Supporting Breastfeeding

La Leche League Canada

Storing Human Milk

Human milk is a fresh, living substance – not just a ready-to-use food.  When you make the effort to provide expressed milk for your baby, if he or she cannot nurse directly, you are ensuring that your baby continues to receive ideal nourishment and protection against many diseases.

Before you begin to express your milk, wash your hands with hot, soapy water and have your storage containers ready.   How you store your milk will affect how well its nutritional and anti-infective qualities are preserved.

Human milk’s anti-bacterial properties actually help it stay fresh.  The live cells and antibodies in the milk that discourage the growth of bad bacteria in your baby’s intestines also guard against bacterial growth when the milk is stored in a container.  The interpretation of research on human milk storage varies widely.  The following guidelines are adapted from La Leche League International’s pamphlet, which was created with the assistance of members of the LLLI Health Advisory Council and Anne Eglash, MD, FAAFP, FABM.  They provide evidence-based ranges for the storage of milk for full-term, healthy babies.

How Long to Store Human Milk

Whenever possible, babies separated from their mothers should get milk that has been refrigerated, not frozen.  Some of the anti-infective properties are lost when milk is frozen—though frozen milk still helps protect babies from many diseases and is much better for your baby than commercial infant formula.  How long you can store milk depends on the temperature.  A mother’s expressed milk can be safely stored at room temperature for 4-6 hours, in a refrigerator for 3-8 days, and for 6-12 months in a standard home freezer (See “Milk Storage Guidelines” below for details)

If cold milk is warmed but untouched, it can be returned to the fridge for a later feeding. It is not clear how long it is safe to keep milk after the baby drinks from the container.  Some mothers keep the leftover milk at room temperature to use within an hour if the baby appears hungry after a short sleep.  Others refrigerate and reheat the milk left from a previous feeding.  However, there is no research on the safety of either of these practices. Avoid wasting precious milk by offering small amounts at a feeding.

Frozen milk which has been thawed can be kept in the refrigerator for up to 24 hours.  While there is some evidence that milk thawed for a few hours may be refrozen, this results in further breakdown of milk components and loss of antimicrobial activity.  It is best not to refreeze thawed milk.  Remember that refrigerated milk will stay fresher than milk that was once frozen.

Expressed human milk can be kept in a common refrigerator at a workplace or day care center.  Check that the refrigerator temperature is 4°C or less.  Health authorities agree that human milk is not among the body fluids that require special handling or storage in a separate refrigerator.  To keep expressed milk cool when a refrigerator is not available, place it in an insulated container with an ice pack.  This also helps when transporting milk home from the workplace or to the babysitter, especially on warm days.

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Containers for Storage

The best options for storing human milk are glass or hard-sided plastic containers with well-fitting tops.  Be sure they do not contain the controversial chemical bisphenol A (BPA). Containers should be washed in hot, soapy water, rinsed well, and allowed to air-dry before use.   Containers may also be washed and dried in a dishwasher.  If you are using these containers for freezing your milk, do not fill them up to the top – leave an inch of space to allow the milk to expand as it freezes.

If you plan to store your milk in bags, choose thick plastic bags that are designed for storing human milk rather than bottle liners.  Care must be used to avoid contamination during handling and storage of bags as they are less durable than glass containers.  Double-bagging can help prevent leakage accidents.  Squeeze out the air at the top before sealing and allow about an inch for the milk to expand if it is to be frozen.  Stand the bags in a rigid container at the back of the refrigerator shelf or in the back of the freezer, where the temperature consistently remains the coldest.

Put only 60 to 120 ml (two to four ounces) of milk in the container – the amount your baby is likely to eat in a single feeding.  This avoids waste.  Small quantities are also easier to thaw.

If a mother expresses a small amount of milk in one session, it is fine to add fresh milk to chilled milk.  The newly expressed milk should be cooled in the refrigerator for 30 to 60 minutes before being added to the stored milk.   This method can be used for frozen milk, although this practice is questioned by some researchers.  The volume of fresh milk should be less than what is already in the frozen container.

Be sure to label every container of milk with the date it was expressed; if milk expressed on different days is combined, then the earlier date should be used.  If the milk will be given to your baby in a day care setting, also put your baby’s name on the label.

 

Using Stored Milk

Human milk may separate into a milk layer and a cream layer when it is stored.  This is normal.  Swirl it gently to redistribute the cream before giving it to the baby.

The milk only needs to be lukewarm, not hot.  Some babies accept milk right from the refrigerator.

Do not use a microwave oven to heat human milk.  Because microwaves do not heat liquids evenly, there may be hot spots in the container of milk, and this can be dangerous for infants.

High temperatures can affect many of the beneficial properties of milk.  Warm milk gradually and with care.

If milk is frozen, containers should be thawed in the refrigerator overnight or under cool running water.

Cold milk can be gently warmed under warm running water for several minutes.   Or immerse the container in a pan of water that was warmed on the stove.  Do not heat the milk in a pan directly on the stove.

