The Benefits of Respecting the 'Golden Hour'

I recently had the privilege of assisting a mother breastfeed her baby shortly after birth. When I came into the mom's hospital room, her baby was already placed on her chest skin-skin and looking ready to breastfeed. We used the baby-led latching technique and after about 20 minutes of attempting, got the baby latched on and the breastfeeding journey had begun. This made me think that we as health care providers really need to examine the way we respect the mother-baby dyad within the 'Golden Hour' after birth. Hence my latest blog!!!

 The way your baby is cared for and nurtured immediately after birth significantly impacts their transition from the womb to life outside. In a culture that commonly separates mothers and babies for routine procedures such as cleaning, weighing and measuring, most babies are missing that critical time of being skin to skin with their mothers, which has short and long term consequences for all. As these procedures are not necessary to maintain or enhance the well being of either mother or baby, there is no reason why they cannot be delayed beyond the first critical hour.

The first hour should be focused on baby’s first breastfeed and mother-baby and family bonding. Unless mother or baby is in need of medical assistance, hospital protocols should support this time of new beginnings for both vaginal and caesarean births.

What Is An Undisturbed First Hour or sometimes referred to as the 'GOLDEN HOUR'? Babies are born and immediately placed tummy down on their mother’s stomach. A warm blanket should be placed over both mother and baby, to keep mother warm. This slows the production of adrenaline hormone in her so as to not interfere with oxytocin and prolactin hormones being produced (essential for bonding and breastfeeding). - At this time, the mother’s needs are simple: warmth and a quiet, calm environment. It is important to remember that she is still in labour – the placenta and membranes are still to be birthed, and her uterus needs to contract down.

Here are 7 important reasons why the first hour after birth should be undisturbed:

#1: Baby-Led Initiation of Breastfeeding It is quite common these days for hospital staff to want baby to begin breastfeeding within the first hour. In addition to the importance of early feeding for mother-baby attachment and bonding, it also helps to expel the placenta more quickly and easily, reducing the risk of postpartum hemorrhage. Read more about the benefits of a natural third stage here. It’s common for caregivers to assist baby to latch onto the nipple, which is unnecessary in most cases. When babies who have not been exposed to medications are placed skin to skin with their mothers and left undisturbed, they will instinctually crawl to their mother’s breast and attach themselves to the nipple. This is now known as the ‘breast crawl’ and was first observed by Swedish researchers in the 1980s. Further observation discovered that babies are born with innate instincts that assist them in finding their mother’s nipple, like all newborn mammals.

#2: Body System Regulation Babies who are left skin to skin with their mothers for the first hours immediately after birth are better able to regulate their temperature and respiration. Newborns aren’t able to adjust their body temperature as well as older children and adults as they don’t have the same insulating fat levels. They have spent nine months in an environment that is perfectly temperature controlled. If babies lose too much heat, they have to use more energy and oxygen than they can spare to try and keep their temperature stable. An undisturbed first hour with skin to skin also reduces the risk of hypoglycemia (low blood sugar levels). Newborn babies can produce glucose from their body stores of energy until they are breastfeeding well and are more likely to do so when they remain skin to skin with their mothers.

#3: Promotes Delayed Cord Clamping Leaving the umbilical cord intact while it is still pulsating allows babies to receive oxygen still via the placenta, while adjusting to breathing through their lungs. Being skin to skin with their mothers helps babies to stabilize respiration, meaning that their cord will remain intact for longer and giving them more chance to receive vital red blood cells and reduce the risk of iron deficiency anemia. Even if you have a c-section, delayed cord clamping is possible, but not in all cases. Ultimately it depends on the willingness of your chosen care provider and your unique situation. Speak to your care provider to see if he or she supports delayed clamping during straight forward c-sections. It’s an important question to ask when interviewing your care provider.

#4: Promotes Mother-Baby Attachment Prolonged skin to skin after birth allows mother and baby to get to know each other. Mothers who have skin to skin contact after birth are more likely to feel confident and comfortable in meeting their babies’ needs than those who had none. Attachment is critical to newborn survival and mothers are hard wired to look after their young. Oxytocin receptors in a woman’s brain increase during pregnancy, so when her baby is born, she is more responsive to this hormone that promotes maternal behaviour. Oxytocin is produced in large amounts when breastfeeding and holding babies close skin to skin. Mothers who had early skin to skin with their babies are more likely to demonstrate bonding behaviours later in their child’s life, such as kissing, holding, positive speaking and so on. 

#5: Improves Breastfeeding Success Rates Breastfeeding initiation and duration is likely to be more successful with babies who have early skin to skin contact. This is particularly important in countries where breastfeeding rates significantly drop a few months after birth, such as Australia, America and the UK. The World Health Organization recommends exclusive breastfeeding for babies in the first six months to achieve optimal growth, development and health. Creating the right conditions for the initiation of breastfeeding would help promote longer durations of breastfeeding for many women. Babies who are left to self attach usually have a better chance of proper tongue positioning when latching. This can increase long term breastfeeding as mothers experience more ease and fewer problems when latching is not an issue.

#6: Protects Against The Effects of Separation Babies are born ready to interact with their mothers – a newborn baby who has not been exposed to excessive medication will be very alert and gaze intently into their mother’s face, recognizing her smell, sound of her voice and the touch of her skin. Remaining with their mother is key to a baby’s survival and separation is life threatening. Babies are born with a mammal’s primal instinct to stay within the safe habitat of mother, where there is warmth, safety and nourishment. When babies are separated from their mother they will protest loudly, drawing their mother’s attention to their distress. Babies undergo what is literally a cold turkey withdrawal from the sensory stimulation of their mother’s body. If they are not reunited with their mother despite their protests, they will go into a despair state – essentially giving up and becoming quiet and still. This is partly a survival instinct to avoid attracting predators, and their body systems slow down to preserve energy and heat.

#7: Boost Your Baby’s Immunity Naturally When babies are born, they emerge from a near-sterile environment in the uterus and are seeded by their mother’s bacteria. This essentially trains the baby’s cells to understand what is ‘good’ and ‘bad’ bacteria. This kicks tarts their immune system to fight off infections and protects from disease in the future. Research indicates that if babies aren’t given this opportunity to be exposed to their mother’s bacteria, either because they are not born vaginally, held skin to skin or breastfed, then the baby’s immune system may not reach its full potential and can increase the child’s risk of disease in the future. Skin to skin contact and early breastfeeding is an excellent way to help increase your baby’s exposure to bacteria if you need a cesarean section for medical reasons. Find out more ways to boost your baby’s immune system here.

Tips For Planning An Undisturbed Hour After Birth A better understanding of how an undisturbed hour after birth impacts breastfeeding, mother well being and newborn development, helps make it possible for us to make informed choices about this critical period: Choose your birth carer and setting to increase your chances for an undisturbed natural birth and first hour. Caregivers should support you having an undisturbed first hour and leave routine baby checks until you are ready. Create an optimal environment for birth (warm, dim lighting, quiet, private, supported). This boosts the right hormones for natural birth, which reduces the need for interventions that could cause separation from your baby. Ensure your caregivers understand the important of leaving the umbilical cord intact until it has stopped pulsating, so baby cannot be separated from you. To promote production of oxytocin and prolactin, make sure your environment after birth remains warm and calm.

I hope you enjoyed this latest Nourish Blog. As always, please feel free to post any comments or questions. 

Happy Breastfeeding!!!

Credit to Sam McCulloch

 

 

Posted on May 1, 2016 .

When Does Breast Milk Come In? 7 Important Facts

Did you know that your breasts actually start making milk before your baby is born?

From around four months pregnant, your breasts start making colostrum.

Colostrum is the first milk your baby gets after being born, and is a concentrated source of anti-infective factors, protein and minerals.

However, your milk ‘coming in’ refers to when your breasts start making large volumes of breastmilk, and the composition changes (e.g. higher lactose and lower sodium concentration).

When Does Breast Milk Come In?

Here are 7 important facts about your milk coming in:

#1: Your Breast Milk Will Come In Regardless Of Whether Your Baby Breastfeeds Or Not

Your milk coming in is driven by hormones, which means it will happen whether your baby breastfeeds or not.

During pregnancy, you have high levels of prolactin (your milk making hormone). But you don’t make lots of milk during pregnancy due to high levels of the hormone progesterone. High levels of progesterone prevent prolactin from doing its job fully.

After your placenta has come away (third stage of labour), this makes your progesterone levels plummet. In turn, this means prolactin levels (which continue to be high) can now kick into action, and start the process of making lots of milk.

#2: Your Breast Milk Will Most Likely Come In Around Day 3

For most mothers, their breast milk comes in between days 2 and 5.

Many first time mothers notice their breast milk comes in around day 3 or 4.

With subsequent babies, many mothers notice their milk comes in sooner – around day 2 or 3.

It’s important to remember that your baby gets colostrum from the very start, so you don’t need to be concerned that he is not getting anything to eat.

#3: Frequent Feeding In The Early Days Helps Build A Good Milk Supply

Ideally, your baby will have skin-to-skin time with you straight after birth, and during this time, he will receive his first breastfeed.

Thereafter, ideally you and your baby will be kept together (rooming-in) and you will continue to spend as much time as possible in skin-to-skin contact with your baby, feeding him whenever he needs to be fed. Learning hunger cues can be very helpful.

For more information about how to get breastfeeding off to the best start possible, read our article about what you need to know before the first breastfeed.

Getting breastfeeding off to the best start possible is important, because early frequent and effective milk removal increases prolactin activity in the breast, which helps you to set up an abundant and robust milk supply.

#4: Your Breasts May Feel Full, Warm And Hard

Milk production usually starts to increase between 30 – 40 hours after your placenta is delivered, but it may take a little while longer for you to notice the increased volume your breasts are making.

Different mothers feel different things in their breasts when their milk comes in. Most women experience their milk coming in as a gradual change, rather than something that happens all of a sudden.

Most commonly, mothers notice their milk coming in when their breasts feel fuller, warmer and harder. However, the degree to which different mothers feel this varies a lot. For some mothers, this feeling may be subtle (especially for women with large breasts) while for other mothers it may be very obvious and even painful.

If you happen to be expressing or leaking milk, you may notice that the milk changes from the thicker, yellow colour of colostrum to a thinner, whiter colour when your milk comes in.

If you don’t notice your milk coming in but you notice your baby’s poos changing to a lighter colour (e.g. yellow mustardy colour) by day 5, this is a good sign that your milk has come in.

#5: You May Notice Your Let-Down Reflex

The let-down reflex is where the hormone oxytocin allows the milk stored in the breasts to be released from the glandular (milk-making) tissue into the milk ducts and out of the nipple.

A baby suckling at the breast stimulates tiny nerve endings on the nipple and areola which signal for the release of the hormone oxytocin from the pituitary gland in the brain.

Some mothers don’t ever feel their let-down reflex while others feel it very strongly, especially when their milk comes in.

If you are a mother who feels your let-down reflex, you may notice a tingling sensation, a slight pain or sudden fullness in your breasts. You may notice milk leaking from the breast your baby isn’t feeding from (as the let-down reflex occurs in both breasts simultaneously). You may notice your baby’s sucking changing from a quick shallow suck to a deeper more rhythmical sucking when your let-down occurs.

#6: There Are Some Things That May Delay Your Milk Coming In

If your milk comes in later than day 3, it is said that there is a delay in your milk coming in.

Here are some possible reasons that could mean there is a delay in your milk coming in:

Birth Factors

Mother’s Health

Issues that affect a mother’s hormones may cause a delay in her milk coming in. For example diabetes,polycystic ovary syndrome, hypothyroidism, obesity.

Other Factors

Anything that impacts how well and how often milk is removed from a mother’s breasts may delay her milk coming in.

For example, if a mother is separated from her baby (e.g. baby is in special care nursery) or if her baby isn’t feeding well (e.g. due to a tongue-tie), milk may not be removed as often or as well and hence can cause a delay in her milk coming in.

#7: Don’t Lose Heart If There Is A Delay In Your Milk Coming In

If there is a delay in your milk coming in, remember that many mothers have been able to bring in a full milk supply even after a week or two (and sometimes even longer).

If it is recommended that you begin to supplement your baby with extra milk, you may find the Academy of Breastfeeding Medicine supplementation protocol very helpful.

Here are some things that can help to make your milk come in:

  • Discussing with medical or nursing staff, or a lactation consultant about what the possible cause of the delay for your milk coming in is. There may be things that can be done to help rectify the situation (e.g. if retained placental fragments are the issue, the milk usually comes in normally once the fragments are removed).
  • See a lactation consultant. A lactation consultant can undertake a thorough assessment to work out an individualised plan to get breastfeeding working well for you and your baby.
  • Ensure your breasts are frequently and effectively drained – at least 8 times every 24 hours. Ideally, this would be achieved by feeding your baby, but if your baby happens to not be feeding well, then expressing may need to occur. Before your milk comes in, hand expressing is the mainstay of expressing. Once your milk has come in, using a hospital grade electric pump (and finishing up with hand expressing) is ideal.
  • Frequent skin-to-skin contact with baby can also help with milk production.

