"The Breastfeeding Answer Book continues to be the recommended and dependable resource for LLLI Leaders who need to address more complicated questions regarding breastfeeding…Breastfeeding Answers Made Simple, while an additional excellent resource for PL Administrators, should not replace The Breastfeeding Answer Book for Leaders….The Breastfeeding Answer Book is slated for revision and Executive Management is working to identify authors or persons who can coordinate the new edition….In the meantime, LLLI is preparing an update sheet which will provide references to the 8th edition of The Womanly Art of Breastfeeding and online resources to address the most important changes in breastfeeding information since The Breastfeeding Answer Book was published. We expect this Breastfeeding Answer Book supplement to be ready in early 2012 and it will be available on the LLLI website."

As author of both The Breastfeeding Answer Book (BAB) and Breastfeeding Answers Made Simple (BAMS), I'd like to weigh in on this issue.

Although BAB’s copyright is dated 2003, I finished writing its third edition—the book  recommended in this communique--in 2002, exactly 10 years ago.  My co-author Julie Stock and I revised only about one-third of this book at that time.  The same process occurred with the second edition (finished in 1995), which was a revision of the first edition (finished in 1990), which we also wrote.  In other words, much of the information in BAB’s third edition is as old as 1990.

No matter who published the next version of this book, it needed to be entirely rewritten to bring it up to date.  Also, significant information was missing from BAB.  For example, it has no chapter on milk production, which I added to BAMS.  Plus, in the eight years between BAB and BAMS, even the most basic breastfeeding information such as latch and positioning had undergone a huge paradigm shift.  I believed that revising BAB piecemeal, as I had done twice before, would not do it justice.  BAB needed to be completely rewritten, which is how I created BAMS.

It saddens me greatly that LLLI, which was founded to support breastfeeding mothers, seems to care more about money than about its reason for being.  Granted, I am not entirely unbiased, as I do not receive royalties from BAB sales.  As should be true for any author, I do receive the usual royalties for BAMS.  However, my motivation for rewriting this book was not entirely financial.  I spent two years laboring on BAMS primarily because I am committed to giving all breastfeeding supporters access to the latest information.  This passion of mine has not changed.  If anything, it's grown stronger.

The underlying message of today’s statement from LLLI seems to be that the money it earns from sales of BAB, an outdated resource, is more important to its decision-makers than keeping its Leaders current.  LLLI, please be reasonable here.  Note that I said it took me two years to rewrite BAB as BAMS.  And I had written this book three times before.  The soonest you could hope to have a rewrite ready—assuming you can find someone to take on that gargantuan task—is several years.  Do you really expect your Leaders to continue to use such an out-of-date reference in the meantime?

Please rethink this decision!  By announcing publicly that your Leaders are expected to use a decades-old book to help mothers undermines their effectiveness and in the process breastfeeding itself.  It may also make those outside the organization think twice about referring mothers to LLL Leaders.  And some Leaders may reconsider their commitment to an organization that would make such a questionable decision.  This announcement is like a shout-out to the world that LLL has lost sight of its fundamental purpose.

Available in two formats, one for the Amazon Kindle and one for all other electronic devices, BAMS can now be ordered directly from the Hale Publishing website: http://www.ibreastfeeding.com/catalog/Digital-Books/c34/index.html   If you have questions or would like to order by phone, call 806-376-9900.  You can also e-mail books@halepublishing.com

Also in the works, a pocket-sized edition of BAMS for those without an electronic reader who would like to have a smaller, lighter book to carry with them when helping mothers.  I am currently in the process of finishing this project.  The pocket guide version will not contain the references and the lengthy explanations.  Instead, you'll find in its pages only the recommended helping strategies to remind you of what to try next.  This pocket guide version should be available for purchase this summer.  Wish me luck!

But when babies lose more than 7% of birth weight during these early days, does this automatically mean they are not getting enough milk?  No, according to a recent study. 

A greater weight loss may be completely unrelated to breastfeeding and due instead to excess IV fluids mothers receive within the final 2 hours before delivery.  According to this study, these excess IV fluids inflate babies’ birth weight in utero and act as a diuretic after birth.  Babies whose mothers received more IV fluids before birth urinated more during their first 24 hours and as a result lost more weight.  Number of wet diapers during the first 24 hours predicted infant weight loss.  This was true whether the babies were born vaginally or by c-section.  Another study published earlier this year had similar findings.

