Feeding Babies in Emergency Situations

Nursing in a hotel room

In late October 2012 the historic hybrid storm, or "Frankenstorm," named Hurricane Sandy devastated the East Coast of the United States, especially New Jersey, New York, and Connecticut. When disasters such as this happen it conjures up all sorts of feelings, and people are especially compelled to help. But what happens when an act meant to be a good deed results in more death?

This is exactly what can happen when infant formula is donated and improperly distributed in disaster areas. It should also be noted that many relief organizations do not have first responders trained in proper infant feeding protocol and infant formula distribution.

I know it may be hard to wrap your head around why it is so dangerous to donate infant formula to donation drives or shelters. I know the feeling of urgency to help, especially the tiniest victims. And I know that it might feel like I am saying that formula fed babies should not be fed. Of course, formula fed babies need to be fed, but it needs to be done safely to prevent illness and death.

First, I will outline the dangers of formula distribution and improper feeding protocol in emergencies, and then I will offer alternatives and practical ways to make a difference.

Dangers of Infant Formula Distribution:

* The majority of the deaths of infants in emergencies are due to diarrhea from drinking formula mixed with contaminated water and/or unsanitary formula feeding conditions (ie. no way to sterilize equipment).

* It can be difficult or impossible to keep infant formula safe from spoiling if power goes out.

* There is often a disproportionate amount of infant formula donated. This leaves relief agencies with a lot more formula than they need, and/or the wrong type of formula (powdered should not be distributed). Surpluses mean that formula may have to be discarded or it will be handed out to breastfeeding mothers (which has a negative impact on breastmilk supply). Surpluses of any one item also take away from donations that are truly needed.

* Formula should not be distributed without the complementary supplies to make it safe. These supplies include things like bottled water, liquid soap, cups for cup feeding, storage container, paper towels, and a gas stove or other cooking stove for heating water if the formula is not ready-to-serve. Hand sanitizer can be useful, but be aware that it is harmful to children if accidentally swallowed.

Breastfeeding in Emergencies:

Breastfeeding is important under the best of circumstances, but during an emergency it is lifesaving. Breastmilk is clean, full of antibodies, requires no special equipment to deliver, and adjusts to meet the baby's needs (contains more water when it is hot outside and more hydration is needed, for example). The act of nursing is calming for both mother and child. During nursing the mother's breasts will change temperature to either warm or cool the baby, as needed.

But breastfeeding can be undermined in emergencies by well meaning, but uninformed, volunteers. There are many myths that even nursing mothers themselves might believe.

Myths include that breastmilk will "dry up" when a mother is under stress, that a malnourished mother can't breastfeed or will make inadequate milk, and that breastfeeding mothers are safer with some formula "just in case."

In reality, breastmilk supply is not impacted by stress, however the milk ejection response, also known as "letdown," which makes the milk available for the baby to swallow can be impacted when a mother isn't relaxed. Once the baby starts nursing and MER happens, both mother and baby will become more relaxed. The solution is not to discourage nursing or offer formula, but simply to provide an environment where the mother can relax.

Unless a mother is severely and catastrophically malnourished, she will make adequate breastmilk. Her body will protect her baby's nutrition first.

The dangers of formula samples for breastfeeding mothers are magnified in times of crisis. Having formula on hand for "just in case," especially if handed out by someone perceived as an expert (relief worker, shelter volunteer, nurse, etc) can impact breastfeeding, even if the sample is never used. It sends the message that breastfeeding and breastmilk supply are fragile and prone to failure.

Parents of breastfed babies can put together an emergency kit, especially if there is advanced warning of a disaster. Some things to include are diapering or EC supplies, instructions for building milk supply, tips on nursing in an emergency, a baby carrier, and contact information for breastfeeding counselors.

During and after a disaster, there are a few things you can do to preserve breastfeeding. Breastfeed frequently to maintain or increase your supply, as well as keep both mother and baby calm. Nurse while your baby is in a baby carrier so that you are able to have hands free for other things, to make it easier to nurse frequently, and to feel more comfortable nursing in crowded areas.

Infant Formula Feeding in Emergencies:

Extra care needs to be taken to formula feed safely in emergency situations. The first thing that can be done by families is to prepare in advance. An emergency kit for formula feeding can include a 1 week supply of ready-to-serve formula in individual serving sizes, a knife or scissors to open the formula packages, sanitary wipes, bottled water, bottles/nipples or cups, paper towels, and a storage container.

