Why You Should Pump Your Breast Milk

Like it or not, most things in life come with some sort of controversy. One would think that wanting to give your baby the health benefits of breast milk, no matter how that is accomplished, would be an exception. The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists both strongly recommend breast feeding. Research is confirming that breast milk is, by far, the best choice to feed an infant. Medical experts and common sense agree that milk from the mother contains a nearly ideal mix of nutrients, provided in a way that is most easily assimilated by the baby. Breast milk contains antibodies, specifically designed to protect against viruses and bacteria, and babies who are breastfed rather than given formula for at least the first six months have far fewer medical issues.

Unfortunately, even with breast feeding, there is disagreement. Breast feeding in public has inspired a huge outpouring of opinion, from both sides of the debate, and is unlikely to end any time soon. Less public are the issues of breast milk versus formula and breast feeding versus feeding via pumped breast milk. The formula discussion has its own issues, but pumping is a bit more subtle. There are those that contend that pumping is somewhat unnatural, and that there is something lost between mother and child when feeding is done other than directly from breast to child.

No one argues the value of bonding that takes place during breast feeding, but breast milk is breast milk, whether the baby receives it while latched to the breast or from a bottle that has been previously expressed. Many women are unable to breast feed because of medical reasons, and others simply choose not to do so.  They do recognize the tremendous value for the baby and believe that every time feeding consists of breast milk, the baby wins. This is where pumping comes in and, for many, feels like a life saver.

Reasons That Women Pump Breast Milk

Some of the more common reasons that women pump breast milk, include:

  • Return to work or some other reason that separates mother from baby but allows feeding of breast milk to be done by family member or caretaker.
  • Baby is unable to latch or feed directly from the breast. This could be a medical issue, for instance premature babies sometimes have difficulty creating enough suction to stimulate a full breast milk supply, or there may be some sort of birth abnormality, like a lip or cleft palate or muscle tone issue.
  • Prevent or relieve engorgement.
  • To donate milk to a milk bank or milk exchange program.
  • Alleviate pressure during weaning stage.
  • Need to drain breast during mastitis to facilitate healing.
  • Parents may be separated and father need breast milk if sharing custody of the baby.
  • Mother may be incarcerated and not permitted to breast feed.

In other instances, mothers recognize the value of breast milk for their baby but cannot bring themselves to actually breast feed or simply do not want to. There are a variety of reasons for this, but the important part is finding a way for the baby to receive the enhanced nutritional value of breast milk. Pumping is, currently, the best way for that to be done.

If you would like to learn more about preparing for having a baby, please watch this video:

Early Stage Breast Cancer

During an age where technology continues to improve at an alarming rate, so to do the ways in which it impacts many aspects of our lives. Communication, marketing and, of course, the healthcare fields in particular. Modern medicine has improved so much over the past several years that the days of resorting to standard methods of medical practice are steadily on the decline in favor of more personal, individualized treatment plans. Most recently, this shift in practice has been seen to affect treatments regarding breast cancer, particularly in its early stages.

In days gone by of the medical world, breast cancer – and many other cancers besides – were generally approached with only a few options for treatment: surgery and blanket treatments such as radiation, hormonal or chemotherapy. Apart from being invasive and altogether unpleasant, the side effects of such treatment plans generally came with a plethora of cons comparative to the pros. For example, in a typical treatment plan of chemotherapy, many patients can potentially look forward to the following sorts of side effects:

  • Fatigue
  • Hair loss
  • Easy bruising or bleeding
  • Skin and nail changes such as discoloration or dry skin
  • Appetite changes
  • Mood changes

And these are just minor inconveniences compared to the more problematic side effects that chemotherapy could provide.

  • Diarrhea
  • Constipation
  • Nausea and vomiting
  • Urine and bladder changes, kidney problems
  • Nerve and muscle problems such as numbness, tingling, and pain
  • Mouth, tongue and throat problems such as sores and pain with swallowing
  • Anemia
  • Infection

The reason for this being that chemotherapy, when introduced into the body via an array of drugs, targets and kills fast-growing cells. Unfortunately, as mentioned before, the medicine is a sort of blanket treatment and cannot differentiate between cancerous cells and healthy cells that just happen to grow at a faster rate, and thus many of the side effects occur because of unintentionally targeted cells in hair follicles, skin, intestines, and even bone marrow.

