By Amber Ziring — Oregon, USA
Earthquakes strike when you least expect them, and I certainly had not planned for a 7.8 magnitude earthquake while on vacation with my family in Costa Rica. I managed to duck and cover with my 23-month-old and then we fled for high ground, realizing a tsunami might be coming. There was definitely a lot on my mind that day, yet how I would keep my daughter fed and hydrated never worried me. I just kept breastfeeding.
Every corner of the world can face an emergency: wildfires, earthquakes, hurricanes, snowstorms, and the resulting disruptions to infrastructure — like unsafe drinking water — can impact our daily routines. Having a plan for how to care for your nursling during challenging times can help reduce everyone’s stress and keep your family healthy. Stay informed about your region’s directives should a natural disaster occur and share this information with your family. Maintain your breastfeeding relationship by keeping these key strategies in mind:
1. Head to safety first
When evacuating, get to safety first. Once you’re safe, offer the breast more frequently to help soothe your baby and to make up for any lost feeding time.
2. Think positive
During high stress times, you will keep making high quality milk. Stress can impact your letdown time, which can sometimes lead to a frustrated baby or fear that you’re not making enough milk. If you are feeling stressed as you start to breastfeed, try to focus your thoughts on your baby or other happy things. This should help your milk to flow more readily.
3. Change things up a bit
If pumping is already part of your usual routine, it may be easier to offer your baby the breast instead during an emergency, if possible. If you exclusively pump, learn to hand express (before an emergency arrives!) in case there is no electricity or safe way to clean your pump parts. For refresher tips on how to hand express, check out these great how-to links:
4. Keep offering the breast
If your emergencies have forewarning (snowstorms, hurricanes, or pandemics) and you mix feed, start offering the breast as much as you can, as soon as you know a storm is brewing. The more you offer the breast, the more milk you will start to produce. This can make supplies stretch longer.
5. Try cup feeding as a step toward breastfeeding
Feeding at the breast is the safest way to feed a baby during an emergency. If you would like help bringing your baby back to breast as part of your emergency preparedness, call your local La Leche League Leader. You can also learn to cup-feed your baby — yes, using an open cup! Here are two great YouTube examples of babies of all ages being cup fed: https://www.youtube.com/watch?v=o01U_i2CDFw [3] and https://www.youtube.com/watch?v=fCyWvcsdYOE [4]. Cups are easier than bottles to keep safely clean, as there are fewer nooks and crannies [5, 6].
6. When possible, store extra breastmilk near your baby
Consider what would happen if you were unable to reach your baby during a natural disaster due to being at work or school. How long would it take you to navigate your way back to your baby if the bridge is out or your normal transportation is not an option? Once breastfeeding is well established, consider expressing and storing a little extra breastmilk to account for that time.
7. In extreme situations, consider cross (shared) nursing
The World Health Organization (WHO) recommends that in cases such as natural disaster [7], cross nursing (having another lactating woman feed your baby) may be the safest option if you are unable to breastfeed your baby. Talk about any wishes you may have related to cross nursing with others who may be caring for your baby in your absence. Include how you would like to address concerns about HIV. While HIV testing is recommended beforehand, the reality is it may not be feasible. [8] People with a history of injection drug use, for example, should not cross nurse. Beyond those recommendations, it is up to you to decide what level of screening is appropriate for your circumstances. The WHO also recommends inducing lactation or relactation as an option for other caregivers if it is evident that the mother will not be able to breastfeed the baby for an extended period of time. You can read more about the WHO’s recommendations for cross nursing and relactation here [9].
8. Delay weaning
Some families plan to wean at a certain milestone, or after reaching a specific duration of time. If this is your plan, consider waiting until after wildfire, flood and snow season. That way, safe nourishment for your little one remains available regardless of what nature throws your way!
Human milk can provide critical nutrition during an emergency. It can also help keep your baby or toddler healthy if you’re sheltering in less than ideal settings, reduce stress and anxiety for both the baby/toddler and parent, and is a supply that is readily available. Creating a plan for an emergency will help you feel confident when the time comes, even if it happens to be while on vacation.
Amber Ziring, MSW, MPH, IBCLC, has been a La Leche League Leader since 2011. Beyond her own breastfeeding in emergencies experience, she has supported Syrian refugees and local public health authorities with creating safe infant feeding practices during emergencies. Amber is the proud mama of two children who share her passion for breastfeeding.
References
1. LLLI, Hand Expressing, 2020, https://llli.org/breastfeeding-info/hand-expressing/ (accessed 17 May 2020).
2. Global Health Media, How to Express Breastmilk, 2014-2020, https://globalhealthmedia.org/portfolio-items/how-to-express-breastmilk/ (accessed 17 May 2020).
3. SIKANA Health, Breastfeeding: Feeding a Baby with a Cup of Milk, 7 June 2016, https://www.youtube.com/watch?v=o01U_i2CDFw (accessed 17 May 2020).
4. Dr. Jack Newman and birth.world, Dr. Jack Newman – Cup Feeding, 10 July 2016, https://www.youtube.com/watch?v=fCyWvcsdYOE (accessed 17 May 2020).
5. Carothers, Cathy & Gribble, Karleen, Infant and Young Child Feeding in Emergencies. Journal of Human Lactation. June 2014; 30(3):272-275: https://journals.sagepub.com/doi/10.1177/0890334414537118
6. Gribble, Karleen, Evacuation with a baby? Here’s what to put in your emergency kit. The Conversation, 18 November 2019: https://theconversation.com/evacuating-with-a-baby-heres-what-to-put-in-your-emergency-kit-127026
7. Emergency Nutrition Network, Infant Feeding in Emergencies, Module 1 for emergency relief staff, November 2001, http://files.ennonline.net/attachments/150/module1-manual-refer-ops-gv2-1.pdf (accessed 17 May 2020).
8. United Nations High Commissioner for Refugees (UNHCR), Guidance on infant feeding and HIV in the context of refugees and displaced populations, Version 1.1, June 2009, http://files.ennonline.net/attachments/1512/unhcr-guide-2009.pdf (accessed 17 May 2020).
9. Emergency Nutrition Network, Infant Feeding in Emergencies. Module 2, Version 1.1, for health and nutrition workers in emergency situations, December 2007, http://files.ennonline.net/attachments/141/module-2-v1-1-core-manual-english.pdf (accessed 17 May 2020).