What’s the difference between lactation professionals and infant feeding safety experts?

Newborn baby sleeping on a drip in a hospital

Lactivist Prof. Amy Brown has a new piece on The Conversation this morning. It’s entitled Breastfeeding is not ‘easy’ – stop telling new mothers that it is and it’s a clumsy effort to deny that lactation professionals have spent the last decade pressuring, shaming and blaming women who can’t or don’t breastfeed.

It’s difficult to talk about breastfeeding in a productive way right now…

One of the traps public health promotion can fall into is being so keen to promote breastfeeding that any challenges get glossed over, through fear that it’ll put women off. Instead breastfeeding gets painted as some kind of idyllic, simple, miracle cure for all ills…

Sounds good, right?

It’s the difference between life and death.

Until you get to this:

Breastfeeding is not easy. It requires women’s time and investment and can be a steep learning curve…

What in life worth doing is easy? We put ourselves through challenges all the time. We work hard for exams. We train for races. We do it because we think it’s worth it, not because it’s easy. And we expect others to support us. Imagine our outrage if we were training for a race and everyone suggested it wasn’t worth it.

Faux empathy with a helping heaping of more pressure, blame and shame. Talk about tone deaf!

It’s difficult for me to understand such a profound lack of empathy for the feeding struggles of new mothers but perhaps it comes from some fundamental differences between lactation professionals like Brown and a feeding safety expert like Christie del Castillo-Hegyi, MD of the Fed is Best Foundation.

1. It’s a difference in personal experience.

I don’t know it for a fact, but I suspect that Amy Brown did not have to watch one of her children struggle with the effects of dehydration induced brain injury.

In contrast, Dr. del Castillo-Hegyi’s eldest son sustained a breastfeeding related brain injury:

My son was born 8 pounds and 11 ounces after a healthy pregnancy and normal uneventful vaginal delivery. He was placed directly on my chest and was nursed immediately. He was nursed on demand for 20-30 minutes every 3 hours. Each day of our stay in the hospital, he was seen by the pediatrician as well as the lactation consultant who noted that he had a perfect latch. He produced the expected number of wet and dirty diapers. He was noted to be jaundiced by the second day of life and had a transcutaneous bilirubin of 8.9. We were discharged at 48 hours at 5% weight loss with next-day follow-up.

… We saw our pediatrician at around 68 hours of life (end of day 3). Despite producing the expected number of wet and dirty diapers, he had lost 1 pound 5 ounces, about 15% of his birth weight… Our pediatrician told us that we had the option of either feeding formula or waiting for my milk to come in …

Wanting badly to succeed in breastfeeding him, we went another day unsuccessfully breastfeeding and went to a lactation consultant the next day who weighed his feeding and discovered that he was getting absolutely no milk… We fed him formula after that visit and he finally fell asleep. Three hours later, we found him unresponsive. We forced milk into his mouth, which made him more alert, but then he seized. We rushed him to the emergency room. He had a barely normal glucose (50 mg/dL), a severe form of dehydration called hypernatremia (157 mEq/L) and severe jaundice (bilirubin 24 mg/dL)…

These numbers put her son at high risk of brain injury and indeed:

At 3 years and 8 months, our son was diagnosed with severe language impairment, autism, ADHD, sensory processing disorder, low IQ, fine and gross motor delays. He was later diagnosed with a seizure disorder associated with injury to the language area of the brain…

2. It’s a difference in professional training

Amy Brown is a professor of psychology. To my knowledge she has no medical training. Dr. del Castillo-Hegyi, in contrast, studied the effects of glucose on neonatal ischemic brain injury at Brown University and is a practicing, Board Certified Emergency Room physician.

It’s not really surprising then that Dr. del Castillo-Hegyi has much more experience with the medical aspects of breastfeeding and its complications.

3. It’s the difference between having no responsibility for patient care and having ethical and legal responsibility for the care of the vulnerable.

Amy Brown never has to see the results of her “advice.” She just gives it and assumes it works. Dr. del Castillo-Hegyi takes responsibility for providing medical advice and sees the effect of her recommendations every time she steps into the ER.