If thrush or yeast infections are affecting you or your baby, continue to breastfeed during the outbreak and treatment.  While being treated, you can continue to express your milk and give it to your baby.  It is unknown if milk expressed and stored during a fungal infection could cause a recurrence.  If you are concerned, after treatment is finished, already stored milk could be boiled and cooled to kill any yeast before use.

Occasionally, breastmilk that has been frozen and thawed may smell or taste soapy; sometimes it may even smell rancid (‘off ’).  This is due to the breakdown of milk fats.   The milk is safe and most babies will still drink it.  In the future, you may want to scald your expressed milk by heating it just until bubbles form at the edges.  This deactivates the lipase enzyme, which breaks down milk fats.  The scalded milk should then be quickly cooled and frozen normally.  Scalded milk is still a healthier choice than commercial infant formula.

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Milk Storage Guidelines

                 Where            Temperature                      Time
At room temperature

(fresh milk)

             19° to 26°C 4 hours (ideal); up to

6 hours (acceptable)*

(some sources use 8 hours)

In a refrigerator                      <4°C 72 hours (ideal); up to

8 days (acceptable)**

In a freezer

(standard home freezer)

           -18° to -20°C 6 months (ideal); up to

12 months (acceptable)

 

*The preference is to refrigerate or chill milk right after it is expressed.

**Eight days is acceptable if collected in a very clean, careful way.

 

Making It Work for You and Your Baby

This information can help you decide how to store your milk to best meet your needs. Breastmilk is remarkably resilient and stores well because of its antibacterial properties. However, it is always preferable to store milk for as short a time as possible. This will minimize the loss of antibodies and nutrients, and keep bacterial growth to a minimum. The fresher your milk, the better.

 

http://www.lllc.ca/Information-sheets

 

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

 

 

 

 

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Breastfeeding Can Reduce Breast Cancer

Mothers who breastfeed are at significantly lower risk of developing breast cancer, hypertension and suffering heart attacks than women who do not, according to researchers at Harvard Medical School and the University of Pittsburgh School of Medicine.

“Anyone wearing a pink ribbon to fight breast cancer, or a red dress to fight heart disease, should take note of these findings”, said co-author Eleanor Bimla Schwarz, M.D., M.S., associate professor of medicine, epidemiology, and obstetrics, gynecology and reproductive services at Pitt’s School Of Medicine.

“While breastfeeding is widely recognized as important to infant health, more people need to understand that breastfeeding appears to have substantial long-term effects on women’s health as well,” Dr. Schwarz explained.

The study findings indicate that if 90 percent of mothers were able to breastfeed as recommended (for 12 months after each birth), U.S. women might be spared nearly 5,000 cases of breast cancer.

 

http://www.lllc.ca/tuesday-tip-womens-heart-health-and-breastfeeding

 

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If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

 

October is Breast Cancer Awareness Month in Canada

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Breastfeeding and Cigarette Smoking

La Leche League Leaders are often asked whether smoking cigarettes impact a mother’s ability to breastfeed. It is not the role of La Leche League to judge a parent’s decision to smoke. We are here to provide fact based information which allows parents to make their own decisions. So what does some of the research say?

What people believe about smoking and breastfeeding: a study that looked at the factors which contribute to intention to breastfeed and breastfeeding outcomes examined how smoking status affected the decision making. The conclusion of the researchers was “Women perceived that a strong risk of harming the baby was posed by smoking while breastfeeding and received little encouragement to continue breastfeeding despite an inability to stop smoking. The perceptions of the toxic, addictive, and harmful effects of smoking on breastmilk constitution and quantity factored into reasons why women weaned their infants from breastfeeding much earlier than the recommended 6 months.”

Breastfeeding duration: a 2006 study followed mothers who had smoked during pregnancy and mapped how long they continued to breastfed. The results showed a lower rate of initiating breastfeeding and a shorter duration (average of 11 weeks vs 28 weeks) when compared with the non-smoking mother control group. The statistical difference persisted even after adjusting for mother’s age, education, income, father’s smoking status, mother’s country of birth, mother’s intention to breastfeed for more than 6 months and baby’s birth weight.

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Does breastfeeding change smoking behavior? A 2012 study done in Italy showed that women who had stopped smoking during pregnancy were less likely to resume smoking after giving birth if they were breastfeeding. Women who had continued to smoke during pregnancy and breastfeeding smoked less at the interview check points than the mothers who were not breastfeeding. A similar study concluded that early prenatal care and breastfeeding is associated with postpartum smoking abstinence.

Infant sleep: a 2007 study looked at sleep duration in a group of infants on two separate occasions: after their mothers had smoked and when their mothers had refrained from smoking. They found the babies spent less time over all and the longest sleep session was shorter.

