Book Review: Mothering Your Nursing Toddler by Norma Jane Bumgarner

“How long do you intend to nurse?”

If my experience is typical, it’s a question many a nursing mother has heard many a time.

And my answer has always been… difficult to give.

Because I didn’t have any hard and firm answer. I intended to keep nursing until we stopped.

I did know that would not be until Tirzah Mae was at least 12 months old, since cow’s milk is not recommended until age 1 due to a high sodium and protein content that can tax an infant’s kidneys (and because I had no desire whatsoever to provide formula, that nasty-smelling, clothes-staining stuff.) But after a year? Who knew.

Generally, my questioners would follow up with the question they really wanted answered: “But you aren’t going to still nurse when she’s old enough to [lift your shirt, walk up to you, ask to nurse in English]?”

And I… didn’t really know what to say exactly.

My observation has been that most mothers I’ve talked to who have nursed for truly extended periods of times (past their child’s third birthday, for example) have often delayed practices that I consider healthy (for instance, waiting to give their nursing child solid food and water until long after six months) or prolonged practices that I consider less than ideal (such as frequent nighttime nursing.) Since I intended to introduce solid foods at six months and water to go along with solids – and felt that an infant or toddler should, at some point, learn to sleep through the night without waking to nurse, I imagined weaning would occur sometime before my child’s third birthday.

When Tirzah Mae turned one, I had an easy excuse for continuing to nurse beyond the American Academy of Pediatrics’ minimum recommendation of one year – Tirzah Mae was born early, so it was really only like she was ten months old. But I also knew it would be worthwhile to read up on this “nursing a toddler” thing – and I knew just the book.

La Leche League’s Mothering Your Nursing Toddler by Norma Jane Bumgarner is THE book on the topic – and my library happens to have it.

This book’s greatest strength is in encouraging mothers of nursing toddlers through countless stories that can assure them they are not alone – a very useful thing for those mothers who often DO feel alone as they nurse their baby-who-is-no-longer-a-baby.

On the other hand, Mothering Your Nursing Toddler seems to assume that nursing for a very extended period of time is both beneficial and desirable in almost all cases. While I don’t think that nursing for a very extended period of time is harmful, I don’t know that it is necessarily to be encouraged by default. But, since that is the position Bumgarner takes, she encourages those practices that I’ve observed in prolonged nursers – suggesting that following the practices I recommend is actually parent-led weaning.

And if that’s so, I started weaning at six months, when Tirzah Mae started eating solid foods and drinking small quantities of water to go along with it. We continued weaning when Tirzah Mae turned one and I started giving her small amounts of whole cow’s milk with a couple of meals or snacks a day. If I didn’t feel like nursing when she was grabbing for the breast, I offered her cow’s milk or water in a cup first. If she was satisfied with that, we didn’t nurse. If she refused the water or milk, we’d nurse despite my not feeling like it. Sometime around a year, I stopped automatically feeding her when she woke up at night. I cuddled her close and rocked her and put her back in bed without nursing unless she made clear that she would only be pleased if I nursed her.

Now, she’s nursing a couple of times a day, usually before naptime and bedtime – although we occasionally nurse more, depending on her state of mind and my own.

I have no plans for stopping anytime soon (although I also don’t begrudge the days when Tirzah Mae falls asleep before we’ve nursed and ends up not nursing at all.)

I feel no need to pump on days that Tirzah Mae chooses not to nurse. Before I read this book, I would have assumed that was a part of child-directed weaning. She doesn’t nurse, so my body doesn’t make as much milk, so weaning commences. But I don’t think Bumgarner would agree. She seems to think it quite unlikely that a child would self-wean before age 2 and would therefore encourage pumping to keep supply up.