4. It’s the difference between “easy vs. easier” and “possible vs. impossible.”

Breastfeeding, like pregnancy, has a substantial failure rate. Current best estimates are that as many as 15% of first time mothers cannot produce enough breastmilk to fully nourish a baby, particularly in the early days. That’s significant but not as high as the natural miscarriage rate of 20%.

Imagine if lactation professionals like Prof. Brown treated women who miscarried like they treat women who can’t breastfeed because they don’t produce enough milk. Would insisting that pregnancies could be divided into easy or easier address their problems? Would efforts to make their pregnancies “easier” prevent miscarriage? Would refusing to acknowledge the biological basis of miscarriage reduce the suffering of these women? No, no and no.

The situation is the same when it comes to breastfeeding. For the 15% of women who are biologically unable to produce enough breastmilk particularly in the early days after birth, would making breastfeeding “easier” increase milk output? Would ignoring the consequences of infants screaming frantic from hunger and mothers weeping desperate to soothe their babies increase milk output? Would refusing to acknowledge the biological basis of insufficient lactation reduce the suffering of these women? Of course not, yet that is precisely what lactation professionals continue to offer instead of being honest about medical reality.

5. It’s the difference between process and outcome.

Prof. Brown promotes breastfeeding (a process); Dr. del Castillo-Hegyi promote healthy babies and healthy mothers (an outcome). That might involve exclusive breastfeeding, combo feeding or exclusive formula feeding. I suspect that Prof. Brown imagines that breastfeeding guarantees a healthy outcome, but that’s because she’s ignoring the latest scientific evidence and not listening to what struggling mothers are telling her. Breastfeeding has a high failure rate that leads to suffering, injury and death. That’s why breastfed babies are readmitted to the hospital at double the rate of bottle fed babies. That’s why there is a growing problem with infants presenting with profound dehydration. That’s why 95% of cases of kernicterus (jaundice induced brain damage) can be traced back to breastfeeding.

6. It’s the difference between an echo chamber and an uphill battle.

As we speak Prof. Brown is currently enjoying the atta-girls from dozens of lactivist colleagues on Twitter. She never appears in a setting where her ideas and claims can be subjected to probing questioning from other medical professionals. In contrast, Dr. del Castillo-Hegyi occupies the same place in the breastfeeding world that Ignaz Semmelweis purportedly occupied in the world of puerperal fever. Her knowledge, her integrity and her sanity are repeatedly called into question. Lactation professionals ignore the data she presents and the warnings she issues, demeaning and insulting her.

7. It’s the difference between life and death.

Dr. del Castillo-Hegyi is desperately trying to prevent agonizing infant hunger, prevent neonatal brain injuries and deaths and prevent the maternal suffering that results from all three. Prof. Brown ignores those outcomes, refuses to acknowledge the frequency with which they occur and refuses to listen to what women are telling her. Tragically, that can be the difference between life and death.

  • Sarah

    Shitloads of things in life worth doing are easy. I ate a beautiful meal cooked by my husband last night, and I can’t say that it was particularly difficult. I just sat on my arse and chewed. If she thinks that wasn’t worth doing, she hasn’t tasted his garlic chicken.

    • The Bofa on the Sofa

      For this, I bring up cake.

      I’ve made cakes from scratch. In fact, my 9 yo and I just did it a couple of weeks ago for my wife’s birthday. And it turned out better than usual (I’ve never had much success making a cake from scratch).

      But you know what? The reason we made it from scratch was because we didn’t have a cake mix handy. If we had had a cake mix handy, we would have used it. And it would have been easier. And likely turned out better.

      No, there was no virtue in doing in the hard way.

  • Sue

    “We work hard for exams. We train for races.”

    Did she intentionally include examples of activities that are, by their very nature, competitive?

    • Who?

      I’d suggest everything she talks about doing, or having done, is with a competitive spirit, and that, not coincidentally, we will never hear about anything she doesn’t star at.

    • Good point. “We work hard for digestion. We train for kidney function” would be closer to the mark, but doesn’t have quite the same ring to it.

