Posted February 28, 2010
If you attachment parent (AP), then you believe in the principals laid out by Attachment Parenting International. This type of parenting has been popularized, in large part, by Dr. William Sears, who has his own list of "Baby B's." AP emphasizes on bonding with your newborn, breastfeeding, co-sleeping, and responding to your baby's cries. In essence, it means following your natural instincts as a parent - to snuggle and love and soothe your baby.
Baby training (BT) methods, which often go hand-in-hand with letting babies "cry it out" (CIO), follow a very different style of of parenting. Made popular in books like Babywise, these methods encourage parents to resist the "temptation" to "give in" to the desire to feed, hold, or soothe their crying babies. Attention is dispensed according to a disciplined schedule designed to teach babies when it's okay to need food, diapering, or human contact.
You Can't Actually Train a Newborn
BT promotes the idea that a baby's needs can be managed and controlled. This can be a welcome idea for overwhelmed, tired new parents. Unfortunately, it's not true. The needs of a baby, especially a new baby, are very high and cannot be "managed" away. New babies are also biologically incapable of being trained to sleep or eat on a schedule, so training a baby is simply not a realistic goal.
You Can Train A Parent
Parents, unlike new babies, can be trained. If a new mom is instructed not to "give in" to her baby's cries, and this type of "disciplined" parenting is encouraged by everyone around her, she can be conditioned to repress her natural urge to hold and soothe her baby. Her baby won't actually learn to need less human contact - he will still cry. He'll just be ignored. A continually ignored baby may finally become detached after enough isolation - giving up on the parents who won't "give in" to him, but many babies will just keep crying - hoping for those moments when the BT schedule decides their cries will be answered.
Will Your Early Parenting Style Decide Your Child's Fate?
Does BT, CIO style parenting turn children into cold, psychotic delinquents? No. Does AP guarantee happy, successful, loving children? No. So many parents who argue the relative merits of these parenting styles (and the continuum between them) focus on whether or not a kid can "turn out just fine" one way or the other.*
Your choice of early parenting style will certainly affect how your baby relates to you and likely reflects how you feel about your child or having children in general. Your choice of parenting style will have some impact on your child's personality, too, but it will get mixed in with hundreds of other factors in determining how he "turns out," including general health, genetics, education, peer group, siblings, environment, cultural influences, talents, preferences, and many other things.
Why Bother Attachment Parenting, or Even Breastfeeding?
So why bother attachment parenting? Why even bother breastfeeding for that matter? Breastfeeding, of course, has a more direct, objective impact on health and intelligence (some studies debate aspects of the IQ claim, but most research supports it). There are, however, plenty of formula-fed children who "turn out just fine" by adulthood. For the sake of argument, let's even pretend that baby-trained, formula-fed kids "turn out" no different that breastfed, attachment-parented ones.
More Effort, More Commitment, and More Awesome
Guess what? Attachment parenting is still a much nicer way to live. Yes, it's more work. It takes more time, and more commitment to being a mom or dad. Breastfeeding alone is a huge undertaking, especially if you have to go back to work while your kids are still little. The thing is, you had a baby. Don't fight the situation - enjoy it! Snuggle him, comfort him, hold him, love him, play with him. Forget your hairdo and miss the call. Let him take up your time and invade your life, you'll be glad you did.
I'm not talking to the parents who are just trying to survive and cannot AP or breastfeed for reasons beyond their control (working two jobs to pay rent, medical problems, etc...). They probably don't have time to read parenting and breastfeeding blogs. I'm talking to people who spend so much time and energy trying to manage their children and protect some highly marketed idea of "my precious child-free time" that parenting becomes a miserable chore.
Babies Are Not Evil
We all have times we just want to take a long, quiet bath or finish writing a blog post or have a uninterrupted conversation with our spouse. We all want to put on nice clothes and go out for a glass of wine with friends on occasion. What I don't understand is the fearful, defiant reaction some people have to attachment parenting and the sadly common attitude that babies are selfish manipulators trying to horn in on the lives of their parents.
You're expected to hope and pray for a beautiful baby, but the second that baby comes out you'd better "watch out" for that kid.** It's like your baby is some menacing stalker. With a deadly serious look, someone will warn you, "Too much coddling and before you know it, they'll want to be held all the time!" Quick - file a restraining order! Or just leave them alone in a crib sobbing their little heart out, that'll teach 'em. I don't get it.
Throw All the Science Out the Window and AP and BF Still Win
Yes, there are lots of scientific (psychological and medical) reasons to attachment parent and breastfeed. But the argument for attachment parenting practices - like breastfeeding, cosleeping, and lavishing your child with love - doesn't hinge on those studies. That's why articles like Hanna Rosin's "The Case Against Breastfeeding" and "gotcha" press releases like this one (describing one study that indicates increased intelligence in breastfed babies may be due to genetics) have little impact on my views of parenting. Attachment parenting and breastfeeding aren't about winning a medal or creating a perfect child, they're about giving yourself permission to love your children and enjoy the awesome experience of being a parent.
*I have noticed that "turn out just fine" is a phrase used a lot by people defending a parenting practice they don't feel good about.
