Friday, April 17, 2015

A Nursing Mom Walks Into A Bar


"One a day helps the boobie milk stay!" They trademarked that specific phrase. They actually did.
Anyway, brought to my attention today: The (yes, really) Boobie Bar, merely the latest in processed, packaged lactation cookies, though it claims to be "the original lactation bar", which I guess refers to the fact that it's the first to be cut into a rectangle rather than a circle, since it's obviously far from the first. Look, I know nothing is new about manufacturing and marketing lactation cookies at this point, there are a couple of them out there now, but as far as I'm aware, this is the only one trumpeting the fact that it was co-created by an IBCLC.

A few starter questions:
  1. The aforementioned IBCLC is identified only as "Nurse Wendy" anywhere on the site that I can find. Why no last name so we can verify her credential?
  2. This "independent study" they refer to on the Our Story page, highlighted in pink but not actually linked to anything - where is it? What does it say? What was the control? How large was the group? Are there any details you can tell us beyond the claim that they "can increase milk supply up 4.6oz per day! [sic]"?
  3. The "proprietary herb blend" that each bar contains: How much of each? All the information about each herb they list on your Ingredients page is great. I'm actually a big fan of lactogenic foods. I also know that much depends on the use of an actual therapeutic dose, which is why many of the tea blends that throw a little of every popular galactagogue into the mix are a serious gamble. Those blends might happen to have one or two of the right ingredients for a particular mom (galactagogues are NOT one size fits all, either, but that's another post), but in such a minuscule amount that they have minimal, if any, effect on mom's production. The Boobie Bar promotional materials make a big show out of the claim that you only need to take one per day to increase your supply (okay, to "make the boobie milk stay"). That's pretty impressive, so how much of each herb, exactly, goes into that one bar?
  4. Each bar has more sugar and carbs than a Krispy Kreme doughnut. Okay, that's not a question, I just thought it was worth pointing out.
It's genuinely nice that they refer to the importance of seeking an IBCLC in multiple places on their site. I will say that one positive thing for them. I just wish it didn't come as part of the promotion of a product that does nothing to actually target any individual woman's underlying cause for low supply. I wish even more that it, and others like it, didn't contribute to the undermining of mothers' confidence in their own bodies, and to the overall perception that perfectly normal women need to purchase and consume products in order to have a healthy milk supply.

I've said it before and I'll say it again and again and again: physiological low supply doesn't just randomly happen to unlucky moms for no reason. There is always an underlying cause.

Galactagogues CAN often be part of that solution - but only if they're A) tailored to that specific mom's underlying cause, and B) used in therapeutic doses. Boobie Bars and Milkmakers and the like? Hey, you might get lucky if you just so happen to need one of the herbs included in the melange, and need so little of it that it happens to work. And placebos can also be very effective. Is either possibility worth $16 per box (6 bars each)?

*As opposed to perceived low supply, a critical distinction and one that is imperative to rule out first (and which is coincidentally very likely to respond well to the placebo effect).

Thursday, February 26, 2015

The Unexpected Shower Guest




INT: SMITH-JONES RESIDENCE in Kensington. Afternoon.  A baby shower is underway, with stylishly dressed women sitting in a semicircle around DR. MARTHA SMITH-JONES, who is clearly in her third trimester. A huge pile of pastel-festooned gifts is in front of MARTHA, who is opening a large flat box.

MARTHA: 
This is from Sarah, eh?

She takes out a yellow onesie, as all the women coo. She turns it around to show off the back, which has a duck face on the bottom. The women squeal.

SARAH:
 I do wish you’d let us know whether it’s a boy or a girl. It’s so hard to buy everything in gender neutral yellow, or purple, or green, or white, or . . . Well, you know what I mean.

MARTHA:
 It’s a mystery to us, too, on purpose. We’re totally fine with being surprised, and besides, who knows how they might identify in the futu-

She trails off, distracted by a telltale whooshing sound outside their window. Only a few of the partygoers notice the sound, and seem undisturbed by it.