Lower respiratory tract infections: Lower respiratory tract infections (LRTIs) considered in this study were pneumonia, bronchitis and bronchiolitis. This study looked back at a large group of children born over a two year period in Oslo Norway and tracked health information from physicians. Their data showed that the babies of non-smoking breastfeeding mothers who breastfed for more than six months had the lowest risk of having a LRTI in the first year of life. Babies of mothers who smoked and breastfed for more than six months had an increased risk of an LRTI in the first six months of life. The risk decreased in the second six months although not to a level as low as that of the non-smoking group. Short term breastfeeding (less than six months) and smoking had an increased risk of LRTIs compared with short term breastfeeding without smoking. The results suggest that breastfeeding has a protective effect for babies who are going to be exposed to environmental tobacco smoke. A 2008 study on a similar topic looked at breastfeeding, maternal smoking, recurrent LRTIs and asthma in children.

http://www.lllc.ca/thursdays-tip-breastfeeding-and-cigarette-smoking

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources:  https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

 

 

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Breastfeeding, Inflammation & Infection

We have long known that babies who are breastfed have a lower risk of getting an infection and that their immune systems develop differently. The biological mechanisms behind these differences are still under investigation by scientists.

 
A recently published study by Arnardottir, Dalli and Sehan into a class of molecules called “specialized pro-resolving mediators” (SPMs) found that these inflammation resolving molecules are found in high numbers in human milk. This group of molecules is involved in clearing infections, reducing inflammation, combating pain and healing wounds.

 
The highest levels of these SPMs were found in the breastmilk of healthy mothers. Mothers who had an active case of mastitis (a breast infection) had much lower levels in their milk samples. When their milk was tested it did not have the same ability to resolve inflammation and infection. Cow’s milk and artificial infant formula showed no detectable level of SPMs.

 

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Further study will be needed to see how these SPMs have a role in the protection of the infant from infection and the development of the babies’ immune system. For now it would appear that they play a role in the mother in protecting against or resolving mastitis.

 
For more information about avoiding or resolving mastitis check out:

⦁ La Leche League Canada’s FAQs

⦁ La Leche League International’s Breastfeeding Today

⦁ Talking things over in-person with a La Leche League Leader is always the best way to get support and information that is right for your situation.

 
http://www.lllc.ca/thursdays-tip-breastfeeding-inflammation-infection

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

 

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends .

 

 

 

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Reading Media Reports and Studies About Breastfeeding

Articles about breastfeeding books and breastfeeding research appear in the various forms of media on a regular basis. Sometimes they are reporting on the results of studies and sometimes they are opinion pieces. Whether the reports come from social media, blogs, print media, radio or television reporting, it is important as a reader to have a baseline against which to measure the validity of the reporting or opinion.

 
The most important thing to remember when reading any opinion article or research study is this:  human milk and feeding at the breast are the biologically normal way of feeding human babies and therefore this is the “control” group that all research or opinion about infant feeding must be measured against.

 
The question is never “is human milk and breastfeeding better than XYZ?” It is always “is XYZ better than human milk and feeding at the breast?” Research, and the discussion of the results of the research, should compare the potential for risk/harm/loss from alternate infant food sources and feeding methods against the norm (human milk and feeding at the breast).

olderbaby

 
If you want to look deeper into articles or research it is important to look at the terms and understand what the author means by them. “Exclusive breastfeeding” is one term that has been defined differently in many studies. The precise definition is: nothing other than human milk is given to the baby until the middle of the first year. However, some studies may allow a limited amount of non-human milk liquid in their “exclusive” group or they may use a different time range, which leads to confusion when comparing results and conclusions. To confound the issue further, some mothers may not be made aware that their baby was given a formula supplement in hospital or by a “helpful” family member so, when asked by a researcher, they would define themselves as exclusively breastfeeding. Research shows that once a baby has had any non-human milk feeding, even if it is only once, the gut flora changes. There is an excellent article by Marsha Walker IBCLC which summarizes what we know about supplementation of the breastfed baby.

 
It is also important to consider the scale of the study and make-up of the group of infants being discussed. Is the piece you are reading based on one person’s experience, a study of a small group of children over a short period of time or a very large group of children over a long period of time? Were the parents reporting on their breastfeeding experiences at the time they were breastfeeding or are they looking back and reporting on what they did many years before? All of these options are valid and serve a specific purpose but they need to be recognized and understood so you, as a reader, can consider the potential limitations in how their conclusions could be applied to the general population of infants or your own infant.

 
Realistically, we need to understand that not all research is done to the same standards. The better the quality of the research the greater the value we can draw from the conclusions. Sometimes we have the opportunity to look at individual studies and to consider their implications as stand-alone information. Other times researchers undertake something called a Meta-Analysis where they look at a large number of studies on a similar topic with a goal to finding the common conclusions that can be drawn by looking at a lot of data all together. When doing a meta-analysis, researchers may set aside some of the studies because they had a poor or limiting design. This does not necessarily mean the purpose of that specific study was not worthwhile nor that the conclusions would not be repeated in a larger or more rigorous study; it means only that right now this study is considered weak and not helpful to the general discussion. An example of a meta-analysis of current breastfeeding research can be found HERE.