** common parental advice, but do we really need to "watch out" and protect ourselves from helpless infants?
Posted February 27, 2010
Creating New Medications Based on Human Breast Milk Components
Previously, I've written about the possibility of making therapeutics directly from donor breastmilk, such as Prolacta's HMF (the need for HMF has been discussed in the comments of another post about Prolacta). But what about individual breast milk components being recreated in a lab for use in medicinal products? In my first post on this topic I focused on the irreproducibility of breast milk, but what about the individual components that are reproducible - the ones that can be made in a lab?
This topic, though related to the question of how breast milk might be used by those who collect it (in this case, for research), spreads out into questions about biological patents and intellectual property (IP). True to being a bench scientist, I know little about patents, IP, business, money, etc. That's how they get us to work as postdocs to work for almost nothing.
What I do know is that if a biomolecule like the antimicrobial lactoferrin can be identified and characterized through the study of breast milk and used to prevent illness, I'm in (lactoferrin was brought up in a comment). If what we can learn from breast milk increases our understanding of human biology and allows us to develop effective medications and therapeutics, I support that.
Creating medicines based on the intricate, elegant molecules made by living organisms (as opposed to the relying on the random luck of screens or using sledgehammer drugs with global affects on the body) is tricky work. It's something we have been struggling to do this century because it is finally becoming possible through the sequencing of DNA (genomics) and study of it's gene products (proteomics).
As we move forward, we will be able to create more effective medications with fewer side effects than traditional drugs. Stories like this one about the drug PLX4032, which was created through research and understanding of the biomolecule B-RAF, show how the process works. Medications created like this are the future of treating cancer, cardiovascular disease, altzheimers, autism, HIV and other ailments that lead to human suffering.
If biomolecules discovered in human breast milk (and made in a lab) can be part of that and lead to therapies that improve outcomes for babies in the NICU or even adult patients suffering from something totally unrelated, I think that's great.
What inspires individuals and organizations to do the kind of difficult, expensive research it takes to develop these medications? Three things, really: a desire to help people, a desire for academic prestige and glory, and a desire for money. The individuals tend to focus on helping people and getting glory while the larger, more powerful organizations tend to focus on the money.
The current system for rewarding successful research with money is through patents. Patents allow those who generate new, useful ideas and information to limit anyone else from using them to make money for some period of time. Patents, especially biological patents can get very complicated in how they are issued and legally enforced. Of course, there's lots of controversy and deviousness that goes on around patents, like anything else that involves a lot of money. Valerie McClain, who has commented here, addresses more issues related to this in her blog. Incidentally, the academic glory reward system isn't perfect either, so to be a happy scientist you really have to work on something you believe will contribute to the common good.
In another life, I walked straight from the Cornell Chemistry Department over to the Law School the day after getting my Master's and became a patent lawyer instead of a PhD. In that life, I make way more money than I do now and know all about biological patents. As it is, I know only the basics, but I can still see that there are flaws in the system. Maybe we will find a better system someday. For now, we have patents, and to get them big companies spend about a billion dollars each bringing medications to market.
If some of those medications are designed based on therapeutic components of breast milk and created and delivered to the people who need them (a big "if" in the current US healthcare system), that's a good thing. However clumsily, we will have used our ingenuity to alleviate human suffering and to help or even (dare I say) cure the sick. That gives me hope, the only truly reliable reward for good biomedical research.
What About Formula?
Of course this all brings up another, much more breastfeeding-centric question: What about using this kind of research to make "better" formula? Is that a good thing or a bad thing? Although I don't see how any company could afford to use donor breast milk in the manufacture of formula, they could use what they learn from the research of breast milk to identify components (like DHA and ARA) that can be added to formula. Perhaps more important additives could be included to make formula a little less unhealthy. The question is, do we want unhealthy formula - to keep moms from seeing it as a suitable substitutre, or more healthy formula - to improve the health of those babies forced to drink it? What do you think?
Posted February 20, 2010
If you've read Your Right To Nurse In Public or keep up with informative Breastfeeding and the Law posts like this one on the Sustainable Mothering blog, you will have noticed the glaring absence of any federal laws to protect breastfeeding (except in federal buildings). Breastfeeding moms have to scrounge around state-by-state to figure out whether or not they will be protected when they need to nurse in public or pump at work.
Ideally, breastfeeding will be protected as a civil right, and those who attempt to deny mothers this right or discriminate against them will be subject to legal action. These kinds of strong state laws are a rarity, as discussed in this older but thoughtful discussion of Lactation and the Law from Mothering Magazine. At the minimum, basic federal legislation protecting breastfeeding moms, such as that proposed in the Health Care Reform Bill, would be passed.
How can moms help? Here's one easy but helpful way - write to your senators and representatives. Real people with real voices do reach politicians this way, and the more emails and phone calls, the better. If you are reading this now, you are literate, have internet access, and care about breastfeeding. That is all is takes! Brestfeeding moms tend to be a pretty intelligent bunch, too. I'd bet there are a lot of well above average writers out there, so let's do it! Armchair lactivism at its most convenient - and I'm going to make it even easier with a few helpful links!
Severall tips for crafting a letter are found here. You can find information about how to contact your senator here and how to contact your representatives here. These are the people charged with making and supporting laws in Washington to improve the health and well being of their delegates - like you and your family.
