What is the law in your state?

The states in the US vary widely in the implementation of laws that protect a breastfeeding mother and baby...

Breastfeeding gift ideas for an expecting mom

A reader asks: I am attending a baby shower for a friend. I'd like to get her something that will help make her breastfeeding experience more comfortable. What should I buy?

The sole requirement for NIP

During my pregnancy with my youngest son, one of the parts of motherhood that I looked most forward to was nursing. ...

International and Religious views of NIP

Think nursing in public is only a concern in the United States? If so, is it our religious roots that has instilled our country's prudish (and misguided) desire for "discretion"?

Where are our breastfeeding role models?

I saw a woman breastfeeding her three month old son while walking around the busy farmer's market yesterday morning...

Friday, July 30, 2010

Do It All Over Again

A couple of months ago, McKay and I were talking to someone about nursing in public. Overall it was a positive discussion, but there was one comment that has stayed with me. I had been saying that Margaret doesn't nurse much in public anymore: about 1-5 minutes when it does happen.

"But you'll need to think about how you'll be doing it again pretty soon," he said, eyeing my belly.

"Oh, right."

I think he thought that with all I've been through about nursing in public that I would be more "careful" the second time around. You know: make sure I 'train' my next baby to be under a cover or make sure I always use layers of clothing (I did this for 18 months with Margaret until she decided that she didn't like cloth by her face).

You see, with my second baby coming, I have the chance to start over! Be a 'good' public nurser and not cause waves. And this made me wonder: what would I say to the person who was myself 2 years ago when I was learning to nurse in public the first time around? What would I do differently this next time around?

Heather,


The first time you nursed in public, it was at a Burger King. You were nervous. There was a table of teenage boys a couple of booths away and Margaret was only a few weeks old. You were leaking, leaking, leaking and still learning how to help Margaret latch quickly and on the first try. You didn't know how your first attempts to nurse in public would be and your hands were shaky and you looked around nervously as you latched her on. That's ok. Take as long as you need to make sure the latch is good, accept the fact that you just might be soaked in breastmilk for months, and know that no one's really looking at you and no one really cares.


When you wrote your first post about nursing in public, you nervously clicked "publish." Try clicking "publish" with purpose instead of anxiety. It'll be good for you.


There's a secret to nursing in public: do it confidently, even brashly. Be strong. When your baby is hungry, don't hesitate and put off nursing until later because of what others might think. That stranger isn't the one who will be in bed for the rest of the weekend getting over mastitis if you put off the next nursing session too long. Also, it's better to latch when the baby's first hungry instead of waiting until they are screaming their lungs out. Breastfeed the way that is most comfortable for you and the baby. This will make it easier to latch and relax which will reduce squirming and fussiness in your baby - ultimately leading to less attention on you! The more you do NIP, the easier it will be. Each stage comes with its own difficulties, but you can do it. I promise. After all, hindsight is 20/20.


-The More Experienced Heather

So yes, I will be doing it all over again. And this time, I'll have new challenges to consider: Will I tandem nurse in public? Will I even be able to do that at home with a limited-size lap? But I also have 2 years' experience and a lot more gumption this time around. I will make this "first time" better than the last.
___________________________

NursingFreedom.org is grateful to Heather for allowing us to share her NIP guest post. Heather/TopHat is a mom to a 2 year old nursling, Margaret, and just recently little Isaac who was born last weekend. She knits, blogs, and is most well-known for organizing the nurse-in at Facebook Headquarters in December 2008.

Wednesday, July 28, 2010

Have You Started a Local Breastfeeding Initiative?

Helping my sister latch her new baby on
Have you been involved in a project with the purpose of normalizing or promoting breastfeeding and/or nursing in public? For example:

A video montage of breastfeeding mothers nursing at local points of interest;

A place of refuge for breastfeeding mothers like "Breastaurant";

Free lactation bags for new mothers at a local hospital.

We are looking for stories about your creative efforts to normalize breastfeeding in your communities. We would like to share your experiences as well as step by step instructions on how our readers could duplicate your efforts in their own communities.

Mothers all over the world would love to build on your ideas - please share them with us!

If you or someone you know has helped create a unique breastfeeding project or initiative, please contact us: NursingFreedom (at) gmail (dot) com.

Monday, July 26, 2010

Smoking in Public v. NIP: An Illogical Analogy

Recently a DJ from an Orlando, FL radio station interviewed a midwife about nursing in public. The DJ would prefer that women not nurse in public, and his questions to the midwife were very anti-breastfeeding in nature. At one point he said something to the effect of, “well if women are allowed to breastfeed anywhere, then smokers should be allowed to smoke anywhere they want.”

Today's piece is a collaborative effort that seeks to demonstrate why smoking in public is not an appropriate analogy for nursing in public (N.I.P.). Please feel free to share it with anyone else who tries to compare the two. Thank you to the following bloggers for their help creating this resource:
Annie at PhD in Parenting wrote about individual rights and public health.
Dionna at Code Name: Mama compared legislation on both smoking and breastfeeding.
Paige at Baby Dust Diaries discussed the effect on bystanders of smoking versus breastfeeding.
Lauren at Hobo Mama gave suggestions on how to deal with either smoking in public or N.I.P.


_______________________________________

Individual Rights and Public Health

We all pay for poor health decisions. Whether through private insurance or public healthcare, when other people make bad decisions about their health or when they do things that have a negative impact on the health of others, it costs us money. I reluctantly accept the idea that people have the right to make poor decisions about their own health and that our health care system (be that private insurance or public health care) should still take care of them. But, I also think that our governments and insurance companies have a role to play in promoting healthier alternatives, taxing bad choices, and protecting people from being directly affected by the poor health decisions of others.

Smoking is bad for you. Smoking around other people is bad for them. There are countless studies and stories that point out the negative health implications of tobacco smoke. According to the World Health Organization:
Tobacco is the second major cause of death in the world. It is currently responsible for the death of one in ten adults worldwide (about 5 million deaths each year). If current smoking patterns continue, it will cause some 10 million deaths each year by 2020. Half the people that smoke today -that is about 650 million people- will eventually be killed by tobacco.
In addition to direct exposure to cigarette smoke, secondhand smoke is a significant problem. The Society of Actuaries in the United States determined in its 2005 research report Economic Effects of Environmental Tobacco Smoke that exposure to secondhand smoke costs the United States about $10 billion annually (out of a total of $150 billion annually for all smoking related health costs). This amount has decreased by $5 billion in recent years due to a reduction in the percentage of smokers among the population and also a reduction in exposure to smoke, showing that efforts to promote public health in this regards are having some level of success.