Breastfeeding is our biological norm and thus our bodies are designed to make milk in a way that is suitable for newborns. Their tiny bellies are around the size of a marble on their first day of life, so it makes perfect sense that our mature milk doesn’t come in for a bit of time. Remember that though the milk doesn’t ‘come in’ immediately following birth, you are likely to make the perfect amount of colostrum.

Renee Kam IBCLC in Breastfeeding. Last updated on August 11, 2015

Posted on April 24, 2016 .

How We Make Breastmilk

How does milk production work?

By Kelly Bonyata, BS, IBCLC

To understand how to effectively increase (or decrease) milk supply, we need to look at how milk production works…

For the most part, milk production is a “use it or lose it” process.  The more often and effectively your baby nurses, the more milk you will make.

In the Beginning…

Endocrine (Hormonal) Control of Milk Synthesis — Lactogenesis I & II

Milk production doesn’t start out as a supply and demand process. During pregnancy and the first few days postpartum, milk supply is hormonally driven – this is called the endocrine control system. Essentially, as long as the proper hormones are in place, mom will start making colostrum about halfway through pregnancy (Lactogenesis I) and her milk will increase in volume (Lactogenesis II) around 30-40 hours after birth.

During the latter part of pregnancy, the breasts are making colostrum, but high levels of progesterone inhibit milk secretion and keep the volume “turned down”. At birth, the delivery of the placenta results in a sudden drop in progesterone/estrogen/HPL levels. This abrupt withdrawal of progesterone in the presence of high prolactin levels cues Lactogenesis II (copious milk production). Other hormones (insulin, thyroxine, cortisol) are also involved, but their roles are not yet well understood. Although biochemical markers indicate that Lactogenesis II commences approximately 30-40 hours after birth, mothers do not typically begin feeling increased breast fullness (the sensation of milk “coming in”) until 50-73 hours (2-3 days) after birth.

These first two stages of lactation are hormonally driven – they occur whether or not a mother is breastfeeding her baby.

Established Lactation…

Autocrine (Local) Control of Milk Synthesis — Lactogenesis III

After Lactogenesis II, there is a switch to the autocrine (or local) control system. This maintenance stage of milk production is also called Lactogenesis III. In the maintenance stage, milk synthesis is controlled at the breast — milk removal is the primary control mechanism for supply. Milk removal is driven by baby’s appetite. Although hormonal problems can still interfere with milk supply, hormonal levels play a much lesser role in established lactation. Under normal circumstances, the breasts will continue to make milk indefinitely as long as milk removal continues.

By understanding how local/autocrine control of milk synthesis works, we can gain an understanding of how to effectively increase (or decrease) milk supply.

What does current research tell us about milk production?

Current research suggests that there are two factors that control milk synthesis:

Milk contains a small whey protein called Feedback Inhibitor of Lactation (FIL) – the role of FIL appears to be to slow milk synthesis when the breast is full. Thus milk production slows when milk accumulates in the breast (and more FIL is present), and speeds up when the breast is emptier (and less FIL is present).

The hormone prolactin must be present for milk synthesis to occur. On the walls of the lactocytes (milk-producing cells of the alveoli) are prolactin receptor sites that allow the prolactin in the blood stream to move into the lactocytes and stimulate the synthesis of breastmilk components. When the alveolus is full of milk, the walls expand/stretch and alter the shape of prolactin receptors so that prolactin cannot enter via those receptor sites – thus rate of milk synthesis decreases. As milk empties from the alveolus, increasing numbers of prolactin receptors return to their normal shape and allow prolactin to pass through – thus rate of milk synthesis increases. The prolactin receptor theory suggests that frequent milk removal in the early weeks will increase the number of receptor sites. More receptor sites means that more prolactin can pass into the lactocytes and thus milk production capability would be increased.

Both of the above factors support research findings that tell us:

FULL
Breast=SLOWER
Milk
Production

EMPTY
Breast=FASTER
Milk
Production

Research indicates that fat content of the milk is also determined by how empty the breast is (emptier breast = higher fat milk), rather than by the time of day or stage of the feed.

How does milk supply vary throughout the day?

Earlier researchers observed that milk volume is typically greater in the morning hours (a good time to pump if you need to store milk), and falls gradually as the day progresses. Fat content tends to increase as the day progresses (Hurgoiu V, 1985). These observations are consistent with current research if we assume the researchers were observing babies with a fairly typical nursing pattern, where baby has a longer sleep period at night and gradually decreases the amount of time between nursing as the day progresses.

Storage capacity: Another factor that affects milk production and breastfeeding management is mom’s milk storage capacity. Storage capacity is the amount of milk that the breast can store between feedings. This can vary widely from mom to mom and also between breasts for the same mom. Storage capacity is not determined by breast size, although breast size can certainly limit the amount of milk that can be stored. Moms with large or small storage capacities can produce plenty of milk for baby. A mother with a larger milk storage capacity may be able to go longer between feedings without impacting milk supply and baby’s growth. A mother with a smaller storage capacity, however, will need to nurse baby more often to satisfy baby’s appetite and maintain milk supply since her breasts will become full (slowing production) more quickly.

 Think of storage capacity as a cup – you can easily drink a large amount of water throughout the day using any size of cup – small, medium or large – but if you use a smaller cup it will be refilled more often.

What does the research tell us about increasing milk supply?

Milk is being produced at all times, with speed of production depending upon how empty the breast is. Milk collects in mom’s breasts between feedings, so the amount of milk stored in the breast between feedings is greater when more time has passed since the last feed. The more milk in the breast, the slower the speed of milk production.

To speed milk synthesis and increase daily milk production, the key is to remove more milk from the breast and to do this quickly and frequently, so that less milk accumulates in the breast between feedings:

EMPTY
Breast=FASTER
Milk
Production

In practice, this means that a mother who wishes to increase milk supply should aim to keep the breasts as empty as possible throughout the day.

To accomplish this goal and increase milk production:

  1. Empty the breasts more frequently (by nursing more often and/or adding pumping sessions between nursing sessions)
  2. Empty the breasts as thoroughly as possible at each nursing/pumping session.

To better empty the breasts:

  • Make sure baby is nursing efficiently.
  • Use breast massage and compression.
  • Offer both sides at each nursing; wait until baby is finished with the first side before offering the second. Switch nursing may be helpful if baby is not draining the breast well.
  • Pump after nursing if baby does not adequately soften both breasts. If baby empties the breasts well, then pumping is more useful if done between nursing sessions (in light of our goal to keep the breasts as empty as possible).

Are you having problems with oversupply?

Mothers who are working to remedy oversupply usually need to decrease supply without decreasing overall nursing frequency or weaning baby. One way to accomplish this is by “block nursing” – mom nurses baby as frequently as usual but restricts baby to one breast for a set period of time (often 3-4 hours but sometimes longer) before switching sides. In this way, more milk accumulates in the breast before mom switches sides (thus slowing milk production) but baby’s nursing frequency is not limited.

Posted on April 17, 2016 .

Why spiced-up breast milk is good for your baby’s food acceptance

I  recently attended a conference at the Alberta Children's Hospital called 'Nourishing the Neonate". The study in this article was mentioned during one of the speakers sessions. I find what foods to eat or avoid while breastfeeding is still one of the most common questions I get asked about, so I thought I would share this very interesting and informative article. Enjoy!!!

It was When I had my children, I felt that there was a tendency by experts, including those in my own pediatric profession, to push certain principles that took all the fun out of life. This played out for me, in particular, after I gave birth to my first child, and was told as part of my breast-feeding “support” that I should avoid all spicy foods, because they would upset the baby. Like any good Cambridge, Mass., mother, I turned this into an argument about multiculturalism (“What about the mothers in Sichuan?”), but what I really thought was that it harked back to some old ideas about spices heating up the blood, and generally making life too interesting for the nursing mother.

Why are women told to avoid strong flavours when breast-feeding?

Twenty-five years ago, researchers asked a group of nursing mothers to load up on garlic. In the study, Maternal Diet Alters the Sensory Qualities of Human Milk and the Nursling’s Behavior, which ran in 1991 in the journal Pediatrics, nursing mothers who ate garlic produced breast milk with a stronger smell, as evaluated by researchers who didn’t know which sample was which. What was most interesting was how the milk tasted to the babies, those poetically named “nurslings.” When the garlic effect was there, the babies stayed longer on the breast and nursed more vigorously.

Dr. Julie Mennella, a biopsychologist at the Monell Chemical Senses Center in Philadelphia, was the lead author on the 1991 study; she has continued to study the effect of early exposures on the development of taste. “Amniotic fluid and mother’s milk have a lot of sensory information,” she said. “The baby gets the information when they feed on the milk.”

Another study, published in 2001, showed that babies who had been exposed to a flavour in utero or while nursing were more likely to like that flavour when they were weaned.

What goes into your stomach goes into your bloodstream, broken down into molecules of protein, carbohydrate, fat. The flavours cross as well, including potent molecules called volatiles, which carry scent, which in turn heavily influences taste, as you know if you have ever tried to eat something delicious when you have a bad head cold.

The variety of flavours that you eat during pregnancy go into your blood and then into the amniotic fluid, which the baby is constantly drinking, in utero, and the flavours that you eat while nursing cross from the blood vessels that supply the mammary glands into the breast milk. So instead of restricting the maternal diet, there is now good evidence that by eating a wide variety of healthy and tasty foods during these periods, we are actually doing our babies a major favour.

“Breast-fed babies are generally easier to feed later because they’ve had this kind of variety experience of different flavours from their very first stages of life, whereas a formula-fed baby has a uniform experience,” said Dr. Lucy Cooke, a psychologist specializing in children’s nutrition, who is a senior research associate at University College London. “The absolute key thing is repeated exposure to a variety of different flavours as soon as you can possibly manage; that is a great thing for food acceptance.”

Her own research has included working with children at the age of weaning to increase the acceptance of vegetables by offering repeated exposures to them.

“Babies are tremendously adaptable and very accepting of all sorts of strange flavours,” Cooke said.

What about the idea that some foods in the mother’s diet can make a baby fussy or gassy or colicky? By definition, the foods that cause gas in the mother do so because they are not absorbed, and sit in her intestine, making trouble. On the other hand, a number of studies suggest that some colicky babies do better if their mothers stay away from cow’s milk, so doctors may advise nursing mothers to cut that out for a 10- to 14-day trial, while making sure they still get plenty of calcium.

Caffeine is sometimes also a culprit, pointed out Dr. Pamela High, a professor of pediatrics at Brown University and medical director of the infant behavior, cry and sleep program at Women & Infants Hospital of Rhode Island. But mothers of colicky babies often restrict their diets further and further, and many ultimately give up nursing, High said in an e-mail, even though this usually doesn’t help.

So yes, the flavours we eat when we’re pregnant or when we’re nursing, go to the baby, aromatics and all. But this should be a positive message rather than a list of thou-shalt-nots, since it means that we are providing something beyond protein and calories; we’re actually letting our babies, unborn and born, into some of the joys of our human omnivory.

“A diet of the healthy foods she enjoys is modelling at its best,” Mennella said. “The baby only learns if the mother eats the foods.”

When, as a nursing mother, I ate the spicy foods that I love so well, I’ll have you know that I was actually modelling. My children, after all, were going to grow up in a family in which spicy food was part of every possible family occasion.

And if the flavours of the foods you love can make the experience of childbearing and child rearing a little tastier, or spicier, for mothers, that’s all to the good as well, and very much in line with what we hope our children are drinking in mother’s milk.

“Food gives pleasure,” Mennella said. “There’s a lot of biology underlying the pleasure of eating.”

PERRI KLASS The New York Times News Service Published Thursday, Mar. 31, 2016 3:07PM EDT

Posted on April 9, 2016 .

Breast Milk vs Formula.....The Ingredients Speak For Themselves

What’s In Breast Milk and What’s In Formula?

By Kelly Winder in Baby. Last updated on February 15, 2016

Ever been curious as to what’s found in breast milk and what ingredients can be found in formula?

Developed by the Douglas College for the Breastfeeding Course for Health Care Providers, this eye opening comparison of breast milk ingredients and formula ingredients is astounding.

Please understand that this article has not been published so formula feeding mothers can feel guilty.

Nor has it been posted for anyone to feel superior.

BellyBelly often acknowledges that there are plenty of valid reasons why parents formula feed their babies and we support them.

We also understand that some things can be hard to hear when we’ve not come to peace with them.

This article contains important information that we need to know — it’s science, biology and healthcare all in one. It’s even more important to hear for those who have a choice and are researching what to feed their baby.

