Nursing Your Kids

The news story about the woman causing the scene in the courthouse got me thinking. Breastfeeding is normal and natural and there is nothing sexual about it. I don’t understand the segment of the population who feels that it’s something that should only be done in private. Babies need to eat and mothers need to leave the house. When my 6 week old is hungry I feed him. (When my 2 year old demands “mommy’s milk” which I know he actually doesn’t want I ignore him. ) But it’s not something I want to make a scene over.

Even if he actually wanted to nurse properly instead of just playing with the clasp on my nursing bra I wouldn’t let my 2 year-old nurse in public simply because he doesn’t need my milk for nourishment; he could just as easily have a drink of water and a sandwich if he was hungry. Letting him nurse in public would be more about proving a point than anything else. If Sam really needed or wanted to nurse I’d find a more private, discreet place to let him rather than whipping it out in the middle of Target like I would with Ben. It’s not because I think there’s something wrong with nursing a toddler, it’s because I know my son and I know he can wait. If he was a toddler who still nursed regularly, for comfort and/or a drink, I’d be more apt to let him nurse in public because it would be something that was normal for him. But for a kid who only nursed as a toddler in the early mornings or at bedtime, nursing in broad daylight in a public place would have been weird for both of us.

I’m getting off topic here. What I’m trying to get at, is that since I’ve become a mother, specifically a nursing mother, I’ve been hyper-aware of public breastfeeding since I make it a point to leave my house on a daily basis. The majority of the mothers I know don’t cover up with blankets and don’t leave public areas to feed their babies. But they also don’t make it a point to draw attention to the fact that they are nursing. Some women are such fierce breastfeeding advocates that they feel it’s their job to loudly educate people about their rights and the benefits of breastfeeding every time someone glances at them while they feed their kids. I don’t see how that helps the cause. It’s already protected- why fight about it?

If someone stares at me while I’m nursing I ignore him or her. If someone says something about me nursing I ignore him or her. Nursing in public is something that I feel I should be able to do without whispers or stares. So I feed my baby and ignore the rest. I’ve never been directly confronted (only whispered about), but if someone were to confront me I’d calmly and quietly tell them that the state of Pennsylvania allows me to feed my child in any public or private place. Getting loud about it and making a scene, getting defensive about it would only make it seem like I’m doing something I should not.

I came across this odd story out of Tennessee. My comments after the article, but make sure you watch the video.

Breastfeeding Controversy at Rutherford County Courthouse-Erika Lathon

Breastfeeding in public isn’t against the law but a Murfreesboro woman says it nearly got her arrested.

In this case, they point out that despite being disruptive, Rankins was allowed to leave on her own without being arrested.

Ordinarily I feel it’s my job to side with the mother, but after watching this video I can’t help but think Rankins was out to make a scene. I don’t know what precipitated the complaints that caused the deputy to ask her to move, but I’m sure that once she was asked to cover up she did get loud and she did disrupt court, even from outside of the courtroom. Breastfeeding in public is protected in Tennessee, a point that could have been made without yelling. A simple reminder of the law should suffice when confronted.

My friend called the other day to tell me about the front page news of the study that shows breastfeeding may boost IQ and I pretty much ignored him, saying, “duh,” like the 10-year-old I am. (I mean really, doesn’t everyone already know that breastfeeding is the best thing you can do for your baby, the IQ points, which have been hotly contested in the past, are just gravy.) After my mature reaction he explained that he was just telling me so I could write about it on my blog and I felt like a jerk for blowing him off. So I feel like I should at least mention the recent MSNBC front-page article with the headline, Breast-feeding may boost children’s IQ and the tagline, Study provides new evidence that nursing makes kids smarter.

The study follows up other studies that have pretty much shown the same thing. The question was whether the IQ differences were based on nature or nurture, since breastfeeding mothers in the US and Canada tend to be more well-off financially than mothers who formula feed. This time, researchers followed babies born to mothers in Belarus, randomly assigning babies to a group where breastfeeding was encouraged.

Previous studies had indicated brain development and intelligence benefits for breast-fed children.

The design of the study — randomly assigning babies to two groups regardless of the mothers’ characteristics — was intended to eliminate the confusion.

A BBC article about the study explains,

They found that those who breastfed exclusively for the first three months - with many also continuing to 12 months - scored an average of 5.9 points higher on IQ tests in childhood.

