Infant Feeding During a Natural Disaster: A How to Guide

This week on the Milk Minute, Maureen and Heather are addressing a question they've been answering a lot lately, especially in the wake of the two devastating hurricanes that just hit the southeast US. "How do I feed my baby during a natural disaster?" There are a lot of guidelines out there, so we wanted to put out another great resource for providers and parents to have on hand for when disasters strike.

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Listener question: I was diagnosed with mastitis for the first time and started antibiotics. While pumping at work, I noticed the milk is pink on the side with mastitis. Is that normal? Should I call my doctor?

Mentioned in this Episode
Global Health Media

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Transcript

Welcome back to the Milk Minute. Don't be alarmed by my voice. Our special guest over here. Heather's evil twin. Special guest, Heather ONeal, part two. Three octaves lower. I survive pneumonia and all I have to show for it is this incredibly sexy voice.

Oh man. Try not to get too turned on during this podcast episode. For all the people out there who say they have a hard time telling our voices apart, this is for you. You're welcome. That still blows my mind. Me too. But I get recorded though it distorts it and sometimes we talk over each other. That's true.

And I think when we get excited we hit the same pitch, you know? I mean not now.

Yeah, I'm like, actually, let me just say, I am working like this, of course, and when I put the babies on the scale to weigh them, you know how much they hate it. And so typically when I don't sound like this, I get sort of close to their face and I sort of cover their face with my hand so they're not as scared and I'll roll my tongue and I'll go, And they kind of love it, but with this voice, it's horrifying.

And I tried it today and a mom just looked at me and the baby's like screaming. And I said, I'm sorry, my voice is usually a lot more soothing. You might want to try. Oh man. Sorry. So it's okay. It's okay. You know I had like, what, three months of episodes. I was like that last year. It's just how it goes.

It turns out these meat sacks that we call bodies that we just try to move around all day. They fail us from time to time. And yeah I got bacterial pneumonia and I was negative for all the viral swabs. No RSV, no COVID, no flu, no either flu. Couldn't figure out why. It's like someone came up to me and just coughed bacteria directly in my mouth.

Yeah. And then the lower lobes of my lungs. Just took off in a flourish of bacteria. Well, like, community acquired bacterial pneumonia is particularly rare. Like, it's Oh, I got it. It's, it's like one thing if it's, like, hospital acquired, you know? Yeah. Oh, no. This is, like, the one that they reserve for unhoused individuals.

Yeah. People that go to, go to prisons, no, they live, they live there. People that live in prisons, and then me, you know? Yeah. I, I'm actually wondering, I'm like, I need to get my labs checked, make sure I'm all good to go. Ah, yeah, for sure. Freaked out that I got it this bad. Well, you're on the mend. Hopefully continue to be so.

Yeah. And today, we are back now recording that Heather has any voice at all. Yeah, sorry about that. And we are going to talk about infant feeding in disasters, in emergencies, you know, and I wanted to address this topic because I found myself answering this question a lot in the past few weeks with the hurricanes that have hit.

the southern part of the United States particularly with the devastation that hit Western North Carolina. And there are some really great guidelines around this from the WHO, from the CDC. And I just wanted to kind of run through what that means for providers and what that means for parents and just hopefully have a very consolidated resource that's free and accessible.

And actually, I would argue that it's been a couple years that you've been. Wanting to do this every time there's a natural disaster. You're like, Ooh. We should do an episode on that. And it's come up more than we like to think. It has. And I actually have most of a course prepped on this because I was planning to teach a course on it with another midwife in Mexico.

And we were having trouble making our schedules meet. So we never, finish the course, but it's something I've put a lot of time into. And so I'm excited to talk about it today. Before we do that, I do have a quick question from a listener. We have some patrons to thank, and then we're going to get into it.

All right, perfect. So let's thank some patrons. First of all, we just want to say everybody that donates to our Patreon, we thank you so much. That money goes directly to supporting the show. We don't make money doing this. This is truly a passion project. But it does cost money to produce it. Yeah. We have a wonderful audio engineer named Cherie Louise Turner, and we have another lovely content creator, Tiffany Goetz, who does our social media.

