International Breastfeeding Journal BioMed Central

Background The expression of human milk for later use is on the rise. Bottle systems are used to deliver the expressed milk. Research has shown that storage of both human milk and artificial baby milk, or infant formula, leads to a loss of ascorbic acid (commonly called Vitamin C). As milk is removed from the bottle during feeding and replaced by ambient air, it is unknown if loss of ascorbic acid occurs during the course of a feeding. The purpose of this study is to investigate the effect of the milk delivery system on levels of ascorbic acid in human milk and infant formula. The objectives are to 1) determine changes in ascorbic acid concentration during a 20 minute "feed," 2) determine if there is a difference in ascorbic acid concentration between delivery systems, and 3) evaluate if any differences are of clinical importance. Methods Commonly available bottles were used for comparison of bottle delivery systems. Mature human milk was standardized to 42 mg/L of ascorbic acid. Infant formula with iron and infant formula with docosahexanoic acid were used for the formula samples. Each sample was analyzed for ascorbic acid concentration at baseline (0), 5, 10, 15, and 20 minutes. Each collection of samples was completed in triplicate. Samples were analyzed for ascorbic acid using normal-phase high performance liquid chromatography. Results Ascorbic acid concentration declined in all bottle systems during testing, Differences between the bottle systems were noted. Ascorbic acid concentrations declined to less than 40% of recommended daily intake for infants in 4 of the bottles systems at the 20 minute sampling. Conclusion The bottle systems used in this study had measurable decreases in the mean concentration of ascorbic acid. More research is needed to determine if the observed decreases are related to lower plasma ascorbic acid concentration in infants exclusively bottle fed. The decrease of ascorbic acid concentration observed in both human milk and infant formula using varied milk delivery systems may be of clinical importance. For infants who rely solely on bottle feeds there may be increased risk of deficiency. Bottle shape, size, and venting should be considered.


Background
Infant feeding occurs in the context of other continued gender inequities that include: lack of support by family, worksites and communities for breastfeeding; the sexualization and objectification of women's breasts; public aversion to the "maternal breast" which stigmatizes public breastfeeding and limits women's mobility in public spaces; lack of third party health insurance coverage for breastfeeding support; fragmentation of health care (obstetric care separate from pediatrics) and health care providers' failure to adequately inform women about the benefits of breastfeeding. All of these help create an environment that medicalizes and commercializes infant feeding while undermining women's capacity to breastfeed and alienating them from their maternal breast. These issues are visited even more heavily on low income and minority women as is demonstrated in shorter breastfeeding duration [1].

Methods
Over the last couple of years, I have conducted interviews with women to identify the values that women bring to their decision-making about how to allocate their time, their money, their energy and their bodies in meeting their needs as individuals, workers and mothers; how women today manage their own efforts to achieve personal fulfillment and economic independence alongside their goals as mothers [2]; and then to use these women's experiences to develop a framework for feminist breastfeeding promotion. My purpose was not to assess the average or typical view of all women; rather I sought to interview women gathered around shared values, con-cerns or experiences. To date, I have sought out women gathered around the power of motherhood, breastfeeding advocacy and feminism. This paper draws from analysis of interviews conducted with women artists at the 2005 Mamapalooza music festival in New York City (power of motherhood; 12 participants, "Mamapalooza"), and conference participants at the 2005 La Leche League International and International Lactation Consultant Association Conferences (breastfeeding advocacy; 11 participants, "LLLI/ILCA") [both in Washington, D.C.] and at the 2007 Reproductive Freedom Conference held by Hampshire College in Amherst, MA. (feminism; 6 participants, "Reproductive Freedom"). Open-ended interviews lasted between 30 and 45 minutes and were guided by questions designed to engage women in a discussion of their experiences with motherhood, breastfeeding, employment, the (dis)connections between breastfeeding, motherhood and feminism, and strategies for improving women's lives to make it easier for them to be employed and achieve personal fulfillment while still meeting their goals as mothers and ensuring the wellbeing of their children. The interviews were transcribed and entered into Atlas ti, a software for analysis of text based data and thematic analysis was used. This paper examines these women's experiences with breastfeeding and motherhood to understand our collective alienation from breastfeeding and to outline a process for how we might repossess breastfeeding as a positive function in women's lives.
Ethical approval for this research was granted by the Institutional Review Board of the University of North Carolina, Greensboro. All intended participants were provided with a consent form and they all consented.

