Hurricanes, War and Dystopia

One of the reasons that I cried early in the life of my first boy, when met with the reality of being unable to exclusively breastfeed him, was that I was unable to keep him alive with nothing but myself. I imagined that if he has been born a century ago, he would not survive. It was months before I acknowledged this thought and voiced it to my husband, who immediately reminded me that there were wet-nurses for such a situation, and of course he wouldn't have died.

That made me feel a lot better, until I realised that we were considering only a world where there exists such resources, where women would be available and willing to provide such support to each other, or where I had money to be able to pay them if needed; a world free of extreme crises. If we suddenly were to find ourselves thrown into a wartime situation, running for our lives, I would not have enough milk to be able to sustain my baby. Yes, these are the things I thought about. And these are still the things I think about! Perhaps this is my bizarre way of feeling gratitude for the situation that we are in, for the resources that are so freely available to us to ensure the health of our children and ourselves.

Us, comfortable, warm, safe.
A friend recently asked if anybody else is feeling the need to start honing skills and hoarding supplies in preparation for the world to become "a bad (but very real and less glitzy) version of Mad Max". I was reminded of a novel I read in preparation for the Zurich Writer's Workshop a few years ago, where a Polish woman was breastfeeding her nine-year-old son while living in the forest during the Second World War. Having a milk supply is handy.  

I am then, though, curious about the effects of stress on milk supply (but there's a whole other post there...). There exists many stories among mothers where stress has 'dried up' their milk, or at least significantly reduced their supply, like Sharon's weaning story after the loss of her sister-in-law,  or my own mother's description of her milk drying up when I was a few weeks old, after my dad's stepfather died.  And there does exist a real study (!) that demonstrate that "various types of stressful stimuli can depress lactation". Surely being thrown into a life-or-death wartime situation is as stressful as it can get, right?

When I was in Berlin for a breastfeeding study day recently, there was the mention of Hurricane Katrina and some of the horrific stories that emerged. There was a discussion of the importance of breastfeeding for survival in emergency situations, and how the risks to a not-exclusively-breastfed baby in such situations is incredibly high -- lack of a reliably constant source of formula, lack of a reliably constant source of clean water, and lack of guaranteed sterility of bottles and teats. Breastfeeding in emergency situations ensures a baby's nutritional security, so long as the mother has enough food and water to ensure her own survival. I mentioned that I had heard that formula samples were being handed out to Syrian refugee mothers. As such, a flurry of lactation support headed to landing sites to assist mothers by providing education, support, ensuring good nutrition and hydration, and a safe place for them to breastfeed, and potentially even the education and support necessary to allow relactation.

Image from here
'The culture of bottle feeding in Syria and Jordan was perpetuated through the untargeted distribution of breastmilk substitutes (BMS) in the early days of the response and the concept that poor diet among lactating women negatively impacted on their ability to breastfeed. Especially during the first phase of the influx of refugees into Jordan (end of 2012 and through the first half of 2013), many non-governmental organisations (NGOs), community-based organisations and well-meaning donors from Gulf countries distributed huge amounts of BMS to refugees in camps and host communities. BMS products were not distributed according to assessed needs, for example to mothers who were unable to breastfeed. BMS were usually included as a general item in food baskets distributed to refugee families. Those distributions were in general ‘once-off’ distributions with no provision for sustained supply to infants established on these products.' (Reference)

Am I the only person that thinks of these things? 

(Edit: I found an interesting post here, on the page The Fearless Formula Feeder, about feeding in emergency situations. It's an interesting read, and worth mentioning.)

Interview with Sharon: Breastfeeding Twins

Meet Sharon. Sharon wears an invisible cape every single day that signifies her strength in this world of babies and motherhood. She has been through the ringer. We are incredibly lucky that Sharon is also an 'oversharer' (the best people are, right? ;) and revealed the often gut-wrenching pain of five years of unexplained infertility and resultant invasive fertility treatments on her blog.

She and her husband now have two beautiful girls, Lillian and Matilda. Among all the joy and tumult that new babies bring, they have also had to navigate their way through Matilda's diagnosis of CysticFibrosis, and the incredibly tragic loss of a very close family member.

Read about Sharon's breastfeeding journey here, and how she “didn't realize it would also be kind of a delight!”:

Tell me about your breastfeeding experience

My twin girls were born a day before 37 weeks and were just over 4 pounds each, so we supplemented breast milk with formula from day one to ensure they didn't lose the ounces that newborn babies often lose. We were in a hospital that really understood and encouraged breastfeeding and they had me feed them formula via a Supplemental Nursing System and had me pumping immediately to get my milk flowing. My girls took to the breast right away, even though they were so tiny, and before we left the hospital I was comfortable tandem feeding them. They never were exclusively breast fed and we went through phases where they got more milk and phases where they got more formula, but I loved our breastfeeding relationship. We breastfed until they were 8 months old, moving slowly from exclusively tandem feeding to exclusively individual feeding by the end (as their size and development changed).