And she also adds all of our episodes to the website. She also uploads them to the podcast platform. She does like all of it, actually. If she wasn't there, like they wouldn't. They wouldn't get to your ears. She does the transcripts. We would forget. So people that are hard of hearing can read them. Okay, so here's the patrons that we'd like to thank today.

First up is TJ E, then we have Marissa Littlewood, and Stacy Starsman, who is a CNM IBCLC. Hey, Stacey, let's talk because, you know, as it turns out, we're kind of unicorns out there. So let's chat. But okay. What's your question? Okay. So this comes from our Facebook group which is Breastfeeding for Busy Moms.

If you want to join it, it's fun. And this is from Kaylee and she said she. was diagnosed with mastitis yesterday for the first time and just started antibiotics. And while pumping at work, she noticed that her milk was pink on one side, on the side that has mastitis. Is it normal? Should I call my doctor?

Et cetera. You're good, girl. That shit's a mess in there right now. It's all based on inflammation, and when we have inflammation, we have damage that's being done to the inside of the vessels, and we have, the breasts are highly vascular. There's just a lot going on in there. So yeah, and actually, a little bit of the pink in the milk, it's a lot less blood than you think.

So much less, yeah. If you actually let it sit undisturbed for a couple of hours in the fridge, whatever. Sometimes that blood settles and clots out at the bottom and you can even just pour the milk off, but you don't have to. Yeah. And it's absolutely safe to feed your baby. So with all the mastitis recommendations.

We do say feed and or pump that breast as normal. So please don't avoid emptying that breast and don't over pump it. Just treat it as normal. Yeah, and you know, the only thing that I tell people to watch out for is if there's blood in your breast milk that when your baby digests it, it might turn their poop black.

It might look like some coffee grounds in their poop. That is what digested blood looks like. Yeah, it's not. But it's fine. It's fine because we know where it's coming from. Right, exactly. Yeah, and it just takes a few days to work that out as the inflammation reduces in your breast. And also because you've done antibiotics, you are at risk for getting mastitis again.

Mm hmm. So we do encourage you to do a month of probiotics. Yeah. For breast duct health that has either L fermentum or L salivarius. strains in the probiotic. Okay. Okay. Well, should we get into our episode? Please. Okay. So I want to start first with a little segment for providers, because I actually think this is where our guidelines are lacking more.

I think we have a lot of really extensive guidelines about what parents need to do. And then for providers, often, there will be maybe like a flow sheet or a sentence that's like, encourage people to breastfeed. Okay. And that's kind of it. And that's kind of rude. Yeah. If you can't breastfeed or you're struggling to breastfeed.

And then you're in a hurricane and you don't have access to clean water for formula, but breastfeeding is hard. It's a bit of a slap in the face. Right. So I want to sort of walk through how to do that mindfully and how to do that in a way that works. So we're looking at providers here who are probably providing emergency care, maybe not even in a hospital.

We don't really know what the situation is because we're in some kind of emergency disaster situation, but. Presumably these are either birth providers, they're emergency doctors, whoever is there. When we approach this conversation with patients, especially those who were not planning to breastfeed in the first place, we do have to talk about this as a short term intervention.

Say, hey, you know, what was your plan for baby feeding? If it's breastfeeding, great. But a lot of people are going to say, I was going to formula feed. In that scenario, the conversation has to look like, okay. We are triaging everything right now because we are in this emergency with very few resources. So would it be possible for you to begin breastfeeding, with support from us, and to possibly formula feed with us?

at a later time. This is a short term intervention until we have access to the resources you need to feed your baby in the way that you intended. You're talking immediate postpartum, like people that are actively having babies? Who are birthing in this disaster scenario. There's another, I'll move on for other folks.

Okay. This is people who are like, At their due date, and Hurricane Helene hits. Yeah. So when we have access to those people who are birthing in front of us in this whatever disaster clinic we're in, that's what that conversation has to look like, in a respectful way, where we're like, Hey, just like how we're modifying the way that we are preparing food, and the way that we are caring for our bodies and our hygiene, it's necessary to modify the way that you're going to feed your baby for the short term.

And, and to explain why, right, we don't have regular access to formula, we don't have regular access to clean water. Therefore, this is the safest option moving forward, for now. Right, right. But, I think where it gets more confusing is when, say, the AAP little flow chart is like, Encourage everybody to breastfeed!