    • Abi

      I wondered the same – and concluded that it probably wasn’t intentional, but it wasn’t a coincidence either.

    • Allie

      I’m assuming they’re things she has worked hard for and finds worthwhile. So naturally everyone else should.

  • yentavegan

    Eye opening experience….Twice last month healthy mothers with uneventful healthy newborns at birth, re-admitted into hospital because infant was dehydrated at day 5…..Formula given from a bottle along with breastfeeding…by end of week infant weight stabilized and mother went on to exclusively breastfeed….

    • yentavegan

      Anecdotal but early prelacteal feeds do not have a negative effect on breastmilk production…and actually serves to support the health of the newborn

      • J.B.

        That would be nice to research and educate hospital staff about!

    • StephanieA

      We get these admissions quite often. It’s sad because it’s stressful on the baby, on mom and the entire family. It’s completely unnecessary because these are otherwise healthy newborns that just needed more food. Not mention the expense for the family and use of hospital resources.

      • EmbraceYourInnerCrone

        Then someone needs to educate expectant parents that formula is a perfectly fine way to feed a newborn, that feeding formula before your milk comes in (if you want to try breastfeeding) is fine, and that combo feeding and full formula feeding is also fine/OK/complete nutrition.

        The breast milk is not magic, does not provide immunities to anything but some colds and intestinal upsets(important in counties without clean water), and is NOT complete nutrition (lacks enough Vitamin D and iron in most cases.)

        How are new parents supposed to know ANY of this when all the propaganda says the opposite? “Breast is best, babies don’t need and should get any formula before your milk comes in, feeding your baby a bottle of formula once in a while will irreparably change/damage their virgin gut, your formula feed baby is missing out on all the immunities to vaccine-preventable diseases that they will get from Breast milk (yes I know that one is BS but it’s somehting Everyone Knows…they apparently don’t know those immunities the little that a baby gets, come across the placenta not in the milk)

        Why aren’t OBs/CNMs and hospitals teaching THAT in OB visits and childbirth classes?

        • EmbraceYourInnerCrone

          Also there’s lots of stuff like this out there on the internet…this is from a website about childrens health under Breastfeeding FAQs:

          “When will my milk come in?
          For the first few days after your baby’s birth, your body will produce colostrum, a nutrient-rich “pre-milk” or “practice milk.” Colostrum contains many protective properties, including antibacterial and immune-system-boosting substances that aren’t available in infant formula.

          For some women, colostrum is thick and yellowish. For others, it is thin and watery. The flow of colostrum is slow so that a baby can learn to nurse — a process that involves coordination to suck, breathe, and swallow.

          After about 3 to 4 days of producing colostrum, your breasts will start to feel firmer. This is a sign that your milk supply is increasing and changing from colostrum to breast milk, which resembles skim (cow’s) milk.

          Sometimes a mother’s milk may take longer than a few days to come in. This is perfectly normal and is usually no cause for concern, but make sure to let your doctor know. While babies don’t need much more than colostrum for the first few days, the doctor may need to make sure the baby is getting enough to eat. It can help to breastfeed often to stimulate milk production.”

          Which tells new parents it’s basically perfectly fiiiinnnnneee for your baby to get next to nothing to eat for 3 or 4 days!

          • Roadstergal

            The phrase “boosts the immune system” (and its variants) is an invariant signal for bullshit. It doesn’t mean anything.

          • Abi

            Agreed. How about ‘they might get worse hayfever symptoms’ – more accurate description surely?

          • EmbraceYourInnerCrone

            Anyone who talks about “Boosting” their immune system, I want send them over to talk to my SIL. She has active advanced lupus(also know as What Happens When Your Own Immune System Attacks You) She has kidney problems, circulation problems, breathing problems, and can hardly eat anything anymore…Having an over active immune system is so awesome…/snark

        • PeggySue

          I would guess that they, themselves, either aren’t learning much of anything or are learning the “received wisdom” of lactivism in their training. I have heard young nurses just out of school and believe me they parrot the “breast is best” line over and over.