Lead researcher Professor Michael Kramer said: “Long-term, exclusive breastfeeding appears to improve children’s cognitive development.”

I think Micky at Mocha Milk said it best when in response to the latest “news”:

And by the way, breastfed babies don’t have increased intelligence. They have NORMAL intelligence. Formula fed babies, unfortunately are at increased risk of lowered intelligence. Think of it as an investment in your child’s ability to get college scholarships!

I read an interesting opinion piece at Concurring Opinions about Sophie Currier’s win. The author presented several facts that I didn’t see in any of the news articles I read when the case was at its peak, specifically the accommodations the National Board of Medical Examiners offered Currier after refusing her request for additional break time.

* permission to express milk in a private room at the testing center during the allotted break time;

* permission to bring food and drink into the testing room;

* permission to pump milk while in her separate testing room;

* the option to leave the test center to breastfeed during the allotted time.

The writer’s opinion is that the first two requests are worthwhile because they addressed Currier’s needs. Currier needed additional time because she would not be able to pump, eat and use the bathroom in the time allotted. By allowing her to eat and drink in the testing room, her nutritional needs would be taken care of. By giving Currier a private room to pump in, she’d be able to pump in the testing center without concern for her privacy. The writer also feels that the second two accommodations were worthless. Pumping in a testing room with three glass walls isn’t an option for obvious reasons. Leaving the testing center to breastfeed would further cut into her break time.

The article asks why the first two options weren’t enough. With food and drink available and 45 minutes of break time to use the rest room and pump, why did Currier need additional time. Currier’s opinion was that she’d need more time to set up the pump before use and break it down, clean it and store the milk after the pumping session. The writer wonders why she couldn’t have just brought the pump preassembled with additional preassembled parts if she needed to pump again. Storing milk just involves putting it in a cooler or in the ice pack next to the pump. How much additional time would she need?

I just read the article before beginning this post so I haven’t had much time to mull it over, but my first instincts are to agree with the writer. I’ve never had to pump on a work schedule, so I’m personally unfamiliar with the logistics of it. However, I taught with a first-time mother who had to pump twice a day when she returned from maternity leave. In order to pump she had to find another teacher to cover her class during prep time for 20 minutes a day. Her second pumping session took place during her own prep time. There wasn’t a private room available for her so she was forced to pump in the only staff bathroom. At the time I was irritated that she was hogging the bathroom, but now with close to two years of breastfeeding behind me I just feel sad that she had to express milk in a bathroom. Getting back to the point- she was able to pump for 20 minutes, twice a day. I wasn’t there to watch her assemble and disassemble her pump or see how she cleaned it, but she made it work. I imagine most working mothers without private offices are able to make it work for them as well. Why did Currier need additional time?

The writer ends the piece with this:

What concerns me is that this case sends the message that accommodating breastfeeding mothers is difficult. It’s not. All women need is privacy to pump and the break time that many employees are already afforded during the course of an average day. But employers will understandably protest policies requiring accommodation if they believe that breastfeeding employees require one additional hour on top of what they usually receive…

…As academics have painstakingly documented, there is much that policymakers could do to help women balance families and careers. My fear is that Currier will end up as a poster child for those who oppose these efforts.

I can see the logic in that argument. It makes a great deal of sense. But my instincts still tell me that employers should accommodate breastfeeding employees, and if it takes an additional hour out of their workday they should find a way to accommodate them so that it doesn’t. Plenty of women with private offices are able to work while they pump. If employees offer a separate, private lactation room women could more easily balance their families and their careers.

I started to write back to Stacie in the comments, but decided to make this a post in its own right. Responding to my Weaner-gate post from the other day, Stacie wrote:

I’m saddened that someone as involved in breastfeeding as the lactivist is is weirded out by toddler nursing. Certainly I think she should wean when she wants to but her attitude says a lot about how uncomfortable our culture is with the biological norm of toddler nursing and is unfortunate.

The Lactivist is already nursing a toddler, so that particular piece of the Weaner-gate scandal doesn’t bother me. It seems like a moot point. The idea of it weirds her out, yet she still nurses her son. I completely understand. I’m weirded out by the idea of nursing a two-year-old, yet I have a feeling that in just a few months that’s exactly where I’ll be.

