Knocked Up – Knocked Over

my journey through pregnancy and hyperemesis gravidarum

Category Archives: Breastfeeding


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Talking to Prolacta about improving their transparency

Friday before last, I met with Scott Elster, CEO of Prolacta, and Susan Neumann, Prolacta VP of Milk Procurement (now there’s a job title for a resume), ostensibly to talk about how Prolacta can improve their transparency.  For some background, here is the article I wrote originally that kicked this whole thing off: Prolacta, For-Profit Milk Banks, and Predatory PR Tactics.

Scott, Susan, and I met up at the local Cheesecake Factory restaurant to chat.  Full disclosure: I had water.  With lemon.  I was hoping to talk to them about ways they could become more transparent.  I published those points on Friday, although, reviewing that post, it looks like I made a royal screw-up with my post scheduling and the post was set to private for some reason.  Friday was definitely not a day that was full of awesome.  So in case you aren’t an email subscriber and in case you got the link and you were blocked from reading it, here is that post: Meeting with Prolacta Executives Happening Right Now!

Here are the points I wanted to discuss with them:

  1. Choosing a name other than “milk bank” for your milk collection agencies is absolutely necessary. These are collection agencies and referring to them as banks is confusing and misleading. Banks retain milk, process it, store it, and ultimately distribute it. These agencies simply collect the milk and pass it along to you.

  2. Find a new way to refer to milk given to your company. “Donations” are something given to a non-profit, not a business. Using the language of charity confuses people.

  3. State very clearly on the front page of each and every collection agency website that you are a for-profit company, not a non-profit milk bank. This should be found on the front page and in the pages describing what happens to the milk once it is shipped out. As an alternative, eliminate the middle-man milk collection agencies and collect milk under your own name.

  4. Create a concrete set of communication guidelines to ensure that all employees and contractors know how to engage with the public in an open and transparent way. Ensure that this is communicated cross-functionally, including (and especially) to third party public relations firms and to your milk collection agencies.

  5. Make it very clear on your website and on your milk collection agencies’ websites that you have a partnership with Abbott. This should also appear both on the front page and continue to appear in the FAQ and on the front pages and FAQs of your associated milk collection agencies.

  6. Increase transparency surrounding your Ready to Feed line of products and ensure your FAQ and associated information pages has complete information on this, particularly with regard to the competition with HMBANA banks section.

Scott is very good at managing a conversation, though, and steer it in the direction he wants it to go.  He’s a successful CEO after all.  He’s used to being in control of things.  Mostly, we talked about how much Prolacta cares about NICU premies, how special their needs are, and how awesome Prolacta’s products are.  And I am sure they are great products.

That’s not the point.  The point was to talk to Prolacta about improving transparency.

And we did.  Here is what Scott and Susan had to say about the points I made:

Choosing a name other than “milk bank” for your milk collection agencies is absolutely necessary.

They quibbled quite a bit over this.  It is plain that they did not see how this is confusing, despite the fact that many mothers are misled by this.  Scott and Susan did not express any intent to change this.

Find a new way to refer to milk given to your company.

Again, more quibbling.  ”Well, what are we supposed to call it?”  Honestly?  I don’t have a marketing degree, but surely there is another word they can use here.  Why not just call it pumped milk?  Let’s try it in their FAQ.  Here’s a screen shot of the Milkin’ Mamas FAQ (Helping Hands appears to be down):

The FAQ from Milkin' Mamas

The FAQ from Milkin’ Mamas

Why couldn’t it instead read:

  • Who can provide milk for Milkin’ Mamas?
  • How do I know if I am a candidate to provide milk for Milkin’ Mamas?
  • …
  • Who receives my pumped milk?
  • …
  • After lactation begins, how long can a nursing mother provide pumped milk to Milkin’ Mamas?
  • …
  • Can I smoke while pumping milk for Milkin’ Mamas?
  • …
  • Will I be paid for my pumped milk?

You get the idea.  Not that hard, right?  And removing the word “donation” certainly is more accurate and less confusing and misleading.  To be fair to Scott and Susan, I had thought long and hard about how to change this language and was having trouble finding the words.  I did not suggest simply calling it pumped milk during our meeting.  Like many things, this idea struck me like a bolt of lightning after the fact.  I emailed both Scott and Susan after our meeting with the suggestion and I hope they take it to heart.  Of course, this change would need to take place in all areas of their affiliated websites (not just the FAQs) in order to be effective.   I have not heard back from Scott and Susan to know if they are willing to entertain this idea.

State very clearly on the front page of each and every collection agency website that you are a for-profit company.

Scott and Susan both seemed to believe that they are making this information clear already.  Susan brought me a printout from the Helping Hands front page to illustrate this.  Unfortunately, the printout was not of sufficient quality to see the small, faint message that said something along the lines of “a division of Prolacta Biosciences” and because the Helping Hands website is down currently, I can’t independently verify this.  None of my previous screenshots capture this portion of the website.

I do know that the Milkin’ Mamas website does not have this in their header, nor do they have a Prolacta Biosciences tab (the Prolacta logo is at the bottom of the page):

Milkin Mamas front page

No mention of Prolacta on this header

 

Prolacta, simply put, is unique.  It holds a very unusual place in that it is, to my knowledge, the only for-profit company that deals with human milk.  Of course we wouldn’t ask Pampers to publish their for-profit status on their website because every other diaper manufacturer in the country is for-profit.  We assume that a diaper company is for profit.  Human milk banking is the opposite.  Every other bank in the country (if not the world) is non-profit, so it is fair to assume that if you are dealing with someone collecting milk for babies, that it would be non-profit.  This is why it is critical that Prolacta identify clearly that it is a corporation and not a non-profit company.

