You make all the difference: a letter to the partner of a breastfeeding mum

Emma Pickett IBCLC is leading the breakout session on breastfeeding at Growing Families: Facts, Fiction and Other Stuff, our not-for-profit parenting event taking place in Manchester this October.  Emma is the Chair of the Association of Breastfeeding Mothers, and also works in private practice in North London.  In 2015, she published her book, “You’ve got it in you: a positive guide to breastfeeding” which is available in eBook and print version.  Here Emma explains just how important a supportive partner can be when a mum and baby are learning to breastfeed.

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Dear new/expectant parent,

I know everyone is talking about the person who is about to give birth.

It might feel like not much of the conversation is aimed at you – but I wanted to take a minute to talk about your role in this upcoming breastfeeding story.

You may not have the breasts (or perhaps you do and they are not going to be doing any lactating) but you cannot underestimate how important you are about to be in this next stage.

Breastfeeding works because of breasts and a baby. I would also say that it needs YOU to be there and to get how much you matter.

If your partner is struggling, it’s going to be hard to watch. You might wish you had some sort of magic wand that could make all this struggle go away. Your partner might even be in physical and emotional pain and you desperately wish you could fix it.

When you live in a society where many people choose to bottle feed, it can be difficult to understand why you wouldn’t just stop.

But you chose to breastfeed. Not just your partner. YOU. Your partner’s body also chose it. It was what she wanted. Maybe she looked at the research (you can see a lot of it here: http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Breastfeeding-research—An-overview/) or maybe something more instinctual happened when she held her baby and experienced skin-to-skin and breastfeeding started.

If your partner is asking you to help her stop breastfeeding, then bottle feeding might be an answer.

But if it’s clear she DOES want breastfeeding to work, that’s where she needs your support to help it happen.

Imagine she wanted to run a marathon and it was something she felt passionately about. It was a decision that may take some commitment but her health will benefit in the short and long term and she will live with the sense of achievement for a lifetime. Imagine she was asking you for help and support and your answer was, “Yes, absolutely. How about I drive slowly behind you while you run and then if you get tired you can just pop in the car? Running is hard work and I’ll be there to help you out if you need it.”

Then on her tough runs, when she looks exhausted and seems to be struggling with her timing, you shout out the window: “You’ve tried really hard. Come on! There’s no shame in getting in the car now. Lots of people can’t run marathons. Don’t worry if you can’t manage it”

On the face of it, it might look like ‘help’ but anyone can see what a twit you are being. What would be really supportive would be rubbing her feet, linking her with people who can support her effectively, encouraging her and supporting her goals.

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What does real breastfeeding support look like:

  1. Learn about breastfeeding. Have a look on that UNICEF baby friendly site. Learn about why breastfeeding matters. Do some reading.

Your partner might be sore and emotional so if you can also be the well-informed one, you might be worth your weight in gold. The books about breastfeeding that you read when your partner is pregnant will matter more than the time spent painting a nursery. What are the good websites? What is normal for a newborn baby? How often do they normally feed and how can you tell that they are getting enough milk? What do the first few weeks often look like? What common problems can arise and what do people do about them?

 

  1. Be a gatekeeper and know when to keep people out.

The first few days are crucial when it comes to early breastfeeding success. It is up to YOU who visits, how long they stay for and how they can best support your partner. If just a tiny part of her is nervous about breastfeeding in front of a particular person, that might not be the person who needs to be sitting on your sofa in the first week. And if they care about you, they’ll get that. YOU ask people to only come for an hour, stay in a local B&B, have a Skype visit instead of a real one if you sense that’s what would be best for your partner.

What’s the story with her mum and your mum? Did they breastfeed? Do they understand why it matters to you? Do they understand that guidance has changed and we no longer expect babies to feed to a timed schedule (and we know that can even do some harm)? Perhaps the grandparents can read some books too (or at least something like this: http://abm.me.uk/breastfeeding-information/congratulations-youre-going-to-be-a-grandparent/)

 

  1. Be a gatekeeper in the other direction too.

Partners are champions at finding the right support when things aren’t going well and getting the right people through the door. They call helplines (when your partner is too upset but in the end you do manage to hand the phone over). They find the local breastfeeding support groups. They look for lactation consultants (IBCLCs) on lcgb.org and contact the local peer supporters. This is information you can get lined up before baby is even here. Do you know which local groups welcome partners to attend? What days are they on? When your partner is struggling, you might be the one who approaches midwives on the ward or phones the community midwife service and asks what feeding support is available.

 

  1. Know that you don’t need to feed your baby to bond.

Your new relationship with your baby will be about oxytocin and cuddling and skin-to-skin contact. Anyone that tells you that a partner needs to give a bottle to develop a relationship with their baby is talking baloney. Giving a bottle is not a time without stress – you might be worried about getting it right, a breastfeeding baby might be missing out on some of the aspects of breastfeeding and confused about latch and flow, a baby is more likely to take in air, your partner has to worry about protecting her supply. These are not the ingredients for  some blissful magical experience.

There might be times when it’s really useful for you to feed your baby (especially after the first few weeks when breastfeeding is established) but I can promise you that ‘in order to bond’ is not one of the common uses.

The most magic time is the skin-to-skin cuddle. That produces the oxytocin hormone in you and baby – the hormone that facilitates bonding. Smell your baby, hold them, say hello. Enjoy your new relationship. You have a life-time ahead of you of warming up fish fingers, making sandwiches for school and taking them for special dinners. Right now, you don’t need to do the feeding. You just need to help the feeding to happen. When things are difficult, talk to your partner about what she really wants. If she had a magic wand, what would she wish for? How can you help that to happen?

 

Those of us who support mums who want to breastfeed get how important you are. You are often the person who opens the front door for us and we can see it written on your face – this is a household where everyone is working towards the same goal. You are working as a team. Breastfeeding success is not just about a mum and her baby. It’s about all of us. You are crucial.

 

Further reading:

http://abm.me.uk/breastfeeding-information/dads-and-breastfeeding/

 

Emma Pickett IBCLC
September 2016

Breastfeeding and Drugs in Breastmilk

The Breastfeeding Network’s Drugs in Breastmilk Service will be exhibiting at our event in Manchester on Thursday 6th October.  The service is headed up by pharmacist Dr Wendy Jones, and is an invaluable resource for pregnant and breastfeeding women.