Breastfeeding, on the other hand, is good for you. It is good for the mother and good for the child. According to the World Health Organization:
The protection, promotion and support of breastfeeding rank among the most effective interventions to improve child survival. It is estimated that high coverage of optimal breastfeeding practices could avert 13% of the 10.6 million deaths of children under five years occurring globally every year. Exclusive breastfeeding in the first six months of life is particularly beneficial, and infants who are not breastfed in the first month of life may be as much as 25 times more likely to die than infants who are exclusively breastfed.
An economic study by Melissa Bartick et al called The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis and published in the Pediatrics journal found that if 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save $13 billion per year. If women feel uncomfortable or are made to feel uncomfortable nursing in public, there is a greater chance that they will wean earlier and be unable to meet those targets. It is inconvenient to have to always find a private place or private way to nurse and I can understand how feeling that you need to do so would lead moms to switch to formula. In addition, in order to increase breastfeeding rates, we need more women to be breastfeeding in public and being open about doing so. Only when our society sees nursing as the normal way to feed a baby, will it become the default way of feeding a baby.

So from a public health perspective, in order to improve the health of our population and cut down on medical costs, we need to continue to tell people that smoking is bad for you and ensure that people are not exposed to second hand smoke against their will. We also need to promote breastfeeding and ensure that women are encouraged to breastfeed whenever and wherever they want. Also, from a humanitarian point of view, we need to protect people from having their health threatened by others and also protect their right to do what is best for their family's health.

Interestingly, one of the linkages between the tobacco issue and the infant feeding issue is that poverty is a significant factor in both. People who are poor are more likely to smoke and to spend a significant amount of their limited budget on tobacco. People who are poor are also more likely to formula feed, which can also be costly (although it is often subsidized for low income families). From a public health perspective, I think one of the priorities needs to be on ensuring that low income families have the resources that they need and the role models that they need to be able to breastfeed successfully and to give up tobacco successfully. A part of that, to me, means ensuring that women are not ridiculed for breastfeeding in public by some jerk who is blowing smoke in their faces.

Smoking v. Breastfeeding: The Law


Photo credit: stringberd
Both smoking and breastfeeding have been the subject of legislation on federal and state levels. But legislation on the two differs significantly: whereas smoking is legislated because it is hazardous to public (and individual) health, breastfeeding is legislated because of its great health benefits.

The Long History of Laws Against Smoking


There are records of laws restricting the growth, trade, and use of tobacco products in the United States and Europe from as early as the 1600’s. The General Court of Massachusetts Bay enacted one of the first laws banning smoking in public in 1632. The 1600’s also ushered in the first laws prohibiting minors from smoking.1

In the late 1800’s and early 1900’s, the prohibitionists (those who wanted to ban the production/consumption of alcohol) also targeted cigarettes. “Between 1895 and 1921, 14 states banned the sale of cigarettes. Even in the city of New York it was declared unlawful for women to smoke in public.” But partially due to a powerful tobacco lobby, and partially due to the lure of income from taxes on tobacco, the cigarette bans were soon repealed.2

In “1964, the Federal Trade Commission concluded that cigarette advertising was deceptive . . . and that advertisers had a responsibility to warn the public of the health hazards of cigarette smoking.” Thus the warning labels on tobacco packages were born, but not without a fight from the tobacco industry. Regardless, several years later the FTC reported that the warnings were futile, probably in part because of the massive advertising campaigns by tobacco companies: “cigarette advertisers [were] the single largest product advertisers on television.”3

The Federal Communications Commission required television and radio stations in 1967 to start airing information on the health hazards associated with smoking. And in 1970 President Nixon signed into law legislation that banned cigarette advertising completely on television and radio; the law went into effect on January 2, 1971.

Since that time, lawmakers at local, state, and national levels have enacted (and courts have upheld) a variety of laws and regulations limiting the reach of deadly secondhand smoke. Smoking has been banned in airports, courtrooms, restaurants, on city sidewalks, in jails and schools, cities can even refuse to hire people who smoke in their own homes.4 Our neighbor to the north, Canada, has been at the forefront of anti-smoking measures: public smoking is banned in offices, restaurants, and in some cities all indoor spaces.5


There is no constitutional right to smoke, but we do arguably have the right to breastfeed.

"The U.S. Supreme Court has held that "only personal rights that can be deemed 'fundamental' or 'implicit in the concept of ordered liberty' are included in the guarantee of personal liberty." These rights are related to an individual's bodily privacy and autonomy within the home. Proponents of smokers' rights often claim that smoking falls within the fundamental right to privacy, by arguing that the act of smoking is an individual and private act that government cannot invade. Courts consistently reject this argument.

The privacy interest protected by the U.S. Constitution includes only marriage, contraception, family relationships, and the rearing and educating of children."6 By that definition, it would appear that breastfeeding is a fundamental right. The U.S. Supreme Court has never had to answer this question, though.7


State and Federal Legislation Protects Breastfeeding

While the U.S. Supreme Court has never had to answer the question of whether we have a constitutional right to breastfeed our children, there are both federal and state laws in place to protect a mother and child's right to breastfeed and to nurse in public. There are basically two types of law in place: "(1) those which exclude breastfeeding from indecent exposure or other criminal laws; and (2) those which expressly state a mother may breastfeed in public. . . . The lack of a state law does not mean that it is illegal to breastfeed in public. If a state does not have a law addressing public breastfeeding, it may mean that a private person, such as a restaurant owner, may have the right to ask a breastfeeding mother to leave. States with laws that only exempt mothers from criminal prosecution[] also do not prevent a restaurant or store owner from asking a breastfeeding mother to leave or breastfeed in another area."8

In Canada, breastfeeding is protected as a fundamental right. The right to breastfeed anywhere, anytime is protected by the Canadian Charter of Rights and Freedoms.9


