Lactation Narration

a blog about breastfeeding

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Every week I hear stories from nursing mothers in which their doctors gave them incorrect information or bad advice about breastfeeding. It’s frustrating, because people want to feel that their doctors are knowledgeable and that their advice is trustworthy. People often feel that they have to follow a doctor’s advice. Unfortunately, this advice too often leads to shortened duration of breastfeeding when it is based on misinformation. How pervasive is this problem?

The 1995 Series

A series of studies published in 1995[1,2,3,4] looked at physicians’ knowledge and attitudes regarding breastfeeding. Both senior medical residents and practicing physicians were surveyed for this series in the fields of pediatrics[1,2,3], Ob/Gyn[1], and family medicine[1,4]. Overall, the results showed that physicians had poor general knowledge of breastfeeding and breastfeeding management, poor attitudes towards breastfeeding promotion, poor self-confidence in counseling patients with breastfeeding problems, and had received insufficient formal training on breastfeeding. This series also found that prior personal breastfeeding experience by physicians or their spouses predicted greater knowledge, attitude, and self-confidence compared to those without personal breastfeeding experience.

  • General Knowledge – While almost all agreed that breastfeeding enhances infant immune function, about a third of doctors surveyed were not aware that breastfed infants also have lower incidence of gastroenteritis and otitis media[4].
  • Breastfeeding Management – Generally, around half of medical residents surveyed and around a third of practicing physicians surveyed chose incorrect clinical management practices for breastfeeding. For example, in counseling a mother with perceived low milk supply, 40% of residents and practicing physicians chose incorrect advice. Around 40% of pediatricians and 60% of family physicians did not know how to manage an otherwise healthy 4-day-old breastfed infant with jaundice[1,4]. Almost 50% of both pediatricians and family physicians were not aware that supplementing with formula during the first 2 weeks of life is a cause of breastfeeding failure[2]. The percentage of physicians who recommended complete termination of breastfeeding for treatable lactation difficulties (including mastitis, insufficient milk supply, breast abscess, teething, frequent loose stools, baby not seeming satiated) was significant[2,4].

Percent of surveyed doctors who answered breastfeeding knowledge questions correctly, from National Assessment of Physicians' Breast-feeding Knowledge, Attitudes, Training, and Experience(1).

  • Attitudes – About 25% of doctors surveyed did NOT agree that exclusive breastfeeding is the most beneficial form of infant nutrition[4]. About 25% of family physicians did not feel that breastfeeding promotion was an important use of their time[4].
  • Self-confidence – Less than 50% of all residents and physicians surveyed[1] (and only 14% of pediatric residents[3]) rated themselves effective in counseling breastfeeding patients.
  • Training – More than half of practicing physicians rated their training as inadequate in preparing them to counsel breastfeeding patients[1]. Only 55% of medical residents recalled even one instance of instruction on breastfeeding, and fewer than 20% had at least 5 trainings on breastfeeding[1].
  • Personal Experience – Previous personal breastfeeding experience was a major determinant of improved clinical knowledge and improved self-confidence[1,3]. Those with personal breastfeeding experience chose the correct advice more often than their counterparts in managing mastitis by 14%, insufficient milk supply by 20%, and early supplementation by 8%. There were also 22% more physicians with personal experience than without who felt self-confident in their ability to counsel patients.
    *In this series, “previous personal breastfeeding experience” was defined as whether they or their spouse “had ever breast-fed an infant for at least 2 weeks. This time frame was not intended to represent successful breast-feeding experience, but rather an adequate length of time to initiate a diligent attempt at breast-feeding and to ensure first-hand understanding of common breast-feeding techniques and problem solving.” [4]

The 2004 follow-up

A follow-up study[5] was done 10 years later to determine how knowledge and attitudes of pediatricians had changed over a decade. In the follow-up study, more pediatricians in 2004 than in 1995 were found to have negative opinions and attitudes about breastfeeding. Fewer pediatricians in 2004 believed that the benefits of breastfeeding outweighed the difficulties or inconveniences. The chart below shows the percentage of pediatricians in 2004 and 1995 who recommended that mothers not breastfeed for various reasons. More pediatricians in 2004 recommended that mothers not breastfeed for unnecessary reasons, such as immaturity of the mother and inconvenience. Pediatricians in 2004 did have more personal breastfeeding experience compared to 1995, and personal breastfeeding experience did continue to be associated with better knowledge of breastfeeding management practices compared with non-experienced counterparts.

2004 vs 1995 pediatrician recommendations not to breastfeed, from Pediatricians and the Promotion and Support of Breastfeeding(5).

Other Studies

Other studies from other groups have also demonstrated a lack of knowledge about breastfeeding by medical professionals.

  • Growth Charts – A study from 2000[6]showed that while almost all doctors in the study frequently or always plotted infant growth at well-child visits, none reported plotting breastfed babies on a growth chart specifically for breastfed infants. Only 5% of study participants were even aware that breastfed infants grow at a different pace than formula-fed infants. This knowledge was related to personal breastfeeding experience: Only 2% of participants without personal breastfeeding experience answered correctly, while 12% of participants with breastfeeding experience knew this.
  • Drug Safety – A 2007 study[7] reviewed 10 resources that doctors and pharmacists commonly use to review drug safety information when prescribing medications to lactating mothers. These sources varied widely in their recommendations for safety of medications while lactating. When healthcare practitioners use sources with outdated and incorrect information for determining the safety of a medication, they are likely to inappropriately advise many mothers that their recommended medications are incompatible with breastfeeding, and therefore advise mothers to temporarily or permanently cease breastfeeding unnecessarily. LactMed was found to contain more extensive and current citations than the other resources studied. Out of 14 drugs in the probe, 11 were found to be safe when using LactMed, while some other sources deemed 2 or fewer drugs safe for breastfeeding mothers [see chart below].