You may want to learn how to cup feed your baby and use disposable cups instead of bottles and nipples. You may be in a situation where it is impossible to clean or sterilize feeding equipment.

Put formula preparation and storage guidelines in your emergency kit. Under times of stress you may not be able to think clearly and it can help to have them written out. It can also be helpful if you get into a situation where someone else needs to prepare the formula.

Consider inducing lactation or relactating, especially with younger babies or babies who have nursed at some point. Put an induced lactation/relactaion instruction sheet with breastfeeding counselor contact information in your emergency kit. You may also want to put some milk inducing herbs in your emergency kit.

Wet nursing, if available, should be offered to and accepted by formula feeding parents. If you have any breastfeeding friends close by make sure to have their contact information in your emergency kit. In emergency situations, wet nursing can be safer than formula feeding.

Mixed Feeding and Breastmilk Expression in Emergencies:

If you have warning prior to an emergency, begin to increase time nursing to build supply. If you lose power, have limited water, or need to evacuate you may need to switch to full time nursing. Put instructions for building milk supply in your emergency kit. You may want to start taking milk inducing herbs, or put them in your emergency kit. All the Breastfeeding in Emergencies tips will also apply.

If you express milk using an electric or manual pump, learn how to express milk by hand. Put instructions in your emergency kit.

Consider how you will protect your frozen supply of breastmilk during a power outage. Consider purchasing a back-up generator in case of loss of power. A deep freezer will keep cold longer than an upright freezer. Move milk to the center of your freezer, but away from any frozen meat. Fill empty spaces with containers of frozen water, "blue ice," or even newspaper.

What you can do:

* Donate money instead of formula so that relief agencies can buy the amount and type of formula that can be used. Excess formula ends up being wasted or given to breastfeeding or mixed feeding babies.

It is best to donate money above anything, not just infant formula, because there are often not enough volunteers to sort donations and money can buy exactly what is needed in the correct amounts. Here is what FEMA says about donations:

Cash Contributions
Cash donations are very useful in situations where supplies must be acquired quickly. This is the most efficient way to make an impact with your donations. If you need help in determining who to give to, the National Voluntary Organizations Active in Disaster website has a list of major nonprofits that are active in disaster work or you can make your offer through the National Donations Management Network.


Don't Send Unsolicited Donations
One of the biggest issues around disasters is the amount of unsolicited item donations that start to come in immediately. It's better to wait until communities assess and confirm their needs before you start to send things in. At that time, you can make your donations through non-profits in the National Donations Management Network.

* Donate your time. Contact a relief agency or local shelter and find out how you can donate your time. Often, this is needed more than donations. FEMA offers great tips and resources for helping in a disaster. This is the page specifically on Hurricane Sandy.

* If you are a breastfeeding counselor or lactation consultant, donate your time and expertise in disaster areas. If you have breastfeeding experience, become a breastfeeding counselor or lactation consultant so that you can volunteer if a disaster strikes.

* Shelters and food distribution centers should have the contact information for local and regional breastfeeding support including lactation consultants, breastfeeding counselors (such as through La Leche League or BACE-NMC), WIC breastfeeding counselors, midwives, and postpartum doulas.

These volunteers can offer help with proper breastfeeding support and information, relactating and building milk supply, teaching mothers to hand express, supporting emergency wet nursing, information on protecting expressed milk stashes, information on proper storage and handling of both expressed breastmilk and infant formula, supporting the emotional needs of all mothers.

* If you are a breastfeeding mother it may be appropriate for you to act as an emergency wet nurse. If you have recently weaned a child, you may be able to relactate.

* Donate complementary items to help infants such as diapers, diaper wipes, sanitary wipes, hand sanitizer, and bottled water. Even baby slings and carriers can be crucial in devastated areas. They can help keep infants and toddlers safely attached to parents, keep children calm, provide a buffer between baby and a stangers' potential germs, and offer a way for breastfeeding mothers to feel more comfortable even in crowded areas.

* Contact relief agencies about the importance of having breastfeeding counselors included in front line responders, and having emergencies workers trained in the proper protocol of infant feeding in disasters.

* Donate blood. When an emergency happens, the need for blood may increase. As a result of Hurricane Sandy, many blood drives across the East Coast were cancelled. Blood products, especially platelets, have a short shelf life.

* Donate breastmilk to a HMBANA milk bank. Milk banks are currently facing critical shortages. Do not donate to Prolacta or National Milk Bank because they are for profit companies rather than non-for-profit.