With information comes education, and with both of those things, it gives you power and options. BellyBelly is dubbed “The Thinking Woman’s Website” because it’s written especially for parents who want to know more than marketing hype when making choices and decisions — just as I did as a young mother. So if you feel you may be offended, please do not read any further.

 

Formula Ingredients

Water

Carbohydrates

  • Lactose
  • Corn maltodextrin

Protein

  • Partially hydrolyzed reduced minerals whey protein concentrate (from cow’s milk)

Fats

  • Palm olein
  • Soybean oil
  • Coconut oil
  • High oleic safflower oil (or sunflower oil)
  • M. alpina oil (Fungal DHA)
  • C.cohnii oil (Algal ARA)

Minerals

  • Potassium citrate
  • Potassium phosphate
  • Calcium chloride
  • Tricalcium phosphate
  • Sodium citrate
  • Magnesium chloride
  • Ferrous sulphate
  • Zinc sulphate
  • Sodium chloride
  • Copper sulphate
  • Potassium iodide
  • Manganese sulphate
  • Sodium selenate

Vitamins

  • Sodium ascorbate
  • Inositol
  • Choline bitartrate
  • Alpha-Tocopheryl acetate
  • Niacinamide
  • Calcium pantothenate
  • Riboflavin
  • Vitamin A acetate
  • Pyridoxine hydrochloride
  • Thiamine mononitrate
  • Folic acid
  • Phylloquinone
  • Biotin
  • Vitamin D3
  • Vitamin B12

Enzyme

  • Trypsin

Amino acid

  • Taurine
  • L-Carnitine (a combination of two different amino acids)

Nucleotides

  • Cytidine 5-monophosphate
  • Disodium uridine 5-monophosphate
  • Adenosine 5-monophosphate
  • Disodium guanosine 5-monophosphate

Soy Lecithin (an emulsifier)

When choosing formula for your baby, make sure you read the labels and choose a lower protein formula. A recent study has found that many formulas are being made on the higher acceptable limits of protein, which may be an explanation of the link between formula and childhood obesity.

 

What’s In Breast Milk?

Here is a summary of what ingredients can be found in breast milk.

 

Breast Milk Ingredients

Water

Carbohydrates (energy source)

  • Lactose
  • Oligosaccharides (see below)

Carboxylic acid

  • Alpha hydroxy acid
  • Lactic acid

Proteins (building muscles and bones)

  • Whey protein
  • Alpha-lactalbumin
  • HAMLET (Human Alpha-lactalbumin Made Lethal to Tumour cells): AMAZING!!!
  • Lactoferrin: AMAZING!!!!
  • Many antimicrobial factors (see below)
  • Casein
  • Serum albumin

Non-protein nitrogens

  • Creatine
  • Creatinine
  • Urea
  • Uric acid
  • Peptides (see below)

Amino Acids (the building blocks of proteins)

  • Alanine
  • Arginine
  • Aspartate
  • Clycine
  • Cystine
  • Glutamate
  • Histidine
  • Isoleucine
  • Leucine
  • Lycine
  • Methionine
  • Phenylalanine
  • Proline
  • Serine
  • Taurine
  • Theronine
  • Tryptophan
  • Tyrosine
  • Valine
  • Carnitine (amino acid compound necessary to make use of fatty acids as an energy source)

Nucleotides (chemical compounds that are the structural units of RNA and DNA)

  • 5’-Adenosine monophosphate (5”-AMP)
  • 3’:5’-Cyclic adenosine monophosphate (3’:5’-cyclic AMP)
  • 5’-Cytidine monophosphate (5’-CMP)
  • Cytidine diphosphate choline (CDP choline)
  • Guanosine diphosphate (UDP)
  • Guanosine diphosphate – mannose
  • 3’- Uridine monophosphate (3’-UMP)
  • 5’-Uridine monophosphate (5’-UMP)
  • Uridine diphosphate (UDP)
  • Uridine diphosphate hexose (UDPH)
  • Uridine diphosphate-N-acetyl-hexosamine (UDPAH)
  • Uridine diphosphoglucuronic acid (UDPGA)
  • Several more novel nucleotides of the UDP type

Fats

  • Triglycerides
  • Long-chain polyunsaturated fatty acids
  • Docosahexaenoic acid (DHA) (important for brain development)
  • Arachidonic acid (AHA) (important for brain development)
  • Linoleic acid
  • Alpha-linolenic acid (ALA)
  • Eicosapentaenoic acid (EPA)
  • Conjugated linoleic acid (Rumenic acid)

Free Fatty Acids

Monounsaturated fatty acids

  • Oleic acid
  • Palmitoleic acid
  • Heptadecenoic acid

Saturated fatty acids

  • Stearic
  • Palmitic acid
  • Lauric acid
  • Myristic acid

Phospholipids

  • Phosphatidylcholine
  • Phosphatidylethanolamine
  • Phosphatidylinositol
  • Lysophosphatidylcholine
  • Lysophosphatidylethanolamine
  • Plasmalogens

Sphingolipids

  • Sphingomyelin
  • Gangliosides
  • GM1
  • GM2
  • GM3
  • Glucosylceramide
  • Glycosphingolipids
  • Galactosylceramide
  • Lactosylceramide
  • Globotriaosylceramide (GB3)
  • Globoside (GB4)

Sterols

  • Squalene
  • Lanosterol
  • Dimethylsterol
  • Methosterol
  • Lathosterol
  • Desmosterol
  • Triacylglycerol
  • Cholesterol
  • 7-dehydrocholesterol
  • Stigma-and campesterol
  • 7-ketocholesterol
  • Sitosterol
  • β-lathosterol
  • Vitamin D metabolites
  • Steroid hormones

Vitamins

  • Vitamin A
  • Beta carotene
  • Vitamin B6
  • Vitamin B8 (Inositol)
  • Vitamin B12
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • a-Tocopherol
  • Vitamin K
  • Thiamine
  • Riboflavin
  • Niacin
  • Folic acid
  • Pantothenic acid
  • Biotin
  • Minerals
  • Calcium
  • Sodium
  • Potassium
  • Iron
  • Zinc
  • Chloride
  • Phosphorus
  • Magnesium
  • Copper
  • Manganese
  • Iodine
  • Selenium
  • Choline
  • Sulpher
  • Chromium
  • Cobalt
  • Fluorine
  • Nickel

Metal

  • Molybdenum (essential element in many enzymes)

Growth Factors (aid in the maturation of the intestinal lining)

Cytokines

  • interleukin-1β (IL-1β)
  • IL-2
  • IL-4
  • IL-6
  • IL-8
  • IL-10
  • Granulocyte-colony stimulating factor (G-CSF)
  • Macrophage-colony stimulating factor (M-CSF)
  • Platelet derived growth factors (PDGF)
  • Vascular endothelial growth factor (VEGF)
  • Hepatocyte growth factor -α (HGF-α)
  • HGF-β
  • Tumor necrosis factor-α
  • Interferon-γ
  • Epithelial growth factor (EGF)
  • Transforming growth factor-α (TGF-α)
  • TGF β1
  • TGF-β2
  • Insulin-like growth factor-I (IGF-I) (also known as somatomedin C)
  • Insulin-like growth factor- II
  • Nerve growth factor (NGF)
  • Erythropoietin

Peptides (combinations of amino acids)

  • HMGF I (Human growth factor)
  • HMGF II
  • HMGF III
  • Cholecystokinin (CCK)
  • β-endorphins
  • Parathyroid hormone (PTH)
  • Parathyroid hormone-related peptide (PTHrP)
  • β-defensin-1
  • Calcitonin
  • Gastrin
  • Motilin
  • Bombesin (gastric releasing peptide, also known as neuromedin B)
  • Neurotensin
  • Somatostatin

Hormones (chemical messengers that carry signals from one cell, or group of cells, to another via the blood)

  • Cortisol
  • Triiodothyronine (T3)
  • Thyroxine (T4)
  • Thyroid stimulating hormone (TSH) (also known as thyrotropin)
  • Thyroid releasing hormone (TRH)
  • Prolactin
  • Oxytocin
  • Insulin
  • Corticosterone
  • Thrombopoietin
  • Gonadotropin-releasing hormone (GnRH)
  • GRH
  • Leptin (aids in regulation of food intake)
  • Ghrelin (aids in regulation of food intake)
  • Adiponectin
  • Feedback inhibitor of lactation (FIL)
  • Eicosanoids
  • Prostaglandins (enzymatically derived from fatty acids)
  • PG-E1
  • PG-E2
  • PG-F2
  • Leukotrienes
  • Thromboxanes
  • Prostacyclins

Enzymes (catalysts that support chemical reactions in the body)

  • Amylase
  • Arysulfatase
  • Catalase
  • Histaminase
  • Lipase
  • Lysozyme
  • PAF-acetylhydrolase
  • Phosphatase
  • Xanthine oxidase

Antiproteases (thought to bind themselves to macromolecules such as enzymes and as a result prevent allergic and anaphylactic reactions)

  • a-1-antitrypsin
  • a-1-antichymotrypsin

Antimicrobial factors (used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses)

  • Leukocytes (white blood cells)
  • Phagocytes
  • Basophils
  • Neutrophils
  • Eoisinophils
  • Macrophages
  • Lymphocytes
  • B lymphocytes (also known as B cells)
  • T lymphocytes (also known as C cells)
  • sIgA (Secretory immunoglobulin A) (the most important antiinfective factor)
  • IgA2
  • IgG
  • IgD
  • IgM
  • IgE
  • Complement C1
  • Complement C2
  • Complement C3
  • Complement C4
  • Complement C5
  • Complement C6
  • Complement C7
  • Complement C8
  • Complement C9
  • Glycoproteins
  • Mucins (attaches to bacteria and viruses to prevent them from clinging to mucousal tissues)
  • Lactadherin
  • Alpha-lactoglobulin
  • Alpha-2 macroglobulin
  • Lewis antigens
  • Ribonuclease
  • Haemagglutinin inhibitors
  • Bifidus Factor (increases growth of Lactobacillus bifidus – which is a good bacteria)
  • Lactoferrin (binds to iron which prevents harmful bacteria from using the iron to grow)
  • Lactoperoxidase
  • B12 binding protein (deprives microorganisms of vitamin B12)
  • Fibronectin (makes phagocytes more aggressive, minimizes inflammation, and repairs damage caused by inflammation)
  • Oligosaccharides (more than 200 different kinds!)

 

Summing It All Up

That’s quite a lot to digest — pardon the pun! So to make sense of it all, I asked BellyBelly’s International Board Certified Lactation Consultant (IBCLC), Renee Kam, what she believes to be the most important ingredients in breast milk. We all know that breast milk is known for it’s protective and immune supporting properties — Renee reinforced this with her response. She says:

“Breastmilk contains the right balance of probiotics and prebiotics that human babies need to colonise their bowels with a healthy bacteria. Perhaps the most important anti-infective factor in breastmilk is an antibody called secretory IgA (sIgA). SIgA helps protect a baby from pathogens he is most likely to come across in the environment he lives in (we called this ‘targeted protection’). Breastfed babies may have asymptomatic infections (that don’t show any signs of inflammation) because of the anti-inflammatory factors in breastmilk, which can turn acute-inflammatory cells (e.g. neutrophils) off.”

The fats in breast milk are very important too.

“Of the fats in breastmilk, 88% are made from long-chain fatty acids. It’s these long-chain fatty acids (e.g. omega 3 fatty acids, especially DHA) that are constituents of brain and nerve tissue, and are needed in early life for mental and visual development.”

Finally, the self adjusting properties of breast milk are important too — a mother’s breast milk is custom made for her baby, based on the baby’s age and needs at the time. Renee says:

“The breastmilk a mother makes for her baby is different on day one, to day seven, to day 30, and so on. For example, the breastmilk made by a mother of a premature baby has different concentrations of various substances to suit her baby’s special needs. And, when weaning, a mother’s breastmilk increases the concentration of immune protective factors to give her baby a final dose of immune protection before weaning is complete.”

 



 

 

Posted on April 3, 2016 .

Give Breast Milk

I PRODUCED more than 2,500 ounces of surplus breast milk with my first son. I am almost six months postpartum with my second child, and already my freezers are stuffed with five-ounce bags of milk. Some women are computer programmers or impressive cooks. I’m good at producing breast milk. My friends and family marvel at this talent, sort of. They like to joke that I could make real money if I sold it.

Big milk producers are able to make thousands of dollars selling their surplus breast milk, which led Wired magazine to call breast milk “liquid gold” a few years ago. The going rate now is something like $1 to $4 per ounce. No wonder some women consider the sale of their breast milk a part-time job.

But I don’t sell my milk. I am lucky enough to be able to donate it. With my first son, I sent more than 1,000 ounces of breast milk to the Mothers’ Milk Bank in San Jose, Calif., which distributes milk to neonatal intensive care units around the country. I am about to donate my first several hundred ounces from this round and will continue to send stored milk as long as I am breast-feeding. Milk banks don’t charge hospitals, except for basic fees that cover the cost of processing, pasteurizing and transporting the milk, as well as blood tests and screenings for the donors.