Number of medications deemed safe while breastfeeding by various sources, from Lactation Safety Recommendations and Reliability Compared in 10 Medication Resources(7).

  • Personal Breastfeeding Experience – Recall that previous personal experience with breastfeeding was a major determinant in greater knowledge and confidence in counseling breastfeeding patients in the studies discussed above. Physicians’ personal experience as a predictor of breastfeeding knowledge was further investigated in a 2008 study[8]. The previous studies had divided the participants into two groups, those who had personal breastfeeding experience of at least 2 weeks, and those who did not. This study divided the participating physicians into four groups: those with no personal breastfeeding experience, those with less than 6 months of personal breastfeeding experience, those with 6-12 months experience, and those with greater than 12 months experience.
    .
    In this study, doctors who had less than 6 months of breastfeeding experience had knowledge levels similar to doctors with no breastfeeding experience at all, however they had poorer attitudes toward breastfeeding than all other groups. In addition, they were more confident and perceived themselves to be more effective than their knowledge and attitudes would indicate. 25% of participants with short breastfeeding experience agreed with the item – “Breastfeeding and formula feeding are both equally acceptable methods of feeding infants.” – compared with less than 5% of participants from the other three groups. 80% of participants with short breastfeeding experience agreed that – “Breastfeeding is incompatible with working outside the home.” – compared with less than 50% of other participants.
    .
    One possible explanation proposed in the report was that these participants may have a need to normalize and defend their own decision to stop breastfeeding before the recommended time, regardless of their reason for weaning. Agreeing that infant formula and breastfeeding are equivalent and that it is not possible to breastfeed and work outside the home enables these participants to justify decisions they may have already made regarding infant feeding. Conversely, those who have longer experience with breastfeeding also have a need to justify their decision to continue to breastfeed while participants without children may have an idealistic view of breastfeeding, not recognizing or understanding the difficulties that often arise. Alternatively, the group with short breastfeeding experience may have had lower breastfeeding attitudes before they became parents, which negatively influenced their breastfeeding duration once they did become parents.
  • Training – Because of the low level of knowledge about breastfeeding demonstrated by doctors, it is necessary for more training on this topic for residents and physicians. A 2011 study[9] showed that residents in pediatrics received only about 3 hours of breastfeeding training per year (9 hours over 3 years). Another study[10] showed that training doctors is an effective method of increasing breastfeeding success for their patients. After a training course, residents were more likely to show improvements in knowledge and confidence, and the infant patients of these residents were more likely to breastfeed exclusively for 6 months.

Final Thoughts

Physician attitudes and knowledge about breastfeeding seem to be improving over the last decade, and I look forward to seeing another update to the previous surveys. Adequate training for residents is now understood to be important. But it is apparent that there are still many physicians with poor attitudes and knowledge out there. As a patient, you expect your doctor’s advice to be appropriate, but in the area of breastfeeding there unfortunately seems to be a good chance that your doctor can actually hinder your breastfeeding success with misinformation. And it seems that one of the best ways to gauge your doctor’s knowledge might be to simply inquire as to whether the doctor’s own children were breastfed, and if so, for how long.

References:

1. Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P. National Assessment of Physicians’ Breast-feeding Knowledge, Attitudes, Training, and Experience. JAMA. 1995;273(6):472-476.

2. Freed GL, Clark SJ, Lohr JA, Sorenson JR. Pediatrician Involvement in Breast-Feeding Promotion: A National Study of Residents and Practitioners. Pediatrics. 1995 Sep;96(3 Pt 1):490-4.

3. Williams EL, Hammer LD. Breastfeeding attitudes and knowledge of pediatricians-in-training. Am J Prev Med. 1995 Jan-Feb;11(1):26-33.

4. Freed GL, Clark SJ, Curtis P, Sorenson JR. Breast-feeding education and practice in family medicine. J Fam Pract. 1995 Mar;40(3):263-9.

5. Feldman-Winter LB, Schanler RJ, O’Connor KG, Lawrence RA. Pediatricians and the Promotion and Support of Breastfeeding. Arch Pediatr Adolesc Med. 2008;162(12):1142-1149.

6. Guise JM, Freed GL. Resident Physicians’ Knowledge of Breastfeeding and Infant Growth. Birth. 2000 Mar;27(1):49-53.

7. Akus M, Bartick M. Lactation Safety Recommendations and Reliability Compared in 10 Medication Resources. Ann Pharmacother. 2007 Sep;41(9):1352-60.

8. Brodribb W, Fallon A, Jackson C, Hegney D. The relationship between personal breastfeeding experience and the breastfeeding attitudes, knowledge, confidence and effectiveness of Australian GP registrars. Matern Child Nutr. 2008 Oct;4(4):264-74.

9. Osband YB, Altman RL, Patrick PA, Edwards KS. Breastfeeding Education and Support Services Offered to Pediatric Residents in the US. Academic Pediatrics. 2011;11(1): 75-79.

10. Feldman-Winter L, Barone L, Milcarek B, Hunter K, Meek J, Morton J, Williams T, Naylor A, Lawrence RA. Residency Curriculum Improves Breastfeeding Care. Pediatrics. 2010 Aug;126(2):289-97.

“This Milk Tastes Good” is a children’s book about breastfeeding in which the child imagines that her mother’s milk tastes like all the things that she sees her mother eating.

This giveaway is now closed. The winner is beth c. Congratulations!

This is a joint giveaway with Lactation Narration and Natural Parents Network. You may enter at one site only. Please find the section marked “Win it!” for the mandatory entry and optional bonus entries.

JhaZamoraS Publishing is offering our readers a giveaway of This Milk Tastes Good” plus 4 greeting cards, a value of $28.

“This Milk Tastes Good” is a children’s book about breastfeeding in which the child imagines that her mother’s milk tastes like all the things that she sees her mother eating. The greeting cards feature illustrations from the book.