When I brought up the concerns over the language in the “Understand Where Your Milk Goes…” infographic, Scott did comit to changing the language on there to say that the Human Milk Fortifier is sold to hospitals, although, he said, this would take some time to roll out and would not be an instant change.  I get it.  I work in corporate America.  These things aren’t instantaneous.  This is a step in the right direction.

Create a concrete set of communication guidelines to ensure that all employees and contractors know how to engage with the public in an open and transparent way.

There wasn’t much contention on this issue.  I hope that their agreement on this point means that they will ensure that all employees, contractors, and 3rd parties know how to engage appropriately with the public.  I was not able to convince Susan to share with me their internal communication guidelines for publication on my blog.  This may be because they do not exist, and I hope that if this is the case they will take this opportunity to create communication guidelines.  Every company, not just Prolacta, should ensure that its people know how to engage with the public in an appropriate way.

Make it very clear on your website and on your milk collection agencies’ websites that you have a partnership with Abbott.

When I brought up the concerns with Abbot and their longstanding status as WHO Code violators, Scott made it clear that he could not discuss this with me.  He was able to talk about the Prolacta relationship with Abbot, but he did not address my concerns about his choice to partner with a company who shows through its actions that it seeks to directly undermine the breastfeeding relationships of mothers and babies though its marketing practices.

Increase transparency surrounding your Ready to Feed line of products.

In addition to its Human Milk Fortifier, Prolacta markets a line of products called its Ready to Feed line.  At this time, there is only one product offered under this product line: Standardized Human Milk or PremieLact.

Prolacta's Standardized Human Milk, aka PremieLact

Prolacta’s Standardized Human Milk, aka PremieLact

From my conversation with Scott, I am under the impression that this is no longer being manufactured or was only manufactured as more of a one-off thing when a hospital needed human milk in a very small bottle size (because decanting a HMBANA bottle is not possible?).  Scott explained that the Human Milk Fortifier absolutely cannot be mixed with formula, so there was a need to ensure that hospitals have small quantities of human milk on hand.  Having given milk informally to a mom of a micro-premie (now a gorgeous toddler), I know this is a legit need.  If babies are born early enough, mom doesn’t always go through the hormone shift that allows her to produce milk.  I appreciated Scott clarifying the intent and need behind this product and I think that would be helpful to include in information to pumping moms.

Overall Impressions of the Conversation

First, Scott, and by extension Prolacta, doesn’t seem to think too much about the pumping moms who provide them with milk.  That’s not to say that I think they view those moms with contempt or anything like that.  It’s just that those moms seem to take up far less space in their sphere of concern that getting their product out to NICU babies.  Considering that Prolacta relies solely on pumping moms to stay in business, I find this sad.

Perhaps I’m wrong.  Perhaps Scott wanted to talk more about babies and less about pumping moms because the babies are a major feel-good point for his company and the pumping mom aspect of the business isn’t as comfortable for him because it is an area where his business is vulnerable.  Perhaps his focus on NICU premies is because of the passion he gained from his own personal experience.  Regardless, I am disappointed that we spent most of the conversation on that portion of the business instead of talking about the pumping moms.

I also got the impression that Scott has a certain amount of contempt for the HMBANA banks.  He went on at length about Prolacta’s safety standards and how they set the standard for all milk banks in handling human milk safely.  He shared his experience with Baxter and the group of people who caught AIDS from blood transfusions.  He talked about diseases, the possibility of moms mixing in cow, coconut, or almond milk with breast milk, moms combining milk with other moms to ship, and so on.  These are legitimate concerns, but these are all things, that I am sure HMBANA banks have experience dealing with, especially considering that the San Jose milk bank has been around for more than 30 years  It seems like the relatively young Prolacta could stand to take a few notes from them.

Do I think Scott is a big, bad, evil guy?  No.  He and Susan were both genuinely courteous and friendly to me during our meeting and seemed interested in what I had to say.  At the start of the conversation, I shared with Scott and Susan how I felt when I learned that my “donated” milk had gone to a for-profit company.  Both Scott and Susan listened carefully to my story, and then Scott said this, “Molly, I hope you don’t take this the wrong way, but I am so relieved to hear that this was your experience in 2008 and not in 2013.”  And I understand what he is saying.  Prolacta has worked hard to improve its transparency, and I think they’ve learned some hard lessons in the past and I think they have put those lessons to good use.  I think the fact that they were willing to drive over an hour to meet with me shows that they are interested in continuing the process of improving transparency, and I hope that their actions following our conversation will show us all that they mean what they say.

I would invite Susan and Scott to comment here on this post and tell us in detail what their actions will be in the days and weeks ahead.

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Meeting with Prolacta Executives Happening Right Now!

At the time this post publishes, I will be sitting down with Scott Elster, Prolacta CEO, and Susan Neumann, Prolacta VP of Milk Procurement to talk to them about what caused me to write Prolacta, For-Profit Milk Banks, and Predatory PR Tactics, an article detailing my encounter with a Prolacta public relations representative.

I am pleased at the opportunity to meet directly with Scott and Susan. I hope this meeting turns out to be the opportunity I believe it can be to help Prolacta improve their transparency and make positive changes to their business practices.

Here are the points I am presenting to Scott and Susan during our meeting. I look forward to the conversation that these points will spark.

