Copy of Rock on Sister! The Importance of Peer Support for Breastfeeding Mother’s

 

A large part of what I do as a Lactation Consultant involves teaching, guiding, sharing, touching, and demonstrating. But above all, I think the most important aspect of my job is supporting. Breastfeeding a newborn is not always easy. I like to describe Breastfeeding as a journey. There are quite often many bumps along the way, but with the proper guidance and support, the journey can be a successful one. Most of the mom’s I help in the hospital setting are experiencing challenges with positioning and latching their babies. They always tell me ‘I didn’t realize breastfeeding was so hard! I thought my baby would just know what to do when he came out!’ I reassure them that they are not alone in this struggle....and that this is why I have a job.

Sometimes as a new mother, you don’t realize that even though your story and experience are unique, there are many other women going through much the same. I find it is hard to prepare yourself for breastfeeding. You can read, look at pictures, videos, observe others feed their babies. But until you are going through it yourself, you don’t quite know what to expect.  Yes, there are some mom’s who deliver their babies and they instantly latch on and their journey has begun on a smooth sailing path. But for most, there is usually some sort of challenge that presents. Most of the time when I am consulted in the hospital, I can successfully help a mom figure out what is causing her breastfeeding issue. But sometimes, there is no quick fix. To be honest, it usually takes a few days and sometimes even a few weeks before the issues have resolved. There are times when you fix one challenge and low and behold another one comes up!! This is just the nature of breastfeeding....always evolving, never quite staying the same for too long.

The first few days for a new mother are hard enough in themselves. You are sleep deprived, uncomfortable, hormonal, and now trying to figure out how to nourish this new little person who has suddenly taken over your life.....and your heart. I can easily tell mom what she needs to do. I can easily show mom what she needs to do. I can readily put a plan down on paper for mom so she knows the ’steps’ to follow if she can’t get her baby to latch. The hard part is making her believe that she can do it on her own and that she can do it well!!!

As women, we naturally put a lot of pressure on ourselves to be the best and only do what’s best for our babies.  No mother wants to see herself as a failure or feel that she can’t provide the basic sustenance of life for her infant. But yet so many mothers feel this way. When a mother expresses to me her feelings of guilt and failure, I reassure her that she is doing the best she can RIGHT NOW and that’s all she needs to focus on. She needs to take it feed-by-feed and day-by-day.  Sometimes the latch is perfect and baby is gulping milk at the breast but mom still wants the LC to come in and have a look just to make sure. I am always more than happy to do so as I realize the importance of this simple gesture. We all want to be heard, and have our feelings validated and know that we are on the right path to successful nourishment of our babies. This is one part I truly love about my job. How great is it to be a ‘cheerleader’ for a mommy and her new baby. When I see the happiness and relief on mom’s face, it truly brings me joy and a sense of accomplishment. This is why La Leche League has worked so well and has helped thousands of breastfeeding women over the years. Having someone educated in breastfeeding answer your questions and guide you through some challenging times is so beneficial for the breastfeeding dyad. I never charge for a phone consult or an e-mail consult as I realize a mother so often needs reassurance that everything is on the right path.

But there are times when it’s not all smiles and relief. There are times when things are not going as hoped. Times when baby is not latching well or milk supply is low. In these instances, all I can do is share my knowledge, assist in the best way I can, but most of all support. That support also means supporting whatever decision the mother and her family may make regarding their breastfeeding journey. Clients will ask me, ‘when do I know if ‘this’ is working? When do I decide to go on or quit?’ My answer is usually the following: ‘You will know in your heart when it’s time. You sometimes have to step outside of your current situation and evaluate how things are going.’  Sometimes a mom will say, ‘You know what, this isn’t so bad, I am managing and for now its working.’ Other times she will say ‘You know what, for the sake of my physical and mental health, I cannot do this anymore.’ Quite often there are tears and it is evident the pain that she is going through. At the end of the day, when it’s said and done, she has to make the decision that is best for her and her family.

My role as a Lactation Consultant is to educate, empower, and support. I do not stand in judgement or ever tell a mom what the ‘right’ thing to do is. Only she knows that. And for all the efforts and trials and tribulations she has been enduring the past days, weeks, months......she has to feel ok with her decision and let those feelings of guilt and failure go. This is a lot easier said than done. I’m sure we have all come across women who share their ‘for better or for worse’ breastfeeding stories. Some mother’s never really get over a breastfeeding journey gone wrong. My second daughter self-weaned at 9 months. I was devastated when this happened. I tried my very best to continue breastfeeding her but she just refused. I had feelings of rejection and ohhhh the guilt that I wasn’t going to breastfeed for the entire first year of her life! I’m sure I cried almost every day for a week. Eventually I began to accept it and decided that I could continue pumping and give her my milk in a bottle. I had found a way to make it work, and I was ok with that.

It truly pains me to see my clients experience the bumpy road of breastfeeding. These women are so dedicated and will persevere through almost anything to ensure their babies are breastfed. But sometimes the price they pay by having their physical and mental health suffer is not worth it. There are always options. If feeding directly from the breast isn’t working, pumping and bottle feeding your breast milk is a great one. Bottom line, it is still your breast milk and you are still nourishing your baby.

Without support in the breastfeeding world, I know our success rates would dramatically drop. As women, we need to be there for each other and hold each other up when times are difficult. No other time in a woman’s life is as challenging as entering into the realm of motherhood. To empower a mother with knowledge and support her through her beautiful journey of Breastfeeding is a gift I am given every day, and for that I am grateful.

Happy Breastfeeding!!!

Leanne Rzepa RN BN IBCLC

 

Posted on April 27, 2018 .

Stress and its effect on Breastmilk Production

 

It is a common theme everyday, all over the world that the business of daily life, finances, illness, separation and divorce are all common stressors we face. Sometimes stress is sudden and ongoing such as in the case of a natural disaster or war. Other times, stress is prolonged and ongoing for an indefinite amount of time such as in a divorce. The woman’s body is made to not only grow a baby, but also nourish and protect him once born. Moms can continue to breastfeed despite incredible circumstances.

A lot of moms report that during a stressful life event, their milk supply is affected in some way.  Sometimes moms experience stress that is severe and intense, which can temporarily inhibit her milk from letting down. This is thought to be a protective mechanism. As one doctor put it so well, you wouldn’t want to be leaving a trail of milk behind if you were running from a bear! Over a long period of time, it is possible for chronic stress to inhibit letdown often and long enough that milk production can be decreased. This is usually not the case, as breastfeeding releases hormones that helps mothers and babies both relax and have an easier time enduring stress, even under the worst of circumstances.

"It is not unusual for breastfeeding mothers to notice a temporary drop in their milk supply or a delayed or inhibited let-down, or milk-ejection, reflex when they are under great stress" (Mohrbacher and Stock 1997). The drop is temporary, however, and with time and conscious efforts to relax, a more normal milk ejection reflex will occur.

Let’s first take a look at how stress can affect one’s milk supply in a negative way. We need to realize that there is a very powerful mind-body connection when it comes to breast milk production and let-down. If a mom is feeling stressed out about a life changing event such as a separation or divorce, just the mere presence of these thoughts in her mind while nursing her baby could slow her let-down reflex. Some studies show that physical and mental stress can slow the release of oxytocin into the bloodstream of a breastfeeding mother. Oxytocin is the hormone that causes the milk let-down reflex. So if a mother is stressed, even if she has an abundant milk supply, sometimes her milk can’t let down because her stress level is inhibiting the ability of the milk to flow. Research shows that stress (cortisol) levels don't actually affect the amount of milk available for the baby, but it does affect the initial letdown. Once the baby is on the breast and is sucking, if the mother is not relaxed or "in the moment" letdown can take quite some time, causing frustration for the baby and fussing. This in turn can create more stress for both. If there is a continual delay in letdown from the breast it can lead to reduced milk supply.

Babies are also really in tune with how their mother’s are feeling. Your baby can totally sense when you are sad, stressed, or anxious. They pick up on these emotional cues and can  react in a distressful way usually by crying or pulling away from the the breast.

So what is a mother to do when she fears she won’t be able to let-down or produce enough milk to nourish her baby?  How can we eliminate a stressful situation (ie: not being able to get your milk to flow) within a very stressful life event like a separation or divorce?

Well you are in luck because  I do have the solution….it’s called RELAXATION!!!!

Research has found that breastfeeding reduces negative moods and stress – so nursing your baby can actually help you get through a stressful time.

Remember that little (very important) hormone called Oxytocin? Well oxytocin, is also otherwise known as the ‘love’ hormone. It can have a calming, relaxing effect on the mother. A lot of breastfeeding mother’s notice that when they are nursing their babies, they become very  sleepy and may even doze off. This is the oxytocin effect. This means that a mom who is feeling stressed and breastfeeds her baby, is more likely to become relaxed. When she relaxes, her milk starts to flow again. And since it's the baby's ability to drain the breast,  that stimulates milk production, a mother who keeps nursing is going to keep producing milk.

So the key is to be as relaxed as possible when latching your little one to the breast.

Well speaking from experience, that is a lot easier said than done!!

Below are some tips for initiating letdown before and during breastfeeding or pumping if you are feeling overwhelmed and stressed.  

Find a location to feed your baby where you feel very comfortable and safe. Choose a place that is free from distraction and generally relaxing to be in.

  • Half an hour before feeding time (especially in the afternoon when you are tired) eat a good protein-filled snack. This will help give your milk supply a good boost.

  • Make an effort to relax as much as possible before breastfeeding.  Listen to music, take a few cleansing breaths, meditate,  smell a relaxing scent, or do anything else that helps you feel at peace.

  • Researchers at the University of New Mexico found that listening to tapes of guided relaxation and imagery techniques helped moms whose babies were in intensive care to produce more milk.

  • Among the mothers with the sickest babies, milk production in those who listened to the tapes was more than double that of moms who didn't listen to the tapes. And the more times a mom listened to a tape, the more milk she produced.

  • Consider breast massage prior to nursing. It has been shown to assist with milk ejection and overall milk removal.

  • Bend over at your waist so that your breasts dangle from your rib cage, and shimmy your shoulders (move them back and forth) so that your breasts shake. This movement helps loosen tension in your neck and shoulders and assists milk in moving forward in the breast.

  • Enjoy the moment. If you are with your baby, smell his head, talk to him softly and stroke his hair.

  • Visualize milk spraying forth from your breasts like a waterfall or a rushing river. It sounds strange, but it often works!

  • If you are with someone you trust and feel comfortable asking, have them rub your shoulders and apply pressure between your shoulder blades. This, too, can help trigger the release of oxytocin and assist in milk ejection.