From our reviewer, Alicia at Lactation Narration:

 

 

“This Milk Tastes Good” is written by Chenniah Patrick and illustrated by her husband, V. Kuroji Patrick. This children’s book features a black family which consists of a mother, father, and baby. The baby appears about 9 months old to me and is fairly androgynous, but my older daughter decided that the baby was a girl because she wears earrings.

The text of this book is written from the baby’s perspective. Baby comments that the milk tastes good, and imagines that it tastes like the various foods that baby sees mama eating. These foods include a peanut butter and jelly sandwich, spaghetti and meatballs, oatmeal, a veggie dog, spinach and lettuce, and chocolate kisses. In the introduction, the author describes reading about how breast milk can subtly taste like whatever the mother eats, and this led her to make up a song for her baby about all the things she had eaten throughout the day. This song became the basis for the book. The author states that “the book is in no way suggesting that breast milk drastically changes in flavour, or tastes exactly like what the mother has eaten. The goal is for the child to connect breast milk with healthy foods.”

child reading book

The baby is shown nursing, both with a cover-up at the park and without one at home. The father is shown supporting the mother and bonding with baby, and at one point thawing a bag of frozen “Mama’s Milk” as well, but no bottle imagery is shown on the page. Overall, the imagery in this book helps to normalize breastfeeding.

The baby is also shown being worn by both mom and dad. Babywearing enthusiasts may notice that the baby is worn facing outward in a “crotch-dangler” style carrier.

I am always happy to find a book that features breastfeeding to read with my nursing toddler. My 3 year old liked this book immediately and after the first read-through was reciting “This milk tastes good, this milk tastes yummy”. I think that she is in a good age range for this book based on the length of the book (12 pages with words) and the amount of words on each page (2 lines). There were enough words to keep her attention – not too few to be bored, and not too many to be restless. After I read the book to her, she decided to “read” it to her baby doll.
child reading book

Of course I like that this book normalizes breastfeeding, and I think it is noteworthy that it does so with a black family. I also liked that the father was included in this story about breast milk, and shown to be involved and supportive of breastfeeding too. The father is shown wearing baby, grocery shopping, reading to baby, and thawing frozen breastmilk.

My main problem with this book is that it is a paperback as opposed to a board book. For the age range that I would expect this book to be most popular with, a paperback is more likely to get accidentally torn. My daughter played with this book by herself for about 10 minutes and didn’t rip it though, so maybe I am just not giving her enough credit.

BUY IT!

You can purchase your own copy of “This Milk Tastes Good” at JhaZamoraS Publishing for $15.99 + tax + shipping.

WIN IT!

For your own chance to win a copy of “This Milk Tastes Good” from JhaZamoraS Publishing, enter by leaving a comment and using our Rafflecopter system below.

The winner will receive one copy of “This Milk Tastes Good” plus four greeting cards which feature illustrations from the book and breastfeeding quotes. Contest is open WORLDWIDE.

MANDATORY ENTRY: Visit JhaZamoraS Publishing and tell us one thing you have learned about the company! You must enter your name and email address in the Rafflecopter entry system for your entry to count, after leaving a comment on this blog post.

Leave a valid email address so we can contact you if you win. Email addresses in Rafflecopter are not made publicly visible. Please leave the same valid email address in your mandatory comment so we can verify entries.

This is a joint giveaway with Lactation Narration and Natural Parents Network. You may enter at one site only, and we’ll be recording IP addresses to ensure that there are no duplicate entries. That said, please do visit and enjoy both sites!

BONUS ENTRIES:
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Welcome to the Carnival of Tandem Nursing

This post was written for inclusion in the Carnival of Tandem Nursing hosted by Mommying My Way. Our participants have shared their personal stories of the highs the lows and information on what to expect if tandeming is in your future. Please read to the end of each post to find a list of links to the other carnival participants.

***


I started TTC* when Munchkin turned two years old. I knew that it was very common for nurslings to wean during a pregnancy, and since it was important to me to nurse for at least two years, I waited until then to start trying to get pregnant again. The first time I had tried to get pregnant, it had taken two years, so I expected it to take a while. I started charting my temperatures even though Munchkin was not night-weaned, and it seemed to work fine. To my surprise, it only took 4 months to get pregnant with Sweets!

At the beginning of my pregnancy, Munchkin was nursing about 5 times per day and was not night-weaned. She noticed right away that the milk tasted different. She didn’t seem to mind, but when she was done nursing she would chug a cup of water! I decided to night-wean her early in my pregnancy because the nipple sensitivity was difficult for me to deal with at night. I also purposely decreased her daytime nursing to make things more manageable for me. I did not want to wean her completely – I still wanted that final decision to be hers – but I did definitely want her to cut down.

Within 3 months, she was down to nursing only once per week. I kept thinking that she was about to fully wean, but she just didn’t. If I had wanted to, I think that I could have easily weaned her during this time, but I wanted her to make that final call for herself. I wasn’t sure if I really wanted to tandem nurse, but I was willing to see where things went. It turned out that she just continued to nurse about once per week for the rest of my pregnancy, sometimes going as much as two weeks without nursing! I didn’t have much milk, but she wasn’t nursing for the milk. When she did nurse, she would stay on for 30 or 40 minutes!

Sweets (newborn) tandems with Munchkin (3 years)

Once Sweets was born, Munchkin went back to nursing more frequently again. She was happy that Sweets brought the milk back! But just a few days later, she stopped nursing again. She said she didn’t like the milk and it made her feel sick! Just when I wanted her to nurse to help me with engorgement, she didn’t want to! I thought for sure she was weaned then… but I was wrong! She asked again a few days later. She kept up nursing about once or twice per day after that for about another year and a half!