The benefits of breast milk aren’t just for sick or premature babies, of course. Last week, a Brazilian study found that an infant who was breast-fed for at least a year, no matter what the mother’s education and family’s income were, had a higher I.Q. score and a higher monthly income at age 30 than those who were breast-fed for less than a month. The longer they were breast-fed, the better they did. A 2013 study on intergenerational social mobility in Britain found that children who were breast-fed were more likely to move up the socioeconomic ladder than those who were not.

A market for breast milk seems like the logical solution for matching the deluge of milk some women produce to the desperate need for milk that some babies and hospitals have. Last week, The New York Times reportedon the booming breast milk industry. One private company, Prolacta Bioscience, buys breast milk for $1 an ounce, concentrates it, fortifies it and then goes on to sell the concentrated version for as much as $180 an ounce to hospitals.

This doesn’t seem right to me. I realize that companies like Prolacta and its competitor Medolac are doing some good. After all, they create a product that helps very premature babies. But their product comes at a huge price.

I also understand that not every mother can donate milk. Even for those who are physically able to produce surplus milk, pumping costs time and effort, and one needs to own or rent a breast pump and buy lots of storage bags. And, in order to become a donor, there are a number of steps that complicate things: an application, blood tests, forms for a woman’s obstetrician and the baby’s pediatrician to fill out.

Many women pump milk at work for their own babies, and the last thing a sleep-deprived, overworked lactating mother has is an extra 10 or 20 minutes or the energy to lug extra milk bottles and bags to and from work.

I get all of that. But none of this actually takes that much time. Filling out the forms and taking the blood tests, for example, takes no more than an hour of one’s life. Under the Affordable Care Act, breast pumps are now covered by most forms of insurance, although the tedium of labyrinthine rules may put women off pumping milk for their own babies, let alone for others.

Philanthropic organizations focused on women and children’s health issues ought to provide free pumps and storage bags to those mothers who want to donate but are daunted by the logistics. We need to make it easy for women to provide this service.

We also need more public-awareness campaigns run by the milk banks and the hospitals that rely on them. Even if they have the capacity to do so, lots of women aren’t even aware that they can donate milk. Hospitals and milk banks need to spread the word on how to donate to milk banks and the tremendous help this milk can be to N.I.C.U.s and premature babies.

For those of us who are given generous maternity leaves, who are healthy, who have the extra 10 minutes, or who are genetically disposed to produce surplus breast milk, I say go for it. But give it to a milk bank, and allow hospitals to use their financial resources for other aspects of caring for sick babies.

Breast milk donation ought to be more like giving blood, not for profit and not as part-time work. Yes, there is always a subset of people who sell their blood (in the form of plasma), and that may also be true for some big milk producers, as it was historically for wet nurses who were paid to feed other women’s babies.

Every ounce counts, so even if women aren’t able to send hundreds of ounces to milk banks, milk drives sponsored by hospitals or health organizations could make it easier for women to take part. To donate milk takes a bit more effort than showing up at a blood drive, but it is just as critical. Giving milk, like giving blood, offers an invaluable reward: the satisfaction of doing our duty as healthy humans to help babies who are not.

Elizabeth Currid-Halkett is an associate professor of public policy at the University of Southern 

Posted on March 29, 2016 .

Dad's and Breastfeeding......Everything You NEED To Know

So far all my blog posts have been directed towards the mommies. So I thought it was only fair to write something for all the amazing daddies (and daddies to be) out there too. Let’s face it. They are an integral part to the entire breastfeeding experience. They are coaches, supports, breast massagers, diaper changers, latch assisters, pillow adjusters......you name it, daddies do it!! So why not make sure they know all the important stuff about breastfeeding in order to be as helpful as possible. This blog will highlight the key information about breast changes, colostrum, the critical first few days after delivery, and other helpful tips all dad’s should know.

During a woman’s pregnancy, changes to her breasts are usually the first sign of being pregnant. For most women, the breasts will grow in size and the areola and the nipple may also increase in size and perhaps darken in color. The breasts are quite often tender and become hypersensitive.  If this is the case, your wife may not want you to touch her breasts. All these changes are caused by hormones.

 The body starts to produce colostrum at around 16 weeks gestation. Some woman may actually leak colostrum throughout the pregnancy or notice a bit of dried ‘crust’ on the nipples from time to time. This is all good and normal and just means that your wife’s body is getting ready to feed her baby.

Now let’s have a little discussion about colostrum. Not too many dudes are familiar with the term ‘colostrum’ unless they have had the honour of becoming a father. Colostrum is truly one of the most amazing substances on the face of this planet. What’s even cooler is that it’s made by a woman’s body! Colostrum is the first type of breastmilk a woman produces. It is quite thick and almost has a syrupy consistency. It can range from white, to yellow, to brown, to pink! It usually flows out from the nipple very slowly....bead-by-bead. But every drop is precious. We actually refer to it as ‘Liquid Gold’ because it is so GOOD for your baby. The colostrum prepares the GI tract for feeding as it has many similarities to amniotic fluid, which is what your baby has been drinking in the womb all these months. It is low in volume but high in energy and helps with the early passage of meconium (the baby’s first bowel movements) which in turn assists in preventing jaundice.  It is loaded with protein and antibodies that help ‘immunize’ your baby in the best, most natural way possible. As it is rich in vitamins, and immune factors, it will help your baby fight infections. Colostrum is important because it contains brain boosting fats and hormones to teach a baby’s intestines to move and digest. Colostrum also contains protective cells that can destroy some disease causing bacteria and viruses. The first few days after delivery, your baby’s stomach is super small. We are talking about the size of a chickpea. The belly does not need large volumes of anything at this stage. Colostrum is the only perfectly designed, nutrient dense food your baby requires. It is digested very easily and this is one of the reasons why breastfed infants feed every 2-3 hours.

Some of the other widely known benefits of breastmilk include the following:

·         Decreased rates of GI infections, ear infections, asthma, allergies, and eczema

·         Lower rates of obesity and diabetes

·         Some studies have reported higher IQ’s in breastfed infants

·         Helps the brain and nerves develop in a far superior way

·         Increases closeness and bonding

·         Lower’s a mother’s risk of breast and ovarian cancer

·         Helps mom lose pregnancy weight faster

·         Better for the environment......breastfeeding has no carbon footprint!!

·         Breastmilk is always the right temperature, it is convenient and saves time and money

Your wife’s mature breastmilk will start to ‘come in’ around 4-5 days after delivery. Her breasts will start to feel heavier and fuller. The veins on her chest and breasts will become more prominent. She may need some help at this stage with breast massage or even manual expression. Sometimes the breasts become so hard (engorged) that she experiences pain and has a hard time getting the baby to latch properly. You can encourage her to have a hot shower, or help to massage her breasts with a warm wet facecloth. Sometimes it helps to manually express some milk before trying to latch the baby as the areola can become too hard for baby to grasp onto. After she’s done feeding, it may be helpful to have her ice the breasts for 10 minutes/side.

Now comes the most important part of this blog.....what to REALLY expect in the first few days after your baby is born. I think one of the hardest new things to adjust to when becoming a new parent is sleep deprivation. It’s rough for us mommies but dad’s also suffer......but often in silence. Nothing can prepare you for this part of parenthood. But I am forewarning you now.....you will be exhausted, you will feel like a zombie during the day and you will not sleep well for a very long time. But you still have to be helpful and supportive and all those other amazing things that are expected of you as a new father.

So what’s the best way to be all those things when you feel like hell. Well you have to suck it up buttercup and just do the best you can. Your wife is also going to be exhausted from her labour and delivery. She may be in pain and not be able to move around well. You can help by asking her what she needs. Usually a breastfeeding mother is quite thirsty and hungry. Make sure she always has a full glass of water or even better a water bottle at her bedside. You can also have food available that she can easily snack on like fruits, veggies, cheese and crackers, and nuts at her bedside. But also make sure she is eating 3 well balanced meals during the day. Breakfast is especially important. Foods that are high in fibre are really good for milk supply. So go to the grocery store and buy some oatmeal and make her a bowl every morning!!

Some new fathers aren’t quite sure how or where they fit in to the picture with a new baby in the mix. Dads are really great at changing diapers or getting the baby undressed for skin-skin before breastfeeding. And......dads are also encouraged to do skin-skin with their babies as much as they like. Most of the father’s I have worked with, love that special time when holding their baby on their bare chests. Just be prepared that your baby may try and latch on to you!!!! You can also help by keeping track of when baby is pooping, peeing, and feeding. It helps to have these details recorded on a piece of paper for the first little while.

You can ask your wife if she is comfortable when she is about to begin breastfeeding. Being comfortable when feeding is really key. If she is awkwardly sitting or positioned in the bed or chair, it will affect the way she is able to feed the baby. If she is in bed, she may need to get up and sit in a supportive chair. If she is in bed, make sure she has good back support and a few good pillows within reach. You can also help by bringing in the pillows to support her and the baby, once she has gotten the baby latched on. I am usually not a fan of using a breastfeeding pillow before the baby has latched as it can sometimes lead to a shallow latch. But once the baby is latched well, feel free to snug in some pillows for support. It’s usually the elbows and wrists that are going to need more support. You can roll a receiving blanket or face cloth and slide it under the wrist that is supporting baby’s head. When we are breastfeeding, we tend to carry a lot of tension in our shoulders. Remind her to take a deep breath and relax her shoulders after the initial latch. You may even want to give her a gentle shoulder massage during the feed. If she is relaxed and feeling calm, then her milk is going to flow more easily.

Pain control is also super important. She doesn’t have to be a martyr and just deal with the pain she is having. It’s important for her to stay on top of her pain. You can help by making sure she is taking hermedication regularly and checking in with her to make sure her pain is well controlled. A woman that is in pain will not be able to effectively breastfeed her baby.

Try to encourage her to sleep when the baby is sleeping. If mom and baby are resting, this is your opportunity to get some shut eye as well. You are going to have a lot of family and friends want to come over and visit the first few days you are home from the hospital. Really try to limit the number of people you have over or at least try and keep the visits short. Babies are nocturnal creatures for the first few months so the daytime is really the best (and only time) to catch up on some missed sleep. It’s really hard to do this when you have to entertain guests!! Your wife will so appreciate this gesture if you take control and say, “We would love to see you and have you meet our new little one, but it’s going to have to wait a bit.” But if the offer is put forward to bring some meals over, graciously accept and allow that food to be brought over!!!!

There will be times when breastfeeding is challenging. Your wife is also going to be hormonal and quite emotional the first few weeks after delivery. She may burst into tears for no reason at all. She may yell out of frustration and exhaustion. The best thing you can do is remain calm, cool, and collected. Offer words of love and encouragement. Tell her how proud you are of her and what an amazing job she is doing. The first few days home from the hospital, your baby will do a lot of cluster feeding ( short but frequent feeds especially at night when the prolactin hormone is at its highest) You are both going to be exhausted and drained but stay calm and relaxed. Babies really pick up on the energy of the people in their environment. If you and mom are calm, baby will feed a lot better.

If her nipples become cracked and damaged your wife will be in a tremendous amount of pain and start to panic that she can’t feed her baby. Let her know there are options and support (Me!!!!) out there that can help her get through this rough patch. When I get a phone call from a dad, I know the situation is dire and help needs to happen ASAP or the breastfeeding journey may come to an abrupt halt. The worst thing you can do is say, “Just give the baby a bottle then.” No mother wants to feel that she isn’t capable of feeding and nourishing her baby. You may think that offering a bottle is the answer but I’m telling you straight up.....it’s not and I can guarantee it will only lead to more complications. Seriously, call me and I will come over and get the situation under control (that’s a promise). But in the meantime, if the nipples are too sore for your wife to properly latch the baby, have her hand express or you need to make a trip to the neighbourhood pharmacy and rent a hospital-grade pump. Expressed milk can be given to the baby with a spoon, a cup, or a needleless syringe. Avoid the bottle in the first 4-6 weeks!!!!!!!

When the baby is breastfeeding, the best indicator of a good latch is how it feels. There should be no pain or pinching, just a strong pull/tug on the breast tissue. There are some things that you can look for when the baby is feeding. Check baby’s bottom lip and make sure the lip is flipped out and sitting on the lower part of the areola. The bottom lip should not be right under the base of the nipple. You can also help your wife by massaging or compressing the breast throughout the feed. Just don’t compress too close to baby’s mouth or you can disrupt the latch. This will help the milk move a little quicker for the baby and keep him more actively feeding. Newborns are pretty sleepy in the first week or so. Always make sure the baby feeds skin-skin and you can help keep him awake by rubbing his hands and feet. Offer to change the baby’s diaper after he finishes feeding from the first breast. This will be a good way to wake him up and then he can feed from the second breast.