Remember, most of what breastfeeding moms want is included in The Breastfeeding Promotion Act sponsored last year by Senator Jeff Merkley of Oregon. Tell your senators and representatives why this act is important to you and how you feel about being able to breastfeed your child without giving up the right to leave your house or to work. You might also throw in how much it costs for breastfeeding support and supplies to make it clear why this type of expense should tax deductible, considering the contribution you're making to public health.
Since many of the current laws to protect breastfeeding moms have very dull teeth or none at all, what can I do if I've been harassed or denied my rights? One way is to contact First Right. This organization helps breastfeeding moms who have been treated unfairly find justice.
Posted February 13, 2010
"Wow, that breastfeeding really keeps you thin!"
I've heard this a few times and I'm always tempted to reply,
"Yeah - I actually had kids because I got so sick of spending a whole hour of my time at the gym everyday. What a timesaver that was!"
The calorie-burning aspects of breastfeeding have been given a lot of attention in recent years. Although the calorie burn is real, the net effect on body weight can vary a lot from woman to woman. Regardless, it had been highlighted on websites that support and promote breastfeeding. But the place you really hear about the breastfeeding weight loss bonanza from is Hollywood.
Celebrities and public figures who breastfeed their babies do so much good for breastfeeding rates and general public health. It's truly wonderful when they are willing to go the extra mile and speak openly about their breastfeeding experiences (right Michelle Obama?). The site Best for Babes has an excellent forum for the famous to engage in productive, informative discussions about breastfeeding that can inspire moms and educate the public.
So I'm really happy about Gwyneth Paltrow, Angelina Jolie, Jennifer Garner, Rachel Wiesz, and, of course, Kourtney Kardashian, showing their fans how it's done. I do have a problem, however, with tabloidish "celeb breastfeeding" clips that invariably hone in on weight loss as THE reason to breastfeed. It's really an absurd idea.
Breastfeeding a baby is a huge commitment and one that requires much more from a mother than any diet or workout routine. Maybe weight-loss is what the editors focus on because they think it's what the readers want to hear about. Maybe celebrity-moms tend to focus on it because they feel it's a way to speak about breastfeeding in terms that Hollywood can appreciate.
Maybe the weight loss angle is how some celebrity moms deal with managers, publicists, directors and others who might not be so understanding about the intense commitment to mothering a breastfeeding mom takes on. The subtle threat of "support this or I put on 30 lbs" is probably a smart power play for a star mom who wants time out of the spotlight to spend with her baby.
Whatever the reasons for this "breastfeed your way to a hot bod" idea, it has one good (to encourage breastfeeding) but two annoying outcomes. One, is that if you are thin (usually because you have little time to eat when you breastfeed, attachment parent, cloth diaper and add any of the following: run the household, work outside the home, blog, cook, work at home, workout, coach, serve on the school board, etc...) people rudely and absurdly imply that dress size is your true motivation for breastfeeding.
The second flipside annoyance comes when this same busy schedule leads to weight gain because there is less time to eat right and excercise. If you haven't transformed into a swimsuit model by the time your baby hits 12 weeks, you start to get the not-so-subtle questions like, "So, do you think the breastfeeding will start to take off some of that baby weight eventually? Are you going to keep at it?"
Newsflash TMZ, assorted frenemies, and Aunt Judy: stars and moms commit themselves to breastfeeing out of concern for their children - not their waistlines. I enjoyed seeing a recent story about Heidi Klum's breastfeeding in which she said breastfeeding weight loss is blown out of proportion and, BTW, she does it because "Breastfeeding helps (her) child."
Don't get me wrong - I support anything that increases breastfeeding rates, including making moms aware of the high caloric burn of breastfeeding. But those looking in from the outside shouldn't use this information to make belittling (and ridiculous) assumptions that moms breastfeed (or continue breastfeeding) because it's a convenient "cheat" for keeping slim.
Just found this great post on this topic from Sustainable Mothering:
Posted February 12, 2010
Part 4: Milk Money
Will informing donors about the manufacture of costly therapeutics from their milk mean paying them, too?
This question is hard to answer. First, because I have no idea whether Prolacta has far more milk than they need or just enough to squeak by. Of course, if the donor milk supply is exceedingly high, there will never be any need to pay donors.
How much milk?
So, how much breast milk does Prolacta currently have in its possession? For that matter, how much total milk is collected in the US every year? What percentage of that milk is processed and sold back to hospitals at cost by non-profits and what percentage goes to the development and manufacture of Prolacta products? If anyone out there has access to these numbers, I'd love to know them. I can only find the odd report here and there - nothing comprehensive.
One number I can find is on the IBMP website, which says they've collected 262,682 oz. of milk for Africa. If the milk split described on their How It Works / Donation Process page holds true (25% to Africa and 75% to "critically ill babies in the US," aka Prolacta), than that particular bank has provided Prolacta with 788,046 oz (=6,156 gallons =22,305 L) of breast milk. Add to that 100% of the milk collected at all the other Prolacta milk Banks, and that could be a lot. Or maybe it's barely enough?
How will donors feel?