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When you see media reports on studies about human milk, it is worth trying to look at the original study. You don’t need to be a statistician or university trained researcher to look at a study report and gain some understanding of it. Most studies and journal articles that are being reported on in the various forms of media are accessible online. Search for the author’s name(s) and “breastfeeding” or the study topic and you can usually find it quite easily. Some studies are available to the public in abstract form only, which means without paying for access to the whole article you can only see a summary of the purpose of the study, what group of individuals or specimens were included in the study and the conclusions made by the authors. When you are given online access to an entire article or study, you may feel overwhelmed by the amount and detail of the information included. You will find the information about the purpose and group to be studied at the beginning of the article and the conclusions drawn by the study’s authors at the end. It can also be interesting to look for the information about who the researchers are affiliated with and who paid for the study. This information is usually found at the very end of the report.

 
The fact that there is so much research happening about human milk and breastfeeding is wonderful. This tells us that the research community recognizes the value of human milk and wants to better understand what makes it the ideal food for human infants, what long term health outcomes it is giving to children, and how producing human milk and breastfeeding influences the health outcomes of their mothers. The researchers (for the most part) are looking to find even better evidence to understand the most important health reasons to breastfeed rather than suggesting that the human milk has little value.

 
Studies are generally about large populations and general conclusions, while opinion pieces tend to be about one person’s experience. La Leche League Leaders are happy to help you look at information you may see in any of the forms of media and evaluate it in the context of your own breastfeeding situation with your own baby.

 
http://www.lllc.ca/thursdays-tip-reading-media-reports-and-studies-about-breastfeeding

 

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!

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Premature Babies Need Human Milk

One of the key recommendations from several different studies into improving the long term outcomes for premature babies is the provision of human milk either at the breast or via other feeding methods.

A 2015 study published in the Journal Mucosal Immunology stated “Breast milk is the most effective strategy to protect infants against necrotizing enterocolitis (NEC), a devastating disease that is characterized by severe intestinal necrosis.” If babies have developed NEC all feedings are stopped for a period of time. Human milk is the first food to be restarted because it is easily digested, it supports the growth of healthy bacteria in the intestinal tract, and boosts a baby’s immunity — which is especially important for a preemie with an immature immune system. For women who can’t breastfeed or provide enough breast milk, doctors may recommend giving the baby pasteurized human milk from a milk bank, which is considered a safe alternative.

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Another serious problem that some premature babies develop is Retinopathy of prematurity (ROP). ROP causes extra blood vessels to grow in the retina, the light-sensitive tissue in the back of the eye. When the vessels grow, they can cause the retina to detach, destroying vision. The researchers in a multi-national study said that when babies were exclusively fed breast milk, the risk of any-stage ROP appeared to drop by about 75 percent and the risk of severe ROP seemed to be reduced by 90 percent. Chen’s team found that breastfeeding in any amount appeared to reduce the risk of ROP. And it appeared that the more breast milk, the better. Exclusive breastfeeding seemed to drop the odds of ROP by 75 percent compared to exclusive formula use. And any breastfeeding appeared to reduce the odds of the serious eye disease by 46 percent, the research showed. The antioxidants and immune protective factors in human milk may be part of the reason that human milk is protective. The other part may be due to the decreased risk of infection and NEC both of which may cause the baby to require oxygen therapy which has been linked to a higher risk of ROP.

Skin-to-skin contact (also known as Kangaroo Care) is a key element in the World Health Organization’s recommendations for babies who are considered clinically stable and who weigh over 2000 grams at birth. Skin-to-skin contact between mother and baby stabilizes the baby’s temperature and it encourages the hormonal environment that support breastfeeding. For more information about skin-to-skin contact and breastfeeding check the LLLC website FAQ page or here.

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Having the support of other mothers when dealing with your premature baby and pumping or feeding a tiny baby at the breast can make a huge difference to your confidence. Call or email a La Leche League Leader.
http://www.lllc.ca/thursdays-tip-why-preemies-need-human-milk

 

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!

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Toxic Chemicals in Breastmilk

There is no reason to discourage breastfeeding.

The internet is buzzing with articles about toxic chemicals in breastmilk following the release of research [1] done by the Harvard T H Chan School of Public Health which looked at the levels of perfluorinated alkylate substances (PFAS) in breastmilk.
Perfluorinated alkylated substances (PFAS) make up a large group of chemicals which have been used in industrial and consumer products since the 1950s. The substances are mainly used in firefighting foams, protective coatings in food wrappers and containers, stain resistant textiles, floor wax, polish and in the electronic industries. These substances have a high likelihood of ending up in waste dumps, sewage water and the general environment.

The chemicals of the PFAS group are virtually indestructible and were until recently thought to be completely biologically inert and not available for uptake in living organisms. It now appears that they bond with proteins and fats in food sources. Since the late 1990s, increasing numbers scientific studies have brought PFAS chemicals in the focus of international environmental concern. PFAS are shown to be globally distributed and some of them are bioaccumulative which has implications for human exposure.

 

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The Harvard research, which was done in the Faroe Islands in conjunction with the Norwegian Government, showed that PFASs are transferred through breastmilk and that blood samples levels increased the longer that babies were breastfed. After the babies were weaned their accumulated PFAS levels decreased. Babies who were exclusively breastfeed had higher levels than partially breastfeed babies. This information is important not as a reason to discourage breastfeeding but because it is a look at PFAS exposure and accumulation levels in both women and children in that community. The tested babies only showed levels of PFASs in their blood samples because their mothers had built up an accumulation of PFASs over their lifetimes which they could pass on.