International Regulations on Breastmilk Substitutes

Not only is breastfeeding protected by law, but there are measures in place to regulate the companies that produce and market breastmilk substitutes (including formula). Because "[t]here are no benefits of breastfeeding[; t]here are risks of formula feeding," every member of the World Health Assembly has voted to adopt the World Health Organization's International Code of Marketing of Breast-milk Substitutes. As part of the World Health Assembly's plan to protect and encourage breastfeeding, the Code places restrictions on how and where companies can advertise infant formula and other foods and beverages. Among other things, the Code provides:

  • Article 4.2 requires "[i]nformational and educational materials . . . dealing with the feeding of infants" to include information on: "(a) the benefits and superiority of breast-feeding; (b) maternal nutrition, and the preparation for and maintenance of breast-feeding; (c) the negative effect on breast-feeding of introducing partial bottle-feeding; (d) the difficulty of reversing the decision not to breast-feed; and (e) where needed, the proper use of infant formula . . . . When such materials contain information about the use of infant formula, they should include the social and financial implications of its use; the health hazards of inappropriate foods or feeding methods; and, in particular, the health hazards of unnecessary or improper use of infant formula and other breast-milk substitutes. Such materials should not use any pictures or text which may idealize the use of breast-milk substitutes."
  • Article 5.1 prohibits advertising or other promotion of the products covered by the Code.
  • Article 5.2 prohibits distribution of product samples of items covered by the Code.
  • Article 5.3 prohibits point-of-sale advertising, product samples, or other promotions at the retail level (including special displays, coupons, special sales, etc) of items covered by the Code.
  • Articles 6 and 7 place similar restrictions on health care facilities and health care workers.
  • Article 9.2 sets certain standards for labeling products. Manufacturers must include: "(a) the words "Important Notice" or their equivalent; (b) a statement of the superiority of breastfeeding; (c) a statement that the product should be used only on the advice of a health worker as to the need for its use and the proper method of use; (d) instructions for appropriate preparation, and a warning against the health hazards of inappropriate preparation." Labels may not include "pictures of infants, nor should they have other pictures or text which may idealize the use of infant formula."

Smoking in public is not analogous to nursing in public.

Tobacco use has long been regulated and restricted to protect the health of the users and of those subjected to secondhand smoke. Conversely, governments have enacted laws in order to protect the rights of breastfeeding mothers and children. And, similar to tobacco products, breastmilk substitutes are regulated in order to protect consumers and encourage breastfeeding. To compare smoking in public to nursing in public completely misses an important point: the laws governing breastfeeding exist to protect mothers and children who are safeguarding their own health by breastfeeding. The laws governing tobacco use exist to protect against the dangerous health consequences that occur because of tobacco, both to tobacco users and to those around them.

The Effects on Bystanders: Secondhand Smoke v. Secondhand Breastfeeding

Secondhand Smoke


You are sitting in your local eatery and a person at the table next to you lights a cigarette. What's the big deal, right? This is a free country after all (assuming smoking is legal in said eatery). Is there a real, tangible risk to you?

According to the National Cancer Institute yes.

1. There are more than 4,000 chemicals found in that secondhand smoke wafting over to your table including:
  • arsenic (a heavy metal toxin)
  • benzene (a chemical found in gasoline)
  • beryllium (a toxic metal)
  • cadmium (a metal used in batteries)
  • chromium (a metallic element)
  • ethylene oxide (a chemical used to sterilize medical devices)
  • nickel (a metallic element)
  • polonium–210 (a chemical element that gives off radiation)
  • vinyl chloride (a toxic substance used in plastics manufacture)
2. There are immediate effects on your body due to your co-diner's decision to light a cigarette including;
  • Cough
  • Nausea
  • Headache
  • Eye irritation
  • Sore throat
  • Dizziness
  • Difficulty in breathing in those already suffering from asthma
Additionally, tobacco smoke exposure has immediate and substantial effects on blood vessels in a way that increases the risk of a heart attack, particularly in people already at risk.10 Exposure to tobacco smoke for 30 minutes significantly reduces coronary flow velocity reserve in healthy nonsmokers.11

3. There are long-term risks associated with secondhand smoke;
  • Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke.12
  • In the United States, secondhand smoke is thought to cause about 46,000 heart disease deaths each year.13
  • Secondhand smoke may increase the risk of breast cancer, nasal sinus cavity cancer, and nasopharyngeal cancer in adults, and leukemia, lymphoma, and brain tumors in children.14
  • Children exposed to secondhand smoke are at an increased risk of sudden infant death syndrome (SIDS), ear infections, colds, pneumonia, bronchitis, and more severe asthma.
4. Your Caesar salad will taste like smoke.

Secondhand Breastfeeding


You are sitting in your local eatery and a woman at the table next to you begins to nurse her child. Without a cover. What's the big deal, right? This is a free country after all. Is there a real, tangible risk to you?

In my opinion, yes there is a risk to you.

1. You run the risk of seeing a human female breast being used in a manner that is not sexual and not serving the purpose of selling a product. You might be forced to question the objectification of women in our culture.

2. You run the risk of seeing the natural and standard form of feeding an infant. You may have to feel strong emotions about your decisions (or someone close to you) to feed your child formula.

3. You may run the risk of having your young child ask "what is that lady doing?" and you just might have to explain the biological purpose of breasts. Perhaps you can talk about what makes mammals unique or how breastmilk contains very healthy protective ingredients for the baby (the opposite effect, in fact of the previous smoke rings).

4. You might have your own personal boundaries of decency crossed. You may be offended. You run the risk of being faced with respecting the diversity of thought in our culture and learning to practice tolerance.

4. However, in all but the most extreme and unusual cases, I can assure you your Caesar salad will not taste like breastmilk.

Suggestions on How to Deal with Smoking and Nursing in Public


14th December 1951:  A woman having a cigarette break by the service hatch in a New York bar. Original Publication: Picture Post - 5784 - New York - unpub.  (Photo by Raymond Kleboe/Picture Post/Getty Images)
1951 photo of a woman on a cigarette break
by Raymond Kleboe, Getty Images
When I was pregnant, I was fiercely protective of my unborn little one's health. I don't live with a smoker or have geographically close friends who smoke regularly, so I don't come across it that often. But when I traveled to be with my mother during a health crisis she was having in my third month of pregnancy, I had to walk the gauntlet of smokers lining the waiting area outside the airports.

