Benefits of Extended Beastfeeding (beyond the first year)

For both mother and child to receive the variety of proven health benefits, the World Health Organization (WHO) recommends mothers breastfeed their children up to 2 years of age and beyond. Due to social stigmas, breastfeeding older children (past one year of age) is often considered taboo and therefore done behind closed doors. A recent survey conducted in Australia collected information from breastfeeding moms (ages 21-45) who were currently breastfeeding children between 24 and 78 months old. The mothers answered survey questions, but were also given a list of questions to ask their breastfed child.

Typical responses from the moms:

• I enjoy breastfeeding my child.
• I feel it strengthens our relationship.
• My child still enjoys breastfeeding and doesn't want to wean.
• Breastfeeding is easier.
• Breastfeeding helps to comfort my child.
• I breastfeed for intimacy and closeness with my child.
• My child likes the taste of breast milk.
• 75% of the mothers did not intend to breastfeed past 12 months. However they delayed weaning because of increased confidence and knowledge about breastfeeding, along with their child's enjoyment as well as their own.

Typical Responses from the breastfed child:

• I love it.
• I like the milk.
• It makes me feel happy.
• I like to cuddle with mommy.
• It is my treat.
• Breast milk tastes as good as chocolate.
• It is better than ice cream.

BabyFit Tip: It is important to understanding the health and emotional benefits for both mom and child when breastfeeding is continued beyond the first year. This is the first step in breaking down the barriers that prevent mom from continuing to breastfeed. If you and your infant are enjoying the breastfeeding experience, then by all means continue!

Post-Pregnancy News Flash
-- By Becky Hand, Licensed & Registered Dietitian
http://babyfit.sparkpeople.com/articles.asp?id=696

Inducing Labor with Cytotec: A Questionable Practice

For one reason or another, induction of labor is becoming a more common practice in the United States. In addition to natural methods used uncommonly, there are several options that hospitals have to jump start or pick up a slow-to-start labor. One of these options is a drug called Cytotec, known by its generic name, Misoprostol.

Cytotec is a small pill produced by G.D. Searle & Co. to reduce stomach ulcers. Directly on its label, Searle warns against the use of Cytotec on pregnant women, but somehow doctors figured out that it was a cheap and effective way to induce labor. So Cytotec became an "on-label contraindicated" method of induction.

What were the reasons that G.D. Searle gave the American College of Obstetricians and Gynecologists for warning against induction by Cytotec? Hyperstimulation of the uterus causing uterine rupture, severe fetal distress, amniotic fluid embolism, pelvic pain, retained placenta, severe genital bleeding, fetal bradycardia, cesarean delivery, and fetal and maternal death, all of which have been recorded as actual results of the use of Cytotec for the purpose of inducing labor¹. Shock, fetal brain damage, and newborn pneumonia have also been recorded as side effects of Cytotec^2,3.

Despite the fact that both the manufacturer of Cytotec and the FDA strongly advised against its use, ACOG issued a committee opinion in 2000 stating that if it is used appropriately, Cytotec is a safe and effective agent⁴. By appropriately, they meant not using it for VBAC labors, women with previous uterine surgery, or in labors that are progressing abnormally or with fetal distress. However, it has long been known that the side effects of Cytotec (such as uterine rupture) can occur in both low and high risk categories, regardless of dosage, which explains why so many organizations are still taking a stand against its use.

The only organization recommending Cytotec for use in labor is ACOG. Here are the organizations which advise against it: the US FDA, Best Scientific Opinion - Cochrane Database, G.D. Searle & Co., Society of

Obstetricians and Gynecologists of Canada, British Royal College of Obstetricians and Gynecologists, all obstetric organizations in Scandinavia, International Federation of Obstetricians and Gynecologists, World Health Organization, as well as obstetric organizations and drug regulatory agencies in many other countries⁵.

In 2005, the FDA again released a warning to physicians, not to use Cytotec as an induction agent, saying that not enough scientific proof had been found to say that the drug was safe and effective for these uses. They also said that if physicians do use it, they must warn their patients of all known side-effects, or they may be in serious legal danger, not to mention putting mother and baby at needless risk⁶. Early in 2006, Pfizer, the current producer of Cytotec, also advised against pregnant women using the drug⁷.

According to MotherFriendly.org, the only benefits of Cytotec over Prostoglandin E2 (a similarly used induction agent) are a much reduced cost and faster labors. Both of these only benefit hospitals and doctors as shorter labors are usually more "intense, tumultuous, and difficult"⁸.