So…what DO I think about this book? Just like this entire topic, it’s hard to say. I suppose it could be very encouraging to the mother who feels like her child could benefit from extended breastfeeding – and I would recommend it to that woman. The woman who is pretty sure she doesn’t want to nurse past a year is unlikely to benefit from this book (if anything, she’s likely to feel overwhelmed by the suggestion that she should keep nursing until three, four, or beyond.) It’s tougher for me to say whether I’d recommend this book for a woman who is uncertain about continuing to nurse.

I think there are definite benefits to continuing to nurse as long as both you and your child want to. I do NOT think that means that your nursing relationship has to be on your child’s terms (as Bumgarner generally seems to recommend). It’s appropriate that, as your child no longer relies on your breastmilk for the primary source of his nutrition (usually around a year of age), you as the mother would take a more active role in determining when and where you breastfeed your child.

Rating: ?
Category: Breastfeeding
Synopsis: All about breastfeeding a child at age 1, 2, and older
Recommendation: I’m not sure.

Book Review: Bouncing Back after Your Pregnancy by Glade B. Curtis and Judith Schuler

Of all the books on postpartum issues that I have read so far, Bouncing Back After Your Pregnancy is the most comprehensive and well-organized. Topics flow from immediate issues to infant feeding to maternal nutrition and exercise to marriage and family topics to returning to work and planning your next pregnancy. I’d love to be able to recommend this book.

Unfortunately, the content is simply ridiculous and filled with misinformation. Episiotomies are assumed and, to read the chapters on immediate postpartum care, you’d think the episiotomy is really the most important part of childbirth (before and after). The exercises in the exercise chapter are laughable – some aren’t really much by way of exercise and several list the wrong muscle groups as the ones being exercised. No distinctions are made between strength exercises and stretching and no attention is given to grouping exercises into any logical pattern. And the breastfeeding advice…

Let’s just say the authors probably couldn’t be more anti-breastfeeding if they tried.

Bottle-feeding is listed first in the infant feeding chapter and great pains are taken to list every possible advantage of bottlefeeding and to minimize any possible disadvantage you might have heard. Once the authors get around to discussing breastfeeding, a bold section heading offers “disadvantages to breastfeeding”. Almost every bit of breastfeeding advice is given as a blanket statement that assumes breastfeeding is uncomfortable, messy, and inconvenient. Mothers are educated on “warning signs” in a breastfed baby – but not told what signs suggest that breastfeeding is going well. The authors only recommed breastfeeding for six months and reassure moms that the majority of mothers don’t go that long.

Bad breastfeeding advice and attitudes aren’t limited to the breastfeeding chapter. In the chapter on nutrition, mothers are given lists of foods not to eat while breastfeeding (actually, most breastfeeding babies will grow and thrive even if their mothers make NO changes at all to their diet – even if the mother is eating unhealthfully in the first place.) The chapter on returning to work mentions the possibility of pumping and gives a little advice, but the advice is incomplete and doesn’t offer any middle ground. Yes, I’d rather a baby get only breastmilk, even while his mom’s at work – but feeding formula while you’re away and breastfeeding at the breast when you’re with baby is better than weaning completely, and is TOTALLY doable (I’ve seen dozens of women, mostly Hispanic, who have very good success with this.)

So no, I can’t recommend this book. I’ve focused on the breastfeeding issues mostly because that is an area in which I have expertise, but the problems with the breastfeeding advice are just an example of the poor research and rampant misinformation found within this book.

I do NOT recommend Bouncing Back after Your Pregnancy.

Rating: 0 stars
Category: Postpartum health
Synopsis: A look at issues facing postpartum moms.
Recommendation: Full of misinformation. Not recommended.

Breastfeeding: Normal or Best?

It’s popular, in breastfeeding circles, to talk about how breast isn’t best – it’s normal.

In general, I find the arguments uncompelling (and whenever I do find one compelling, it is unable to withstand discussion with my husband, who is my resident sharpener-of-thought.)

The problem with the debate, I think, is that it adds nothing useful for the woman who is undecided or opposed to breastfeeding. It serves as a rallying cry for the lactivist, but does little for average-Jane-moms.

