Supplementing to Exclusive Breastfeeding

 After approximately 2 weeks after delivering my daughter I started having breastfeeding complications. I was in so much pain that I just couldn't have her on my breasts, I had to start giving her the bottle. Following the recommendation I received from a lactation consultant, I rented a hospital grade breast pump to keep my supply until I was ready to breastfeed again.

It is important to mention that not even the best breast pump stimulates the production of breast milk as a baby sucking on the breast.

Our body is a perfect machine. The production of breast milk is proportional to demand. Every time we skip one breastfeeding or pumping session and supplement with formula, we are "telling" our body that the baby doesn't need breast milk at that time. This decreases the breast milk production.

Even though the lactation consultant advised me to pump at every feeding session, I have to be honest and admit that I didn't do it every time. During that period when I was only giving my daughter the bottle, the amount of breast milk that I was pumping wasn't enough to satisfy her and therefore, I had to supplement with formula.

Once I recovered from the breastfeeding complications, I wanted to go back to exclusive breastfeeding. I knew that it wouldn't be an easy process, but I was very determined to do everything I could to stop supplementing.

One day when I was doing some research on the internet about this subject, I was lucky to come across to a VERY helpful breastfeeding internet forum (ivillage), where I could post questions/concerns and have them answered by an experienced lactation consultant.

After some posts exchange, I learned what I had to do to wean from formula. The lactation consultant advised me to monitor my daughter's weight every week throughout the process to be sure she was getting enough milk.

The process would have to be slow to give time to my body and my daughter to adjust to the new routine. As I mention before, the production of breast milk is proportional to demand. I had to slowly increase the demand to increase the breast milk production.

I observed my daughter's feeding schedule and wet/dirty diaper count for a couple of days. It was important to know exactly how much formula (oz) I was giving her and how many wet/dirty diaper she had per day before starting the weaning process. I also had her weight checked. After I had all the information written down, I started by reducing 1 oz of formula per day (not per feeding) every 3 days.

According to my notes, I was giving her approximately 24 oz of formula per day (4 oz per feeding, 6 formula feeding sessions) and having 4 - 5 breastfeeding sessions. I was also pumping just after the formula feeding sessions (as often as I could) to help increase breast milk production.

These were the steps I followed to wean from formula feeding:

• Step 1 (days 01 - 03): Reduction of 1 ounce of formula from one (1) feeding session and then breastfeed. All the other feeding sessions were kept the same as they used to be. I checked the number of wet diapers per day and they were the same or more than used to be, so I went ahead to step 2. Otherwise, I would have stayed couple more days on step 1.
• Step 2 (days 04 - 06): Reduction of 1 more ounce of formula from the same feeding session and then breastfed. All the other feeding sessions were kept the same as they used to be. I checked the number of wet diapers per day and they were the same or more than used to be, so I went ahead to step 4. Otherwise, I would have stayed couple more days on step 2.
• Step 3: After 1 week, I took her to a local breastfeeding class and had her weight checked to make sure she was getting enough milk and gaining weight. Everything was fine, so I went ahead to step 4.
• Step 4 (days 07 - 09): I reduced 1 more ounce of formula from the same feeding session and then breastfed. All the other feeding sessions were kept the same as they used to be. I checked the number of wet diapers per day and they were the same or more than used to be, so I went ahead to step 5. Otherwise, I would have stayed couple more days on step 4.
• Step 5 (days 10 - 12): I reduced 1 more ounce of formula from the same feeding session and then breastfed. All the other feeding sessions were kept the same as they used to be. I checked the number of wet diapers per day and they were the same or more than used to be, so I went ahead to step 6. Otherwise, I would have stayed couple more days on step 5.
• Step 6 (days 13 - 15): I reduced 1 ounce of formula from another formula feeding session and then breastfed. All the other feeding sessions were kept the same as they used to be. I checked the number of wet diapers per day and they were the same or more than used to be, so I went ahead to step 8. Otherwise, I would have stayed couple more days on step 6. 
• Step 7: Weight check at breastfeeding class.
• Step 8, 9, 10, ... : Same as step 1, 2, 3, 4 and 5.

On the 12th day I had completely reduced 4 oz of formula (1 formula feeding) and substituted by a breastfeeding session. I kept reducing 1 oz of formula every 3 day until my daughter was completely weaned from formula.

