Controversy Corner: Breast Milk

This article is a Controversy Corner for a reason; writing about breastfeeding and formula seems to be more of hot button topic than ever, and I’m really not sure why. Every mother wants to do what’s best for their child, and that should be the primary concern when feeding your infant.

Full disclaimer: I failed at breastfeeding. I say “failed” because that’s how it felt – the hospital staff, family, and society make you feel that you are not doing a great job at being a mom if you can’t do this “simple” task. My body knew how to make a baby and my baby knows he needs to eat… so why is this not working? I am also not a medical expert by any stretch of the imagination. This article is for discussion purposes, because I didn't know about a lot of these options when they might have helped me. Talk to your doctor if something here makes sense to you.

I chose to supplement with formula, and eventually converted entirely for my sanity and my baby’s health. I don’t regret it, because I know I tried everything I could at the time. That doesn’t mean I won’t try again with the next one, and this time I’m armed with even more information: a powerful tool. If you are struggling to produce enough for your baby’s needs and personal belief or religion prevents you from supplementing with formula (even vegan formulations which are available), things might be a little rough as you navigate the options available to you.

Your doctor or mid-wife might suggest a lactation consultant as a first step. Often available to come to your home or bedside, these specialists can assist you with different positions, props, pumping, and other methods that might build a routine that works for you. Lactation consultants can be very expensive. There are free ones, but mine never made it to the hospital the three days I was there. Free ones in your area might require an application based on your socioeconomic status, and if you don't qualify, in Toronto for example, their services can cost 60+ dollars an hour, and they probably won't fix your issue in one session. Coaching could feel awkward at first, but the support of someone that believes in what you’re doing might be nudge you need to push through the harder days. It takes practice and patience, things that are really difficult to regulate with a tired mom and an unpredictable newborn. Successful moms some times dedicate days to focus exclusively on bonding and latching, without visitors (or much time in a shirt.)

Another option is to seek the support of a group of moms. Women who have or are currently breastfeeding get together to discuss biting, mastitis, thrush, engorgement, let down, and all the other tricky topics that come with the territory. It’s not all boob talk, though! My community offers many “cafés,” meetings, and talks for moms to come and chat about anything and have a hot drink. You might find this idea uncomfortable if you are very shy or modest. A cover will help (most ladies wear one), but be prepared for women who are confident in doing it "freely."There may also be women or facilitators that want to help you in a "hands-on" way. If you don't feel comfortable about that, be sure to say so! I very much support finding like-minded ladies with which you can chat for reasons of your own sanity alone, and getting out of the house is a great idea at least a couple days a week. If it makes you feel more relaxed and helps with breastfeeding, all the better.
 

There are also dozens of products on the market aimed at boosting your supply; such as raspberry leaf teas, milk-thistle or fenugreek capsules, and vitamin enriched “lactation” cookies, available at natural health food stores. They are not quick fixes, so you might have to build up over a week of use to see results. I have known a few women who have had great success with one, or a combination of these products, and some that saw no change at all. These items can be a little harder to find, and not all brand names are reputable or regulated, so you do need to proceed with caution. You might feel more comfortable with a thoroughly researched prescription instead of something homeopathic. In that case, you might ask your doctor if domperidone or something like it could help your with your production. 

If none of the above options seem to improve your success, and your baby’s weight is very low, or is ill, there are services available that can even supply pasteurized human donor milk. That’s right, gone are the days of a wet nurse like in Romeo and Juliet. Hospitals work with suppliers that screen, collect, pasteurize, and bottle breast milk from women who have some to spare (whoever these magical women may be.) It might seem odd at first thought, but before formula, wet nursing was the only other option, and they didn’t even have the technology we have today! If formula is off the table, and there is milk that could otherwise go to waste, why not? I think it’s an amazing idea.

While many people still firmly hold the belief that “breast is best,” and that may very well be true (it's certainly cheaper), the fact remains that the breast is no longer strictly "necessary", and you do not need to feel guilt for feeding your baby highly regulated and nutritious formula. For women who are ill, gay couples raising a child, babies that can’t latch, for whatever reason – these children no longer have to die in developed nations because we have formula. That’s a wonderful thing. Of the 4 children born in to my extended family in the last two years, 3 were at least supplemented with formula for a variety of reasons. They are happy, healthy, smart, and wonderful children! That said; you have the right as a mother to not want to feed your child formula, just as I have a right to feed my son the way I see fit.