MARTHA: 
Excuse me. I  . . .  think we might have a late arrival.

She hoists herself up off her chair and walks with effort towards the front door, clearly with equal parts apprehension and excitement.
TISH:
 They’d better have RSVP’ed, yeah?

The women go back to chatting amongst themselves.

MARTHA takes a deep breath, opens the door and sees the back side of the ELEVENTH DOCTOR, who is fussing with a gift bag. He wheels around. MARTHA marvels at his transformed appearance and style, not sure what to make of it.

DOCTOR: 
Well, look at you. Martha my dear. I heard the news and just couldn’t pass up the chance to travel back 6,237 years and drop by for some well-wishing.

MARTHA: 
It really is you.

DOCTOR:
 You look so . . . different!

MARTHA:
 Likewise.

DOCTOR:
 Hm? Oh, oh yes, right. My extreme makeover. (He steps back with a flourish.) What do you think?

MARTHA:
    . . . Quite fetching. I  . . . just wasn’t expecting. I mean, I am. Expecting! That is. As you can surely – won’t you come in?

She steps back from the door and gestures him in. As he enters the living room, all the heads turn to stare at him. He waves amiably if awkwardly.

MARTHA:
 Everyone, this is the Doc . . .tor John Smith,

DOCTOR:
 Hello.

TISH (skeptically):
 Dr. John Smith? So, he’s a . . . relative of Mickey?

MARTHA:
 No, no, just an old friend. Colleague.

SARAH:
 Speaking of Mickey, this IS supposed to be ladies only, Martha! You didn’t even want the father here, much less old flames. (She giggles)

MARTHA (flustered): 
Not a flame at all, just a friend.

DOCTOR:
Very old. 

TISH:
 Suit yourself, it’s your shower. But I only have enough sticky toffees for those who RSVP’ed.
 
She exits to the kitchen, two other women following with wine glasses in hand.

DOCTOR: 
So, I brought you something. Made you something actually.

MARTHA:
 Really? You made something for me?

DOCTOR:
 For you and little Stella.

He jovially pats her belly. The ladies gasp. Martha looks stunned.

DOCTOR:
Ohhh. You – you hadn’t gotten there yet. Right. Well she turns out to be just super, reall-

MARTHA gestures to stop and shushes him.

DOCTOR:
 Sorry, right, got it. ANYWAY, here.

He holds the bag out in front of him.

MARTHA: 
Can’t believe you did this. Thank you.

She smiles and sits down to open it. She pulls out a nipple-shaped contraption with flashing lights, wires and electrodes extending from it.  She and the party guests are all stumped.

MARTHA:
Um, wow! It’s, um. What exactly is it?

DOCTOR: 
I call it the Tracking Incremental Totals Breastmilk Infant Transfer.

MARTHA looks blank.

DOCTOR:
I know, a bit cumbersome, even for the brightest of you humans. So you can just go by the acronym.

MARTHA (pauses to think):
  . . . Oh no.

DOCTOR:
 That's right. The TITBIT.

He beams. MARTHA is now completely nonplussed.

PARTY GUEST: 
So, what’s it for? What’s it actually do?

DOCTOR:
 Here, allow me.

The DOCTOR begins fiddling with the TITBIT, unwinding wires and starting to set it up as he talks.

DOCTOR:
 You see, I knew you’d want to breastfeed, since you surely know it’s the biological norm and the optimal start for your baby.

He places electrodes on various places on mom, looks around and grabs a throw pillow to place in her arms as the “baby”, places electrodes on it as well, then goes to place the nipple shield component on her breast. There’s an awkward pause. He then hands it to Martha to place herself, which she does, skeptically.