The day after our event, Wendy is teaming up with our sponsors the LIFIB (Local Infant Feeding Information Board) to provide a workshop in Blackpool for healthcare professionals, entitled Prescribing for Infants and Breastfeeding Mothers.  More information here: http://www.breastfeeding-and-medication.co.uk/conferences/prescribing-for-breastfeeding-mothers-october-7th-blackpool 

Our thanks to Wendy for her support for our event, and for providing this blog post for us about her work and experiences.

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The time in a woman’s life when she is pregnant, giving birth and breastfeeding is a unique period. All of us remember the smallest details as we grow older. Even after thirty years as a breastfeeding support worker I am humbled and amazed at the way older women (yes there are still a few older than me!) want to tell me what happened to them.

How we feed our babies influences our attitude to infant feeding in the future which is why it is so difficult for women who come from bottle feeding families to feel comfortable with breastfeeding. They have neither seen breastfeeding as normal nor usually do they feel wholehearted support for their chosen feeding method. Subtle comments about milk quality and content may be common, undermining their confidence in their body’s ability to sustain their baby.

Nurturing our babies is a unique way of showing our love for them so it is unsurprising that the breast: bottle debate is always so heated and felt so personally.

It has become increasingly apparent to me that some healthcare professionals underestimate the importance to mothers of continuing to breastfeed. In pregnancy we bombard them with information on the “advantages” of breastfeeding. In fact there are no advantages. What? I hear you splutter. Consumption of its mother’s milk is the biological norm for a mammal. It is in fact artificial formula – prepared from the milk of a different mammal, normally a cow – which is the intervention. As it does not, and cannot have the biological specificity that breastmilk has then it inherently has disadvantages.

Some women feel passionately about breastfeeding before the birth of their baby – I know I did – and will go to any lengths to find a way to feed and overcome any difficulties on their way. Others are more equivocal and will talk about “trying if I can”. These women may become totally committed to feeding after the first few days or weeks and have discovered in themselves a passion. Breastfeeding doesn’t come easily to everyone these days. We have the equipment but not necessarily the support to enable us to achieve a pain free latch immediately. If it hurts we may be told by others that it doesn’t matter, that formula is as good, that a couple of bottles won’t hurt to give the nipples a rest and chance to heal, that Dad is willing to feed the baby overnight so mum can get some well-earned sleep. The more useful comment to a mother struggling is how to find support to make feeding pain-free – be that by a person who can spend time with the mother and baby, via internet links, via social media, by telephone helplines which ever works for the family.

All of us are anxious to provide the perfect start in life for our babies – it is an innate and natural instinct to protect this precious new life to the point of being willing to lay down our life for him or her. So for those of us who choose to breastfeed we want to know that our milk is pure and unpolluted, perfect in every way for our baby. If we choose to formula feed we trust that the manufacturer has undertaken the research to ensure their product is an adequate substitute. How then do we regard taking medication which will get into our milk and pass to our baby? We also have an increasing number of mothers who are still breastfeeding when they fall pregnant again so are concerned about keeping both children safe.

It fascinates me that mothers can be so scared about what will affect their babies that they not only refuse medication for headaches, colds etc. preferring to let their bodies heal themselves, but that they also question much more simple products. So over the years I have been asked if it is safe to have false nails fitted when breastfeeding and indeed if nail varnish itself is safe, whether drinking Ovaltine is safe, whether a breastfeeding mum can have her hair dyed or straightened.

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There is sadly a paucity of research on the safety of drugs in breastmilk. There appear to be a few specialist workers who actively collate information on exposure to infants of newer drugs via breastmilk. My aim is to equip women with the voice to ask for the help they need to find appropriate treatment without compromising the breastfeeding relationship with their baby.

The importance of breastfeeding to a mother with mental health issues seems particularly important to me. It takes courage to make an appointment and go to see your GP to explain you are feeling anxious or depressed. To have your wishes to continue to breastfeed dismissed is soul destroying. GPs and all healthcare professionals need to have compassion for the mother as well as knowledge about the safety of the drugs passing through breastmilk.

I am delighted to be part of the Growing Families Conference and to spread the word to mums, dads, aunts, uncles, grandparents as well as healthcare professionals that mothers can be prescribed medication and continue to breastfeed without harming the baby.

 

Wendy Jones
The Breastfeeding Network Drugs in Breastmilk Helpline
September 2016

Drugs In Breastmilk helpline: 0844 412 4665.

Facebook page: https://www.facebook.com/BfNDrugsinBreastmilkinformation

How to support this vital service: https://www.breastfeedingnetwork.org.uk/friends-drugs-breastmilk/ 

All Change! Some totally new parenting advice is about to arrive!

Our thanks to Mary Nolan for writing for us on the subject of parenting advice, confusion and consistency.  Mary is one of our main session speakers at the Growing Families: Facts, Fiction and Other Stuff event in Manchester this October, and will be delivering the section on Understanding Baby, in conjunction with Helen Ball of the Durham University Parent-Infant Sleep Lab.

Mary trained as a nurse in the 1970s and then as a childbirth educator with the NCT. She has worked with parents across the UK and has trained educators in Australia, New Zealand, Ireland, Belgium and Germany. She has published several books including, ‘Antenatal Education: A Dynamic Approach’, ‘Home Birth: The Politics of Difficult Choices’, and chapters in ‘Essential Midwifery Practice: Intrapartum Care’ edited by Denis Walsh and Soo Downe. Her PhD examined the impact of antenatal education on women’s choices around pain management in labour and her research into women’s and men’s experience of early labour, what women want from antenatal classes, and health visitors’ engagement with new fathers has been published in peer-reviewed academic and professional journals.

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My father is 88 years old – a truly splendid octogenarian who maintains a keen interest in a world which he sometimes finds confusing. He is not slow to remind us – with a twinkle in his eye – that advice is like fashion; it comes and goes and if you hang onto what you wore/were told in the 50s/80s/00s, you’ll eventually find yourself ‘on trend’ and doing ‘the right thing’ again after being out of fashion and doing ‘the wrong thing’ for a couple of decades!