Controversy Corner: Placenta Pills

I was at a trade show dedicated to parenthood when I first heard of this product. At this show, there were booths with every formula, bum cream, and diaper bag was on sale. Nestled amongst the next best thing in baby carriers, sleep training programs, heart monitoring technology, was a small table with flyers. The reason they didn’t have any product for sale, is because what they do is custom - they offer the service of collecting, extracting, and processing tablets of nutrients from your placenta, the after birth of delivery.

I’m not going to lie, my first reaction was to be thoroughly grossed out. I’ve always seen pregnancy as a medical condition, to be supervised by doctors and handled at a medical facility. Everything in the delivery room that was not child, stayed at the hospital. That said, I know many strong and intelligent women that take a slightly more natural approach to childbirth. Homebirth and doulas might not be my style, but they are for a lot of women. Out of curiosity, I decided to find out how the idea of placenta pills came about, and who, if anyone might benefit from them.

Before there were pills, placentophagy, or the eating of one’s placenta is a practice that exists mainly in the animal kingdom. While there have been advertised cases of eating raw, cooked, or in capsule form, (Kim Kardashian anyone?) my research didn’t result in any cultures that regularly performed the action, either recently or historically. For those that choose to, the rationale is threefold:

• Nutrition – the placenta was the life blood of your child in utero and so it contains a number nutrients that supposedly aid in recovery.
• Improved lactation – the chemical makeup of the placenta supposedly helps your muscles relax and release breast milk.
• Improve mood – properties of the placenta are also said to improve pain tolerance and make the consumer feel happier and more at ease.

These claims are largely unproven, and could present an unrealistic expectation for the results of the action. Western medicine is such that, mothers are not usually lacking nutrition and care. If they are, there are programs available to assist them in and out of hospital. Lactation counseling, natural health products and medication are available for those concerned in that regard. Finally, let’s be honest, is a small mood lift worth the price of admission? I’m not so sure. 

There are also risks in consuming a product that was really meant to be eaten. A North Western University article details some of my concerns. 

"Our sense is that women choosing placentophagy, who may otherwise be very careful about what they are putting into their bodies during pregnancy and nursing, are willing to ingest something without evidence of its benefits and, more importantly, of its potential risks to themselves and their nursing infants," said lead author Cynthia Coyle, a Feinberg faculty member and a psychologist. 

“There are no regulations as to how the placenta is stored and prepared, and the dosing is inconsistent,” Coyle said. “Women really don’t know what they are ingesting.” [1]

There is an element of risk, your system will already be in recovery, and the science is slim. On top of the serious “ick” factor for me, I’m not at all sure how someone could detach the purported value from the source. While it’s pretty clear where I sit on this matter, if you still feel that this is a practice that is important, enlist the help of your health care professional, and do your research. Ensure that you are permitted to do so in the location you deliver, and that the placenta is handled in such a way as to minimize loss of nutrients, spoilage, and bacteria. I would love to know more about this. If you have participated in this, or considered it, please tell us about it!

---

[1] http://www.northwestern.edu/newscenter/stories/2015/06/eating-the-placenta-trendy-but-no-proven-health-benefits-and-unknown-risks--.html

Controversy Corner: Baby Ear Piercing

Image Borrowed from http://www.tinyblessings.com/

To some, it might be no big deal and yet to others, it might be wholly unthinkable. To you, it might be somewhere in the middle, and deciding whether or not to pierce your child’s ears is a big decision. There are cultural, societal, and family pressures, one way or the other to weigh, in addition to your own opinion. When your daughter (or son) is under 2, there are some stigmas and risks to consider. There are also some advantages that make this early introduction very tempting; the associated femininity for baby girls, the quick healing of babies, the lack of memory of the pain. That’s a lot to think about. So what’s a mother to do? We decided to look at some of the issues, not to preach, but maybe to help you through making your own decision.

For some reason, a stranger mis-assessing the gender of your baby is a major affront. To you, it’s blatantly obvious, and even if your daughter is dressed from head to toe in pink ruffles, or your little man is wearing Cars attire and holding a monster truck, people sometimes get it wrong. It could be a slip of the tongue, or maybe that person’s experience of monster truck playing children has always been female, it’s hard to say. In an attempt to ultra-feminize baby girls, especially those without much hair, mothers are tempted to buy floral headbands, avoid gender-neutral colours, and otherwise accessorize them so that they are not mistaken for boys. This is a major (although not only) reason why some parents choose to have their little girls ears pierced. If it is, I would suggest - maybe that's not enough.