Sometimes it is helpful to take a video or a screen shot of the baby breastfeeding when your wife feels the baby latched on well and there are nutritive sucks and swallows being heard. It’s also really important to know what a swallow sounds like. It is a suttle, gentle ‘KA’ sound. You won’t hear it after every suck in the first few days, but as the milk starts to come in, you should hear the baby swallow more frequently.

Well I think that about sums it up. I covered the most crucial factors related to being a superdaddy in the first few days after having a new baby. There is a lot of information in this blog that I hope you found useful and informative. Like I always say, knowledge is power. As new father’s you cannot get enough knowledge in order to be helpful and supportive to your wife and to your brand new baby. I am always available for questions or comments.

Enjoy a happy, helpful, breastfeeding journey!!!

Leanne R Rzepa RN BN IBCLC

 

Posted on March 18, 2016 .

Are Private Lactation Consultants Worth It????

Last year, the New York Times published an article about lactation consultant Freda Rosenfeld. A reader responded that the fee charged by lactation consultants is outrageous…depending on where you live, it can cost between $120 – $300+ per session.  It is wise for parents and parents-to-be to understand and evaluate what IBCLCs do and ask “Are IBCLCs worth it?” We come back with a resounding “Yes!”

Why hire an IBCLC?

Families who seek the help of an IBCLC (International Board Certified Lactation Consultant) get the gurus of breastfeeding knowledge and support. If you had a toothache, you would seek the care and advice of someone who is an expert on teeth, your dentist; if you were concerned about your heart, you’d find the most qualified, expert cardiologist. An IBCLC is an expert on breastfeeding. By finding one as you begin breastfeeding, you equip yourself with the very best support available. A strong support system can significantly help you meet your breastfeeding goals. A good IBCLC can be the key player on your A-Team.

What do you get for your money?

IBCLCs work in a wide variety of places and contexts.  Some work in hospitals just after birth and others research and further the understanding of breastfeeding.  You can also find IBCLCs in organizations that promote maternal/child health and nutrition, such as WIC.  IBCLCs are a varied group in terms of background, areas of specialty, and communication styles, but they stand firm that Babies are Born to Breastfeed.

Many moms, through the course of pregnancy and birth, find that what they need is one-on-one help when they have questions or breastfeeding seems difficult.  Private practice IBCLCs fill this role. A lactation consultant in private practice is self-employed, or she might work in partnership with one or two other IBCLCs.  While $120-$300 seems like a lot for the time required for a consultation, think of it this way:  you get years of study and experience, the full attention of an expert focused on YOU, follow up via email, phone or text, a listening ear, detailed reports for health care providers (putting everyone on the same page for your care), and someone who is required to learn, learn, learn how to support you.  Your IBCLC spends time reading research, connecting with other lactation professionals, and staying up to date on the latest methods, trends, and breastfeeding products.  Adding all that up, it’s a bargain!

Are there any IBCLC’s in my community?

Hopefully, YES! Many hospitals and organizations that support mothers recognize the expertise board-certified lactation consultants bring.  Asking your health care provider, childbirth educator, and doula about breastfeeding resources in your community can help you beat the Booby Traps!  These people can recommend IBCLCs who want to support your desire to breastfeed.

Unfortunately, some families struggle to find an IBCLC when they need one.  The CDC looks at the number of lactation consultants per capita and has found that we still have far too few IBCLCs to meet the needs of moms. Mothers have long relied on mother-to-mother breastfeeding support groups like La Leche League, which are outstanding when we have questions and seek a community of other new and experienced moms, but sometimes, the eyes and knowledge of a medical professional are necessary.

The training to become an IBCLC is rigorous. It’s a major commitment, just like the training and education any medical professional must acquire.  IBCLCs must demonstrate competence in a wide variety of subjects and in support of breastfeeding mothers and babies, either as volunteers or in paid work. Most, but not all IBCLCs have breastfed babies of their own.

The good news is, with the increased support spurred by the Surgeon General’s recent Call to Action to Support Breastfeeding, access to help should become easier.  Currently, there aren’t enough IBCLCs in every community, but more candidates will soon seek to become the kind of IBCLCs that moms need.

Are IBCLCs covered by insurance?

Getting reimbursed by insurance for in-home lactation consultations by an IBCLC depends upon the insurance company and plan.  I recently had a call from a mom who said that her insurance would cover a consult, but only with a “preferred provider.”  When we searched the database of preferred providers, the closest IBCLC on her plan was 300 miles away! Some plans cover consults and pump rentals, but there can be numerous barriers to receiving payment.  Unfortunately, many IBCLCs do not pursue insurance plan affiliation because of the difficulty in getting paid.  If a mom would like to submit a claim for insurance reimbursement, she can request a “Superbill” for submission to her insurance company.   It will be prepared by the IBCLC and clearly state the information the insurance company needs.

The fact that support services which augment breastfeeding success rates are not routinely covered by insurance is a huge public health policy concern, one the Surgeon General addressed in her Call to Action.  Ensuring appropriate compensation for IBCLCs as professionals in maternal/infant health care ensures better outcomes for mothers, babies and health care providers. Let your elected officials know if an IBCLC helped you breastfeed your baby, and that you want insurance companies to recognize the professionalism and unique competence of the IBCLC!

Are IBCLCs worth it?

If an in-home consult with an IBCLC seems expensive, consider its value alongside other things you would spend money on for your baby.  How much did you pay for your stroller?  Your highchair?  Would you be willing to pay that much for expert support? If you are feeling challenged by breastfeeding and considering giving up, consider the cost of NOT seeking professional help: artificial baby milk to feed your baby if donor milk is not available; bottles and the energy required to prepare, heat, store, and clean them;  and the statistically likely increase in healthcare costs for a baby who doesn’t receive breastmilk.  These are among the financial costs of not breastfeeding. While breastfeeding is NORMAL, the risks of not breastfeeding are significant – and expensive!

An IBCLC can be a critical player on your team.  They serve a unique and expert role in detecting and solving breastfeeding problems. Having a community of support in your breastfeeding journey can be invaluable, as well. La Leche League and other breastfeeding support groups will keep you on track and help you stay confident in the biological norm of breastfeeding. For those that qualify, WIC can be another fantastic supporter of breastfeeding.

Having experts on your side while breastfeeding your little one is one of the most valuable things you can do.  Enlisting their knowledge and support can be a win-win both for you and your baby and the community as a whole. You get an expert, an encourager, a detective, a clinician and cheerleader all rolled into one!  Strong support means strong Babes!

Did you use an IBCLC?   Was it worth it to you?

reposted from Best for Babes Foundation (February 23, 2016)

Posted on February 25, 2016 .

The Nipple Shield Controversy

Ever since I started my career as a Lactation Consultant, the controversy over the use of nipple shields has been a hotly debated topic. Some people feel that nipple shields are evil and should never be used under any circumstance. Then there are others who think they are useful when used appropriately under the guidance of an LC. I happen to fall under the latter. I am a believer in the use of nipple shields. Not only from my own personal experiences with them, but also from countless successful situations when I have used them with patients and clients alike.

For those of you aren’t so sure what a nipple shield is, it is a small thin silicone barrier that fits over the breast. The tip of it somewhat resembles that of a bottle nipple.  It can be used when a baby is having a difficult or near impossible time latching to the breast. Women with very flat, or inverted nipples may find success with getting their baby to maintain a latch and breastfeed with a nipple shield. Some premature babies who have difficulty maintaining suction at the breast can also benefit from the use of a shield. Mom’s that have an overabundant milk supply and who ‘drown’ their babies with a fast milk flow, may also benefit from using a nipple shield.  A nipple shield is always meant to be a temporary solution to a breastfeeding challenge and should always be used under the guidance of a Lactation Consultant (IBCLC).

The foundation to ensure that breastfeeding gets off to the best start possible involves getting a good latch. If a baby is not latching well to the breast, then a nipple shield is basically like a band-aid. It will ‘cover-up’ the problem, but it won’t address the issue at hand. I don’t believe that any mother should take it upon herself to try and figure out how to use of a nipple shield unless she is under the guidance and support of an IBCLC. Firstly, we like to wait until a mother’s milk has come in before offering a shield. Some studies have shown that if you introduce a shield before milk has come in, there is the potential to compromise supply. This is due to the fact that we are placing a ‘barrier’ between baby’s mouth and the breast and the stimulation to the breast is not as good.  I have yet to see this theory actually proven with myself, or with the clients I have worked with. Most of the studies conducted on the use of nipple shields, were performed many years ago when thicker, rubber shields were used. These older versions of nipple shields did inhibit supply as they were so thick that there was hardly any contact with baby and breast! Today’s shields are made with a much thinner silicone material that provides more direct contact with the breast.

Sometimes the shield can be a real pain in the butt to place on the breast. If a mother hasn’t been taught how to properly apply a shield to her breast, I usually see her just ‘place’ it on top of her nipple. This is incorrect and will only lead to frustration for both her and baby. Proper shield placement needs to be taught and demonstrated by an IBCLC. First, It needs to be almost fully inverted, then placed over the nipple, then STRETCHED out really well before creating suction onto the breast. It must get suction on the breast or it will most likely slip off. It does take some practice.....and patience.

As I have mentioned before in previous blog posts, I had a variety of breastfeeding issues with my daughters. With my first daughter, my nipples were so damaged right off the bat that I needed to use a shield within the first week of breastfeeding. I made an appointment with a Public Health Lactation Consultant to help me figure out how to overcome all the pain I was having. I’m pretty sure it was at this appointment that I was offered a shield. I also had an oversupply so it did help to slow down the flow of my milk but in hindsight, Kayla had a tongue tie that needed to be clipped (again) and the real issue of ‘getting a good latch’ wasn’t truly  addressed. Yes, the shield helped as it allowed me to breastfeed my daughter which I so desperately wanted to do. But it didn’t magically make everything better. I still had pain when I fed her, my damaged nipples weren’t totally healing, but at least they weren’t breaking down further. I was very thankful to the nurse who offered me the shield, but at the same time, I knew that I wanted to get rid of it sooner than later. But if it were not for that nipple shield, I probably wouldn't have continued breastfeeding.

When I suggest and then offer a shield to a mother, it is always with the intention of it being used short term and with the idea that she continues to offer the bare breast at the start of the feed. There is a misconception out there that women with flat nipples cannot breastfeed. This is not true as baby’s do not nipple feed…they breastfeed. With the correct shaping and support of the areola and nipple, most babies can achieve a deep and successful latch. But there are definitely some instances where a baby is not able to latch. Or they can latch on to the breast, but can’t maintain a latch due to prematurity, inverted nipples or very dense breast tissue. This is when a shield can be a good tool to use in order to help the baby stay latched on.

I am also a Lactation Consultant who will sometimes (and I stress sometimes) offer a nipple to shield to a mother before her milk comes in. I know this is fairly controversial and not a lot of people like this idea but I make this decision based on what I see happening between the mother baby dyad. I have worked with numerous moms in the early post partum period who struggle with getting their babies to latch.  I have also been doing this job for a long enough time to know pretty quickly after observing a mother try and latch her baby, if it’s going to work or become a futile effort. If I can tell that a mother is getting so frustrated to the point where she is ready to throw the towel in before her baby is even a few days old, I might make the decision to introduce a shield to provide her with some hope so that she can see there is a real chance her baby can latch and breastfeed.

In the first few days, the baby may not actually drink any colostrum through the shield as it is quite thick and flows pretty slowly. But I do believe that sustained sucking on the breast with a shield is better than nothing. If it is going to put a smile on mom’s face, and encourage her to continue putting her baby to the breast, then I feel it is an allowable thing to introduce. I always get mom to pump/hand express after feeds and offer colostrum to ensure baby is getting enough to eat. Sometimes formula is also introduced and a feeding plan is created. The bottom line is always, BABY HAS TO EAT. But if I can help make a mom’s breastfeeding journey a bit smoother by giving her the opportunity to see that her baby can latch, then a shield is a useful tool in my humble opinion.

Anytime a mother is using a nipple shield, she needs to continue pumping after most feeds to ensure that her supply is ‘protected’. The baby’s weight should also be monitored weekly to ensure that adequate weight gain is taking place. I also encourage my mom’s to use breast compression when using a shield. This involves rhythmically squeezing the breast for 5-6 seconds at a time to help the milk to flow more readily. Compression should only take place when the baby is not swallowing milk. Of course if a mom has oversupply and her milk is flowing quickly, this technique should not be used.  Yes, it is a lot of work when using a shield, but it can also be very rewarding and for some mothers, this is the only way they can get their babies to breastfeed.

