So many of us doulas, nurses, midwives and even doctors need to regularly do some continuing education courses to renew our certifications and or licenses. This is such an important part of what we do. Recently I went to the DONA conference and I came out with some great new insights, new info, and a renewed feeling that what I am doing is exactly what I want to do. You know how important your continuing education is for your clients. Many times I have heard parents come home from the hospital or from family gatherings with old fashion believes that some doctor, nurses, and even doulas and midwives, still have about breastfeeding, caring for a newborn, or pregnancy and delivery. After many years in the business, we all gravitate to workshops on subjects we have not seen before, strange and unusual situations, diseases, complications etc. Yet, once in a while doing the tried and true breastfeeding workshop, or even hearing Dr. Karp’s lecture on the 5 Ss umpteen times has kept my practice up-to-date.
Here are some old fashion myths that are still perpetrated by many who have not bothered to know what is new up there:
“You must induce before 41 weeks, or your baby will be too big and it will get stuck and die – A breech baby must be delivered via cesarean due to the high mortality risk -Once a cesarean always a cesarean or you could lose mom and babe”
So many doctors induce as early at 39 weeks using all sort of reasoning, including fetal mortality. There are only a handful of doctors I know in Los Angeles that deliver a breech baby. For the most part a breech is an automatic cesarean, and don’t even get me started with the VABCs since now many hospital will not allow, even if you find a doctor who is willing. Here are the risk factors according to Andrew Kotaska MD, OBGYN, from his lecture Normalizing Birth in the 21st Century at the Dona Conference, 2008:
The risk of mortality is as follow:
- 1/1000 Stillbirths risk from 41 to 42 weeks of gestation
- 1/1000 Risk of perinatal death with cautious selective vaginal breech delivery
- 1/1000 Composite risk of perinatal death or hypoxic ischemic encephalopathy
- HIE – Reduced brain oxygen in the baby’s brain – with VBAC
Think this is too high consider the comparison:
- 1/200 risk of miscarriage from genetic amniocentesis
- 1/1000 yearly risk death in a 40 year-old non-smoking Canadian man (doc is from Canada)
- 1/1000 background stillbirth risk over ten days at term
- 1/1000 risk of trisomy 21 (down syndrome) infant in a 31 Y/O woman
- 1/1000 risk of MVA (moving vehicle accident) driving for 4 years
Marshall Klauss MD, in his lecture “How Doulas Can Reduce Cesareans by Their Care” (Dona International Conference 2008) told us that “With a cesarean section vs. a vaginal delivery, there is a higher illness rate as well as a higher death rate in the mother. (c/sec – 5.85/100,000 vs. vaginal – 2.06/100,000.)
He further went on to dispel yet another myth:
“Honey, you’d want an epidural as soon as you get into the hospital. It will not hurt mommy or baby”
Dr. Klauss tells us, “An epidural in the a first time mother can delay the first stage labor by an additional 4 hours, and the second stage by an additional 1 ½ hour for a total of 5 ½ hours. With an epidural, the baby receives medicine almost immediately, and 15% of the time the mother and infant develop a fever of 38 degrees centigrade. On delivery after the baby is born, the staff takes the baby to the NICU for observation and a blood culture. The baby is separated from the mother and father but usually there is no infection. If the epidural is started before 4-5 cm of dilation of the cervix, there is a reasonable chance that the infant might not complete rotation, which leads to a posterior position that often leads to a c/section” Let’s add also that often the epidural leads to pitocin and failed induction is the number one cause for cesareans in the United States.
MYTHS ABOUT BREASTFEEDING
“You have no milk; the baby is hungry and losing weight. You should give baby formula”
I can’t begin to tell you how many times moms hear this at the hospital, it seems none has told the nurses that as long as the baby looks good and is nursing every 1 to 3 hours and mom’s nipples are not getting sore, there is no need to do anything but nurse often. New born can lose up to 10% of their body weight in the first week. Is better to help mom switch breasts every 5 minutes or so and wait another day or two for the milk to come in. A thirsty baby nurses strongly and is in no danger. A baby given water or formula might not nurse so strongly and mom’s confidence and milk supply will suffer for it. As Dr. Gordon says “Look at the baby not the scale.”
“Your baby’s weight gain is not acceptable, go ahead and supplement with formula.”
When hearing this comment, pediatrician Jay Gordon MD, suggests asking yourself the following questions:
- Is your baby eager to nurse?
- Is your baby peeing and pooping well?
- Is your baby’s urine either clear or very pale yellow?
- Are your baby’s eyes bright and alert?
- Is your baby’s skin a healthy color and texture?
- Is your baby moving its arms and legs vigorously?
