Tuesday, 24 August 2010

"Los dos" and an awesome new campaign

From the moment my AmeriCorps team started doing breastfeeding education and support in Denver, we came up against "los dos" (literally "the two", better translated as "both"). The majority of our clients, particularly at newborn visits, were Hispanic (largely from Mexico). When we asked them if they were breastfeeding/planning to breastfeed, the answer was almost invariably "los dos" - both breastfeeding, and giving formula by bottle.

I've had a post coming about this for a while - it's a very frustrating thing to deal with and as an inner venting strategy I've composed this post many times in my head.

Why so frustrating? Well, at my current work I see that often "los dos" begins in the hospital. Moms tell me "es que no tengo leche" - "It's that I don't have any milk" - even when I help them hand express abundant colostrum, they don't believe that their colostrum will be enough to sustain baby until their milk comes in. This supplementation often tends to feature HUGE volumes given by bottle (think 1.5 ounces on Day 1, with a baby whose largest feed should probably be 1/3 of an ounce. There is a separate, also long, post about volumes coming - not just about Hispanic moms either.)

Babies get used to the fast flow and firm nipple of the bottle, and they come to expect huge volumes which colostrum cannot provide the first few days. They become fussy at the breast and the mother tells me "es que no quiere el pecho" - "he doesn't want the breast" or "he's refusing it". There seems to be a perception (and believe me, this needs a lot more research) that a large percentage of babies just don't want the breast - with no specific cause or cure - and that if not, you should just give up and bottle feed.

(This, as a side note, is why I think all the people who say nipple confusion is a "myth" are full of it. Over and over again at the newborn clinic in Denver, we'd hear "es que no quiere", slap a nipple shield on, and baby would nurse happily with mom's newly-in milk supply and a nipple that felt more like what they were used to.)

If baby doesn't become nipple preferenced (which some manage to avoid) then continued supplementation often starts to affect milk supply. Mothers tell me they weaned their last babies at one or two months because "no tenía leche" - "I didn't have milk", and "se desesperó" - "he got frustrated" (although used slightly differently it would be mean "to lose hope" which seems so fitting for those babies!)

There seems to be a strong emphasis on babies getting fed a lot, as often as possible, and it's hard to convince/convey to many Hispanic mothers that their babies will get MORE breastmilk if they supplement LESS. Instead, the response to this frustration and dropping milk supply is of course to offer more bottles and fewer breastfeedings. Baby quickly learns where the real supply is coming from and the mother tells me that with her last baby after a few weeks, "no quiso el pecho" - "he refused the breast".

To me all of this is particularly notable as Hispanic moms almost universally tend to want to breastfeed, and when given cooperative babies and milk supplies will generally nurse for a long time - particularly as many stay home to take care of their children. Moms who give up on a nipple preferenced baby will happily nurse the ones who do tolerate "los dos" for a year or two. While many Hispanic moms have yet to make the connection between supplementation and early weaning, I think most of them would prefer to breastfeed longer.

So why is this connection not made? Why is there so much supplementation and so much expectation of "no quiere"? Almost every night at work I dream of rustling up an MPH student to do some focus groups with Hispanic moms on what it means to them to "have milk", for the baby to be satisfied, what they think formula adds to the baby's satisfaction/health, what it means when the baby "doesn't want" the breast, how milk supply is perceived to be driven, etc. etc.

That's still in fantasyland though, so I am so excited that the Massachusetts Breastfeeding Coalition has a new campaign going - the first that I've heard about - targeting "los dos". (Interestingly, they call it "LAS dos" which I've never heard, but maybe it just varies from person to person.)

One poster for the ad campaign has a picture of a baby and a speech bubble saying (in Spanish): "Both (lit. "the two")? Mama, you already have the only two I need! If you give me formula, you won't make enough milk for me." Below it says "Give me only the breast."

Another has the same dialogue with two smiley-faced breasts and a frowny-faced bottle - I love the happy breasts!

And check out the fun story behind the slogan at the Motherwear Breastfeeding Blog!

Will it work? Will moms like it? I hope to hear more about this... and if any MPH/anthropology/sociology/etc. students out there want to get a little qualitative research experience, PLEASE consider this topic!!