While the obvious upside was a better chance of beating cancer, it was a bumpy road that many people trudged precariously. Thankfully, it seems oncologists have found more alternatives for cancer treatments that have them recommending the likes of chemotherapy with less frequency to their patients. In fact, according to this intellectual article by Robert Preidt, the use of chemotherapy among a select group of early-stage breast cancer patients fell by over one third – from 34.5 percent to 21 percent – in a study conducted between 2013 and 2015.

This could be due to a rise of popular treatments and procedures that stray from the likes of chemotherapy and radiation therapy, such as immunotherapy, which predominantly utilizes the body’s own immune system to suppress cancerous growth, or targeted therapy, which incorporates medicine along an entire spectrum for targeting various and specific characteristics of cancerous cells. The latter in particular, unlike chemotherapy, lessens the likelihood that healthy cells will be targeted and thus many of the more offensive side effects from treatments such as chemotherapy can be avoided.

Taking Care of Your Breasts While Breast Feeding

Pregnancy is an experience that is different for every mom-to-be. That is equally true for one pregnancy to the next for the same woman. There are similarities, however, and for every account of it being an easy, joyful nine months, there will be dozens of others that talk about out-of-control weight gain, midnight cravings, swelling feet, never-ending bathroom calls and mood swings that change by the millisecond. This is a lot to ask of someone for such an extended period of time, but once that baby is placed in mom’s arms after delivery, there’s no question it was worth it.

Everything during pregnancy was about doing what was best for the baby growing inside the womb. Not much really changes after birth. Most of what a new mother will do for quite some time will revolve around what is best for the baby, and that includes mom making sure to take care of her own health.  It is still best to maintain a good diet, drink plenty of fluids and, impossible as it may seem, get adequate rest. It is also important to avoid alcohol, smoking, caffeine and be cautious with medications while breast feeding.

Caring for Breasts While Breast Feeding

A mother who chooses to breast feed will want to take special care of her breasts to avoid some of the more common issues, such as, sore or cracked nipples, blocked milk ducts and mastitis, which is a painful infection of the breast tissue. Some good practices are:

  • Hygiene practice good hygiene by washing your hands before touching your breasts and keep breasts and nipples clean by washing them each day with warm water. Using soap should be avoided as it can remove natural oils, which can result in cracking.
  • Wear a Nursing Bra – wear a nursing or supportive bra that is not overly tight or restrictive.
  • Correct Latching – prevent soreness and other issues by having the baby well positioned at the breast to ensure easy and proper latching.
  • Change Breast Pads – Clean and dry nursing pads can help to prevent soreness and mastitis.
  • Moisturize Nipples try rubbing breast milk on your nipples and areola after nursing to help keep them from getting dry and cracked.
  • Disengage Properly After Nursing – do not simply pull baby away from breast, which can quickly lead to soreness. Instead, break the suction by placing your finger in the corner of the baby’s mouth before gently pulling away.
  • Avoid Breast Engorgement – ensuring proper latching and draining breasts as much as possible during each feeding, or by following up with pumping, will help prevent engorgement, which can be painful and lead to infection. If breasts do become engorged, you can try a cold compress for 15 minutes every hour to reduce swelling. Just remember to place a thin cloth between the breast and the cold pack to protect skin.

If you have questions or concerns, talk to your healthcare professional about any issues, such as soreness, dry or cracked nipples, painful engorgement or other problems. Get recommendations about what products are safe to use and which to avoid. This is especially good advice for first time mothers who may have read all the manuals but are still anxious about what are the best practices.

Breast Feeding Positions for Mom and Baby

Becoming a new mom for the first time can be exciting and terrifying all at the same time. What could be more wonderful than bringing a new life into the world? And, what could be more frightening than being expected to know how to care for the defense of this tiny human who is totally dependent on you? Even with all of the manuals in the world, this is true on-the-job training.

Your new baby will likely seem hungry from the moment of birth, and you may be operating by the false belief that breast feeding will just “happen”, naturally and instinctively. This sets many young mothers up for a very difficult time. Breast feeding is a skill that must be learned. This is true for mother and for baby. Once the two of you become pros, the process will seem natural, and you will be able to breast feed and do other activities at the same time. In the beginning, however, it will be important to pay attention to how the baby is positioned to minimize problems with soreness, proper milk flow and adequate nutrition.