He’s particularly keen to point out that the parenting my mother considered appropriate – three meals a day (sitting at the family table) and only water and fruit in between, and bed-time before 8pm are now being advocated again. (Along with real butter which my Dad loves!)

It’s hard today being a mother or a father or a kinship carer or anyone who has charge of children and wants to do the best they can to ensure they are physically, emotionally, socially and spiritually healthy. And people like myself, who are in the business of parent education and research, don’t always make life easier – although we are totally committed to finding the very best evidence to give to parents and co-parents.

Helping out at a playgroup the other day, I was startled to hear two young mothers (mid to late twenties) talking about what kind of milk to give their babies. The babies in question were adorable little girls of around 4-6 months of age. The babies were sitting in their pushchairs smiling amiably at each other and occasionally demanding some attention from their moms which was very willingly given. I presumed that the mothers were discussing breast milk v formula, or different kinds of formula. Not so. The mothers were discussing when to give cow’s milk and whether it should be full fat or semi-skimmed. The conclusion they came to was that it was all right to change from formula (which both babies were receiving) to full fat cow’s milk at 6 months of age. The World Health Organisation and the Department of Health recommendation is not to give cow’s milk before a year at the earliest. It’s one of the few recommendations that has been consistent over quite a long period of time.

These were clearly devoted and conscientious mothers with healthy and happy babies. So how could they have got hold of such wrong information?

It’s not just mothers, of course, who are victims of the confusion that inevitably arises when health information changes from one week to the next, or is transmitted in a confused way or is different according to which health professional you speak to. Health professionals are confused as well. While leading a seminar recently for a bright and dedicated group of student midwives, I found myself in a debate with one young and ardent student about whether caesarean section was as ‘good’ as vaginal birth. I mounted the usual (and, to my mind, correct) argument that caesarean can be a life-saving operation for some mothers and babies and that we are fortunate to have easy access to it, but that vaginal birth has many advantages that may affect the new baby for the whole of their life. I therefore suggested  that it is the midwife’s role to support women and their birth companions physically and emotionally to have a straightforward vaginal birth whenever possible. The student quite definitely did not agree with me and felt that vaginal and surgical birth should be presented as equal options.

You might be thinking now that I have made these two stories up for the sake of this Blog – but, actually, I haven’t. Both are true and both incidents occurred in the last month.

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Research into health promotion is very clear that conflicting and inconsistent advice leads (who would have guessed?) to conflicted and inconsistent parenting. And that inconsistent parenting doesn’t help young children to feel secure and ‘get a grip’ on the world. The baby and toddler are busy developing a template for life. Their fast-growing brains are trying to sort out which behaviours lead to which responses. As humans, we all need to feel pretty certain that our actions will have predictable outcomes if we are to function effectively on a day-to-day basis and avoid becoming anxious and indecisive. As a very young child, I need to know, for example, that food arrives at certain times and that eating it makes me feel content; that smiling at dad and reaching out to him elicits a warm playful response, and that pulling grandma’s hair hard makes her sad. I need my mom and dad, or whoever is looking after me, to do things in ways that I come to recognise as ‘how things are done in our family’. If mom and dad are continually changing the way in which they look after me because the advice they are receiving is always changing, that’s not particularly good for me as the little person on the receiving end of that inconsistent parenting.

For me as a birth and parent educator, and an academic who’s interested in how to transmit accurate health and child care messages, the age of social media is challenging. Twitter and Facebook can function rather like a game of Chinese whispers with a message starting out as one thing and becoming something very different by the time it reaches the hundredth or the thousandth or the ten-thousandth recipient. For parents and co-parents, trying as hard as they can to be not just ‘good-enough’ parents, but excellent parents, ever changing advice is a nightmare.

It’s a conundrum. So what advice would I give about advice???!! I think exactly the same as I would have given when I first started practising as a parent educator about 30 years ago. Choose one person who you have reason to believe knows what s/he’s talking about and understands the way in which you want to parent, or one website that has been recommended to you by a health professional, or one book that is authoritative (the reliable ones generally have reference lists so you can check the research on which they’re based) and stick with that person or information source. As a very wise friend once said to me (rather shockingly, I thought at the time), ‘Even better than loving your children is being consistent’.

 

Mary Nolan
August 2016

This year’s big thing…..

Shel Banks IBCLC, Chair of the Local Infant Feeding Information Board (LIFIB) is speaking about Infant Milks at the Growing Families conference in Manchester this October.  In this thoroughly researched blog post Shel showcases the work of the LIFIB with an independent review of the Haakaa silicone breast pump.

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This year’s big thing in the infant feeding related products world seems to be the Haakaa silicone breast ‘pump’. Coming from New Zealand, the company information on Facebook says they are a “baby brand that provides parents with Safe, Natural, Non-toxic, Eco-friendly baby products” http://www.haakaa.co.nz/ The ‘buzz’ around this product is so strong that people all over the UK are importing from the other side of the world so they can get their hands on this item, and leaving rave reviews! I have been hearing a lot about them and wanted to have a good look at what the fuss is all about.

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This new-ish product is essentially a clever combination of two items which have been around for a long long time – breast shells and breast relievers.

Breast shells are designed to be tucked into the bra of a lactating woman, and the hole goes around the nipple so that any leaked milk is caught in the ‘shell’. The shape of the part which touches the breast, and the size and placing of the hole, creates gentle pressure on the lactiferous ducts behind the areola and actually encourages milk flow and so stimulates leakage.  Two examples here:

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Breast relievers are designed to pump milk from the engorged breasts of lactating women when the baby they have been feeding cannot or does not wish to be fed. They rely upon a combination of suction (creating a vacuum which draws the milk out), rhythm (which might stimulate the ‘let-down’ reflex) and pressure on the lactiferous ducts, which stimulates milk flow. These devices have been around for well over 100 years and are still used today. See this one in the British Science Museum

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which was apparently in production between 1870 and 1901 although many like this were used much more recently – but also this one which is one of many similar ones available online now.