The next question is - how will donors feel about giving milk to a for-profit enterprise that is also a life-saving one? This is hard to predict. I hold to my statement in Part 2 of this post: For every mom who wants her milk to be non-profit all the way, there will be others who don't really care as long as they are helping someone with their extra milk (probably the majority of moms) and still others who want to see as many lifesaving medications developed from human breast milk as possible.
Will the milk river dry up if moms learn more about where it's been flowing? I think there would likely still be plenty of donor milk forthcoming. Let's assume, however, that if Prolacta milk banks started being called just that (with little displays of Prolacta products inside and "Prolacta Bioscience" T-shirts and totebags for all the donor moms) that the moms would stop giving milk without compensation. Would it be so bad?
Can Prolacta afford to compensate donors?
Would it really hurt Prolacta to compensate donors? I'm sure they've invested a lot in establishing so many milk banks across the US. With this milk collection infrastructure already in place, it would seem the cost of compensating donors, if necessary, wouldn't break the bank. And what about those T-shirts? Wouldn't Prolcata benefit greatly from being out in the open, happily marketing their brand and making donor moms feel like part of the Prolacta team? If the fear of paying for milk (as other for-profit "bioscience" companies pay for human plasma) is what’s keeping Prolacta in the closet, it hardly seems worth all the hiding.
A recent study published in The Journal of Pediatrics shows the valid medical benefit Prolacta's HMF has for severely premature babies. This paper, paired with their recent agreement with Abbott Nutrition (makers of the Similac cow-milk HMF) will make hiding in the shadows of their milk banks not only wrong but also exceedingly difficult for Prolacta.
Other issues related to compensating donors
Of course, there are more important issues than money when it comes to paying breast milk donors. One is the concern that non-profit milk banks will never see another ounce after donors hear about the awesome deal down the road. I don't think this would be a major problem because many moms feel strongly about giving milk as a charitable donation. Many women in the US who currently breastfeed are well-educated, fairly well-off, and in a position and a mind-set to make this kind of charitable donation.
The non-breastfeeding community
Now let's consider the women in the US who aren't breastfeeding (the majority of mothers), and the general public. Sadly, unscrupulous members of the food industry have been very successful in portraying breastmilk as a questionable, cheap, and even gross alternative to the gold standard of formula to many of these people.
Maybe Prolacta paying moms for milk, because it can be used to make valuable, life-saving medical treatments, would help to change that. Maybe the only force powerful enough to fully stomp out the bad image of breastfeeding perpetuated by the corporate powers-that-be will come from the corporate powers-that-are-coming - like Zeus defeating Cronus. It's not ideal, but it's practical.
Placing a monetary (and medical) value on breast milk would have a positive impact on how "Joe Public" regards breastfeeding. Mothers who now consider formula an expensive but worthwhile investment in their child's health (and there are lots of moms like this) may start to think twice when they hear the news that breastmilk is valued at some dollar amount per ounce and used to make medicinal products.
Some of these same moms may also benefit from the extra income their own extra breastmilk could earn. Paid milk donation would then doubly encourage these moms to work hard at establishing and continuing breastfeeding their own children, not only to have highly-valued, premium nutrition for their babies but also to be able to donate milk for extra income. Whatever the motivator is, the numerous benefits of breastfeeding will be enjoyed by each new mom willing to try (and her baby).
Would moms sell their milk and feed formula?
The argument that moms who would have breastfed otherwise will instead sell all their breastmilk and feed formula doesn't make sense. Why would they spend an enormous amount on formula when they can make more breastmilk, which they know is superior, for free. A strict screening process for paid donors and limits to the volume a donor can provide could also be imposed to ensure that this is not a problem.
Other Issues related to compensated donation of human fluids
The arguments against compensation of blood donors don't seem to apply here either - these are the possibilities of over-donation causing severe bodily harm and payment attracting a disproportionate number of desperate, diseased drug addicts.
First of all, moms can't risk their lives by over-donating milk as a blood donor could, and with only one company in this business it would be easy to impose and enforce the limits and pre-screening mentioned above. Milk donation is certainly less physically taxing and risky than blood plasma donation, which is legally compensated by many plasma banks.
The plasma collection process takes only part of a donor's blood, and it occurs both with compensation (when given to for-profits) and without (when given to non-profits) in the US. Interestingly, the collection of both plasma and blood products without compensation by the Red Cross has also come under fire – demonstrating on a much bigger and more complicated scale how unhappy donors are to find that their donations are being used in an undisclosed or poorly disclosed way to turn a profit. My thanks to a commenter (Lindsay) for bringing this up.
It’s also easier to prevent the spread of pathogens through breast milk (which is naturally safer and can be pasteurized) than through blood. Although I might worry about desperate souls selling off their blood, I find it hard to envision the same people hatching a plan to become pregnant and bear a child for some limited amount of milk money.
Bankers - breast milk bankers, that is
So although I wince a bit at the phrase "corporate breast milk bank," I realize they are already out there. At the same time, I see the potential for positive outcomes from these banks and the company behind them. Run properly, they could help reshape the way many in our culture view breastmilk and breastfeeding and possibly improve breastfeeding rates, not to mention develop important therapeutics from breast milk both now and in the future.