And they come into your disaster emergency clinic with a two week old, and they've been formula feeding. And you say, have you tried breastfeeding? Relactation is certainly possible for many people, especially within the first month postpartum. But it's not easy. And it's to a point. Right, and it's an inappropriate suggestion to give somebody without any further guidance.

And also, like, some extra questions, like, do you have power in your house? For a breast pump, right? That gets plugged in or charged or can your baby latch? Have you tried that ever before? Would you be willing to try that? And I think that's usually where the conversation has to begin because most of the time in this situation, if we have somebody who's been exclusively formula feeding, we probably don't have a breast pump.

We may not have power. We may not have a hand breast pump, right? We probably don't have those resources that we would typically use in a relactation scenario. And so we would have to utilize the baby for that breast stimulation. And then that person needs really close follow up, right? Say, even if they're 100 percent in, they're like, Oh yeah, my baby, like, we'll try it in clinic here.

They totally latch. I'm down for it. We don't just release them. And say, okay, breastfeed now. They have to be followed up with daily, really closely in that scenario. And so if that's not possible for you as a provider to follow up with them every day to see if they're actually going to make milk, it's an inappropriate suggestion.

And to weigh the baby. Make sure the baby's stable, you know, so it's like are you a provider that's on the front lines of this thing? Because if you are the chances that you're gonna have these folks that are like stable quote unquote Slip through the cracks is about a hundred percent. Yeah, so making sure that you're outsourcing to other folks like IBCLCs that can maybe do home visits or telehealth Yeah, or, or like, I know, you know, I was reading a story about nurses going on horseback in North Carolina to do home visits, you know?

Yeah, I mean like, You're like, we've been waiting for this moment. I feel like if I was in that scenario, I would feel that way. I'd be like, I've been waiting for my moment to ride a horse over a mountain to deliver a baby my entire life. Call me Dr. Quinn, baby. Right. But, you know, You know, you really have to consider that relactation follow up is complex and frequent.

And so, I actually have a really hard time thinking of a scenario post natural disaster where I would feel confident recommending relactation to somebody in like, a temporary clinic. That shit's hard when the sun's shining. Right. And everything's going right. Now, it might be necessary. You might be like, there's literally no formula here.

Yeah, no idea when it's coming. We also don't have a way to ask for it. And in that case it makes more sense to seek donor milk and try to find people in the community who have young babies and connect them together and to see if anyone has other, you know, formula they're not using that we can reallocate.

Are we ready to talk about donor milk? We can certainly talk about it, because I've had a lot of people ask me in the past week since Helene hit, I want to donate my breast milk from a different state. Yeah. Like, how do I get it there? How do I make sure it's getting in the right hands? How do I make sure it's being handled properly?

There's just community milksharing in general. There has to be a trust and understanding and a, it has to, what's the word I'm looking for? It has to be transparent. Yeah. You know, like, here's my lab work. This is what I'm comfortable with. Right. We can't just show up with a truck full of frozen milk. Right.

With no. And I think we've, we've come a long way in community milksharing, and I think that's great, but I think this is a perfect time to screw up all that progress by showing up with a truckload of half thawed milk, giving it to babies, and then babies have some weird outcome, and then 2020 picks up a whole thing about donor milk again.

Yeah, and I think my biggest concern is that if we are sending frozen milk into communities without power, we have no way to preserve that. Right. And that is a resource with an incredibly short shelf life. Yes. Hours. So unless we are also sending freezers and generators and gasoline, It does not make sense.

Right. However, what does make sense is connecting people who are already in that affected community to each other for either hand pumping and bottle feeding or directly breastfeeding other people's babies, which they can figure out themselves. Yes. Like that is where we have a person to person interaction where they decide what is comfortable for them.

I also wonder how the milk banks come into play here because they might be, and I can't confirm this, but I imagine that they are. feeling a little bit of pressure in these disaster situations to broaden their pool of people that they are wanting to give milk to. I know they've been working on transition milk for a while.

They've made some good progress. I feel like we should touch base with them and we should see like, hey, are all of these natural disasters that are popping up kind of pushing you all towards, Opening your doors for that, because that would be a nice, good buffer for people in like West Virginia, for example, that want to donate to the Mid Atlantic Mothers Milk Bank for the folks in Tennessee.