  • Jody Segrave-Daly

    I invite Prof. Brown to visit our NICU, to watch an accidental starvation baby be admitted to the NICU, while we try to get an IV line in for resuscitation, while having a seizure, or worse. I invite Prof Brown to hear the haunting sounds of a mother who is sobbing and wailing knowing she accidentally starved her baby because she was told her body could make enough milk, keep trying harder, pump more and you got this! I invite Prof Brown to read every single story that comes to our Foundation, so she can feel the kick to the stomach, when a mother tells us her baby now has developmental delays from hyperbilirubinemia, because she was told NOT TO SUPPLEMENT her baby.

    • Amy Tuteur, MD

      She would never appear anywhere that her fundamental beliefs could be questioned. After all, she’s such a snowflake that she had to block me on Twitter. Merely reading the words of someone who disagrees with her is too difficult. Obviously she’s not capable of debating the issues.

    • Sue

      Prof Brown would definitely not appear in a NICU because she is an academic psychologist. She doesn’t provide health care to newborns.

  • Young CC Prof

    “Imagine our outrage if we were training for a race and everyone suggested it wasn’t worth it.”

    If training for a race was harming my physical or mental health, or having an adverse effect on my family or job, I would really appreciate people telling me that it was OK to quit and the race wasn’t the most important thing.

    • Who?

      What you said.

      And, who gets ‘outraged’ when someone disagrees with them? Your feelings might be hurt, you might feel slighted, you might wish you could make them understand why it was important to you. You might even wonder if, given your friend thinks it’s a bad idea, that the possibility it is in fact a bad idea might be worth exploring.

      But ‘outrage’? In a world where children are locked in cages so a petulant orange man can make a point?

      If one thing demonstrates lactivists’ lack of perspective, it’s that.

    • fiftyfifty1

      And actually as a doctor I tell people this frequently. Many people have the mistaken belief that fitness = health and that fitness = longevity. In reality, fitness (usually defined by patients as visibly defined muscles and the ability to complete endurance contests such as running races) has very little to do with health or longevity. Our bodies do their best to adapt to what we make them endure. If we run for hours, thus sending our bodies the message that it is necessary to run for hours, our bodies will do their best to make adaptations that favor the ability to run for hours. (I imagine our bodies saying something such as “yikes, something must be chasing her, I better do my best to become a good runner.”) But the goal of running for hours is not the same as the goal of longevity, and often is at odds with that goal. At our local yearly marathon, there are not infrequently a couple of deaths-usually from heart arrhythmia or MI. Certainly it’s not ideal to be totally sedentary. But neither is it good to wring yourself out exercising to the point of inflammation. Being “fit” is a status symbol, not a marker of health. I tell patients all the time to stop training for races due to a variety of reasons: eating disorders, injuries, heart disease, others.

      • The Bofa on the Sofa

        You’d think the story of Jim Fixx would have ended all that “fitness = longevity” stuff. Instead, it seems to be used as the exception that proves the rule.

        As for your last sentence, I’m figuring if I have to ask my doctor if my heart is healthy enough to have sex (which is what they say on the radio), I should also consult about running on the treadmill.

      • BeatriceC

        Do you mind if I screen cap this for use in other discussions? It’s a fantastic point and extremely well worded.

        • fiftyfifty1

          go for it

      • Roadstergal

        Yup, this. I run races and lift weights to bolster my ego. Nobody needs to do it for fitness!

      • Gæst

        Fitness messed up my knees and now I am fat and unstable. (Well, breastfeeding twins had something to do with the weight gain, to be honest, but it’s difficult to get it off with diet alone).

    • Gæst

      I trained for some long triathlons and many people questioned me. I was never “outraged.”

  • crazy mama, PhD

    OT: Came across this article today (it’s from May, so maybe you all already saw it): “There Is a Hidden Epidemic of Doctors Abusing Women in Labor, Doulas Say” https://broadly.vice.com/en_us/article/evqew7/obstetric-violence-doulas-abuse-giving-birth

    Pardon me if I don’t consider doulas a reliable source on what is and isn’t necessary during labor.

    • The Bofa on the Sofa

      Hey, but because of those mean and evil doctors, that means that more women should be using doulas.

      I’m sure that is just a coincidence.

