In the past  month, I have attended my first ILCA (International Lactation Consultants Association) conference, graduated from my 8-month lactation consultant prep course, and took the exam that will certify me as an IBCLC (International Board Certified Lactation Consultant.) Whew! As I recover, I’ve been reflecting on these events and the profession of lactation consulting.

ILCA

What an awesome experience. In mid-July, my mom, 2 1/2 year old son and I drove down to San Diego, CA for my first ILCA conference. Despite carrying a brain saturated with IBLCE test preparation, I learned new and amazing things that have already improved the work I do with moms. I met cool people, ate good food, and came home refreshed and inspired. A few things that struck me about the field of lactation consultants:

• I am so impressed by the leaders in this field. The presentations I attended were strongly research-based, yet many esteemed authors and educators also shared wisdom from their decades of experience… stuff that you can’t find in books and science journals yet.
• This is a profession with high ethical standards. There were statements everywhere about compliance with the WHO code and presentations about ethical issues in lactation consulting. These ethical standards are far more respectable than those of my other professional nutrition organization I belong to as a Registered Dietitian, which accepts sponsorship dollars from fast food, soda, and candy companies.
• The face of the profession is changing. You wouldn’t know it from attending ILCA, where Katherine Shealy from CDC described an aging profession full of  peachy white faces. In her powerful and informative presentation, she challenged the profession to draw in a new workforce of young, racially diverse lactation professionals. Great message, however I think she missed the wonderful fact that it’s already happening. I see it in my classes, at WIC events, and at my IBCLC exam. Take a look at the beautiful photo above of my class of lactation consultants - what do you think?

Displaying my diploma

Graduation

Graduation was extra special for me because it fell on my birthday! We had a lovely dinner and ceremony where graduates were awarded with beautiful plaques and gifts of breastfeeding reference books. It was a great way to celebrate all the work we’ve done to become lactation consultants. This class wasn’t a requirement for me to qualify for the IBCLC exam – I already had enough education and practice hours. A year ago, I really agonized about the decision to take it: the sacrifice of work vacation hours to attend classes, the studying, homework, and projects to squeeze in on top of my full-time job and mothering. It was worth it! It prepared me well for the exam, but more importantly, I will be a better lactation consultant as a result of the course.

IBLCE Exam

That exam was hard. I prepared well, knew my facts, but the exam took the facts and asked candidates to apply them to gray areas drawing on clinical judgment, counseling skills, areas where lactation is more of an art than a science. It left me feeling unsettled, unsure, unlike exams I’ve taken where I leave knowing I nailed it. But since I took a bunch of practice tests with good results, I’m assuming I passed. Results will be out October 28th. . . wait for my announcement.

Thanks for your patience with me during these couple of months with no blogging action. I’ve been pretty busy, but gradually I’m feeling the weight lift. I am thrilled to be formally entering the field of lactation consulting. I’ve enjoyed working with moms and babies for years, but the new skills, knowledge, and growth I’ve gained over the past year have been huge!

Maybe it’s because circumcision has become a controversial practice. Or maybe it’s the fact that there’s no scientific research linking breastfeeding and circumcision. Whatever the reason, all the breastfeeding education I had before my son’s birth was silent on the topic of circumcision. I didn’t know that circumcision could affect a newborn’s ability to breastfeed.

I know many of my readers have strong feelings about circumcision. I am not going to condemn circumcision, nor am I defending the fact that my son is circumcised. My primary focus in blogging is breastfeeding, and that remains the focus of this post on circumcision. Parents should know that breastfeeding problems are among the risks of circumcision in the first few days of life. If I had known, we would have made different choices.

My experience

My son was circumcised on his third day of life.  He wasn’t breastfeeding well yet and we were reluctantly supplementing with formula as instructed by the pediatrician. While my husband accompanied him, I anxiously waited for him to return to my hospital room so I could comfort him and nurse on demand as he recovered from the procedure.

When he returned, however, he was asleep. He wouldn’t wake up to feed. An hour went by. He just slept. Far longer than he had ever slept in his short life. Hours passed. When he finally started to stir and show hunger signs, I eagerly put him to my breast. He screamed and arched his back. My doula tried to help, with no success. I dropped my few precious drops of colostrum, extracted by the breast pump, into his mouth. We were discharged from the hospital later in the day, without breastfeeding established. Eventually, we got breastfeeding on track. Circumcision wasn’t the cause of all the breastfeeding problems we had, but I couldn’t shake the suspicion that it might have contributed to them.