DOCTOR: 
But I read that early cessation of breastfeeding is attributed largely to lack of maternal confidence in her supply, and not knowing how much milk their baby is actually getting. So I thought, why not develop technology that can demonstrate both! The TITBIT here measures flow of milk, volume in the mammary gland, corresponding volume in the infant stomach, and maternal hormonal levels as well.

He sets up a switch that goes *DING*

DOCTOR: 
Brings back memories, eh? Then, all that lovely data connects to an app [he grabs MARTHA’S phone off the side table and hands it to her] so Mum can follow the whole flow of the feeding, right on her mobile. Not unlike the monitors they use to track contractions at the hospitals when you’re in labor! All right there in a readout.

He steps back to admire his handiwork, very self-satisfied.

DOCTOR: 
There you have it.

There is a long, uncomfortable pause as Martha and the guests all look at each other. The Doctor rocks back on his heels. 

DOCTOR: 
So, accolades now?

MARTHA: 
It’s  . . . I know you mean well, and I can tell you put a lot of –

PARTY GUEST:
 Oh, I’ll say it. I know he’s your friend, so I’ll say it. Dr. Smith, I appreciate that what you meant to do was encourage Martha, but honestly, all that contraptions like this do is undermine a new mum’s confidence. Doing things like weigh-ins at home before and after feedings, just creates an obsession with numbers, and makes mom start doubting everything. Mums need to trust themselves, and if something seems to be going off the normal path, they need real support, not a mechanical measuring system spitting out numbers she can’t make sense of.

YET ANOTHER PARTY GUEST:
 I thought the diaper was the breastfeeding measuring system.*

ANOTHER PARTY GUEST:
 Exactly. In most cases that’s the only one you need! I’m a lactation consultant at Martha’s hospital, and while pre- and post-feed weights can be useful information – and only if it’s done with a VERY accurate scale, which is unlikely to be in a layperson’s home – but it’s only one part of a very complex picture. Just giving mums the raw numbers doesn’t give her any idea how to put them in context. And in most cases, she doesn’t need to anyway.

The guests all murmur their agreement. The DOCTOR is taken aback by the conversation, occasionally looking like he’s about to interject, but thinks better of it each time, and continues to listen to them.

STILL ANOTHER PARTY GUEST:
 And numbers aside, using a nipple shield is already an intervention, isn’t it? And one that can interfere with breastfeeding if it’s not actually indicated in their situation? Why would you introduce one in a contraption like this, for no good reason?

YET ANOTHER PARTY GUEST: 
What about the sensors supposedly reading milk volume? It’s like he has no idea how human milk is synthesized – which is constantly adapting and changing.

SARAH:
 This won’t be the last such invention we see, I’m afraid.  I actually attended the MIT Hackathon in Boston last fall. Many of the brilliant engineers wanted to "fitbit" breastfeeding, exactly like this device. I spent all weekend telling them NO. And then explaining why this would actually hurt breastfeeding. They had a hard time understanding the concept, and I can imagine we will see lots more devices like this in the coming years. Sigh. Let's hope the innovative breast pump ideas I saw work better than these feedback devices.**

YET ANOTHER PARTY GUEST (gesturing with her wine glass): 
Quit trying to biohack breastfeeding, technology overlords!

The guests all raise their glasses.

DOCTOR: 
Not overlord, actually, Timelo-

MARTHA shakes her head vigorously at him, and he zips it.

1st PARTY GUEST: 
If you really want to create something that helps nursing mums, why not hook up with Human Milk for Human Babies to create an app that will match milk donors with babies who are in need?

STILL ANOTHER GUEST: 
Yeah, or what about an app that connects mum to her community and helps coordinate all the support she needs? Meals, errands, a load of laundry, I would have loved that in those early postpartum days.

YET ANOTHER PARTY GUEST: 
Or if you really must invent a wearable device that measures something, make it measure the amount of time the mother and baby spend skin to skin. That alone is so powerful and so overlooked, since there’s no way to make money off it. Well, YET, I suppose.