Breast Feeding Positions

Every mother and baby will find the variations of positions that will work for them. The lucky ones will have lots of older relatives hovering around with advice. As much as we sometimes believe we don’t want that, it’s the way that mothers in all cultures have always learned how to be mothers. The trick will be to listen and then find what works best for you and your baby. Some common positions that work for many and may be helpful include:

  • The Cradle Hold – one of the most traditional positions, also known as the Madonna Hold. The baby should be supported on the arm that is on the same side as the breast that will be used with the hand on that side supporting the rest of the body. It is important the baby’s head is aligned with the rest of his body rather than turned to the side. Cup the breast with the other hand, with your thumb just above the nipple and areola as close as possible to where the baby’s nose will touch your breast. Compress the breast using your index finger so that the nipple points slightly toward your baby’s nose. At this point the baby should now be ready to latch.
  • The Cross-Cradle Hold – this one is a variation on the cradle hold. Position the baby’s head with the hand opposite to the breast you’ll be nursing from. Rest your wrist between your baby’s shoulder blades, your thumb behind one ear, your other fingers behind the other ear. Again, be sure to rotate your baby’s entire body so it faces you and his mouth is lined up with your nipple. Use your other hand to cup your breast in the same way as the cradle hold. This can be a useful position if the baby has difficulty latching properly, because it will be easier to guide the head.
  • The Clutch Hold – also called the football hold, this position keeps the baby’s weight off the abdomen, so it can be a good choice following a cesarean birth. Imagine a football player running down the field, protecting the ball by holding it to his side — that is the basic position you will want to use. Position the baby at your side, facing you, with the baby’s legs tucked under your arm on the same side as the breast you will be nursing from. Place a pillow or something under your elbow for support and then using the hand on that side to support your baby’s head, the other hand can cup your breast the same as in the cradle hold.
  • Reclining or Laying Down –this one is good for moms who have smaller breasts. Use pillows for support while leaning back on a bed or couch. Place the baby on top of your body so that you are tummy-to-tummy and the baby’s head is near your breast. Your baby can rest on you in any direction, as long as the whole front of the body is against yours within easy reach of the breast. You may or may not have to assist in directing the baby to the nipple, but once that is done, this position can provide a very relaxing experience.

These are just a few of the variations on breast feeding positions. Every mother has had to use a little trial and error to find what works best for her and her baby.

If you would like to learn more, please watch the following video:

Latest Trend: Donating Breast Milk?

Is donating breast milk a new trend? Perhaps, not. The sharing of breast milk from one mother to the child of another has been going on for as long as babies have been being born. Without the modern day alternatives currently available, it was often all that stood between life and death for small infants. Milk banks, which are services that collect, screen, process and dispense breast milk by prescription, have been around for more than a hundred years, the first opening in Vienna, Austria in 1909.

Donating breast milk via milk banks began in the U.S. in Boston, in 1919, and other locations opened and expanded the process until the 1980s. This was when the HIV virus was creating its wave of fear and, consequently, many milk banks closed down out of fear of transmitting the deadly virus. Today, the Human Milk Banking Association of North America (HMBANA) processes more than a million ounces of milk a year in their 11 milk banks, primarily for at risk newborns.

Not everyone donates breast milk through a milk bank, however, and this is where the current controversy takes hold. For women in earlier times without another option, hardly any risk outweighed a baby starving to death. Today, however, there are alternatives, like formula, and a clear awareness of the very real risks involved. Milk sent to a milk bank is pasteurized, combined with other donors’ milk to balance the components and tested for any sign of contamination. Donors commit to certain restrictions, like no smoking or drinking, and are screened for diseases that might be passed through their milk, such as HIV and hepatitis.

Considering the thoroughness of the process, it’s not surprising that a major limitation of breast milk received through a milk bank is cost, which can be as much as $5 per ounce. Insurance coverage is inconsistent from one state to another and, even when coverage is available, rarely full reimbursement. This explains, at least in part, the burgeoning business being done on the internet where donors can sell extra breast milk, and buyers can purchase for far less than through a milk bank.