  • Drink a big glass of cold water. Moms often sip water while nursing, so that alone may initiate letdown through what is known as conditioned response.

  • Consider breastfeeding while bathing with your baby. This can help release tension in your muscles, and may help your milk flow freely.

  • Between feedings, spend time in skin-to-skin contact with your baby. This will help you  both relax, and aid in release of hormones associated with breastfeeding.

  • Contact a local Lactation Consultant for continued support, including tips to manage stress as it relates to mothering and breastfeeding.

  • Eat well and exercise. Eating nutrient-dense foods gives your body the necessary vitamins, minerals, and energy needed to overcome stress. Exercise is a well-known stress buster. Even a 30 minute walk around the block can lower blood pressure, ease tension, and clear your mind.

  • Contact a medical or mental health professional if you’re experiencing ongoing, chronic stress. They can provide information for stress management, and evaluate for related issues like depression and anxiety.

  • Consider talking to your doctor about taking a magnesium supplement.  This mineral is often depleted during times of chronic stress, and some experts suggest that supplementation may help reduce stress-related symptoms.

At the end of the day, we all know that stress happens and for some it happens on a regular on-going basis. But if you can remember to relax  and take a few deep breaths, this will help make your breastfeeding journey a lot more pleasant. I hope you have found this blog post helpful and informative. As always, if you have any questions or comments, please feel free to contact me directly for further support.

Happy reading and Happy Breastfeeding

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Posted on September 10, 2017 .

Nourish Lactation and Calgary Pride Festival

Nourish Lactation Consulting is pleased to be hosting the 'Breastfeeding Friendly' Tent at the Calgary Pride Festival this Sunday September 3rd from 12-6pm at Prince's Island Park. The space will offer a comfortable, relaxing place for mother's to breastfeed their little ones. I will be on hand to answer any breastfeeding related questions or concerns. I'll have my Medela Babyweigh scale set-up if anybody would like to weigh their baby. There will also be a draw for a Medela Swing Breast pump and some other treats and resources to give away. So please come down to the park on Sunday to take part in this wonderful community event. Have a fun & safe long weekend everyone!!!

 

 

Posted on September 1, 2017 .

My Favorite Tips and Tricks for Breastfeeding Success

This blog was posted on Little Chief Covers Instagram page this past Wednesday June 14th where I was 'LIVE' answering all your breastfeeding related questions. For the next few months I will be collaborating with Dana Saric of Little Chief Covers and regularly posting blogs to her instagram site to answer your breastfeeding related questions. Feel free to check out her website at www.littlechiefcovers.com. She created and sells some wonderful nursing/carseat/stroller covers. 

I thought I would share this blog post on my website as well. Happy reading and Happy Breastfeeding!!

Like most things in life, changing the way we do things in even the simplest manner, can make a positive difference. The same holds true for Breastfeeding.  I have been working in the Breastfeeding world for over 17 years and have seen how our practice and knowledge shared with families has evolved.  I am a firm believer in “if it works, keep doing it, if it doesn’t, let’s find a better way.”

I thought I would take this opportunity to blog about some of the ‘Tips and tricks’ that can really make for a more positive Breastfeeding journey for mom and baby, yet are quite subtle in their doing. These subtle adjustments and slight changes can make all the difference in the world.

Tip #1) Areolar Sandwiching combined with Nipple Tipping

I use this technique time and time again when a mother is having a difficult time getting her baby to maintain a latch and suckle at the breast. Moms are generally taught to cup their breast like the letter C (which is correct) BUT to keep their fingers far back and away from the areola. Using my technique, I prefer mom’s to bring their C-hold to  the border of the areola and to make an exaggerated ledge out of the areolar tissue. Sometimes this is referred to as ‘aerolar sandwiching’.  Then with their thumb, they pull back slightly on the breast tissue thinking of tipping the nipple up. This technique helps to accomplish a few things. Firstly, when you ‘sandwich’ the areola, you help thebaby take a deeper mouthful of the breast when latching fast and boldly. When you tip the nipple up, you ensure that baby will capture more from the underside of the breast (which is what we want all babies to do!!!)  Tipping the nipple up also ensures that the nipple will touch the roof of his mouth which will help to elicit the suck reflex. I encourage my mom’s to keep their thumb in the nipple tipping position until baby begins to sustain his suck/swallow pattern. Once this happens, she can back her hand away and continue to support the breast throughout the remainder of the feed (if she desires). I can confidently say that I have pretty much a 100% latching success rate using this technique!!!

Tip #2) Chin touching the lower part of the Breast before Latching

Another helpful tip is to always remember to have your baby’s chin touching the lower part of the breast before latching. When baby can feel the breast touching his chin, this will help him open his mouth big and wide to search for the nipple. A helpful way to know exactly where to place his chin is to make sure that his lower lip IS NOT right below the base of the nipple. If the lower lip is right below the nipple base, when he opens his mouth wide, he is only going to latch onto the nipple. This is painful and an ineffective way for a baby to breastfeed. So make sure his lower lip is touching the lower border of the areola and then his chin will be touching the breast in just the right spot!!!

Tip #3) The ‘Snuggle and Slide’

I love using this technique because it accomplishes so many things in one simple action. And it also sounds really cute!!! I encourage all Breastfeeding mom’s to use the ‘snuggle and slide’ after baby has comfortably latched and let-down is achieved and then periodically throughout the feed if baby starts to slow down. The Snuggle and Slide consists of mom snuggling her baby in a bit closer to her chest (baby should always be tummy-mummy if she is using the cross cradle-hold) and then pulling baby’s shoulders and bum in a bit more across her chest. Almost think of it as wrapping baby’s body slightly around your torso. But we always want to ensure that baby is in an asymmetric position with his bum and legs lower than his shoulders (almost diagonal) across the chest.  What this does is threefold. Firstly, it will take baby’s nose off the breast if he is having a difficult time breathing. Second, it offers more extension in his neck, which will help to open his airway and allow him to coordinate his suck-swallow-breathe pattern more easily and prevent him from falling asleep.  Thirdly, it places more weight of the breast onto baby’s lower jaw, which will ensure better drainage and therefore more efficient feeding.

Tip #4) Breast Compression While Breastfeeding

Rhythmically compressing the breast while baby is slowing down his suck/swallow pattern can make a big difference in how the milk flows and entice a baby to continue transferring milk. The technique I like moms to use involves encircling the entire top portion of the breast with her hand. This means placing her thumb on the outside of the breast and having her 4 fingers more-so on the inside of her breast. She needs to start with compressing up high on her breast. Pretty much from where the breast tissue begins.  She needs to firmly compress and hold for approx 5-6 seconds before releasing her hand. Then she slowly walks her hand down the breast and continues to compress and hold making sure she doesn’t compress to close to baby’s mouth. This can disrupt the latch and cause baby to lose suction on the breast. This technique assists with the ‘compression’ action of breastfeeding and encourages the milk to flow more readily. Breast compression works especially well with pre-term, jaundiced, and bottle-fed babies. But I do encourage all breastfeeding mom’s to use this technique when their babies swallows start to slow down. It‘s important to remember that the compression is slow and steady, not fast and pulsating. The milk ducts are located around the entire breast, just like the spokes on a bicycle wheel.  We know that babies respond best to milk that flows more readily into their mouths.  That’s why encircling the breast with one’s entire hand, is the best and most effective way to encourage more milk to flow.

Tip #5) Pushing back into the chest wall while hand expressing.......not pinching towards the nipple!!!

I believe that hand expression is an essential skill that all nursing mother’s should have. You never know when you may be without your breast pump and find yourself in a woman’s washroom hovering over the sink dripping milk everywhere because your breasts are about to explode. This has happened to me on numerous occasions when I thought I would be home in time to feed my daughter. Thank goodness I knew how to hand express. It was a little sad though watching all my precious milk drip down the drain!!!

When a baby breastfeeds, he uses 2 actions; compression on the milk ducts and suction to draw the milk out. So when you want to hand express your breastmilk, it’s important to maintain compression on the milk ducts at all times.  I realize that most of us are more visual learners (especially our post-partum mother’s) but I will do my best to describe what I mean. Before you begin expressing, first massage the breast for a few minutes. It helps to do this with a warm wet facecloth. Position your fingers on the border of your areola, then push straight back into your chest wall. You have to press quite firmly. Now keep that firm pressure and think about pulsing your fingers slightly forward but staying well behind the nipple.  DO NOT ROLL THE FINGERS FORWARD. If you roll forward, you lose compression on the ducts and will only expel a minimal amount of milk. You can also do more damage by pinching on the nipple when rolling the fingers forward. The ‘pushing back into the chest wall’ and pulsing forward method, works optimally for removing milk in a timely, comfortable manner. Sometimes you have to change the angle of your fingers to compress on different milk ducts. I also recommend hand expressing from one side for a few minutes, then switching to the other side for a few minutes, then repeat once or twice more. Mother’s are truly amazed when I show them this technique and can’t believe how changing something so small can make a HUGE difference. It can really empower a mom who has believed that she has no/minimal milk to see that yes, there is milk in her breasts and she alone can remove it!!! To see a really good video on hand expression, follow this link: http://med.stanford.edu/newborns.html

Well I think that about covers most of the tips and tricks I have to share with you for today. I hope you have found them useful and will be able to incorporate them into your breastfeeding journey. Knowledge is empowering and I hope that I have shared and empowered you with a little more today that can make a big difference for your precious little one

Thank you!!!

Leanne Rzepa RN BN IBCLC

Nourish Lactation Consulting Inc

www.nourishconsulting.net

nourishconsulting@gmail.com

403-803-9348

 

Posted on June 18, 2017 .

Some Thoughts on Weaning

Ideally, when to wean is a decision that you and your baby make together.  Realistically, as many moms head back to work, this may be hard to do. 

If you have been told to wean because of a medication you are taking or because of an illness, pregnancy, or surgery, make sure you check this out first. There's a bunch of bad information out there about medication and lots of unnecessary weaning taking place.  And if you are weaning because you've been told that breastmilk has no benefits after a certain time, just keep nursing.  No formula has come close to breastmilk, despite what they advertise, and there is no cow out there making better milk for your child than you are.

Weaning is almost always accompanied by some guilt and regret.  I hope all of you know that I am really impressed with all the work that you put into nursing. I have helped some of you through very difficult starts to breastfeeding and I'm continually amazed at the motivation that you have to continue to breastfeed through very difficult circumstances. 