I never dreamed I’d nurse this long. When Sam was one-month-old I wrote, “So yeah, it’s all about the boobies these days. I’m thrilled that they’ve come through for Sam and me- he’s probably at least 9 pounds by now since he was 8.5 last week- but man, it’s exhausting. Every few days he’ll go through a little growth spurt where he eats every hour. EVERY HOUR! Give a girl a break. I don’t know how people do this until their kids are two and three years old. In my opinion, if the kid’s old enough to use utensils, he’s old enough to be weaned.”

Utensils? In my head I based weaning on the use of utensils? How little I knew. The child’s been using utensils for more than half of his life now. What used to weird me out has become my every day. I still nurse my 20-month-old son and I’m not afraid to admit it, but I don’t nurse him in public. He doesn’t need to or want to and I don’t particularly want him to. He’s old enough to eat a cracker if he’s hungry. So while nursing a toddler may be normal for me, people only know I’m still nursing him because I write about it or tell them about it. It’s not something anyone sees anymore, not even my husband since these days Sam never asks to nurse in front of him.

Our culture is uncomfortable with toddlers nursing because it’s the exception, not the norm. I very rarely see anyone nursing a toddler and when I see it it’s weird. It’s not wrong, I nurse a toddler fairly regularly. It’s just different. It’s also weird when I see someone topless on the beach. Not because it’s wrong or unsavory, but because it’s out of the ordinary.

I think the Lactivist’s statements show that she’s reevaluating her feelings every step of the way. I think it’s fair to be weirded out by something that’s a cultural rarity and I think it’s fair that she’s ambivalent about her current situation.

Now that I’m a third of the way through my pregnancy (and nursing while pregnant is weird and painful enough) it looks like I may be faced with tandem nursing- another idea that weirds me out. To have a newborn attached to my breast for weeks at a time with a toddler, a walking, talking, jumping, singing, alphabet-reciting toddler, trying to get in on the action terrifies me. I never would have dreamed that I’d even have to consider the possibility. It’s weird. But perhaps in six months if it’s my reality it will cease to be weird. Honestly, I hope that Sam will wean on his own and I won’t have to deal with it, but if he doesn’t, my future seems weird to me.

I don’t think that the use of the word weird is necessarily negative. I am ambivalent about my current situation and ambivalent about what the future holds. I think that ambivalence is something that many women are still afraid to address. Honestly, I think breastfeeding is weird. It’s strange to have something (and a newborn is hardly even a someone yet which is why I use the word something) attached to your breast so many hours a day for so many weeks. I’m sure that all over the world nursing women look down at their newborn infants and think, “this is pretty weird.” Once you get used to it and it becomes less of a struggle it seems like the most beautiful, natural, thing in the world, but each new development in a nursing relationship, each foray into the unknown (like the first time Sam nursed standing in front of me!) feels strange. I don’t think it’s bad to be weirded out.

In a completely unrelated thread on the message board, a mother used the phrase “breastfeeding natzi’s.” It certainly wasn’t the first time someone on the board used the phrase to describe lactivists, but after the “crazies” post I couldn’t let it slide. I didn’t respond in the thread, instead I started a new thread. Here’s what I wrote.

If you are going to refer to breastfeeding advocates as “natzi’s” as least have the courtesy to spell it correctly and omit the unnecessary apostrophe.

Sorry for the history reminder, but I think the word “nazi” to describe a breastfeeding advocate is totally off base. Maybe it’s because I’m Jewish, maybe it’s because I’m a breastfeeding advocate myself. I also hate the term feminazi to describe a woman who stands up for herself and other women and I don’t particularly care for the Soup Nazi episode of Seinfeld for the same reason.

Well, I guess one response is better than none so here’s the follow up to my message board situation. Many other people responded in between, but I’ll just post the conversation between me and the woman who used the word crazies. Her responses are in italics, mine are in bold.

Oh come on. I wasn’t saying anything mean. But I guess people can get offended by anything! I think people that tell others they are wrong and don’t know how they feel or where they are coming from are crazies (and that is me putting it nicely!), if that makes you mad…oh well. Nothing I can do about that. I’m really starting to get frustrated that women can get on here preaching to breastfeed and it’s ok, but as soon as I support someone by saying you don’t have to listen to them I’m suddenly offensive. I’ve never had problems like these on any other board, It’s so weird.