Tandem nursing wasn’t very hard on me because Munchkin was not nursing that often, so it didn’t add a whole lot of nursing on top of how often Sweets was nursing. She either nursed first thing in the morning, or last thing before bed, or both. Sometimes I nursed them together – one on each side – and other times I made Munchkin wait. I would say “sometimes we share and sometimes we take turns”. When I nursed them together, my usual routine would be to nurse Sweets first on one side, and then when she switched sides I let Munchkin nurse on the side that Sweets was finished with. It may not have been necessary, but it made me feel like I was making sure that Sweets got everything she needed first. After all, Sweets had no option but nursing, while Munchkin was eating and drinking other foods most of the time. When they did nurse together, Munchkin would often sweetly hold Sweets’ hand or stroke her head.

Tandem nursing - one year out

As Munchkin got older, she stopped being able to get a letdown when she nursed by herself. She told me that she could only get milk when she nursed together with Sweets. She was especially happy to nurse together with Sweets then! But this was the beginning of the end of nursing for Munchkin. She drastically decreased the frequency of her nursing at that point, and eventually nursed for the last time about 6 weeks later.

*TTC – Trying To Conceive

***

  • My Tandem Nursing Journey: Jenny at I’m a full-time mummy is sharing her tandem nursing journey so far…
  • Built for Two: No matter how much you read and plan, things may not always go as you expect. A few things that Jennifer at True Confessions of a Real Mommy wished she knew when she was planning to tandem feed her toddler and newborn.
  • Tandem Nursing – Magic Cure?: Jorje of Momma Jorje had high expectations of tandem nursing easing her toddler daughter’s transition from being the baby to being a big sister.
  • Mutually Desirable – Navigating a Tandem Nursing Experience: Amy Willa at www.amywilla.com talks about limit setting and meditations that help her navigate an intense tandem nursing experience.
  • My Adventure in Tandem Nursing: Alicia at Lactation Narration tells her story of nursing her daughter through pregnancy and then tandem nursing.
  • 4 months in: the good/hard: Becca at Exile Fertility writes about the joys and struggles of having two nurslings 17 months apart.
  • Tandem Nursing: One at a Time: When tandem nursing resulted in a nursing aversion, Mandy at Living Peacefully with Children looked for ways to meet everyone’s needs.
  • Why Nurse a 4 Year Old?: One of the questions Dionna at Code Name: Mama keeps getting is, “but why breastfeed a four year old? What are the benefits?” Today she answers that question.
  • My Hurt Feelings: Shannon at The Artful Mama shares how her first son reacted to nursing after the birth of his brother and the gift she received the last time he nursed.
  • Carnival of Tandem Nursing: A Letter To Myself 7 Years Ago: Dulce de leche shares the advice and reassurance that she would have given to herself if she could go back in time.
  • Nursing Both My Babies: Cassie at There’s a Pickle in my Lifeshares her experience with nursing and transitioning into tandem nursing. She also gives tips for struggles.
  • Our Tandem Nursing Journey: Kim at Life-is-Learning describes her journey into tandem nursing and why it is important to her.
  • Based on her own experience, Lauren at Hobo Mama dishes about the benefits and downsides to nursing multiple children.

Welcome to the Carnival of Weaning: Weaning – Your Stories

This post was written for inclusion in the Carnival of Weaning hosted by Code Name: Mama and Aha! Parenting. Our participants have shared stories, tips, and struggles about the end of the breastfeeding relationship.


Munchkin is turning 6. Which means it’s been a whole year now since her 5th birthday and her weaning party.

In the past year, she has asked me to read her weaning book to her several times, and she enjoys looking at the photos. She has worn her milk pendant necklace only a few times, but she does like it.

She is still very aware of nursing – if only because her little sister is still nursing daily. She also loves to come to LLL meetings with me.

I asked her if she remembers her 5th birthday party, and at first she actually described her 4th birthday. I reminded her about her 5th birthday and then asked if she also remembered her weaning party. She said yes, she did remember it.

I asked her what she remembers about nursing, and she said she does not remember actually nursing. I found this very surprising!

First – it wasn’t that long ago. She remembers plenty of things that happened when she was younger than that. But, granted, the last time she nursed was almost 6 months before she actually considered herself weaned, so it has been a year and a half. She was 4.5 years old.

Second – it was something that happened so many times, that there are lots of opportunities for memories. Though she didn’t nurse as frequently when she was 4.

Third – it was something that was so important to her for so long. I was just sure she would have remembered it!

She remembers about it of course. She knows that she nursed and she remembers weaning. She enjoys looking at the pictures. She enjoys hearing the story of her nursing and weaning. But she says she doesn’t remember actually nursing!

My husband was not at all surprised. He thinks it is because nursing was such an everyday, routine activity. It didn’t stand out as a special occasion to be remembered, the way that her birthday party did, for example.

I had hoped that she might remember it fondly as she grew up, the way that I have a single memory of my mother rocking me and singing to me to sleep when I was 3 years old. I’m sure that my mother did that more than just that once, but I only have that one memory of it.

It makes me sad that she doesn’t remember nursing anymore. I thought that one of the benefits of nursing her past 4 years old would be that she would have memories of nursing. And that those memories of nursing might some day influence her own decisions as a mother the way that my own memory influenced mine.

But even if she doesn’t remember, I know that I always will. And I am glad that I have photos and that I wrote down the story of her nursing years to help me share that with her as she gets older.



Thank you for visiting the Carnival of Weaning hosted by Dionna at Code Name: Mama and Dr. Laura at Aha! Parenting.

Please take time to read the submissions by the other carnival participants (and many thanks to Joni Rae of Tales of a Kitchen Witch for designing our lovely button):

Many babies go through a distractible or disinterested phase somewhere around 10-15 months, where baby seems much less interested in nursing. For moms who would like to wean around 12 months, this can be a window of time that can make that transition easier. If you are interested in weaning, you can use this opportunity to try some gentle weaning techniques.