The other problem with the debate is that there are a couple of different definitions of normal that come into play. There are cultural norms and physiologic norms – two quite different things. Cultural norms refers to what is usual or expected in our cultural. Unfortunately, breastfeeding is not currently normal in our culture. Physiological norms refers to the expected standard for health. So a physiological norm might be a BMI between 18 and 25 (despite many in our culture falling above that range).

Proponents of the “breastfeeding is normal, not best” argument state that using the “best” terminology suggests that breastfeeding is something that women can do to go above and beyond – like telling them that a glass of wine daily can reduce their risk of heart disease. No one would fault a woman for choosing not to go the extra mile to drink a glass of wine daily. They could still be acting appropriately and normally without consuming wine. But breastfeeding is not like a glass of wine daily, adding some benefits but not really something women should be expected to do.

In my opinion, this only adds fuel to the mommy-war flame, without really helping women (who experience great pressure from cultural norms opposing breastfeeding.)

To tell a woman that something is normal and expected physiologically (as it certainly is – just as heterosexual sex is normal and expected versus homosexual sex**) before it is normal and expected culturally is more likely to cause her additional anguish rather than to assist her in making a decision and holding to it.

As an aside, I would love to live in a world where breastfeeding was the cultural norm – where women breastfeeding was common and accepted and where bottles were not the ubiquitous symbol of a baby. I would love to live in a world where all husbands made enough money that their wives could stay home for a minimum of six months after delivering so they could breastfeed their babies (without having to pump and provide expressed breastmilk) – and where there were no husbandless mothers. But that is not the world we live in, so calling breastfeeding “normal” when it is not culturally so confuses the issue.

So I’m not a fan of the “normal” argument. Or at least I wasn’t until I read the following in Jack Newman and Teresa Pitman’s The Ultimate Breastfeeding Book of Answers:

“There is no evidence that what is called ‘breastmilk’ jaundice is bad for the baby. None. On the contrary, bilirubin may be good for the baby, protecting him from potentially damaging chemicals in the body. What we have here is a lack of understanding; that is, too many people do not understand that breastfeeding is the normal physiological method of feeding infants and young children. If most exclusively breastfed, well-gaining babies are jaundiced, then this is normal and not a concern. On the contrary, we should be concerned about babies fed with formula (advertised as being ‘close to breastmilk’) who are not jaundiced. What’s wrong with them that they are not jaundiced? The breastfed baby should be the model of what to expect, not the artificially fed baby.”

This argument, I can agree with wholeheartedly. It would be incredibly useful if medical practitioners got used to the reality that breastfeeding is the physiological norm – and evaluated babies accordingly. If medical practitioners had growth charts that expressed biological norms for breastfed babies instead of formula fed babies, it is likely that fewer women would be encouraged to supplement with formula. If medical practitioners understood biologically normal levels of bilirubin and blood sugars in the breastfed neonate, many more women would be able to successfully establish breastfeeding.

This is a “normal” argument I can get behind.

As another aside (in other words, stop reading if you’ve got hurts related to breastfeeding that are exacerbated by women celebrating breastfeeding), I love Newman and Pitman’s follow-up paragraph:

“For these reasons, there is no call to take the baby off the breast for 24 or 48 hours ‘to be sure that it is breastmilk jaundice,’ and to bring the baby’s bilirubin down to those of the artificially fed baby. In fact, logically, we should not be worrying the breastfeeding mother at all about her jaundiced baby. We should be saying to the formula-feeding mother, ‘Your baby’s bilirubin is too low. This is probably not dangerous, but just to make sure that it is the formula that is keeping his bilirubin too low, I would like you to put the baby to the breast for a few days, so that his bilirubin moves up into the normal range.’ That’s logical.”