You said crazies. It doesn’t make me mad, it just doesn’t belong in this thread. Perhaps in the debate thread it could be appropriate, but even then you’re still calling people you disagree with names.

And for the record, I’m not preaching breastfeeding. I think it’s wonderful and that every mother should try it, but if it doesn’t work, it doesn’t work. If you don’t want to, you don’t want to. As long as you’re feeding your baby so that your baby is happy and healthy that’s all that matters. Does that make me a crazy?

I never said I didn’t say crazies, but I never referred to breastfeeding advocates. Like I’ve said a million times I was referring to people who think they know better than you and try to push their opinions off on you. I can honestly say I don’t know what you are so upset about? I wasn’t debating, merely supporting someone to not listen to someone if they are trying to make you feel your decisions are wrong. Would my statement have been ok if I called them sillies? It’s all the same! I didn’t call anybody any names. I never referred to anyone. I probably should have just let you be mad and not replied, but I felt like standing up for myself. This whole thing is crazy! Or silly! Or whatever doesn’t offend you.

At this point I stopped responding. I wasn’t at all emotionally invested in the topic, I just don’t like to hear people call lactivists crazy and thought I should explain why. I can find something offensive without being offended. Like Family Guy- I love that show, but it’s totally offensive in more ways than I can count and doesn’t offend me at all. I thought it was strange that the woman kept insisting I was mad, and that she had to explain herself a million times (I counted twice) when I don’t feel like I expressed anger. I don’t know why I keep going back. It’s a sickness.

When I was pregnant with Sam I joined a message board for expectant mothers and I’ve been annoyed ever since. While I’m sure some of the women on the message board are reasonable human beings they just don’t come across as reasonable online.

The argument that irritated me today came in a thread where a woman new to the board and expecting a second child asked for opinions concerning breastfeeding. She did not go into detail but she said she was unable to breastfeed her first child and despite her knowledge of the benefits was considering not even trying to breastfeed the second. She asked the women on the board for feedback.

Four or five posters told her she shouldn’t worry what other people thought and if she wanted to formula feed she should. Some of the women specified that they thought breastfeeding was best, but that it was her decision and no one else’s business. One woman said she was physically able to breastfeed but just didn’t want to. I wasn’t crazy about that response, but since she wasn’t looking for feedback I wasn’t going to give it.

Another poster wrote that she tried to nurse her son and couldn’t. She beat herself up over it until she realized he’s never had an ear infection. She then told the original poster not to listen to crazies who tell her she’s wrong for not breastfeeding.

I wanted to respond to the original poster, but couldn’t let that comment go. Here’s my response:

I think that the decision to breastfeed is a personal choice. Women choose not to breastfeed for many reasons, all of them valid. However, I think the use of the word “crazies” to describe breastfeeding advocates is offensive. While I know you specifically said “crazies who try to tell you you’re wrong,” in my experience the only ones who try to persuade someone to breastfeed are those who truly believe it’s the best thing possible. Does that make them crazy? Intrusive, sure. Rude, absolutely. But crazy?

Breast is best and it’s proven in study after study. I don’t believe that formula is harmful, nor do I believe that it’s any of my business how a mother chooses to feed her baby.

I plan on summarizing the rest of the thread tomorrow, but before I do I’d like to know if you think my comment makes me sound angry.

Back when I had a TiVo I had the pleasure of watching a lot more television than I do now. Every so often I’d have the double pleasure of watching back to back episodes of Wife Swap and Supernanny. Well I think it was Wife Swap, but it could have been Trading Spouses. I can’t tell those two apart. I can tell Nanny 911 and Supernanny apart though, just because one of the shows has more nannys. Good times.

Anyway, my point is that I found one episode of Supernanny especially alarming. In the episode, a woman with several kids and a home day care spent a large portion of her day nursing her toddler. The Supernanny came in and demanded that the 17 month old girl be weaned immediately. I was surprised that an “expert” would recommend quitting cold turkey, a practice that’s traumatic for both mother and child, especially when neither party has expressed a desire to stop. When I saw the episode Sam wasn’t quite a year old. I’d planned on weaning him at a year, but watching that episode helped me realize that I’d stop when he was ready, not when some know-it-all British broad told me to.