  1. Choosing a name other than “milk bank” for your milk collection agencies is absolutely necessary. These are collection agencies and referring to them as banks is confusing and misleading. Banks retain milk, process it, store it, and ultimately distribute it. These agencies simply collect the milk and pass it along to you.
  2. Find a new way to refer to milk given to your company. “Donations” are something given to a non-profit, not a business. Using the language of charity confuses people.
  3. State very clearly on the front page of each and every collection agency website that you are a for-profit company, not a non-profit milk bank. This should be found on the front page and in the pages describing what happens to the milk once it is shipped out. As an alternative, eliminate the middle-man milk collection agencies and collect milk under your own name.
  4. Create a concrete set of communication guidelines to ensure that all employees and contractors know how to engage with the public in an open and transparent way. Ensure that this is communicated cross-functionally, including (and especially) to third party public relations firms and to your milk collection agencies.
  5. Make it very clear on your website and on your milk collection agencies’ websites that you have a partnership with Abbott. This should also appear both on the front page and continue to appear in the FAQ and on the front pages and FAQs of your associated milk collection agencies.
  6. Increase transparency surrounding your Ready to Feed line of products and ensure your FAQ and associated information pages has complete information on this, particularly with regard to the competition with HMBANA banks section.

I hope to come back to you with real and concrete actions that Prolacta is willing to commit to. They have invested time and effort in this meeting and I hope that they do not squander this by turning it into a simple PR stunt. I hope that they come away from our meeting with a deeper understanding of the impact their lack of transparency has on so many mothers, and I hope they turn that understanding into meaningful change.

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Prolacta Update

You may remember the article I wrote about Prolacta and their lack of transparency when it comes to soliciting for milk from pumping moms.  In case you missed it:

Prolacta, For-Profit Milk Banks, and Predatory PR Tactics

Next Thursday, I will be sitting down with Scott Elster, Prolacta CEO and Susan Neumann, VP of Milk Procurement for Prolacta.  Susan has worked to arrange the meeting, and I hope it will be an opportunity to discuss the steps Prolacta needs to take to become fully transparent in its business.  More to come on that later.

In the meantime, I have a fantastic guest post that my friend Julie has been working on about her experience with Pinterest as a new stay at home mom.  It’s a fun article and I know you will enjoy it.  Look for that to come out tomorrow!

Also upcoming, Kombucha making, Sauerkraut making in the incredibly new crock my grandma gave me for my birthday, a few more hippie hygiene experiments, setting up a sidecar crib for your bed, and more!

Between now and then, hug your kiddos, kiss your babies, and love one another!

IMG_3592

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Non-Profit Milk Banking and How You Can Help

Following my article about Prolacta and the for-profit breast milk industry, I received an email from Maryanne at the non-profit Mothers’ Milk Bank in San Jose.  Maryanne wondered if I would be interested in posting about non-profit milk banking, and I jumped at the chance!  I had a wonderful conversation with Executive Director Pauline Sakamoto about the work that Mothers’ Milk Bank does, and I’m glad to be able support this organization by sharing what I learned.

Mothers’ Milk Bank in San Jose, California is a non-profit, HMBANA (I am having a hard time saying “Hmmbana” for some reason) milk bank.  It’s one of many scattered across the US and Canada that collects breast milk from donors to provide to babies and children in need.  HMBANA banks set the standard for all milk banks in that they not only receive endorsements from health agencies, but they collect and distribute their milk in a way that adheres to a specific set of best practices.

Photo courtesy of Mothers' Milk Bank, San Jose, CA

Photo courtesy of Mothers’ Milk Bank, San Jose, CA

Pauline explained to me that one of the biggest things that sets HMBANA banks apart is the focus on the breastfeeding relationship.  The main goal is to get mom and baby breastfeeding, not ship out a certain volume of milk.  Many of the employees at Mothers’ Milk Bank are IBCLCs and RNs, and they work with moms to get them in touch with lactation support specialist in their own area.

I learned so much from speaking to Pauline.  I had always been under the impression that milk bank milk was almost impossible to get and that it was only for premies in the NICU.  I had assumed that, upon leaving the hospital, moms and babies would be left to fend for themselves.

Nothing could be further from the truth!

I was amazed to learn about the diversity of the population that Mothers’ Milk Bank serves!  They provide milk to micropremies up to babies 2 and 3 years old!  They are even currently providing milk to a 7 year old suffering from spinal-muscular dystrophy.  Without his own mother’s milk and the milk provided by the milk bank, this little boy would not be alive today.  They also occasionally provide milk to adult cancer patients.

All a person needs to receive milk from the bank is a prescription from a doctor.  Many insurance policies cover the cost of the milk, and if not, often employees of the bank chip in to cover the cost of the milk.  And what is that cost?  Only enough to cover the costs of shipping and processing the milk, usually between $3 and $4.50. 

It is often difficult for the bank, though, because demand almost always outpaces supply.  The bank focuses on situations where a mom is trying very hard to breastfeed but is not able to due to medical reasons like a double mastectomy or other situation.  In other cases, they support the mom’s attempts to breastfeed while providing the donor milk as a supplement to the mom’s actions.

I was also surprised at how easy it is to donate milk.  If you can give blood, chances are good that you can also donate milk.  Mothers’ Milk Bank covers that cost of shipping and for moms not living in a city with a milk bank, there are often depots set up to receive the milk and help transfer it to the bank.  This was surprising to me.  I always thought that you had to live in a city with a milk bank in order to donate to the bank.  They can even collect milk from Alaska and Hawaii and there are three banks in Canada!

Photo courtesy of Mothers' Milk Bank, San Jose, CA

Photo courtesy of Mothers’ Milk Bank, San Jose, CA

Once they receive the milk, they process it in very small batches.  Typically, they will combine milk from 2-4 donors, although sometimes they will note that there is a higher level of bacteria in a particular mom’s milk.  If they see that, they pasteurize her milk separately.  They work to make sure that the donors in the combined batches all have babies that are of similar age so that they can match the “age” of the milk to the age of the recipient baby.  They bottle the milk and treat it in a hot water bath using a method called Holder Pasteurization.  They heat the milk to 62.5 degrees C for 30 minutes.  Pauline told me that they have found that this method is most effective in killing off bacteria and viruses that may be in the milk while preserving as much of the benefits of the milk as possible.