This weight loss has nothing whatsoever to do with breastfeeding and milk intake.  In fact, the authors suggest that if clinicians want to use weight loss as a gauge of milk intake, they calculate baby’s weight loss not from birth weight, but from their weight at 24 hours.  According to their findings, this could neutralize the effect of the mother’s IV fluids on newborn weight loss.

This is one more reason weight loss alone should not be used to determine when newborns need formula supplements.   The Academy of Breastfeeding Medicine put this well in one of its protocols: “Weight loss in the range of 8-10% may be within normal limits….If all else is going well and the physical exam is normal, it is an indication for careful assessment and possible breastfeeding assistance.”

Thanks to my online contacts, within 2 hours 12 local mothers had volunteered to talk to this reporter. I had high hopes, but the article was a disappointment.  Formula company spokespeople were given the last word, noting that “it’s good to have a back-up” and characterizing it as “irresponsible” not to give new mothers free formula in the hospital.   

What was not reported was the true cost of this “free” formula to parents and the impact of hospital formula marketing on breastfeeding.  The most recent study on the effect of hospital distribution of infant formula  found that the mothers who received formula samples at discharge were less likely to be exclusively breastfeeding during each of their baby’s first 10 weeks as compared with women who did not receive them.  For a summary of decades of research on this issue, click here.

What’s most important for parents to know, though, is that this is not just about breastfeeding.  The reason formula companies work so hard to establish these unholy alliances with hospitals is that they know from their own research that due to fear of adverse reactions, most parents will continue to buy the formula their baby is given first. 

The “free” formula included in those stylish marketing bags is each brand’s most expensive type.  A cost analysis done by the outstanding nonprofit organization Ban the Bags found that formula-feeding families who use the high-priced formula in these marketing bags will spend $700 more during their baby’s first year than if they bought the generic store brand.  This is the true cost of these bags to families.  No wonder formula companies are so anxious to get this product into their hands! 

What’s in it for hospitals?  In many cases, in exchange for acting as formula marketing agents (and therefore endorsers of infant formula) hospitals receive unlimited free formula for their use.  And when formula flows like water on maternity floors it’s more likely to be fed to newborns unnecessarily to the detriment of breastfeeding: a double benefit for the formula industry. 

How can we convince hospitals that it is inappropriate and unethical to give formula samples to new parents?  In many ways, as Ban the Bags points out, this practice is like giving out free Big Macs on the cardiac floor.  Babies who receive infant formula have poorer health outcomes and higher health-care costs than exclusively breastfed babies.  It makes far more sense for hospitals to focus their energies on marketing health, not commercial products.  Click here for some ideas from Ban the Bags on how to sell this idea to your local hospital.

One last thing.  If you received a formula marketing bag from your local hospital, don’t forget to write a letter of complaint to the hospital's administration.  Patient satisfaction has a huge effect on hospital policy decisions.  Use your influence for the benefit of all new parents.

When I published my post, I was flooded with invitations from LLL Leaders and Area administrators who warmly welcomed me and extended their unconditional support.  So many people wrote that it was impossible for me to respond personally to them all.  If you were one, please accept my deepest thanks! 

Although I had many LLL Areas to choose from, I decided what was most important to me was not the quality of its beaches (as one Florida Leader offered as an incentive) but whether my presence was likely to bring the LLL International (LLLI) hammer down on my new Area.  I did not want to join a new team only to make their lives miserable by becoming a liability. 

So when I received an invitation from LLL of Connecticut, I knew that this was a match made in heaven.  These amazing ladies have become known for standing their ground against unreasonable LLLI policies and directives.  Of course, disagreeing with LLLI’s administration these days is almost guaranteed to result in sanctions and threats, so when the LLL of CT Area team made its concerns known publicly, LLLI wrote them a letter accepting their resignations, which they had not offered.  But LLL of CT has long been registered as its own nonprofit organization with the team as its legal representatives.  This allowed them to thumb their noses and continue their work.  They also bought their own liability insurance, so that could not be used as a weapon against them.  When LLLI tried to convince other CT Leaders to take their places, these Leaders made it clear that this team had their full support.

I have a feeling I’ll fit right in with LLL of CT, which just yesterday became my official LLL Area.  After all, as the saying goes, “Well-behaved women rarely make history.”  As you might expect, my opinion on the issue that led to my actions has not changed.  If anything, I am more convinced than ever that LLLI’s directive that Leaders must choose between LLL and BFUSA is divisive and therefore destructive to breastfeeding. 