There are some drawbacks to using a nipple shield. I find that when shields are being used, the amount of time it takes a baby to breastfeed can increase. Sometimes the feeds aren’t always as efficient as there is a barrier between baby and the breast (this is why breast compression comes in handy). Sometimes a baby will still require a supplement after breastfeeding with a nipple shield. If a mom has an overabundant supply and her milk flows quite quickly, this isn’t generally the case.  I find it helpful to test weigh these babies a few times weekly for a couple of weeks just to ensure they are feeding efficiently and gaining weight appropriately. This involves weighing the baby before and after she feeds to see how much milk she is drinking from the breast.

Another drawback is that some babies get quite dependent on the shield. I find this is more the case with premature babies who are usually introduced to a bottle before they get proficient with breastfeeding. These little peeps get used to a longer, harder, silicone-type feel on their palates in order to stimulate their suck reflex. Shields are used quite routinely and with much success in the NICU but these are the babies that tend to get more dependent on a shield. This is why I encourage all moms using shields to always offer the bare breast first so babies ‘remember’ what it feels like in their mouths. These babies also require more pronounced areolar shaping and nipple tipping so they feel mom’s nipple on the roof of their mouths to stimulate the suck reflex.

My babies were not premature and I used a shield with my first and third daughters (not for very long….maybe a few weeks here and there). If it weren’t for the shield I probably would not have continued breastfeeding.  Luckily, I was able to wean them off of it without any trouble and we managed to continue breastfeeding without incident.

So my advice to all you breastfeeding mommies out there is to get in touch with an Internationally Board Certified Lactation Consultant (IBCLC) sooner than later if you are experiencing any kind of latching issue. These issues are super important to figure out in the early days of breastfeeding. Sometimes a nipple shield is useful and necessary to ensure that your little one breastfeeds. Again, any time a shield is used, it needs to be under the guidance of an IBCLC and your milk supply and baby’s weight gain need to be monitored closely for the first few weeks.

I hope you have found this blog helpful and informative.  As always, I am open to questions, comments, or concerns.

Happy Breastfeeding!!!!

Leanne Rzepa RN BN IBCLC

 

Posted on February 1, 2016 .

Super Cool Breastfeeding Fact!

'According to Katie Hinde, PhD, a Biologist and Associate Professor at the Center or Evolution and Medicine at the School of Human Evolution & Social Change at Arizona State University, when a baby nurses, it creates a vacuum in which the infant's saliva sneaks into the mother's nipple. There, it is believed that mammary gland receptors interpret the "baby spit backwash" for bacteria and viruses and, if they detect something amiss (ie: the baby is sick or fighting off an infection,) her body will actually change the milk's immunological composition, tailoring it to the baby's particular pathogens by producing customized antibodies. "Putting this all together, some scientists hypothesize that this could be one of the ways babies let moms 'know' about their condition and moms respond with infection-fighting antibodies," Hinde said in an interview.'

Info taken from Leslie Goldman

I don't know about you, but I think this is super cool!!!! Our bodies are pretty incredible!!!

Leanne Rzepa RN BN IBCLC

Posted on January 19, 2016 .

Breastmilk and Your Diet

"The composition of breastmilk is relatively independent of what the mother eats, breastmilk contains hundreds of items including live cells, that will never be a part of formula and that the biochemistry of formula is entirely different from that of breastmilk. Eating "poorly" does not cause the immune factors (including the antibodies) from breastmilk, nor the stem cells, nor the prostoglandins, nor the white cells and dozens of other important ingredients to disappear from breastmilk. Proteins, sugars, fats and other nutrients in breastmilk are "high quality" no matter what the mother eats."

Dr Jack Newman.

 

A question I get asked frequently relates to breastmilk and one’s diet. A lot of women are concerned how their diet will affect the nutritional components of their breastmilk. This blog will answer how one’s diet affects breastmilk, what is needed for maintaining an ample supply of milk, and are there certain foods that should be avoided when breastfeeding.

Pregnant women usually pay very close attention to their diet since every food, drink, and medication ingestedmay make its way to the developing baby. Fortunately, this is not exactly the case with breastmilk.

Breastmilk is produced from the mammary glands in your breasts, not directly from the substances you ingest (Yay!!) These glands draw on the resources available in the form of nutrients from your diet and from your body’s stores of nutrients. Luckily Mother Nature is quite forgiving. A mother’s milk is designed to provide for and protect the baby even in times of hardship and famine. If your diet contains insufficient calories or nutrients to sustain both you and your baby, your mammary glands will have “first shot” at your body’s available nutrients to produce highly nutritious breastmilk, leaving you to rely on whatever is left over (not always the greatest thing for mom). So a less-than-ideal diet will probably not affect your breastfeeding baby, but it may leave your body at nutritional risk.

According to Katherine A. Dettwyler, Ph.D., breastfeeding researcher and anthropologist, women throughout the world make ample amounts of quality milk while eating diets composed almost entirely of rice (or millet or sorghum) with a tiny amount of vegetables and occasional meat. I tell my clients all the time when they ask me about their diet and breastmilk production that for centuries, women in third world countries have survived on a bare-minimun diet, and still seem to find a way to produce and provide nutritionally balanced breastmilk for their infants.

The breasts are actually very smart. The mammary glands and cells that produce milk also help to regulate how much of what you eat and drink actually reaches your baby. Moderate consumption of caffeinated beverages, and occasional glass of wine or other alcoholic beverage are fine when you are breastfeeding. However, some babies are more sensitive than others, so keep a close eye on your baby and see if she is acting any differently after consuming certain foods/beverages.

So what is needed for maintaining an ample supply of milk? The main thing needed is quite simple. It’s called supply and demand. The more often and effectively your baby breastfeeds, the more milk you will have. An exclusively breastfeeding mother, on average, needs to take in 300-500 calories/day above what was needed to maintain her pre-pregnancy weight. Since the recommended added calories during the last 2 trimesters of pregnancy is 300 calories/day, an exclusively breastfeeding mother will typically need either the same amountof calories she was getting at the end of pregnancy, or up to 200 additional calories/day. That’s not very much. It is basically equivalent to an additional1-2 healthy snacks per day.

 The main message when it comes to calorie and fluid intake is to eat when hungry and drink when thirsty. When exclusively nursing a new baby, it is very common to feel hungry a lot of the time. I remember while nursing my last daughter Maya, that sometimes in the middle of the night I would feel so ravenous that I would send my husband downstairs to bring me a protein bar or a sandwich. You may also feel hungrier when your older baby goes through a growth spurt and temporarily wants to feed more frequently. Bottom line....listen to your body!!!  Oh.....BTW, drinking more milk does not help your body make more breastmilk and vitamin and mineral supplements are not considered necessary if you are eating a reasonably well balanced diet. Your fat intake does not affect the amount of fat in your milk, but can affect the kinds of fats (balance of good vs. bad fats) in your milk to some extent. I will delve into this a little deeper in a bit.

If you really want (or need) to count calories, studies show that most healthy women maintain an abundant milk supply while taking in 1800-2200 calories per/day. Consuming less than 1500-1800 calories per day, may put your milk supply at risk, as may a sudden drop in caloric intake. A mother’s “baseline” need for calories depends on her activity level, weight, and nutritional status. A mother who is less active, has more fat stores, and/or eats foods higher in nutritional value may need fewer calories than a mom who is more active, has fewer fat stores, and/or eats more processed foods.

It is not necessary to force down extra fluids either while breastfeeding. Again, drink to satisfy thirst.  Breastfeeding mothers are sometimes warned that “Only water counts!” when it comes to fluid intake, but this simply doesn’t make sense. You body can utilize water from many other sources, including vegetables, fruit, soup, water, fruit and vegetable juices, milk, tea and other beverages. The food you ingest accounts for about one-fifth of total fluid intake. Some fluids are certainly more nutritious than others, but even soda will provide fluids you need (but may also provide you with other things you don’t like extra sugar and caffeine!)

Let’s have a discussion about fat in breastmilk as it is a highly talked about topic. The average calorie content of human milk is 22kcal/oz. Caloric content varies widely throughout each feeding and the day. This is actually due to changing fat content. The amount of fat in human milk also changes dramatically during each feeding and throughout the day. Since fat content depends on the degree of emptiness of the breast (empty breast= creamier, fattier milk, full breast=lower fat content. The average fat content of human milk is 1.2 grams/oz.

So what affects the amount of fat in your breastmilk? The research tells us that a mother’s diet does not affect the average amount of fat or calories in her milk. However, a mom can change the types of fat in her milk by altering the types of fats that she eats (Lawrence 1999, p.106-113, 300-305; Hamosh 1996, Hamosh 1991, p.123-124). An increase in one fatty acid could generally be expected to occur concurrently with a decrease in another. For example, one study has shown that black mothers in South Africa who eat a traditional maize diet have less monounsaturated fatty acid in their milk than urban mothers who consumed more animal proteins and fats (van der Westhuyzen 1988). The degree of emptiness of the breast is what research has shown to drive breastmilk fat content, and thus calorie content. The fuller the breast, the lower the fat content of the milk; The emptier the breast, the higher the fat content (Daly 1993). I use this very interesting fact as a teachable moment with almost all my clients. A lot of moms get worried when their initially very-full-breasts suddenly become soft most of the time, they fear something has happened to their milk supply. I reassure them that as long as their baby continues to gain weight and settle after feeds, that soft breasts are a good thing......because they contain creamier, fattier milk. Another quick little tip is that breast compression (while breastfeeding) has been shown to increase fat content of milk (Stutte 1988). This is another one of my favourite teachable moments. Almost all my clients are taught and encouraged to do breast compression in the first few weeks after delivery.

 Are there certain foods that should be avoided while breastfeeding? To answer that question simply....NO. There are no foods that a mother should avoid simply because she is breastfeeding. It is generally recommended that you eat whatever you like, whenever you like, in the amounts you like and continue to do so unless you notice an obvious reaction in your baby to a particular food. There is no list of banned foods for breastfeeding women.  Even foods that are known to be gas causing have no more potential to affect your baby than other foods. Eating certain foods may cause gas in mom due to the normal breakdown of some undigested carbs (sugar, starches, soluble fiber) by bacteria in the large intestine. However, breastmilk is made from what passes into mom’s blood, not what is in her stomach or digestive tract. Neither gas nor the undigested carbohydrates (whose breakdown can cause gas in mom) pass into the mother’s blood. So it is impossible for these things to pass into your milk to make your baby gassy.

 But.....I know there is always a but. An unhealthy diet often means unhealthy gut, which is irritated and lacking in the healthy bacteria it needs to function optimally. I do believe the health of your digestive tract is tied closely to the health of your baby’s gut, which has lifelong implications. The better the health of your gut, the more effectively you are digesting all the food you take in and the fewer irritating proteins you pass through your bloodstream to your breastmilk. Your baby benefits from the greater availability of nutrients, less irritation in his digestive tract, and a variety of components that support normal development of his digestive system.

That about sums it up for this edition of ‘Let’s Nourish Our Babies: A Breastfeeding Blog’. I hope you found this blog helpful and informative. I am always happy to answer any of your breastfeeding related  questions or concerns. Knowledge is power and I hope I have been able to share a little more knowledge with you today in order to make your breastfeeding journey the best it can be!!!

Happy Breastfeeding and Happy Eating!!!!

Leanne R Rzepa RN BN IBCLC

Posted on January 17, 2016 .

Breastfeeding and Exercise

As a Lactation Consultant I get asked all kinds of breastfeeding related questions. I would have to say the one question that comes up most frequently relates to breastfeeding and exercise. Most new mother’s can hardly wait to get back to the gym once their Doctor has given them the thumbs up at their 6 week post-partum check-up. As women we naturally put (unnecessary) pressure on ourselves to get back into our pre-baby skinny jeans as fast as humanly possible. I am too guilty of this phenomenon.  With all 3 of my daughters I’m pretty sure (but can’t remember 100%) that I started going back to the gym or running even before I got the ok from my Obstetrician. I knew that breastfeeding was helping to shed a LOT of those pounds gained during pregnancy by keeping my metabolism revved up........ but I wanted to help it out a little more!! The average woman burns an additional 300-500 calories/day just by producing breastmilk for her baby. That’s like doing half a spin class....without actually having to get on a bike!!!  

But what are the effects of exercise on breastmilk? Does exercise affect your milk supply? Does exercising change the taste of your breastmilk? These are some of the questions this blog will answer.

It has been widely researched and documented that moderate exercise while breastfeeding improves your health in a variety of ways. Exercise has positive effects on your emotional well-being thanks to all those lovely endorphins that circulate through your system while your heart rate increases. Breastfeeding women have improved lipid profiles and better insulin response while exercising. Women report feeling less stressed, have an enhanced maternal infant relationship, and if they are having symptoms of post-partum depression, those symptoms are often alleviated with exercise.

So does exercising while breastfeeding impact ones milk supply? I have worked with a number of clients who felt that once they returned to the gym, their supply went down. Research shows that moderate exercise, and by moderate, I mean not pushing yourself to 100% exhaustion, has no negative effect on milk supply, milk composition, or baby’s growth.