Informal exchange of breast milk is expected to grow, despite most of the medical community warning against it. According to Ari Brown, M.D., a spokesperson for the American Academy of Pediatrics, “We support breastfeeding, but if you can’t nurse, we recommend breast milk from a milk bank, or that you use formula. Even if you have a good friend who wants to donate milk, you can’t guarantee that it’s free of infections, like HIV. Breast milk is a bodily fluid, just like blood. Would you be willing to give your baby a blood transfusion without first having it tested?” Purchasing breast milk blindly off the internet would be even more rigorously discouraged by healthcare professionals. This, however, competes with the rapidly increasing belief in the health benefits of breast milk and the inability to get it from a source like an official milk bank. Not only does cost make it prohibitive, there simply isn’t adequate supply.

Just as the decision to breast feed is a personal one for the mother, donating and sharing breast milk seems to also fall in the same category. Many women who engage in milk sharing within families and communities find it a very fulfilling and bonding experience. Others cannot imagine even considering the idea of milk sharing. This is a controversy that is likely to continue, at least for the foreseeable future.


Is Combining Formula and Breast Feeding Safe?

When you first become pregnant, you learn that there is a set number of pounds that you will gain, nausea is called “morning sickness” because it only strikes in the morning and not to worry because, once the baby is born, you will just know what to do. How often do you suppose that works out?

Unfortunately, even for new mothers who know better than to believe everything they are told or read, there is a very real chance that they will have unrealistic expectations when it comes to breast feeding. There is a phrase that has become very popular, “breast is best”, which is more or less a slogan for advocates of breast feeding. Consensus, even in the medical community, now stands solidly on the side of breast feeding as being the healthy choice, especially for a child’s first year. In addition to providing the best nutrition, breast milk is believed to reduce the risk of serious conditions, like childhood obesity, diabetes, ear infections, needing a disability attorney and many others. While all true, what about mothers who, for one reason or another, are unable to provide adequate milk?

When a young mother quickly begins having difficulty breast feeding it can lead to a feeling of guilt and inadequacy. While no one argues the benefits of breast feeding, there are times when it is either not possible because of some physical problem or a matter of logistics due to time spent away from the baby, like when a mother has to go back to work. Pumping is, of course, one solution but it, too, does not always fill the need. Formula can provide a good alternative. Formula used in combination with and to supplement breast milk can provide a particularly good balance in terms of nutrition and lifestyle issues.

Advantages of Formula

In the first half of the 2oth century, formula was aggressively advertised as being superior to breast milk. The healthcare community actually promoted it over breast milk. Claims of unfair influence by formula manufacturers and lobbyists by breast feeding advocates pushed back and eventually swung the pendulum of opinion against formula. Some of it was undoubtedly deserved but not all. In many cases, formula can provide much-needed nutrition for a baby that is not getting it through breast feeding and a way to balance life’s many demands for mom.

Some specific advantages of using formula include:

  • Convenience – the ability to feed at any time by anyone, such as a spouse, partner, family member or caretaker.
  • Flexibility – formula is available whenever it’s needed without the necessity of working pumping into your schedule.
  • Shared bonding – your partner can also experience the bonding that comes during feedings.
  • Less dietary restrictions – when using formula exclusively, you do not have to avoid eating or drinking something that might adversely affect the baby.

Controversy aside, the main concern should always be that the baby is getting adequate nutrition, closely followed by the sanity and health of the mother. Whether that is accomplished through breast feeding exclusively or some combination of breast feeding and formula turn out to be the best route, should not matter.

If you would like to learn more about baby formula, feel free to watch the following video!

Foods That Help Increase Breast Milk Supply

Have you had your daily requirement of galactagogues? If you are the proud mom of a new baby then working galactagogues, which are foods that promote milk production, into your diet would be a very good idea. Of course, the number one way of increasing milk production is through the nerve stimulation that happens during breast feeding. As your breasts empty during meal time, your body gets the signal to produce more milk. At least, this happens when the sun, moon and stars all align and everything is right with the world. In other words, your system could probably use some assistance in maintaining an optimal supply of breast milk, and there are certain foods that may help make that happen.

Some foods are believed to enhance lactation, which is the secretion of milk by the mammary glands. This list includes many of those foods, some backed by research and others more anecdotal. Besides aiding in increasing milk production, many are healthy for mother and baby in other ways.