Now Superanny Jo Frost, a woman with no children of her own, has the potential of alarming a much larger audience. Her new book about infant care ignores all recommendations of the American Academy of Pediatrics and World Health Organization and suggests introducing infants to formula feeding between six weeks and three months because it will help them sleep better. Right. This advice goes hand in hand with my mother’s ill-informed advice of slipping some rice cereal in my two week old son’s bottle to help him sleep through night.*

The “expert” also says that co-sleeping, a practice that has helped countless families around the world sleep better, is a “no-no” and suggests giving infants pacifiers to help them sleep, but only if you’re prepared to take them away the minute your child turns one. I can’t wait to read the rest of her great advice.

*Please note that there is absolutely no evidence that any types of formula or cereal actually help babies sleep longer. Some babies sleep well and others don’t whether they’re formula or breastfed, and solid foods like cereal before the age of four months at the absolute earliest can do more harm than good to an infants immature digestive system. I wrote more about starting solids at Kids Dish.

I was totally creeped out when I read Neil Steinberg’s piece about Currier’s win in the Chicago Sun-Times. While I assume his point is that bodily functions performed in public isn’t a victory, the line “…and the lady next to me wordlessly flops out a swollen breast and begins firing hot streams of foamy milk into the yearning, baby-sparrow mouth of her tot, or toddler, or 5-year-old child,” stopped me and I had trouble reading further. I managed, mouth wide open, to skim the rest of his column, but I was so disturbed by the image of something I’ve found to be so sweet and beautiful that I couldn’t figure out what King Lear had to do with it all. Then I realized it had nothing to do with it. I failed to notice the topic change.

Dahlia Lithwick at Slate seemed to be creeped out by Steinberg’s column as well, even quoting the same line that made me lose all ability to comprehend the written word. She wrote a lengthy piece wondering about the silence surrounding Currier’s victory, specifically wondering why more feminists aren’t excited.

The Mike and Juliet show also explored the case with tons of video of Currier setting up her pump. She wasn’t able to join them in the studio, but her lawyer, a lawyer from the National Medical Examiner’s Board and a OB/GYN all weigh in.

The Lactivist finally shares her opinion about the case. “The medical board…the people who are supposed to value and promote breastfeeding…were telling a mom she should just wean her daughter so she could pass the boards and become a doctor.”

Sonia, a commenter here, wrote, “To me, this isn’t about nursing, it’s about trying to game the system to get the best advantage to yourself. Seriously, why else would she schedule her final exam when she knows she’s going to be breastfeeding? She totally could’ve done her exams later, and considering she’s failed the exam once already, it might’ve been better for her to schedule the exam for later when she’s not sleep-deprived or engorged. She’s making the rest of us nursing moms look bad and I’m really pissed about it.”

And Katharine, another commenter wrote, “Hurray for Sophie! This sets a precedent for all nursing women, one that is long overdue.”

Sophie Currier, breastfeeding, expressing milk, extra time granted, victory

We all know smoking is bad for you. Yet it’s been said that breastfeeding is beneficial even if a mother smokes. But if you’re still on the fence about whether to quit or not, here’s yet another reason to quit smoking asap.

A new study reports that nicotine interrupts infant sleep patterns. Nicotine that passes through the mother’s breastmilk can make a baby sleep less. In the study, the amount of nicotine in the mother’s system correlated directly to the sleep disturbance.

Total sleep time over the 3-1/2 hours declined from an average of 84 minutes when mothers refrained from smoking to 53 minutes on the day they did smoke, a 37% reduction in infant sleep time. This was due to a shortening of the longest sleep bout, or nap, and to reductions in the amount of time spent in both active and quiet sleep.

The level of sleep disruption was directly related to the dose of nicotine infants received from their mothers’ milk, consistent with a role for nicotine in causing the sleep disruptions.

Women who quit while they were pregnant may think that it’s okay to start smoking again, even if they’re nursing. Especially if they don’t smoke in the house or around their child. I used to be a smoker and quitting was tough- many, many tries and relapses tough- but based on my experience with a baby who generally sleeps pretty poorly I can say with authority that this study would have made me quit in a heartbeat. If you’re still a smoker and you’re nursing, pregnant or trying to conceive and planning on nursing I’d recommend quitting immediately without looking back. Sleep is a precious, precious thing.