Presumably every other adult in that community has similar levels of accumulated PFASs.
Choosing to formula feed doesn’t necessarily protect an infant from exposure to these chemicals for two reasons. Firstly the baby has already been exposed in utero. Studies have shown that PFASs cross the placental barrier and high maternal levels can be linked to miscarriages. Secondly, community water supplies can carry high levels of PFASs. Drinking water prepared by treatment which does not include GAC filtration or reverse osmosis will generally contain higher PFAS levels. The potential for exposure to PFASs in formula fed babies through water supply applies both to the water used in the manufacturing of the formula and the water used to prepare it at home.
Philippe Grandjean, adjunct professor of environmental health at Harvard Chan School and spokesperson for the research team said “There is no reason to discourage breastfeeding, but we are concerned that these pollutants are transferred to the next generation at a very vulnerable age. Unfortunately, the current U.S. legislation does not require any testing of chemical substances like PFASs for their transfer to babies and any related adverse effects.”

 
More information about PFASs can be found at the following links:

 
Community Drinking Water [2]

Immunization response and PFAS exposure [3]

European Commission Community Research and Development information Service (CORDIS) Final Report summary – PERROOD (Perfluorinated organics in our diet) [4]

 

Do you have questions or concerns about breastfeeding or are you searching for a supportive community of other breastfeeding mothers? Check out a LLLC group near you.

 

1 http://www.ehjournal.net/content/14/1/47
2 http://www.ewg.org/enviroblog/2015/08/your-drinking-water-safe
3 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488050/
4 http://cordis.europa.eu/result/rcn/55843_en.html

 

 

http://www.lllc.ca/thursdays-tip-toxic-chemicals-breastmilk

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!

 

 

 

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Should You Mix Human Milk With Formula?

The Canadian and American Pediatric Associations recommend exclusive breastfeeding for the first six months of life and then the slow introduction of complementary foods while continuing to breastfeed for a year or longer. Exclusive breastfeeding means nothing but breastmilk: no water, no juice and no formula. Many mothers are happy to know that their breastmilk is all baby needs in the first six months but other mothers may consider supplementing with formula for a variety of reasons. Those mothers may have questions about whether it is okay to mix formula into their breastmilk.

Dad and Babe

 

Here are some science based answers to this question:

It’s best not to mix breastmilk and formula in the same bottle because the storage guidelines for the two substances are very different. If you mix your milk with formula, and the baby doesn’t finish the bottle, then some of your milk goes down the drain. Formula has to be discarded after the feeding (Alberta Health) [1] whereas human milk left in the bottle can be refrigerated for another feed (LLLI Safe Handling and Storage of your milk [2]).

Mixing formula into the breastmilk will affect some of the protective components of human milk. The following quotes are from the Human Milk Banking Association of North America (HMBANA), [3] in their 2005 publication “Best Practice for Expressing, Storing and Handling Human Milk in Hospitals, Homes and Child Care Settings”: “Feed human milk, with or without fortifiers, separate from formula to maximize the benefits of human milk. If the mother is not producing sufficient milk for each feeding, collect as many pumpings as necessary to make one exclusive human milk feeding and use formula at the other feedings.”  The rationale: Quan et al [4] found that when bovine milk based formula is mixed with human milk prior to feeding, there is a significant (41-74%) decrease in lysozyme activity. Additionally, there is significant increase in the growth of E coli, resulting from the decrease in anti-infective properties in the milk. “Adding human milk fortifier causes a 19% decrease in lysozyme but no corresponding effect on the anti-infective properties or increased growth of E coli.”

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It makes sense that human milk, which is alive, would not be in its ideal state by adding a dead substance, possibly containing agents that might bind up some of the live constituents in the human milk, making them hard to absorb by the baby, or maybe not available at all.

The aim for most mothers is to exclusively human milk feed their babies. Therefore, if formula is used because the mother has not enough milk, but might in the future, it is best to treat the formula like a medicine, used temporarily and separately, to ‘top up’ her milk until such time as she has enough of her own.

Mothers with adequate milk supplies who may choose to use formula for some feedings rather than expressed breastmilk, will also want to ensure that their babies get the full benefits of the breastmilk by using the formula separately rather than mixing it with breastmilk.