SARAH: 
Another area that could use some help is making at-breast supplementers a little more user-friendly, so that in the cases where supplementation is truly needed – again, hopefully with professional guidance - mums have an easier time with doing so at the breast. But it needs to be minimally invasive. Not like this nightmare. [She gestures at MARTHA, then looks at the DOCTOR.] No offense.

DOCTOR: None taken, none taken, but I . . .

TISH enters with a tray of sticky toffee cupcakes and her two friends.

TISH:
 Here we are, everyone. [To the DOCTOR] I think there are some Jaffa cakes in the pantry, if you’d like.

MARTHA starts taking off the device and placing it back in the bag.

MARTHA: 
Come on, I’ll get them for you.

She rises from the chair and walks to the kitchen, the DOCTOR following.

DOCTOR: 
Is that all true, what they’ve said? What do you think?

MARTHA (rummaging around in a cupboard):
 Doctor, you know I adore you, more that I even should. Even with the bowtie. I appreciate you wanting to do this for me so much. You mean so well. But they really are right.  

DOCTOR: Well, I just . . . I wondered about, you know. You’re not particularly, um.

MARTHA turns around with a packet of Jaffa Cakes.

MARTHA:
 I’m not particularly what?

DOCTOR (looking around, avoiding her gaze):
 Not, well, I mean relatively. Compared with, I mean . . .

He notices a portrait of a Rubenesque woman on the wall and gestures to it.

DOCTOR: 
With, say . . . and you, not that there’s anything wrong. You’re, you’re quite comely, but, I mean, rather petite and . . .

He gestures quickly and bashfully at her chest.

MARTHA:
 Oh Doctor. That? (She laughs, looking at her bosom.) Breast size has next to nothing to do with supply. Women with cup sizes even smaller than mine can produce more than enough milk quite well. It's supply and demand, as long as babies have plenty of access and everything else is proceeding normally.

DOCTOR: 
Really? I mean, that’s wonderful of course. But really?

MARTHA: 
Really. (She hands him the packet of Jaffa Cakes.) Think of them as being bigger on the inside.

DOCTOR: 
Marvelous.

MARTHA:
 All that unbelievable intelligence, all those hundreds of years in that spectacular head of yours, and yet you somehow missed that little, uh, tidbit of information.

DOCTOR: 
Well, it doesn’t happen often, but when it does, I am happy to stand corrected.

He bows, takes a bite of cake and then looks suddenly crestfallen.

DOCTOR (through a full mouth): 
But now I have no gift for you and Stel- er, the mystery fetus.

MARTHA: 
Oh, it’s quite alright, just coming here at all was such a nice ges –

DOCTOR: WAIT! I’ve got it.

He turns and runs back through the living room, past the cupcake eating guests who watch him fly by.

DOCTOR: 
Beg pardon, won't be a moment . . .

TISH: 
Awfully rude.

He departs. We hear whooshing.  Martha walks to the front door and waits. We hear whooshing again. The DOCTOR races back up, slightly winded and hands her another bag.

DOCTOR: 
There we have it. Go on.

MARTHA cautiously opens the bag and takes out a tiny fez.

MARTHA:
 I . . .

DOCTOR: 
Cool, isn’t it? Now available in size Cute as well.

MARTHA:
 It’s absolutely both. Thank you.

She reaches out and squeezes his shoulder. He pauses and then hugs her in return.

DOCTOR: 
Well, universe calls, as always. Best of luck. Dr. Smith-Jones.  And abundant breastfeeding.

MARTHA: 
And best of luck to you, Doctor.

DOCTOR: 
Oh, and if you ever need someone who speaks Baby to translate . . .


He waves, hops back into the TARDIS and is gone. She walks back into the party, smiling. 

____________

* Quote by Pauline Gnesin, on Anne's personal Facebook page
** Quote by Lori Bond Atkins, on :LACTNET Facebook group discussion (links in quote are my own addition)


Sociable