As a result of these findings, it would be appropriate for women facing induction to first consider the necessity of induction in their particular case, and second, an alternative to Cytotec, also known as Misoprostol.

Resources:
1 - www.pfizer.com/files/products/uspi_cytotec.pdf
2 - www.wikipedia.org
3,8 - www.motherfriendly.org
4,7 - www.medicalnewstoday.com/medicalnews.php?newsid=43186
5 - "Cytotec Induction and Off-Label Use" by Marsden Wagner, MD, MS. Midwifery Today Issue 67 Fall 2003
6 - www.fda.gov/cder/drug/infopage/misoprostol/default.htm

thanks to http://www.associatedcontent.com/article/484891/inducing_labor_with_cytotec_a_questionable_pg2.html?cat=71

Amazing Video

So many times I am asked "What is a doula?" This video sums it up perfectly

Rub It In: Making the Case for the Benefits of Vernix Caseosa

I just found this article, and LOVED it. Great read on the case for keeping the vernix on the baby.

____________________________________________________________________

Rub It In: Making the Case for the Benefits of Vernix Caseosa

December 3rd, 2010 by Kimmelin Hull

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Childbirth educator, doula and midwife apprentice Cole Deelah recently posted her thoughts on the beauty of vernix caseosa on her blog site Sage Beginnings. Referencing a 2004 study published in ACOG’s Journal of Obstetrics and Gynecology, Deelah reminds us of the protective benefits vernix provides to the fetus and newborn–some of which include antimicrobial activity and maintenance of skin hydration following birth. I’d like to look a little deeper into the benefits of vernix, and make a case for rubbing in versus washing off this innate host defense substance.

The 2004 study, referenced above, came out of Cincinnati Children’s Hospital by Dr. Henry Akinbi, et. al, and looked at the type, function and distribution of antimicrobial peptides (protein building blocks) contained in both vernix caseosa and amniotic fluid (AF). Despite some concerns[i] over this study, I found the methods of analysis and conclusion intriguing: in the [suspected] absence of chorioamnionitis, vernix and AF contain a mixture of antimicrobial peptides which are biologically active against several common bacteria and fungal agents. Specific antigens tested included E. coli, Group B Strep, Staph aureus, Pseudomonas aeruginosa, Candida albicans, Listeria monocytogenes, Serratia marcescens and Klebsiella pneumonia. Without diving into the microbiology of these nasty agents, I will simply remind you these make up the lion’s share of microbes that can cause severe diarrheal illness, pneumonia and meningitis in the newborn (or anyone, for that matter). The assumption this study was chasing involved the idea that the sebaceous (oil) glands of the fetus produce these peptides during the third trimester to act as a host defense mechanism, providing a barrier-type protection from the above-listed agents while in utero. Of interest to me, was the discovery that the combined amount and distribution of these peptides (think: natural antibiotics) in both AF and vernix were found to be most effective against the bacterial and fungal microbes when compared to the successful antimicrobial activity of each peptide subset, alone.

Likewise, another interesting finding brought forth in the Comments section of the study was the fact that the immune proteins found in vernix and AF are similar to those found in breast milk. The researchers linked this to the evolutionary similarity between mammary glands and cutaneous (skin) glands.

Furthermore, it has been known for some time that as pulmonary surfactant levels increase in the amniotic fluid, vernix begins to detach from the fetal skin—increasing its components into the surrounding AF.[ii],[iii] As the fetus continues swallowing and “practice breathing” in the womb, this antimicrobial peptide-rich mixture enters the fetal lungs and digestive tracts. The postulation I draw here, which is also hinted at in this study, is the likelihood that the vernix-AF antimicrobial peptide mixture prepares the GI tract for acceptance of the similar peptides found in breast milk—thereby preparing for the process of establishing normal flora within the gut (and perhaps digestion processes, themselves) and prepping the immune system for an important, pending transition. In short, a heightened defense mechanism plays a key role in making the transition from purely innate defense barrier mechanisms to adaptive defense mechanisms.

These findings are furthered by this 2005 study which appeared in Cellular and Molecular Life Sciences 2005 (62: 2390-2399). With the goal to not only confirm the presence of the 20 different protein host-defense-enabled-proteins which had been isolated in previous studies, this study also looked at the interaction between proteins and lipids (fats) found in vernix. We have known for some time (and likely taught to our pregnant students/patients) that the fatty, creamy nature of vernix acts as a moisture protectant to the fetus while in utero—not to mention (if rubbed into the skin immediately following birth) a wonderful emollient to prevent excessive drying of the newborn skin in the days following birth. But this study by M. Tollin, et. al discovered that the lipid component of vernix actually enhances the functionality of the antimicrobial peptides.