If you have questions about how to increase your milk supply or any other
breastfeeding questions please contact a LLL Leader.
http://www.lllc.ca/thursdays-tip-should-you-mix-human-milk-formula

 

Links:

1 https://myhealth.alberta.ca/health/Pages/conditions.aspx?hwid=hw97537&

2 http://www.llli.org/faq/milkstorage.html

3 https://www.hmbana.org/

4 http://www.ncbi.nlm.nih.gov/pubmed/8200164

 
If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!
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LLLC Spring Appeal Campaign [5] for the support of breastfed babies: Help LLLC Grow – If you, or someone you know, has benefitted from the support of LLLC, a donation is one way you can “pay it forward”.
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Over 385,000 babies are born in Canada each year and we want to ensure every mother has access to La Leche League Canada support whenever she needs it. We are working hard to grow and we need your support. Every donation helps us provide more support to more families!
Thanks to past donations, we have been working hard to grow our services:
Our volunteer Leaders are the cornerstone of LLLC and the support we provide. We have increased our Leaders by 10% in the past year and Leader Applicants by 40% over the past 2 years!
More than 13,000 mothers attend LLLC meetings and another 20,000 receive one-to-one phone support from Leaders.
We have doubled our community and health professional outreach in just one year!
5 new Information Sheets in various languages were made available free of charge to mothers and health professionals
A new Communication Skills program was developed to strengthen health professional and breastfeeding peer support skills and our Best for Babies pre-natal program continues to grow.
Our Leaders are a vital part of LLLC’s breastfeeding foundation. They freely devote their time to help other parents give their children the optimal start in life. You, the donor, make up the other part of the foundation on which the LLLC breastfeeding services rest. Your gifts mean that our Leaders can carry out the valuable help families need. Frankly, we would be unable to deliver services to families without you or our Leaders so please take a moment to consider how valuable your support is and make a donation, either online or by using our pledge form. If a one-time donation is not suitable for you, perhaps spreading your gift over a year would make sense. Our pledge form has the monthly donation option for your convenience.
We are proud of our growth – but we want to do so much more! We need your support to help us serve even more mothers. Please donate today so we can grow to serve the mothers and babies of tomorrow.
Thank you for taking the time to consider supporting La Leche League Canada and our continued efforts to support all breastfeeding families who need us.

5 http://www.lllc.ca/fundraising-campaign

 

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The Continuum from Baby Blues to Postpartum Depression

Almost every new mother has had experience with being completely overwhelmed and wondering what the universe was thinking leaving her in charge of a tiny human being. For most mothers, this feeling is mild and it passes as her pregnancy and birthing hormones wane, breastfeeding gets established and she starts to feel more in control of the pace of life with a baby. This feeling may come and go in waves over a few hours or days but it generally dissipates a few weeks after baby is born. This is the “Baby Blues” and about 80% of mothers experience it. Unlike the baby blues, postpartum depression (PPD) symptoms don’t fade away after a few weeks and in fact they can start at any time during the first year after birth. If the underlying causes aren’t dealt with, the symptoms may continue to get worse over time. Mothers experiencing PPD report feeling that they are not doing a good job of parenting, guilty for having had a child, despair that they will never feel happy again. They may have difficulty concentrating and making decisions. Often their appetite and sleep patterns are disrupted (beyond the level that is normal with a young baby in the house). Mothers experiencing PPD often become isolated because they don’t have the energy to get out of the house or to interact with other people.
A mother who is experiencing relatively mild postpartum depression may not recognize what is happening to her. Because our society expects women to be happy to have their babies and enjoying their new role as a mother, it can be hard for someone who is not experiencing this to feel safe speaking up about her feelings. Although she may be struggling with feelings of inadequacy as a parent, she may also be afraid of being judged for not being thrilled about life with a baby. One mother remembers her son’s first birthday and feeling a huge wave of relief that he had survived in spite of her (self-perceived) inept parenting. Looking back she recognizes that from that day onward, life felt easier and the joy came back into it. Neither she nor anyone around her recognized that she was dealing with PPD throughout that first year because she appeared to be functioning just fine.
Post-partum depression can also be confusing for those around the mother. Partners can be unsure of how to help or unable to understand that the mother can’t just “snap out of it and cope like other new mothers”. Older children may feel neglected and uncertain about the changes in behaviour from the mother they had before the new baby arrived. Newborns are at risk of long term health, social and behavioural problems if their mothers are chronically depressed because the depression prevents their mothers from engaging with them. When PPD is more severe, it is often those around the mother (partners, relatives and friends) who put together the clues and help her get proper diagnosis and support.

Meeting

La Leche League group meeting

Some of the predictors of postpartum depression are:
* previously diagnosed depression or other mental illness
* high levels of systemic inflammation
* pain from childbirth or breastfeeding
* the mother’s perception that she had a negative birth experience (this is different from having an actual negative outcome of the birth)
* having a baby with a “highneeds” or “intense” temperament
* a pessimistic personality
* a dysfunctional family situation
* lack of social supports
The Edinburgh Postnatal Depression Scale is the most common tool used to help diagnosis postpartum depression.

The treatment of PPD generally focuses around three major strategies: medication, getting enough good quality sleep and family/community support. Finding a combination of strategies that considers all these areas and respect the beliefs and structure of each family is of the utmost importance.
Lack of sleep is one of the biggest factors in exacerbating and dealing with PPD. One mother, whose four week old baby had only ever slept for 20 minutes stretches, found herself one afternoon hallucinating her husband’s voice downstairs. When she went downstairs to find out why he was home from work so early (for which she was deeply grateful) there was no one there. She recognized that things were not normal and called a friend who took her and the baby to the doctor. The mum didn’t feel that that the doctor’s suggestions were compatible with breastfeeding which was very important to her. There weren’t any postpartum depression resource groups in their town so she didn’t get a referral to a support group. Fortunately for her, the local La Leche League Group mothers offered suggestions from their own experiences and a combination of better breastfeeding technique and learning to nurse lying down worked for this family and helped this mother overcome her severe sleep deprivation. Some resources for mothers with postpartum depression have sleep promotion ideas which are not compatible with breastfeeding. Breastfeeding mothers who are struggling with sleep deprivation need support to find ways in which to maximize their sleep while not interfering with milk supply. Like all families, they need to figure out what will work best for them and it may need to be re-evaluated on a night-by-night basis in the early weeks and months.