Kids who are ready to wean are distractible, spend less time during feedings and may be more interested in solid foods.  If we let the baby lead in weaning, we wait until they decide they want to nurse, without initiating or refusing to nurse.  That way, the baby can cut back on the amount of feedings.

More likely, it's mom who wants, or needs, to wean. There are many ways to do this.  The most common involves cutting back on one feeding every 3 days or so.  The feeding should be replaced with lots of cuddling and close contact and if the baby reacts poorly (they may do things to get more attention) then we should slow down the process.  And it's nice to try to replace the "work" feedings first, meaning, eliminate the feedings where you will be working or away from the baby first, and leave the nighttime and first morning feedings for last.  In fact, you can keep those feedings for months after you eliminate the other ones. This doesn't have to be an all -or -nothing process.

If your breasts get uncomfortable, then pump just enough to relieve the pain.  Staying full tells your body to make less milk. Staying too full however can lead to infection. Weaning too quickly can lead to mastitis and plugged ducts.  You can use ice packs, tylenol, and ibuprofen just as we did during the early days of engorgement.  Never do any breast binding-- that still shows up as as a way to stop milk production in some older references.  It can lead to all sorts of bad things!

We should wean the baby to formula if they are under one year of age, and to cow's milk if they are over a year.  I don't care which formula or which kind of milk.  They can be weaned right to a cup or a container with a straw if they are over 6 months or so.

There are a few things for mom to be aware of.  You may need to cut back on the calories you consume now in order to avoid gaining weight. You may have milk secretion for several months after you are finished weaning.  Your period should start coming back, if it hasn't already, and it may be a bit irregular for awhile.  

The guilt that comes with weaning is natural. Be kind to yourself. Your child didn't ask you to be perfect. Being the best you can be as a parent is enough. Whatever length of time you spent breastfeeding is a time for celebration. Do something nice for yourself. Seriously.

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Posted on May 20, 2017 .

Should You Be Breastfeeding on Both Sides?

Until the baby is done. It isn't the length of time, but the quality of the feeding that counts. My son and I both have a bowl of Cocoa Puffs every morning, the same amount, in the same size bowl.  It takes him like 20 minutes to finish off the bowl, whereas I inhale it in about 45 seconds.  It's the same bowl of Cocoa Puffs.

There are many extraordinary things about breastmilk. Chief among them is that the composition of the milk changes from the first feeding in the morning to the last feeding at night and from the beginning of each feeding to the end.

At the start of each feeding, the first milk the baby gets is called the foremilk which is designed to quench thirst.   It is lower in calories and high in lactose.  Lactose is a very important sugar that contributes to human brain development, helps absorb iron and calcium and promotes the growth of a healthy gut.

At the end of each feeding, the milk becomes higher in fat.  This milk is called the hindmilk, and is higher in calories because of its fat content.  The more hindmilk the baby gets, the longer the baby should go in between feedings.  And nighttime feedings have more fatpromoting longer periods of sleep.  You'll know when the baby gets the hindmilk--your child will come off the breast looking a little funny, totally zonked.  I refer to it as the "milk buzz."

If we feed the baby, as many women are told "15 minutes on a side" we artificially limit the time the baby gets on the breast.  Mom gets sore nipples because she has to break an often strong suck and the baby gets lots of foremilk and not a lot of hindmilk.  Too much foremilk gets the baby lots of lactose, to the point where there isn't enough of the enzyme to break it all down, and the baby starts to show signs of lactose overload, like gas and really frequent watery stools.  Plus, since the foremilk is lower in calories, the baby is eating all the time.  Inevitably, mom feels like her milk isn't "good enough" or she starts examining her diet for the cause of the gas.

All we have to do is let the baby decide when they are done.  The baby should get soup, salad, meat, potatoes, and dessert on the first side and an after dinner drink on the second, if they want it.  Just begin the next feeding on the opposite side.  

 

 

Posted on April 14, 2017 .

Can You Make Too Much Milk?

    I suppose it depends on who you ask.

There is something called "oversupply" or "hyperlactation"  or "overactive milk ejection" that can be a mixed blessing.  You sure get to store up a bunch if you are pumpingbut if you don't remove the milk adequately, you can get recurrent plugged ducts and mastitis and other unpleasantness.

We don't know really why it happens (I have my theories though).  The ability toproduce breastmilk exists on a spectrum.  On one end, we have moms who aren't able to produce enough milk.  I can usually help with that, or at least attempt to explain it.  On the opposite side of the spectrum are the moms who can't ever seem to be empty, leaking through clothes and bedding, pumping crazy amounts of milk even when their obviously full baby is done eating.  Maybe it's from too much pumping (one theory).  Maybe it's because there is something really cool about those moms we haven't figured out yet.  Some people say that these women are "blessed."  I bet the people who can still pump 8 ounces after the baby eats aren't very comfortable, and probably don't feel so blessed.

Mothers who overproduce breastmilk can have plugged ducts, recurrent mastitis, and breast abscesses.  We need to slow milk production, use antibiotics if mastitis occurs, and anti-inflammatory medications like Ibuprofen for discomfort.

Infants of mothers with an oversupply of breastmilk (or more accurately, an aggressive milk ejection- and I think you have both oversupply and a powerful milk ejection or just one) will often choke and sputter at the breast, and pull off and reattach themselves to the breast as they attempt to control the flow of milk.  This can happen even at the end of the feeding since the milk ejection reflex (“let-down”) occurs several times during a feeding.  I've seen these kids actually use their hands to push away the breast.  They sometimes bite to slow the flow and often get on the breast, suck a few times and then cry.   They always sound "congested" because there is always food banging around the back of their nose.  You can try to suck that noise out, but it's food, not snot. 

These babies feed frequently, gain weight very quickly, are often “colicky” and have explosive watery bowel movements.  Mothers of these children are often told to wean the baby since the child is “allergic” to the milk.  Of course I wouldn't tell you that.  These babies can be managed without having to wean. Plus, breastmilk allergy is extremely rare if it even occurs. 

Overabundance of maternal milk should be distinguished from other reasons for breast fullness, such as engorgement, which may be related to a poor latch and poor milk transfer from the breast.  Usually, the baby is gaining like crazy when the mom has breast fullness from overproduction.  Breast fullness from engorgement should be managed with the help of someone experienced in assessing breastfeeding complications, like me or Karen or Jenny (687-3275.)

Before we try to fix the problem, you could try positioning the baby more upright, facing the breast, so at least they won't get a big spray of forcefully- released milk while they are lying on their back.  I would suggest, if you can do it, latching the baby as you normally would and then reclining back so that you are almost laying down and so that the baby is coming at the breast from the top, taking away the effect of gravity.  It takes some practice, but really helps decrease the amount of air the baby is taking in, thereby decreasing the burping and gas stuff.  And put your feet up.  One of my theories has to do with blood pressure, and nursing with your feet up or on your side while lying down raises your blood pressure and may slow the squirting.  (My theory.  Lots of clinical experience; no data yet, so don't quote me, at least for this part.)

It's the aggressive milk ejection reflex that makes them sputter.  You would too if you got a big blast of something in the back of your throat.  You might even make choking noises.  You might throw up and perhaps burp loudly.  This oversupply/aggressive milk ejection isn't any fun for the kids.  Most breastfeed kids don't burp well or at all since they can control the rate of flow from the breast.  These kids can't control the flow of milk and they will burp with the best of 'em.

We could fix the oversupply, if you want to,  with a little "lactoengineering."  You only make as much milk as is removed- “demand and supply” rather than “supply and demand” soooo demand less.  Feed several times on one side and let the other side stay more full.  Make sure that you don't let the other breast get so full that it's going to explode since that's what causes the plugged ducts and mastitis.  Pump it until you're comfortable, but not to empty.  Pumping to empty makes you make more milk. 

A couple of things happen when you use just one side.  First, we work on foremilk/hindmilk imbalances.  We're not really supposed to be using these terms anymore, but I think they are helpful. 

Foremilk is the thirst- quenching milk in your breast, ready to go at the beginning of the feeding and has lots of lactose but not much fat so it's low in calories. Lactose is very important.  Ithelps with the intestinal absorption of calcium and iron.  It helps promote the growth of good bacteria in the gut.  And probably most importantly, it is a sugar that attaches to a lipid needed for brain development.

Hindmilk, at the end of a feeding,  is higher in calories because it's higher in fat.  The amount of fat slowly increases over a feeding, releasing a gut hormone called cholecystokinin (CCK) and CCK is one hormone that tells your brain you are full.  If you don't get that fat, you don't get CCK, you keep eating. If you do several feedings on one breast, then there is less foremilk to get through and the baby might just feel full.  You'll know when the baby gets to the hindmilk because they come off the breast looking verrrrry satisfied. This process works on opioid receptors, you know, like morphine. That state of enough-fat -contentment I call the "milk buzz."  The baby who is blown off the breast by a squirt after a let-down is different than the one enjoying the milk buzz.  The kids with the milk buzz are out, hard to arouse.  Kids squirted off wake up right away, if they even slept.  Those kids should go on the same breast until you see the buzz.

If mom hasa lot of milk, the kids get lots of milk, and lots of lactose.  Lactose is a sugar.  Lots of sugar delivered to your stomach makes your stomach empty faster.  Fat makes it empty slower.  Lots of lactose leaves the stomach, heads to the intestine in a big blop and just can't all be digested because it's moving fast and there may not be enough enzyme to break it all down.  This is often mistaken for a lactose intolerance which is really, really, really rare in infancy.   The kids then get gassy, have explosive poops and get really irritable.  Most moms blame something in their diet.  It's probably that the baby doesn't know they are full.  They gain weight like crazy and are always at the breast.  We just need to make the baby know they are full. 

I'm not a fan of nipple shields but this may be one time where, if position changes don't help, that it may work.  Here's what it looks like (and I have them in the office) You can see that it might serve as a "breakwater" to slow things down a bit and make the feeding more pleasant.  We could also use drugs, although this is a desperate measure.  For example, while pseudoephedrine is compatible with breastfeeding, just one 60 mg capsule can suppress milk production. Estrogen-containing birth control pills may also help. 

If this goes on without us realizing that the kids are getting blasted, they may start to refuse the breast.  Wouldn't you?  If you were getting squirted every time you ate something (even if it's something you really loved), wouldn't you try to avoid it?  Maybe.  Or the kids may "play" at the breast, latching on, pulling off, latching on, pulling off...you could get the idea that the child didn't like your milk, or that you ate something bad, or that you don't have any or enough milk when your child is actually developing defensive maneuvers to protect themselves from the big squirt. They may bite to slow the flow and that mightbe an important cause of nipple pain.