One of the peptides identified in the process of Tollin’s study is the Human Cationic Peptide LL-37. This particular peptide works both as an innate defense mechanism and an adaptive one. As a result, vernix caseosa contains a microbiological element that helps a fetus (and then, newborn) bridge that gap between basic and complex(adaptive) immune function.

The Tollin study proved to have some additional methodological benefits. While still small in numbers (vernix samples were analyzed from eighty-eight newborns; n=88) the analyses were done following vaginal births and vernix-AF analysis was completed on like mother-baby duos. Similar to findings in the ’04 study, the interaction of antimicrobial peptides in both the vernix and AF displayed heightened effectiveness in comparison to isolated peptides from AF and vernix samples alone. Because the 2004 study examined AF and vernix samples from immediate post cesarean birth participants, and the 2005 study assessed samples from vaginal birth participants, an appropriate follow-up study might be to compare innate and adaptive antimicrobial effectiveness between babies born via cesarean section versus vaginal birth.

The second study discussed here revealed similar results in the effectiveness of antimicrobial activity against several bacteria and fungi—found to be colonized on the newborn skin within minutes of birth (samples were collected immediately following birth, before any wiping/washing off was performed). Additionally, the study authors postulated that

“The antimicrobial property of vernix may also act to facilitate colonization of normal flora following birth and to block colonization of unwanted microbes or pathogens. For example, psoriasin which is identified in vernix, directly kills E. Coli…”

So…how do we implement all of this into our own practices? My suggestion: teach the expectant parents with whom we interact the enormous benefits contained in that cream cheesy stuff their babies will be covered in (to one degree or another) following birth. Encourage them to facilitate or request rubbing the vernix into the baby’s skin, rather than wiping/washing it all off. Born covered in a complex of antibacterial and antifungal elements, babies bring with them into the world additional mechanisms to boost their own immune function than what we once thought.

Posted by: Kimmelin Hull, PA, LCCE

2011 Hypnobabies Classes

Here is the schedule for the first quarter of the new year

SLC (Murray)

January Class:

Tuesdays from 6-9pm 5 spots left

January 4, 11, 18, 25, February 1, 8

February/March Class:

Tuesdays from 6-9pm 5 spots left

February 15, 22, March 1, 8, 15, 22

April Class:

Tuesdays from 6-9pm 5 spots left

March 29, April 5, 12, 19, 26, May 3

Pleasant Grove

January class:

Saturdays from 9am-12pm 5 spots left

January 8, 15, 22, 29, February 5, 12

February/March Class:

Saturdays from 9am-12pm 5 spots left

February 19, 26, March 5, 12, 19, 26

April Class:

Saturdays from 9am-12pm 5 spots left

April 2, 9, 16, 23, 30, May 7

Great article on breastfeeding

Should Milk Sharing Among Mothers Be Encouraged?

My guest poster today is Karleen Gribble, PhD, Adjunct Research Fellow in the School of Nursing and Midwifery at the University of Western Sydney in Australia. She also serves as one of Lactnet's listmoms and is well-known worldwide for her research and writing on adoptive and long-term breastfeeding, the risks of formula-feeding, and infant feeding in emergencies. Thank you, Karleen, for weighing in on this hot topic.

The recent launch of the peer-to-peer breastmilk sharing group Eats on Feets has brought the issue of women sharing human milk to the attention of health authorities. Due to safety concerns, organisations such as Health Canada and the U.S. Food and Drug Administration have warned mothers not to use another woman’s breastmilk unless it comes from a milk bank. Individuals associated with milk banking have gone so far as to describe peer-to-peer milk sharing as “very unsafe” and “dangerous”

The discussion about peer-to-peer milk sharing has much in common with the discourse that surrounds bed sharing. We know many mothers bring their baby into bed with them at night.¹ Bed sharing makes breastfeeding easier² and breastfeeding mothers get more sleep.³ It also allows mother-baby interaction to continue throughout the night and may protect the infant against the long periods of deep sleep thought to contribute to SIDS.^4,5

However, we also know that bed sharing is not always safe. We know that if a mother smokes, if she has consumed alcohol or other sedatives, if the baby is formula fed, if the sleep surface is a sofa or water bed, or if the bed is also shared with other children that a baby sleeping with his or her mother is at heightened risk of SIDS or accidental death. Infant deaths that occurred as a result of bed sharing under these circumstances have resulted in health authorities such as the American Academy of Pediatrics recommending that parents not sleep with their infants.⁶ It is ironic that not only does blanket condemnation of bed sharing potentially make parenting unnecessarily more difficult for some mothers, it also has the unintended outcome of increasing deaths in places other than beds, such as sofas. This has occurred because due to fears of falling asleep while feeding in bed, some mothers have gotten up to feed on a sofa, fallen asleep there, and infants have died as a result.^7,8 Thus, it seems that bed sharing should not be promoted nor condemned. Rather, parents should be given information about how to bed share safely as well as its risks so they can examine their individual circumstances and decide for themselves where their baby sleeps.