Researching circumcision and breastfeeding

Ever since that day, I’ve wondered if my son’s post-circumcision behavior is a common response. I’ve heard of breastfeeding problems arising after circumcision from a few of my clients. I set out to find some good, peer-reviewed published studies linking circumcision and breastfeeding, and found nothing that directly links the two. There is research establishing that circumcision is painful, which I discuss below, but the most informative resources I found came from major professional organizations and lactation consultants.

Original research on circumcision pain and infant behavior:

I was disappointed to find that most of the scientific literature on behavior and feeding response to circumcision is decades old. Many variables can change in this time, such as circumcision procedures, anesthetic measures, and feeding practices (most of the babies in those studies were bottle-fed.) What we can conclude from the published research available is that circumcision is painful to a newborn and may lead to what lactation consultants call a “shut-down” response. Circumcision results in vigorous crying, even with topical anesthetic treatments that continue to be used today, and is usually followed by prolonged, non-REM (very deep) sleep. None of the studies I found directly linked circumcision or the behavioral response to breastfeeding. I’d say we’re overdue for a study of breastfed infants that assesses latch, milk transfer, and duration of feeding in the hours post-circumcision. From here, we’ll turn to the breastfeeding and pediatric organizations for more on the stress of circumcision and it’s effects on breastfeeding.

La Leche League

La Leche League has no official policy or statement on circumcision, but I found the following warnings about circumcision:

The Breastfeeding Answer Book: When a baby undergoes a painful medical procedure, such as a heel stick, injection, spinal tap, or circumcision, he may shut down and be unreceptive to feedings until he is feeling better.

La Leche League responds to a leader’s question about addressing circumcision: “Circumcision, in and of itself, is not directly related to breastfeeding. However, like other elective surgeries, this procedure can affect the early days of breastfeeding”… “The majority of babies are sleepy at least twenty-four hours after birth. If they are already sleepy, and have not nursed well or often, the circumcision being performed early in the hospitalization may cause breastfeeding problems. As a mother and a patient, it is your choice to ask the physician to wait until the last hospital day to perform the surgery, or to ask if it could be done later.”

American Academy of Pediatrics (AAP)

The AAP’s policy statement on pain management states, “research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward.”

The AAP’s policy on breastfeeding, while not directly mentioning circumcision, suggests that after birth, “Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized.”

Journal of Human Lactation

Two letters to the editor in 2000-2001 raised the issue of circumcision’s effect on breastfeeding. A well-known IBCLC notes her observation that baby boys circumcised before breastfeeding is established have more problems breastfeeding. Another lactation consultant responds in agreement: “…what I observe in the hospital again and again, with babies shocked into a stupor, some having not yet even suckled well, milk volume not yet increased, and mom not yet experienced with feeding.”

Breastfeeding Management for the Clinician: Using the Evidence (Marsha Walker, 2006)

Marsha Walker describes the effects of the prolonged hard crying associated with circumcision: “as crying progresses, infant behavior becomes more disorganized and the exhausted infant may be unable to make eye contact or breastfeed effectively.”

Why this is a big deal

The interference with breastfeeding may only be temporary, but for a baby still struggling to learn to latch, a brief unreceptive period may derail breastfeeding. A long stretch of time with no breastfeeding this early on can impact the amount of milk a mother starts to produce. Less milk removal means less milk will be made. A newborn who goes long periods without “practice” at the breast can lose the learning opportunity to develop the good sucking skills that are required for successful breastfeeding. When a newborn seems to not want to breastfeed, hospital staff are often quick to turn to a bottle of formula, another strike against learning to breastfeeding during the critical first few days.

Circumcision doesn’t impair breastfeeding for every baby. What the evidence above shows is that it’s particularly a risk for newborn babies who have not yet learned to breastfeed well- often the case when circumcision is done prior to hospital discharge. Interestingly, the traditional Jewish ceremony of circumcision is performed on the 8th day, by which time most babies have learned to breastfeed well and their mothers are making plenty of milk.

Circumcision is a common birth-related practice in U.S. hospitals. Rates are dropping, with recent U.S. average rate of 56% of baby boys (rates are much lower outside the U.S.) but in some areas of the country, the rate is higher than 80%. If only a fraction of these procedures leads to breastfeeding complications, that’s still a lot of baby boys whose mothers don’t meet their breastfeeding goals. But without more research, it’s hard to say how commonly circumcision leads to breastfeeding problems.

My questions for you: Did you know breastfeeding problems were a risk of circumcision? If you circumcised, did your baby’s response affect the breastfeeding pattern in any way? Please be respectful of readers whose feelings about circumcision may differ from yours.

Welcome to the April Carnival of Breastfeeding on the topic of Extended Breastfeeding! There are many other great  bloggers participating, so take a moment to check out the links the end of this post. Thanks for reading!

