Breastfeeding support on demand, through your phone. Yes, really!

Disclosure: I am part of the Pacify provider network but was not asked to nor will I be compensated for writing this post. I work with brands and companies I believe in, such as this one. All views and words are my very own.

I consider myself lucky. My first child was delivered at a baby-friendly hospital which truly lived up to its distinction. There was breastfeeding support as soon as my daughter was born, and I wasn’t discharged until I had at least one visit from the lactation consultants.

Also available to me were weekly breastfeeding support groups at the hospital, as well as unlimited calls to the lactation consultant support line. I’d leave a message and get a return call within about 2 hours, or the next business day if it was late in the day. I used that line a lot, as I was a nervous first-time mom with a smallish little baby girl – the honor roll student in me did not understand how 30 percent(ile) could be considered “good” or “normal”,  but so goes the growth chart system! Thanks in no small part to the support of the lactation consultants, as well as to my support system at home and of like-minded mamas, I was able to reach my goal of breastfeeding for one year. (OK, 13 months. It’s that honor roll/overachiever in me!)

That’s why when I first heard about Pacify, I knew I wanted to get involved. Pacify is a new company, an app on your mobile phone that connects subscribers (usually moms) with health professionals. For a monthly fee you can have unlimited, on-demand access to nurses, lactation consultants and dietitians to answer questions when you need it, not to mention the support and reassurance from a qualified health professional quite literally right there in front of you (most calls are done via video chat). While a goal of Pacify may be to increase confidence in a mom’s ability to breastfeed which may also increase duration, Pacify providers like me may also help with non-breastfeeding-related questions like when to introduce solids and how to overcome picky eating in a toddler.

Like it or not, we are an on-demand culture: we want to binge-watch television shows, get questions answered by Google, and hate waiting for a call back or when business hours roll around. When it’s the middle of the night and baby is crying but won’t latch, mom wants help from a professional and needs it now. Thankfully, services like Pacify are now there.

D.C. area readers: Tomorrow you can meet Pacify directly! Visit the Pacify booth at the Big City Moms Biggest Baby Shower tomorrow, September 30, from 6:00-9:30 p.m. at the Georgetown University Hotel and Conference Center. You can get $15 off (that’s one free month) with a special code. No obligation – just try it out. Makes a great baby shower present, too!!

Everyone else: If you’re interested in trying Pacify and you’re in the D.C. area, Maryland, Virginia or California, leave a note for me in the comments and I’ll email you the code. Pacify is quickly expanding into other states, so stay tuned.

TIME for one more opinion?

OK, so I finally read the TIME magazine article that people have been buzzing about lately. I know I’m a little late to the game, but hey – I’m a busy mom of young children! Reading of any kind – even getting caught up in the not-so-critical-but-certainly-buzzworthy news of the day – is a bit of a luxury. I’m a subscriber to TIME (and several other magazines…most of which end up in a “to read” pile until the next time I fly and have to turn off all electronic devices.) But this magazine – with *that cover!* – was moved to the top of the pile once it arrived in my mailbox.

Clearly this was a thinly-veiled but nevertheless clever stunt designed to spur debate, boost magazine sales and increase website traffic. I mean, the timing was just right with the magazine hitting newsstands just before Mother’s Day. Bravo, TIME marketing team.

And I’ll admit, I fell prey to TIME’s social experiment. When I first heard about the cover and saw the provocative cover photo, I was outraged. I mean, who is TIME magazine to suggest whether or not I’m “mom enough”? And that picture? With that mother? And that…that…KID? Yuck!

Then I thought to myself: hypocrite.

Breastfeeding rates among women in the U.S. are climbing but we’re still far lower than other first-world nations. And while we can celebrate the fact that 75% of babies born in the U.S. have been breastfed according to the CDC’s 2011 Breastfeeding Report Card, a scant 35% are breastfeeding exclusively at 3 months (meaning the baby is getting formula or some other kind of nourishment in addition to breast milk), and only 44% are continuing to do any kind of breastfeeding by 6 months.

Why are moms not continuing to breastfeed? It’s a complex issue, but the general consensus is that moms don’t have enough support. Whether it’s a lack of baby-friendly hospitals or baby-friendly workplaces, or a glut of meddlesome relatives or unsupportive partners, or a combination of factors – who knows? All I can tell you is that if your 3 YEAR old is coming at you as his own personal bubbler, you are WAAAAYYY ahead of the game. And I should be applauding that.