- Are baby’s nails growing?
- Is your baby meeting developmental milestones?
- Is your baby’s overall disposition happy and playful?
- When your baby is awake do they have periods of being very alert?
If you have answered yes to the above questions, you may want to progress on to two important questions which the “charts” seem to ignore:
- How tall is mom?
- How tall is dad?
If someone were to ask you what weight a 33 year old man should be, you would laugh. The range of possibilities varies according to height, bone structure, ethnicity and many other factors. Yet babies are expected to fit onto charts distributed throughout the country with no regard to genetics, feeding choice or almost anything else.
“When breastfeeding, don’t eat broccoli, tomatoes, onion, and garlic. It will give your baby colic!!!”
This is one of my favorites, so many ‘experts’ including friends and grandmas and even midwives and doulas speculate on what a mom should and should not eat and how what she eats gives baby colic. Here is what Kittie Frantz, R.N., C.P.N.P.-P.C, one of the lactation luminaries of Los Angeles, and professor at USC says about the subject:
“I find these myths come from the mother community and not the hospital! Who on earth is spreading this incorrect information? Which hospital? Egad! Most agree that a breast feeding mother should eat a VARIETY of good wholesome foods and she will do just fine. In a variety, too much of one food is diluted by the variety. It is that simple. For example: The FDA says to reduce the amount of certain fish to avoid large amounts of mercury for pregnant women, breast fed babies and small children. A variety of food would prevent getting too much of any one fish so that would take care of that issue! A mother should not be told never to eat fish while pregnant or breast feeding.
Manella did research on foods and flavors in mother’s milk. She found that what mother eats flavors her amniotic fluid and her breast milk. Is that such a bad thing? The mother who ate onions in pregnancy, has a baby who is used to onion flavor and will enjoy it in her milk. Manella found that the garlic flavor actually makes baby suck better! Vanilla is like catnip to a baby. I am sure the same thing is true in cultures who eat spices and chilies in pregnancy and breast feeding. They do breast feed in Central America and India you know! I was donating my milk to research while I was nursing my son back in the 1960’s. I loved horseradish and ate a lot of it. My son was avidly breast feeding so I never gave it a thought that the flavor got through. The lab called to ask me what I was eating as the monkeys were rejecting only my milk. They asked if I would stop the horseradish and I did and the monkeys then began to take my milk. My son, who had tasted the horseradish all through my pregnancy was used to it in my milk and loved it.
Foods like peanuts, tomatoes, cow milk, etc. are known allergens. These foods do not CAUSE allergy in a child of a family with no allergy to peanuts. A child who has inherited an allergy to that food will have an allergic reaction to the food if he ever eats the food. Eating peanuts would only effect babies born of families with known allergies to peanuts. Example: Allergists who saw severe peanut allergy reactions to two year olds getting their first peanut butter & jelly sandwich (pb & j) realized that humans do not have severe reactions to foods the first time they get them. They realized that the peanuts eaten in pregnancy was the first exposure in the amniotic fluid. The peanuts eaten while breast feeding was the second exposure. The pb & j was the third exposure and tipped the severe reaction. This would only have relevance to the family with a history of peanut allergy. Peanuts given to children of families without an allergy to peanuts would not develop the allergy. So why tell all pregnant and breast feeding women to avoid peanuts?
Broccoli, cabbage, beans often aggravate reflux in humans and some feel it causes gas to the eater. Does it do this to the baby from the breast milk? Don’t know. If a baby is gassy or bothered by reflux, the mother might try avoiding these foods and see if her baby seems less bothered. If baby gets better, try eating the foods again next week to see if he gets bothered by them a second time. If he does not, then it was only a coincidence that the broccoli bean salad you ate was on the same day he was fussy. If he reacts the second time you ate these foods, stop again and see if he is better and reintroduce it a week later to see if he reacts again. If he does get fussy all three times, then avoid those foods. If he does not react each time, then it was probably just a coincidence. NOT ALL BABIES WILL REACT TO THESE FOODS! Why take all women off of them just because a few babies reacted? Avoid telling all the moms in your breast feeding support group to avoid these foods just because your baby reacted.
Sometimes I think giving mothers too many “breast feeding rules” is done by folks who have controlling tendencies. Are they trying to punish the woman for doing something so wonderful for her baby? Just remember that variety is still the spice of life and everything in moderation! Eat a well balanced diet of foods that are good for you: fruits, vegetables, whole grains, & protein. Eliminate from your diet only what family members are allergic to. If your family has allergies, you are probably in touch with an allergist. Consult your allergist for his/her advice. If you have no family allergies and you feel your baby is reacting to a food you have eaten, experiment. Every baby is different. Every family is different. Enjoy breastfeeding!”