Conceptual framework
Repossession is a strategy commonly used by women and other groups who have experienced oppression as a way of reconnecting to previously alienated parts of their bodies, experiences and lives. For over 30 years women have been marching together at night through red-light districts and other dangerous parts of cities as a way of reclaiming our right to walk at night. The popular Vagina Monologues provides a way for women to reclaim and revalue vaginas [3]. Matria and Mullen based on their study of women reclaiming menstruation, conceptualized a three step process to repossession that emerges out of a sense of alienation from parts of ourselves, our bodies and our lives: reconnection; redefining; and normalizing [4]. According to Matria and Mullen, reconnection starts with women getting in touch with and validating personal experiences, unlearning concealment, sorting out what to keep, and filling in the gaps [4]. Redefining draws on personal experience to reinterpret old mythology, and substi-tutes positive explanations for negative ones.
Step three, "normalizing", refers to trying out new perspectives and behaviors beyond immediate networks and seeks to normalize breastfeeding for society at large. Normalizing comes from creating customs and norms that increase women's comfort with themselves and each other, helping them live as they choose. This conceptualization provided a framework for examining women's repossession of breastfeeding as normal and healthy.

Results
Themes emerged for each of the four components of the framework (Alienation, Reconnection, Redefining, Normalizing); these are presented below with supporting quotes.

Alienation from breastfeeding
With some exceptions, this group of women was not alienated from motherhood or breastfeeding. Nonetheless, they put forward several ideas that help shed light on how, from their point of view, liberal feminist theory and praxis may have contributed to women's alienation from breastfeeding. These themes, with quotes illustrating some of them, are below: • Feminism stressed the goal of helping women become players in a man's game in a man's world  Figure 1 illustrates a three step iterative process of women's repossession of breastfeeding that emerged from this study.
Step 1 in the Repossession process is Reconnection, which involves getting in touch with and validating with our own experiences. The following themes emerged from across the interviews: Repossessing breastfeeding: Reconnecting, redefining, and normalizing

Redefining
Step 2 in the Repossession process is Redefining: this involves using personal experience to reinterpret myths, stereotypes and norms and substitute positive explanations for negative ones. The women I interviewed were revaluing and redefining many different things including how they understood breastfeeding, motherhood, feminism and women's reproductive rights.
• Breastfeeding is a feminist issue

Normalizing
The last step in the iterative Repossession process is Normalizing, which comes from trying out new customs outside one's own social group to create new norms that increase women's comfort with themselves and each other and which make our lives more possible. The Normalizing customs I derived from these interviews are: •

Conclusion
Hausman writes that "Breastfeeding provides a focus that encourages us to see women's bodies at the centre of the dilemmas of modern societies, as women are increasingly called to labor in ways that disturb or make impossible the biosocial practices of maternity" [5] (p. 283). One dilemma identified by the women interviewed here is that the feminist strategy of advocating for women's equality with men left women vulnerable to a system that, while making it possible for women to be more engaged in the labor force, still defined the male body and mind as the norm. They suggest that women's alienation from their own bodies and from motherhood, from the feminine, may hinder women's, in particular mother's, abilities to become fully human. Nonetheless, as feminists have done for decades, these women find power in honoring and validating their own experiences as breastfeeding mothers, in claiming those experiences as legitimate feminist actions, and then drawing on these experiences to seek new meanings, customs and norms that honor, value and support their rights to those experiences without otherwise excluding them from public opportunities and rewards. They argue that we need a feminist movement that fully incorporates women's needs as biological and reproductive social beings, alongside their needs as productive beings, and a movement that defines the female body and mind as the norm. Then, perhaps breastfeeding could become normalized as a labor of love.