You see, the TIME magazine cover gave me a sense of where the breastfeeding bashers are coming from. They want nursing moms not to “flaunt” breastfeeding, to put the boob and baby away and nurse in a dressing room or in a hiding spot away from the general public so they can go on with their normal lives of dressing little kids up as tarts and having young men wear their underwear above their pants. Because seeing a baby pressed up to a breast makes people uncomfortable. Even if we don’t actually “see” it, we KNOW what’s going on under that hooter-hider.

My main beef about the TIME piece is that the article really didn’t address any of this. You flip through the magazine, looking for more info about that sexy young mom with her preschooler appendage, but all you find are smiling pictures of a 72-year-old man. In fact, the article was all about Dr. Sears and attachment parenting and how the whole philosophy is based on single anecdotal observations by Mrs. Sears in her childhood and by some lady who went to Venezuela a lot instead of finishing college. As a dietitian who believes in an evidence-based approach, this is appalling.

A not-so-minor-side-“beef” with this article: in one fleeting bit near the end is a gloss-over on Dr. Sears’ controversial stance on vaccinations. It’s not mentioned directly (in the passage a mother was discussing “whether to vaccinate” her 6-month-old during her child’s routine checkup), but Sears advocates an extended schedule for vaccinating, which has no real scientific basis and could actually introduce more harm than do good. Does he also advocate slowly removing band-aids, bit-by-bit, so as not to stress the child excessively? I wonder.

But I digress. Look, TIME magazine was clearly out to make people think and talk, and talk they did. But will it help boost breastfeeding rates, or will it set us back even further as the stigma of breastfeeding is perpetuated?  We shall see.

Photo credit: iStockphoto

My formula for successful breastfeeding

Well hello again! I’ve been quite busy lately, with life and work and my two little kids – guess my blog got a little neglected. If only I could post the blogs I’ve been writing in my head! There has been so much going on in the news lately, a bunch of things I’ve wanted to blog about, but somehow hadn’t found the time. Sometimes it was just easier to tweet (follow me @elanaRD), but I’m back to blogging. Nice to see you!

One major news item that caught my eye recently was the announcement by Kaiser Permanente and its commitment to breastfeeding support. Among the action steps all KP hospitals will take is that no longer will formula be given to new moms upon discharge.

Now, I’m a huge proponent of breastfeeding. I gave breastmilk to my daughter from birth to 13 months, including the last 6 or 7 months of exclusive pumping. My son is nearly 7 months old now and still breastfeeding. I haven’t decided how long we’ll go – maybe a year, maybe longer – we’ll see.

But I’d be lying if I told you that neither of my kids ever had formula. With my daughter, she was about 6 months old before I finally broke down and fed her some Similac. My milk supply was scant, thanks to an out-of-whack thyroid, stress related to a cross-country move, a new job, and general new-mom anxiety. I felt defeated when I popped the vacuum seal on the can and shook a 4-oz bottle. But she gobbled it up and happily went back to breastmilk once my supply rebounded.

With my son, introducing formula happened earlier and occurs more often. I still hate it, but try as I might I simply can’t pump enough to keep him satisfied while he’s at daycare. As if my working mom angst needed additional guilt – “First you pawn off your child to daycare and now you can’t even FEED him?” (no, no one actually said that to me, but working/nursing moms know how I feel!)

Now did I give my son formula earlier because I was given 2-oz premixed bottles of Similac as a parting gift from my hospital stay? Doubt it. Even though my daughter was born at a Kaiser Permanente Baby-Friendly-Designated hospital in Colorado (my son was born in Virginia, at a hospital without the baby-friendly designation), the formula companies still sent me free canisters and unsolicied coupons for formula (probably got my mailing address from my baby registry).

Let’s face it, formula isn’t hard to get, whether it comes home from the hospital with you or is a quick trip to the drugstore down the street. Even the most well-meaning grandparents and husbands (and breastfeeding moms!) may purchase a can or bottle “just in case.”

