day work weeks, and I was having a blast working in the fast-paced field of fashion retail.

About five years later, my husband and I were starting to get that something’s missing feeling, having done all the things we wanted to do. We found ourselves sitting around the house looking at each other on weekends saying, “What do you want to do?” round and round until we decided that maybe that something missing was a baby!

It took us nearly a year to conceive our first-born. We discovered I was pregnant the day of my first fertility appointment. My only knowledge of pregnancy came from what I had heard from my mother or from fellow co-workers with children. I never really researched anything to do with birthing or babies until late in my pregnancy. Continue reading Traci’s Story: Developing an Appreciation for Bottle-feeding →