One popular technique is “Don’t Offer, Don’t Refuse”. For this weaning method, you don’t nurse unless your baby has requested to nurse. You may already be doing this without having even considered that it is a weaning technique. If you had previously been nursing at specific times in your daily routine (such as upon wake-up, or before nap time), try seeing what happens if you don’t automatically nurse. Does your baby request to nurse, or get upset? During the distractible/ disinterested window, she might not notice that you haven’t nursed. You may be able to wean during this phase without much or any protest.

Distractible Sweets

For moms who would like to continue nursing, that is also possible. When Sweets went through this phase, she was about 14 months old. For me though, weaning at 14 months was not something I was interested in. It was my priority to nurse her until at least 2 years old.

If you are not interested in weaning, be careful not to fall into the “Don’t Offer, Don’t Refuse” pattern.  Consider “Don’t Offer, Don’t Refuse” a gentle weaning technique, and don’t use it if you are not interested in weaning. You will really need to continue to offer nursing through this phase. There were many times when I knew that if I did not offer, Sweets would not have asked to nurse. If I was interested in weaning, I would have just gone along with that – but I wasn’t, so I continued to offer. Once I offered, she would nurse, though maybe not for a long time.

I was also working out of the home through this, and while I considered quitting pumping (due to her age and that she could drink cow’s milk at daycare), I decided to continue pumping at work to keep up my supply. I wanted to make sure that there would be milk for the times when she DID want to nurse.  So that she wouldn’t ask to nurse one day and end up frustrated at the breast due to no milk.

I also continued to co-sleep and night-nurse during this time. Though I considered at least night-weaning her during the disinterested phase, I was afraid that if she wasn’t nursing at night that she would stop nursing all-together because she seemed to nurse the best and longest at night.

After about 6-8 weeks or so, the phase passed and she started to be more interested in nursing again. I successfully nursed her past her 2nd birthday, and she is still nursing once or twice per day most days now at almost 3 years old.

It’s that time again! You might remember the great post in December 2011 that highlighted the Natural Parents Network Volunteer’s most popular or favorite posts from the year. Well, we are back and this time we are bringing you a collection of posts that focus on Do It Yourself projects, How To’s, Tutorials, Recipes, and anything related to a step by step guide or informational how-to.

There are a lot of really wonderful posts here and I hope that this serves as an excellent resource that you can pass on to your friends! Enjoy!

Momma Jorje: a slightly crunchy mommaJorje of Momma Jorje.com shares her Family Cloth Tutorial in pictures. She includes step by step photos with some tips for making very neat family cloth. You can find Momma Jorje on Facebook, too!

Lani at Boobie Time Blog shares “How to Help a New Breastfeeding Mom.” This post provides some tips on helping a new mom while she is learning to Breastfeed. You can also find Boobie Time Blog on Facebook and Twitter.

Amanda at Let’s Take the Metro shares “How I Make Cloth Wipes.” This post details how Amanda made all of her cloth wipes. You can also find Let’s Take the Metro on Facebook.

Jennifer at True Confessions of a Real Mommy shares “Lessons in a Picture Book.” A Lesson plan for pancakes and how to make your own butter! You can also find True Confessions of a Real Mommy on Facebook and Twitter.

Jenn at Monkey Butt Junction shares “Tips for Road Tripping with a Toddler.” A long car trip with a young child can be a great way to make some wonderful memories if you are prepared to meet the challenges. You can also find Monkey Butt Junction on Facebook and Twitter.

Abbie at Farmer’s Daughter shares “Maple Cinnamon Swirl Bread.” This recipe tutorial shows you how to make a sweet whole wheat bread with beautiful cinnamon swirls in each slice. You can also find Farmer’s Daughter on Facebook and Twitter.

Jennifer at Hybrid Rasta Mama shares “How To Consume Coconut Oil Plus Coconut Oil Candy Recipes.” This post provides some tips on how to get your daily dose of coconut oil down the hatch. It also provides some very tasty recipes for coconut oil candy! You can also find Hybrid Rasta Mama on Facebook, Twitter, Pinterest, and Google +.

Alicia at Lactation Narration gives some ideas for how to accomplish Partial Weaning for moms who would like to cut down on nursing without completely weaning. You can also find Lactation Narration on Facebook and Twitter.

Cynthia at The Hippie Housewife shares “A Learning-Rich Environment.” This post provides a number of suggestions for creating a learning-rich environment and incorporating learning into everyday life, with a particular focus on the preschool age. You can also find The Hippie Housewife on Facebook, Pinterest, and Google +.

BecomingCrunchyKelly at Becoming Crunchy shares “Kale Chips = Awesome! This post shares a super easy recipe for making a super easy (and surprisingly tasty) snack from one of the most healthful greens around. You can also find Becoming Crunchy on Facebook, Twitter, and Pinterest.

Shannon at Pineapples & Artichokes shares “How to Move to California.” A silly how-to she wrote while she and her then fiance were driving to their new home. You can also find Shannon on Pinterest, Flickr, and Google +.

Gretchen at That Mama Gretchen shares a recipe for “Homemade Fruit Leather.” It’s easier than you ever thought and the perfect snack for you and your family. You can also find That Mama Gretchen on Facebook, Twitter, and Pinterest.

Julia at A Little Bit of All of It shares “How I Cloth Diaper (Part 1).” This post details the way Julia has cloth diapered her daughter along with the products she uses. You can also find A Little Bit of All of It on Facebook, Twitter, Pinterest, and Google +.

Joella at Fine and Fair shares “Our First Sensory Bins.” In this post, she shares how she made a “Scoop, Measure, and Pour” themed sensory bin, as well as an “In the Garden” themed bin. She also shares some tips for making your own sensory bins! Fine and Fair can be found on Facebook and Twitter.