**Please don’t misunderstand me, I am in no way suggesting that formula feeding and homosexual sex are at all morally equivalent. That is absolutely untrue. What is true is that they are both different from the physiological or biological norms.

Ditching the Shield

Disclaimer: This post contains a frank discussion of some of the difficulties of breastfeeding a preemie. I try not to be vulgar, but I do discuss the mechanics of breastfeeding openly. If you’d rather not read, feel free to skip this post.

After two half-hearted attempts to get my nipple situated in Tirzah Mae’s tiny red mouth, the nurse told me to wait right there.

As if I could do anything else. The swaddled miniature in my arms was hooked to half a dozen monitors, keeping her – and me – tightly bound to our recliner.

I tried again, squeezing breast tissue between thumb and forefinger to make a “nipple sandwich”. But Tirzah Mae was looking away – and my attempt to draw her close caused my sandwich to fall apart.

The nurse returned, deftly separating the cardboard insert from the back of a blister pack.

“Here.” She handed me a clear silicone nipple with small holes on the end. “Your nipples are too big for her to latch onto.”

I thought about protesting. We’d barely tried to latch Tirzah Mae on – and nipple shields, I knew, were not without risks. But they’d drilled home the NICU truth – we couldn’t waste calories doing unnecessary things, even things like latching her on at the breast.

So that was that.

A week later, a different nurse asked me how breastfeeding was going as she weighed Tirzah Mae before a breastfeeding session.

I explained that we were using a shield, but that it was going okay with that.

I heard myself in her voice, urging me to try to latch on without the shield.

I nodded halfheartedly, just like my clients do when I make the same suggestion.

“You don’t understand,” I thought. “I only get to breastfeed once a day and that for only thirty minutes. I can’t waste our precious time trying to get her latched.”

And the frustration at NICU policies caught up to me – scheduled feedings that were spaced too far apart for my infant daughter who was clearly hungry, crying and eating her fists after just two and a half hours, being able to breastfeed only once a day, having breastfeeding timed and with before and after weights constantly measuring our performance. Hot tears rolled down my cheeks and I was thankful for the dimmed lights that hid my anger.

Once we had Tirzah Mae home, Daniel asked me occasionally how it was going – practicing without the shield.

I loved him for internalizing my antipathy towards the shield – and hated him for rushing me.

Practicing wasn’t easy. Tirzah Mae would become angry that milk wasn’t already flowing. I became impatient with her anger. I was tired, drained from long nights with little sleep and days where nothing got done.

It was so much effort to go without the crutch.

I cursed the nurse who gave it to us, who got us hooked on its subtle evil. I blamed her, crying stormily, as I fumbled with the shield with sleep-numbed hands. As it fell off – once, twice, five times.

Tirzah Mae grew angry with the wait and Daniel woke up to her wail. I blamed the nurse when Daniel complained of being unfocused at work the next day.

But we kept practicing, first once a week then more and more frequently.

We’re almost done with it, Tirzah Mae and I.

I never take it when we go out. I never use it when we’re breastfeeding around the house. It stays in the basket beside the bed, only to be used if Tirzah Mae’s too frustrated to latch after a few tries at night.

We’re on our way to losing the shield.

Good riddance, I say.

Lactose intolerance in babies

It happens in my office all the time. A mother declares that her infant is lactose intolerant: “Everyone in my family is”.

The professional in me keeps a neutral facial expression while I internally groan. And since the doctor has marked that the infant should receive Similac Sensitive for Fussiness and Gas, helpfully providing an additional diagnosis of “lactose intolerance”, I issue the infant checks for the lactose-free formula.

I groan because lactose intolerance in babies is incredibly rare. Babies’ guts make the lactase enzyme so they can break down the lactose found in their mother’s milk (all mammals’ milk includes lactose). It is only as children grow older and less dependent on mothers’ milk that their bodies stop producing the enzyme to process it.