Of course we don't necessarily have to fix the oversupply.  And not every kid is bugged by the fast flow.  It may come in handy for later use, such as a return to the workplace.  We could also consider donating it to our local milk bank, the Mother's Milk Association of Wisconsin in Madison. 

 

Posted on March 17, 2017 .

The Normal Newborn and Why Breastmilk is Not Just Food 

The Normal Newborn and Why Breastmilk is Not Just Food 

Dr. Jen 4 Kids: Breastfeeding Medicine

What is a normal, term human infant supposed to do?

First of all, a human baby is supposed to be born vaginally.  Yes, I know that doesn't always happen, but we're just going to talk ideal, normal for now.  We are supposed to be born vaginally because we need good bacteria.  Human babies are sterile, without bacteria, at birth.  It's no accident that we are born near the anus, an area that has lots of bacteria, most of which are good and necessary for normal gut health and development of the immune system.  And the bacteria that are there are mom's bacteria, bacteria that she can provide antibodies against if the bacteria there aren't nice.

Then the baby is born and is supposed to go to mom.  Right to her chest.  The chest, right in between the breasts is the natural habitat of the newborn baby. (Fun fact:  our cardiac output, how much blood we circulate in a given minute, is distributed to places that are important.  Lots goes to the kidney every minute, like 10% or so, and 20% goes to your brain.  In a new mom, 23% goes to her chest- more than her brain.  The body thinks that place is important!)

That chest area gives heat.  The baby has been using mom's body for temperature regulation for ages.  Why would they stop?  With all that blood flow, it's going to be warm.  The baby can use mom to get warm.  When I was in my residency, we would put a cold baby "under the warmer" which meant a heater thingy next to mom.  Now, as I have matured, if a baby is "under the warmer," the kid is under mom.  I wouldn't like that.  I like the kids on top of mom, snuggled.

Now we have a brand new baby on the warmer.  That child is not hungry.  Bringing a hungry baby into the world is a bad plan.  And really, if they were hungry, can you please explain to me why my kids sucked the life force out of me in those last few weeks of pregnancy?  They better have been getting food, or well, that would have been annoying and painful for nothing.

Every species has instinctual behaviors that allow the little ones to grow up to be big ones and keep the species going.  Our kids are born into the world needing protection.  Protection from disease and from predators.  Yes, predators.  Our kids don't know they've been born into a loving family in the 21st century- for all they know it's the 2nd century and they are in a cave surrounded by tigers.  Our instinctive behaviors as baby humans need to help us stay protected.  Babies get both disease protection and tiger protection from being on mom's chest.  Presumably, we gave the baby some good bacteria when they arrived through the birth canal.  That's the first step in disease protection.  The next step is getting colostrum.

A newborn baby on mom's chest will pick their head up, lick their hands, maybe nuzzle mom, lick their hands and start to slide towards the breast.  The kids have a preference for contrasts between light and dark, and for circles over other shapes.  Think about that...there's a dark circle not too far away.

Mom's sweat smells like amniotic fluid, and that smell is on the child's hands (because there's been no bath yet!) and the baby uses that taste on their hand to follow mom's smell.  The secretions coming from the glands on the areola (that dark circle) smell familiar too and help the baby get to the breast to get the colostrum which is going to feed the good bacteria and keep them protected from infection.  The kids can attach by themselves.  Watch for yourself!  And if you just need colostrum to feed bacteria and not yourself, well, there doesn't have to be much.  And there isn't because the kids aren't hungry and because Breastmilk is not food! 

We're talking normal babies.  Breastfeeding is normal.  It's what babies are hardwired to do.  2009 or 209, the kids would all do the same thing: try to find the breast.  Breastfeeding isn't special sauce, a leg up or a magic potion.  It's not "best. "  It's normal.  Just normal. Designed for the needs of a vulnerable human infant.  And nothing else designed to replace it is normal.

Colostrum also activates things in the baby's gut that then goes on to make the thymus grow.  The thymus is part of the immune system.  Growing your thymus is important.  Breastmilk= big thymus, good immune system.  Colostrum also has a bunch of something called Secretory Immunoglobulin A (SIgA).  SIgA is made in the first few days of life and is infection protection specifically from mom.  Cells in mom's gut watch what's coming through and if there's an infectious cell, a special cell in mom's gut called a plasma cell heads to the breast and helps the breast make SIgA in the milk to protect the baby.  If mom and baby are together, like on mom's chest, then the baby is protected from what the two of them may be exposed to. Babies should be with mom.

And the tigers.  What about them?  Define "tiger" however you want.  But if you are baby with no skills in self-protection, staying with mom, having a grasp reflex, and a startle reflex that helps you grab onto your mom, especially if she's hairy, makes sense.  Babies know the difference between a bassinette and a human chest.   When infants are separated from their mothers, they have a "despair- withdrawal" response.  The despair part comes when they alone, separated.  The kids are vocally expressing their desire not to be tiger food.  When they are picked up, they stop crying.  They are protected, warm and safe.  If that despair cry is not answered, they withdraw.  They get cold, have massive amounts of stress hormones released, drop their heart rate and get quiet.  That's not a good baby.  That's one who, well, is beyond despair.  Normal babies want to be held, all the time.

And when do tigers hunt?  At night.  It makes no sense at all for our kids to sleep at night.  They may be eaten.  There's nothing really all that great about kids sleeping through the night.  They should wake up and find their body guard.  Daytime, well, not so many threats.  They sleep better during the day.  (Think about our response to our tigers-- sleep problems are a huge part of stress, depression, anxiety).

I go on and on about sleep on this site, so maybe I'll gloss over it here.  But everybody sleeps with their kids- whether they choose to or not and whether they admit to it or not.  It's silly of us as healthcare providers to say "don't sleep with your baby" because we all do it.  Sometimes accidentally.  Sometimes intentionally.  The kids are snuggly, it feels right and you are tired.  So, normal babies breastfeed, stay at the breast, want to be held and sleep better when they are with their parents.  Seems normal to me.  But there is a difference between a normal baby and one that isn't.  Safe sleep means that we are sober, in bed and not a couch or a recliner, breastfeeding, not smoking...being normal.  If the circumstances are not normal, then sleeping with the baby is not safe.

That chest -to -chest contact is also brain development.  Our kids had as many brain cells as they were ever going to have at 28 weeks of gestation.  It's a jungle of waiting -to-be- connected cells.  What we do as humans is create too much and then get rid of what we aren't using.  We have like 8 nipples, a tail and webbed hands in the womb.  If all goes well, we don't have those at birth.  Create too much- get rid of what you aren't using.  So, as you are snuggling, your child is hooking up happy brain cells and hopefully getting rid of the "eeeek" brain cells.  Breastfeeding, skin-to-skin, is brain wiring.  Not food.

Why go on and on about this?  Because more and more mothers are choosing to breastfeed.  But most women don't believe that the body that created that beautiful baby is capable of feeding that same child and we are supplementing more and more with infant formulas designed to be food.  Why don't we trust our bodies post-partum?  I don't know.  But I hear over and over that the formula is because "I am just not satisfying him."  Of course you are. Babies don't need to "eat" all the time- they need to be with you all the time- that's the ultimate satisfaction.

A baby at the breast is getting their immune system developed, activating their thymus, staying warm, feeling safe from predators, having normal sleep patterns and wiring their brain, and (oh by the way) getting some food in the process.  They are not "hungry" --they are obeying instinct.  The instinct that allows us to survive and make more of us.

 

 

Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM

 

Posted on February 26, 2017 .

Induced Lactation.....it is possible!!

Induced Lactation: You Can Breastfeed Your Child Even Though You Didn’t Give Birth

by proudadmin | Dec 12, 2016 | Breastfeedingeducationfertilitysurrogacy |

Induced Lactation: You Can Breastfeed Your Child Even Though You Didn’t Give Birth

People are often surprised to learn that Intended Mothers can produce milk for their child after their child is born through surrogacy and egg donation. Induced lactation is also suitable for Adoptive Mothers who have adopted a baby.

The ability to breastfeed a baby that you did not give birth to is indeed possible. This process is called ‘Induced Lactation’. Women who become parents through surrogacy and egg donation or adopt a baby may induce lactation in order to have a breastfeeding relationship with their infant.

Leanne shares more …

One does not have to go through an actual pregnancy in order to produce breastmilk. This is because the 2 hormones that drive lactation, (Prolactin and Oxytocin) are produced by the pituitary gland in the brain and not the ovaries. Both of these hormones are produced in response to nipple stimulation.

So how does one go about inducing Lactation? First, I recommend getting in touch with your primary healthcare provider to talk about your desire to produce breastmilk for your baby. There may be some prescription medications needed, such as Domperidone, to help build your milk supply. I would also encourage getting in touch with a Lactation Consultant (IBCLC)  who can offer guidance and support during this process. It is recommended to use a hospital grade breast pump to stimulate your breasts to help establish your milk supply. This process can sometimes take a few weeks.

It’s important to remember that you can and you will make milk. The million dollar question is will you be able to make enough to meet baby’s nutritional needs? Most Mother’s who induce lactation find that they need to do a combination of formula feeding and breastfeeding. There is a device called a supplemental nursing system (SNS) that can be used to assist in the milk production/breastfeeding process. The mother wears a bottle of milk around her neck and a long thin tube runs from the bottle to the breast where it is taped close to the nipple. As the baby latches on to the breast, he will drink milk from the tube as well as from the breast itself. Having an actual baby ‘breastfeed’ is the best way to build the milk supply and enjoy the wonderful bonding relationship that breastfeeding creates.

It’s also important to keep an open mind and be happy with any amount of breastmilk your body can produce. The nutritional benefits of breastmilk alone are worth going through the process of induing lactation.

Happy Breastfeeding!!!

Leanne Rzepa RN BN IBCLC

Leanne Rzepa is a Registered Nurse with a Bachelor’s Degree in Nursing. She is also an Internationally Board Certified Lactation Consultant. She has been working with breastfeeding families for the past 16 years. She presently works in the hospital, clinic, and home setting in Calgary, Alberta.

You can contact her at nourishconsulting@gmail.com or check out her website at www.nourishconsulting.net

Posted on December 22, 2016 .

To Wine or not to Wine???........That is the Question???

Just in time for Stampede!!! Happy Reading and Happy Breastfeeding!!!              