Once the milk is processed, they ship it out to the patients.  It’s that simple.

According to Pauline, the biggest challenge they face is finding enough milk to meet the demand of patients.  Because they serve a larger population than just premies in the NICU, they often find that they have more patients than available milk.  This is where for profit milk collection becomes an issue.  It can take enough milk to feed four or five babies to make enough of the fortified milk for one baby.  Any competition for milk can make servicing the existing patients difficult for the non-profits.

When I asked Pauline about mother-to-mother milk sharing, my preferred method of milk sharing, she did not discourage this practice, but she said that no matter what you are doing with your milk, be sure you really know where it is going.  She has heard stories of professional atheletes soliciting for breast milk, and one advantage of going through a HMBANA bank is that it gives mom a layer of protection from liability in case a recipient baby does become ill.  This definitely made me pause and think.  The milk I have given has been to friends, but I wonder how comfortable I would have been donating milk in a more annonymous situation?

The main thing that Pauline wanted to get across is this:

HMBANA has been here for years and years.  We all service different people with different needs, and if we could work together and keep in concept that the mission is to help moms breastfeed it would be beneficial.  We do need milk. We do need moms to know about us.  There are babies behind who we serve and children who are failing to thrive that really need the support. If we had to close down because every mom was breastfeeding, we would do it!

We have excellent moms in the US that are breastfeeding in this country.  And bless them for having that extra milk and saying “Can anybody use it?”

Here is more information about donating to Mothers’ Milk Bank in San Jose.

Here is a link to the HMBANA site to help you find a non-profit milk bank near you.

I am grateful to Pauline for her time and for the hard work that she and other HMBANA bank employees do for breastfeeding moms and babies.

Photo courtesy of Mothers' Milk Bank, San Jose, CA

Photo courtesy of Mothers’ Milk Bank, San Jose, CA


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Working for Change in the For-Profit Breastmilk Industry

Last week, I wrote about Prolacta in my post Prolacta, For-Profit Milk Banks, and Predatory PR Tactics, and I received responses from Prolacta, the International Breastmilk Project (a Prolacta milk-collection agency), and a non-profit HMBANA milk bank.  You can read their responses to my posts in the comments, and each had different thoughts on my article. 

I am excited to let you know that I have been emailing directly with the non-profit HMBANA bank, and I hope to bring you a post soon about non-profit milk banks and how you can help.  There is a truly critical shortage of breastmilk in the non-profit milk bank sector, so I am looking forward to bringing awareness to that issue.

I have also been emailing directly with Susan from Prolacta, and she and I agree that there is an opportunity here for dialogue.  Having worked in corporate America for as long as I have, I know that change is only achievable through open dialogue, and I think there is an opportunity here for change to be made.  Will I ever agree with the concept of a for-profit milk bank getting their raw material for free?  Unlikely.  However, I think there are improvements that need to be made, and I hope that by talking with them, some changes will be possible. 

I will certainly keep you all updated as this develops.  If you have questions that you would like for me to ask either the non-profit HMBANA or the for-profit Prolacta, please let me know in the comments section.

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Prolacta, For-Profit Milk Banks, and Predatory PR Tactics

The world of milk donation is complex.  There are non-profit milk banks, mother-to-mother donations, and then there is Prolacta.  Each method of donation has its pros and cons, but Prolacta is special in that it is the only for profit milk “bank” that actively seeks donations of mothers’ milk to process and sell for profit.

In her article, “Swindled: The Ugly Side of Milk Donation,” Amy from Just West of Crunchy unpacks the issue thoroughly, and I would really encourage you to read her article and the two follow-up articles (Prolacta’s Mole, Prolacta responds to “Swindled: The Ugly Side of Milk Donation”) to get a full understanding of the complexity of this issue.  It’s important background information for what I will be talking about here.

I donated to Prolacta in the past via their project to send milk to African babies.  At the time, I was excited to help out with orphans in need.  I was thrilled at the prospect that I could help a sweet orphaned baby who might otherwise die from tainted water used to mix its formula.  Later, when I learned that it was highly unlikely that any of my milk actually went to help those babies and had most likely instead been sold for profit, I felt used.  It was a horrible feeling in the pit of my stomach, and it’s a feeling that I have never quite managed to shake.

With this in mind, you can imagine how I felt with I received the following message on my Facebook page (bolding mine):

I am loving your site and your story! Best of luck with your two girls! I was doing research for my client Prolacta (to be completely transparent) and its Helping Hands Milk Bank when I found you and thought you might want to do a blog post to educate your readers.

Prolacta has this program called the Helping Hands Milk Bank where nursing moms can donate excess breast milk to be given to premies who aren’t getting enough. I’ll paste some information below for a blog entry about this group so that other moms reading your blog can be aware that this resource is available. Let me know…thanks!

Rita T*****
[phone number]
[email]

Helping Hands is a virtual milk bank that allows qualified donors to make breast milk donations from the comfort of their home. Prolacta Bioscience collects excess breast milk from mothers who donate through Helping Hands and processes it into the first and only commercially available breast milk fortifier made from 100% human milk (rather than cow milk) for critically ill, premature infants in neonatal intensive care units (NICUs). Among other improved risk factors, a recent study published in the Journal of Pediatrics shows that an exclusive human milk diet (which includes Prolact+ H2MF) reduces the odds of developing NEC (the #1 health risk for preemies) by 77%.

The process is simple. Helping Hands allows busy mothers to apply online in about 15 minutes. Helping Hands supplies storage containers, and covers all shipping costs & supplies, so there is no out-of-pocket cost to the donor, and she doesn’t have to travel anywhere to donate her breast milk.