BreastReliever

Where these have been promoted as breast ‘pumps’ in the past I have been a little concerned as this suggests the milk is being saved for use in feeding baby, and I’m never sure how one would effectively clean the ‘bulb’ – which both gets squeezed to create the vacuum / pumping, and also serves to store the collected milk. Nor whether the plastics or rubberised materials used, might leech substances into the milk – which is a worry if this is to be used for feeding baby, but of less concern of course if it is purely used to relieve engorgement and the resulting milk is discarded. However I don’t know many lactating women who are happy about the idea of discarding breastmilk!!

So when I first saw the Haakaa in a breastfeeding group online I was impressed by the simplicity of the design and the ethos behind it – namely that it’s simple to care for, and non-toxic!

How does it work?

For this we can turn to the company’s own website: “Simply suction to your breast and let the pump do the work for you as it draws your milk using suction”. It’s true – the reports I have had tell me that the flange is placed on the breast, nipple lined up with the ‘neck’ of the device, and then the bulb is squeezed to compress which expels air from the bulb and creates a vacuum around the flange on the breast, securing it to the breast. Mums tell me that they then feed their baby on the other breast and while they are feeding the device fills up with their milk! The device has a scale on the side up to 90ml but I suspect it would accommodate 100ml – whether it could do this without falling off the breast as the vacuum reduces and the device itself becomes heavier with milk, is another matter – but you could hold it on.

How is it different from other pumps?

Most breast pumps work in a similar way – there’s a flange or funnel which sits on the breast, a hole and tube which accommodates the nipple, and then something on the other side to provide the vacuum in a rhythm so that it does actually pump the breast. Usually there’s some sort of valve so that the milk once removed from the breast is released into a bottle via some sort of ‘one way’ affair and cannot come back out again into the body of the pump. Whether hand pump or electric, whether double or single, costing £10 or £200 – all the same basic design.  So there are at least 4 parts, of which at least 2 are moving. Usually many more than 4, and first time assembly for the exhausted new parent is akin to completing a passport application using only your mouth to hold the pen! But the Haakaa is just one piece of silicone and not really a ‘pump’ at all – no valve, no pumping required – though the manufacturers do say that you COULD squeeze and release the ‘bulb’ at the bottom, which contains any milk, if you choose to – it isn’t necessary. Because it involves no ‘pumping’, in spite of the dictionary definition of pump only meaning to move liquid through suction or pressure, for some reason I’m a little uncomfortable calling it a ‘pump’ and am finding myself using the word ‘device’ to describe it!

How can it be cleaned?

Unlike any of the more complicated ‘moving part’ pumps there’s only one piece to this device which makes it far simpler to wash inside and out (in hot soapy water) and of course no assembly required. Unlike its predecessors the breast reliever, Haakaa’s device is also dishwasher safe (not sure how to position it so that it would definitely get washed and rinsed thoroughly, however – dishwashers tend to send small light things like this spinning around inside the machine during the cycle, in my experience), and because we don’t want any nasty things leeching into baby’s milk they are made from 100% food grade silicone and certified BPA, PVC and Phthalate free. So it’s as simple as it looks.

Which brings us to a troubling issue with these devices:

Copycat pumps.

Since these devices have become popular, almost inevitably some copycat devices have spring up on the internet – some in China, some in Malaysia. Examples here

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Some look identical to the Haakaa, some do not, and are not. The authentic Haakaa pumps are available only from New Zealand at present, costing $27NZ (about £15) and it’s not currently possible to buy them from the UK, without relatively high transport costs. The main (New Zealand-based) websites selling them would charge around £27 to sell and deliver one to an address in the UK, within about 2 weeks.
However, the copycat pumps are available through amazon and other mainstream retailers, claiming prices from as little as £3 delivered! From the families I have spoken with who have ordered these copycat pumps, I know that the very cheap ones often do not turn up at all, and sometimes the refunds have been impossible to secure, also that even the £12-20 ones have been arriving without proper packaging – this is one example given to me by a local mum

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As you can see – the packaging isn’t quite as sophisticated!

These copycat pumps are often more ‘solid’ than the authentic Haakaa, made from a material that feels more rigid to the touch, and weighs more – 100g compared to 74g. This suggests they are not made to the same standards as the authentic Haakaa. Reviews on some of the copycat pumps on eg Amazon.com suggest that this thicker silicone actually causes pain when it is suctioned onto the breast, and there have been reports of burns to the skin, like chemical burns, from users – the reviews on some of the third party selling sites containing these damning claims have now been removed as far as I can see.

Interestingly the copycat pump shown above donated by a local mum has a  different pattern on the silicone to the Haakaa, but the design is identical and it’s just as squishy – even came shrink- wrapped squished in the post as you can see above! BUT it weighs LESS than the authentic Haakaa – so the copies are getting more sophisticated but still are not the real thing.

The authentic Haakaa pumps are certified BPA free. BPA is Bisphenol A – an industrial chemical used in the production of polycarbonate which is a hard, clear plastic, used in many consumer products. BPA is also found in epoxy resins, used as a protective lining on the inside of some metal-based food and beverage cans. It also leeches into liquids and is now thought to be carcinogenic, to which end it has been banned from the production of baby bottles since 2011 in the EU.

Buyer Beware!

Copycat pumps make some claims on the advertising and packaging but we cannot of course be sure if these are true. One mother I spoke to was concerned about these copycat pumps and, fearful she had bought one, she emailed the seller to ask if they were safe and what testing they had had. The response she received was that they had no idea, they were just selling and sending them out. In the UK/EU the importer actually has the responsibility for the safety and conformity of imported products, the ‘CE markings’, so if a UK resident is importing things from abroad then as the importer, THEY are responsible for checking that the products are appropriately CE marked for conformity to required standards.

Are they any good?

Assuming we’re now talking only about the authentic Haakaa silicone pump, what most families will want to know, I imagine, is are they any good?

If you go online and search for Haakaa reviews, a few clicks will bring you many many positive stories, lots of five star feedback, youtube videos and so on. The point is it’s a simple idea, and it works. Gentle pressure on the lactiferous ducts, plus gentle vacuum as the bottle expands, plus feeding baby or active pump on the other breast to create a ‘let-down’, will elicit a flow of milk into the device. Some women find they could completely fill it, others just an ounce – but as many mothers have told me – they have always failed at expressing, they are no good at it, and this device gives them an ounce they would never otherwise have had! Mothers who have trouble with leakage while feeding on the other breast and so use lots of breast pads, are finding this saves them lots of breast pads and leakage AND gets them some milk to store.