Resources for Infant Feeding in Emergencies:

World Health Organization:
        Breastfeeding: A vital emergency response. Are you ready?

        Guidelines for the safe preparation, storage, and handling of powdered infant formula

UNICEF:
        Breastfeeding a crucial priority for child survival in emergencies

International Medical Corps

United States Breastfeeding Committee

International Breastfeeding Journal (includes detailed information on formula feeding in emergencies)

La Leche League:
        La Leche League Resources

        Infant Feeding in Emergency Situations

        Relactation

Kellymom

Breastfeeding USA

Relief Organizations and Volunteering:

UNICEF
Experts in proper infant feeding protocol, including breastfeeding, in emergencies

Save the Children
Have set up safe breastfeeding areas in Hurricane Sandy shelters

The American Red Cross
Accept blood donations. Volunteers may or may not understand proper infant feeding protocol in emergencies.

Salvation Army
Accepts donations and volunteers

FEMA
FEMA has updates on coordinated relief efforts and great tips on how to help.

National Donations Management Network
This is a great page to go to if you want to donate cash or supplies, or donate your time.

The Importance of N.I.P (nursing in public)

Nursing Frankie at my pottery studio

There have been a couple of situations recently that have again started up dialogues and debates about nursing in public. They have both gotten media attention, and one sparked a nation-wide "nurse-in."

The first involved a college professor who brought her daughter to class on the first day because she was ill and had no child care options. She nursed her child during her feminist anthropology class, Sex, Gender and Culture, as one normally would throughout the course of the day.

This simple act created an uproar when a student tweeted negative comments about it during class. The school newspaper picked up the story, sensationalizing it into a major campus incident rather than life as usual for humans.

Some have claimed that they didn't have a problem with the baby nursing, but rather with the fact that a sick child was in class. If that were true, then why isn't it a news story each time a professor teaches class sick or students show up to class sick?

In Georgia, a mother nursed her baby at an Applebee's restaurant and was told by the manager that she needed to go to the bathroom or leave the restaurant. When the mother stated her right to nurse in public, the police were called. The police backed up the parents' statements of the law, but there is no punitive provision within the Georgia law.

Due to this humiliating and unfair treatment of this family by the Applebee's manager, a nation-wide nurse-in took place on Sept. 29, 2012. These peaceful protests went a long way towards raising awareness for breastfeeding.

These two stories shouldn't have to be stories at all.

The fact of the matter is that it is important to nurse in public, not to make a political statement, but to return nursing to the biological and cultural norm. There are many reasons why it is important to return to a culture where nursing children is just a normal part of life.

Nursing is normal:
I'm about to make a controversial statement... There are no benefits to breastfeeding. That's right, there are no benefits. How can there be benefits to a normal part of biology? We don't say, "There are benefits to using your body's own insulin." Instead, we say, "There are risks to being diabetic." It is important that nursing be viewed as normal.

When mothers separate themselves from the rest of society to nurse, it sends the message that they are doing something wrong. They send the message that they should be ashamed.

Nursing will only be viewed as normal when it is done wherever, whenever, as needed. The more it is seen, the less it will be sensationalized.


Nursing is a learned skill:
We are mammals, named for our mammary glands and defined, in part, by our ability to nurse our young. It is natural and instinctive, yet it is a learned skill. It is not the type of thing best learned by taking a class or reading a textbook. It is best learned by seeing it. Nursing needs to be seen in everyday life, not as clinical sketches.

Nursing is social:
Humans are social. We participate in many different activities to socialize. Eating is one of the biggest social activities we have. A baby should be able to nurse in a restaurant without sparking a national incident or starting a movement.

The argument has been made that because breasts are also sexual, it makes public nursing inappropriate. Well, mouths are sexual and are also used for eating, and yet public eating is not considered provocative.

It has to be something more. I clearly remember a Nurse Out celebration I hosted for World Breastfeeding Week. It had been going well all day with a lot of positive responses. Towards the end of the day, my 3 month old needed to nurse. I asked my sister to stay by the table display while I nursed him a few feet away on a blanket.

Shortly after I left the table, a grandmother, mother, and two kids got out of their car. The kids were naturally drawn the the poster with the two ice cream scoops with cherries on top. The grandmother came over to get the kids and express her disgust at the poster. She was offended by the poster vaguely representing breasts and said that we should not be promoting breastfeeding. She did not even notice that I was nursing a baby with my own real life breasts just a few feet away in plain view.