I just hope that Prolacta is dedicated to biotherapeutics. I hate to think of a future with very expensive formulas made from processed human milk - like a wet nurse in a can (with many key components long since destroyed during processing, plus an unhealthy dose of can-liner chemicals).
If this ever did move away from therapeutics and toward food products, I hope moms would realize that they can make real "liquid gold" far superior to anything processed in a plant. Remember that Prolacata, or any company making pasteurized, processed human milk products still cannot keep many of the critical antimicrobial biomolecules (which our mammary glands originally evolved to deliver) viable and active through processing.
Posted February 9, 2010
Part 3. The Haiti Milk Mix-up
What happened to all the milk donated for Haiti?
Soon after I started this blog and got a Twitter account, I saw a flurry of requests for donor milk to save Haitian orphans (this was shortly after the earthquake). A press release asking for milk was "going viral" in the breastfeeding community - one from some very trustworthy sources, including La Leche League, HMBANA, and the ILCA. Like many, I was really moved by these requests and sorry that since my youngest is two and nurses mostly for comfort, I don't make enough milk to donate.
Later on, I started to see reports that donor milk might not actually be able to get to Haiti. After that, I read this great article in the Sustainable Mothering blog about why donated breastmilk may not be the best way to help Haiti - for numerous reasons: Haiti, Hell, Good Intentions, and Breast Milk Donations. So there was a big misunderstanding, it seems. That total disconnect is described in an article from MSNBC excerpted below:
“Tell them not to send it,” said Eric Porterfield, a spokesman for the American Red Cross. “I’m 100 percent sure we didn’t ask for that.”
The international Emergency Nutrition Network has asked one group, the Human Milk Banking Association of North America, to retract a press release this week that issued an “urgent call” for breast milk for orphaned and premature infants in Haiti, saying the donations contradict best practices for babies in emergencies.
Such donations pose problems of transportation, screening, supply and storage and create an “unfeasible and unsafe intervention,” according to a statement from the Office of U.S. Foreign Disaster Assistance, or OFDA.
Simply trying to fill a need
Pauline Sakamoto, executive director of HMBANA, said the group was simply trying to help fill a need, if not in Haiti, then elsewhere. Donated milk that doesn't make it to Haitian babies will be diverted for use in the U.S. and Canada, she said.
“We don’t want to waste an ounce of milk. It’s very precious,” she said, adding.
The confusion started earlier this week when the milk bank group and several organizations — including heavy hitters like La Leche League International — urged nursing mothers to donate milk. While representatives for aid agencies such as the American Red Cross, Doctors Without Borders and World Vision said there never was a need for donated milk, some agencies said they heard from workers at orphanages in Haiti who indicated that babies were going hungry.
“This was very grass roots,” said Amanda Nickerson, executive director of the International Breast Milk Project.
So maybe this was all just a big misunderstanding. Or maybe the visceral reaction a nursing mother has to the type of horrific images of human suffering caused by the earthquake in Haiti was seen as an opportunity to stock up on milk (a point raised by blogger Valerie McClain). I trust the organizations who signed off on the original press release had the earnest intent of helping Haitian orphans. But who got that release underway? Was it really "very grass roots," as the director of the Prolacta-partnered IMBP stated? Perhaps it was. It certainly was a big misunderstanding.
My concern is that the breastfeeding institutions and banks involved should have made more detailed plans and policy agreements with those on the ground in Haiti before sounding the call-to-boobs. The thing that really bothers me is the idea that - hey, no big deal because "donated milk that doesn't make it to Haitian babies will be diverted for use in the U.S. and Canada."
That's the same type of thinking behind showing donors pictures of needy children (in Africa or in the NICU) and then using their milk to make an unmentioned product that's sold by an unmentioned company (see the previous post, Part 2).
Potential milk donors should not be told whatever it takes to get them in the door (or on the pump). They should be respected as valued members of the process that brings breast milk or breast milk-derived therapeutics to those in need.
This means banks should do their homework and provide a complete description about where the milk is going. Fully inform and include breastmilk donors and the public- don't just show them pictures of sick babies and call it a day. This applies to the Haiti solicitation, to Prolacta collection banks, and to any milk banks. Women who donate breastmilk are handing over liquid gold (see Part 1), and they don't need to be tricked or manipulated, they need to be respected.
Next, Part 4: Will informing breast milk donors about the manufacture of costly therapeutics from their milk mean paying them as well?
Posted February 8, 2010
Part 2: The Prolacta Milk Bank Story Recap
Breastfeeding moms planning to donate milk to Prolacta (including those who donate to the National Milk Bank, Milkbanking.net banks, and 75% from those who donate to the IBMP) generally only read that their milk goes to "critically ill babies in the US" or to "severely premature babies." On most of these sites for these banks (Milkin' Mamas being a notable exception) , no mention is made that the milk is processed into a specific line of products (HMFs) and sold by a very specific company (Prolacta) and provided to "critically ill babies" whose parents are lucky enough to be able to afford and have access to Prolacta's HMF products.
This is not a new story - Prolacta was in the news a lot when they began collecting milk in 2006 and in 2007 after the fact they collect 75% of the milk donated to the International Breast Milk Project (IBMP) came under scrutiny.