Granted, it looks really cute, and maybe you had yours done at the same time (or always wish you had), but consider the following:

· Management of the pain – while it doesn’t last long, it is a minor injury, and it is done without anesthetic. Consider ways to numb the earlobe (such as ice) and how you are going to hold your baby still. I’m sure you know how hard it is for doctors to administer needles. Same thing.

· Skills of the piercer – not all locations that offer the service of ear piercing have representatives with a great deal of training, comfort with squirmy babies, and knowledge of the sanitation practices required to do the job correctly.

· After care – you are dealing with a wound that is generated by the piercing, and there is a risk of allergic reaction and infection. You will need to regularly clean the area, rotate the posts, and apply medicated healing ointment to minimize the risk. Consider asking if the posts are pure gold, nickel free, or surgical steel. 

Something else to consider as you form your own view on the matter - people will have an opinion. They always do. While not a direct risk to your child, a decision to pierce opens you up to comments from people (whether or not that’s appropriate). Some might just be how nice they look, but you might want to prepare yourself for how you would handle criticism from friends, family, or strangers, should it arise. As with most parenting decisions, if you’re doing it because you’ve thought about what’s best for your baby, you’re doing the right thing. Not because some old lady on the bus calls your daughter “Sport”, or because your grandma keeps asking asking you why she's so bald. Be confident, one way or the other.

Controversy Corner: Consent

As with all babies, my three month old daughter is currently completely reliant on me. I have to nurse her and change her diaper several times a day, bathe her several times a week, and carry her from place to place. Every single day I am building her trust and proving to her that she can count on me to protect her, to care for her, and to respect her needs and wants. Right now, she doesn’t have much of a say in where she goes or who holds her, but I am already teaching her about consent. I want my daughter to know from the earliest age that she is in charge of her own body.

In my opinion, consent is not something we simply teach our children like math or reading, it is something they learn through experiencing respect and feeling empowered from as early on as possible. Right now, this just means that I tell her what we’re going to clean next in the bath, or when I’m going to put lotion on her tummy or toes. Even if she can’t understand the language, I let her know in advance of my actions and I pay attention to her cues. I have to clean all the residual poo off of her body, obviously, but if I can accommodate her, I do.

As she grows up, I am going to continue to take her cues and respect her feelings about physical contact and this means - and here's where it gets controversial - that I will never insist that she hug, kiss, or even high five someone if she doesn't feel comfortable. No matter how much I want a picture of her with a mall Santa. Even if that person is someone as close to her as her Grammy who she doesn't get to see very often. I am prepared to have to explain this decision as feelings may be hurt, but I want to make sure that she is always fully aware that her body is her own.

Just as a woman does not owe a man sex because he pays for dinner and a movie, a child does not owe a person a hug and a kiss just because they are related to them. I want to be clear: This has nothing to do with an anxiety about hidden pedophiles in our everyday lives and allowing my child to keep her distance until she feels comfortable with an individual is not an accusation of bad intentions. You or I would feel awkward and potentially distressed if we were forced to embrace a stranger on the subway, someone whose scent is unfamiliar, or whose history we do not know. Friends and family members who do not visit often are almost strangers to a child, and it is natural for them to feel uneasy in their presence. A few minutes (or maybe hours) of conversation and child-led bonding will most likely lead to a hug, or at the very least a fist bump.

It is important to me that my children are comfortable telling me how they feel, or telling others when something is not okay with them, and I don't believe we can inspire this kind of confidence by over ruling them in some cases. If we want them to know that "no means no" then we must respect it at home.

Controversy Corner: To Vaccinate or Not To Vaccinate

My earliest memories of needles only dates back to junior high. We were called down to the nurses office in groups to receive a vaccination that came in three doses spread over the year. I wasn't nervous at first, but as I watched each twisted face and heard each involuntary shriek, my mind started to work against me. My bicep was about to be mutilated by this horrible object no bigger than a pencil. Shortly after my injection, my symptoms started to catch up with me. My arm was hot and swollen, it felt a little numb... in fact, I felt quite faint! That is, until the pizza was delivered.

It's funny the tricks you can play on yourself, and in the interest of being a good parent. In recent history certain celebrities and special interest groups have been lobbying against standardized vaccinations. From terrible outbreaks of the illness we are trying to avoid, to serious cognitive repercussions like Autism, they claim that the needles do far more harm than good. The science behind these controversial claims, largely published in the now infamous Lancet article, has recently been heavily criticized (if not outright debunked), but there are still parents who question the government sponsored immunization schedule.