Well it’s that time of year again when I get asked the question about the effects of drinking alcohol while breastfeeding. Most mother’s look forward to that corporate stampede event, or rockin' concert  when they can indulge ever so slightly in their ‘before-baby life’.  But like any good mother would do, before taking a sip from that wine glass.....she questions is she making the right decision? Will that enticing alcoholic drink get into my breastmilk and harm my baby?

This blog will answer alcohol and breastfeeding related questions and concerns.

First we need to understand how alcohol gets into the breastmilk to be able to determine whether or not it is actually a harmful thing.

Alcohol is a drug. It is probably one of the most commonly used drugs worldwide. Any drug a person takes is eventually diluted throughout the entire body. Some drugs cross the blood-brain barrier and some drugs do not. The only way for a drug to get into your breastmilk is for it to find its way into the bloodstream. Alcohol does in fact cross the blood brain barrier and does get into your bloodstream. But it does not get trapped in the milk. It is constantly removed from the milk as it diffuses back into the bloodstream during the metabolization process. So when your blood alcohol levels are back down, so are your milk alcohol levels.

So what does this mean when you are about to accept that glass of wine from a handsome waiter? Let’s dive into the punch bowl a little deeper!

Consuming alcohol while breastfeeding means planning ahead and making smart, informed decisions. Current research says that occasional use of alcohol (1-2 drinks) does not appear to be harmful to the nursing baby. La Leche League’s opinion on this matter states: ‘The effects of alcohol on the breastfeeding baby are directly related to the amount the mother ingests. When the breastfeeding mother drinks occasionally or limits her consumption to one drink or less per day, the amount of alcohol her baby receives has not proven to be harmful.’  The American Academy of Pediatrics recommends that most breastfeeding mothers should wait at least 2 hours or longer after alcohol intake before nursing their infants to minimize its concentration in the ingested milk.

The concentration of alcohol in blood and breastmilk is about the same. So however long it takes your body to metabolize a glass of wine or beer, that’s how long it is going to take before it’s out of the breastmilk. For most women, this is between 2-3 hours. This is also why there is no need to pump and dump your milk. Unless it is primarily for comfort, pumping and dumping your milk after consuming alcohol does not speed the elimination of alcohol from the milk. So the best piece of advice would be to wait at least 2-3 hours after having your last drink before breastfeeding your baby.

Majority of jurisdictions consider you too drunk to drive if your blood alcohol level is more than 0.05%-0.1%. Most breastfeeding women at the holiday Christmas party are not going to have a blood alcohol level much greater than 0.1%. This is not a concentration of alcohol that is going to make baby sick or cause brain damage. Generally, if you are sober enough to drive, you are sober enough to breastfeed. Less than 2% of the alcohol consumed by the mother reaches her blood and milk. Alcohol peak’s in mom’s blood and milk approximately 30 minutes to 1 hour after drinking. But remember, this depends on how much food she has eaten, BMI, and percentage body fat.

So when you know that you have a stampede event coming up, it’s important to plan ahead. Start to pump and store your breastmilk a few days before the party. Make sure you have enough milk stored for at least 2 feedings. When enjoying at your festive soiree, make sure to eat a substantial amount of (healthy) food. Make sure to combine a protein with a carb and drink plenty of water throughout the evening. Keep checking in with yourself as well. Ask yourself, ‘how am I feeling?’ ‘Could I safely get into my car and drive home?’ This is a good gauge in order to determine if you are ‘sober’ enough to breastfeed your baby.

If you are going to be out for the entire evening, you may need/want to bring your breastpump with you. Try to pump as often as baby usually feeds. This is just to help maintain your supply and prevent plugged ducts, not because of the alcohol in your breastmilk. You may also have to re-consider your holiday dress choice if you are going to have to sneak off somewhere and pump. Dresses with zippers in the back are generally a pain in the butt!! I say this speaking from experience!!

It is also important to consider the age of the baby before consuming alcohol. A newborn has a very immature liver. Even small amounts of alcohol are going to put a strain on this underdeveloped organ. Until an infant is around 3 months of age, they detoxify alcohol at around half the rate of an adult. An older baby or toddler can metabolize the alcohol more quickly.

Alcohol does not increase milk production and has been shown to inhibit let-down and actually decrease milk production. Studies have shown that after a mother has consumed alcohol, babies nurse more frequently but take in less milk in the 3-4 hours after mom has had a drink. One study showed a 23% decrease in milk volume with one drink (Mennella and Beauchamp 1991,1993; Mennella 1997,1999) Another study by Coiro et al 1992; Cobo 1974, showed that 2 or more drinks may inhibit let-down. Alcohol is a CNS depressant. Any depressant is going to diminish your reflexive behaviour. Let-down is a reflex. So therefore, it makes sense that this reflex could be ‘slowed’ when alcohol is consumed. One study also showed changes in the infant’s sleep-wake patterning after short-term exposure to small amounts of alcohol in breastmilk-infants whose mothers were light drinkers slept less (Mennella & Gerrish 1998)

So to sum it all up for you, here are the key points to take away from this festive season blog:

  • Your baby’s age. The younger your baby is the more affected his liver will be by the metabolization of alcohol
  • Your weight determines how quickly the alcohol will be metabolizedand cleared from your breastmilk/bloodstream
  • The amount of alcohol consumed is directly related to the effects on the infant. The more alcohol consumes, the longer it takes to clear your body
  • An alcoholic drink consumed with food decreases absorption
  • It is best to wait 2-3 hours after your last drink before breastfeeding your baby

I hope this post was helpful and informative. Please feel free to leave your comments or contact me with any questions or concerns. Have a great Stampede week everyone. Have fun and Happy Breastfeeding!!!

 

Always, Leanne Rzepa RN BN IBCLC

 

Posted on December 16, 2016 .

Watch Your Baby....Not The Clock!

One of my most favorite things to share with new parents is that there is no magic number of minutes their baby is supposed to breastfeed for. Babies are much like us grown-ups in the sense that we don't always sit down at the table and eat the exact same amount of food for the exact same amount of time each day. Some of baby's feeds will be longer, and some of their feeds will be shorter. At times they are looking for a big meal, often times they just want a snack, and sometimes they are just trying to quench their thirst. Bottom line is, it's about the quality of the feed, not the length of time your baby spends on the breast.

Nancy Mohrbacher writes a great article on this very topic:

The clock looms large in the lives of many breastfeeding families. When a new baby is born, some parents are told or make assumptions about:

  • How many minutes their baby should breastfeed
  • How long their baby should be satisfied between feedings
  • The longest stretch of time their baby should sleep

Does it make sense to focus on time during the early weeks of breastfeeding? Let’s take a closer look.

What Do Number of Minutes Spent Breastfeeding Tell Us?

One common recommendation is to make sure newborns feed at least 10-15 minutes on each breast and take both breasts at each feeding. But that’s not always possible.

One mother and baby I saw in my private practice stand out in my mind. This mother called me with concerns about her 5-day-old daughter. The baby was born at just 5 pounds and she would only take one breast for 5 minutes before completely shutting down. She also refused one breast completely. I scheduled a home visit and brought my trusty scale. Unlike scales for sale at baby stores, this one was so accurate (to 2 grams) that it could reliably measure baby’s milk intake at the breast.

First I weighed her little girl with her clothes on for a “before” weight. With some small tweaks in positioning, we convinced her to take the breast she had previously refused. I watched her as she nursed. I didn’t see much jaw movement, and I didn’t hear any swallowing. Sure enough, after 5 minutes, she came off her mother’s breast and was unwilling to continue.

I put her back on the scale and to my amazement discovered she had taken 2 oz. (60 mL) of milk, way more milk than most babies this age take during a breastfeeding. (At 5 days, average milk intake per feeding is more like 1 oz., or 30 mL.) When this mother realized that her baby was such a fast, effective feeder, she relaxed. Her baby was doing fine.

Later that day, I saw another mother and her 10-day-old baby boy. This mother was worried because her little guy was spending more time nursing than she was told was normal, around 55 minutes at each feeding. This time my scale showed that he consumed the same amount of milk (2 oz. or 60 mL) in 55 minutes as the baby girl had taken earlier in the day in 5 minutes. Rather than being a fast eater, like the little girl, this baby boy was a slow eater.

How many minutes should a baby breastfeed? There’s not a simple answer. Just like adults, some babies are fast eaters and others are slow eaters. The number of minutes your baby feeds does not tell you anything about how much milk he consumed. On average, it takes most newborns somewhere between 5 and 55 minutes to finish a breastfeed. Both fast and slow nursers usually have periods of wide jaw movements along with some pauses. Over time, most babies get faster and more efficient at breastfeeding, so as they grow, the slow eaters usually speed up and get the same amount of milk (or even more milk) in less time.

Also like adults, your baby may be hungrier at one feed than another, so feeding longer or shorter at different feedings is not a cause for concern. This is perfectly normal. Being finished after one breast at some feedings and wanting both breasts at some feedings is also perfectly normal.

Does the Number of Minutes Between Feeds Mean Anything?

Not really. The most important thing to focus on is how many times each day your newborn breastfeeds. (Count one feeding as any amount of breastfeeding from one or both breasts followed by at least a 30-minute break.)

Most tiny babies need to breastfeed at least 8 to 12 times every 24 hours, but many parents do the math and assume this means they should expect their baby to be satisfied for 2 to 3 hours between feedings. Until your baby is a little older, usually after about the first 40 days or so, regular feeding times are uncommon. 

 Most breastfed newborns bunch their feedings together during wakeful times or “cluster nurse.” For this reason, it’s not helpful to focus on when baby fed last. Whenever baby shows feeding cues (increased activity, rooting, mouthing), assume it’s time to breastfeed again. Yes, even if it’s only been 10 minutes. If baby seems hungry again soon after feeding, don’t worry about overfeeding and don’t consider it a reflection of your milk production. It’s just what newborns do. This is how your baby helps you build a healthy milk supply.

There is no value whatsoever in trying to convince your baby to go for longer stretches between feeds. Newborns have no sense of time, and putting your baby off only adds stress to your life. If your baby seems interested in feeding or is fussy, try nursing first, and if that doesn’t help, move on to other comfort techniques. As your baby grows and matures (and his stomach grows and can hold more milk), he will naturally become more regular in his feeding patterns. You don’t have to do anything to make this happen.

How Long Is It Okay for a Newborn to Sleep?

Beginning on about second night after birth, don’t be surprised if your newborn goes into a feeding frenzy just about the time you’re thinking about going to bed. Most babies are born with their days and nights mixed up. That’s why it’s best for the sake of your own rest and recovery to sleep when your baby sleeps so that you’re rested and ready for more feedings at night.