Visit Code Name: MamaFor all of you breastfeeding mamas, Dionna at Code Name: Mama has the ultimate DIY experience with the main ingredient being your breastmilk! 58 Medical, Costmetic, and Other Alternative Uses for Breastmilk includes a cradle cap remedy, an anti-itch salve, weaning jewelry, lotion, and more. You can also find Dionna on Facebook, Twitter, Pinterest, and YouTube.

Melissa at Vibrant Wanderings offers several ideas for “Keeping a Toddler Happily Busy on a Long Flight.” The list includes handmade felt activities, among many other things. You can also find Melissa on Facebook, Twitter, Pinterest, and Google +.

Shannon at The Artful Mama shares “Preparing Toddlers for Birth.” This post features MamAmor dolls and shows some alternative ways to talk to toddlers about pregnancy and birth. You can also find The Artful Mama on Facebook and Twitter.

Kym at Our Crazy Corner of the World shares her “Family Binder DIY.” This post shows how to put together a family binder, to help organize cleaning, meal planning, shopping and budgeting all in one convenient location!

I Thought I Knew Mama: A window into the adventures of stay at home mamahood, natural parenting, & green and healthy livingCharise at I Thought I Knew Mama shares “5 Green Living, Spring Cleaning Tips.” This post provides easy ways to keep the toxins out of your home and to freshen up your home for spring. You can also find I Thought I Knew Mama on Facebook, Twitter, Pinterest, and Google +.

Kristin at Intrepid Murmurings shares “Daily Bread: My Favorite Whole Grain Bread Machine Recipe.” This recipe is easy, highly adaptable, and a great starting point for creating your own daily (or almost daily!) homemade bread. You can also find Intrepid Murmurings on Facebook, Twitter, Pinterest.

Mandy at Living Peacefully with Children shares “10 Tips for Toddler Carseat Woes.” Check out these ideas of dealing with toddler carseat issues without resorting to punishments. You can also find Living Peacefully with Children on Facebook.

Kat at Loving {Almost} Every Moment shares “DIY Mom’s Night In.” A somewhat humorous solution, this post provides exhausted Mamas the recipe for the perfect way to recharge!

Stacy at Sweet Sky shares “Ways to Bring More Mindfulness Into Your Days.” This post provides tips and tricks to bring yourself back to the present moment, so you can be the parent you want to be. You can also find Stacy on Facebook.

AnktangleAmy at Anktangle shows us how to make your own popsicle stick puzzles, a fun and simple “busy bag” activity for toddlers and preschool aged children. You can also find Amy on Facebook, Twitter, Pinterest, and Google +.

Hobo Mama: A Natural Parenting BlogLauren at Hobo Mama shares “How to sew a mei tai baby carrier.” The mei tai is Lauren and Sam’s favorite carrier for baby Alrik: as comfortable and simple as it is beautiful. You can also find Hobo Mama on Facebook, Twitter, Pinterest, and Google +.

Visit African Babies Don't CryChristine at African Babies Don’t Cry shares “How to Make Rainbow Coloured Rice (Without Alcohol) for a Toddler Sensory Bin.” This post provides a step by step tutorial for making vibrantly coloured rainbow rice for sensory play, includes a printable PDF. You can also find African Babies Don’t Cry on Facebook, Twitter, Pinterest, and Google +.

Luschka of Diary of a First Child shares “How To Send A Hug In An Envelope.” This post is a creative way to send more than just the standard card to love ones. It literally is a hug in an envelope! You can also find Diary of a First Child on Facebook, and Twitter.

Welcome to the Pregnancy Necessities Carnival!
This post was written for inclusion in the Pregnancy Necessities Carnival hosted by Parenting God’s Children. Today, participants share what they simply cannot live without during their pregnancies or simply what to gather for their upcoming new addition. Please see the full list of links to the other carnival submissions at the end of this post. Enjoy!
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So, you are an expectant mom, you plan to breastfeed, and you wonder what products you should have on your list to buy before baby arrives? As breastfeeding regains popularity in our society, more and more products are available on the market for nursing moms. Here is a list of things you may want to put on your shopping list. Or not. You may not need to buy many of these after all.

1. Nursing bras - These bras allow you to unclip one side for easy access to your boob at feeding time. They are pretty useful, but not necessary for everyone. I have one friend who doesn’t wear a bra ever – nursing or not! My regular bra has enough elastic, and my breasts are small enough, that I can just pull one side down under my boob for access, without the need to use specialized bras. Also consider nursing tanks instead, which also cover your tummy.

2. Nursing pads – Put them in your bra to catch the milk you leak. These come in washable or disposable varieties, as well as LilyPadz. I liked the contoured pads best and felt like they didn’t show as much through my shirt as the flat variety. I actually started wearing these when I was still pregnant and started leaking colostrum, but not everyone leaks. They are most helpful for the first few months with baby, and you probably won’t continue to need them later on in your nursing career. If you are crafty, you could also make these yourself pretty easily using scraps.

3. Nursing shirts/dresses – These clothes are designed with openings underneath so that you can nurse very discreetly in public. I found them really essential in the beginning, when I was not very comfortable with nursing in public yet. I bought some online from Motherwear and Expressiva, but I found them to be quite expensive. I got the rest of mine at consignment sales, usually mixed in with the maternity clothes, where they were much cheaper! As time went on, I got better at nursing in public and felt fine just pulling up my regular shirt without needing special nursing clothes. I do still wear specialized nursing dresses though. Most of my regular dresses are not nursing friendly though, and obviously I can’t just pull them up to nurse the way I do with a shirt! Some styles of dresses are more nursing friendly though, where you can pull them down from the top.

4. Nursing coversThese are typically a sheet of fabric that covers the baby while nursing and attaches around your neck so that it doesn’t fall off. These are also meant to ease nursing in public if you are uncomfortable with others seeing baby nursing. Some people love them, others hate them. Personally, I never used one. This is another item that you could probably easily make yourself.