As I mentioned above, every week I would go to a breastfeeding class to check my daughter's progress (weight and growth). During the classes, the lactation consultant would check my daughter's weight (using a very sensitive scale) before and after the breastfeeding session to check the breast milk intake. It was important to know if my breast milk production was increasing and my daughter was getting enough. Every week she would write the results down and compare them to the previous week to make sure we were doing well.

According to Kellymom's website, the average weight gain for a breastfeeding baby should be:

• 0 - 4 months old baby should gain 5 - 7 ounces per week 
• 4 - 6 months old baby should gain 4 - 5 ounces per week
• 6 - 12 months old baby should gain 2 - 4 ounces per week

The whole process took more than 2 months. It wasn't easy, I really had to be persistent and determined, but at the end I was thrilled. I just couldn't believe my accomplishment. My daughter was healthy and growing thanks exclusively to my breast milk!

I exclusively breastfed my daughter until she was 6 months old, as it is recommended by the American Academy of Pediatrics (AAP) and the World Health Organization (WHO), when I then started to introduce solid foods.

I continued breastfeeding until she was 30 months old. The AAP recommends breastfeeding for at least 12 months, and thereafter for as long as mother and baby desire and the WHO recommends continued breastfeeding up to 2 years of age or beyond.



Image source: Duron123

Breastfeeding Statistics

About a month ago while talking to one of my friends who is a new mom and lives in Brazil, she asked me about the breastfeeding statistics here in the U.S. and how acceptable was to supplement breastfed babies with formula.

Even though I breastfed my daughter for the first 6 months almost exclusively (I only supplemented with formula for a couple of weeks when I was having breastfeeding complications) and continued breastfeeding until she was 30 months old, I know that it is not a common thing to do. Some of my friends only breastfed for the first 3 months (supplementing with formula) and others went straight to formula without even trying to breastfeed.

Based on my circle of friends, the large majority only breastfed for the first 3 months and they didn't feel any pressure to do it longer nor saw any problem in supplementing with formula when necessary.

To give my Brazilian friend a correct answer based on facts and not only on my experience, I researched these topics and found this statistics:

The Centers of Diseases Control and Prevention's 2011 breastfeeding report card (CDC), shows that in the U.S. National:

• 74.6% were ever breastfed 
• 44.3% were still breastfeeding at 6 months
• 23.8% were still breastfeeding at 12 months
• 35.0% were exclusive breastfeeding at 3 months
• 14.8% were exclusive breastfeeding at 6 months

They also show on their CDC National Immunization Survey (Breastfeeding Among U.S. Children Born 2000—2008), that:

• approximately 25% of the breastfed children were supplemented with infant formula before they were 2 days old
• approximately 38% of the breastfed children were supplemented with infant formula before they were 3 months old
• approximately 45% of the breastfed children were supplemented with infant formula before they were 6 months old

On the World Health Organization (WHO) Infant and Young Child Feeding Data by Country chart, you can see the difference between the breastfeeding statistics between Countries. For example, in Brazil (2006-07):

• 96.4% were ever breastfed
• 49.0% were exclusive breastfeeding at 4 months
• 39.8% were exclusive breastfeeding at 6 months

In Brazil they have a large breastfeeding campaign. They have prime time commercials showing famous actresses breastfeeding their babies and talking about the benefits of it. To help promote breastfeeding they have recently extended the maternity leave from 120 days to 180 days (On the United Nation Statistics Division website you can find a table with a list of all countries showing the length of the maternity leave and the percentage of wage paid in the covered period. The maternity leave varies from 7 weeks in Lebanon to 480 days in Sweden).

There is no question that exclusive breastfeeding is the most complete and healthy form of nutrition a baby can have it, but it is CERTAINLY not easy to do it.



Picture source: Daquella Maneira

Vaccine debate and the 2012 Immunization Schedule

 The American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the American Academy of Family Physicians have approved the 2012 vaccine schedule.

 Vaccination can be a debatable topic. Some parents prefer to not vaccinate their children believing that it could cause more harm than good. In fact, a study published in the journal of Pediatrics in March 2010 showed that one in four parents was concerned that vaccines could cause autism. “I don’t think we should expect that the science is going to completely counter what is a largely emotional response,” said Dr. Margaret C. Fisher, ex-medical director of the Children’s Hospital at Monmouth Medical Center in Long Branch, N.J. in 2010. “We are at a time in this country where there is a general distrust of science. I don’t think people distrust their individual doctors, but there is distrust of the medical establishment.”