Yeah, it would be an interesting concept that I would be curious about the execution of, again, because we come up across the same resource barriers to keep that milk. As a safe, healthy food that somebody can eat where it has to be preserved frozen. But it would be an interesting conversation to have.

Maybe we can send an email and see what they say. Yeah, TBD. Yeah, but I do want to shift us from provider to parent perspective here and actually really focus on hygiene. because there's some not so obvious things that we can do that really make both breastfeeding and formula feeding safer in a disaster.

So, of course, off the top, if you are already breastfeeding in a natural disaster where we lose resources, the recommendation is to continue to do so regardless of what your plans were next. If you were like gonna start weaning next week, we're postponing that. Yeah. And if you are already partially breastfeeding, to do your best to incorporate as much breastfeeding as possible, even for toddlers, right?

Because we may not have continued access to safe food. So that is a food that will remain safe whether we, whether or not we have clean water, whether or not we have fresh food. All of that. Because it is being made daily by your body. So as long as you can keep yourself reasonably healthy, you can make a healthy food for your child.

That is pretty wild. It is like, if you're stuck on a desert island, three things with you, every man out there is like. I'd bring my wife, because at least she'd have her boobs and she could lactate for me. It's like, eww. But also But, you're right. Yeah. Yeah, and I do really love to mention that toddler part because it's not obvious.

Right. You know, and often with those older babies who are like a year old or two years old, you might be able to entice them to breastfeed more, and they will usually naturally do so when they are stressed. Like when your entire environment has changed. And so that is something we really encourage you to encourage them to do.

God, I can't imagine having a toddler in a disaster situation like that. I can barely take my toddler to the Walmart bathroom. It's like, what's the rule? Don't lick the floor. Touch nothing but yourself. Like she'll touch every toilet and immediately suck her thumb. And I'm like, oh my god. What are you doing?

Okay, so it gets more complicated when we have parents who are pumping, formula feeding, bottle feeding in any way. So usually in most natural disaster scenarios, we are without power for some period of time. And for those that are reliant partially or solely on a breast pump to feed your baby, that is a big problem.

And this is why when we did our hand expression episode, we talked about hand expression as an emergency skill. That every person who is breastfeeding should learn because it may be all that you are left with if you have a pump that is electric. Because even if you had it fully charged and it was a battery pump, that's two days maybe at the most of power.

And, you know, I would hope you'd be able to have access to a generator every couple days at least, but that may not be true. And I can also tell you that if you see that a storm is coming, you can get external battery packs that, like, for example, the Medela external battery packs will plug into a Spectra.

Oh yeah. Totally. Which is pretty cool. Yeah, those are really helpful to have extra batteries for those. And I just. I would really love it if everybody who pumps also has a hand pump. Mm hmm. Just even one, you know, because if the worst case is you alternating which breast you pump and using a hand pump, that is better than only having your hands.

Yes. However, if you only have your hands and your baby, and your baby's not helping you out, you can absolutely express your milk with your hands. It's hard for me. It's hard. Yeah. It gives me hand cramps. It's hard. It like hurts me. I, you know, I suck at it. I personally have never been able to fully empty doing it, but it would be better than nothing.

And that's sort of the entire mantra of disaster care, right? Is better than nothing. And, you know, that's, we're sort of looking, when we talk about these protocols, we have a hierarchy, right? Yes, if you can use your breast pump, do it. If not, use a hand pump. If not, use your hands. If not, find a baby anywhere on the street.

Right. Somebody's baby. And we, we sort of have these flow charts for all of this. What goes hand in hand with people who are pumping is bottle feeding. And this. Advice will also apply to those who are formula feeding. Bottle feeding becomes very tricky in a scenario where we do not have clean water. Yeah.

Because you are unable to clean or sanitize the vessels your child is drinking from. The best recommendation in a scenario like that is to use disposable cups or spoons to feed your baby. Things you never have to wash. Plastic solo cups. Something like that. You might not have those, but also, you know, you might have access to a community center that has a whole closet of them, or you might have a hundred of them in your basement.

That is a hundred days of feeding your baby because something like that you could use for 24 hours and then discard. And like the disposable straws. So if it's too messy with a solo cup, you could try to do the pipette method with a straw where you dip it in the milk, put your finger over the straw. And then drip it into your baby's mouth.

