It seems like these days the breast pump has joined the ranks of baby registry basics: every new mother assumes that she needs one. Like most spaces where breastfeeding and consumerism meet, there are good and bad aspects to this.

The fact that it’s automatic is a big YAY!: it means that breast milk is what mothers assume their babies will drink. But breast milk doesn’t equal breastfeeding – and there are important benefits to breastfeeding that breast milk from a bottle can’t replicate. One of the main ones is the ease of preparation and clean up.

Pumping has a place for mothers who have to be separated from their nurslings for longer periods. It also has a place for mothers for whom latching has proved challenging and nursing supplementers too cumbersome. And for some families, the typical suggestions on how to cope with night-waking and high-needs babies aren’t practical or sufficient. In these cases where a mother is maintaining a full supply, a heavy-duty double pump is in order – and that’s not a worthy ‘just in case’ expense (renting a hospital grade is the better option most of the time anyway).

I remember stinging at a speech that Jack Newman gave a number of years ago where he scoffed about the “silly contraptions” manufacturers were coming out with for hands-free pumping. Clearly, I thought, he’s never had to pump every three hours around the clock for a baby in the NICU – hands-free pumping meant a lot to me. Not that I had proper hands-free set-up, but I got fairly good at balancing the bottles on my knees while I read trashy magazines to distract myself from the anguish in my heart.

But like all things commercial, what would have been helpful to me when pumping was a necessity has the potential to overreach. Most women who are planning to breastfeed have no reason at all to expect that they’ll need a pump in the first few months of their baby’s life. Unless they are planning on returning to work within the first month or so, pumping right away has very little benefit at a time when the focus should be establishing a balanced milk supply and good breastfeeding relationship. Stashes can be built, but not at the expense of those early moments.

For mothers who are able to take humane maternity leaves, pumping is even less important. Certainly, for those mothers, an electric pump is probably overkill and even a manual pump will fail to encourage that most basic skill that every lactating woman should have – manual expression. This is so important that I am stunned how few women are taught it, much less properly.

So much as I stung at his cavalier attitude, Dr. Newman had gotten a whiff of the direction in which things were going. Medela, previously one of the very few WHO-compliant gear companies out there, last year decided to take a different step and begin actively marketing bottles and artificial nipples directly to consumers. In the grand scheme, they’re certainly no Nestle and they make quality products that have saved and prolonged many breastfeeding relationships.

But so few women are getting good information about breastfeeding – I mean really good information about the practicalities of the day-to-day, not just “Breast is best” – that these kinds of products flooding the market and making it on must-have lists really does have the potential to create a whole new set of breastfeeding problems. Oversupply from over pumping, nipple confusion/flow preference, plugged ducts and mastitis from poor pumping practice (IE: balancing the bottles on your knees can create uneven pressure that leads to plugged ducts) and ultimately breastfeeding ending earlier than nature intended. Maybe it ends earlier because the problems become acute and force the hands of the nursing pair or maybe it’s simply because the connection in breastfeeding that evolves between mom and baby is interrupted and there comes a day when “breast is best” just isn’t enough.

So, don’t be surprised next time you ask “Which pump should I buy? (or “buy for her”)” that my answer is no pump at all.

Breathtaking - and not only because of my fear of heights

Enjoy this pic - almost caused a pile-up when I stopped to take it

Fox Entertainment knows how to tweak the ovaries – PUPPIES (for a Marley & Me movie launch)

]]> http://www.mamabear.ca/2011/08/blogher-in-fairly-random-pictures/feed/ 2 http://www.mamabear.ca/2011/08/stuff-to-do-local-food-festival/ http://www.mamabear.ca/2011/08/stuff-to-do-local-food-festival/#comments Sun, 14 Aug 2011 05:27:53 +0000 Michelle http://www.mamabear.ca/?p=957 [...]]]> Toronto’s Conscious Food Fest came across my twitter feed this week and when we were wondering what to do on Saturday afternoon, it seemed like a perfect fit for a sunny afternoon. As it worked out, it would have been worth it even in the rain – history lesson and all!

The festival isn’t exactly kid-focused – though there were a good number of kids there and the Real Food for Real Kids tent had some cool activities. Isabelle and Tom had fun grinding their own oats (oh, they’re real sophisticated, my kids) – though I think the bag-decorating probably took longer. I do doubt that it will get Tom to actually eat oatmeal (he’s suspicious of the hot cereal idea), but we came away with just about enough for Isabelle and I to have a nice breakfast. We also planted a dill plant for Oxfam and collected a bunch of buttons – all a hit. My favourite may have been the bike-powered corn grinder at the Chocosol booth – though we were too stuffed to try the tortillas themselves by then!