I can get you some links or code for a supporter badge for your site, just let me know…

Essentially, what Rita T (a PR rep) is asking me to do is advertise for free for her for profit company.  She does mention Prolacta several times, but she never mentions that both it and Helping Hands are for profit enterprises.  Instead, she says that the milk will be “given” to babies.  She talks about milk donations and refers to Helping Hands as a milk bank, which further confuses these for profit businesses with legitimate, non-profit milk banks.

Here is the response I sent to Rita T’s solicitation:

Rita, I am very familiar with prolacta, having donated to them in the past, and I am one of those moms that finds their business model to be absolutely beyond the pale. I am not interested in becoming involved with anything further to do with prolacta. After donating to them, I felt used and misled. The milk prolacta collects is not “given” to premies, as you say. Rather, the milk is processed and sold for profit to hospitals for use as a human milk fortifier. Their marketing and advertizing is misleading and predatory. I will always continue to encourage mothers to donate milk, but I will encourage mother-to-mother direct donation or donations to non-profit milk banks rather than donating to a company that preys on the good intentions of mothers for their own profit.

I am sorry if this seems like a harsh response, but you are asking me to promote a business based on misleading information. Nowhere do you mention that prolacta is for-profit and nowhere do you mention that the human milk fortifier will be sold for profit. In no other industry do businesses expect to get their raw materials for free, and I am, frankly, shocked, that prolacta continues to pursue this in this manner.

As a for profit business, I would imagine they could afford to pay for their own PR rather than trying to get that for free as well.

I decided to do a little digging on Helping Hands, and I was disappointed, but not surprised, by how misleading their website is.  A quick google search turned up the website straight away, and I expected it to be clear somewhere on the front page that the milk would be sold for profit. 

The helping hands front page is all about helping the babies and curing cancer with nary a mention that it is a for-profit business.

The helping hands front page is all about helping the babies and curing cancer with nary a mention that it is a for-profit business.

Alas, no.  Not even if you scroll down and read all the teeny-tiny print at the bottom of the page.

Not even when you click the button”Understand Where your Milk Goes” do they disclose their for-profit status.  Instead, they bring you to a pretty graphic with trucks and buildings showing how milk is brought from the mother, processed, and delivered (not “sold”) to the hospitals. 

No mention of selling the product to the hospital or the parents.

No mention of selling the product to the hospital or the parents.

It isn’t unless you click on the HHMB FAQ tab at the top of the page and scroll all the way through the FAQs to the bottom that they reveal their for profit status.  Can you find it?  It took me 20 minutes from the time I opened their website and I knew what to look for.

Is it for profit or isn't it?

Is it for profit or isn’t it? Hint: Take a close look at question 24 out of 27. Nicely buried way down at the bottom

Look, I don’t have a problem with their product.  I don’t even necessarily have a problem with the plain fact that they are a for-profit business.  I work in corporate America.  I completely get the need to cover the costs of research. I really and truly do. Heck, I don’t even have a problem with corporate PR as long campaigns are ethical and transparent.

What I do have a problem with is that Helping Hands and Prolacta Biosciences hide behind the language of non-profits (using words like “milk bank” and “donate”) to solicit for free the raw materials they use to make their product.  They are not up-front with mothers about the fact that they are selling their milk for profit.  They are not upfront about the fact that they are in direct competition with non-profit milk banks both in gathering milk and selling a product.  This kind of misinformation is completely unacceptable and it must stop. 

If you are going to run an ethical business, you have got to be transparent.

Fellow moms, please research where your milk is going if you choose to donate to a milk bank.  Read all the fine print.  Here is a quick list of “banks” that collect and sell milk to Prolacta (according to the Prolacta website):

  • International Breastmilk Project (this is the one that supposedly sends the milk to Africa and the one I briefly donated to)
  • Milkin’ Mamas
  • South Coast Milk Bank
  • Helping Hands Milk Bank
  • National Milk Bank
  • Milk for Wishes Milk Bank
  • University of Minnesota Medical Center, Fairview
  • San Gabriel Valley Milk Bank

So, Rita T, please think carefully about what you are doing by contacting bloggers such as myself and asking us to shill for your client.  Think carefully about the misleading messages and emails you are sending out.  Think about it, and then please stop doing it.  You, Helping Hands, and Prolacta Biosciences are not behaving in an ethical way. 

If you have excess milk and you would like to donate to a reputable organization, below are some good resources*:
I personally prefer to give milk directly and have given milk to several mothers I know locally.  We connected through a local mothers’ group, and the experience of giving my milk to those babies directly and watching them grow into toddlers has been amazing.  I am a huge fan of informal, direct, mother-to-mother milk sharing.
 
*By the way, when I ran my google search with the words “non profit milk bank” Prolacta “banks” Helping Hands and Milkin’ Mamas were the first two hits that popped up.
 

Update:

The dialogue between myself and the PR rep continues.  Perhaps there is a possibility here of making some real and lasting change for the better.

 
 
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Wild and Wonderful Toddler Nursing

I finally have to admit to myself that Katie is a toddler.  She’s walking, starting to talk, getting more and more active, and starting to lose her baby rolls and chub.  I’ve been mourning this quite a bit.  She is my last baby, and while it’s amazing to see her grow, I have a lot of nostalgia for the cuddly baby stage.

These days, cuddles are short and to the point.  So is nursing for that matter.  Sometimes.  And then sometimes nursing takes hours and hours.

That’s right.  We’ve entered the land of…

Toddler Nursing

Anyone who has practiced full-term breastfeeding (also known as extended breastfeeding) is going to be able to empathize with me on this.

Toddler nursing can be exasperating.  Now is when the acrobatics start.  They nurse standing up, upside down, standing on one foot while balance on your leg (Katie’s personal favorite). They latch on and off as people walk past and daily activity happens around them.  Can you blame them?  The world is interesting!

They’ve learned to verbally (or with sign language) ask to nurse* and, like any new exciting skill, they like to practice.  A lot.  This means that they seem to constantly ask to nurse. 