Yeah, absolutely. Same with a spoon. And a reminder that a baby of any age can be fed with an open cup or a spoon or a straw. You just have to modify your method. And it is a good reminder, too, for those who are not affected by current disasters, but might be in the future, to just generally kind of think of, Hey, if I had to do that, how would I?

Maybe I should go watch a YouTube video quick on how to open cup feed a newborn, you know. Global Health Media is a great resource for that, where they have lots of how to videos for breastfeeding and bottle feeding and cup feeding, but specifically cater to low resource people. So, disposable items are going to be our top, top choice here when we have no way to wash things.

If that is not available, the second best choice is any other open cup. Because the hardest part of a bottle to clean is the nipple. Mm hmm. And the little ring that goes around it, whatever other junk is attached to it, for those, like, Dr. Bronze, anti-colic, or, like, we don't need any of that stuff. Yeah.

Because if we are doing our best to clean a vessel, we want it to have the least amount of surface area in the most open space. manner so we can easily clean. Yeah. A gas bubble is going to be the least of your worries in this situation. Right. So get rid of the little gas. I don't even know if those things work.

I don't know how to study it, but they really annoy me when I have to clean them. But regardless, if you were using bottles, you're going to take all your rings and nipples and caps and set them aside and say, we will revisit this when we have clean water. As far as then how you're going to clean a reusable vessel, of course, the best way is with hot water and soap.

Clean hot water. If you don't have access to clean water, but you do have access to heat, like a stove, a fire, whatever, boiled water, that you can then clean with, with soap if you have it, or submerging your cups or bottles into boiling water as the next best thing. The guidelines don't agree on this. I've seen anywhere from 30 seconds to like three minutes.

Yeah, I would err on the safe side of longer if the water in the first place was not clean and we don't have soap, right? If you don't have access to either of those things. Cleaning. Something with chemicals like bleach or those like pump sanitizing wipes or whatever is kind of our lowest, worst option.

It can work and sometimes can be effective, but the challenges we have with chemical cleaning something like a baby bottle is that one, if those chemicals are kept improperly, they simply might not work, right? Have been denatured. They might not be active. Or two, if we then don't properly rinse or let these things air dry or whatever the directions are, we might be contaminating baby's next meal with whatever you use to clean the cup.

So not my favorite option, but also. possible option if you have access to certain cleaning chemicals. Those pump wipes though are pretty invaluable when it comes to something like this. And if you say had a had access to a very limited amount of clean water, you could choose to use those for a day and then do one clean water soap wash in the evening.

We're really just doing the next best thing in this scenario. Yeah, and I'm also thinking about The age of the baby and the health of the baby. So in addition to the hierarchy of options, thinking about what, where your baby currently is in their health and their age to kind of guide you and how much you should give a shit about this.

Because, you know, like obviously if the water is like really bad where you are, if it's like, yep, we're basically like literal flood water, it's flood water. That's all you have. Yeah. It's not really an option. No matter how old your baby is. But if it's like water that you filled up in your tub before the, or maybe you had a cistern out back that you hadn't used in years, but it was clean water.

It's just been really stagnant or like in that case, it's like. If your baby's older than six months, they're crawling around, they have a pretty decent microbiome at this point, they've put tons of stuff in their mouth, I'm going to be a little bit less paranoid than I would be about a brand new baby whose immune system is wide open.

Who's, you know, there's a lot of gaps between the cells where like things are definitely going to permeate a lot more. And we also just like when babies are that small don't have a lot of time between when we notice them being sick to when we have to get them to help. Exactly. And really it is when you're in a scenario like this, just a constant mental process of figuring out what is the best you can do and what has to be done for survival next.

So if it's like. 12 hours before you're going to be evacuated to anywhere with clean water and you're a straight formula fed baby situation, no breast milk. Would you say refrigerated cow's milk? It would depend on the age of the baby, but maybe. And, you know, when we talk about formula feeding, we also have to consider most people use powder based formula.

Right. And that becomes a huge problem in a scenario where we do not have clean water. Yeah, I would probably, if you're buying stuff for like a disaster prep, Ready to feed formula. I would get ready to feed formula if you could find it. And bottled water. And that's what we have to consider then is okay.