The difference between a baby-friendly hospital and one without that designation is not just about whether you get the “gift” of formula or not. The Baby-Friendly Hospital Inititative has at least 10 criteria that BFHI hospitals must comply with in order to be labeled as such. Not one works in isolation to ensure breastfeeding success. I can tell you what worked for me:

  • Breastfeeding support groups: By far I felt these groups offered me the greatest support for my decision to initiate – and continue – to breastfeed. In Boulder where I lived, most of the hospitals with birthing centers offered weekly breastfeeding support groups in which moms and their babies could come in, nurse their babies, weigh them, talk to a lactation consultant (or several of them) hosting the group. But perhaps most importantly, it gave me a reason to get out of my house, maybe put on some makeup if I really had energy, and meet some other moms. Those early infant-caring days are wonderful but can also be lonely…especially for moms battling with post-partum baby blues or worse. My daughter was a little peanut, and I always worried that I wasn’t producing enough milk for her. Going to these groups, doing a pre-feeding weight and a post-feeding weight to find out how much milk she drank, helped keep my confidence up. I actually went to two different hospitals each week. OK, I was a little obsessed about my daughter’s weight.
  • Access to lactation consultants (LC) 7 days/week: At the Boulder hospital where I delivered my daughter, the lactation consultant came to my room no less than twice during my stay (I was there for only 36 hours – my choice). I was also given the number for the LC support line, available 7 days/week (except holidays) during normal business hours. Just leave a message and the LC on staff called me back within 2 hours (often much quicker than that!). There was no charge for the service, and the LCs were always more than happy to answer my questions. And I asked a LOT of questions!
  • In-home post-partum well-check: KP isn’t just a medical center, it’s an insurance plan. I don’t know if this was a service of the hospital or of my insurance, but a few days after my baby and I came home, a nurse came to MY house to do the mom and baby wellness checkup. She weighed my daughter, observed my breastfeeding, checked my uterus and answered all our questions. Those of you with kids know that the first few days of having a newborn at home are a blur: days and nights are mixed up, hormones are a mess… Keeping track of time, bundling a newborn baby and all the accoutrements said baby needs (my husband declared that the size of the baby is inversely proportional to the amount of stuff you need!) – getting out of the house can be exhausting! Also, something as private and sensitive as nursing I think is better dealt with in the privacy of one’s home than in a clinical setting.

I’m glad I had the experience I did with my daughter first, as nourishing her for a full 13 months gave me the confidence I needed to get me through nursing my second child. I can easily see how a new mom’s confidence would be shot if she had difficulty nursing and had to navigate a complicated system to help her get answers. The pressure to breastfeed – and particularly to continue breastfeeding – can be tough, and it’s of little wonder why most moms choose to wean well before the recommended 1 year mark. I strongly believe that keeping formula in the house isn’t what derails most people – it’s the lack of support.

Breastfeeding on the road

It’s no secret that I’m a huge proponent of breastfeeding. I gave my first child breast milk for the first 13 months of her life, despite a wildly fluctuating milk supply (thanks to an out-of-whack thyroid plus stress related to moving across the country and starting a new job). Making life more complicated was the fact that after 7 months, my daughter refused to nurse directly, so for 6 months I exclusively pumped and fed her from bottles.

Luckily, I have a job that allows me to work from home, so pumping during the work day isn’t as big a deal to me as it is to most working women. However, when I’m out of my element – such as traveling or even going out for an extended period of time – I truly feel the pain of my fellow working women and other mothers who face major hurdles as they strive to keep their babies well-nourished with breast milk.

One major downside of my chosen career is that there’s no such thing as paid time off. That includes maternity leave. So when my second child was born two months ago, I resumed work after just two weeks. Granted, my hours are flexible and I’m able to work in my pajamas, unshowered and without makeup, without anyone knowing the difference. And with temporary live-in childcare that allows me to keep my son at home for the first three months (thanks, Mom and in-laws!), I can easily grab a chunk of time to nurse throughout the day. However, with my child not even one month old, I found myself squeezing my postpartum body into business clothes, applying makeup and gathering all 8 AA batteries needed to power my breast pump. Yep – I had a business trip.

A few people think I was crazy for resuming work and traveling so soon after having a child. But my circumstances are unique and I’m glad we found a way to make this happen. Still, it required a fair amount of planning ahead and commitment, not just on my own behalf but also my mom’s, who was the one watching my son during that trip, and my husband’s. Luckily we made it through (despite a luggage snafu, but that’s a story for another day…)

Since that trip, I’ve done a fair amount of breastfeeding-on-the-go. It’s not my favorite thing to do, lugging a breast pump on a trip, even just into the city for an afternoon meeting. But it’s so worth it in the end when you can bring home that liquid gold and feed it to your little one.