In 1998,  Dr. Andrew Wakefield, M.D. published an article in the British medical journal (The Lancet) suggesting that the measles, mumps, and rubella (MMR) vaccine could cause symptoms associated with autism.

After that article, parents started to question if vaccination was really necessary and some of them preferred not to vaccinate their children.

Cases as of the actress Jenny McCarthy, who has a son with autism and believes it may have been caused by vaccines, also help lend credibility to the idea that autism could be caused by vaccination.

Some parents who are against vaccination say that some of ingredients in various vaccines are formaldehyde, aluminum, lead, sulfates, egg proteins and mercury among others. They believe that these ingredients can't be good for a child. The CDC Ingredients of Vaccines - Fact Sheet says that minute amounts of chemical additives is necessary to ensure that vaccines are potent, sterile and safe. They also say that vaccines manufactured for the U.S. market contain no thimerosal (mercury containing preservative) or only trace amounts.

Since 1998, many studies have been published from different researchers showing no relationship between autism and vaccines. According with Alison Tepper Singer, founder and president of the Autism Science Foundation, who has a daughter and an older brother with autism, "There is no link between vaccines and autism."

In 2009, The Lancet retracted Dr. Wakefield's study and in 2010, Dr. Wakefield had his medical license revoked in his native UK.

On the Autism Science Foundation, National Autism Association and Autism Society websites you can find articles about the debate:

What Causes Autism
May 2003  - Mercury in Medicine - Taking Unnecessary Risks
2004           - An investigation of the Association between MMR Vaccination and Autism in Denmark
06/11/2007 - http://support.autism-society.org/site/News2?page=NewsArticle&id=9659
05/19/2008 - National Autism Association Press Release 
05/22/2008 - http://support.autism-society.org/site/News2?page=NewsArticle&id=11433
09/04/2008 - Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study
09/13/2010 - CDC Study Shows No Vaccine, Autism Link
01/05/2011 - Study Linking Autism, Vaccines Deemed an "Elaborate Fraud"

09/19/2011 - Behind the Vaccine Science: An Interview with Dr. Paul Offit, Author of Deadly Choices, How the Anti-Vaccine Movement Threatens Us All

I am not here to support nor to judge parents. The more questions we ask, the more studies are published on both sides and more information we have to make a conscious decision.

The AAP and the CDC still recommend vaccination as the best way to prevent diseases and the current immunization schedule is as follow:

1 - Children 0 - 6 years old:

 
You can click on it to see it larger.
Source: http://pediatrics.aappublications.org/content/129/2/385.full


2 - Children and Adolescents 7 - 18 years old:

You can click on it to see it larger.
Source: http://pediatrics.aappublications.org/content/129/2/385.full


3 - Adults:

You can click on it to see it larger.
Source: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6104a9.htm



Image source: Image: Sura Nualpradid / FreeDigitalPhotos.net

A Belated Thank You!

After 4 months being away from writing on my blog, I'm coming back thanking Amber from Jade Louise Design. In October, she awarded me with the Versatile Blogger Award! It is my third Versatile Blogger Award!!!

Amber has a great blog where you can find a little bit of everything. From recipes, reviews and giveaways to beautiful hand craft design for babies and girls . As in her own words: "My name is Amber; and I am the writer/creator of JadeLouise Designs; a PR and Family Friendly Hodge Podge blog that shares everything about living in healthy and happy homes." 

I'm as happy and honored as I was when I received my first one. Thank you, Amber!

The Rules after accepting the Versatile Blogger Award are:

• Thank the person who gave you the award and link back to them in your post. (Checked)
• Share 7 things about yourself. (I have already done it when I received my first Award)
• Pass this award along to 15 recently discovered blogs. 

There are many GREAT blogs that deserve to receive this Award, but at this time, I want to make it special and for that, I am breaking the rules by awarding only one (1) website instead. I want to Award a great site and a parenthood community that has helped me and thought me tremendously. If you are a parent, you should check it out!

1 - The VoiceBoks - the voice of parenthood