Sleep
Many people are under the impression that breastfeeding is contraindicated when treating PPD with medication. This belief can make some mothers reluctant to consider medication as an option. Mothers who are considering antidepressant or anti-anxiety medication and who wish to continue breastfeeding may want to ask their health care provider the following questions:
Can I breastfeed while taking this particular medication?
If the answer is “no” then a follow up question would be “Is there an alternate medication that would be effective and compatible with breastfeeding?
Other treatments such as increased consumption of long-chain fatty acids, exercise, SAMe and Cognitive-Behavioural Therapy, either in a group or individual setting, can be discussed with the mother’s health care team and used alone or in conjunction with medication. The New Hampshire Breastfeeding Task Force’s documentA Breastfeeding-Friendly Approach to Depression in New Mothers” is an excellent resource for parents and professionals who want to look at all the options for treating PPD including drug therapy.

While successful breastfeeding can be both protective against developing PPD and helpful as one of the coping strategies, every mother will need to decide for herself whether to consider treatment options that are not breastfeeding friendly. “I know some mothers who suffered from PPD that felt incredible relief when they decided to stop breastfeeding, while others found their depression worsened. The decision to breastfeed or not is a very personal one and it is critical to recognize that breastfeeding is more important to some mothers than it is to others (whether that is biologically, intellectually, or emotionally determined).Katherine Stone

For more information check out Why Breastfeeding is good for Mothers’ Mental Health here.

Breastfeeding friendly resources for PPD can be found by clicking here.

Very occasionally (less than 1%) mothers with PPD have thoughts of hurting themselves or their baby. Immediate mental health help is needed in these cases. Often hospitalization and medication is required to stabilize their symptoms and to keep themselves and their babies safe.

https://www.lllc.ca/sites/lllc.ca/files/LLLConnections-2015-Issue-2_0.pdf in http://www.lllc.ca/publications

 

May 4, 2016 is World Maternal Mental Health Day

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!

*   *   *   *   *   *   *   *   *   *   *   *   *
LLLC Spring Appeal Campaign for the support of breastfed babies: Help LLLC Grow – If you, or someone you know, has benefitted from the support of LLLC, a donation is one way you can “pay it forward”.
Donate Today!
Over 385,000 babies are born in Canada each year and we want to ensure every mother has access to La Leche League Canada support whenever she needs it. We are working hard to grow and we need your support. Every donation helps us provide more support to more families!
Thanks to past donations, we have been working hard to grow our services:
Our volunteer Leaders are the cornerstone of LLLC and the support we provide. We have increased our Leaders by 10% in the past year and Leader Applicants by 40% over the past 2 years!
More than 13,000 mothers attend LLLC meetings and another 20,000 receive one-to-one phone support from Leaders.
We have doubled our community and health professional outreach in just one year!
5 new Information Sheets in various languages were made available free of charge to mothers and health professionals
A new Communication Skills program was developed to strengthen health professional and breastfeeding peer support skills and our Best for Babies pre-natal program continues to grow.
Our Leaders are a vital part of LLLC’s breastfeeding foundation. They freely devote their time to help other parents give their children the optimal start in life. You, the donor, make up the other part of the foundation on which the LLLC breastfeeding services rest. Your gifts mean that our Leaders can carry out the valuable help families need. Frankly, we would be unable to deliver services to families without you or our Leaders so please take a moment to consider how valuable your support is and make a donation, either online or by using our pledge form. If a one-time donation is not suitable for you, perhaps spreading your gift over a year would make sense. Our pledge form has the monthly donation option for your convenience.
We are proud of our growth – but we want to do so much more! We need your support to help us serve even more mothers. Please donate today so we can grow to serve the mothers and babies of tomorrow.
Thank you for taking the time to consider supporting La Leche League Canada and our continued efforts to support all breastfeeding families who need us.

Leave a comment »

Breastmilk as Medicine?

If you have hung out with a group of breastfeeding mothers for any length of time, you will have heard someone suggest using breastmilk as a cure for rashes or eye infections or any number of other childhood maladies. Is this just crazy talk or is there science to back up using breastmilk as medicine?

The most common suggested “medicinal” use of breastmilk is to treat children’s eye infections. This is not a new idea as an 18th century quote, referring to human breast milk said: “It is an emollient and cool, and cureth Red Eye immediately.” Studies show that most conditions that cause gunky eyes in babies (blocked ducts and the common cold) will resolve on their own without any treatment. For bacteria caused pink eye, evidence shows that mother’s milk is unlikely to be effective against the bacteria that cause this infection. And certainly, in a newborn, genuine pink eyes need to be evaluated by a physician because there is the potential for long term irreversible eye damage.