The few exceptions are 1) primary lactase deficiency, which rarely ever occurs, 2) secondary lactase deficiency, where a gastrointestinal illness temporarily wipes out the body’s ability to make lactase, and 3) prematurity, where an infant is born before her gut lining has started to produce lactase.

Which brings me to my biggest groan.

Tirzah Mae had only ever received my breastmilk, slowly increasing feedings as the IV nutrition was decreased. Most of what she got was via the feeding tube, but she’d started taking it by bottle in the last few days – and we’d started practicing breastfeeding once a day as well.

As I prepared myself for our breastfeeding practice, I noticed that Tirzah Mae had spit up – and I mentioned it to the nurse, who observed that the spit up was bright yellow (my color discrimination has been poor since I delivered, so I didn’t notice anything odd about it under the dim lights.) When the nurse checked the residuals left in Tirzah Mae’s stomach, they were green. Feedings were put on hold and breastfeeding practice suspended.

That evening, the nurse practitioner came in to discuss the situation. She explained the plan: to start again with smaller feedings and work our way up again – and asked me how much dairy I consumed.

She explained how preemies sometimes don’t yet have the ability to process lactose and requested that I reduce my intake of dairy down to maybe one serving a day – and maybe I could try lactose-free milk instead of regular.

I put on my patient face, inquiring about what she thinks might help, while inwardly groaning.

You see, despite the opinions of plenty of doctors and nurses, lactose intake by a woman actually has no impact on the amount of lactose present in her milk.

In a lactose-tolerant woman, any lactose she eats is broken down into its component sugars in her gut, from which the component sugars are absorbed into her blood stream. Then, independently, her breasts take sugars from her blood stream and synthesize them into lactose for her breastmilk.

In a lactose-intolerant woman, any lactose she eats passes through her gut into her colon unabsorbed – and bacteria in her gut ferment it, producing the typical symptoms of lactose intolerance (gas, diarrhea, abdominal cramping, etc.) Then, independently, the mother’s breasts take sugars from her blood stream and synthesize them into lactose for her breastmilk.

It’s simple science, really. But doctors and nurses didn’t spend their educations studying the science of digestion and absorption and metabolism like dietitians do.

So they give silly, unscientific advice related to diet and mothers swear by it because they see improvement when the prematurity (or the GI illness) that caused the problem in the first place resolves (sort of like thinking the antibiotic cured your child’s cold when it resolves in 7-10 days)**.

I choose not to argue and dutifully consume just one serving of dairy daily (actually, I only ever consumed one serving of lactose-containing dairy daily – since my former pattern was one cup of milk, one cup of yogurt, and one serving of hard cheese daily). I label my breastmilk “low dairy” and dream of the day when I can go back to eating whatever I want to without being dishonest. (Since the only reason I’m not eating the dairy now is so I wouldn’t be dishonest in writing “low dairy” on my breastmilk – I already know the restriction isn’t affecting her at all.)

**Caveat: Some women who are told that their infant has lactose intolerance and who reduce dairy as a result discover that this truly is helpful (and symptoms resume when milk is reintroduced). This is generally a case of mistaken identity. While lactose in mom’s intake and lactose in breastmilk are not related, the more cow’s milk a mother consumes, the more cow’s milk proteins will end up in her milk – and some babies do have sensitivities to cow’s milk proteins, which would resolve when mom reduces dairy intake.**

Book Review: Bottled Up by Suzanne Barston

Of course, Suzanne Barston intended to breastfeed. She intended to be a good mom – and, as the subject of internet-based reality show hosted by, she had incentive to do everything right.

When breastfeeding went poorly and she started supplementing, eventually giving up on breastfeeding entirely, she spent months ashamed over her “failure” before deciding to embrace her ultimate decision as “The Fearless Formula Feeder” (the blog where she can now be found.

Bottled Up follows some of Suzanne’s journey, but it goes far beyond a memoir. Barston argues that breastfeeding is not a good option for many women, does not live up to its extravagant health claims, and is overly politicized.