What did I do? I took a deep breath before arriving near any smoker and held my breath as I passed, to the point that I could. When I had to stand outside waiting for a bus, I continually moved my position to be as far from smoke as I could.

What did I not do? I did not fake a cough or wave my hand in front of my face. I did not grimace at the smokers and point tellingly at my slightly protruding belly, reminding them that there were children present. I did not tell them that if they wanted to smoke, they should do so at home where it's decent, or that they should have planned their trips so that they smoked just before they left and just after they got back. I did not heckle them and threaten to call airport security on them.

I feel like there are a lot of people out there saying the sight of public breastfeeding offends them. And to those people I say, that's why you have a neck. That's why you have eyelids. That's why you have the right to go somewhere else or stay home.

In other words, we as citizens of this diverse planet have personal responsibility to deal with our own feelings and reactions to things that bother us but are perfectly legal. In a free society, I have the right to form my own opinions about smoking, about interracial partnerships, about homosexual partnerships, about children's presence in public, about breastfeeding in public or at all, about wearing low-cut tops or no tops at all (men in summer hereabouts), about being part of a religion or culture that requires dressing in a very distinct way, etc. (I hope it's clear I'm not listing things I'm against. I'm listing things some people are against.)

What I don't have the right to do is impinge on people exercising their legal rights to act as they see fit. I don't have the authority to hand a blazer to someone I think is too skimpily dressed and insist that person don it. I don't have the right to pull a cigarette from someone's mouth and extinguish it beneath my heel. I don't have the right to demand a couple remove themselves from my sight.

Granted, free speech does give me the right to be a jerk. It's not good manners, but I could certainly voice my opinions on everyone else's behavior and generally make everyone in earshot feel uncomfortable. But I don't have the right to coerce the people I'm targeting to abide by my opinions, or to call in authorities to enforce my opinions.

In short, people who are against breastfeeding in public should do what I do around smoking in public: Deal with it on a personal level.

If it bothers you, turn away. Leave the area.

Even better, educate yourself on why breastfeeding is important, and therefore why breastfeeding in public is important. Work through your own hang-ups about what you demand of nursing parents, and reconsider it from their point of view. (For instance, would you want to eat in a restroom or with a blanket over your head? Would you want to be told you had to stay home for a year or couldn't leave without a complicated preparation of sterilized feeding gear that must stay at a proper temperature?)

And even more so, meet people who breastfeed. Find out what it's like for them, and hear their stories.

This actually works for anything on the list of things that might offend you. The more you get to know the people who practice what bothers you, the more you realize: "Huh! They're humans, too."

In regard to smoking, I have done all of those things. I still don't agree that it's a good idea to smoke, but I know smokers I admire and like, and I know more now about the hold smoking's addiction can have on people. I also take steps to curb my exposure to smoke. Before indoor smoking bans were passed, I avoided restaurants that were too smoky for my taste; I've asked to change hotel rooms when I've been granted a smoking room inadvertently; and I will avoid standing near someone who is smoking. It's up to me to make myself comfortable. It is not up to me to make smokers bow to my every wish.

When other people are doing something that's perfectly legal and reasonable, even if I don't agree with it, I need to step aside and deal with my own objections. My objections do not trump their rights.

In the same way, my right to feed my baby anywhere I am allowed to be is legally protected, and no one's opinion is allowed to take that away from me.

P.S. This doesn't even get into the myriad reasons smoking is different from breastfeeding and the way public smoking impinges on my right to physical health (because other astute bloggers will be tackling those issues) or the fact that oftentimes now, I'll come across smokers breaking the law, smoking directly under No Smoking signs. In Washington State, it's now illegal to smoke within 25 feet of doorways, so that I should be able to wait for my bus outside the airport's sliding doors without being engulfed in a poisonous cloud.
________________________________

1. Jane Lang McGrew, History of Tobacco Regulation (citations omitted)
2. History of Tobacco Regulation (citations omitted)
3. History of Tobacco Regulation (citations omitted)
4. Action on Smoking and Health
5. Global Anti-Smoking Efforts
6. Public Health Institute, There Is No Constitutional Right to Smoke (citations omitted, emphasis added)
7. Melissa R. Vance, Breastfeeding Legislation in the United States: A General Overview and Implications for Helping Mothers
8. Breastfeeding Legislation in the United States: A General Overview and Implications for Helping Mothers
9. For more information, visit INFACT Canada.
10. Barnoya J, Glantz SA (2005). "Cardiovascular effects of secondhand smoke: nearly as large as smoking." Circulation 111 (20): 2684–98.]
11. Otsuka R, Watanabe H, Hirata K, et al. (2001). "Acute effects of passive smoking on the coronary circulation in healthy young adults". JAMA 286 (4): 436–41.
12. National Cancer Institute. Cancer Progress Report 2003. Public Health Service, National Institutes of Health, U.S. Department of Health and Human Services, 2004.
13. California Environmental Protection Agency, Office of Environmental Health Hazard Assessment. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant: Part B Health Effects, 2005.
14. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006.

Friday, July 23, 2010

Nursing In Public with Twins: My Story, My Thoughts

This post was written as part of The Breastfeeding Cafe's Carnival. For more info on the Breastfeeding Cafe, go to www.breastfeedingcafe.wordpress.com. For more info on the Carnival or if you want to participate, contact Claire at clindstrom2 {at} gmail {dot} com. Today's post is about nursing in special circumstances. Please read the other blogs in today's carnival listed below and check back for more posts July 18th through the 31st!
Kristin tandem nursing her
newborn twins.

When my twins were two weeks old, I took them on an outing. By myself. We first had an appointment with my wonderful lactation doctor, and when that was over, I took them shopping at REI, which was close by. I wanted to get a Father's Day present for my husband, the new Daddy of three. I also hadn't been much of anywhere other than my house, the grocery store, and the hospital in more than a month.