If you're feeding your baby either partially or exclusively powdered formula, we really want to be using bottled water in a scenario where we don't have like clean tap water. Second to that would be boiled water of other origin, but better than That would be ready to feed formula that is already hydrated.

It's just like, you pour it out and you feed your baby, but it's hard to get. And it's what I always tell people over and over and over when they're like, like, what can I donate? Like, if you are donating baby formula, it had better be ready to feed. And if you are donating powdered formula, you need to donate an adequate amount of bottled water to hydrate them.

Or like those gallons of nursery water. Yes, exactly. And also another thing you could do if you see the storm is coming, you could do the pitcher method and you could actually boil water ahead of time and you could actually prep the powdered formula and keep it in the fridge. Right. And that's good for 24 to 48 hours.

when done correctly. And again, you could push it a little further if you have to. Right. And that's, that's always what we're going to be asking in those scenarios is like, how far can I push this safely? Yeah. And if I can't push it anymore, what's the alternative? Yep. If you all are at the end of this episode here thinking about, well, I'm in this, you know, safe place I want to donate to help.

We will list a couple of links in the show notes of places you can donate to because by far donating money is the best option, especially if you are not geographically close to an affected area. So I'll put some links for like mutual aid funds and whatnot that I know are good places to donate in our show notes and hopefully we can get some donations for people who are helping out those affected by these hurricanes.

Yeah, that'd be great. I actually received a message today asking if we'd want to donate, like if my clinic wanted to donate for infant feeding supplies as well as menstrual cycle stuff. And I'm like, I'm about to donate a bunch of menstrual discs. Yeah, absolutely. Those make so much sense. And, and, you know, I mean, we're not going to be donating bottles.

You donate disposable shot glass, solo cups, right. You know, it's definitely like a hard thing to, to know what to donate sometimes. But menstrual products are very much needed. Batteries are often very much needed. Things like that. Gosh, this is crazy. Yeah. And actually, as we record this, there's another hurricane brewing hurricane Milton.

So hopefully when that. It's, it's not horrible. It's probably going to be horrible. It's just kind of the way things are going right now. So yeah, I think this episode is really timely. And if you need anything individually. If you need some advice, feel free to reach out to us on social media or on our Patreon and we'll try to get you connected with what you need.

Absolutely. And I just wanted to give a shout out to our friend Beth, who is a midwife in Southern West Virginia, who is currently driving down a U Haul full of baby feeding stuff and menstrual pads and all kinds of postpartum supplies. So I hope her travels are very safe. And I'm going to shout out to Sarah McBride.

Who actually is doing the same thing, so she's on her way down as well. And Sarah McBride actually put together the huge fundraiser for the Ball of the Year. And all that money went towards the P3 program in our town for postpartum support. So she's really, really big in supporting postpartum mothers in our town.

And here she goes again, just helping people in Appalachia. So thank you to Sarah. And we'll give them both the award. Absolutely. What should we call it? Appalachian disaster queens? No, not that. You're a disaster queen. Oh, can we give them the look for the helpers award? Do you remember that Mr. Rogers quote?

Yes. I don't know if you guys are not familiar. There's a quote from Mr. Rogers where he was talking about if things were looking scary, like news on the TV and big events. He told children to look for the helpers, because then it's less scary. Makes me want to cry. I tear up when I think about it. I've been crying a lot lately.

You also came off your antidepressants. This pneumonia's got me emotional. I'm off the Prozac now. Hard to say where that's from. You about to get your period too? No. Oh, man. No, I'm just feeling feelings. All right. Well, everybody, thank you for listening to this very important episode of the Milk Minute Podcast.

The way we change this big system that is not set up for lactating families, especially in disaster situations, is by educating ourselves, our loved ones, And sometimes even our providers. I have a special ask for you today for how to support all of us here is that you download this episode and save it onto your phone, because if you need it in the future or a friend needs it, you may not have cell service or internet or access to any of that.

But if you download this episode, save it in your files, you will have this resource at your fingertips. Yes. And send it to a friend. You probably said that already. I don't know. Okay. Good night, everybody. We are tired. All right. Well, my voice is going bye bye and here we go. All right. Love you. Bye.