As an avid breastfeeding promoter (a good portion of my job is helping women understand the benefits of breastfeeding and helping them to successfully initiate and maintain breastfeeding), this book was frustrating, challenging, and sometimes painful – but in a good way.

Barston begins by arguing that breastfeeding promotion is all about fear and guilt: fear that you’ll be perceived as a bad mother (which makes you choose to breastfeed in the first place) and guilt that you weren’t able or willing to breastfeed (when you choose not to breastfeed or end up quitting.) I do not doubt that there is plenty of fear and guilt wrapped up in breastfeeding. There is a lot of fear and guilt wrapped up in parenting in general. But I wonder if this is how the women who enter my office perceive me to be operating. Do they feel that I am trying to use fear to induce them to breastfeed when I tell them about the marvelous immunological benefits of breastmilk and the many childhood ailments that breastfed babies have reduced risk for? Does the suggestion of risk reduction mean fear mongering? Many of these women have no reason to fear postpartum hemorrhage, yet I might still tell them that breastfeeding in the immediate postpartum reduces risk of postpartum hemorrhage. Does this produce fear for an adverse event (hemorrhage) rather than wonder at the marvels of our bodies (what I experience when I think about the effects of the hormone milieu of early postpartum breastfeeeding)? Do the women who didn’t breastfeed or didn’t breastfeed for long with their earlier children feel guilt when I encourage them that every breastfeeding experience is different and that just because they had some difficulties with one child does’t mean they’ll have those same difficulties with the next? Or do they understand that information as I intend it – to empower them to make a decision now unbounded by the fear of past experiences?

Next Barston discusses “lactation failures”, giving herself as a prime example. She started supplementing at two days when her infant had lost 10% of his body weight and was experiencing jaundice from AB-O blood incompatibility. The hospital pediatrician had offered Barston an option: “waiting it out” or supplementing with formula – and Barston chose supplementing, hoping to get herself and her baby out of the hospital as quickly as possible. Based on this experience, and a review of the many medical conditions for which the Academy of Breastfeeding Medicine does not feel supplementation is warranted, Barston believes that the today’s medical community is inappropriately disinclined to supplement and does so at the expense of infants – and their mothers. She argues that the common medical belief that only 1-5% of women experience primary lactation failure is scientifically baseless and that a much greater proportion of women are physically unable to breastfeed.

As a breastfeeding advocate, I frequently remind women that most women can successfully produce sufficient milk for their babies. I believe the 1-5% number, despite it being, yes, just an estimate. The simple fact is that there is no way for us to know, of those women who give up breastfeeding or supplement on day 2, how many of those women were incapable of producing sufficient milk and how many simply hadn’t had their milk “come in” yet (It’s a rare woman who has mature and voluminous milk on the second day postpartum – a more typical timeline is 3-5 days postpartum.) The number of women who enter my office complaining of engorgement after quitting breastfeeding because they “didn’t make enough” is astounding. I believe that there is true primary lactation failure. It exists. Other women (like my sister-in-law) experience secondary lactation failure, where their milk supply suddenly disappears due to extreme stress or starting a breastfeeding incompatible form of birth control. But the majority of women, including the ones who come into my office saying they quit because they weren’t making enough, are physiologically capable of producing breastmilk (and in sufficient quantities to meet their infant’s needs.)