What we know is that probably milk is the one allergen that most commonly brings a negative reaction. In August 2000, the American Academy of Pediatrics issued an official statement about allergenic proteins in a mother’s diet appearing in her breast milk and creating problems for her baby. As Kitties says moderation is the name of this game, too often overtired moms simply open the fridge and start with cereal with milk, followed by scoops of cottage cheese, topped off with delivery pizza for dinner, and we wonder why the baby is fussy?
Babies simply cry, that’s how they express themselves, often there isn’t anything truly wrong with them. They need to be heard, and parents should be taught how to calm them with cuddling techniques not drugs such as Mylicon. Too many babies have been wrongly diagnosed with colic, or the latest craze – acid reflux. Dr. Karp suggests that colic are grossly misdiagnosed. In fact only 10 to 15% of all babies do have colic and usually it comes from milk allergy and a very low percentage from other foods such as caffeine, also contained in chocolate. Dr. Karp jokes, “How can you call it colic if the screaming and fussy stops when the baby is either swaddled, or placed in a sling, or taken on a car ride? How can these actions make pain go away?” Is it really pain or is the baby just in need of something else? Reflux usually only happens in 1/50 crying babies. More women should be told to expect the baby crying and not to immediately go into “something must be wrong” mode.
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“It sounds like your baby has a lot of gas, it’s probably colic”
Studies show that actually gas increases in babies’ stomach after the baby cries and not before. Dr. Gordon tells us, “Babies are gassy. That is an immutable fact caused by the need to double or triple one’s weight in a year. Try doing that yourself and see if you don’t spend a little time gassy.”
“You just don’t have enough milk to feed your baby”
Here is a list of common early breastfeeding challenges according to Jacqueline Kelleher in her lectureWhen Mommy Really Wants to, But It Just Isn’t Working at the Dona conference, 2008.
For the baby:
- Attached frenulum
- Down Syndrome
- High Palate
- Cleft palate
- Hormonal problem (bleed out)
- Conical shaped breasts (insufficient tissue)
- Thyroid problems
- Postpartum mood disorder
- Retained placenta fragments
- Large nipples (flat nipples)
- Breast reduction or augmentation
- Common early breastfeeding challenges
- IV fluids in labor
- High cesarean rates
- Separation in hours following birth
- Separation during hospital stay
- Lack of emotional support
- Lack of experienced support
- Contradictory information in support
“Just One Bottle of Formula Won’t Hurt the Baby”
According to Dr. Gordon, “one bottle can make the a difference.”
· Breastfed and formula-fed infants have different gut flora.
Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci. Babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species.
In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week.
When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached.
Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants.
- The neonatal GI tract undergoes rapid growth and maturational change following birth.
- Infants have a functionally immature and immuno-naive gut at birth.
- Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens.
- Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy.
- sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function.
- Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings.
- The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe.
Thus, Dr Gordon suggests that, “Infant formula should not be given to a breastfed baby before gut closure occurs.”
Bottom line, unless there is a serious medical reason for low milk production a woman with enough professional support can breastfeed her baby. Unless there is a serious reason for the newborn to have formula supplement, breastmilk is best. By addressing any health issue before the birth and having the help of a professional Lactation Consultant can make a difference in your experience. Knowledge is power. If you know about breastfeeding before you go into the hospital all those nay-sayers about your ability to feed your baby can be, gently and lovingly, put in their place.
Keeping up to date is the only way I know we can serve our clients best. Not only by our recommendation but also by providing facts and figures they can show their provider when given old and no longer substantiated information.
Mothers can stand up for themselves demanding information that is accurate, proven and if needed with sound back up material. I often suggest, when a client has been told she must have a cesarean for elective reasons (such as your baby is too big, or VBACs are dangerous etc.,) that she should do as most people do when they are told they need major surgery – get a second opinion hopefully from a doctor who is mother-friendly. When it comes to feeding your baby, trust that you are the perfect mother and the perfect match for your baby, and unless you have a serious health problem all it takes is patience, loving support and when it gets difficult the resources to get professional help.
There are so many more myths and this is the very first article of a series I am planning to write to keep you up-to-date.
DONA International Conference
Kittie Frantz, RN, CPNP-PC –
Dr Jay Gordon
Dr Harvey Karp
Kimberly Durdin, IBCLC – Local Lactation Consultant – 310 986-4996
 Drjaygordon.com “Look at the Baby, Not the Scale”
 Illingsworth, Arch Dis Child 1954 – from Dr. Karp’s recent presentation at the Dona International Conference
 DrJaygordon.com “Just one bottle won’t hurt – or will it?”