They are also learning to control their environments, which means that some babies (Katie) may take to trying to open the shirt themselves.  Often in public.  Or in front of your male boss. 

It is absolutely okay to teach nursing manners.  In fact, it is critical to do so at this time.  Teaching baby to show respect and kindness to Mama helps them to learn respect and kindness for themselves and others.  For shirt opening, I immediately either put her down or pass her to Juan. Consistency is key. She is gradually getting better.

Between the ages of 15 and 20 months, they seem to nurse like newborns!  Round the clock!  This is because they are in the middle of growth spurts, teething, and learning that they are independant people. Is it any wonder they need to come back to Mama so much for reassurance?

“I want to run and play, but I need to make sure you will still be here Mommy. You’re still here, right? That was a fun slide! Wait! Where’s Mommy? Oh, thank goodness. There you are! I still need you, Mommy. Don’t leave without me.”

Toddler nursing is just as wonderful as it is wild. Finally, they can thank us and show appreciation for our hard work. A kiss on the cheek, clapping, words of thanks, and hugs are just a few of the ways toddlers show us that they love us.  Those bedtime nursings are still the soft quiet times that they were in the beginning.  We still get to watch those big eyes slowly close in sleep.  The magic is still there.

Like everything else, toddler nursing is a stage.  The hard parts and easy parts and parts that you want to remember forever. 

We are in the autumn of our breastfeeding relationship now, and every cuddle and every nursing is precious and fleeting.

*Let me be very clear for the “When they can ask for it, it’s time to stop” crowd: Babies ask to nurse from the moment they are born. We just don’t always understand their language. Believing that they should stop nursing when they finally learn our language is like telling an adult that he can’t have sushi anymore because he learned Japanese.


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Handling Breastfeeding Criticism

With the holidays coming up, many of us are on our way to visit friends and family.  Those visits can be full of joy, but they can also be stressful. I am so fortunate to have supportive friends and family, but not everyone is so lucky in that regard. So many times, moms and dads find themselves receiving criticism for the parenting choices they made, particularly if those parenting choices don’t exactly line up with the way grandparents, uncles, aunts, and friends view child-rearing.

I believe that criticism, particularly breastfeeding criticism comes from two major places, ignorance and pain, and if you can identify the root of your critic’s feelings, it can make it easier to move past their hurtful words.  To be clear, when I say “ignorance,” I don’t mean stupidity.  Ignorance is simply a lack on knowledge on a subject.  Because breastfeeding wasn’t the norm in the US for an entire generation, much of the tribal knowledge surrounding it has been lost.

Is it any wonder Aunt Edith worries your baby might need to switch to formula if her doctor told her that milk turns to water at six months?  Is it any wonder that Great-Grandma Cathy worries you are overfeeding your baby if her doctor instructed her to space out feedings to every four hours?  Is it any wonder your young, childless friends think you might be spoiling your child by nursing her down for naps if all they see on TV and in movies are peacefully sleeping babies that never, ever seem to need to eat (or poop for that matter)?

I’d like to go through a few scenarios, and by the end of this article, I hope you will have some tools added to your belt to help you through these situations.

Scenario 1: The Opportunity to Educate

Your Aunt Edith approaches you while you are breastfeeding your 8 month old and says something along the lines of, “When are you going to get that baby off the boob? Your milk isn’t enough for her anymore.  She is starving!”

This is a great opportunity to help educate Aunt Edith (and other family members who may be listening in).  Tiny ripples can cause big changes, but it’s important to educate in a way that is sensitive and loving.  Getting angry at your Aunt and giving her a piece of your mind will only leave her feeling hurt and defensive, and while it may get her off your back, it won’t help other family members who may be in a similar situation.

Here’s how I have gently educated my friends and family members when in a similar situation (I’ll highlight the key “gentling” phrases):

“You know, that is a really interesting point that you make.  Did you know that new research shows us that breastmilk grows and changes as the baby grows?  Nowadays, doctors tell us that breastmilk should be a baby’s main source of nutrition until they are a year old and that we should continue nursing until the baby is two!  It’s really amazing how recommendations change over time, isn’t it?“

Sure, it’s not brand new research, but it’s new research to her.  And framing it that way can sometimes feel less agressive and patronizing than saying, “Actually, that’s wrong.  Here is the right information.”

I would encourage you to take every chance you can to educate your friends.  Taking the time to educate Aunt Edith, even though she isn’t nursing anymore, may mean that in the future, when Aunt Edith’s daughter-in-law has a baby, Aunt Edith will be better able to support her.

Scenaro 2: The Opportunity to Connect

Sometimes, people’s own breatfeeding-related experiences may have been emotionally painful.  They may feel guilty for not breastfeeding and the fact that you do breastfeed may make them feel defensive.  That defensiveness can manifest in that person being hypercritical of you.  It seems counter-intuitive that a person would want to bring another person down like that, but it’s human nature.  It doesn’t make them a bad person, it makes them a person in pain.

If you run into a situation like this, and if the friend or relative mentions that, well, they couldn’t breastfeed at all because of [whatever reason], you can take the opportunity to reach out and connect to that mom and honor her pain.  No, that doesn’t mean that you grill her on why and tell her why she probably would have been just fine if she had just stuck it out or gotten in touch with a proper IBCLC.  That doesn’t help.  What happened happened.  What you can do, though, is offer her sisterhood and say something along the lines of, “I am so sorry that you didn’t have the support you deserve. I wish I could have been there to hug you and cry with you and tell you that it was going to be okay.”

My dear friend Paris at Mother Revolution is way better at this than I am.  You should definitely read her blog.

