Gail and others,
Here is a copy of the letter I sent to this site. I wasn't going to
post such a long letter here but since Gail brought it up........ ; )
********************
Thank you for posting about your parent info site.
The asthma info center was easy to read with lots of useful info for
parents.
Since breastfeeding is my main area of concern I always "check out" a
health site for bf info. I
was happy to see lots of positive info about bf on your site. The books
listed from Amazon are
all great.
I would perhaps suggest however, that a few refinements might make the
info more accurate and
helpful to parents. I hope that you will not be offended by the
following comments and
suggestions. I am sure that you would like your information to as
up-to-date as possible.
For instance:
ENGORGEMENT
"After three or four days, your breasts will
become engorged as your milk comes in. If your
breasts are too swollen or breast feeding is
painful, then you may have to pump before your
baby can latch on effectively."
While engorgement does occur, it should not occur if mums receive good
help in the first few
days and babies are latching frequently and effectively. Engorgement is
a preventable problem.
Treatment for engorgement usually does not require a pump. Heat before
a feeding, getting a
good latch, gentle massage toward the nipple during a feeding, cold
compresses or ice packs
after a feeding would be better suggestions. Cabbage leaves applied
after a feeding have also
been very helpful. Softening of the areola by hand expression is more
effective to facilitate
baby latching than pumping the breast.
The main issue with engorgement is swelling of the breast tissue with
blood, lymph and
interstitial fluids - not milk. The swelling makes it hard for the milk
to get out and then the milk
makes the swelling worse by preventing drainage of the area. This
creates a vicious circle.
Cold reduces swelling and blood flow, heat before feeding dilates the
milk ducts and promotes
letdown.
I know this is long winded but I wanted to explain my reasoning.
POSITION AND LATCH:
"Now, place the nipple and areola (the dark area around the nipple)
inside his
mouth."
This would lead a mother to think that she gently places the areola in
the baby's mouth when in
fact she should be rapidly pulling the baby towards the breast so that
he gets a good mouthful of
breast. The latch should be deep enough tat the chin is buried in the
breast tissue, the cheeks are
toughing but the nose is slightly away.
A good latch can be assessed by:
1. lack of pain
2. signs of effective nursing - swallowing every 1-2 times his jaw moves
after the letdown
3. appearance of the nipple after feeding - If the nipple is blanched,
pinched, squished, ridged
etc. after the baby lets go then the latch was too shallow
For positioning and latch you might just want to include a link to:
http://users.erols.com/cindyrn/barnes.htm
Which is an excellent guide to latching
Or
http://www.breastfeeding.com/helpme/helpme_images_positioning.html
which has some great pictures
Frequency/Duration of feedings
"You will probably want to switch breasts after
five to ten minutes."
I have strong concerns about this info. Limiting amount of time on the
first breast is unnecessary
and will likely lead to a number of problems including a compromised
milk supply, slow
weight gain, or cranky/colicy baby. A better suggestion is to "let baby
finish the first breast
first" this may take 5-10 mins at some feedings but, at least in the
first 6 weeks, it is likely to
take longer for the baby to finish the first breast. The mum knows when
baby is done when he
comes off on his own or when he is no longer actively swallowing.
Timing of feeds:
It would be more useful to suggest that newborns generally nurse 8-12
times per 24 hours
spaced however baby likes. Once baby is pooping yellow poop he can
likely be trusted to
wake on his own for feeds. Letting parents know what feeding cues to
look for would be
helpful. Crying is a late sign of hunger. It is normal for babies to
want to cluster feed and then
may go a longer stretch before feeding again.
For a discussion of Cue feeding see this good article:
http://www.fix.net/~rprewett/evidence.html
"You will know that your baby is getting enough
breast milk if he is gaining weight, seems
satisfied after eating, and he is having four to six
wet diapers each day."
Waiting for a weight to know if baby is getting enough milk would be
foolish. Parents need to
know what they should be looking for. From day 4 onward baby should be
having 5-6 soaking
wet disposable diapers (7-8 cloth diapers) and at least 2, preferably 5,
yellow, runny poops.
The addition of yellow poops and upping the # of wets listed on your
site is essential. A baby
who is peeing just 4 wet diapers and not pooping could be seen by
parents reading your info as
quite fine when in fact they might be heading for big trouble.
WEANING
"Weaning usually begins at about four to six
months of age, as you begin to introduce solid
foods. If you stop breast feeding before your baby
is a year old, then you will need to start him on
formula."
While the definition of weaning does mean starting other feeds such as
solids the way this
section is worded it sounds like you are advocating beginning to stop bf
at 4-6 months. Perhaps
using the AAP statement of the initiation of solids and weaning would
be helpful. This would
recognize that breastmilk can and should remain the major component of
the baby's diet for the
entire first year with the addition of solids when baby shows signs of
readiness.
http://www.aap.org/policy/re9729.html
"Exclusive breastfeeding is ideal nutrition and sufficient to support
optimal growth and
development for approximately the first 6 months after birth.
Infants weaned before 12
months of age should not receive cow's milk feedings but should
receive iron-fortified
infant formula. Gradual introduction of iron-enriched solid foods in
the second half of
the first year should complement the breast milk diet. It is
recommended that
breastfeeding continue for at least 12 months, and thereafter for as
long as mutually
desired."
For mums looking for more help some links to useful sites would be an
excellent addition:
http://www.lalecheleague.org/
http://breastfeeding.com/
http://users.erols.com/cindyrn/drjack0.htm
http://www.promom.org/
http://www.breastfeeding.co.uk/
http://www.ilca.org/
If you would like to discuss these comments/suggestions further please
contact me. Perhaps you
have access to an IBCLC who could help with some editing on your site.
Good luck with your parent site. It is a mammoth job with precious few
rewards (or at least it
may seem like that at times) I hope my comments have been constructive
and not seen as too
negative. I am always eager to improve things but don't intend to
dismiss the hard work that has
gone into your site. Thank you for including breastfeeding on your
site. You are right to
consider it an important part of infant health.
Sincerely,
Janet Vandenberg RN, BScN, IBCLC
Public Health Nurse
Ontario, Canada
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