It’s not uncommon for a brand-new baby to have one 4- to 5-hour sleep stretch, but it is often during the day. As long as your baby fits in at least 8 feedings every 24 hours and is gaining weight well (after Day 4, an average of about 1 oz. or 30 g per day), there’s no reason to wake your baby to feed.

It usually takes a few weeks for your baby’s body clock to get closer to yours. To speed up this process, try keeping stimulation to a minimum at night (lights low, sounds low, no diaper changes unless baby has a stool). Make daytimes full of light, sound, diaper changes, and before you know it, baby will be taking her longer sleep stretch at night.

Gaining Confidence in your Milk Production

Your baby’s feeding patterns are not a reflection of your milk production. But there are other ways you will know that your baby is getting the milk she needs. Her stool color is one sign. If breastfeeding is going well, your baby’s stool will turn from black to green by about Day 3 and green to yellow by Day 4 or 5. Weight gain is the best way to gauge your baby’s milk intake and your supply. Once baby reaches her low weight on Day 3 or 4, expect a weight gain of about 1 oz. or 30 g per day. Weight gain is the gold standard of healthy milk intake and milk production.

When it comes to breastfeeding and the clock, keep in mind that breastfeeding has been around much longer than clocks. In other words, you don’t need a clock to make breastfeeding work. Sometimes too much focus on the clock can even cause problems by shifting your focus away from what really matters.

Your baby will tell you everything you need to know. The American Academy of Pediatrics recommends breastfeeding babies on cue rather than on a schedule. Don’t be distracted by the clock. Instead, watch (and trust) your baby.

Written By: Nancy Mohrbacher

I hope you found this article helpful and informative. As always, please feel free to comment or contact me via e-mail if you have additional breastfeeding questions.

Happy Breastfeeding!!!!

Leanne Rzepa RN BN IBCLC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Posted on October 30, 2016 .

Nourish Lactation Consulting & Mommylicious

Nourish Lactation Consulting is Proud to be Hosting a Booth at the Calgary Mommylicious Show

 Carriage House Inn: Sunday October 16th

 10am-4pm

Enter a Draw to Win a Free Pre-Natal Breastfeeding Consult or an In Home Lactation Consult

SWAG Bags include a Nourish Brochure with a coupon for $20.00 off your initial Consult

Bring your family, friends and little ones to this FREE event to connect with some amazing Calgary community resources.

Leanne Rzepa RN BN IBCLC

www.nourishconsulting.net

Posted on October 8, 2016 .

WTF!!!! My Baby is on Strike!!!

I have been consulted numerous times in the last month to resolve what appears to be a nursing strike. Strikes can be very frustrating and emotional for both mom and baby. Here is a great article from Nancy Mohrbacher on how to overcome this bump in the breastfeeding journey.

If your baby is younger than one year, even if she seems to be losing interest in breastfeeding, chances are she is not yet ready to wean. After all, during their first twelve months babies still physically need mother’s milk. If your baby was nursing well and suddenly refuses your breast, this may be what some call a nursing strike. Besides baby’s age, another clue that a nursing strike is not a natural weaning is that baby is unhappy about it. A nursing strike usually lasts two to four days, but it may last as long as ten days. It may take some ingenuity plus the following insights and suggestions to help a striking baby go back to breastfeeding. 

What to Do

When a baby completely refuses the breast, focus first on two things:

1.  Expressing your milk

2.  Feeding the baby

Pump as often as baby was breastfeeding. This avoids uncomfortable breast fullness and helps maintain your milk production. Ideally, if your baby isn’t nursing at all, a double electric breast pump will make this faster and easier and will be more likely to keep up your supply.

Feed your baby your milk. How you feed it depends in part on your baby’s age. A sippy cup is a good choice for a baby at least six to eight months old, as it does not satisfy baby’s sucking urge like a bottle. A younger baby can take your milk by cup, spoon, or even eyedropper.

Most mothers think first of using a bottle, but choosing a feeding method that does not satisfy your baby’s sucking urge may end the strike sooner. When a baby has no other sucking outlets, such as a bottle or pacifier, he will be more motivated to go back to the breast. If your baby has been taking a pacifier regularly, consider giving it a rest until the strike ends and he’s back to breastfeeding.

What Causes a Nursing Strike?

Why do babies who nursed well suddenly refuse the breast or begin to struggle with latching? Before choosing a strategy for overcoming a strike, see if you can determine its cause from the list below.

Physical Causes

  • Ear infection, cold, or other illness
  • Reflux disease, which makes feedings painful
  • Overabundant milk production with a fast, overwhelming flow
  • Allergy or sensitivity to a food or drug mother consumed
  • Pain when held after an injury, medical procedure, or injection
  • Mouth pain from teething, thrush, or a mouth injury
  • Reaction to a product such as deodorant, lotion, or laundry detergent

 Environmental Causes

  • Stress, upset, or overstimulation
  • Breastfeeding on a strict schedule, timed feedings, or regular interruptions
  • Baby left to cry for long periods
  • Major change in routine, like traveling, a household move, or mother returning to work
  • Yelling during breastfeeding
  • A strong negative reaction when baby bites
  • An unusually long separation

 Knowing the cause will make it easier to choose an effective strategy. For example, if an ear infection is the cause, the right medical treatment and time to recover may be the best solution.

Breast refusal is stressful, but it is almost always possible to overcome it and return to breastfeeding. The following basic approaches can reduce your stress and shorten the strike.

Strategies for Overcoming a Strike

Keep time at the breast happy. Avoid turning the breast into a battleground. If your baby fights your attempts to breastfeed, feed another way and spend lots of happy cuddle time at the breast. When your baby is near the breast, talk, laugh, play, and look into his eyes. Make time there emotionally rewarding, and make any feeding time away from the breast emotionally neutral. Hold your sleeping baby against your breast during naptimes to help shorten the strike.

Spend time touching and in skin-to-skin contact. When not feeding, hold baby with his bare torso against your skin, and stay that way as much as possible. This is soothing to both of you, and the hormones released make baby more open to breastfeeding. If needed, throw a blanket over both of you. Take a bath with your baby, and use a sling or baby carrier to keep him close.

Offer the breast while baby is drowsy or in a light sleep. Many babies accept the breast again for the first time while asleep or in a relaxed, sleepy state. Try breastfeeding while baby naps. Use feeding positions baby likes best and experiment. To make the most of your baby’s natural feeding reflexes, start in a semi-reclined position with baby tummy down on your body. Lean back, and allow baby to take naps on your breast.

Trigger immediate milk flow. Pump before offering your breast to give baby milk he doesn’t have to work for. Or first try hand-expressing a little milk onto baby’s lips. If baby goes to the breast but won’t stay there, ask a helper to drip expressed milk on the breast or in the corner of baby’s mouth with a spoon. Swallowing your milk will trigger suckling, which triggers swallowing. If baby comes off the breast, offer more expressed milk and try again.

Try breast shaping and breastfeeding in motion. Shaping the breast so that it’s easier to latch may help baby take the breast deeper and trigger active suckling. Keep in mind that some babies accept the breast only while being walked or rocked, so if baby is not responding to semi-reclined positions, it may be time to get moving.

Try breastfeeding when baby’s not ravenous. To feed well, baby needs to feel calm and relaxed rather than hungry and stressed. If baby’s agitated, calm him first. Some babies will take the breast more easily if they are not very hungry, so try feeding a little milk first, using whatever feeding method is working for you. Start with one-third to one-half of his usual feeding, just to take the edge off his hunger before offering the breast.

Make the most of times that breastfeeding is going well. When baby takes the breast, breastfeed as long as he will suckle. Offer the breast again soon, rather than waiting until he is very hungry.

If your baby takes a bottle but not the breast, try a bait-and-switch. Start by bottle-feeding in a breastfeeding position and, while baby is actively sucking and swallowing, pull out the bottle nipple and insert yours. Some babies will just keep suckling.

Use breastfeeding tools. With the guidance of a lactation professional, the following devices may help you turn the corner.

  • Silicone nipple shield.In some cases, nipple shields can help a baby transition back to the breast, especially if the strike occurred after a period of heavy bottle and pacifier use.
  • At-breast supplementer.These devices provides milk at the breast through a thin tube that attaches to a container. If slow milk flow is an issue, it may help. If not, it may not be a good choice.

If these strategies don’t work, it’s time to get skilled breastfeeding help. Find someone in your area by clicking on this link.  Your technique may need a simple tweak or you may need some breastfeeding tools or help with how to use them.

Breastfeeding is the biological norm, so nearly all breastfeeding struggles have a solution. It’s just a matter of finding it. Even if settled breastfeeding seems impossible now, with time, patience, and skilled help you can make breastfeeding work again.

Nancy Mohrbacher

Posted on September 29, 2016 .

5 Things You Need to Know About the First 3 Days of Breastfeeding

Breastfeeding is both a science and an art, heavy with conflicting advice from family, friends, medical professionals, and even strangers.  So what's a mama to do in those first couple days in the hospital to get breastfeeding off to a good start?

1. SKIN TO SKIN

Mom's chest is home for baby.  Newborns know exactly what to do when you place them tummy to tummy with their mother.  Their brains are programmed to recognize the nipple, and they have a crawling reflex to get there.  It can take a newborn, on average, 50-60 minutes of uninterrupted time with its mother to latch on after birth, so be patient.  Your baby will be alert for 2-3 hours, so there is plenty of time for nursing and bonding to happen, and hospital routines can be delayed until after that first breastfeeding session is finished.

2. SLEEP

It's tempting to invite your family and friends to come see the baby in the hospital as soon as he or she arrives, but remember, you, your partner, and your baby have been through a grueling experience!  There won't be much time to catch up on lost sleep, so give yourself the gift of rest whenever you get the chance so that you're at your best to care for your baby during his or her waking hours.

3. FORGET THE CLOCK

Maybe you've heard that breastfed babies should eat 8-12 times a day.  In truth, breastfed newborns need to be fed on demand--which means anytime they are showing you feeding cues, including rooting, putting their hands in their mouth, and crying.  In the first day or two, breastfed babies can be highly variable in how often they want to eat.  Particularly if you had a long labor, your baby may be sleepy and may only nurse 7-8 times a day, but 7-8 good feedings is often better than 8-12 mediocre or poor feedings that a baby isn't truly awake for.  Other babies may be highly sensitive to being off the breast in the first couple days and may be content to spend the entire day suckling on and off.  Both of these variations are normal.  Trust your baby.