Scenario 3: The Jerk Factor

It’s all well and good to talk about the above two opportunities to connect and grow closer to your family.  However, it would be naive to believe that there aren’t people out there who are just plain mean.  I’ve had friends who have dealt with friends and family members who try to cut them down for a variety of destructive reasons, and there are times when your parenting choices simply need to be off-limits for conversation.

The best way to shut a conversation down politely is by using the Bean Dip Method.  I honestly don’t know where this term was coined.  It was something we talked about over on the Kellymom.com forums.  If you know where this came from, please let me know so I can properly attribute this.

The Bean Dip Method (or in light of the upcoming holidays, the Cranberry Sauce Method) is a polite way to redirect a conversation.  It’s not about changing someone’s mind.  It’s about setting a boundary and enforcing it.  Here’s how it works:

Cousin Jill has been harping on you all weekend and will not leave you alone about breastfeeding.  She thinks that it is high time you wean your toddler, and despite the fact that you have told her the WHO recommendations and attempted to connect with her in a loving way, she will just not stop.  Cousin Jill has an axe to grind, and you are her current target.

Cousin Jill: Ugh, breastfeeding again?  You’re turning him into a sissy.
You: That’s interesting.  Can you please pass the cranberry sauce?
Cousin Jill: Seriously, when they’re old enough to ask for it, it’s time to quit.
You: Okay.  Can you pass the gravy?
Cousin Jill: Seriously, that’s just gross.
You: I know you love the baby.  We’ve researched and made our parenting decisions, and they aren’t open for discussion.

If it continues, be prepared to quietly remove yourself from the situation.  There’s no need for you to subject yourself to that kind of thing.

 

Family gatherings can be fun, but they can also be stressful.  Have you had to deal with criticism over your parenting choices?  How did you handle it?

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Stop it Enfamil. Right Now.

Recently, a friend of mine forwarded me an email she received from Enfamil.  Now let me be clear: This friend is a breastfeeding mom.  She’s never purchased formula.  She’s never signed up to receive emails from formula companies.  She’s never received any emails before now.

Here’s what appeared in her inbox:

There is so much wrong with this email that it’s hard to know where to start.  It is so carefully crafted and timed so precisely to drive women away from breastfeeding and onto formula.  Let’s break it down piece-by-piece.

 Perhaps you’re getting closet to a time when you’ll be going back to work. Or maybe you’re doing a bit more outside the house these days – like getting some exercise or running a few errands.

As carefully timed as this email is, it likely will coincide with a mom returning to work.  The US has pitiful provisions for maternity leave, so many moms have to go back to work at around six weeks.  Additionally, by this time, many moms have reached a point in their postpartum recovery that they would be feeling self-conscious about the way their bodies have changed post-baby.  They may feel like they want to get out more and more.

They go on to say,

This could be a good time to supplement with Enfamil. Supplementing gives you added flexibility and also allows other family members or caregivers to feed the baby when you’re not there.

Let me just stop you right there, Enfamil.  Breastfeeding does not shackle you to the couch.  It doesn’t prevent you from exercising.  It doesn’t prevent you from returning to work.

Here’s the thing that’s weird about this.  They talk about all of this needed flexibility.  So why don’t they mention breast pumps?  Not one single mention of expressing milk.  No mention of breastfeeding in public which most of us do on a regular basis, either. Remember folks.  This wasn’t an email targeted to a bottle-feeding mom.  This wasn’t an email targeted to a mom who reached out asking for this information.  This was targeted at a breastfeeding mother who, at seven weeks, has an established breastfeeding relationship.

Let’s read a little further in this email.

[Blah blah blah, Enfamil is so great and awesome.]  Thinking of a time when you’ll switch to formula entirely? Check out our tips for weaning your baby.

Notice the wording here.  They don’t say, “Thinking of switching to formula entirely?”  They don’t say, “Are you thinking you might switch to formula entirely?”

No.

They say,

Thinking of a time when you’ll switch to formula entirely.

When you will switch to formula entirely.  Will.  Not might. Not thinking of.  Will.  As if this is the regular course of action. As if it’s what’s done.  You nurse for six weeks, supplement a bit longer and eventually wean entirely over to formula. It’s normal. It’s what everyone does.  Why wouldn’t you?  It’s not like there are no alternatives, right?

Alternatives like maybe breast pumps.  Hand expression. Nursing in public. Federal laws protecting mothers’ right to express milk during the work day.

They go on to provide some very “helpful” links.  Here’s what they have to say about supplementing.

Enfamil’s “helpful” guide to supplementation.

The very top section says,

 If you’re weighing the decision to supplement your baby’s diet with formula – for extra nutrition, back-to-work flexibility, or to give dad and other caregivers a hand in feeding…

Excuse me?  Extra nutrition?  Is Enfamil really going there?  Let me be very clear.  Breastmilk is the perfect food for a baby.  No extra nutrition required, thankyouverymuch. 

But good on Enfamil for preying on a mom who might be feeling stressed and inadequate if she didn’t know that the six-week growth spurt was coming.  When that baby nurses and nurses all day long, plenty of moms think their milk is drying up.  Unless they’ve got a good support network built, they may not realize that this is completely normal infant behavior that only lasts a week.  Remember what I said earlier about how carefully timed this email is?

She may also not realize that bottles of breastmilk don’t need to have more than a few ounces.  She may be using the common formula method for calculating bottle size instead of just figuring on 1 ounce of milk per hour.  She may be fresh back to work and looking at the huge 6 oz bottles that formula fed babies are getting and feeling like she can’t produce enough milk to feed her baby.  Extra nutrition indeed.   Well played, Enfamil.

Also, let’s not forget, breast pumps are available and, while not cheap, they’re far less expensive than formula.  Only the briefest mention of that here, though, and only as a stepping stone to prepare a baby to receive formula.