I have heard comments many times that whether or not any part of the breast is seen, it is the idea of it, of nursing, that is offensive.

When mothers are shamed and humiliated until they retreat to the bathroom, car, or their own home to nurse, they wean their babies earlier. Mothers need to continue to be part of society. Many mothers report feeling isolated after giving birth, and some mothers suffer from postpartum depression. It is important for mothers to be embraced, not shunned.

Nursing is ancient, nursing is modern:
If you could take a peek into an indigenous, hunter-gatherer culture you would see mothers nursing anywhere and everywhere, not held up in huts or on the outskirts of the village. Nursing would be infused in village life, yet not given a second glance.

Some people are put off by breastfeeding because they equate it with "primitive" life or something that's done in developing countries because they have no choice due to poverty.

The fact is that nursing is both ancient and modern. When we nurse our babies, we are honoring our ancestors. When we look to them for their wisdom, we are not regressing. We are only moving forward. Why re-invent the wheel? If we waste time trying to re-invent something that does not need re-inventing, we are wasting time.

In our busy modern culture time is more important than ever. Nursing helps us multi-task. It helps us to sit down for a minute and relax. It keeps kids and moms healthy, reducing time spent at the doctor or sick in bed.

Nursing is practical:
For some reason we have become a culture critical of mothers. The pressure on mothers is enormous. Anything that can make the blending of biological wisdom with modern lifestyle easier reduces this pressure.

The formula industry has worked hard to portray breastfeeding as difficult and inconvenient and bottle feeding as easy and convenient. But the fact is that nursing is much more convenient. It is essential to support nursing. Nursing becomes difficult when it is not supported. It becomes impractical when barriers and restrictions are imposed by an overly critical society.

What do you think? Does this post change your view on nursing in public? What are your stories, good or bad, of nursing in pubic?

Tales: Father's Day



helping Frankie eat

I was recently asked to find pictures of my son Jack with his dad for a special Father's Day gift. I scoured hundreds and hundreds of photo and could only find a few shots. It wasn't because of him not being involved, in fact, it was because he is so involved. I realized he wasn't in most of the pictures because he takes most of the pictures.

Frank's involvement started right from the start, during pregnancy. Now he cooks dinner every night, and that started when I was pregnant with Frankie. I was so tired and nauseous all the time that cooking was impossible.



Frank with Frankie and Bekah

  
It was also with Frankie's pregnancy that we took Bradley childbirth classes together. The Bradley Method is also known as Husband-Coached Childbirth.





Frankie was born 45 minutes after getting to the hospital and there really wasn't a lot of time for Frank to use the childbirth coaching skills he'd practiced. He did manage to film the birth with 2 different cameras, on a tripod and a handheld.

falling asleep

Frank comforting a fussy Frankie

Frankie turned out to be a very high need and sensitive baby. He went through a difficult period of colic, and I don't know how I would have gotten through it with out Frank.

finally sleep

When Frankie was scared to start kindergarten, Frank gave him a special key to hold to remind him of home. It helped him get through the rough beginning. Frankie's teacher commented on his ability to rhyme, something he always enjoyed doing with his dad. Frank also volunteered during library and on field trips.

carrying Frankie at Disney

And Frank was the one who had to say Frankie's long goodnight wishes in the exact right order before Frankie could fall asleep.

cuddling Bekah

Bekah was the first to be born at home. Not only was Frank able to document the birth on video, but I never felt like he wasn't there for me as well. After Bekah was born, Frank made all of my meals and brought them up to me in bed, sometimes with flowers.

mini golf with Jack

For the other 3 homebirths, Frank documented the births, set everything up for the midwives, cleaned up afterwards, and even played host by making food and coffee for everyone. And I still got my trays of food in bed for weeks so I could focus on our new babies.

hangin' with Jack at the pool

Frank took care of the older kids and always made sure I had a glass of water close by while I was nursing. He was always available to hold a newborn so I could shower or take a nap.




Singing Happy Birthday to Lillian







As the children have grown, Frank is always there. He has documented their growth in his "wall photos."

And his voice is always heard in the background of the video clips he records (especially when he's trying to teach them to say "dada" instead of "mama.").



foofing Bekah while teaching her to swim

He's helped the kids learn to swim and ride bikes. The kids help him with chores, like grocery shopping and taking out the trash. Together they love to play basketball.


the whole family


So, even though you don't see him in most of the family photos, you can feel him in there. As I look over years of photos, I see Frank in every single one.

holding Luke's hand

Tales: Luke's Birth Story

I found out I was pregnant with Luke after I had started dancing a lot again. I was also working at a dance supply store and teaching several dance classes. I got pregnant in September which meant I was due in June, right around the end of the year dance concert at the studio where I worked.