In recent weeks, people on the inside have confirmed that the goal of this directive is to undermine BFUSA, which includes ex-LLL Leaders among its founders.  LLLI is headed down a slippery slope.  In Illinois, nearly half of its Leaders have resigned in the last two years.  It’s clearly time for it to look in the mirror and reevaluate its Leadership and its strategies.

I heard that one aspect of my actions was particularly upsetting to LLLI: my announcement on Facebook about my new BFUSA Breastfeeding Counselor status.  Should I take this to mean that it’s all right for LLL Leaders to be involved with both organizations as long as they don’t say so publicly?  Can we expect this to become LLLI’s version of “Don’t Ask, Don’t Tell?” 

If LLLI wants to grow and thrive, booting out those who question it is exactly the wrong approach.  LLL Leaders have never been easily cowed.  Those who breastfeed long term are clearly comfortable following a different drummer.  They are not women who can be bullied into following directives that are obviously wrong.  Take it from one who knows… or ask the Leaders in my new LLL Area.

September 2010 issue

After my article appeared, the editor received a letter from Dr. Harvey Karp, author of the popular book The Happiest Baby on the Block and its companion DVD.  Not surprisingly, Karp disagreed with many of my conclusions, as swaddling is the first "S" in his "5 S's" approach to calming fussy babies.  The journal editor kindly asked me if I would like to respond to Karp's letter, which I did.  You can read both Karp's letter and my response on page 26 of the Summer 2011 issue of the International Journal of Childbirth Education.

I’ve been thrilled to receive many offers from other Areas, both within the U.S. and internationally, to join their ranks and affiliate with them.  I’ve been assured that I would be welcome to serve in these Areas and that they have no intention of forcing their leaders to choose one breastfeeding organization over another.  It’s going to take me a little time to sort out the details, but I’ll make it public when I determine which will be my new Area.

In the meantime, I’m hoping we can right this wrong.  I encourage every La Leche League member and leader who agrees with me that a new liability insurance policy is in order to contact LLLI’s Board of Directors and make your opinion known.  Hopefully we can convince them of the destructiveness of making us choose one organization over another.  With enough support, we may be able to make La Leche League International once again an organization that supports all those who help breastfeeding mothers.   

You’d think that the loss of nearly half of Illinois’ leaders in the last 2 years would give her pause about eliminating leaders who are willing to serve.  I guess not.  She referenced La Leche League International’s announcement last spring that any LLL leaders who were affiliated with both LLL and Breastfeeding USA would have to choose one, because representing both would put its leader liability insurance at risk.  Yet oddly, the liability insurance through Breastfeeding USA does not carry this same prohibition.  It assumes the covered individual knows which organization she is representing.

Is LLLI looking into finding alternative liability insurance?  Word has it that earlier this week those at La Leche League International were given the opportunity to switch to another policy that does not require its leaders to make this choice and they opted not to do so.  It appears those in charge would rather kick out those who step over this line. 

My ACL had some choice words for me.  She told me that I clearly thought I was more important than other people. (Because I want to help breastfeeding mothers in more than one capacity?)  As she was leaving, she told me that although I am no longer an LLL leader in IL, I have the option of affiliating with another Area if any would have me, a possibility she seemed to think remote.

I told her that I consider this policy short-sighted and destructive of the greater good.  Until now, La Leche League International has always cultivated cooperative relationships with other breastfeeding organizations.  This is the first time it has created a policy that was openly antagonistic. 

To me, this is a serious problem.  The slogan of the Chicago Area Breastfeeding Coalition, which I helped to found, is “Strength in Numbers: Creating One Breastfeeding Community” and it exists to unite IBCLCs, LLL leaders, BFUSA breastfeeding counselors, peer counselors, doulas, physicians, midwives, everyone who comes in contact with breastfeeding mothers.  When we speak with one voice, we promote our cause more effectively.  When we undermine each other, we also undermine breastfeeding. 

I told my ACL that if my example will help to right this wrong and shine a light on this destructive policy, then I am willing to be the sacrifice.   We need to stand together and support one another, not tear each other down. 

La Leche League International, hear my words, you cannot afford to alienate more dedicated women!  And if you continue to implement and defend policies that undermine breastfeeding, you are not long for this world.