4. KNOW WHAT'S NORMAL

Breastfed babies almost always lose some weight during the first couple days of breastfeeding.  5-7% weight loss is average, and up to 10% (or sometimes even more) is normal.  Babies whose mothers had IV fluid during labor tend to lose more weight, so keeping that in mind is an important part of advocating for your baby's health in the hospital.  It's also totally normal for newborns to have feedings that last 2 minutes or 60 minutes, for a newborn to want to nurse almost immediately after they're "done" and to want to be close to you or your partner all day and night.  Remember that all your baby has known up to this point is warmth, softness, your voice, and your beating heart.  We know your baby is getting enough based on diaper counts.

5. ANTICIPATE THE SECOND NIGHT

Your little one sleeps sweetly over the first 24 hours and you think, "wow, we lucked out with this baby!" Suddenly, the second night after birth is a whole different story.  As soon as you put the baby down, he or she wakes up.  Your newborn wants to nurse non-stop but never seems satisfied at the breast.  The colostrum in your breasts probably has not transitioned to mature milk yet, and you wonder if your baby is getting enough.  Unplanned supplementation tends to happen right after this second night because it coincides with the baby's lowest weight (highest weight loss) and mothers interpret their baby's behavior as hunger.  Rest easy, your baby just wants to be close to you.  Let your baby drift off to sleep at the breast, gently break the latch with your pinky finger, skip the burping, and then let the baby use your breast as a pillow until he or she falls into a deeper sleep--then try to put the baby down.

Posted on September 8, 2016 .

MILK & COOKIES A Nourish Lactation Consulting Breastfeeding Support Group

Nourish Lactation Consulting is pleased to offer a Breastfeeding Support Group for any Breastfeeding family, and even those who are pregnant and not breastfeeding yet, but have questions about what to expect once baby arrives. 

We meet every 2 weeks for approximately 2 hours (location TBD)  to talk about YOUR Breastfeeding questions and concerns. 

Upon arrival, there will be a box for you to 'drop in' your Breastfeeding related questions.

The group will run on a Q & A format with lots of time for discussion and sharing

You are more than welcome to ask as many questions as you like

Please bring your baby and partner along

You will be provided with delicious, nutritious fresh, locally made snacks and beverages.........and yes, there will be LACTATION COOKIES

At each group session, you will be entered into a draw for a free in-home Lactation Consult ($150.00 value)

Every 2 months, I will feature a guest speaker who will talk about women's, infant, and family health related topics

Guest Speaker Topics:  Infant sleep, Pelvic Floor Health,  Nutrition while Breastfeeding, Nutrition for your infant starting solids and beyond....just to name a few

Support groups are a great way to network, share experiences and stories, and best of all.....meet new people!!

The cost for attending 'Milk & Cookies" is $99.00 for 6 months worth of sessions. Or you can drop-in for $20.00/session

To sign up for the support group, please fill out the form on the 'Book Appointment' page and I will get back to you with group meeting details.

Happy Breastfeeding and I look forward to seeing many of you soon!!!!

 

Posted on September 2, 2016 .

BLOCK FEEDING.....THE DOs & DONT's

This morning I talked with a breastfeeding mother whose story is becoming all too common. Her 1-month-old third baby was having trouble coping with her fast milk flow. At many feedings, she coughed, sputtered, and sometimes pulled off the breast crying. This mom assumed from this behavior that she had an overactive let-down (OALD) and started a strategy called “block feeding.”

What is Block Feeding?

Block feeding involves restricting baby to one breast for 3-hour or longer blocks of time before giving the other breast. It is very effective at bringing down milk production when a mother is making way too much milk. Allowing the breasts to stay full for a set period of time sends the signal to slow milk production.

Block Feeding Dos

This strategy can be a lifesaver in some cases, as oversupply (aka “hyperlactation” or “overabundant milk production”) can decrease quality of life for both mother and baby. For a mother, the drawbacks include regularly full and uncomfortable breasts and recurring plugged ducts. For the baby, oversupply can cause a very fast milk flow that can be hard to manage. In this case, block feeding used for no longer than 1 week can be a boon for both mother and baby.

Block Feeding Don’ts

What seems to be more and more common, though, is the assumption that any struggle with milk flow is due to OALD or oversupply, when there is usually another cause. As a result, some mothers bring down their milk production with block feeding when their supply is actually at a healthy level, leading to other problems, such as slow weight gain.

As I told the mother this morning, during the early weeks, most newborns cough and sputter during breastfeeding some of the time. It takes practice and maturity for babies to learn to coordinate sucking, swallowing, and breathing during breastfeeding. Some episodes of milk flow struggles and pulling away are completely normal and are not necessarily signs of OALD or oversupply.

How to Know If Block Feeding Will Help

The most reliable gauge of whether block feeding may be helpful is baby’s weight gain.If breastfeeding is going well, during the first 3 months, most babies gain on average about 2 lb/mo. (0.90 kg/mo.). If baby’s weight gain is double this or more, block feeding for no longer than 1 week makes sense. If baby’s weight gain isn’t this high, it is likely that block feeding will cause more problems than it solves.

Alternatives When Baby Struggles with Milk Flow

What can you do if your baby’s weight gain is average but she is struggling with milk flow during breastfeeding? The best strategy is using feeding positions that give baby more control over flow. The most difficult feeding positions for babies from a milk-flow standpoint are those in which milk is flowing downhill into their throats, such as all those in which mothers sit upright.

In the feeding position shown at left, however, milk flows uphill into baby’s mouth, giving her more control. See this post to read more about these types of feeding positions and their advantages.

If baby continues to have consistent problems with milk flow, it's time to see a lactation professional to check for anatomy, swallowing, and breathing issues. To find a lactation consultant near you, go to this website, click on the "Find a Lactation Consultant" link, and enter your zip or postal code.

References

Caroline, G.A. & van Veldhuizen-Staas, C. G. Overabundant milk supply: An alternative way to intervene by full drainage and block feeding.International Breastfeeding Journal 2007; 2:11.

Nancy Mohrbacher/

 

Posted on August 26, 2016 .

SHOULD MILK SHARING AMONG MOMS BE ENCOURAGED?

The recent launch of the peer-to-peer breastmilk sharing group Eats on Feets has brought the issue of women sharing human milk to the attention of health authorities. Due to safety concerns, organizations such as Health Canada and the U.S. Food and Drug Administration have warned mothers not to use another woman’s breastmilk unless it comes from a milk bank. Individuals associated with milk banking have gone so far as to describe peer-to-peer milk sharing as “very unsafe” and “dangerous

The discussion about peer-to-peer milk sharing has much in common with the discourse that surrounds bed sharing. We know many mothers bring their baby into bed with them at night.1 Bed sharing makes breastfeeding easier2 and breastfeeding mothers get more  sleep.3  It also allows mother-baby interaction to continue throughout the night and may protect the infant against the long periods of deep sleep thought to contribute to SIDS.4,5

However, we also know that bed sharing is not always safe. We know that if a mother smokes, if she has consumed alcohol or other sedatives, if the baby is formula fed, if the sleep surface is a sofa or water bed, or if the bed is also shared with other children that a baby sleeping with his or her mother is at heightened risk of SIDS or accidental death. Infant deaths that occurred as a result of bed sharing under these circumstances have resulted in health authorities such as the American Academy of Pediatrics recommending that parents not sleep with their infants.6  It is ironic that not only does blanket condemnation of bed sharing potentially make parenting unnecessarily more difficult for some mothers, it also has the unintended outcome of increasing deaths in places other than beds, such as sofas. This has occurred because due to fears of falling asleep while feeding in bed, some mothers have gotten up to feed on a sofa, fallen asleep there, and infants have died as a result.7,8 Thus, it seems that bed sharing should not be promoted nor condemned.  Rather, parents should be given information about how to bed share safely as well as its risks so they can examine their individual circumstances and decide for themselves where their baby sleeps.

It’s much the same with milk sharing. There is a growing awareness of the importance of breastmilk to the normal health, growth and development of children and of the unavoidable risks associated with the use of infant formula. There are also women who are unable to provide their child with all the breastmilk they require because they have had breast reduction surgery or a double mastectomy or because they have insufficient glandular tissue or are extremely ill. These women have the choice of either obtaining breastmilk from peers or using infant formula. Health authorities who have condemned peer-to-peer milk sharing have told these mothers to obtain human milk from milk banks.  But banked donor milk is an extremely rare commodity available to only a tiny number of (usually hospitalised) infants.

The only real alternative to obtaining human milk from a peer is using infant formula, and the evidence for short- and long-term negative impacts on infants from exposure to infant formula is overwhelming.9 It is interesting that the same health authorities who condemn peer-to-peer milk sharing have not condemned the use of infant formula.  One wonders why the risks of formula are somehow more acceptable than the risks of milk sharing.  Is it because formula feeding is so entrenched in our cultures, while breastfeeding remains marginalised? It is ironic that nearly all of the risks Health Canada identified as applying to breastmilk from a peer (http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2010/2010_202-eng.php) also apply to infant formula.  But a similar health advisory on the use of infant formula does not exist.

Milk sharing allows mothers to avoid the risks associated with formula feeding.  For some this may be particularly important, for example, those with a family history of diseases associated with formula feeding (diabetes or asthma), the death of a formula-fed baby from necrotising enterocolitis or SIDS, or a baby with formula intolerance.  In most cases, milk sharing is not something a woman does lightly or without good reason. For one mother’s story, click here

When mothers use human milk, they avoid the risks associated with infant formula.  However, they potentially expose their child to a whole different set of risks. Fortunately, most of these risks are manageable and some very easily eliminated altogether.  (Although very few diseases can be transmitted via breastmilk, one of them is HIV.  Fortunately, however, a simple home pasteurisation process destroys HIV.10) The Eats on Feets website provides extensive information onmanaging and minimising risks associated with peer-to-peer milk sharing.

As with bed-sharing, peer-to-peer milk sharing should not receive either a blanket endorsement or condemnation, because the safety of the practice depends very much on the situation.  An alternative to endorsing or condemning it is to acknowledge the reasons women want to milk share (banked donor milk unavailable, infant formula deficient), provide information on how to  manage the risks (recognising that the risks are manageable) and affirm that it’s the parents’ decision.  Just as with bed-sharing, as James McKenna noted:  “It remains the right of parents to make informed decisions, which requires access to unbiased information exchanged within an appropriately relaxed and non-judgmental educational venue.”5

1Rigda, R.S., I.C. McMillen, & Bucley, P.  Bed sharing patterns in a cohort of Australian infants during the first six months after birth. J Paediatr Child Health 2000; 36(2):117-121.