5. Breastfeeding pillow- The Boppy and My Breast Friend are the most popular examples of breastfeeding pillows. They are designed to prop the baby close to your breast to put baby in a comfortable position for feeding. Some people find these very helpful. They are completely optional though. You can get the same effect from a few throw pillows under your elbow. I used it with my first, but never did with my second.

6. Lanolin – You put lanolin on your nipples if they hurt. It’s like ultimate chap stick to heal the cracks. It is particularly useful in the first few weeks, when your nipples are still adjusting to nursing. Some people use a ton of it, but I only used a tiny bit and found I had lots left over. I never actually purchased it. You can email Medela and Lansinoh and tell them you are an expectant mother and ask if they have any free samples they can send. They both sent me free tubes of lanolin, and it was way more than I ever needed. One thing to consider is that lanolin can promote thrush, so be aware that not all nipple pain should be treated with lanolin. There are non-lanolin nipple cream options too, for those looking for an alternative.

7. Breast Pump – Are you going to be separated from baby, ie work or school? If so, you probably want a quality, double electric pump. The most popular brands for this are Medela, Ameda, and the newer Hygeia. If you are not planning to be separated from baby, you do not need a pump unless you want one. It is in no way true that all nursing mothers need to have a pump. It is your choice. For occasional pumping, I’d say once per day or less, I would recommend just a manual or a cheap electric – you don’t need an expensive pump in this situation. Now, if you end up dealing with an unusual circumstance, such as prematurity or cleft palate, then you will want to use a high quality pump. You don’t need the pump in advance though. I think it is fine to wait until baby is born and see what your situation is. Even if you do use it, it likely won’t be until several weeks out with a healthy baby if you do not plan to be separated.

8. Hands-free pumping bra – If you will be pumping more than once per day, this may be useful for you. I never used one when pumping at work for my first, but I did for my second and thought it was really helpful just so I could do other things while pumping, such as writing, typing, or turning the pages of a book. If you will only be pumping once per day or less often, I probably wouldn’t bother with this though. The more common style can only be used for pumping, but I needed one that could be used for nursing or pumping, because I pumped at work, but nursed on my lunch break, and didn’t want to change my bra several times per day! You could also make your own DIY hands-free pump setup using hair-ties, as demonstrated on Kellymom.

9. Bottles and bottle nipples – If you do use a pump, you will also likely use bottles. If you don’t pump, then you may not need bottles at all – not all babies use bottles! If/when you do buy bottles, I recommend only getting the smaller 4-5 oz size, and not the big 8 oz size. Formula fed babies typically do need the larger bottles eventually, but breastfed babies rarely take more than 4-5 oz in a bottle (mine never took more than 3oz). Along with bottles go nipples. Use the slowest flow nipple you can find to prevent nipple preference; there is no need to ever increase the flow as your baby gets older. Keep in mind that some brands of “slow flow” or “stage 1″ nipples are slower than others. And some babies are picky and will only take certain brands. I made the mistake of buying a bunch of one kind, and then not being able to use them. I say wait and see what you need; you don’t need this in advance either.

10. Milk storage bags – Most people who pump end up freezing milk too, and most freeze milk in special storage bags. I preferred the Lansinoh brand for this, personally. Some other brands were hard for me to seal properly and leaked on me. Don’t freeze in too large of amounts. Just because the bag can hold 8 oz, doesn’t mean you should freeze 8 oz – then you have to thaw 8 oz! If your baby only drinks 3 oz servings, then you’ve just wasted the rest. If you freeze in smaller amounts, you can always thaw another bag if needed. I didn’t freeze in bags at all for my second baby; I used ice cube trays. They freeze in nice 1 oz portions, which I can then pop out and store in plain ziplock freezer storage bags. No expensive milk bags to buy, and always easy to thaw the number of ounces that I want.

Bottom line: none of this stuff is essential for every nursing mom. All you really need to breastfeed are your baby and your boobs. Some products can help ease the process, but it’s optional. Pumping is not required for breastfeeding, and half of these products are irrelevant if you never pump.

When I was pregnant with my first, we ended up buying all sorts of things that seemed so essential at the time, but that we never actually needed at all (a bottle warmer that plugs into the car for my baby who never even took a bottle!). When I was pregnant with my second, I really wanted to buy stuff (I guess I was “nesting”), but couldn’t find anything that I needed! You really don’t need all the stuff at all!

**Disclaimer: No links are affiliate links and I have received no free products or monetary payment in exchange mentionimg or linking any products. Product mentions and links are simply for illustration and examples for readers’ convenience. Product preferences mentioned reflect only my personal opinions of products with which I am familiar.**

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Please take time to read the submissions by the other carnival participants!

The previous (2005) version of the AAP’s (American Academy of Pediatrics) Breastfeeding and the Use of Human Milk document, had the following statements about breastfeeding beyond infancy (emphasis mine):

Pediatricians and parents should be aware that exclusive breastfeeding is sufficient to support optimal growth and development for approximately the first 6 months of life, and provides continuing protection against diarrhea and respiratory tract infection. Breastfeeding should be continued for at least the first year of life and beyond for as long as mutually desired by mother and child.

There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.

This was a very supportive statement for those of us who nurse beyond infancy, and even beyond toddlerhood into the pre-school years. I have pulled out this AAP statement many times to defend myself from those who would call breastfeeding beyond infancy not just un-beneficial, but actually harmful to children.