The food? Excellent. Buddha Dog’s hot dogs are spicy delciousness (not kid-friendly, which suits me fine!) and Dan had a great taco from the Grindhouse. The kids got a big kick out of the watermelon lemonade from Marben – something I think I will need to figure out how to make now.

Lots of beer vendors as well – though we stuck to the other end of the indulgence spectrum: ice cream. Mapleton Organics in the Kids’ Zone has some rich natural flavours: you can tell a lot about an ice cream maker by their mint ice cream and theirs is excellent. Organic Meadow is a brand we often buy here anyway, so their ice cream didn’t disappoint either. Having had some bad early experiences with kefir, I was a little wary of Yogalicious. Their frozen kefir was actually very good in vanilla, despite no added sugar in the weird fermented brew that can explode without warning in your fridge (ahem).

The other nice thing is that we got to also look around the buildings at Fort York which was open. It’s not somewhere I would really think to bring the kids as a outing – seeing as I’m not that into military history (or military anything) and it’s not so easy to get to despite being right in the city. I may end up having to go back though – Tom was fascinated by the canons and the bunkbeds were beloved by all.

The festival ends tomorrow: it’s FREE admission ($15 to park and food is $1-$4 per dish) – I’m glad to read that they’ve done this, as at $15 per ticket, it got to be a pricey afternoon. If you don’t make it though, you can be glad I did as I also picked up information on a bunch of other events happening throughout the fall along the same local food/family farm theme:

27th Annual Vegetarian Food Festival: Toronto September 9-11

taste-real Feast: Wellington County (Guelph) September 11

22nd Annual Feast of Fields: Cold Creek Conservation Area (King) September 11

Fall Rural Romp: Wellington County (Guelph) September 24

Big Latch-on takes hold in the US: Interesting that it seems that this is considered a new thing – since the Quintessence Foundation in British Columbia has been doing it for 10 years now. Last year’s challenge saw over 4,700 children breastfed in over 18 countries – looking forward to attending the Toronto site on October 1 2011.

Vancouver women may be low in Vitamin D in pregnancy: Presumably along with every other pregnant woman in Canada – this is a tough area, but boy, it’s time that Health Canada took a harder look at recommended levels, especially given the potential for long-term health impacts from deficiency.

Lactation support covered under preventative services insurance requirements: Great news that lactation support is being given a place among preventative care services in insurance reimbursement, though it take some time to sort out exactly what this looks like for lactation consultants and other care providers like doulas. Having worked some years in US health benefits, I am reserving judgment for a bit – the path between regulation and the cheque in the mailbox is often long and winding.

Breastfeeding mother charged with murder after ingesting meth: These are not ever simple situations and it’s always tragic. Much of the time I feel like breastfeeding itself isn’t the issue, regardless of feeding, someone who is heavily using illicit drugs isn’t in any condition to care for an infant. It does seem that in this case, there was an alleged direct connection between the drug in the breastmilk and the infant’s death: most of the news coverage on this story is not nearly as nuanced as care2 ‘s piece.

The sound of a palm striking flesh is such a distinct sound – clean, sharp, focusing. Even in a busy restaurant, it stung my ear and I looked across to the little hand – the chubby, dimpled one of a toddler who reached for an empty wine glass.

Now, I was exhausted after five jam-packed days at BlogHer. I was eating alone reading news on my phone because I was schmoozed out and needed to feel a little bored. I was missing my littles a lot. So maybe that sound rung in my ears longer and louder than normal.

It sure seemed that the sound of that smack & its accompanying  “NO! No touching!” disturbed my dinner a lot more than the mess a broken wine glass might have.

The second time she reached for it, I was already listening. And flinched – though she didn’t. The third, this time for the break basket, I braced for her and ached when she cried as her mother coldly scolded her, “I told you, no TOUCHING!”. By that point, I was so enraged that I knew that no good would come from engaging – so I left.

When I tweeted it, one response suggested that I should intervene. And I admit I did think about it. I had several responses fully scripted out from withering to thoughtful – but I probably wouldn’t have pulled off thoughtful and supportive because I was feeling neither.

And really would it have been helpful to tear a strip off a complete stranger in a restaurant? Clearly, if you are regularly slapping your toddler, you have given some thought to it – this wasn’t a knee-jerk grab as a kid darted into a crowd or instinctively slapping her hand from a flame.