2Blair, P.S., J. Heron, & Fleming, P.J.  Relationship between bed sharing and breastfeeding: Longitudinal, population-based analysis. Pediatrics 2010; peds.2010-1277.

3Quillin, S.I.M. & Glenn,L.L. Interaction Between Feeding Method and Co-Sleeping on Maternal-Newborn Sleep. JOGNN2004; 33(5): 580-88.

4McKenna, J.J. & Mosko, S.S. Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine. Acta Paediatr Suppl  1994; 397:94-102.

5McKenna, J.J. & McDade,T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Resp Rev 2005; 6(2): p. 134-152.

6Task Force on Sudden Infant Death Syndrome, The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk.Pediatrics 2005; 116(5):1245-55.

7Blair, P.S., et al., Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK.  Lancet 2006; 367(9507):314-319.

8UNICEF Baby Friendly, U.K., New research reveals a four fold increase in babies dying when co-sleeping on a sofa, in Baby Friendly News. 2006.

9Ip, S., et al., Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, in Evidence Report/Technology Assessment No. 153. 2007, Agency for Healthcare Research and Quality: Rockville, MD.

10Jeffery, B.S., et al., Determination of the effectiveness of inactivation of human immunodeficiency virus by Pretoria pasteurization.J Trop Pediatr 2001; 47(6): p. 345-49.

Nancy Mohrbacher

Posted on August 14, 2016 .

FOREMILK & HINDMILK.......WHAT EXACTLY IS THE FUSS ALL ABOUT?????

A little knowledge can be a dangerous thing.  This has never been so true as in the ongoing debate about foremilk and hindmilk and their impact on breastfeeding.  The misunderstandings around these concepts have caused anxiety, upset, and even led to breastfeeding problems and premature weaning. 

The 2003 edition of The Breastfeeding Answer Bookdefines these terms this way:

“The milk the baby receives when he begins breastfeeding is called the ‘foremilk,’ which is high in volume but low in fat.  As the feeding progresses, the fat content of the milk rises steadily as the volume decreases. The milk near the end of the feeding is low in volume but high in fat and is called the ‘hindmilk’” (Mohrbacher and Stock, p. 34).

It goes on to explain that by simply letting the baby “finish the first breast first”—switching breasts when the baby comes off the breast on his own rather than after a set time—the mother can be sure her baby receives the “proper balance of fluid and fat.”  Since this book was published, research has expanded our understanding of foremilk and hindmilk and answered many of the common questions mothers have about these concepts.

What worries?  Confusion about foremilk and hindmilk has led to all sorts of uncertainty. Are there two distinctly different types of milk?  Does the baby need to breastfeed for a specific number of minutes before foremilk suddenly turns to hindmilk?  Can a baby miss out on hindmilk altogether if he breastfeeds for too short a time?  If this happens often, will his weight gain suffer?  Sometimes healthcare providers get into the act, telling breastfeeding mothers they should watch the clock to make sure their baby breastfeeds “long enough to get the hindmilk,” with the number of minutes recommended varying by adviserWhat do we really need to know about foremilk and hindmilk? And is there any reason to worry?

The truth about foremilk and hindmilk.  Research has found this concept is not as simple as it sounds.  It is true that fat sticks to the milk ducts in the breast and the percentage of fat in the milk increases during a breastfeeding as the fat is released from the ducts during milk ejections.  But the reality of this seemingly simple dynamic is not always as it seems. 

  • There are not “two kinds of milk.”Despite this common belief, there is no “magic moment” when foremilk becomes hindmilk. As the baby breastfeeds, the increase in fat content is gradual, with the milk becoming fattier and fattier over time as the breast drains more fully. 
  • The total milk consumed daily—not the hindmilk—determines baby’s weight gain.  Whether babies breastfeed often for shorter periods or go for hours between feedings and feed longer, the total daily fat consumption does not actually vary.
  • Foremilk is not always low-fat.  The reason for this is that at the fat content of the foremilk varies greatly, depending on the daily breastfeeding pattern.  If the baby breastfeeds again soon after the last feeding, the foremilk at that feeding may be higher in fat than the hindmilk consumed at other feedings. 

How does this work?  Interestingly, foremilk and hindmilk are concepts that really only make sense when longer intervals such as two to three hours or more occur between feedings.  The longer the time gap between feedings and the fuller a mother’s breasts become, the greater the difference in fat content between her foremilk and hindmilk.  These differences in fat content can vary greatly over the course of a day even among individual mothers.  For example, when a long breastfeeding gap occurs during the night, at the next feeding a mother’s foremilk will be lower in fat than during the evening when her baby breastfeeds more often. 

What really matters.  Research indicates that there is no reason to worry about foremilk and hindmilk or to coax a baby to feed longer.  As long as a baby is breastfeeding effectively and the mother does not cut feedings short, baby will receive about the same amount of milk fat over the course of a day no matter what the breastfeeding pattern (Kent, 2007).  This is because the baby who breastfeeds more often consumes foremilk higher in fat than the baby who breastfeeds less often.  So in the end it all evens out.

What’s most important to a baby’s weight gain and growth is the total volume of milk consumed every 24 hours.  On average, babies consume about 750 mL of milk per day (Kent et al., 2006).  As far as growth is concerned, it doesn’t matter if a baby takes 30 mL every hour or 95 mL every three hours, as long as he receives enough milk overall (Mohrbacher, 2010).  In fact, researchers have found that whether babies practice the frequent feedings of traditional cultures or the longer intervals common in the West, they take about the same amount of milk each day (Hartmann, 2007) and get about the same amount of milk fat.  Let’s simplify breastfeeding for the mothers we help and once and for all cross foremilk and hindmilk off our “worry lists.”

References

Hartmann, P.E.  (2007). Mammary gland: Past, present, and future. in eds. Hale, T.W. & Hartmann, P.E. Hale & Hartmann's Textbook of Human Lactation. Amarillo, TX: Hale Publishing, pp. 3-16.

Kent, J. C. (2007). How breastfeeding works. Journal of Midwifery & Women's Health, 52(6), 564-570.

Kent, J. C., Mitoulas, L. R., Cregan, M. D., Ramsay, D. T., Doherty, D. A., & Hartmann, P. E. (2006). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics, 117(3), e387-395.

Mohrbacher, N.  Breastfeeding Answers Made Simple: A Guide for Helping Mothers.  Amarillo, TX: Hale Publishing, 2010.

Mohrbacher, N. and Stock, J.  The Breastfeeding Answer Book, 3rd edition.  Schaumburg, IL: La Leche League International, 2003.    

Nancy Mohrbacher

Posted on August 10, 2016 .

BREASTFEEDING AND GREEN POOPS......WHAT EXACTLY DOES THAT MEAN?

Baby poop is high on many new parents’ worry list. How often should baby poop? Does baby’s poop provide clues to how breastfeeding is going? What do color and consistency mean? When should you worry?

Normal Color and Consistency

Baby’s first stools are the black and tarry meconium that was in her gut at birth. When breastfeeding is going well, by about the third day, baby’s poop changes to “transitional stools,” which have a dark greenish color. By the fifth day or so, the poop’s color changes again to yellow. Its consistency now (and until baby begins consuming anything other than your milk) may look like split pea soup, liquid with seedy bits in it. But if your baby’s poop is all liquid and no seeds, this is also normal.

Baby’s yellow poop is made mostly from the fat in your milk. During the first six weeks, babies gaining weight well usually poop at least 3 to 4 times a day with stools at least the diameter of a US quarter (22 mm) or larger. There is no such thing as too many poops. (Lots of pooping just means your baby is getting lots of milk, which is great.) But too few poops mean it’s time for a weight check.

If your baby is younger than 6 weeks old, is pooping fewer than 3 to 4 times per day, or her stools haven’t turned yellow by the fifth day, a weight check will tell you if this is just a normal variation or a cause for concern. It’s not until after 6 weeks that some healthy breastfed babies poop much less often, sometimes even once a week. Check baby’s weight at a health-provider’s office. A bathroom scale just won’t do. A weight gain of about 1 oz. (30 g) or more per day indicates that all is well. No matter what your baby’s age, as long as she is gaining weight well, don’t worry if she has fewer stools than expected.

Causes of Green Poop

Despite what you may have heard (see the next section), green and brown are in the normal range of poop colors. They are not a reason to worry if baby seems well and is gaining weight.What can cause green poop?

  • Your diet. Eating lots of greens or other green foods or drinks (green gelatin, green sodas, green sports drinks) can turn poop green. Natural and artificial food colors can change the color of both your milk and baby’s poop.
  • A tummy bug. When your baby is ill, this can cause a change in poop color that may last for weeks. Keep breastfeeding! It’s the best way to help baby recover.
  • Oversupply. If you produce so much milk that your baby receives mostly high-sugar/low-fat milk, it may overwhelm baby’s gut and cause watery or green stools. (Click HERE more details and tips for adjusting milk production downward when needed.)
  • Ineffective breastfeeding. If on the fifth day, baby’s stools turn green instead of yellow, as in the case of oversupply, this may be a sign that baby can't drain the breast well enough to get past the low-fat/high sugar foremilk. In this case, though, a health or anatomy issue (like tongue tie) may be the cause. Unlike oversupply, baby’s weight gain may or may not be below average. Now is the time to see an IBCLC.
  • Sensitivity to a food or drug. When a sensitive or allergic baby reacts to a drug you’re taking, something in your diet, or something baby consumes directly, this may turn her poops green or mucusy. You may even see bits of blood in it, which is not considered serious. (Click HERE for info you can share with your health-care provider.)

Food sensitivity occurs most often in families with a history of allergy. When this is the cause, expect to also see other physical symptoms, such as skin problems (eczema, rashes, dry patches), tummy upsets (vomiting, diarrhea), or breathing issues (congestion, runny nose, wheezing, coughing).

What about Foremilk-Hindmilk Imbalance?

Many new parents read online that “foremilk-hindmilk imbalance” is the most likely cause of green poop. This term was coined in a 1988 journal article that reported the experiences of a few mothers who breastfed by the clock, switching breasts after 10 minutes even though baby hadn’t finished on that side. Its results have never been duplicated, and newer findings call into question this article’s conclusions. Many now wonder if foremilk-hindmilk imbalance even exists. To learn more, click here.

Setting Worries to Rest

In most cases, green poop is nothing to be concerned about. But it helps to know what’s normal, possible causes, and some of the common myths about this experience. If your breastfeeding baby is healthy and thriving, that’s the most important thing you need to know.

Nancy Mohrbacher

Posted on July 30, 2016 .