At the time, I was feeling brave. Thinking back, I realize I was a little bit crazy, too. In in a good way, perhaps. You kind of just need to jump in and do this kind of thing at some point.

We had a good appointment, and then I packed us up and headed to the store. I transferred the girls in their carseats to the double Snap and Go (aka, the extra long baby bus). I also brought a ring sling. We wandered around, I got to browse -- everything was going well! As expected, one baby got fussy pretty quickly so I put her in the sling. I pushed my backpack and the other baby in the stroller. Soon she was calm and happy, but the other baby would fuss, and I'd switch, and buy myself a bit more shopping time. Worked pretty well!  I knew my time was limited, though.

Soon, I knew they needed to nurse. At that age, they were often nursing around the clock. Hourly, often.  It's hard with two newborns and a milk supply issue! My girls wouldn't take pacifiers, either, and had a strong need to suck. I sat down on some benches in the play area, near the restaurant. I was really lucky -- this is pretty much the ideal place to nurse in public. In breastfeeding-friendly Seattle, in a crunchy outdoor store, in an uncrowded area surrounded by parents with young children. Geesh, what could be better, really?

I started nursing one baby in the sling, and I doubt many folks even knew or noticed what was happening.  The other baby was peacefully sleeping in the stroller. A few minutes in, though, she -- as usual -- sensed what she was missing and wanted in on the action. What to do? At this age, tandem nursing was still a challenge, with floppy, hard to latch babies. They were so little!  And I was used to lots of specially placed pillows, and a nice chair with a footrest, not a hard bench in playland!

But, necessity is the mother of invention, so they say, and if I wanted to finish my shopping trip in peace, I needed to nurse both babies. Right now, before the screaming happened. So, I scooped her up (thanks to the sling I had a free hand) and positioned her in the crook of my arm, under the extra fabric tail of the sling.  Easy, peasy. Now, I had two content, nursing babies.

Of course, that's when a big conference room opened up right near us, with tons of people (mostly men) pouring out for lunch. Many sat on the extra benches, right next to me. I am not sure if any of them noticed (or cared) what I was doing, but nobody said anything, if they did. Several other moms did cheer me on, quietly, with friendly, positive comments, which I appreciated.

Eventually, I was able to finish my shopping and head home. It was good. I felt very empowered and competent in my baby-wrangling that day. And it was so nice to be OUT in the world, seeing something other than my own four walls & family.

In those early months, getting out of the house -- doing something "normal" like going to a store, a restaurant, or just being out in the city -- was a huge thing. The isolation you start to feel when you are locked in your own house gets really tedious fast.  If a mother goes anywhere with a newborn, it's likely she is going to have to feed it. If she is nursing, she will need to nurse!

I am a big breastfeeding advocate, and am not shy to nurse one baby in public. I will admit, though, that tandem nursing in public places and in front of strangers was not something I ever really felt that comfortable doing. As the babies got bigger, it was just too hard. It's harder to be discreet. It feels like a freak show. I wish I could be that person who does what all women have a right to do -- to proudly feed their babies wherever they need to be fed. I wanted to be that woman. But, most often, I hid in my car. Or, I gave one or both of them a bottle (I needed to supplement as it was, so that was not a difficult choice for me). Or, even more likely, we stayed home -- it was just so much easier for me to stay home.

If I was feeling this way and doing these things -- someone who is confident in my decisions and rights, supported, and in a super breastfeeding friendly city as well -- what about all those women who are not?  Who have faced real criticism, who have been asked to cover up, or to leave, who have been shunned or even encouraged not to breastfeed in the first place?

I think of those women and wonder what I can do now to empower them, to make them feel like strong and capable mothers the way I felt that day in the store -- out and active in their communities, accepted and supported, mothering their babies the best way they know how. For now, I will share my thoughts and stories, encourage mamas when I can, and hope we all continue to create a new normal, for the sake of all those who follow in our footsteps.
_______________________


We are proud to host today's guest post on tandem nursing in public by Kristin. You can normally find Kristin at Intrepid Murmurings, where she writes and photographs her attempts to embrace motherhood, nurture creativity, and maintain sanity while raising twin toddlers and a preschooler.


Here are more posts by the Breastfeeding Cafe Carnival participants! 

Wednesday, July 21, 2010

Letter to Missouri Department of Social Services and Centerpoint Medical Center

Dionna Ford
 (Address)
July 21, 2010

Ronald J. Levy
Director, Missouri Dept. of Social Services
Office of the Director
Broadway State Office Building
P.O. Box 1527
Jefferson City, MO 65102-1527

Cc: Ms. Denise Molland
Director of Women's Services
Centerpoint Medical Center
19600 East 39th St.
Independence, MO
64057

Dear Mr. Levy and Ms. Molland:

I respectfully write this letter to express my utmost concern over the conditions of the removal of Mikaela Sinnett from the custody of her parents, Erika Johnson and Blake Sinnett on May 23, 2010 from the Centerpoint Medical Center in Independence, MO. Of course the public does not know all of the details of this family’s story, but the fact that a breastfeeding mother was not given every opportunity to provide her child with proper nutrition should be addressed.

Mikaela was born to Erika Johnson and Blake Sinnett on May 21, 2010. The sound of Mikaela’s first cries after her birth may have been more special to her parents than they would be to other parents, because Mikaela’s parents are blind.

As with any new mother, when Erika latched little Mikaela on to breastfeed in those first few precious hours of her life, Erika struggled a little. Breastfeeding has a learning curve for every woman, but there is no requirement that a mother must see her infant in order to nurse her. When the Centerpoint lactation nurse noticed that Erika’s breast was covering Mikaela’s nostrils, she was concerned. But instead of patiently working with the young mother (like we would hope any nurse or lactation consultant would do), she decided that Erika was incapable of caring for her newborn.