A word of caution though – a quick search of reviews online shows that some babies think it’s a great game to knock them off the other breast as they are feeding, and because of the design, a knocked Haakaa pump can spill ALL the milk collected – up to 4 ounces – all over the place. So now you have been warned about that, there’s no use crying…!

Lots of rave reviews however, and little images sent in of milk collected in them!

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From the Haakaa Facebook page

Are there any drawbacks?

However because they apply the gentle pressure on the lactiferous ducts AND a gentle suction too, they will encourage continued leaking and can exacerbate the issue for anyone for whom leaking is already an issue; so as breasts are really supposed to work individually – assuming you are feeding only one baby! – if you have a problem with leaking from one side when the other is ‘working’, or perhaps a slightly different but related issue such as an over-supply, perhaps it’s better to manage that rather than encourage more of the same by collecting the milk in a device like this. See someone qualified and experienced in supporting mothers with breastfeeding issues – perhaps from the voluntary sector (ABM, BfN, LLL or NCT) or an IBCLC www.LCGB.org/Find-An-IBCLC has a list of local practitioners.

Nutritional content of milk collected

One final drawback of these devices which should be noted before going ahead and encouraging their use, is that they also only collect ‘drip milk’ which is not suitable for use as a full feed for baby, as it’s the watery carbohydrate-rich milk not the fattier richer milk. Fat soluble nutrients will be contained in the fattier richer milk in greater quantities.

If it’s used as an occasional drink to be left when mum isn’t able to feed then probably the only negative issue would be baby being more dis-satisfied. However if you fed nothing but ‘drip milk’ to a baby it would not do well. In milk banking ‘drip milk’ is not suitable for donation because it is not whole milk, essentially it’s skimmed milk.

A very quick search for evidence to corroborate my assertion about ‘drip milk’ when chatting online about the potential drawbacks of this device, brought me this from 1978 http://www.ncbi.nlm.nih.gov/pubmed/571325 – the author of that piece Alan Lucas does take money from the infant formula industry (though this was long ago so not sure whether this pre-dates the industry money) and so some may pooh-pooh the impartiality of his work, but we cannot dismiss everything he does on that basis alone – he has come up with some interesting stuff! And industry-funded work is often extremely informative too – no sense throwing the baby out with the bath water so to speak!

I know too from my experience working with UKAMB for these past many years, and as a member of the 2009/2010 Development Group for NICE Guidance on Milk Banking that the donation or collection of ‘drip milk’ is not recommended as it is not suitable for fully feeding growing babies, because of the nutritional shortfalls it may have. However, as an antidote, of course one could hand express a little of the much fattier richer milk from the other breast after a feed, to even up the nutritional composition, and make it more suitable for using as a full milk feed. The best ‘how to’ guide I have seen online for massage before pumping and expressing by hand is to be found here http://sw4.bestbeginnings.org.uk/

Because of the vacuum, it’s slightly less drip milk than milk which is REALLY dripping out, but not much more than the milk elicited by the breast shells which apply pressure to the areola. In  the photos posted online the colour of the milk is suggestive of higher water / carbohydrate content and lower fat content. But of course composition of breast milk will be slightly different from mum to mum and from one session to another!

Other online blogs about this product

Most of the blogs I found seem to be rave reviews about the product, or akin to an instruction manuals, rather than a look at how they work and why it’s so important to get an authentic one and not a copycat: however in this FB post from May, Ellen from New Zealand, who is a midwife, compares the ‘China Cheapie’ to the authentic Haakaa pump, and shows that they cheaper one is less flexible and much heavier.

https://www.facebook.com/IllawarraBreastfeeding/photos/a.309837029174354.1073741828.296016403889750/592858850872169/?type=3 (from the Haakaa Facebook page)

ChinaCheapy
Taken from Breastfeeding Illawarra’s post about the Haakaa and the “China Cheapie”!

As reported above however, newer copycat pumps are now on the market which look much more like the authentic pump, and behave in a similar manner – the pattern on the pump is different on the one I have (authentic Haakaas have a bamboo pattern – this one is flowers!), but the shape, feel and function are almost identical. The main factors pointing to a copycat pump rather than an authentic Haakaa device are the packaging – this one arrived in the shrink-wrap shown earlier, and stuffed into a plastic mailing envelope, not the cardboard tube of the Haakaa pump – and the weight is just 5g less.  So we have no idea what it is made from or where it was made.

Haakaa2

As with everything, Buyer Beware – and in this case, you definitely get what you pay for  – so if the Haakaa is the pump for you then be sure you order a genuine Haakaa!

One final note – the Haakaa UK Facebook page suggests that the pumps may be available in the UK to buy soon. They’ll still be more expensive than the ‘China Cheapies’ but they’ll be easier to get hold of than currently.

 

Shel Banks IBCLC
August 2016

Is THIS normal? The first week with a breastfeeding newborn

Emma Pickett IBCLC is leading our breakout session on Breastfeeding at “Growing Families: Facts, Fiction and Other Stuff” this October.  It is a one-day event for all expectant and new families – mum, dad, grandma, grandad, aunts, uncles, supporters – and the professionals who work with them. This is a not-for-profit event, created by four mothers, two of whom are also healthcare professionals. Our mission is to tackle the postnatal information that desperately needs covering for new families. To explore expectations and evidence around the early days with baby. To keep ticket prices low, with no expectation of making a profit, in order to open up the event to as many people as we can. To ensure that support for the event comes from ethical organisations and those who share our interest in evidence based information and family well-being. To give new families the confidence to face the challenges ahead.

Please click here to book your place: https://growingfamilies.co.uk/prices-booking/

Here Emma tells us about what is actually “normal” when breastfeeding a newborn baby.

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I’ve been taking calls from new parents on the National Breastfeeding Helpline since it opened in 2008. Calls often begin with a mum in tears and she’s sounding desperate. Breastfeeding really matters to her and she wants it to work. She’s overwhelmed and confused. The first voice we hear might sometimes be the partner’s and a mum is too upset to even come to the phone.