I have also used the AAFP (American Academy of Family Physicians) statement from its 2008 position paper:

NURSING BEYOND INFANCY
As recommended by the WHO, breastfeeding should ideally continue beyond infancy, but this is not the cultural norm in the United States and requires ongoing support and encouragement. It has been estimated that a natural weaning age for humans is between two and seven years. Family physicians should be knowledgeable regarding the ongoing benefits to the child of extended breastfeeding, including continued immune protection, better social adjustment, and having a sustainable food source in times of emergency. The longer women breastfeed, the greater the decrease in their risk of breast cancer. Mothers who have immigrated from cultures in which breastfeeding beyond infancy is routine should be encouraged to continue this tradition. There is no evidence that extended breastfeeding is harmful to mother or child. Breastfeeding during a subsequent pregnancy is not unusual. If the pregnancy is normal and the mother is healthy, breastfeeding during pregnancy is the woman’s personal decision. If the child is younger than two years, the child is at increased risk of illness if weaned. Breastfeeding the nursing child after delivery of the next child (tandem nursing) may help provide a smooth transition psychologically for the older child.

and the AAFP 2007 policy statement also states:

Breastfeeding beyond the first year offers considerable benefits to both mother and child, and should continue as long as mutually desired.

The AAP has released a new and updated document today on Breastfeeding and the Use of Human Milk. The new 2012 version does not say much about extended breastfeeding, only the following:

The AAP recommends exclusive breastfeeding for about 6 months, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant, a recommendation concurred to by the WHO and the Institute of Medicine.

Mothers should be encouraged to continue breastfeeding through the first year and beyond as more and varied complementary foods are introduced.

While this is still supportive of breastfeeding beyond infancy, I wonder why this topic was not covered as fully in this revision? Was it an oversight? I would have appreciated more on this topic from the new AAP statement, not less.


I participated in a study recently, in which the researcher was investigating the maternal cells present in breast milk. She needed fresh milk for the study, so I went to her lab to express some milk.

She provided a Medela Symphony breast pump for the mothers in the study, but I found that it didn’t really work for me to pump. Sweets is over 2.5 years old now and it’s been a year since I pumped at work. She typically only nurses 1-2 times per day, so I don’t have a lot of milk anymore, and the pump just wasn’t doing anything.

I decided to hand express instead, and I did get a little milk that way, but only about 6 mL. For reference, there are about 30 mL to an ounce, so that is really not very much milk!

The researcher let me watch as she centrifuged my milk sample, which separates the fat to the top of the sample and the cells to the bottom with the liquid portion of the milk in between. Then she removed everything except the cell pellet, washed the cells, and centrifuged them again. After the cells were washed, she looked at them on a microscope to count them. This is what we saw.

A photo of the cells from my breast milk sample

And from that little 6 mL, she was able to get 7,850,000 cells! That is 1.3 million cells per mL, which would be almost 40 million cells per oz! She had several experiments she wanted to do with the cells, and while this was enough for one experiment, it would not be enough for all of them. She encouraged me to come donate again if I was willing and able.

I went back two more times, with pretty similar results. The second time I had 6,160,600 cells in 5 ml of milk. The third time I had 9 million cells in 7 mL of milk.

Donation Total Cells mL cells/mL cells/oz
1 7,850,000 6 1,308,333 38,692,035
2 6,160,600 5 1,232,120 36,438,137
3 9,000,000 7 1,285,714 38,023,109
Average 1,275,389 37,717,760
Std Dev 39,142 1,157,559
Std Err 22,598 668,317

Not too bad for 2.5 years out! Next time someone tells you that there are no benefits to breastfeeding past a certain age, don’t believe it!  Most of the mothers who donated to the study had about half as many cells per mL than I did (though of course they had more milk volume too).

Another photo from my third milk sample

So the next question is, what are all those cells?

Most of the cells in milk are mammary epithelial cells.  The research study I donated to is investigating mammary stem cells in this subset.  Total leukocyte (white blood cell) counts are reported to be 4 million/mL in colostrum and 0.1-1 million/mL in mature milk. These are comprised of about 55-60% macrophages, 30-40% neutrophils, and 5-10% lymphocytes. Of the lymphocytes, about 80% are T cells and about 5% are B cells. Of the T cells, both CD8+ (cytotoxic) T cells and CD4+ (helper) T cells were present, and most were activated memory cells.

In short, a whole variety of live cells are present in breast milk. Milk is more than just a source of food for the infant. These cells can be absorbed by the infant through the mucosal membrane of the intestine, where they continue to carry out their normal functions. (One interesting side-effect of this is that it is postulated that kidney transplant recipients who were breastfed as infants and receive a half-matched kidney donated by their mother are less likely to experience rejection than those who were not breastfed, or those who receive a half-matched kidney donated by their father.) The maternal immune cells continue to  support and influence the child’s immune system.

It is an amazing gift that I give to my child, of my own body. Truly.

I don’t know how she does it, but on weekends Sweets is like an alarm clock. She wakes up right at 7am, no matter when she went to bed.

But on weekdays, I often have to wake her up to get her ready for daycare.

This morning, I went to wake her up at 7:15, and she was grumpy!

Sweets, 2 years

She didn’t want to get dressed, she didn’t want to eat breakfast. But she did ask to nurse.

Sweets hasn’t been nursing in the morning every day lately. She used to always nurse twice per day: in the morning when we get up and when we got home from work. But lately, she skips one or even both of these some days. She skips the morning nursing more often, and I’d say she only nurses in the morning about 60% of the time lately.

But this morning, she wanted to nurse. And she didn’t want to nurse in this seat, it had to be in that seat.

THAT ONE!

I’m telling you, grumpy.

She nursed for maybe 20 minutes and got progressively happier and happier and more giggly and playful as she switched back and forth a few times between sides.

When she was done, she started just looking up at me with the most smiley, happy face! She was just so adorable!

I looked down at her and I said “Oh, I just love you!”

And she looked back at me and said “Yah Yoo Doo.”

Love You Too.

And my heart melted.

And then she happily got down and went to the kitchen to eat the waffle that was waiting for her. Then she trotted over to the door, ready to go, and said happily “Ass Doh!” (Let’s Go!)

I’m so glad we are still nursing. We can still turn a grumpy morning into a happy morning, just like that!

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This post has been cross-posted from my other blog, My Baby Sweets.