According to WebMD, "Measles is an infectious disease that causes a red, non-itchy rash over most of the body and severe flu-like symptoms with a high fever." It is a serious illness, that does claim lives every year. Why you would want to risk this for your family, I don't know. However, out of respect for informed decision making, we have researched how this anti-vaccination movement started and what the leading health organizations are doing in the interest of protecting our health.

Anti-vaccination activism as been around for a very long time. According to www.procon.org, The Anti-Vaccination Society of America was founded in 1879 in response to the states enacting vaccination mandates and with the belief that it "is undignified" to mandate vaccinations and that the "efficacy of vaccination as a disease preventative is a matter of individual opinion." Efficacy has long been proven with a barrage of medical tests as each strain was developed, but the supposed indignity? This violation of the individual's right to choose (infringement on religious or autonomous rights) what's best for ones children remains one of the largest reasons to not inoculate. I have to wonder, however, if you had all the information, would you not choose to protect your family?

More recently, however, the major concern divides into fear of the unknown/dangerous/ potentially immoral ingredients and the possible side effects. There have been hundreds of international court cases claiming cognitive delays, and even Autism caused by the MMR (measles, mumps, rubella) vaccine specifically. Wikipedia notes "In the United States, Jenny McCarthy blamed vaccinations for her son Evan's disorders and leveraged her celebrity status to warn parents of a link between vaccines and autism. Evan's disorder began with seizures and his improvement occurred after the seizures were treated, symptoms experts have noted are more consistent with Landau–Kleffner syndrome, often misdiagnosed as autism. After the Lancet article was discredited, McCarthy continued to defend Wakefield."

The cost of this anti-vaccination movement has been staggering in a few short years. Certain diseases which were considered practically dead to modern risk, returned with devastating results, including a major measles outbreak at Disneyland. I think the National Post sums up my opinions on the matter very well "Most often... travel notices pop up to alert Canadians to health risks in countries where a dearth of clean water, sanitary supplies or reliable medical care facilitate the easy spread of infectious diseases. The United States, generally speaking, has none of these problems. What it does have — along with Canada and many other Western countries — is the scourge of misinformation, which has allowed the spread of diseases once thought to be eradicated by modern medicine." A common comment made by those who contracted the illness was of how unaware they were of the severity of the discomfort. It is not a easy pain to suffer by any means.

World Health Organization has done a quite a bit to try to undo the damage, including new recommendations for immunization week in Europe. They have produced a straightforward document titled "Seven Key Reasons Why immunization must remain a priority in the WHO European Region," accompanied by world statistics on the diseases preventable with current scientific advancements. Of note is item #4: Diseases can be controlled and eliminated. The concrete information provided is certainly food for thought for any doubting mother. I am firmly of the belief that the standardized immunization schedule of any country is not put together lightly. It is a huge cost, both in terms of the research and production undertaking, and the cost of any potential risk to the lives of the population. We have access to well researched, well tested, medical advances that many countries would so gratefully have.

My doctor told me just recently that measles went from eradicated in 2000, to thousands of cases currently confirmed. This includes 5 cases in the greater Toronto area at the time this was written. While your child is too young for vaccination, it can be very hard to protect them. Be aware of any areas that have known outbreaks and try not to expose your baby to people with rashes. I know that's a little extreme, and hard to do, but that's about the best you can do. If you are still worried about immunizing your child, inform yourself and discuss your concerns with your physician. You might find that the hype was just that.

Controversy Corner: Screen Time

New Year's Resolution:  Watch less TV and/or spend less time on the computer.

Since 1999, the American Academy of Pediatrics has been sharing ways in which parents and caregivers can be media wise with babies and children; including the famous recommendation of avoiding screen time altogether for babies under two. Fast forward sixteen years and it seems almost impossible to follow their suggestions in 2015. You may not agree with the recommendations, but it would behoove you to set up some ground rules that make sense for your family. Here are some tips on managing screen time in your home.

• Be Informed. Take advantage of streaming services (like Netflix, CraveTV, or Shomi), PVR, OnDemand, and the library to be sure that TV and video game time is age appropriate and stimulating. Take the time to watch an episode, or visit a website, or play a video game, before your child does to make sure that it fits into your value system and you approve of it. Don't flip on the Cartoon Network and leave it to chance. It's good to make use of websites like Common Sense Media for research, but, in the end, you're the best judge of what is okay for your child. 