10/20/06 Blisstree.com Milk Donors Beware – Choose a Milk Bank Carefully!
05/22/07 The Lactivist Is The International Breast Milk Project a Scam?
09/02/07 Breastfeedingsymbol.org Thinking of Donating Your Breastmilk? Read This First.
Recently, Prolacata has been in the news again, both for research that shows the benefits of human breast milk HMF and for their business partnership with Abbott Nutrition, makers of Similac. I learned about Prolacta from this on from The Motherwear Breastfeeding Blog: Formula maker to sell human milk product. I also found a post by blogger Valerie W. McClain Human Milk Patent Pending and some discussion at the Mothering Magazine forums about Prolacta.
Now, I understand that the profitability of Prolacta allows them to do more research and help more premature babies. I also understand that the more breast milk Prolacta gets, the more HMF products they will be able to supply for premature babies. For severely premature babies, a system for increasing the caloric density of their mother's milk without exposing them to cow milk or soy proteins can make a critical difference. For them, HMF is not a formula supplement - it's a biotherapeutic medication.
So why does Prolacta think they need to hide behind the curtain and hand-wave about where the milk goes? Why is there no mention of Prolacta or HMF or developing breastmilk-based biotherapeutics on the National Milk Bank website? Why does the IBMP speak so hesitantly and defensively about their relationship with Prolacta?
Breastfeeding moms tend to be well-educated women who are very capable about making decisions based on complete information. Who decided these women can't handle the facts and instead should know nothing more that the milk goes somewhere that "helps babies" (now run along, ladies, it's time for man-talk)? It's not like the milk is being turned into high priced hand-cream or something.
Biotherapeutics from breast milk make sense. Some smart people looked at the amazing medical treatments that can be made from human blood and realized that breast milk could also have important medicinal properties. They invested a lot of time and money into researching whether medically relevant therapeutics could be derived from human breast milk. They found that yes, this is the case. They made those products. They charge money for these products, just like all companies who develop and manufacture medical treatments do. Why are they afraid of making their mission a clearly stated goal of the many milk banks they run?
The only answers that make sense are
A. They think that breastfeeding moms will stop giving them milk
B. They don't want to have to pay donors for breastmilk
Option A: Yes - some women may choose to provide milk to a non-profit bank instead, like the HMBANA which provides breast milk (in milk form) to babies in need. Others may choose to provide milk to a company interested in developing biotherapeutics. For every mom who wants her milk to be non-profit all the way, there will be others who don't really care as long as they are helping someone with their extra milk (probably the majority) and still others who want to see as many lifesaving medications developed from human breast milk as possible. The point is, Prolacta milk banks should be called Prolacta milk banks. All of this "processing partner" stuff is ridiculous.
Option B: I'll discuss this in my final post on this topic.
My next post will be more about how the earthquake in Haiti inspired a great call to arms (or boobs). The subsequent news - that the donor milk flowing in could not get to Haiti and might not be as helpful as we'd thought - has made me (and others) question the great hue and cry for milk donations to help third world orphans from institutions who know most of the donated milk will never get to them.
Posted February 7, 2010
Part 1: The complex evolution of breastmilk
Human breast milk is not reproducible, but can be collected from donors.
Breast milk is full of active proteins and other complex biomolecules. As a scientist who struggles to purify stable, soluble, biologically active proteins (or even small fragments of them), I know how difficult and expensive it is to do this. Figuring out how to produce even one milligram of one protein that is still folded (shaped properly) and active (able to work like a tiny machine) can take a year.
The protein content listed on a formula label refers to what's left of once-active proteins that are now unfolded, inactive, and simply a source of amino acids. Formula provides protein as well as carbohydrate and fat for food calories, it's cheap and easy to produce, and it's nothing like breast milk.
Breast milk actually evolved as part of the immune system, not as a method for feeding. It started as an antimicrobial fluid, not a food. This ancestral substance was composed primarily of complex immune-related proteins and biomolecules and acted then as it does today - as a system for properly establishing the immune system of a newborn under the direct guidance of the parental immune system. Mammals now produce breastmilk that also contains lactose and lipids, which provide sustenance (a later evolutionary flourish).
Infant formula is not synthetic breastmilk. Creating synthetic breastmilk would be a feat comparable to making synthetic blood. Anyone who considers the problem will quickly realize that, like blood, there is only one way to get breast milk - from a donor.
Since breast milk is such a precious, useful substance I wasn't surprised to learn that, like Telacris and CSL Behring, companies that make therapeutics from blood plasma, another company has figured out what a commerical goldmine donor breast milk - processed and sold as a biotherapeutic - could be.
Enter Prolacta, a company that has spent an enormous amount of time and effort researching human breastmilk - what's in it, why it's medically important, how it can be effectively collected, safety checked, pasteurized, processed, and sold at a profit.
The work Prolacta does is good for breastfeeding science, and for the image of breast milk. Prolacta supports an excellent charity (the IMBP). It also helps a lot of severely premature babies, because they sell a breast milk version of human milk fortifier (HMF) - an additive that boosts the calories in milk fed to those babies in the NICU. Unfortunately, the way they get the milk is pretty devious.