  • Oats – loaded with energy and fiber, which aids in digestion. Oats are also believed to help in preventing the onset of diabetes following pregnancy.
  • Salmon – good source of essential fatty acids and Omega-3, both important for lactation.
  • Spinach and beets – dark green leaves contain iron, calcium and folic acid.
  • Carrots – known to improve lactation.
  • Fennel Seeds – also aid in digestion and controlling colic.
  • Fenugreek Seeds – increases milk production and alleviates post-delivery constipation.
  • Bottle Gourd – aids in digestion, normalizing blood sugar levels and hydration, as well as lactation.
  • Basil Leaves – good source of anti-oxidants and have calming effect.
  • Garlic – the lactation super star, plus helps prevent cancer.
  • Barley – also helps keep mother hydrated.
  • Chickpea – good source of energy-boosting protein, calcium, B-complex vitamins and fiber, as well as aiding in milk production.
  • Asparagus – stimulates hormones active in lactation and good source of vitamins A and K and fiber.
  • Brown Rice – stimulates hormones active in lactation and boosts energy for nursing moms.
  • Cumin Seeds – used in moderation, boosts milk supply and aids in digestion.
  • Black Sesame Seeds – also should be used in moderation to increase lactation.
  • Oils and Fats – important for lactation, aids in bowel movements and helps with vitamin and mineral absorption.

Some of the other foods that can aid in milk production include apricots, dill, poppy seeds, almonds, papaya and sweet potatoes. The same food can often affect people in totally different ways so it’s important to pay attention to your own body and how it reacts.  

If improving lactation is the goal, then knowing which foods are antilactogenic, meaning that they can decrease milk supply, is also useful. As you might expect, alcohol is on this list. One infrequent glass of wine won’t bring the lactation process to a screeching halt, but breast feeding is really a good time to order something non-alcoholic. Other foods to avoid include, sage, parsley, peppermint, menthol and chasteberry. Advice to avoid something you aren’t familiar with, like chasteberry, might not seem worthwhile, but chasteberry is often recommended to breastfeeding mothers who have painful swelling and engorgement.


Benefits of A Nursing Pillow

So, you think your back hurt while you were pregnant? Wait until you are breast feeding for the 5th or 6th feeding of the day and the muscles in your back and neck start to scream no matter how you try to shift positions. It may not be fair, but, while some women seem to never have a moment’s discomfort while pregnant and have no back problems at all when breast feeding, others are tied in knots with pain from the moment they buy the home pregnancy test.

For some, the time period spent breast feeding can actually be the most difficult when it comes to physical discomfort. Because it is so important to position the baby in such a way as to get a good latch, it often requires lifting and holding the baby’s head and body up and closer to get to the breast. Doing this over and over again can create severe aching in the neck, shoulder, back, hands and wrists

Trying different feeding positions is important. Some will work better than others, depending upon the individual mothers and babies. Switching positions is also a good option to try. It may be tempting to find a favorite and stay with it, but switching and rotating positions puts different muscles to work and lets those that may have been overworked have a chance to rest. Getting as much rest as possible, although never easy with a newborn, will, of course, help, as will working in exercise whenever the chance arises.

While all of these suggestions are certainly worth trying, many women find that using a nursing pillow makes a huge difference for them. Nursing pillows, also called feeding pillows, come in a variety of shapes and styles and are usually designed to go around your waist so that there will be something to support the baby on while breast feeding or bottle feeding.

Benefits of Nursing Pillows for Breast Feeding

  • Provides support and encourages proper feeding position
  • Lifts baby so that the mother does not have to lean forward and lift, which strains back, neck and arms
  • Places and holds baby at correct height for a proper latch, which is essential for nutrition and supply
  • Easier to nurse preemies and twins
  • Protects incision site for cesarean
  • Helps prevent reflux

Nursing pillows may be great for breast feeding, but they also have other uses. During pregnancy, they can be used for supporting the back, as well as placed between the legs or under the stomach to provide some comfort and relief. Down the road a bit, when your baby is between 4-6 months of age, what is now considered a nursing pillow can be put to use as it was originally intended. Today’s nursing pillow is a variation on one that was actually designed to help babies sit up. It becomes a platform to lean on, grab hold of and pull, all the while providing a soft and safe place to land.