When I was struggling to breastfeed my newborn son, a friend offered me some encouragement to remind me breastfeeding would be worth the initial effort. She told me her favorite thing about breastfeeding didn’t surface until toddlerhood: the ability to calm, comfort, and redirect a child through breastfeeding.  “No matter how upset they are, they just melt in your arms,” she told me.

It’s true. My family watched it happen as I breastfed my son into toddlerhood and my mother started referring to breastfeeding as “setting the reset button.” Our second year of breastfeeding must have dried a million tears from bumps on the head, scrapes, overstimulation, frightening near-falls, bad days, frustration, airplane ears, and head colds. I didn’t breastfeed every single time he cried, nor did he expect this. But often he just needed a little re-centering to transform his mood, and breastfeeding was just the right remedy.

It wasn’t about the milk. It was about me, and the comfort nursing offered. Breastfeeding toddlers develop a strong sense of security. Mother’s breast is a place they return to time and again, a place they have known since birth, offering warmth, routine, comfort, security, and mother’s loving attention. Breastfeeding gives an upset child something external to focus on, to collect themselves and calm that hiccuping, gasping stage when they’re almost ready to let go of their tears. For a small child who has so little control over anything in the world, breastfeeding is something that the child can control, adjusting the pace and flow with rhythmic suckling.

After two years of breastfeeding, I have a healthy, well-adjusted, active little boy on my hands, bursting with independence. There was so much that I loved about breastfeeding into toddlerhood, but the best thing was how it soothed my child’s fears, pain, and fatigue and made us both happy, over and over again.

I have yet to discover a parenting technique that works quite the same. Breastfeeding was mothering magic.

Did anyone else discover magical mothering powers through breastfeeding your toddler? What is the best thing for you about extended breastfeeding?

Mamapoeki from Authentic Parenting: Extended Breastfeeding?

Mama Alvina of Ahava & Amara Life Foundation: Breastfeeding Journey Continues

Elita @ Blacktating: The Last Time That Never Was

Diana Cassar-Uhl, IBCLC: Old enough to ask for it

Karianna @ Caffeinated Catholic Mama: A Song for Mama’s Milk

Judy @ Mommy News Blog: My Favorite Moments

Tamara Reese @ Please Send Parenting Books: Extended Breastfeeding

Jenny @ Chronicles of a Nursing Mom: The Highs and Lows of Nursing a Toddler

Christina @ MFOM: Natural-Term Breastfeeding

Rebekah @ Momma’s Angel: My Sleep Breakthrough

Suzi @ Attachedattheboob: Why I love nursing a toddler

Claire @ The Adventures of Lactating Girl: My Hopes for Tandem Nursing

Elisa @ blissfulE: counter cultural: extended breastfeeding

Momma Jorje: Extended Breastfeeding, So Far!

Stephanie Precourt from Adventures in Babywearing: “Continued Breastfeeding”: straight from the mouths of babes

The Accidental Natural Mama: Nurse on, Mama

Sarah @ Reproductive Rites: Gratitude for extended breastfeeding

Nikki @ On Becoming Mommy: The Little Things

Dr. Sarah @ Good Enough Mum: Breastfeeding for longer than a year: myths, facts and what the research really shows

Amy @ WIC City: (Extended) Breastfeeding as Mothering

The Artsy Mama: Why Nurse a Toddler?

TopHat @ the bee in your bonnet: From the Mouths of Babes

Beth @ Bethstedman.com: Extended Breastfeeding: To Wean Or Not To Wean

Callista @ Callista’s Ramblings: Pressure To Stop Breastfeeding

Amanda @ Postilius: Nursing My Toddler Keeps My Baby Close

Sheryl @ Little Snowflakes: Tandem Nursing- The Good, The Bad and The Ugly

Zoie @ Touchstone Z: Breastfeeding Flavors

Lauren @ Hobo Mama: Same old, same old: Extended breastfeeding

Tanya @ Motherwear Breastfeeding Blog: Six misconceptions about extended breastfeeding

Jona (Breastfeedingtwins.org): Breastfeeding older twins

Motherlove Herbal Company: Five reasons to love nursing a toddler

 

I don’t usually post local events on my blog, but this one is special since I’m involved in planning it! As a fundraiser for the lactation consultant preparation program I’m enrolled in this year, my class is putting together an awesome conference. It will be a full day of exciting breastfeeding topics!