Based on the numerous studies I have read, I believe it is not exercise itself that effects supply, but perhaps the ‘taste’ of the milk is altered slightly due to a metabolic bi-product of exercising called Lactic Acid. Perhaps it is this altered taste of the breastmilk that bothers the baby and prevents proper drainage of the breast, which over time, could lead to a decrease in milk supply. My theory would only hold true for those breastfeeding women who are pushing themselves to exhaustion while exercising. If you fall into the moderately exercising category, the lactic-acid build-up is not enough to alter the taste of your milk.  I am not a researcher by any stretch of the imagination. I am merely hypothesizing based on my own personal observations of clients who have noticed a decrease in their supply after resuming ‘vigorous’ exercise. Most of the literature does not support my observations but I don’t think it is fair to rule out lactic acid as a contributing factor to changes in breastfeeding patterns if mom has recently started exercising again.

Now let’s take a closer look at what the literature tells us:

There have been a couple of studies over the years related to the presence of Lactic Acid in breastmilk post-exercise. Research has not shown a noticeable increase in lactic-acid build-up after moderate exercise (50%-75%) intensity. BUT, the Lactic acid in breastmilk does increase somewhat if the mother exercises to maximum (100%) intensity, also described as exhaustive exercise. I don’t know about you, but I’m pretty sure those first few months back at the gym, I was feeling pretty exhausted after my work-outs. I couldn’t run the same distances, my core was a total mess, and my overall ‘strength’ was practically non-existent. I know I pushed myself pretty hard and probably had a fair bit of lactic acid build-up in my milk. I was also blessed (and sometimes cursed) with an abundant milk supply. So I’m sure that’s what saved my supply from decreasing, but I do remember times when my girls refused to breastfeed after I returned home from the gym or from a run. I’m pretty sure it was the lactic acid altering the taste of my milk that my girls were not fond of.  Lactic acid may be present in the breastmilk for up to 90 minutes post-exercise but there are no known harmful effects for the baby.

So does this mean that your baby will refuse to breastfeed after a vigorous work-out?  Most studies have found no difference in acceptance of the breast even after a maximum intensity work-out. There was a highly publicized study in 1992 that indicated a baby might fuss or refuse expressed milk from a mom who had been exercising at 100% intensity. The results of this study were questionable because these breastfed babies were actually fed breastmilk from a medicine dropper. No wonder they acted strangely when being fed their mother’s breastmilk...they were being fed in an unfamiliar way. In addition, these mothers reported that the babies had not had any feeding problems post-exercise to begin with. A more recent study showed no change in infants’ acceptance of mom’s milk an hour after exercise, even for the moms who exercised at a maximum intensity (and did have a slight increase in lactic acid in their milk. Bottom line is, it is safe to breastfeed even after a vigorous work-out. The milk may be slightly altered in taste but MOST babies will not refuse the breast.

If your baby is one of those few who refuses the breast after you get home from the gym, it could be for a variety of other reasons. Most likely when you get home from your work-out, you are going to be a sweaty hot mess (I know I always was...and still am today when I workout). If you decide to feed your baby before you have a shower or wipe off your breasts, there is a good chance your little one will refuse to breastfeed because you taste salty...and probably smell a little different too.  So remember to have a quick rinse before you decide to latch baby on!!! But if your baby consistently refuses to breastfeed after you exercise, he may be a bit more sensitive to the taste of lactic acid in the milk. Don’t worry about this....lactic acid in the breastmilk is safe for your baby to consume. Nothing bad is going to happen!!

You could consider doing the following:

  • Express 10-15mls of milk from each breast before feeding baby
  • Delay feeding baby for 30 minutes or so to allow lactic acid levels to subside
  • And/or try decreasing workout intensity levels.....try being the optimal word here

Some other suggestions for when you resume your work-out regime are the following:

  • Pump or breastfeed the baby right before you exercise
  • Wear a good, supportive bra (with no underwire) while exercising
  • If you regularly lift heavy weights or do other exercises involving repetitive arm movements (Tracy Anderson Method) you may be more at risk for developing plugged ducts
  • Keep well hydrated before, during, and after you exercise!!!!

So how about the effect of exercise on immunologic factors in breastmilk? The immune factor that gets mentioned the most when it comes to exercise and breastmilk is IgA.  Basically, immune factors protect a baby from becoming ill.  IgA is the antibody that protects our mucous membranes from being infiltrated by bacteria and viruses. It is the most common antibody found in breastmilk. A few small studies have shown that there is no difference in immunologic factors after moderate exercise, but that IgA levels are decreased short-term after exhaustive exercise. ‘Most’ breastfeeding mothers do not exercise to exhaustion, but for those that do so and breastfeed soon after, a decrease in IgA levels in one feeding per day are unlikely to be significant.

In 1997, a study by Gregory et al found that IgA levels in breastmilk were decreased for a short period of time (10-30 minutes) after mom had exercised strenuously, but that levels had returned to normal within an hour. They also observed that IgA levels increased after the breast had been emptied, whether or not mom had been exercising strenuously. In 2003, Lovelady et al looked at immunologic factors (IgA, lactoferrin, lysozyme) in breastmilk after moderate exercise and found no difference in the milk of exercising and non-exercising mothers. So there you have it, straight from the experts..... going to the gym and getting your sweat on is not going to alter the important immunologic components of your precious milk!!!!

I think that about sums it up. I hope the information shared was helpful and informative. As always, please feel free to contact me with any questions, concerns, or comments. Happy Breastfeeding and Happy Exercising!!!!

Warmly,

 Leanne Rzepa RN BN IBCLC

 

Posted on December 16, 2015 .

Let's Have a Chat About Hormones

I think most of us are aware that hormones play a major role in breast milk production and supply. But I’m not sure how many women know the actual importance and effects these hormones have on our bodies throughout pregnancy and lactation. Hormones start drastically increasing once conception takes place and the changes to our breasts are often the first tell-tale sign of pregnancy. This blog will highlight which hormones effect the changes to our breasts during pregnancy and lactation. I'm not going to go into too much depth physiologically speaking as I want to try and keep this blog as reader-friendly to the general mommy population who may not have a medical/nursing background.

 Estrogen and Progesterone are the 2 main hormones that cause changes to the breasts during pregnancy. Estrogen levels increase during the pregnancy, which stimulates the milk duct system to grow and become specific for milk production. Once the baby is delivered, there is a drop in estrogen levels and the body knows that it is time to start building a milk supply.

 Progesterone levels increase during pregnancy and influence the growth of the alveoli and lobes of the breast. It is also this high level of progesterone that inhibits lactation from taking place during pregnancy. Progesterone levels drop drastically once the baby is delivered and the placenta is removed triggering the body to start making milk. If a woman has any retained placental fragments, her milk supply will suffer. This is due to the powerful inhibiting influence of progesterone on prolactin (Neifert, McDonough, & Neville, 1981).

 Another important hormone that is often overlooked is called Human Placental Lactogen. It is released in large amounts by the placenta and appears to be important in breast, nipple, and areolar growth before birth. This level also drops after delivery of the placenta and promotes the action of prolactin.

 A question that I get asked quite regularly is, “Will my milk come in?” My answer to this question is always, “Yes, it will. Give your body time to do what it is designed to do.” The reason for this, was stated in the above regarding estrogen and progesterone (endocrine control or hormone driven). Once that placenta is removed, your body knows to start working on making milk. Women who choose not to breastfeed still produce breastmilk because in the first few days after delivery, milk production is driven by the changes in hormone levels after the placenta is removed. It’s once the milk has come in (and yes, sometimes it can be delayed in coming in for varying reasons) it has to be removed effectively every 2-3 hours around the clock in order for the body to keep producing more. This shift is to ‘autocrine control’ and is milk-removal driven (Prentice et al., 1989)

 Prolactin is probably the most important hormone when it comes to breast milk production/supply. During pregnancy, a steady rise in prolactin prepares the breasts for lactation (Neville, 1983). After delivery of the placenta, progesterone levels drop and prolactin levels start to rise. Prolactin levels rise in response to the baby suckling at the breast and peak approximately 45 minutes after the feeding is over. Prolactin levels tend to be at their highest between the hours of 2am and 6am. This is generally why our sweet little daytime angel babies are serious party animals in the middle of the night. Babies biologically know that if they feed more during the night, they will help their mother’s make more milk and in turn be able to take in more calories. This nighttime feeding frenzy usually leads to fuller, heavier breasts in the morning hours. Prolactin levels are at their lowest when the breast is full. So in order to keep up with good milk production, you must regularly feed your baby and ensure good drainage of both sides. 

 A few other interesting facts about prolactin that I came across are the following:

  •   Prolactin levels rise in response to anxiety and psychological stress ( Hill, Chatterton, & Aldag, 1999)
  •  Mother’s that suffer from depression have lower serum prolactin levels (Groer, 2005b).
  • Prolactin levels drop with cigarette smoking (Baron et al., 1986) and rise with beer drinking (Mennelle & Beauchamp, 1993)

 Oxytocin is a hormone that when released during labor causes the uterus to contract. During breastfeeding, oxytocin is responsible for the milk-ejection reflex, otherwise known as the let-down reflex. It causes the smooth muscle layer surrounding the alveoli to squeeze milk into the ductal system. Some women can actually feel their milk let-down. It is often described as a rushing sensation, or pins and needles throughout the breast. Being able to feel your let-down is not an indicator one way or another of adequate milk supply. Sometimes, a let-down can happen without the presence of the baby suckling at the breast. Sometimes just hearing a baby cry, or even thinking about your little one, can cause your breasts to start leaking milk. Another thing to note is that when you are breastfeeding, you may feel your uterus contracting……and it is!! Just as oxytocin causes the uterus to contract during labor, it also causes the smooth muscle of the uterus to contract while breastfeeding especially during the first week post-partum when the uterus is shrinking back to pre-pregnancy size. This happens to be one of the many benefits of breastfeeding. If these contractions are painful, try taking an anti-inflammatory like motrin or advil approx 30 minutes before a feeding is to start or lacing a heating pad or warm blanket over your belly.

 Here are some interesting facts about milk let-down as reported by La Leche League International:

·         On average 75% of mothers have more than one let-down during a feeding. (From my own experience, the average is 2-3 let-downs per/side.

·         Women have on average 2.2 let-downs per breast at each feeding. (My experience seems to be pretty close to the research!!!)

·         The more let-downs a woman has, the more milk her baby receives

·         Babies receive on average slightly more than one ounce (35ml) of milk per let-down

·         About 30% of mother’s don’t feel any let-down occurring, and most mothers don’t feel the subsequent let-down after the first

 Another interesting fact that I have no supporting research to back is that most mothers produce more milk in their right breasts. The milk seems to flow a little faster from the right breast and the right side is usually the preferred breast for most babies. I would say that 90% of the breastfeeding women I have ever worked with made more milk on their right sides. Some have speculated that most people are right-side dominant. This didn’t hold true for myself personally as I am left-handed and always made more milk on my right side. I really have no idea why this is!!!!

 So there you have it!! All you ever wanted to know about hormones and breastfeeding! I hope you have found this blog post interesting and informative. Please feel free to comment or contact me at anytime with additional questions or concerns.

Happy Breastfeeding!!!

 

Leanne Rzepa RN BN IBCLC

Posted on November 15, 2015 .

I Know This Much is True Part 2

I’m sure you have all been in suspense wondering what else I could have possibly endured as a breastfeeding mother after reading part 1. Well I assure you, there is more to share.

This blog will hi-lite the following 3 challenges:

#1) Raynaud’s Phenomenon

#2) Bottle Refusal

#3) The Boobie-Bob

Raynaud’s Phenomenon....What happened then: I would have to honestly say that my most painful breastfeeding experiences involved my first daughter, Kayla. As a new and inexperienced mother, I really struggled the first 6 weeks and literally seemed to have every breastfeeding issue under the sun. Despite my challenges, Kayla was a happy and healthy baby. She was getting lots to eat, napping very well during the day, and started sleeping through the night at 6 weeks of age. On paper, all should have been a breeze, but my poor breasts were taking a beating.

The pain associated with Raynaud’s of the breast can be difficult to distinguish from other sources of nipple/breast pain. Quite commonly, Raynaud’s is mistaken for a yeast infection and treated as such. Unfortunately, diflucan and canestan are not the cure for this issue. My fiery relationship with Raynaud’s started at approx 2 weeks post-partum. I can’t exactly say when I noticed the nipple pain changing as I had pretty much experienced pain since day 1, but I can definitely remember that the pain now felt different from just ‘damaged nipple pain’. The pain I started experiencing didn’t happen right after I was done feeding. It took a minute or two to set-in, and when it did, it was excruciating. It was a deep stabbing pain that started in my breasts but also radiated all the way around into my back. It truly felt like nerve pain and I could hardly stand it. Then I started to notice that my nipple was turning white while this pain was radiating through my body. “What the heck is going on?” I thought to myself. And that’s basically where it ended for me. I knew there was something wrong and I knew this pain wasn’t normal. I just assumed it had something to do with the way Kayla was latching and figured it would eventually get better. Eventually it did, but I never knew what I had until years later.