Nursing pillows come in a wide range of shapes, from the popular c-shaped Boppy to the ergonomically designed naturally curving pillow. Every baby, website, and mom is different, and you will find this reflected in the different designs.

If you would like to learn more about this subject, please watch the final video:

How The Environment Affects Breasts

Who doesn’t love boobs? Whether you are a baby needing to feed or a grown man who gets his jollies from a nice pair… who doesn’t love boobs?! Believe it or not, the modern world in which we live does not.

Believe it or not, the modern world in which we live does not.

Boobs, breasts, titties, dirty pillows, whatever you want to call them, are the most tumor prone organ in the entire body. Florence Williams, the author of “Breasts: A Natural and UnNatural History” states that breasts soak up pollution like a pair of soft sponges. She further adds that these environmental toxins are then passed through babies when they feed on breast milk.

With genetically modified crops that help protect them against insecticides in Costa County, you’d think that we’d be able to help find something to protect our own bodies besides replacing them with saline and silicone.

The ever growing environmental factors are also contributing to young females developing breasts earlier in age and larger than ever before.

Williams also explores the reason that breasts exist in the first place. For those interested in evolution and biology, from that scientific approach, breasts simply exist due to natural selection. Mammary glands which produce milk for offspring must exist for a species to survive. Do huge breasts that make men fall over upon gazing need to exist? That is left for debate. On one hand, being attractive to the male species to create more offspring is fundamental for survival. On the other hand, humans are the only species to overtly sexualize the breast.

And with so much emphasis on breasts in our culture, there are over 300,000 people a year that get breast implants. But even without surgery, as previously mentioned, boobs are getting larger and larger. A lot of that has to do with the American diet and most of the population being obese. The fat from the diet, the environmental chemicals, birth control pills and other hormone replacement therapies interact with breast tissue and have caused the overall breast cup size in the country to increase. However, even the “skinny” girls are getting their boobs at earlier ages so the whole obesity thing isn’t an exact answer. There are obviously other environmental factors at play.

At What Age Should You Stop Breast Feeding?

Unless you work in the marketing department for one of the infant formula companies, if you have read any of the literature on breastfeeding, it’s hard not to agree with pediatric health experts when they say that when it comes to a newborn’s development, breastfeeding is the way to go. Breastfeeding provides numerous health benefits, may actually increase IQ and promotes a strong bond between the mother and child.

The American Academy of Pediatrics recommends that breastfeeding continue for at least 12 months, and then for as long as mother and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond.

Breastfeeding for the first six months is crucial. The World Health Organization recommends that mothers initiate breastfeeding within one hour of birth; that infants should be exclusively breastfeed for the first six months of life to achieve optimal growth, development and health, and thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods, while continuing to be breastfed; and, breastfeeding should continue for up to two years or beyond. 

The World Health Organization

There has been a movement to increase awareness of the benefits of breastfeeding and address some of the issues that discourage it. This includes nearly nonexistent workplace accommodation, lack of social support and marketing pressure by companies that have a vested interest in mothers not continuing to breast feed.

Research has shown breastfeeding to be one of the most effective ways to ensure child health and survival. Despite the research and these recommendations and the work of breastfeeding advocates, less than 30 percent of American mothers exclusively breastfeed their babies for even 6 months. And, this is not an issue just here in the U.S. According to the World Health Organization, there is not a country in the world that meets these standards, but if they did, and breastfeeding was practiced universally, the lives of more than 800,000 children would be saved every year.

Breastfeeding is a global issue, but it is also very much a personal issue. Mothers who want to breastfeed can be overwhelmed by the demands of a new baby. Operating on very little sleep, a new mom starts off feeling unprepared and inadequate and that can either balance out or get worse largely depending upon the amount of support she has. There is a reason that “it takes a village” has become somewhat of a cliché: it happens to be universally true when speaking of childcare, and even more so in the beginning when trying to make decisions about breastfeeding.

At what age should you stop breastfeeding? There is no answer to that question. It is personal and different for every mother and child. Ideally, mothers should have the support to breastfeed her child for as long as it is a positive experience for both of them. Realistically, the answer falls somewhere closer to as long as she can tune out the voices of a society that values convenience over substance. Many obstacles exist for mothers who wish to continue breastfeeding and that does not seem likely to change anytime soon.