On Mikaela’s chart, the Centerpoint nurse recorded the words that would irrevocably change the course of the infant’s future: “The child is without proper custody, support or care due to both of parents being blind and they do not have specialized training to assist them.”[1]

A social worker came next to ask questions: “How could she take her baby’s temperature? [Ms.] Johnson answered: with our talking thermometer. How will you take her to a doctor if she gets sick? Johnson’s reply: If it were an emergency, they’d call an ambulance. For a regular doctor’s appointment, they’d call a cab or ride a bus.” The couple’s answers were not good enough. The social worker declared, “Look, because you guys are blind, I don’t feel like you can adequately take care of her.”[2]

Two days later, Mikaela was taken by the Missouri Department of Social Services. For the next 57 days, Erika and Blake were only allowed to see Mikaela two or three times each week for an hour at a time, and only under the supervision of Mikaela’s foster parent.

Ironically, the Missouri Department of Social Services proudly proclaims on its website that its “mission is to create opportunities for eligible blind and visually impaired persons in order that they may attain personal and vocational success.” To accomplish that mission, you provide services “on the premise that with adequate preparation and reasonable accommodation, each blind or visually impaired person will be able to achieve his or her maximum potential in the home and community, in educational settings, and in employment.”[3]

How is taking a two day old infant away from her parents and placing her in foster care “adequate preparation” or “reasonable accommodation” to help Social Services achieve its mission of helping Erika and Blake “achieve their maximum potential”?

What reasonable efforts did the Missouri Department of Social Services make to prevent removal of Mikaela from her parents?[4] Why could Social Services find no family or community resources to help Erika and Blake learn how to parent their newborn?[5] The fact that a person is blind does not make him or her incompetent or incapable of caring for a child.

The Missouri Department of Social Services only removes children who are in “imminent danger.”[6] This covers situations where a child is in danger of physical or sexual abuse, unsanitary conditions, neglect, or is not having his basic needs met. I do not comprehend how the simple state of being blind can lead Social Services to believe that the parent is in danger of failing to meet a child’s basic needs, neglecting the child, subjecting the child to unsanitary conditions, or abusing the child.

And regardless of whether Social Services decided it was in Mikaela’s best interests to remove her from her parents’ home, there appears to have been absolutely no reason that Erika and Blake should have been limited to such infrequent, supervised visits. Two or three times per week for an hour each time is a reprehensible visitation schedule for new parents who had shown no signs of abuse or neglect. Erika and Blake were even barred from holding their newborn daughter – and so Erika lost her right to nourish and comfort her daughter at her breast.

The consequences to a child’s health from being denied the opportunity to breastfeed are well catalogued. Mikaela’s health has been irreparably harmed by the Missouri Department of Social Services’ decision to deny Mikaela her basic human right of the standard in infant nutrition.

Erika was never given adequate lactation support by Centerpoint Medical Center or Social Services, nor was she given adequate contact with her daughter to establish a healthy breastfeeding relationship. There appears to have been reason to bar Erika from visiting her daughter on a sufficient basis to maintain breastfeeding and/or pumping. The apparent lack of forethought given to this family’s situation by both Centerpoint and by Social Services is deplorable.

It is disheartening that no one at Centerpoint or Social Services cared about what was truly in Mikaela’s best interests: if she was to be denied the company of her parents, at least she could have been protected by her mother’s breastmilk. (And for those who would have advised Erika to pump her breastmilk, it is often a challenge to pump an adequate supply of breastmilk at all, much less to pump under the incredibly stressful conditions of having a child forcibly removed from your breast and of not having your child physically close to you while pumping, which helps stimulate milk production.)

If Social Services was that concerned about Erika and Blake’s ability to care for Mikaela, why couldn’t they have been placed with a social worker or foster parent who would have helped them in those crucial first few days or weeks? Why could they not have remained at the hospital for additional training? Surely someone could have come up with a solution that would have been less cruel than ripping a newborn from her loving parents’ arms.

Breastmilk and breastfeeding are the standard for infant nutrition.

There are numerous and well-documented benefits for both infants and mothers who breastfeed, as well as risks to those who do not breastfeed. Colostrum, the first milk that Mikaela was denied when she was taken from her mother, has over sixty components, each with a specific function to nourish and protect newborns. Colostrum acts as a vaccine: it is rich in immunoglobulins, which produce antibodies specific to the environment. The high concentrations of leukocytes found in colostrum can actually “destroy disease-causing bacteria and viruses.” Colostrum also protects by helping to “seal” a newborn’s intestines; this enables an additional defense against viruses and bacteria. [7] Moreover, colostrum provides the perfect amount of nutrients necessary for further growth and development of the brain, heart, and central nervous system.[8]

Mature breastmilk also contains growth factors, hormones, enzymes, and other substances that are immune-protective and foster proper growth and nutrition.[9] Breastfeeding is associated with a reduction of the risk for children of contracting pneumonia, staphylococcal infections, influenza, ear infections, severe infections of the lower respiratory tract, asthma, obesity, type 1 and type 2 diabetes, childhood leukemia, certain types of cancer, and sudden infant death syndrome (SIDS).[10]

Encouraging breastfeeding is an integral part of many governmental health and wellness initiatives, including programs created by the US Centers for Disease Control and Prevention (CDC), the US Department of Health and Human Services (HHS), and the White House Task Force on Childhood Obesity, among others.[11] And breastfeeding is not just for infants. The American Academy of Family Physicians 2008 Position Paper on breastfeeding states that “breastfeeding at least until the second year of a child's life is not considered 'extended' breastfeeding. Rather, breastfeeding until the bare minimum age of 2 years is the norm and anything less brings about detrimental consequences.”[12]

The law protects a child’s right to breastfeed in Missouri.

Regardless of the many benefits of breastfeeding and its promotion by medical and governmental organizations, Missouri law protects a child’s right to nurse. Missouri enacted Mo. Rev. Stat. § 191.918 (1999), which reads:

Notwithstanding any other provision of law to the contrary, a mother may, with as much discretion as possible, breast-feed her child in any public or private location where the mother is otherwise authorized to be.

The Missouri legislature has recognized the critical importance of breastfeeding; Centerpoint Medical Center and the Missouri Department of Social Services should do the same.

Breastmilk and breastfeeding are the standard for infant nutrition. No infant should ever be forcibly denied the nourishment and comfort of her mother’s breast. The actions of Centerpoint Medical Center and the Missouri Department of Social Services have harmed the health of a newborn child. Such a situation should be intolerable.