    • lawyer jane

      Yikes, that’s a pretty inflammatory article. I actually did experience one of the things described in the article (although by a crunchy midwife NOT a doctor.) Malpractice is everywhere though, and I seriously doubt the solution is more doulas.

      • lawyer jane

        And in case anyone is wondering … what happened was an unmedicated, unconsented to “manual dilation” of my cervix while I was in labor. Despite my screaming for her to stop. (My partner said it was the worst thing he ever heard.) It’s totally possible I would have consented to this if properly discussed (and offered pain relief!) but that’s not what happened …

    • The Kids Aren’t AltRight

      I noticed that too. Didn’t interview any women; only the views of people who make a living off women not trusting doctors.

    • Gæst

      When I actually needed my doula to help, she was useless.

  • Mel

    I hate the “What in life that is worth doing is easy?” line of reasoning.

    It’s palpably stupid at the outset because people choose to do things that are hard, but reasonably attainable based on their personal skills and talents.

    Climbing K-2. Getting an advanced degree. Becoming a professional ballerina. All of those are challenging – but I picked “advanced degree” because cerebral palsy, asthma and vertigo make the other two options impossible.

    Sure, some women might be able to overcome issues in breastfeeding with work – but IGT or non-specified lack of enough breast tissue producing milk isn’t going to get better from effort. Ditto for babies who lack mouth coordination or good muscle tone or have weak lungs.

    I was barely producing enough breast milk to feed my son when he reached term age. He enjoyed sucking, but needed every bit of oxygen he could to survive and grow. Maybe he would have learned to breastfeed – but the potential risks of failure to thrive in a baby who already had lung damage was just too high a risk for me – so I went for optimal nutrition that came in the form of formula.

    • “Dr. Johnson was observed by a musical friend of his to be extremely inattentive at a concert, whilst a celebrated solo player was running up the divisions and subdivisions of notes upon his violin. His friend, to induce him to take greater notice of what was going on, told him how extremely difficult it was. “Difficult do you call it, Sir?” replied the Doctor; “I wish it were impossible.”

    • Who?

      I think it’s a good reminder that sometimes, where practice or learning lists or developing endurance is required, doing it when you don’t feel like it is important to achieving your goals. Even the most talented person has to practice.

      It’s totally useless when what is being worked on is something you can’t fix.

      • BeatriceC

        And sometimes even a person who works hard, has the skills, and even the inborn talent doesn’t succeed. I was a classical oboist. I was accepted to The Juilliard School. But shortly after my audition I got into a mountain climbing accident which destroyed my hands and wrists and can no longer play. All the work in the world wasn’t going to change that.

        • Who?

          That is so tough, and it must have been difficult as well to then find an outlet for the musical talent and artistic drive that went into your oboe playing.

          • BeatriceC

            It’s the cause of my one and only suicide attempt. That was a really bad year.

            But, I discovered I loved math more than I realized, and also discovered I was good at teaching it, and a new passion was born.

          • Who?

            That is truly rough. Glad you found a new passion and carried on.

  • PeggySue

    Look, I have to say that, if a friend came to me and said they were training for a race, I’d say “That’s nice.” If they wanted me to do more to “support” them I’d be dumbfounded. Do people REALLY expect others to “support them” with all their endeavors?

    • JDM

      Apparently, you should not only support them, but encourage them to run even after they’ve severely sprained their ankle, with maybe a possible break. Because after all, it’s not always easy, but it’s always the thing to do.

      • The Bofa on the Sofa

        And you can’t tell them that you knew someone who wasn’t training for a race, and especially that it was ok for them to not be racing. Because that wouldn’t be supportive.

  • demodocus

    One of Bofa’s laws, all else being equal, but it’s never equal.
    Once my milk came in and the monster cracks finally turned into a scar, the physical part was (for me) pretty easy. The psych part only got worse and worse.

  • crazy mama, PhD

    So if breastfeeding was relatively easy for me, does that mean (according to her logic) that it wasn’t worth it?

    • momofone

      I wondered the same thing. If formula feeding is so much more difficult, isn’t it the more worthwhile pursuit?