Hundreds of these calls end with a contented calm voice saying, “Thank you. It’s such a relief to know that’s normal. I feel so much better now”. As it happened, breastfeeding was actually going OK but it was her understanding of everything else that was confused. What she interpreted as a breastfeeding ‘problem’ was actually a new baby’s normal and natural response to their new environment. She just didn’t know how babies were ‘supposed to behave’.

If I had a magic wand, I would download into all parents the knowledge of what is normal in a newborn. Think The Matrix film – but instead of the ability to pilot helicopters or practise high level martial arts, you’d know about cluster feeding and a newborn’s desire for closeness, nappies and normal fussiness.

The National Breastfeeding Helpline would be quieter overnight but we’d all feel a lot more relaxed and able to enjoy these teeny new people in our lives.

But actually… you’ve already had that download. You just may not have realised it. It’s deep in there after millions of years of evolution, facilitated by hormones and natural instincts. It may not mean you know the exact details of the colour of baby poo on day 3 or how to correct a baby’s latch without help but there’s so much you do know. You probably didn’t grow up surrounded by breastfeeding (as Elena Abell’s recent blog highlighted) and for some aspects of breastfeeding you will need support and information, but there’s a ton you do know about your baby: things that just feel right and things that don’t.

And your baby had the download too. Sometimes it gets fuzzied with a birth that didn’t go to plan but their instincts are in there too.

Two things that are normal:

  1. Babies want to be close to you.

Imagine a news story about a baby gorilla just born in London zoo:

“ZSL London are delighted to announce the birth of new baby Fumbi. Mother and baby are in good health” but days later it’s reported that staff are concerned. Fumbi’s mother (despite being surrounded by other older female gorillas and having observed newborn care) keeps trying to put Fumbi down. She places her in the hay and walks off repeatedly and appears to be trying to avoid holding her for long periods. Fumbi is agitated. Her heart rate and respiratory rate shows signs of distress. She’s losing heat (because teeny newborn gorillas have a large surface area and need to be held to regulate their temperature). Fumbi isn’t feeding as often a newborn usually does because of the periods of separation. The mother appears to be missing out on some of the oxytocin induced bonding that helps the formation of their early relationship. Fumbi is at risk.

Oh dear. Something seems to have happened to Fumbi’s mother. We’d be worried.

However this is exactly what is happening in human homes across the UK today (though not in many other countries and cultures). We are primates just as gorillas are. We’re not designed to dump our babies and go off hunting and foraging for nuts. We can see that by looking at the constituents of our breastmilk. Other mammals have much higher fat milk so babies can be left while mum fishes or grabs a rabbit for lunch. Our babies are born immature because of our pelvis shape from being upright and our large brains and they are designed to have milk regularly for a relatively long time. We are supposed to hold our babies. Some people call us ‘carry mammals’.

But instead we got the message somewhere that babies can be ‘spoilt’. We are supposed to encourage them to be independent and sleep apart from us. We’re meant to be able to put them down. If we can’t put them down, if they want to sleep touching us, if we hold them when they sleep – we’ve apparently failed some test. Though it’s not quite clear who the examiner is.

There are popular books that even use terms like ‘accidental parenting’ just to load on the value judgments. Parenting experts such as Truby King in the 1910s told parents to avoid cuddling and unnecessary attention and the spectrum of ‘advice’ has been flip-flopping backwards and forwards ever since. Today one book will tell you to wear your baby in a sling as much as possible and another will tell you to arrange a baby’s sleep by the clock and leave a baby only a few weeks old to cry if necessary.

What does your baby want?

They don’t want to be put down and eaten by a sabre toothed tiger (less of a problem these days). They don’t want to waste energy keeping warm and crying when they don’t need to. They want to keep those calories to lay down fat and develop their brain. They want to use your breathing rate to regulate their own respiratory rate. They want you to notice when they start to show early feeding cues. They want your familiar smell and taste. You are home to them.

“My baby won’t go down in its Moses basket”. Yes, it’s frustrating when you thought that was what they were ‘supposed to do’. But would it feel easier if you knew that wasn’t likely to be their first choice and there are good biological and evolutionary reasons for that?

“But I’m not going to get any sleep”.

From the Infant Sleep Information Source [1]:

“70-80% of breastfed babies sleep with their mother or parents some of the time in the early months, and many studies have found that mothers and babies who bed-share breastfeed for much longer than those who sleep apart.”

Research shows that these mums breastfeeding through the night (and mostly bed sharing) will ALSO be getting better quality sleep and be more rested than other parents [2] Good sleep is possible if we stop battling nature.

The book “Sweet Sleep: night time and naptime strategies for the breastfeeding family” is a great place to start. It talks to you about creating a safe space where everyone gets a better night’s sleep.

A lot of your baby’s urges are eminently sensible. If they don’t want to sleep in a separate pile of hay, trust them. They are here today because those urges have kept them safe over the generations.

Don’t expect to be up and making a moussaka on day 5. The feeling that you ‘shouldn’t’ be holding your baby is exacerbated when we live in a society which tries not to let new parenthood change our lives. Our bodies aren’t supposed to change. Our commitment to work isn’t supposed to change. Our ability to engage with political life and housework and social media isn’t supposed to change. Actually, throughout much of human history, mum isn’t going to do much of anything for a good 40 days. Someone else is making the moussaka, just as you would have once made the moussaka for them. We are supposed to be doing nothing else other than eating the food made by others (really doesn’t have to be moussaka), sleeping and being with our new baby.

  1. They come to the breast for lots of different reasons and they usually have a good reason for doing so.

Just as parents feel they’ve failed if their baby doesn’t sleep in the separate pile of hay (aka fancy Moses basket that cost £75 and granny knitted a blanket for), they feel a failure if baby is at the breast ‘too much’. I have written elsewhere on the dangerous obsession of the infant feeding interval [4]. It’s dangerous for both babies and mothers. But we need to remember breastfeeding isn’t just about feeding and it never has been.

A phrase most breastfeeding supporters would like to evaporate from the planet is, ‘he is using me like a dummy’. No, dummies were invented partly because we forgot what breastfeeding was about. There’s not enough evidence to say for certain how dummies impact on breastfeeding [5] but those of us who work with breastfeeding families can see how the sucking action and latching can sometimes shift when babies use dummies a lot and there can be issues when mums feed less and milk supply doesn’t get the messages it needs.