Please work with me to protect the rights of breastfeeding children and mothers. I am writing to ask:
·        
Centerpoint Medical Center: please revisit and improve the training provided to and the services provided by any staff member that comes in contact with a new mother. I would also ask that you provide to Ms. Johnson, free of charge, an in-home Lactation Consultant to help her induce lactation, so that she can enjoy a healthy breastfeeding relationship with her daughter.
·         Missouri Department of Social Services: please revisit and modify your policies about 1) the removal of breastfeeding infants in such circumstances and 2) the visitation privileges of breastfeeding mothers. Additionally, if the parents’ blindness was truly the only reasons for removal of Mikaela, please revisit and modify your policy on the removal of children from parents with disabilities.

If Mikaela was actually removed simply because her parents are blind, I hope that both Centerpoint and Social Services are working on official apologies to the family for the family’s emotional distress and the couple’s loss of time with their daughter caused by the agencies’ actions.

Thank you for your time and consideration.
Sincerely,
Dionna Ford




[1] Kavanaugh, Lee Hill, Infant is Returned to Couple After State Places Her in Protective Custody, Kansas City Star, July 21, 2010
[2] Infant is Returned to Couple After State Places Her in Protective Custody
[3] Missouri Department of Social Services, Rehabilitation Services for the Blind
[4] Missouri Department of Social Services, Request and Summary for Authority to Remove a Child
[5] Missouri Department of Social Services, Safety Assessment, Part B, Section 2
[6] Infant is Returned to Couple After State Places Her in Protective Custody
[7] What Is Colostrum?; The Importance of Colostrum (citing Alm, J. et al. An anthroposophic lifestyle and intestinal microflora in infancy. Pediatric Allergy and Immunology 2002; 13(6):402)
[8] Hamosh, Margit, PhD, Breastfeeding: Unraveling the Mysteries of Mother’s Milk; Penchuk, Ellen, The Importance of Colostrum (citing Oddy, W. The impact of breastmilk on infant and child health. Breastfeeding Rev 2002; 10(3):5-18; Rivers, L. The long-term effects of early nutrition: the role of breastfeeding on cholesterol levels. J Hum Lact 2003; 19:(1))
[9] Breastfeeding: Unraveling the Mysteries of Mother’s Milk
[11] See http://www.cdc.gov/breastfeeding/ ; http://www.cdc.gov/breastfeeding/policy/hp2010.htm ; http://www.letsmove.gov/tfco_fullreport_may2010.pdf
[12] http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionpaper.html; The AAFP’s position is almost identical to that of the World Health Organization (WHO) and UNICEF, Global Strategy for Infant and Young Child Feeding.
For similar positions from the American Academy of Pediatrics (AAP) and other medical organizations, see http://www.aap.org/breastfeeding/faqsBreastfeeding.html#10; see also http://www.liebertonline.com/doi/abs/10.1089/bfm.2008.9988?journalCode=bfm.

Did You Help Lobby for Better Breastfeeding Laws?

My lactivist friend Raegan nursing
on the Missouri capitol building's steps.
We are seeking stories and resources from people who were on the front lines in lobbying for better breastfeeding laws.

One of the main goals of NursingFreedom.org is to help women advocate for their breastfeeding rights. There are still several states with either no laws protecting breastfeeding mothers and children, or only minimal protection. For example, Idaho, Nebraska, and West Virginia have absolutely no laws protecting nursing in public. Michigan, South Dakota, and Wyoming only exempt nursing in public from public indecency laws. Tennessee limits the protection of nursing in public only to infants younger than twelve months.

We still have work to do in these states, as well as states that do not give full protection for mothers who nurse their children in any public or private location. Please help us provide resources so that our sisters in these states can be educated in their efforts to change the law.

If you have resources - sample letters, reports, studies - anything your state legislature considered when writing your statute, please email it to NursingFreedom (at) gmail (dot) com.

If you have a personal story about the journey to new breastfeeding laws in your state, please contact us. We would love to share your story and experiences with our readers.

If you know someone who could contribute, please share this information with them.

We don't want women to have to reinvent the wheel in their advocacy efforts. Let's learn from each other!

Tuesday, July 20, 2010

Take Action: Tell Johnny Rockets that NIP is Legal

Just when you think NIP is yesterday's news (where you thinking that?) it is back in the headlines.  Corday Piston, a Lexington, KY mother was visiting a Newport, KY Johnny Rockets Restaurant when she was told she could not breastfeed her 6-month old daughter on their patio.  Apparently, despite Piston informing the manager of her legally protected right to nurse her child wherever she is authorized to be, she was given the options of a) nursing in the full-sun on a public bench, or b) nursing in the bathroom.

Piston organized local mothers for a peaceful demonstration outside the offending restaurant and returned with the KY statue in hand to show the manager.  Overall I think this mother should be applauded for the way she handled it - for knowing her rights and advocating for them.  But what can we do?

Newport, KY is a suburb of Cincinnati, Ohio, my home state, so this literally and figuratively hit close to home.  Both KY and  OH have laws protecting the right to NIP (find your state's laws here).  More importantly, Johnny Rockets is an international company with restaurants in 28 US States, Canada, Mexico, Europe, Africa, the Middle East, and Asia.  This incident effects all nursing mothers and this is an opportunity to educate the entire Johnny Rockets Corporation.

This is the letter I am sending to Johnny Rockets Corporate (and cc'ing the local restaurant).  Will you join me?  Feel free to alter the letter in any way you see fit.  I think mail is powerful but feel free to email them at their website as wellI am hopeful that a large and multi-state, multi-country response will encourage the company to take action.






Cozette Phifer Koerber

Vice President of Brand Marketing and Corporate Communications

The Johnny Rockets Group, Inc.

25550 Commercentre Drive,

Suite 200

Lake Forest, CA 92630




Dear Ms. Phifer Koerber:




I respectfully write this letter to express my concern over a recent incident that took place at your location at Newport on the Levee Johnny Rockets, Newport, KY 41071. A mother nursing her 6-month old child was asked to leave or nurse her child in the bathroom by the restaurant manager. The is troubling for a number of reasons:




Breastmilk and breastfeeding are the standard for infant nutrition.