      • Sue

        Exactly! If all that bottle and teat washing and sterilisation is so difficult, it must be worth doing, no?

    • Cassandra

      No, that’s affirming the consequent, which is a fallacy.

      • fiftyfifty1

        I’m not so sure it’s affirming the consequent. The author asks the rhetorical question “What in life worth doing is easy?” with the implied answer being “nothing.” Nothing worth doing is easy. Therefore if easy, then not worth doing.

    • Who?

      You have hit upon the breastfeeding paradox.

      It’s easy, so why wouldn’t you do it?

      But also, if it happens to be hard for you (little lone snowflake that you are) that’s because either you haven’t been properly supported (up to you to find better support) or you haven’t tried hard enough and just need to do more of everything to make it work.

      Heads I win, tails you lose.

  • The Kids Aren’t AltRight

    It’s funny how she identifies the fact that breastfeeding promotion seems to trump actual education on this topic, and then after acknowledging that breastfeeding can be difficult. However, instead of offering sympathy or advice, which would actually be useful, she immediately resumes brow-beating.

    I am still kind of pissed about the lack of info in my beastfeeding class at the hospital. We went over and over the naturalness and the alleged benefits of breastfeeding, as well as the alleged benefits (but never once the size of a benefit, that might be too useful)! However, I still don’t know how to choose a breast pump or how to use it. How to prepare a bottle of pumped milk, how long such milk lasts and how best to store it. Let alone any info about combo feeding. I have 10 weeks to go, and feel a bit overwhelmed with it all, but don’t feel like I have a place to turn for help unless I want to call a lactation consultant for either a brow-beating or pseudo-feminist-empowerment platitudes.

    • Madtowngirl

      Yes, this was all information I didn’t get either, and the LC in the hospital acted like I was stupid for not knowing how to use my pump. I had it easy – I chose the free one. I did like it, and it was a Medela. Not the top one, but it was easy to travel with.

      Honestly, Fed Is Best might be a good place to ask about combo feeding/pumped milk questions. I think you’ll get a lot of good information from them.

    • crazy mama, PhD

      I had so much trouble getting a straight answer about when and how to start pumping! With my first kid, I was going back to school part-time at 6 weeks, so we wanted to introduce a bottle at 3ish weeks, which would require having some pumped milk to go in the bottle. No written resource seemed to address this initial part. I asked the two LCs who were teaching my breastfeeding class. One recommended pumping a little bit after feedings as soon as my milk came in (which is what I ended up doing), while the other went “nooooooo you have to wait at least 3 weeks.”

    • BeatriceC

      Jody runs an amazing support group through FB. It’s a secret group because there’s been problems with lactivists coming in and causing trouble. There’s a screening group you can join and they have a process for getting you into the feeding support group. The group is full of wonderful information and real support for every type of safe feeding.

    • Justanrph

      I mostly pumped. It worked so much better for us and it was so much less stress when I stopped trying to force a baby that didn’t want to nurse to nurse. “I want it from a bottle, mom! You are too sweaty and I don’t like to eat at this angle. Plus, make sure it is cold.” Still doesn’t like warm food…

      I used the one my insurance covered, it was a Medela. Luckily, the hospital lactation consultant showed me how to do it in the hospital. Otherwise, I would have called one of my several friends who had pumped for help. Or YouTube.

      From the fridge magnet sent home from the hospital with me:
      Good for 4-6 hours at room temp (shorter if it is hot out). I always put straight into the fridge (see above, my kid didn’t like it warm).
      I think 3 days in the fridge.
      3-6 months in the separate freezer of a fridge/freezer combo.
      6-12 months in a deep freezer.

      You are supposed to keep it in the back of the fridge, but I kept it up front so I could reach while holding baby.
      So people’s milk fat breaks down when frozen and then tastes funny; they need to scald before freezing. I was lucky and didn’t need to do this as I didn’t find out that was a thing until I had been pumping and freezing for about 4 months.
      I never sterilized my pumping stuff or bottles, just cleaned with hot water and soap. I had a full term baby with a typical immune system, if that weren’t the case I would probably have sterilized.