It’s much the same with milk sharing. There is a growing awareness of the importance of breastmilk to the normal health, growth and development of children and of the unavoidable risks associated with the use of infant formula. There are also women who are unable to provide their child with all the breastmilk they require because they have had breast reduction surgery or a double mastectomy or because they have insufficient glandular tissue or are extremely ill. These women have the choice of either obtaining breastmilk from peers or using infant formula. Health authorities who have condemned peer-to-peer milk sharing have told these mothers to obtain human milk from milk banks. But banked donor milk is an extremely rare commodity available to only a tiny number of (usually hospitalised) infants.

The only real alternative to obtaining human milk from a peer is using infant formula, and the evidence for short- and long-term negative impacts on infants from exposure to infant formula is overwhelming.⁹ It is interesting that the same health authorities who condemn peer-to-peer milk sharing have not condemned the use of infant formula. One wonders why the risks of formula are somehow more acceptable than the risks of milk sharing. Is it because formula feeding is so entrenched in our cultures, while breastfeeding remains marginalised? It is ironic that nearly all of the risks Health Canada identified as applying to breastmilk from a peer (http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_202-eng.php) also apply to infant formula. But a similar health advisory on the use of infant formula does not exist.

Milk sharing allows mothers to avoid the risks associated with formula feeding. For some this may be particularly important, for example, those with a family history of diseases associated with formula feeding (diabetes or asthma), the death of a formula-fed baby from necrotising enterocolitis or SIDS, or a baby with formula intolerance. In most cases, milk sharing is not something a woman does lightly or without good reason. For one mother’s story, click here.

When mothers use human milk, they avoid the risks associated with infant formula. However, they potentially expose their child to a whole different set of risks. Fortunately, most of these risks are manageable and some very easily eliminated altogether. (Although very few diseases can be transmitted via breastmilk, one of them is HIV. Fortunately, however, a simple home pasteurisation process destroys HIV.¹⁰) The Eats on Feets website provides extensive information on managing and minimising risks associated with peer-to-peer milk sharing.

As with bed-sharing, peer-to-peer milk sharing should not receive either a blanket endorsement or condemnation, because the safety of the practice depends very much on the situation. An alternative to endorsing or condemning it is to acknowledge the reasons women want to milk share (banked donor milk unavailable, infant formula deficient), provide information on how to manage the risks (recognising that the risks are manageable) and affirm that it’s the parents’ decision. Just as with bed-sharing, as James McKenna noted: “It remains the right of parents to make informed decisions, which requires access to unbiased information exchanged within an appropriately relaxed and non-judgmental educational venue.”⁵

http://www.nancymohrbacher.com/blog/2010/12/6/should-milk-sharing-among-mothers-be-encouraged.html

Discounted Hypnobabies Classes

Because the holidays are right around the corner, and The Doula House is about to start their Holiday series of classes; we are offering a $25 discount on our classes. That bring the cost to $275, which is a great deal for an 18 hour childbirth course

What is Hypnobabies?

Hypnobabies is a complete childbirth education course. Hypnobabies uses real medical hypno-anesthesia, the kind they use to put people under for surgery. Hypnobabies uses “Eyes-Open” hypnosis which allows the mother to move about during birth, while staying in a deep state of relaxed hypnosis. Using Hypnobabies will teach you how to stay in a deep state of hypnosis, and how to tell your body how to work best during your birthing time.

Hypnobabies is a complete childbirth Education class, covering everything from nutrition, and optimal fetal positioning.You will learn about informed consent and how to make the best choices for you and your baby. We help our fathers or birth partners know how to best help our hypno-moms.

Hypnobabies can be used in a hospital delivery setting, a birthing center, or a home birth.

The Course includes 6 3 hours classes held once a week. This is the optimum to allow the subconscious mind to reprogram belief systems about birth. Hypnosis can be used not only for the birthing, but for morning sickness, turning babies, and getting the birth process started when you are past-due.

Please call or visit our website for the dates of the next scheduled class.
www.TheDoulaHouse.com
Marinda Lloyd 801-548-2917