Here are my tips for making breastmilk pumping a success:

  • If you plan to pump more than once in any given outing, invest in an electric, dual pump breast pump. Also, buy one of those hands-free bra-like things so you can multitask (as working moms, we’re masters of multitasking!)
  • Pack extra batteries. At least one more complete set. And bring your power cord, too. It doesn’t take up much extra space so when available, plug in rather than run your pump off battery power.
  • Rent a refrigerator for your hotel room. The minibar often isn’t cool enough for properly storing breast milk, so call ahead to have a mini-fridge put into your room upon check-in so it’s cold and ready when you arrive.
  • Bring a cooler bag with a frozen ice pack. My business trip was a quick 24-hour jaunt, so I really didn’t want to check my bag. I know that TSA rules seem to vary from person to person, but even when traveling alone and with an empty cooler bag with just a frozen pack inside on my flight out, the TSA agent allowed it through since the pack was still solid.
  • When you get to your hotel, put the frozen pack into your mini-fridge’s freezer. If you don’t have a freezer compartment, ask the front desk if they’ll store it for you. My freezer pack came from the freebies the hospital gave us when my son was born, so it had Similac logos all over it. No one was going to steal that! At the very least, put your name and check-out date on it (perhaps room number, too), to reduce the chances that it’ll get misplaced.
  • Get a nursing cover. Yes, even for pumping. I was lucky enough to be on a flight that still had empty seats. I found an entire row (the last row on the plane) without any passengers and took a window seat there. As soon as we were allowed to use our electronic devices, I pulled out my pump, strapped on my “hooter-hider,” even put my laptop up on the middle seat tray to do some work, and pumped away. No one had any idea.
  • Store pumped milk into bags made for freezing breast milk. This is something I discovered after so many times bringing all my supplies and realizing I forgot to pack caps for my bottles. Doh! Just pump and dump into those bags, which also fit really well into coolers and don’t take up any extra space. You can add fresh pumped milk to previously chilled milk, so fill it with two or more pumpings. Just don’t freeze your milk, because once it’s thawed you have to use it within 24 hours.

 For information about how long to store pumped milk, click here.

Body After Baby

Attention, ladies! There’s a surefire way to lose about 10 lbs…in one day! Of course, you need to first gain about 25-35 pounds, and how you lose that extra weight is a heck of a lot harder.

Yes, I’m talking about pregnancy. For a women at a normal weight, she can expect to gain about 25-35 lbs over the course of the 9 months. Underweight women need to gain more, and overweight women need less. Obese women might not need to gain any weight at all, according to the latest recommendations. Steady, moderate weight gain is good for both mom and baby, helping to prevent low birthweight (less than 5.5 lbs at birth) and high birthweight (greater than 9 lbs at birth).

Steady, moderate weight gain can also help women more quickly bounce back to their pre-pregnancy weight. For greatest success, follow a healthy diet and eating plan, and get some physicial activity, before the baby is born – ideally before you even become pregnant. But for those who find themselves weeks or months post-partum, struggling to lose the weight, all is not lost. Here a few tips and hints:

1. You are NOT eating for two.

Sure, when you’re pregnant a single body is carrying two beings, with two heartbeats, two digestive systems and so on. But a 130-pound woman does not deliver a 130-pound baby (can you even IMAGINE??), so strike from your mind any notion about eating for two. It’s more like eating for 1.2.

As I said before, most women can expect to gain about 25-35 pounds during pregnancy, and deliver on average a 7.5-lb. baby. So what about that extra weight? That’s placenta, amniotic fluid, extra blood vessels and several other ways your body grows and adapts to accomodate the being growing inside of you. Any weight accounted by the baby and placenta will automatically be lost at birth, but the other weight takes time to lose.

So even though you need to take in extra calories during pregnancy, the actual calorie amount needed is about 100-300 per day. If you’re breastfeeding, your calorie needs actually increase to about 500 extra per day. Continue to make those calories count by eating nutritious foods, having an extra snack or two, or using more calorie-dense oils and fatty/healthy foods such as avocadoes, fatty fish (no more than twice/week, and avoiding high-mercury fish), nuts and olives.