Babies have jobs to do. They are helping you to form new breast tissue in the first few weeks. They are elevating your prolactin levels (the hormone that governs milk supply). They are stimulating oxytocin hormone (which is the hormone key in relationship-building and creating a sense of calm and well-being). They are increasing milk volume and altering fat content. They are reducing cortisol stress levels. They are facilitating digestion and the passing of stools. They are hydrating, regulating their temperature, feeling emotional secure, growing brain connections, trying to get to sleep (which YES is one of the purposes of breastfeeding.)

If you just think breastfeeding is about food and calories (and “quick, measure the gap between breastfeeds!”) you are doing a nature a huge disservice.

And you want to use an app on your phone to measure all those different reasons why a baby comes to the breast? You’re measuring fairy dust. Do you count all the times your partner cuddles you, strokes your arm, kisses you, smiles at you affectionately, communicates with you, has a drink of water, eats a snack, has a meal? You wouldn’t find an app for that and if you did, it would probably flag you up as someone needing some urgent assistance.

Stop thinking about minutes. No one can tell you a baby should feed for X number of minutes because we all have different physiology and our babies do too. Create your world around you so you can meet your baby’s needs in the way they are asking you to. Don’t try and mould your baby to fit into a world that has become obsessed with counting and measuring. If you know you are routine person and you are struggling with a feeling of ‘losing control’, give yourself a few weeks and see how it feels to trust your baby. Once your milk supply has maximised, you’ll have some options. Try and ‘control’ too early and you’ll find things go out of your influence in ways you can’t come back from easily.

Get help if things feel wrong- if breastfeeding hurts, if you’re not sure about weight gain or nappies, if you can’t work out how to meet your own needs for food and sleep. There are lots of people who will help out and we’re at the end of a phone or a Twitter account or Facebook page. But don’t confuse your baby behaving unexpectedly for something going ‘wrong’. Maybe no one told you what normal would be.

If we let normal happen it WILL make all of your lives easier in the long term.

You’re creating a little person who enters this world with their needs being met – we call it love.

Emma Pickett IBCLC
ABM Breastfeeding Counsellor

abm is kindly sponsoring Emma’s session at Growing Families – http://abm.me.uk/

References:

  1. https://www.isisonline.org.uk/where_babies_sleep/parents_bed/
  2. http://www.ncbi.nlm.nih.gov/pubmed/17700096
  3. http://www.llli.org/sweetsleepbook
  4. http://www.emmapickettbreastfeedingsupport.com/twitter-and-blog/the-dangerous-game-of-the-feeding-interval-obsession
  5. http://www.unicef.org.uk/BabyFriendly/News-and-Research/Research/Miscellaneous-illnesses/Review-of-dummy-use-and-its-potential-impact-on-breastfeeding/

 

Why is breastfeeding so bloody hard?!

This post by Growing Families organiser Elena Abell was originally shared on her personal blog platform, Trust Your Baby.  Elena works as a Business Unit Director for healthcare communications company Watermeadow Medical in Witney, Oxfordshire. Her background is molecular biology having studied to PhD level at Imperial College London, and she is also a qualified babywearing consultant.  You can find out more about Elena and the other three members of our conference team here: https://growingfamilies.co.uk/conference-team/

We are incredibly fortunate to have Emma Pickett IBCLC leading our breakout session on breastfeeding in October – sign up for this session to find out how to give yourself the best chance of meeting your breastfeeding goals, whatever those might be.  Expecting a baby? New to parenting or wanting to explore more about what you know? About to become a grandparent? Supporting new families?  Then this conference is for you!

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At 2 ½ weeks into breastfeeding my newborn son, I was ready to jack it in. I developed an excruciatingly painful cracked nipple (think toe-curling, eye-watering pain!), and I dreaded every single feed. Not exactly the easy, picture-perfect breastfeeding experience I had imagined. Far from it….It was a very dark time and I felt like an utter failure for considering giving up. I’m happy to say I managed to persevere through sheer bloody mindedness and some fabulous peer support but since then, it has really bugged me…

Why is something that is supposed to be so ‘natural’ so bloomin’ difficult?

Well….as it turns out, we really shouldn’t be blaming ourselves, AND it’s not just humans that find nursing their newborns difficult…..all the great ape species do. Here’s a little story for you….In 2012, at North Carolina Zoo in the USA(1), a captive born and raised chimpanzee called Maki gave birth to her first baby. Baby Nori was the first baby chimp to have been born at the zoo in 12 years but it soon became apparent that Maki wasn’t able to nurse her baby effectively. Eventually, baby Nori had to be taken away and hand-reared. Spare a thought for poor mama Maki though; in her short, captive life, she had never even seen a baby chimp before, let alone observed any other chimp mamas nursing their offspring. No wonder she found nursing difficult. She had absolutely no idea what she was doing. Research shows us that primates (yep, that includes us) who have never observed or experienced nursing  face a strong likelihood of failing to nurse successfully.(2,3)

By comparison, for ‘lower’ mammals such as cats, dogs, horses and cows, nursing is instinctual (meaning it’s not a learnt skill, it just comes naturally) and they make it look easy. The offspring of lower mammals are relatively well developed and mobile at birth and their babies are able to root, find a nipple and latch with pretty much no help from mum at all. Primates however are an exception to the rule of easy nursing.(4) Most primates require a period of learning in order to successfully nurse their babies,(5) and for humans at least, this may be the price we have paid for having evolved a relatively large and flexible brain that is capable of learning lots of new skills. In fact, the greater the intelligence of a primate, the greater the need for learning, and as it turns out, humans may be the most problematic nursers of all primates, if not all mammals.(4)