Breastmilk contains growth factors, hormones, enzymes, and other substances that are immune-protective and foster proper growth and nutrition.[1] Breastfeeding is associated with a reduction of the risk for children of contracting pneumonia, staphylococcal infections, influenza, ear infections, severe infections of the lower respiratory tract, asthma, obesity, type 1 and type 2 diabetes, childhood leukemia, certain types of cancer, and sudden infant death syndrome (SIDS).[2]




Encouraging breastfeeding is an integral part of many governmental health and wellness initiatives, including programs created by the US Centers for Disease Control and Prevention (CDC), the US Department of Health and Human Services (HHS), and the White House Task Force on Childhood Obesity, among others.[3] And breastfeeding is not just for infants. The American Academy of Family Physicians 2008 Position Paper on breastfeeding states that “breastfeeding at least until the second year of a child's life is not considered 'extended' breastfeeding. Rather, breastfeeding until the bare minimum age of 2 years is the norm and anything less brings about detrimental consequences.”[4]




Children should not nurse in a bathroom.




The thought of a mother taking her child to a public restroom to nurse is disgusting and dangerous. Every time you flush your toilet, an aerosol spray of water droplets – laden with bits of feces and urine – explodes into the bathroom. Significant quantities of microbes float around the bathroom for at least two hours after each flush. In a public bathroom, that means the air is continuously blasted by feces droplets. What’s more? Women’s public restrooms contain twice as much fecal matter as men’s, probably due to the fact that there is the added contamination of soiled tampons and pads, and women are more likely to be dragging in small children and babies in need of a change.[5]




The Law Protects the Right To Nurse in Public.




Kentucky State Law KRS § 211.755 states that a mother may breastfeed her child in any location, public or private, where the mother is otherwise authorized to be. Additionally, every US State in which Johnny Rockets currently operates has similar laws in place as does locations in Canada, Europe, and other countries in which Johnny Rockets operates. As such it is the responsibility of your corporation and local managers to ensure that those working at your restaurants are aware of these laws and regulations. To not do so is truly a dramatic oversight that can lead to dangerous precedent and negligence.




Please work with me to normalize breastfeeding in our society. I am writing to ask you to take positive steps to help breastfeeding mothers.
First, if your organization has internal guidelines regarding breastfeeding mothers and how to handle complaints of patrons about a mother breastfeeding their child I encourage you to review these guidelines on a state-by-state basis to ensure that your guidelines are not actually violating local laws. There are some very real business risk reasons to follow through on this particular item.
Second, I would also encourage you to post your policy in an easily accessible location so that all mothers who may be nursing their child can read your policy and decide for themselves whether they are comfortable with your policy.
Third, a public and sincere apology to the mother in question.
And, fourth, please educate your employees and franchisees about the rights of breastfeeding pairs. If you need help finding materials or someone to lead an informational session, I will gladly help you find a qualified attorney, Lactation Counselor, or La Leche League leader.










Paige Lucas-Stannard

Co-founder, NursingFreedom.org




cc: Rick Thompson
Johnny Rockets Newport on the Levee

One Levee Way

Newport, KY 41071

859-581-0700




References:

[1] Hamosh, Margit, PhD, Breastfeeding: Unraveling the Mysteries of Mother’s Milk, http://www.asklenore.info/breastfeeding/additional_reading/mysteries.html

[2] Ip S, et al., Breastfeeding and maternal and infant health outcomes in developed countries, http://www.ncbi.nlm.nih.gov/pubmed/17764214; see also Burby, Leslie, 101 Reasons to Breastfeed Your Child (and citations therein), http://www.promom.org/101/

[3] See http://www.cdc.gov/breastfeeding/ ; http://www.cdc.gov/breastfeeding/policy/hp2010.htm ; http://www.letsmove.gov/tfco_fullreport_may2010.pdf

[4] http://www.aafp.org/online/en/home/policy/policies/b/breastfeedingpositionpaper.html; The AAFP’s position is almost identical to that of the World Health Organization (WHO) and UNICEF. Global Strategy for Infant and Young Child Feeding, http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/index.html.

For similar positions from the American Academy of Pediatrics (AAP) and other medical organizations, see http://www.aap.org/breastfeeding/faqsBreastfeeding.html#10; see also http://www.liebertonline.com/doi/abs/10.1089/bfm.2008.9988?journalCode=bfm.

[5] Breastfeeding and Bathrooms Do Not Mix, http://codenamemama.com/2010/05/24/breastfeeding-and-bathrooms/

Thursday, July 15, 2010

Save the Planet: Nurse in Public

Why is it that every time nursing in public comes up, someone suggests the mom could easily pump and bottle feed as an alternative? I’d bet money that you could find a comment in every recent news story on the topic with this helpful hint.

Well, of course we could do that, but ask any breastfeeding advocate and she’ll give you a laundry list of reasons why this is less convenient and less healthy than just nursing baby. But have you ever stopped to consider that nursing in public is the greenest way to feed your baby on the go?

Let’s consider the process of pumping and bottle-feeding:

1. Wash and sterilize bottles and nipples.
2. Use electricity or battery power to pump milk.
3. Store milk in disposable bags.
4. Refrigerate or freeze the milk.
5. Use water and soap to wash pump pieces.
6. Optional: Sterilize parts by using microwave energy or boiling water.
7. Freeze ice pack to transport milk safely while out.
8. Use warm water to defrost or bring milk up to temp for consumption.
9. Put milk in bottle and throw away disposable bag.
10. Feed child.
11. Wash bottle and nipple using either a sink of heated water or dishwasher.

Compare that to:

1. Sit down or sling child.
2. Feed child.

Sure, a mom could plan ahead and expend all that extra energy to feed her child by bottle, but why would she, especially considering how much energy and resources it consumes? Feeding by bottle for a nursing mom wastes water, uses electricity, and creates waste.

Nursing in public isn’t only best for baby, it’s the best choice for our planet!

_______________________

Jennifer Albin was on her way to a PhD in Literature and Women's Studies when she took a detour into motherhood.  Using her academic and teaching background, Jennifer advocates for breastfeeding, attachment parenting, and natural birth - all from the comfort of her living room with children at her feet.  She is the founder and editor of Connected Mom, a website that encourages natural mothering.