And it’s legal, right? Well, I don’t know about the state of California, but I was thinking about this and so I checked out the details. In fact, it turns out that in Canada, it would not be legal to slap a toddler’s hand. A summary of the majority opinion of the Supreme Court of Canada that on section 43 of the Criminal Code of Canada (the “spanking law”):

The majority of justices in Canadian Foundation for Children, Youth and the Law upheld s. 43 on the basis that it protects only parents, schoolteachers and persons who have assumed all of the obligations of parenthood.  Further, it maintains a risk of criminal sanction if force is used for non-educative or non-corrective purposes, and limits the type and degree of force that may be used.  The words “by way of correction” in s. 43 mean that the use of force must be sober and reasoned, address actual behaviour, and be intended to restrain, control, or express symbolic disapproval.  The child must have the capacity to understand and benefit from the correction, so that s. 43 does not justify force against children under two or those with particular disabilities.

The words “reasonable under the circumstances” in s. 43 mean that the force must be transitory and trifling, must not harm or degrade the child, and must not be based on the gravity of the wrongdoing.  Reasonableness further implies that force may not be administered to teenagers, as it can induce aggressive or antisocial behaviour, may not involve objects such as rulers or belts, and may not be applied to the head.  While corporal punishment itself is not reasonable in the school context, a majority of the Supreme Court concluded that teachers may use force to remove children from classrooms or secure compliance with instructions.

I would guess that most parents, whether they spank or not, don’t realize that corrective force cannot legally be used against children under the age of 2 or against teenagers. I would also guess that the law is rarely applied except in aggravated cases. It’s hard to imagine calling the police over a parent slapping their toddler’s hand or spanking them on the bum.

And yet, there it is – and I am left wondering even more what the right answer was. Clearly, since I am still troubled by it four days later, my “slink away and stew about it” solution wasn’t it.

Creative Commons by alegri / 4freephotos.com

Back in July 2007, I attended a session by Dr. Peter Hartmann at the La Leche League International Conference in Chicago where he showed pictures of some groundbreaking research into the anatomy of the breast.

While the room watched in awe at the multi-coloured wax models of milk ducts and grainy video of ultrasounds, it was both amazing and confounding that he was presenting brand-new information about the basic structure of the breast.

What is more amazing to me is that more than 6 years after Dr. Hartmann and his colleagues originally published this new information in March 2005, the diagrams in both anatomy text books and reference materials available on-line have not changed.  The trouble with this is that this work was more than just fascinating to the lactation geek – they have significant implications for how to treat the breast in order to preserve lactation. Yet, the medical students today (who may never learn anything more than this about breast anatomy) are still learning an anatomical model that’s plain wrong.

Detail of the breast structure ©Medela AG, Switzerland, 2006

So, here’s what you need to know:

1.     You probably have fewer milk ducts.

The old model of the breast assumed that the average breast had 15 to 20 milk ducts that lead to the nipple. Hartmann’s research shows that the number is actually much lower: on average, between 9 and 10 with a very significant variation (from a low of 4 to a high 18 among mothers producing a full milk supply).

Who cares? Well, the fewer milk ducts you have, the more significant the severing of anyone of them is. If you have 18 ducts, then severing 2 of them isn’t likely to reduce milk supply much. If you have 4, then half of it is gone. It means that no one really knows how much an incision will affect a particular woman’s ability to produce milk. On the positive side, because they also start “branching” sooner into multiple ducts that end in the secretory lobules, incisions further back in the breast might compromise less (since the main duct can still collect from other branches if they are not cut).

2.     Your milk ducts are closer to the surface and the nipple base.

Textbooks suggest that the lobules of milk-making cells at the end of milk ducts where breastmilk is actually secreted are located quite far back in the breast near the chest wall and evenly distributed.

In fact, the milk ducts are quite a lot shorter and the secretory cells are much closer to the surface, within the first 3 cms. Furthermore, they are not neatly arranged in a radial pattern and may curl around each other in roundabout way on their way to the nipple.

Who cares? This research suggests that the closer to the chest wall you stay, the more likely you are to preserve milk-making ability – on the other hand, incisions that happen around the nipple (sometimes chosen because they are better hidden by the areola) are more likely to cause damage. Because the ducts are not evenly distributed, the effect of an incision is again going to be very individual – there may be several ducts or none at all at any particular location.

The idea of positioning a baby in a certain direction to clear plugged ducts? Not so likely to be helpful if your ducts take the scenic route – though nursing in different positions can still help.

3.     Your nipples aren’t fat.

Or they don’t sit on fatty tissue anyway – the tissue underlying the areola is almost all glandular. This means not only that an incision in this area is more likely to compromise lactation, but also that even fairly mild pressure at the wrong angle could block a duct and prevent milk ejection. Also, because the fat is not concentrated along the surface of the breast as was previously believed but is actually mixed throughout, removal of only fatty tissue is significantly harder.