Interestingly, primate researchers have found that for apes living in captivity, being reared by an ape mother and observing other ape mothers means that new ape mums are more likely to successfully nurse and raise an ape infant.(6) In fact, there is evidence that specific training programs aimed at teaching maternal skills to apes can significantly improve their ability to appropriately care for and nurse their infants.(7) Sounds scarily like NCT courses for apes! But seriously, we’re no different to our ape cousins and almost certainly, like most other primate females, human mothers do not have an instinctual knowledge of how to feed their baby, meaning we need appropriate support in order to ‘learn’ to breastfeed.(4) In fact, research shows that on balance it’s TWICE as challenging for humans to learn to breastfeed properly as it is for other great apes.(6,4) How very unfair! Basically, there is a perfect storm of factors that make it spectacularly difficult for humans to breastfeed.(4)

  • Human intelligence: it may be that humans face an extra disadvantage when it comes to breastfeeding, because of our heightened intelligence. Having a larger brain that is ultimately more flexible, and more capable of learning than other apes, may result in an increased reliance on learned behaviours over instinctual behaviours.(4) It seems that humans and other primates ‘lost’ the ability to breastfeed by instinct very early on in our evolutionary history.(4)
  • Human breast shape: This is a classic case of form over function. We all know that human males love boobs, right? In our evolutionary history, men would have been more attracted to women with the most prominent boobs as this would have signaled fertility and health.(8) Because we use our boobs as sexual ‘signals’,(9,10) our boobs are now more rounded compared with our flat-chested primate cousins. However, this rounded shape means that human infants rely on a more complex set of mouth movements to retrieve milk from a human breast than other primates and mammals.(4,11-13) Although this complex sucking action in human babies is instinctual for them, they generally require assistance from the mother in order to successfully translate that reflex into successful breastfeeding.(14)
  • Infant development and mobility at birth: Humans evolved to walk on two legs but this means we have a relatively narrow pelvis and birth canal. As such, human babies need to be born relatively underdeveloped so that the brain and head are still small enough to pass through the birth canal. All this means that human babies are much more helpless at birth than other primate babies and it’s almost impossible for human babies to breastfeed without some assistance from mum. For example, without help from mum, newborn human babies find it very challenging, at least at first, to insert the nipple far enough back into their mouth to avoid seriously stressing out mum’s nipple and making it sore.(4,15) That means that if our technique is even a bit wrong, we’ll have very sore nipples, something very many of us mums have experienced I have no doubt. A helpless baby also means smaller, weaker jaws, which, as mentioned above are trying to carry out these more complex sucking movements than our primate cousins,(4) so it’s no wonder that we, as human mums find breastfeeding tricky.

Breastfeeding was crucial to the survival of our ancestors, yet it’s clear that humans face potentially significant challenges associated with breastfeeding. This is an evolutionary dilemma – breastfeeding is essential for survival, yet it requires (potentially variable or absent) learning and support.(4) Our human ancestors found the perfect solution to this problem however. We evolved to live in large, stable and supportive groups meaning that baby care could be shared among not only the parents, but extended family and other members of the group.(4) You might have heard the traditional African proverb ‘it takes a village to raise a child’? How very, very true this is.

It takes a villageSimilar to other primates, this predictable, group environment allowed human women to observe and learn the techniques of breastfeeding from other women. Evidence for this ancestral ‘group’ approach to breastfeeding comes from traditional cultures, where breastfeeding is the norm and women are frequently exposed to it.(4) In these cultures breastfeeding initiation rates are almost 100%, and after 6 months, breastfeeding rates of 98% are still seen.(4,16,17) Compare this to a woeful 74% initiation rate in the UK, which falls to 47% after only 6-8 weeks.(18)

Our ancestral history suggests that the support and instruction provided by breast feeding ‘peer supporters’ and the experience of family and friends may be a crucial part of any new Mum’s plan to successfully breastfeed.(4) Modern and international pro-breastfeeding organizations such as La Leche League (who teach and promote breastfeeding techniques), hospitals and midwives are playing an increasing role in reviving this ‘group’ breastfeeding culture. However, all too often I think new mums expect that they should just instinctively know how to nurse, and be able to just ‘get on with it’. If new mums are not adequately prepared, or set up with help and support from the beginning, they can end up feeling like utter failures, if or rather when they encounter problems. It shouldn’t be like this. The onus should be on society as a whole to create that ‘ancestral’ group support that helps teach and encourage new mums to breastfeed successfully. For those of us who are or have been nursing mothers, it’s also super important that we share our experiences with other women who are just beginning their breastfeeding journeys. Like our human ancestors and primate cousins, we ALL need support and encouragement to learn how to breastfeed.

If you’re a mum-to-be or new mum (or know someone who is!), here’s my 5 point plan to help prepare for the ancient art of breastfeeding.

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Elena Abell
June 2016 (first published October 2014)

1. http://www.zooborns.com/zooborns/2010/08/baby-chimp-doing-well-at-nc-zoo.html. Accessed 21/09/2014.
2. Abello, M; Fernandez J. International Zoo Yearbook, 2003; 38: 186-191.
3. Harlow, H;  Harlow, M. Bulletin of the Menninger Clinic, 1962. 26: 213-224.
4. Volk, A. Journal of Social, Evolutionary, and Cultural Psychology, 2009; 3(4):305-314.
5. Smith, H. Parenting for Primates, 2005. Cambridge, MA: Harvard University Press.
6. Abello,, M; Colell, M. International Zoo Yearbook, 2006;40:323-340.
7. Desmonde, T; Laule, G; Zoo Biology, 1994;13:471-477.
8. Møller, A. Ethology and Sociobiology, 1995;16:207-219.
9. Barber, N. Ethology and Sociobiology, 1995;16:395-424.
10. Morris, D. The naked ape: A zoologist’s study of the human animal, 1969. Toronto: Bantam.
11. German, R; Crompton, A. Brain, Behavior, and Evolution, 1996;48,:157-164.
12. German, et al., Journal of Experimental Zoology, 1992;261:322-330.
13. Woolridge, M. Midwifery, 1986;2:164-171.
14. Fisher, C.  Journal of Maternal & Child Health, 1981;6:52-57.
15. Righard, L; Alade, M. Birth, 1992;19:185-189.
16. Houston, M. Journal of Advanced Nursing, 1981;6:447-454.
17. Lee, R. B. The !Kung San: Men, women and work in a foraging society. 1979. Cambridge, UK: Cambridge University Press.
18. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/206553/Breastfeeding_Statistics_2012-13.pdf. Accessed 21/09/2014.