I should add that while I may be discussing this lightly, nicotine addiction is serious. Nicotine can cause developmental problems in babies’ brains that may lead to learning and behavior problems. The study also suggests that babies who taste nicotine in breastmilk may develop a taste for nicotine later. Smoking while nursing could encourage your child to become a smoker too.

If you’re a smoker and nursing make sure you read Kellymom’s page about Breastfeeding and Cigarette Smoking.

I’ll take sleep over nicotine any day, sleep, breastfeeding, smoking, tobacco, development

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This is open to anyone and everyone. So, um… - that means YOU.

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News Roundup
Here’s an interesting article about pregnancy advice regarding alcohol consumption - it gives a nice perspective of how some Europeans regard the issue.

An article on Why Women Don’t Nurse Longer. A pretty standard article that lists all the usual reasons.

And great scott - here’s yet another article about co-sleeping. Confession time: These articles piss me off (is that language allowed here???). Sleeping with my children feels so right and natural - it boggles my mind how the “experts” declare it to be unsafe. Yes, have some common sense - don’t crowd your kid out with comforters and pillows, don’t go to bed drunk and if you are heavily overweight, don’t sleep with your children. But for the rest of us? Co-sleeping can go MILES in comforting parents AND babies. These days, I can’t even remember when Anjali wakes up. I don’t bother fumbling for my glasses to see the clock because that would be wasted effort. I roll over when she squawks, get her latched on and she begins nursing. At some point, I must pull her off because by the time the sun rises, she is no longer attached to my breast. And truly - I love waking up and seeing her little face furrowed in sleep. Precious. Simply precious. Also, for the record, my own doctor is 100% on board with co-sleeping and even admitted that she thinks parents should sleep with their children, but she would never push that opinion on her patients.

It makes me sad to think of how many parents are afraid to sleep with their own children because of articles such this.

breastfeeding, co-sleeping, cosleeping

I really appreciated the honesty in the comments in my “Trapped” post. Unfortunately, I honed in on the breastfeeding aspect without looking at the big picture. Your comments made me think more about the issue and what I take for granted - the fact that I do feel comfortable nursing in public and that I am a bit of a homebody anyway.

Oh, and talk about feeling trapped. I’ve been trying to write this post for some time now and have written most of it with my left hand only at a snail’s pace since my right arm has been occupied for most of the afternoon. And holy cow. The other kid just woke up as the new kid just fell asleep. Trapped? Perhaps.

By the way, I like my crow with a side of garlic roasted mashed potatoes, please.

I came across an article about how breastfeeding can contribute to post-partum depression because a mother can feel “trapped” by all the demands of her new baby. Um, this article just made me sad. Yes, motherhood can make one feel trapped. Any new life change can make someone feel trapped - a new job, a new house, a new husband. But to lay so much blame on breastfeeding? For me, breastfeeding actually made me feel freer in many respects. When I rush out the door to run errands, all I need are diapers and a blanket. When I was traveling coast to coast with my son, I appreciated not having to worry about cups, bottles, formula. Regardless of how breastfeeding makes an individual feel, if a new mother feels trapped by breastfeeding what other aspects of motherhood will make her feel trapped? After all, Breastfeeding is just the very teeny tip of a monumental iceberg of Responsibility that motherhood brings.

Breastfeeding is temporary, much of everything else about motherhood is forever.

Allison over at The Attached Mother has some great thoughts about the whole “should prescriptions be required for formula?” question. I agree with her that requiring a prescription would a little too “militant”. And I love her recommendation that some sort of questionnaire be given to mothers to find out why they are quitting. This could go a long way in helping the breastfeeding community determine how we can best support breastfeeding mothers.

But requiring a prescription? I’d never support that. Make no mistake about it, I have no love at all for the companies that produce and market formula. I’ve made it no secret that their aggressive marketing tactics make me angry, particularly in 3rd countries. But I don’t necessarily fault a mother for using formula. Yeah, I think formula is crap, but I’ll admit it here in front of the world that my kid has had a McDonald’s cheeseburger. Or two. Besides, if we start requiring prescriptions for formula, where else could that lead us? I know folks disagree with me for not having gates on my stairs and that weird molding crap on my fireplace hearth. Even co-sleeping is still a bit controversial and I’ve had more than one person get all squinty-eyed on me as if I was putting my child in mortal danger.

So, no. No prescriptions please.

breastfeeding, formula, prescriptions