I encourage women not to supplement – especially not in the first two weeks. I discuss what they can expect in those first two weeks. Baby might be really drowsy in the hospital and then “suddenly” be hungry all the time once you get home. That’s normal and not a sign that you don’t have enough milk. Normal babies have tiny stomachs that can’t stretch – they need to eat 8-12 times a day in those early days. Normal babies lose weight in their first few days of life. This is because they started out with a lot of fluid (even more if you had an IV during delivery), it doesn’t mean you don’t have enough milk. Your milk will start out yellowish and if you tried pumping it, you might only see a few drops in the bottle because the rest is stuck in the tubing. This is colostrum, it’s wonderful and he doesn’t need large amounts at a time (remember how little his tummy is?) What’s more, baby is better at getting milk from your breasts than the pump – don’t try to pump to figure out how much you’re making. Etc, etc, etc. I repeat it at least a dozen times in my “what to expect” speech: “That doesn’t mean you’re not making enough milk.” What does mean you’re not making enough milk? I educate them on that too – and I encourage them to let that be a sign for them to drop by the breastfeeding clinic at the hospital where they delivered. Most of the time, I explain, insufficient milk supply at the beginning is correctable. A lactation consultant (free at the hospital you delivered at in Wichita) can help you troubleshoot what’s going on with yours – they can evaluate latch and see if baby has a tongue tie or is pulling his lower lip in; they can do before and after weights to see how much transfer is actually taking place, they can walk through your breastfeeding routine and help you learn how to increase your supply. If your baby is showing some of the warning signs of not enough milk, don’t supplement, instead get yourself over to a lactation consultant!

In other words, I spout the stuff Barston complains about.

At the end of the second chapter, Barston explains how the seventh lactation consultant she and her son saw finally discovered the cause for the pain she had been experiencing while breastfeeding. Her son was tongue-tied. Barston describes how common this situation is and takes it as another proof that breastfeeding advocates are lying when they say that most women are able to breastfeed.

My chest aches and my eyes fill with tears.

I pray that I am not one of the six lactation consultants who offered ineffective advice without truly discovering the cause of breastfeeding difficulties. I pray I’m not one who tells women to just try harder, just keep going, it’ll get better without addressing their real needs.

Tongue tie is a true breastfeeding complication – but it doesn’t make breastfeeding impossible. A skilled lactation consultant can help the mother of many tongue-tied babies to find a position that allows for sufficient breastmilk transfer and avoids pain for the mother and the child. If the first consultant had discovered the tongue-tie, had helped Barston find a good position that worked for her and her child, would this book exist? Probably not.

Like I said, this book was frustrating, challenging, and sometimes painful.

I’m glad I read it. I feel it has given me much more perspective into how women who have “failed” at breastfeeding perceive our current breastfeeding culture – and how the breastfeeding community has let down some vulnerable mothers. Reading this enhanced my belief that most women know that breastfeeding is good for their babies – they don’t need to be convinced of breastfeeding’s benefits. Instead, they need to be educated regarding how to breastfeed, what to expect, how to know if something’s going well or poorly, and how to get help. And they need to receive careful individualized help when they ask for it. As breastfeeding support people, we need to ask questions, listen to mothers, and determine root causes of breastfeeding difficulties before we start handing out prescriptive advice (breastfeed more, put some lanolin on it, eat oatmeal). And we need to stop making the ideal the enemy of the good. We need to admit that many women are going to supplement even though we know exclusive breastfeeding is the best route – and we need to help them give baby as much breastmilk as they are willing or able to give.

I think this is a valuable book for all of us in breastfeeding support professions.

I do not think it’s a good book for mothers in general. Barston swings so far from the “breast is best” that she calls into question pretty much every bit of breastfeeding research that’s ever been done. Now, it’s true that breastfeeding research (like all research, but especially that sort that deals with human choices) is far from perfect, but the bulk of the evidence supports breastfeeding as the optimal feeding choice for both mothers and infants. The undecided reader of this book (or maybe the one who only knows from her friends who latched their baby on once that breastfeeding hurts) might get the impression that breastmilk substitutes are basically as good as breastmilk. And that just isn’t true. Breastmilk substitutes have been a lifesaver to infants whose mothers have been unable to breastfeed for all sorts of reasons. They are designed by scientists to meet an infant’s needs the best we know how. But breastmilk substitutes are to breastmilk what vegan bacon is to real bacon – an awfully poor substitute. If you can give your child breastmilk, it’s by far the better option.