Look at this photo! What are we missing?

This is a photo of my friend Vanessa's great-grandmother, publicly breastfeeding her son,Vanessa's grandfather, ninety years ago. How amazing is it that she is in possession of such a photo?! What a snippet of social history right there!
When I looked at this photo, there were a few things that jumped out at me immediately, so I decided to take a look at a few historical images of breastfeeding.

Look what I found:


Supplementation – It's all about the HOW

So. Your baby needs some extra milk (Not sure if this is the case? Check here.). I know that sometimes this realisation is hard, sometimes very very hard. First things first: know that you are an amazing mama! You are now taking steps to ensure that your baby grows and is healthy, and have made that your priority. You are doing the absolute best thing for your baby.
Now let's presume that you still hope to breastfeed, and just need to give a top-ups. There's not many catch-phrases that I use when discussing the feeding of a baby; I'm certainly not one to throw out a 'breast-is-best' anywhere whatsoever. But there is one that I do use, and I think it's one of the most important ones. It has to do with supplementing.

It's not the what, it's the how. *

The problem is that supplements are almost always given with a bottle. This still makes me sigh. There exists so many risks to long-term breastfeeding when a bottle is introduced, and there are so many stories where babies were given bottles in the hospital and subsequent breastfeeding problems have emerged. Yes, there are families who easily alternate bottle and breast all throughout the day with no problem whatsoever, but it is risky, and this ability to switch between the two easily is not a common situation. 
Using my Supplemental Nursing System
(I'd like to point out here that I didn't know any of this with my first boy, and we had to supplement from the first week. He was six weeks when he first began to refuse the breast, eight weeks when this was becoming more and more common, and eleven weeks when I finally had to give in and stop trying. Potentially, supplementing in a different manner would have resulted in a different story for us.)

How breastfeeding and bottle-feeding differ

Bottle feeding my first little baby with love.
When you give a bottle, the milk comes immediately. When you give a breast, your baby has to work hard for a while before any milk comes. When you give a bottle, the milk comes continuously. When you give a breast, your milk varies in flow as you have multiple letdowns throughout a feed. When you give a bottle, the baby often doesn't have to work for milk at all and a very slow stream is slowly pouring into their mouth. Breastfeeding doesn't work like this.

I liken it to my dinner-making procedure. Kids are in bed, I'm shattered, and I haven't yet cooked anything for myself and my husband. Sigh. We could get food delivered, or I could make us something. If I knew that nutritionally rich, delicious food was going to be delivered at my door for free, immediately, surely I'd choose that option! Every time, right?And after a week of choosing delivery, I don't even have any food left in the fridge to make dinner with in the first place. But if delivery was never an option, then I would just have to cook -- no other possibility would ever enter my mind.

Avoiding the Bottle 

If you need to supplement, I personally think it is best to avoid a bottle for as long as possible, and particularly when the baby is very very young. There are so many other ways that you can give additional milk.
  • You can feed your baby using an at-breast-supplementer, like the  Supplemental Nursing System (SNS -- which was my supplementer of choice for almost six months). Here, a tube is taped to your breast and baby latches with the tube and your nipple. While breastfeeding, supplemental milk and simultaneously be released via the tube, from a bottle of milk hanging from your neck. 
  • You can feed your baby milk from a small cup, like a shot glass. Watch this video for how -- it is important not to pour the milk in, but let them control the flow of milk themselves with their tongue. 
  • You could try finger feeding, where a feeding tube is attached to the end of your finger and milk is released through the tube while they suckle on your finger -- similar to the SNS, but with your finger. 
  • You can syringe feed your baby, filling a 10ml or 20ml syringe with milk and slowly, in a controlled manner, release some milk into the inside of their cheek, giving them time to swallow it before releasing some more. 
  • You can give milk with a small soft spoon in a similar, controlled manner. 

Six months of supplementing, and we made it through.
If you do choose to use a bottle to supplement your feeds, make sure you look into 'paced bottlefeeding', which attempts to imitate the variable flow of breastfeeding and increases the likelihood that your baby will come back to the breast. Aim for a bottle-feeding session to take between 20 and 45 minutes.

Supplementing does not have to be the beginning of the end. Remember that you are being a great mum, ensuring that your baby thrives as your number one priority, while still searching for ways to continue to breastfeed -- high five to you. 

* I know, I know. I used donor milk, I am running the Swiss page of Human Milk 4 Human Babies, I'm passionate about enabling women to connect and share milk when they choose to. So therefore surely I must be all about the 'what'. But I'm not. This was the right decision for me, but it's definitely not for everyone. Mums can choose to supplement with whatever they feel comfortable, as long as they are aware that milk donation is an option available to them (Hmm. I'm thinking that 'informed choice' is potentially another catch-phrase I use... ha.).

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