We read several times in this article how Enfamil’s formula is “patterend after breastmilk.”  They emphasize how “low” breastmilk is in Vitamin D (Uh, really?) and how great the DHA and ARA in formula are.  There is so much wrong with this page that it’s hard to know where to start. 

Let’s also have a peek at Enfamil’s kind-hearted tips for weaning your child entirely onto formula.

 

 Again, it starts bad right at the top:

1. Know when to say wean.  Sometimes babies lose interest in breastfeeding on their own when things like walking steal their interest.

Okay, really?  They say walking could steal their interest, but right around this time, many babies realize they’re no longer inside Mama’s womb.  They become interested in the world around them.  Then at four months, BAM!  Distractibility hits.  This is biologically normal.  Every baby does this.  It’s simply part of the natural course of breastfeeding.  This doesn’t mean a baby is weaning. 

Check out this article from Kellymom.com: Do babies under 12 months self-wean?

At no point does this article reference the WHO recommendations for breastfeeding duration:

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.

At no point do they reference the AAP recommendation to breastfeeding duration:

In the policy statement, “Breastfeeding and the Use of Human Milk,” published in the March 2012 issue of Pediatrics (published online Feb. 27), the American Academy of Pediatrics (AAP) reaffirms its recommendation of exclusive breastfeeding for about the first six months of a baby’s life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.

At no point do they mention the financial cost of formula.  Or the very real risks that can be associated with formula.

Let me be very clear.  Formula is not poison.  Formula can be a medical necessity and a life-saver.  Moms who feed formula are not bad moms.  Gabi required formula supplementation during the first few weeks of her life because of the side effects of pitocin I received during labor and lack of breastfeeding support available to us.  This post is not about that.

This post is about a company that is using half-truths, misinformation, and predatory tactics to market its product at the cost of the health of babies and mamas.  This is unacceptable.

Stop it Enfamil.  Stop preying on the insecurities of breastfeeding moms.  Stop.  Right now.  Stop with your ”breastfeeding support” emails, hotlines, and websites.  Stop trying to get into the middle of the relationships we have built with our babies.  Stop lining your CEO’s wallets at the cost of our children’s health.  Stop putting the almighty dollar over the well-being of our babies.  Stop right now.

We don’t want what you’re selling.

 

 

Update: This post has gotten way more of a response than I expected.  I’m not the only one mad about this. Please take a moment to tell Enfamil to stop this kind of marketing.  Tell them on their facebook page or tweet at them using #stopitenfamil as your hashtag.  Call them.  Email them.  Make your voice heard!


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Chronic Plugged Ducts and How I’m Fighting Them

I think it’s finally time to admit to myself that I’m having an issue with plugged ducts. A plugged duct is when one of the milk ducts becomes blocked and milk can’t exit the breast.  A hard, painful lump can form as the milk backs up.  If the milk isn’t removed, a plug has the potential to develop into mastitis, which is an infection of the breast.  Think fever, chills, nausea, etc.  Plugged ducts are not fun.

I’ve had six instances of plugged ducts in the last month and a half, which is more than I had the entire three and a half years of nursing Gabi.  Twice now, the plugs have been especially exciting because I’ve gotten a bleb along with them.  A bleb is a hardened bit of milk that forms a blister right at the nipple. Once, I got a mild case of mastitis and ended up missing work because of it.  Obviously, there’s something going on.

I brought it up the last La Leche League meeting, and I got some great help.  We really thought together about what kinds of things I notice before a plug occurs.  Here’s what I came up with.  My plugged ducts coincide with:

  • Juan travelling for work
  • Eating fast food
  • Especially wakeful periods for Katie
  • Missed pumping sessions at work
  • Feelings of stress, anger, and disconnect
  • Allowing Katie to roll her lips in for a lazy latch

In doing some online reading, it seems like these items play into the risk factors for developing plugged ducts: sleep deprivation, stress, poor diet, bad latch, failure to remove milk.

Priority number one with all of this is to clear the plug and remove the milk.  Easier said than done.  My old stand-by trick is to lay the baby on her back on bed, turn myself around so that her chin points at the plug, and nurse over her so that her suction and gravity can clear the plug.  Trouble is, that hasn’t worked the last two times.  The resulting let-downs from the nursing just seemed to make the plug worse.

At this point, hand expression seems to work best.  I express most of the milk out (or have her nurse for a while).  Then I start hand expressing very gently over the area.  If you don’t know how to hand express, here’s a YouTube video.  This is an incredibly valuable skill.

Once I get to the point where I can look really closely and see the pore that is clogged (I typically see a bit of white that just isn’t coming out), I gently squeeze on the nipple to work that bit out.  A warm wet washcloth or even getting into a warm bath really helps with this.  Typically, that bit will come out with a POW! and I’ll be able to very easily hand express the backed up milk out.  Massaging at the front of the plug, instead of trying to push it from the back), can also help loosen things up and get it moving.

If you have a clog that you just can’t get out, get help!  Find a lactation consultant.  Ask for help from (dare I say?) your husband.  Don’t let it sit around.  Having a plug long-term is not only really painful, but it can lead to mastitis.

At this point, I’ve got my plug clearing routine down.  But how do I keep from getting them in the first place?

Here’s what I’m doing to try to prevent plugs from forming:

  • Removing milk often (as in, no more skipping pumping sessions)
  • Taking a lecithin supplement
  • Trying to eat healthier, whole foods
  • Paying careful attention to Katie’s latch
  • Taking a few minutes each day to relax and have some time for myself

So far, this seems to be helping, but I think to a certain extent, the occasional plug may just be part of my landscape right now with my oversupply.  I’m okay with it happening once every few months, but I’m looking forward to a few plug-free weeks.

Here are some more resources that I found on plugged ducts.

Have you had plugged ducts?  How did you deal with them?  Do you have any tricks for getting rid of them?

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