The conference will feature Dr. Bob Sears speaking on “postpartum parenting,” Dr. Touraj Shafai speaking about his research linking extended breastfeeding to prevention of autism, and Christy Jo Hendricks, IBCLC, on “The Business of Breastfeeding.” You’ve probably heard of “Dr. Bob,” and I can vouch for the other speakers, both of whom I have had the opportunity of hearing on other occasions. Dr. Shafai presented his research to my class as a guest lecturer, and his results are very interesting. And Christy, a fun and energetic speaker, has fascinating insights into the culture and marketing surrounding infant feeding.

The conference is on Saturday, May 7th, 8:00-5:30, and costs $75 for general admission. You can also register as a health professional at a higher rate for 5.5 contact hours. Student discounts are available. Check out the registration form for more details. 

If you plan to register, please note on your registration that you were referred by this blog.

When my son was 4 months old, he was diagnosed with reflux. The pediatrician wanted me to stop breastfeeding. Her first recommendation was to start pumping my milk and feed it in a bottle mixed with cereal to thicken it. Um, excuse me, WHAT!? I had just spent 3 agonizing months working with lactation consultants, using special techniques to teach my baby how to breastfeed, all with the goal of being able to feed him at the breast for a good long time. Things were just starting to go well for us. I refused to take my baby off the breast and feed him processed rice starch in a bottle when there were other treatment options.

Recently, in my preparation for the IBLCE exam I’m taking this summer, I came across some fascinating information about thickening breastmilk with cereal: It doesn’t work. You see, breastmilk is full of active enzymes that aid in digestion. They start digesting the milk immediately so baby’s stomach doesn’t have to work too hard. When you mix cereal into breastmilk, the enzyme amylase gets right to work and the cereal starts to be digested even before reaching the baby’s mouth. Before the baby finishes the bottle, the thickening properties of cereal are lost. Breastmilk knows what’s best for baby’s tummy.

I observed this firsthand when my son was older and I gave him infant cereal in a bowl. When I poured cereal into my breastmilk, it would thicken at first, but before the feeding was over, the cereal was watery. I didn’t know why this happened. It was my milk doing its job!

Doctors, like my son’s former pediatirican, often recommend thicking with cereal for reflux and spitting up. Bad advice! I’ve even heard from moms whose pediatricians told them to stop breastfeeding and give formula thickened with rice cereal. Even for a baby already on formula, studies show that cereal thickeners don’t improve reflux. But a breastfed baby is already getting the best, most easily and thoroughly digested food possible!

There are other ways to treat reflux. Minor adjustments to feeding position, post-feeding position, and burping routines may be all that’s needed. In my son’s case, we started him on a medication that made a world of difference. And we kept on happily breastfeeding.

Isn’t breastmilk amazing? Don’t ever let a doctor tell you that your baby’s tummy would be better off with anything else!

My recently-weaned 2-year-old just had his first ear infection, and I wanted to breastfeed him again. A few days after coming down with a cold, he woke up one morning screaming. Nothing would console him.  “Mommy kiss it,” he whimpered, holding his ear, “I need ice.” Oh, my poor, sweet little boy.

He hadn’t breastfed for 2 months, but boy did he need it now. I pictured the antibodies helping him fight the infection, the suckling jaw motions soothing his ear, and the comfort of Mommy’s skin. “Do you want nuh-nuh?” I asked. He stared up at me, considering the offer. “No,” he finally replied, and he went on clinging to me and sucking his fingers.

Of course, I already knew he was weaned. In fact, he apparantly forgot how to breastfeed. Before getting sick, when I thought we were all done breastfeeding, he actually asked to nurse once more. Out of the blue. And he didn’t just ask, he begged. So I obliged. He stared for a moment, looking like I had just set a geometry problem in front of him. Then, very slowly, he pursed his lips and leaned in as if he were giving a kiss. Next, he opened his lips just enough to suck, as if through a straw. I winced and reminded him to open his mouth. He just looked at me for a moment, confused, and jumped off my lap to go find something more interesting.

My baby forgot how to breastfeed, and that was that. We’re all done with nursing. I suppose he was comforted by the reassurance that if he needed it, Mommy was willing to give him “nuh-nuh” even if he didn’t actually breastfeed.

I miss it more than I thought I would. So much that I made a brief attempt to try hand expression and pumping again to see if I could get more milk. Nope, not enough to make it worthwhile. So we’re done breastfeeding. I will continue to teach my son about how babies eat and point out babies we see breastfeeding. Some of his friends still breastfeed, and we talk about that. And someday he’ll get to see me breastfeeding another baby. . . something I look forward to even more now that his weaning is final.

Moms, what do you miss (or what do you think you will miss) about breastfeeding? Did you wish you could breastfeed again after weaning?