2. Drink up!

Staying hydrated during pregnancy helps prevent Braxton-Hicks contractions (those false-labor contractions). If you’re nursing, you tend to get very, very thirsty. Also thirst may mask itself as hunger, so before you reach for another bite, try drinking something first. Water is always a good option, but it can get boring after a while. Try mixing it up by serving it ice-cold, or adding a slice or two of fruit or veggies: lemon, lime, orange, cucumber – even some watermelon or frozen berries. Your calcium needs increase during pregnancy and breastfeeding, so you might even reach for a glass of lowfat or fat-free milk. Other good, low-calorie options are unsweetened iced tea (careful how much caffeine you’re getting), seltzer water, 100% fruit juice (try diluting with water, since a little goes a long way), even Gatorade or flavored bottled water. Of course, avoid alcohol during pregnancy and limit it when you’re nursing – try to time it until after the baby eats, and wait about an hour or more before breastfeeding again. Remember, alcohol can be dehydrating, so drink some extra water as well.

Fruits and vegetables also provide lots of water in addition to vitamins and nutrients, so don’t be afraid to load up on things like lettuce, celery, watermelon, oranges, and berries.

3. Get moving!

Gone are the days in which pregnant women need to stay off their feet and “endure” pregnancy. Research shows that being active during pregnancy can help keep weight gain in check and may even help ease delivery. Women who were not active during pregnancy should not suddenly take up a vigorous activity such as running, and all women should first check with their doctors before doing any kind of physical activity. Certain exercises such as bicycle riding, horseback riding, skiing – even volleyball and basketball, aren’t recommended during pregnancy due to their high risks for falling and colliding with others. Also, after the first trimester, pregnant women should avoid anything that has them laying flat on their backs. Activities that are typically safe during pregnancy include yoga, most cardiovascular machines (elliptical, treadmill, stationary bike), weightlifting (some modifications may be needed)…and, of course, walking.

In the immediate post-partum days, you need to give your body time to recuperate. Labor and delivery is a major event, and there’s a tremendous amount of recovery going on inside your body. Especially if you required stitches or had a c-section, it’s important to take it easy for the first 6 weeks, or at least until your doctor gives you the green light to exercise. Even then, take it slow.

Keep in mind –

Remember, it took 9 months to grow a pregnant body. It will take some time to lose the weight. Pregnancy is not a time to diet, but it is a great time to think about reassess your eating habits and to set yourself and your baby up for the best possible success.

The politics of breasts

Never thought these words would come out of my mouth (or be typed by my computer), but thank you, IRS! On Feb. 10, the Internal Revenue Service allowed breast pumps purchased in 2010 and later to be considered a reimbursible medical expense. Many health groups, from the World Health Organization to the American Academy of Pediatrics recognize the importance of breastfeeding, encouraging women who choose to and are able to breastfeed to do so exclusively in the first 6 months of a child’s life, and to continue until the child reaches a year to two years or more.

Unfortunately, this issue has become policial, after First Lady Michelle Obama made a statement supporting the IRS decision, which was met by backlash from Tea Party Republicans Sarah Palin and Michelle Bachman. The Washington Post did a nice article outlining each woman’s statements, including the flawed remark by Gov. Palin suggesting that Mrs. Obama was trying to compensate for higher milk prices (cow’s milk should not be introduced until after a baby reaches age 1). Here are some additional counter-arguments for the nay-sayers and considerations worth noting:

  • The government is not paying for breast pumps. This is a tax rule that will allow for reimbursement and use of a flex spending account to purchase medical devices. Breast pumps were merely added to the list. Even the IRS spokesperson noted that the tax rules that apply to the breast pump reimbursement are the same that applies to men getting vasectomies.
  • This tax break will serve moms beyond those who work in an office setting. Today’s moms are balancing more than ever, between office jobs, work-from-home jobs, and stay-at-home parenting – which is one of the most underappreciated jobs a woman can have. For my daughter’s first 7 months, I was a stay-at-home mom but relied on my breast pump to: keep up my supply as we adjusted my thyroid medication (which at one point caused me to nearly dry up); allow my husband to participate in the feeding process and the bonding that goes with it; provide me with some much-needed breaks and a weekend away for my husband and me to remember it’s not always all about the baby, and so on. A good breast pump is also a must for any mom – working or not – who either does not want to or cannot directly nurse or whose baby does not latch well.
  • Women need MORE support, not less, when it comes to continuing to provide breastmilk to their babies. A recent news article found that women are more likely to breastfeed and continue breastfeeding if she had family support. Although I’m not aware of any research on the matter, a breast pump is a sizeable expense and could be considered an obstacle to breastfeeding. With a reimbursement program in place, more families may be able to spare the expense — and reap the rewards.