1BabyCarrier

 

So what did the studies say?

Verd, in 2007, published an account of his clinic’s switch from treating infants with blocked tear ducts with antibiotic eye drops to mother’s milk drops. The study is retrospective and descriptive rather than quantitative, but it suggests that routinely using mother’s milk is probably safe. Blocked tear ducts, we know, get better without any therapy at all. But if you want to do something, instilling mother’s milk seems safe.

In 2012, Baynham and colleagues published a letter  in the British Journal of Ophthalmology, looking at the in vitro inhibitory effects of donated fresh breast milk against common ocular pathogens. (Translation: they squirted milk into petri dishes of eye germs to see what would happen.) They found that 100% of their donated milk samples contained bacteria (including, in some cases, bacteria that could cause human disease). Though there was some inhibition of bacterial growth against some bacteria, the inhibition wasn’t strong, and the authors concluded that “… human milk is unlikely to be effective against the most common causes of paediatric conjunctivitis.” There was one interesting finding: of all the bacteria tested, human milk was most effective against the bacteria that causes gonorrhea, which is the same bacteria that causes most serious neonatal eye infections, world-wide. Now, it wasn’t as good as an antibiotic, but for resource-poor communities in the developing world, human milk may be much better than nothing.

Ibhanesebhor, in 1996, also did an in vitro (in the lab) study  looking at the effects of human milk against bacteria. He found that while colostrum had some inhibitory effects, mature milk did not—presumably because colostrum has a much higher concentration of antibodies. In any case, even colostrum was effective against only some bacteria, and it wasn’t nearly as effective as an antibiotic.

udownload

 

Another commonly suggested use of breastmilk is to treat ear infections. Most ear infections are middle ear infections, that is to say they are behind the ear drum. Breastmilk in the ear canal will not cross the barrier of the ear drum to reach the bacteria. Breastmilk in the ear canal may be effective against bacteria if the infection is in the outer ear canal such as a “swimmer’s ear” infection. Most inner ear infections clear up on their own. The American Academy of Pediatrics recommends waiting 48-72 hours after diagnosis before trying antibiotics. Warmth is soothing to an inflamed ear so mothers who have tried putting breastmilk in baby’s ear may have found that it gave some relief. Warm compresses or warmed oil drops or ear drops will also have the same effect.

Infant atopic eczema is a skin condition that affects about 50% of infants in the first years of their lives. Mothers often try breastmilk as a treatment. One study looked at the short-term efficacy of breastmilk versus hydrocortisone 1% ointment in infants with mild to moderate atopic dermatitis (AD). There were no significant differences between these two groups at days 0, 7, 14, and 21, and the interventions of both groups were found to have the same effects. As breastmilk and the hydrocortisone 1% ointment provided the same results in the healing of AD, the study’s authors support using breastmilk to treat infant atopic eczema because of low cost and accessibility.

Need help sorting out the myths from facts about breastfeeding? La Leche League Leaders are available by phone, e-mail and at group meetings.

http://www.lllc.ca/thursdays-tip-breastmilk-medicine

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.
If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!

 

LLLC Spring Appeal Campaign for the support of breastfed babies: Help LLLC Grow – If you, or someone you know, has benefitted from the support of LLLC, a donation is one way you can “pay it forward”.

Donate Today

Over 385,000 babies are born in Canada each year and we want to ensure every mother has access to La Leche League Canada support whenever she needs it. We are working hard to grow and we need your support. Every donation helps us provide more support to more families!

Thanks to past donations, we have been working hard to grow our services:

Our volunteer Leaders are the cornerstone of LLLC and the support we provide. We have increased our Leaders by 10% in the past year and Leader Applicants by 40% over the past 2 years!

More than 13,000 mothers attend LLLC meetings and another 20,000 receive one-to-one phone support from Leaders.

We have doubled our community and health professional outreach in just one year!

5 new Information Sheets in various languages were made available free of charge to mothers and health professionals

A new Communication Skills program was developed to strengthen health professional and breastfeeding peer support skills and our Best for Babies pre-natal program continues to grow.

Our Leaders are a vital part of LLLC’s breastfeeding foundation. They freely devote their time to help other parents give their children the optimal start in life. You, the donor, make up the other part of the foundation on which the LLLC breastfeeding services rest. Your gifts mean that our Leaders can carry out the valuable help families need. Frankly, we would be unable to deliver services to families without you or our Leaders so please take a moment to consider how valuable your support is and make a donation, either online or by using our pledge form. If a one-time donation is not suitable for you, perhaps spreading your gift over a year would make sense. Our pledge form has the monthly donation option for your convenience.

We are proud of our growth – but we want to do so much more! We need your support to help us serve even more mothers. Please donate today so we can grow to serve the mothers and babies of tomorrow.

Thank you for taking the time to consider supporting La Leche League Canada and our continued efforts to support all breastfeeding families who need us.

 

 

 

 

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