• Be Involved. Children need some exposure to screen time in order to be socially connected to their peers, and to be prepared to be successful in a technologically dependent world. Denying them time on a computer, or watching a popular cartoon, is doing them a disservice. However, sitting a toddler in front of the television and walking away, or leaving a 13 year old alone on the internet for several hours a day is not okay, either. For young children, screen time should be mediated, meaning you should be experiencing it with them so that you can have an open dialogue about the actions of characters or the choices of advertisers. For older children, some independent screen time is okay, but computers should be set up in open family rooms, and the conversation should continue as media gets more dicey.

• Be Consistent. If you elect to set rules about screen time in your home (ie. No screen time under 2 | mediated screen time 2-7 | some independent screen time 7+ and less than 2 hours weekdays | less than 4 hours on weekends) then stick to those rules. If you give in once - whether you're giving in to your own need for a few hours of peace, or to your child's whining - your son or daughter will believe the rules are flexible and will ask until you give in. Five more minutes means five more minutes and no violent videos games means just that! 

• Be Prepared. Keep colouring supplies, play dough, Lego blocks, a jigsaw puzzle, or another quiet, independent activity handy for times when you would be likely to turn the TV on to get some uninterrupted time to accomplish a task. Set up at the kitchen table or island while you're making dinner, so that you can have a conversation while you cook. Take a minute here and there to comment on their drawing skills, or add a piece to the puzzle, but make it the routine that this is a calm time. This will help to keep you from going over the allotted screen time just to get things done. It is also recommended to establish no screen zones within your home (like bedrooms) so that imaginative play can happen with no distractions or temptations.

Screen time is a hot button issue. Families that outlaw it all together can clash with families that eat dinner together in front of the TV. There is no absolutely correct answer to how much screen time, or what kind of media, is right for your family, but I think it is very important to set some boundaries. The research suggests that there are behavioural and developmental repercussions to a totally limitless media policy, so it is worth it to take some time to consider and plan your screen time approach.

Christmas Controversy Corner: Gender Specific Toys

When I was a child, my favourite toys were Hot Wheels. I had a vast collection of those miniature sports cars and spent hours perfecting my "vroom" sounds. I had no idea that these were considered boys toys and that I was being subversive by preferring them over dollhouses. (Although, my number one favourite toy was my Cabbage Patch doll Christina.) My parents encouraged me to choose the toys I liked - regardless of gender stereotypes.

Fast forward a couple of years, I worked in a children's book and toy store and was taken aback by the intense gender segregation of products being sold to children. The boys costumes were fire fighters and the girls got fairy princesses. The boys books were about sports and the girls books were about first crushes. Children who start their lives with no specific tastes or interests are quickly ushered into the appropriate gender camp. But, what purpose do these stringent rules serve? It is not to the benefit of the child and, let's face it, it's silly. Why is a kitchen set a girl toy? Many of the world's most accomplished chefs are men. Why can't a boy play with a baby doll? Most of the women I know find a man who's a good father really sexy.

When it comes to toys, girls have it a bit easier than boys. They are not generally chastised or shamed for wanting toys that have been segregated into the "male" category (sports equipment, building blocks, etc) - so long as they get them in "girly"colours like pink and purple. Lego is an excellent (and sad) example of this requirement; while boys are building cities and vehicles and secret agents and medieval scenarios, girls are building cupcake shops, hair salons, juice bars, shopping malls, and "Cinderella's Romantic Castle." All in shades of pink, purple, teal, and pale yellow. It's true you can just buy any Lego set for either gender, but the commercials make it pretty clear to the children who should buy each kit.

The fault does not lie only with the toy companies. They are businesses looking to make money and thus create products based on consumer demand. If parents made more of a fuss about the advertising practices and blatent sexism in the toy market, the businesses would make changes. They're not, though. When the Lego Friends line was launched, I overhead many a mother say "finally, a Lego set for girls!" Sigh.

The answer isn't "gender neutral" toys (play doh, for example) either, because that should not be a distinct category. All toys should be available and encouraged for all children inclined to play with them. As parents it is our job to help our children navigate the world by exploring, creating, imagining, learning, and playing, no matter what they choose to use in order to do this. Girls can be superheroes fighting crime and boys can be princes preparing the castle for a ball. Let's take the shame out of play.

Merry Christmas Eve! What was your favourite toy as a child?