I realize that this is an emotionally charged issue – and that my unapologetic preference for breastmilk over breastmilk substitutes makes me subject to accusations of insensitivity. Please believe me that I am not judging the women who don’t breastfeed or feel that they can’t breastfeed (and I certainly hope you don’t believe I’m judging the women who actually can’t breastfeed despite their desire to do so!) In fact, I frequently find myself reminding women that every drop of breastmilk their babies did get made a difference – and that they can wear their two weeks of breastfeeding proudly. I cheer for the women whose babies get formula during the day but who breastfeed at night because it’s easier than getting up to make a bottle – Good for them! I sympathize with the women who were told by a doctor or someone else that they needed to start supplementing or else and who found their supply dwindling as a result. And I try to make sure that every pregnant woman who comes into my office has more than just information about the benefits of breastfeeding but the practical help she needs to be successful at breastfeeding – whether that be for the three days she’s in the hospital, for the six weeks she’s at home with baby before returning to work, for six months combined with formula, or for two years with never a bottle to be found.

Rating: 3 stars
Category: Breastfeeding – social aspects
Synopsis: Barston argues against the current breastfeeding culture and argues that breastfeeding is not necessarily the best choice for moms and babies.
Recommendation: Recommended for breastfeeding support people as a call to compassionate care, but not really recommended otherwise.

Bird Books

As I continue my path through Eiseley library’s children’s picture book section, I become pickier and pickier about children’s books. So much is monotonous pages of empty words accompanied by bright splashes of illustrations that are equally empty. The rhythms start to grow old, the archetypes tedious. I get worn out.

So when I discover a book that is sweet without being saccharine, educational without being pedantic, and illustrated artistically without trying to be avant-garde, I get excited.

Dianna Hutts Aston wrote two such books that I thoroughly enjoyed coming across this month.

Mama outside, Mama insideMama Outside, Mama Inside tells the story of two mamas preparing for their coming children. The mama outside is a bird, preparing a nest, sitting on the eggs, bringing her hatchlings food, and teaching them to fly. Mama inside is a woman, preparing a nursery for her baby, knitting a blanket, feeding her baby, and taking her new baby to the window to see the baby birds learn how to fly.

The illustrations by Susan Graber are soft and realistic. I was excited to see that Gaber chose to portray Mama inside breastfeeding her child (discretely) while Papa brings a pillow. The image of an infant being fed a bottle has become iconographic–but I’d much rather have the normative image portray breastfeeding! Artists like Gaber deserve kudos for subtly working towards re-establishing breastfeeding as a normative practice.

An Egg is Quiet

The Second Dianna Aston book I was impressed with was An Egg is Quiet, illustrated by Sylvia Long. The book starts with the simple words “An egg is quiet. It sits there, under its mother’s feathers…on top of its father’s feet…buried beneath the sand. Warm. Cozy.” And on it goes, telling about the features of different eggs–their colors and shapes and sizes and patterns and textures. The main text is in large script, with only a short sentence or phrase per page. The bulk of the page is composed of naturalistic illustrations of different eggs, labeled for easy identification, and more detailed descriptions of whatever principle the main script is discussing in smaller (but still not small) print.

This is a delightful book that is sure to have children pouring for hours over its illustrations and dreaming about seeing all the different birds (and a few reptiles) and eggs. Parents could easily read just the large script to their youngest children, while exploring the smaller print in more detail with their slightly older children. I can see this title holding the attention of preschoolers all the way through middle-elementary school children. (It held my attention pretty well too–and I had to go back to check out Sylvia Long’s illustrations in better detail.) This is the nature book I wish I had in my home growing up.

Reading My LibraryFor more comments on children’s books, see the rest of my Reading My Library posts or check out Carrie’s blog Reading My Library, which chronicles her and her children’s trip through the children’s section of their local library.