      In the end, you will do what works for you and baby and your family. I wish you the best of luck at the end of you pregnancy and hope everyone comes out healthy and recovers quickly. Don’t sweat the feeding as long as baby is growing and it isn’t destroying your mind; in a year you will be pulling lint and dirt out of his/her mouth anyway!

    • Mel

      Since my son came so early, I was completely unprepared for anything involving breastfeeding or pumping. Thankfully, the nurses helped a lot because my LC was nutso.

      Pumping is really straightforward. Generally, health insurance covers a certain brand or a few brands of pumps. In my neck of the woods, the Medela Pump In Style was the pump provided by insurances. The pump comes with easy instructions. The “hardest” bit is figuring out how to put the flange, valve and collection piece together – but once you’ve done it once or twice it’s pretty simple.

      The flange is the part that connects your breast to the pump. The size of the flange needed is determined by the diameter of your engorged nipple – and by whatever feels the most comfortable for you. YouTube is useful for this because there should be a certain amount of movement of the nipple without too much play on the areola. My Medela came with size 24 and 27 (mm) flanges. If you need a different size, you can order anywhere from 21 – 33mm flanges online.

      Wash all of the pieces that come in contact with milk after each use. I just used dish soap and warm water. If you think you are going to be pumping a lot, purchasing extra valves is a good investment. The valves become softer after time and cause the suction to become weaker. (My local Target and Meijers had them on the shelf, but you can get them online, too).

      My son was a micropreemie so the rules were 48 hours for fresh breastmilk that had never been frozen to either be used, frozen or discarded, 24 hours for defrosted breastmilk and could keep for 6 months frozen.

      No special prep is needed to put breastmilk in a bottle. Breast milk isn’t homogenized so the fat will separate on top. Shake it gently to disperse the fat back into the milk. Frozen breast milk can be defrosted in the fridge or in warm water.

      Combo feeding – do what works for your family. Formula and human breast milk are at about 20 cal/oz so formula and breast milk can be used separately or mixed together. Some babies will refuse to take a bottle from their nursing mother – but will take the bottle from any other human being. If you are thinking about combo-feeding, there’s some benefit to introducing formula pretty soon; some kids will refuse formula because it tastes different if they’ve only had breast milk before. My SIL was EBF her son. She and I were out and about with my nephew when he became hungry at about 3 months, but she had just pumped before leaving the house. We made up some formula for him – and he refused it from her. I gave it a shot and he took about 3 gulps before screaming at me. After that, he was chary about taking a bottle from me for about a week – and would smile and coo happily when he found I was giving him food that tasted “right”; the human instinct for positive reinforcement starts young 🙂

      • demodocus

        You -devil- trying to give him some odd substance. Girlbard has the same reaction to cheese crackers that aren’t fish or squares, lol.

    • Guest

      I had the medela pump with my first and now the Spectra with my second. The Spectra is a completely different pumping experience from the medela and for me has been a much much better pumping experience. It’s more comfortable and I pump more with it. Not trying make your pump choosing experience more difficult with an added type since most people have used the medela. I just really wish I had had the Spectra the first time around. It’s been so much better!

    • demodocus

      Breastfeeding Without the BS is a useful blog, too. She hasn’t written anything new in ages, because her “baby” must be school age by now. It was a big help to me when Boybard was new.

      http://breastfeedingwithoutbs.blogspot.com/search?q=pump

    • Cartman36

      Funny enough, I found the information that formula companies sent me with the samples really helpful for breastfeeding. They actually had a LOT of information about breastfeeding and storing breastmilk, etc. Gerber offers a free phone consult with a lactation consultant.

    • swbarnes2

      One more tip to pile on…if you end up doing some combo-feeding…give a few trials to giving formula at room temp or cold from the fridge.

      As for pump choice…you probably won’t get much. You need to find a medical supply place that your insurance covers, and you get whatever they have, if they have any. It sometimes takes some calling around. I ended up getting one from the same supply place that the bili blanket came from

    • The Kids Aren’t AltRight

      Thank you for all the advice! This is a lot of good info. I just wish the class got to hear it too.