Part 2. The Prolacta/IMBP Controversy Recap (this story broke in 2007) - preview this Lactivist article
Part 3. How much breastmilk donated for Haiti will actaully make it to Haiti?
Part 4. Paying moms for breastmilk (shudder) - could there be a silver lining?
Posted February 4, 2010
… here's how I knock out my nemesis,
GI Jane style.
I am writing this as a mother of two boys whom I nursed for one year each. I’m also a pediatrician, but I’m writing this as a mom. Some of my thoughts below might not be ones I’d share gracefully in the office.
So in two years of nursing I probably had clogged ducts 15 times. I have no idea if this is average, but I certainly know friends who’ve had 5 or so. I got to where I could tell when one was starting and begin my routine ASAP to keep it from getting worse. One thing I DID know from my medical experience: clogged ducts can lead to mastitis, and I do not ever want to have mastitis. I’ve seen lots of people in lots of pain, but none of it compares to the women I’ve seen with untreated mastitis.
How do you know if you have a clogged duct? Well read good sources of information. My signs? A vague feeling like one section (think pie slice) of one breast wasn’t emptied at the end of a feeding, and the same area feeling more so a feeding or two or three later. Or feeling a lumpy firm area (again, sometimes like a pie slice, sometimes like a rock) in my breast that became increasingly tender. Sometimes the area was starting to pink up, and sometimes the veins in that area would become a little bluer, a little more noticeable. Only once did I have the “little white spot on the end of the nipple” that some resources describe.
What to do? Simple. Get the area unclogged. How to do that? Not always easy. I would do a few things, alternating between them, until I got it completely unclogged (when the whole breast is soft, there’s little to no more milk coming, and the pain is pretty much gone about 12 hours later, save for some bruising if you had to cause some… read on.)
1. Nurse, nurse, nurse. Let your baby drink as much as s/he wants as often as s/he wants while you’re trying to get unclogged. While nursing, as much as possible, massage (with your hand) the firm and tender part of your breast. How hard? Not as hard as you can take it- Harder than that. This is the not-fun part, but it is ABSOLUTELY worth it when you get it unclogged and you avoid further problems. Frankly, nursing alone only solved my clogged ducts once or twice
2. Take two to four ibuprofen, ie Motrin or Advil (400mg to 800mg) with your doctor’s okay. It will make the next part more bearable.
3. Pump, pump, pump. Find a good t.v. show, brew some tea, and pump the affected breast (you can pump both if you want to) and, with your hand, massage the tender firm area like it’s a bear about to mawl your baby. You can start gentle, but you will likely have to use a good bit of pressure (read: a heck of a lot) to get the milk to get through. Also increase the strength of the pump to the highest you can stand without harming your nipples. You will know when it really starts releasing as there is a flood of more milk (sometimes yellowish or reddish- don’t be alarmed) and the area slowly turns softer. KEEP GOING until the whole breast feels soft and there’s pretty much no more milk coming. This method worked for about 75% of my clogged ducts. The worst ones took 2 or 3 pumping sessions, usually about 30 minutes long each (one time was 45 minutes but finally worked).
4. Shower Power. Basically, you use your hands to massage and somewhat manually pump the affected breast. I used this method more after I realized how well it worked with my second child. After trying the first two, if the area is still partially or completely clogged, turn on a steamy shower, as warm as you can take it, and step in and massage the firm tender area more firmly than you can take and use the fingers of your other hand to express some milk.
In my experience, it often took 5 to 15 minutes, and occasionally two showers, but then the area unclogged and I was able to manually express the milk until the whole breast was soft.
Re-clogging: The same area will be sore and slightly swollen for a day or two, and is also at risk of re-clogging. So try to make sure your breasts get completely emptied with every feeding or pumping over the next few days.
Be Proactive: The sooner you start trying to clear a clogged duct, the easier it will be. The longer you wait, the harder it will be (and the more you’ll regret waiting- you might get to the point where you can’t tolerate even the slightest touch to the area).
If your pain is severe, you get a fever, or your baby isn’t eating well or seems ill, call your doctor. I was able to treat all mine at home, but I was aggressive and I knew the signs of when I should call my doctor.
This post might highlight some of the rougher parts of breastfeeding, but the VAST majority of my nursing times were some of the most intimate, cozy, beautiful times I’ve had with my children.
I hope this helps if you ever have clogged ducts. Please write any other things that worked for your clogged ducts in the comments!
Posted February 1, 2010
"Cracked Nipples" sounds pretty bad, but considering it describes nipples that look and feel like they've been pressed against a belt sander, the term is actually a euphemism. I feel a strong sisterhood with anyone cursed to pass through this dark, dark place on the path to established breastfeeding and a strong jealousy toward the lucky majority who never had to deal with this. This is not a post about pain, which is common; it's about raw, abraded, and even broken skin. I've been through it twice, and still can't decide which time I was less prepared for.
With my first, I knew I might have sore nipples, but had no clue what horrors were in store. After a natural birth, I thought I'd conquered a pretty tough experience, but that was nothing compared to the first weeks of breastfeeding. I tried everything - changing my latch, using lanolin, applying breastmilk, leaving my boobs clean and dry - all of it. Nothing worked, and soon my beautiful baby began to resemble a savage pirana and my supply began to fade.