I continued to dance through my pregnancy and for the first time I had a hard time gaining weight. I would often not gain anything, or even lose weight, from month to month.

I continually tried to convince the studio director that I should perform, after all I had done it while I was pregnant with my oldest. Of course, I wasn't 40 then and it wasn't a week before my due date. Still, I thought I could pull it off.

The week before the dance concert, I had resigned myself to not performing, but I still had a lot to do to get my students ready. I was still demonstrating full out, even in Irish Step Dance, but I remember feeling very tired and "funny" after my Thursday classes.

On the morning of Friday June 13th, I woke up not feeling right. I felt like it was getting to be that time. I was supposed to take the train and then a bus to Arlington to see my midwife, but I didn't think I could make it. Thankfully, she came to me.

After checking me out, she thought it would be soon but could still be a few days away. The baby's head was still up pretty high. That was all I needed to hear for the "green light" to finish up everything I needed to get done. I would be at the dress rehearsal that evening. I also had a load of pottery I needed to fire.

I carried 2 boxes of pottery a couple blocks up the street to my kiln. I unloaded finished ware and loaded the kiln back up again. On the way home carrying the boxes of finished pieces, I felt a small gush. Soon after I got home and rested, it slowed to less than a trickle.

I put on a pad and went to the dress rehearsal. My daughter, Lillian, was performing and I wanted to be there for her in addition to my students. I had mild cramps throughout the night, some strong enough that I stopped talking to breathe through them. I left at about 9pm and immediately went to bed.

At about 5:45am strong contractions woke me up. I went over to the computer and started timing them on a website to monitor contractions. After a very short time, I decided that it was not only time to wake up my husband Frank but that we should also call my midwife.

I wasn't totally sure I was in labor because my water had very obviously and dramatically broken prior to labor in all 5 of my older kids' births. I also generally retreat and get very quiet in active labor. This time I was more stir crazy and wanted to sit up rather than relax lying down. Still, I could not talk through contractions.

My midwife left to come over as quickly as possible, knowing how fast I can go.

In the meantime, Frank got everything ready. He first had to line our bed with plastic under the sheets, and put chux pads down over the sheets. He lined a cookie sheet with foil and placed sterilized items from our birth kit, like a nasal aspirator, thermometer, cord clamps, ad scissors. He put the alumunum foil wrapped baby blankets in the oven to warm up, and filled the crock pot with water and sliced ginger for warm compresses.

I was sitting on the edge of the bed when my midwife arrived, and then the assistant. I asked my midwife to check to see if I was dilated because I still wasn't sure if I was really in labor. She checked and said I was fully effaced and dilated, and that my baby was about half way down the birth canal.






Several contractions later, at exactly 9am, Luke was born. He was my 2nd Saturday birth. Lillian was also born on a Saturday, and also at 9am. All my other kids were born on Tuesdays.

getting ready to sneeze...

He sneezed twice immediately after being born!

the sneeze!

5 minutes old

Even though the birth was really fast, Frank managed to take photos and record a video of the birth.


Luke nursed right away with no problems. Since we had practiced Elimination Communication (EC) starting at birth with 2 other kids, we were able to catch his meconium and first pees in a potty. He wore tiny little training pants and undies.

needs the potty

It is amazing and empowering to recognize facial expressions and other signs expressing various needs.

 

hungry

That evening was the dance concert. I did Lillian's hair and make-up and my parents brought her to the show. They announced Luke's birth during the performance.

Soon after Luke was born, the kids came in to meet him.

Bekah holding Luke

Six weeks after Luke's birth my family was in a family member's bridal party. I needed to have my bridesmaid dress altered so that I could nurse Luke, and I had to find a halter style nursing bra. My mom made me a brocade sling to match my bridesmaid dress.

When Luke was a few weeks old, I took him with me to help out at the dance supply store. The wonderful owners bought a baby swing for Luke to sleep in while I worked. Most of the time, though, Luke just liked to be carried in the sling. By now I had plenty of babywearing experience, including working and wearing.

Luke turned 4 years old yesterday. He is smart, funny, energetic, imaginative, and extremely empathetic. Happy Birthday Luke!