Who cares? Well, partly it’s important because it means that a good latch is important to good milk transfer (duh), but also that gear like breast shells and pump flanges need to be even more carefully fitted to reduce ‘pinch points’ (no kidding).

4.     The lactiferous sinus does not exist.

Pretty much every text you read about breastfeeding refers to the “lactiferous sinus” – which refers to the widened ducts right behind the nipple where the milk is stored. The baby latches to the breast, compresses the sinuses and gets a hearty mouthful of delicious milk.

Except that apparently, the lactiferous sinus is the unicorn of anatomy – no matter how much good you think it does, it actually does not exist. The milk ducts do widen briefly when milk is ejected (letdown), but if the milk is not drained, the milk flows back up into the lobules that it came from.

Besides the small issue of technical accuracy, does it matter? Well, yes – though accuracy is reason enough. It points to a greater importance of the hormonal cascade that causes letdown – it’s not just the physical compression of the baby’s mouth that ejects the milk.

Are you so bored that you could cry by now? I was when I was stringing this all together. If you can only remember a couple things from all this, here they are:

1.     Keep incisions as far away from the nipple as you can. You are likely to sever fewer ducts with an incision toward the nipple than around it.

2.     No one can tell you with any certainty how much a particular incision will impair your milk-making ability – you may have 20 ducts all neatly arranged evenly or four that are completely assymterical. You won’t know until you try.

Note: This post is not medical advice. This is general information. Always consult a qualified medical practitioner and remember that many factors come into play when making a final recommendation for a particular breastfeeding dyad in a particular situation.

Outside SWALA Tent

I’ve seen the ads for the Toronto Zoo’s overnight educational programme a couple times and decided to finally give it a try as mother-daughter adventure after my exam this week. At almost $200 for a single night for the both of us, it was a bit of a splurge and not something that everyone can spring for.

The evening starts with a personal tour of the zoo’s African area with two well-trained guides, Chris and Sarah-Lynn. With kids ranging from about 6 to their late teens, plus adults, the balance of story-telling to teaching was well done. We learned about the time an ill-fated wild deer wandered into the lion enclosure while sneaking in how zookeepers use food to incent the behaviours they need to run the zoo safely. We also got to meet the giraffe keeper and walk inside their enclosure as she fed them some treats – the kids (and adults) were awe-struck.

Bedtime!

Meals are included and were acceptable – it’s nice to see meals that appeal to kids (chicken, mashed potatoes, pasta with tomato sauce), but that aren’t totally junk. Breakfast was fine too – nothing fancy or gourmet, but edible! It would be neat to see them develop the menu a bit to include some more traditional African foods as part of the evening.
The camp itself is a grouping of canvas tents on wood platforms with cots and deck chairs. I was fairly impressed with the comfort level of the cots and we got lucky with a warm night – I can also report that the tents are well water-proofed as we woke up to some pretty good rain. Bathrooms are clean and nearby – there are no showers, though.

The camp fire comes complete with smores and is very smartly preceded by a lengthy scavenger hunt through the dark. Even though your brain knows that the calling lions are safely in their

Some loose wildlife - a whitetailed rabbit outside our tent

“house” and not lurking just behind the glass, it does take some courage to wander through the area in the dark with just a circle of your flashlight. We held it together with the help of another mom and daughter team – but the skittish might need to skip that part! The cutest line of the night goes to the kid who, when asked the name of a deer-like creature with a car named after it, confidently exclaimed, “TOYOTA!”.

The morning saw another tour, this time of the primate area – it was nice to get to see the gorillas first thing in the morning as they were exceptionally active and he got to see the “new” baby who is now almost two in full swing (literally).

At the end of the tour, you get a free pass to return to the zoo (with parking) for another day – we initially planned to go do it right after the overnight, but Isabelle agreed that she was visited out (the pouring rain helped the decision).

Riding the Zoomobile back to 'civilization'

I’ve been going to this zoo since I was a young child myself – in fact, I was only about too when one of the little monkeys once stole an ice-cream right out of my hand (it was the 70s, I can only assume that safety has improved!), but this was a really unique experience. While we emerged wetter and lighter in the pocketbook, it also gave me new insight into how the zoo is run and how the zookeepers care for the animals. It’s definitely a worthwhile adventure for kids this age – and the memories will make all our future zoo trips a little more special.

Disclosure: I paid full price and was not asked or incented in any way by the Toronto Zoo or any of its agents to write or publicize this post. The opinions are entirely my own.