Now I have read (and you may have, too, if what brought you to this post is your own pain) that cracked nipples are only caused by caused by poor technique and latching problems. To be sure, a number of things I learned from working with a certified lactation consultant, including better technique, helped me get back on track with my first son. Then, 3 1/2 years later and with almost 3 years of breasfeeding experience under my belt, I was again looking down at my beautiful newborn baby past two horribly cracked, insanely painful nipples.
Though I fully agree that poor latch can be the culprit, I have also observed that some women just have really delicate skin or an extra rough-nursing baby (or both). Expert latching or no, these women will have an extra hurdle getting started breastfeeding (and not just with kid #1). If you're the girl on the ski trip whose cheeks and lips get chapped the first day, this is a bad omen.
Unfortunately, study after study shows that ointments, creams, gels, breastmilk, and warm compresses don't help much with cracked nipples (breatmilk can help reduce pain). What does work? Preparing beforehand and doing what you can for the pain and damage to get through it and keep on nursing.
First consider the basics of lactation. Note that Lactation II, the milk production phase that begins at birth and ends 3-5 days later, does not depend on suckling the way later milk production does. This means your milk will not come in faster if you nurse constantly in the first 48 hours (plus, the colostrum you produce at this time is perfect nutrition for your baby - no need to rush it!).
You won't feel sore until the second or third day, and it's better if this doesn't hit you like a ton of bricks. Certainly, feeding on demand is best, but don't initiate extra frequent or long sessions in a race to bring your milk in. It won't help, anyway, and instead of a first place trophy you may end up with sore, damaged nipples.
Once you're home, keep your boobs in a breathable accessible place, like the open air. An open nursing bra will let you add nursing pad quickly as needed. This "boobs out" state is a great reason that anyone not in your innermost circle will be more comfortable waiting a few weeks for when all this "early breastfeeding stuff" is done before they intrude, I mean visit. Although it truly saddens me that so many people are scandalized and offended by breastfeeding, use it to your advantage when you can. You'll catch the downside of it enough once you're ready to take your baby out in public.
Besides seeing a lactation consultant, pacing yourself, and keeping your boobs out/dry/clean, you can try to deal with the pain. Remember this is not advice for everyone who has a twinge of pain or general soreness, it's advice for people whose skin is worn off and scabbing over.
Here are some options:
1. Nipple Shields: These can be hard to use properly so get help choosing and fitting one at a breastfeeding class or with a consultant. They can also complicate and already tough process for both you and your newborn. That said, a good nipple shield can really save your skin. You may hear that nipple shields can cause the dreaded "nipple confusion" (more thoughts on this later). Unfortunately, when your nipples started bleeding, you officially left the realm of "ideal scenario" and entered the realm of "make it work" (this applies to #5, A Pump, too).
2. Ice Water: Sound awful? It is for a minute, but when your nipples are wrecked, numbing them can get you through the first extra painful moments after latch-on.
3. Drugs: Motrin (ibuprofen) and Tylenol (acetaminophen) are cleared for breastfeeding mothers (look them up here, but still talk to your pediatrician about her recommendation). Like many biochemists (the very people who make them), I am sketched out by almost all drugs, especially while pregnant or nursing a newborn. I don't take cold medicines, skip the lidocaine at the dentist, and did two natural births. That said, I took Motrin and was happy to have it when my nipples were a warzone.
4. Lamaze Breathing: Another technique that keeps your focus off the pain and on the goal (one feeeding at a time until you start to heal). The bonus is, you probably have this technique fresh in your mind.
5. A Pump: This is never a first resort for an early breastfeeding problem, but it's often the last. If you have major damage, alternating between your baby and a pump (which will still hurt) can spare some areas that have gotten especially worn down. Also, pumping can help you get out of a vicious cycle of pain/damage -> incomplete emptying of the breast through nursing -> reduced supply -> increased, frustrated suckling -> pain/damage, etc..
6. A Stout Heart: I think I've been pretty candid about how bad this can be, but there is one more thing that no one likes to mention. If your nipples are cracked, they will bleed. Your baby will injest some blood. Sounds like something out of a nightmare, but it does happen. It's not going to hurt your baby. It may cause your baby to have reddsih brownish spit-up. Don't lose it, and don't quit brestfeeding over it. Being a mom is tough stuff. Being a breastfeeding mom is even tougher. Talk to your IBCLC and your pediatrician about what you are going through and get through it - you will!
The biggest thing that will get you through this phase is knowing that it will end. It can take up to a month or more for your boobs to improve. Once they get adjusted to nursing and your newborn becomes less of a savage, the damage will completely heal, the pain will fade, and you will still be nursing your lovely bundle of snugglefection. You'll be on your way to sucessful mothering and able to use the most reliable rule of parenting - "When the baby cries, stick a boob in her mouth." It really is a magical balm - for you and your baby. Until you get there, do what you can to make it though - and remember you are not alone.
A great and thorough discussion of nursing pain from from PhD in parenting
More information about cracked nipples from kellymom
Please post any other references you know in the comments!