 Raynaud’s........What I know now: Raynaud’s phenomenon of the nipple is usually caused by a poor latch. A poorly latched baby will spend most of her time compressing the nipple on the hard palate leading to eventual vasospasm (constriction of the blood vessels). It is the vasospasm that causes a color change in the nipple. Often the nipple will turn white after feeding but sometimes can turn red or blue. This is extremely painful and can be described as a burning or shooting pain in the breast that can radiate into the back. First and foremost, the latch should be corrected. If the vasospasm doesn’t go away after correction, a few other comfort measures can be taken. #1) Pectoralis muscle stretches before a feed help to increase blood flow to the breast area thereby decreasing the likelihood of a vasospasm. I usually have moms do these stretches in the frame of a door. #2) Applying heat to the center of the back during breastfeeding helps to ‘calm down the nerves’ that innervate from the breast into the back. A magic bag or heating pad work very well to achieve this. #3) Covering up the breasts or applying heat to the breasts as soon as the feed is over helps to reduce vasospasm. If these treatments fail, sometimes Nifedipine 30 mg long acting tablet once a day for two weeks is prescribed (calcium channel blocker, used in high blood pressure).

Bottle Refusal....What happened then: I’m not going to spend too much time on this topic because as a Lactation Consultant I am not an advocate of bottlefeeding. But as a busy working mother, I know that for a lot of families, bottles are a reality. With my first daughter Kayla, I gave her an occasional bottle every once in a while the first 2 weeks. Then I stopped altogether and decided again around 6 weeks to try bottlefeeding again. By that time it was too late. She would have nothing to do with any type of nipple I tried and I literally bought every bottle out there in hopes that she would drink my pumped milk that was quickly filling up my freezer!! I tried every trick that was suggested. I left the house, I had my husband, my brother, my sister, and my mother offer her the bottle but to no avail. I tried waiting until she was starving to finally cave into the silly silicone device that was being shoved into her tiny little mouth. But she was too smart for any of that nonsense and refused every single time. So I really couldn’t be away from her for more than 3-4 hours for the first 6 months. It wasn’t easy for me but especially stressful for anybody that I would leave to watch her. If she got hungry, there was nothing that could be done until I returned home. So with my second and third babies I basically combined fed them right from the beginning. My second daughter Alyssa, was small for gestational age and required supplementation right from the start. I continued breastfeeding and bottlefeeding her until she weaned herself at 9 months of age. (Side note: I do think that her early weaning and early introduction of bottles are related) Maya, my third daughter was also combo fed but I waited until she was a few weeks old before I started giving her the occasional bottle of pumped milk. She transitioned nicely from breast-bottle and I nursed her until she was 13 months old.

 Bottle Refusal........What I know now: If you would like your baby to have the occasional bottle (of pumped breast milk of course), don’t wait more than 4-6 weeks to introduce it. After that time, most babies will refuse to feed from an artificial nipple. It doesn’t matter if it’s Dad, or Grandma, or the babysitter giving the bottle, most of the time it is not going to happen!!! The reason for this is that babies are very very smart. The way they suck on a bottle nipple is very different from the way they suck at the breast. They coordinate their jaw muscles, ligaments, and tongue very differently. It frustrates them when we change up their feeding routine so most of them flat-out refuse.  I have worked with quite a few clients who want my help with introducing a bottle to their older babies. Most of the time, it doesn’t happen and I spend time counselling them on why it won’t work and we end up having the discussion around introducing a ‘sippy cup’. If the infant is closer to 4 months of age, I say forget the bottle idea altogether and start working with the cup. Most babies at 4-6 months of age are ready for the sippy!

The Boobie Bob.....What happened then: This little phenomenon occurred with my middle daughter Alyssa, and then again with my third daughter Maya. I call this section the boobie-bob, because they would bob on and off the breast like little birds.  There were times when I was pretty sure the girls were hungry so I would try to breastfeed but they would just latch on, then pop off and cry. Latch on, then pop off and cry. I would get super frustrated and stressed out because I was positive they needed to eat but for some reason just would not stay latched onto the breast. So this little battle would persist for 10-15 minutes at a time. Sometimes it would end with them feeding, other times it would not. Bottom line, it really frustrated me and I’m pretty sure my girls could sense my frustration too.

 

The Boobie Bob.....What I know now: The Boobie bob is your babies was of saying “Mom, I know that sucking is soothing and I am tired and want to use your nipple to soothe, but I really don’t want to eat at the moment.” That is why they bob. They want to suck to help them settle but if they sense that the milk is starting to flow, they will pop off and get mad because they aren’t hungry. Most babies for the first few months can only stay awake for approximately one hour. Quite often the cues a baby shows when they are hungry are the same they show when they are sleepy. So most moms assume if baby is rooting and putting her hands in her mouth that she must be hungry and needs to feed again. Yes, sometimes she is especially if it’s growth spurt time. But most of the time, if she has just fed within the hour, and she is acting hungry again, it’s because she’s tired and she wants to pacify in order to fall asleep. I always tell my moms, “When in doubt, offer the breast”. If baby is acting hungry, then always try the breast first. But if you latch baby on and she starts to bob and it becomes a battle to keep her there, she’s not hungry. So now would be the time to help her settle for a nap without using your breast as a pacifier. I suggest, rocking, swaddling, having her suck on your finger, or passing to daddy for a little cuddle time. If I had known this when I was breastfeeding, I would not have gotten so flustered and frustrated when my babies refused to breastfeed. But as mother’s we are always worried if baby is getting enough to eat or what is wrong with them if they don’t calm down and settle nicely after they have fed.  I see this issue a lot with my clients and know how utterly frustrating it can be. I am happy that I can share my own experiences and knowledge with them in order to make their breastfeeding journey as enjoyable and stress-free as possible. I’ll say it again as I have said it before......KNOWLEDGE IS POWER!!!!!

That concludes part 2 of ‘I Know This Much Is True’. I hope you have enjoyed reading it and again, please feel free to comment or contact me with any questions.

Happy Breastfeeding!!!

Leanne Rzepa RN BN IBCLC

 

 

 

Posted on October 25, 2015 .

Nourish is Opening a Clinic!!!!!

After 8 years of offering in-home Breastfeeding Support, Nourish Consulting is thrilled to be opening it's Clinic doors this Friday October 9th, 2015. The Clinic will be operating out of the Lifemark Physio office located in the Southland Leisure Centre (2000 Southland Drive SW). Hours of operation will be Fridays 10am-6pm. At some point in the near future, we will open up another clinic day during the week and possibly one during the weekend. Consults will be offered on a drop-in basis for the time being. Visits are typically 1 hour-1.5 hours in length. The cost of a consult is $100.00. We accept cash, cheque, and e-transfer. Credit card payments are in the works!! As with in-home consults, if you have an employer paid benefit plan, submit your invoice, sometimes a portion of the consult or even the entire consult is reimbursed.

Clinic consults will operate the same as in-home support visits. A detailed history will be taken at the beginning of the consult. The baby will be weighed before the feeding takes place, and if necessary, a post-feed weight will be done as well. A detailed feeding plan will be documented and provided for you at the end of the consult. If you have any additional questions or concerns, we are always available by phone or e-mail support at no additional charge.

I am also pleased to share that I am partnering with my sister Abbie Ksienski in this new venture. Abbie is also an RN BN IBCLC. She has extensive knowledge and experience working with post-partum mothers in the hospital and public health setting. I know she will be a very valuable addition to the Nourish Consulting team. I look forward to having you all meet her in the clinic!!!

Please come see us this Friday October 9th, 2015. We are happy to have you drop-in, see the clinic, ask questions, and have a cupcake on us!!!

Please share this info with all your friends and family members who are breastfeeding or planning to breastfeed!!

Thank you all so so much for your support over the past 8 years. We look forward to many more years of successful, happy Breastfeeding journeys.

                                                                                                                         

Posted on October 4, 2015 .

I KNOW THIS MUCH IS TRUE: PART ONE

I have stated regularly in my previous blogs that knowledge is power. I firmly believe this statement to be true, especially when it relates to breastfeeding. The more we know, the better equipped we are to navigate through the bumpy, yet extremely rewarding journey of breastfeeding.  

So basically...I am a Powerhouse of Knowledge when it comes to breastfeeding.  I’m not trying to brag or ‘toot-my own-horn’ but as I was sitting at my desk trying to think of a topic to blog about, I started to recall all the tumultuous experiencesI had while breastfeeding, and how those experiences have helped shape the type of Lactation Consultant I am today. I made a list of all the issues and challenges I had when breastfeeding my 3 daughters.....and it’s bittersweet to report the list is a long one!!!!! I say bittersweet because, if I knew then, what I know now, I may have saved myself a lot of tears and perhaps many sleepless nights. But at the same time, if I hadn’t had just about every single breastfeeding issue imaginable, I probably wouldn’t be able to relate so well to my patients today. 

A bit of historical information for you:  I was a full-time post-partum nurse for 3 years before giving birth to my first daughter in 2003. I had worked a LOT with breastfeeding women and by the time I had my daughter, I thought I was pretty well prepared when it came to feeding my baby. Was I ever wrong!!! Same thing happened with baby #2 in 2005, and then again with baby #3 in 2009. I had been certified as an IBCLC in 2007. You’d think by 2009, I would have been able to figure out breastfeeding!! Sure I was more experienced and a bit more relaxed, but when you are on the other side of the hospital bed, your brain can turn to mush and you literally second-guess yourself on everything you thought you knew so well.

So I’m sure you are all dying to hear my list!! So here it goes in no particular order....well maybe from my worst nightmare to bad dream........

1.       Tongue ties in 2/3 daughters

2.       OAMER (Overactive Milk Ejection Reflex)

3.       Yeast infection (of the breasts my friends)

4.       Raynaud’s phenomenon

5.       Bottle refusal (with my first daughter.....and yes, some Lactation Consultants choose to give their babies a bottle.....but only pumped breast milk)

6.       The Booby Bob (I will elaborate on this later)

Tongue Ties, What Happened Then:  After I gave birth to my first daughter in 2003, I quickly found out that breastfeeding was not as enjoyable as I thought it was going to be. I had so much pain every time she latched on, yet everyone told me her latch looked perfect. Finally, on day 2 in the hospital, the Pediatrician decided that Kayla had a tongue-tie and would snip it. Yay!! Finally I thought breastfeeding would be on the up-and up. Unfortunately, the frenotomy didn’t really make a difference and I still had a LOT of pain which eventually developed into damaged, blistered, bleeding nipples and one very sad, sore mommy.  Within a few days of being home from the hospital, I was using a nipple shield and basically cringed every time I had to feed my hungry little baby. The damage wasn’t getting better and the condition of my breasts was only getting worse. I remember my husband telling me to just quit breastfeeding. I think I must have been a mess at that point because I remember yelling at him through reddened , tear stained eyes saying, “I HAVE NEVER QUIT AT ANYTHING, NOT GOING TO HAPPEN NOW BUDDY! “ I endured this hell for 6 weeks before things started to turn around.

Tongue Tie Saga Part 2 With Baby #3. Maya was a great little feeder and I definitely had the latch perfected yet I was still having nipple pain. Not with every feed, but with most. My nipples were getting damaged again and I was back to using the shield and compound nipple cream (saving grace...more on this when I get to challenge #3) Never once did I think my baby had a tongue tie. My Family Doctor had examined her and so did the Public Health Nurse. Nobody said boo about her tongue. Eventually things got better with her. My nipples healed, I eliminated the shield, and we went on our merry breastfeeding way.

Tongue Ties.....What I Know Now: So, my oldest daughter is 12.5 years old, my middle daughter is almost 10, and my baby is turning 6 next week. It has only been in the last 5 years that my knowledge and experience related to tongue ties has expanded. I owe most of this credit to Dr Cynthia Landy who has taught me so much when it comes to anterior and posterior tongue ties. I know there are numerous functions the tongue needs to perform besides passing the lower gum line. Now that I have had more than enough time to reflect back on what happened with my first daughter, I realized her anterior tongue tie got ‘kinda’ clipped, but there was still a very tight posterior tie that was never released. With my third daughter, she also had an anterior/posterior combo that was never identified.  If it hadn’t been for my more than abundant milk supply, I’m pretty sure I would have quit breastfeeding after one week with both babies.  If I knew that by sweeping under the tongue with a finger and actually looking under my daughter’s tongues, I would have been able to prevent so much unnecessary trauma and damage, I would have another baby all over again!! Well maybe that’s exaggerating a little. The bottom line is, I know a lot more now than I did then. I know that in the past 5 years I have been able to diagnose and properly manage tons of tongue ties, saving many mother’s from needless tears and pain this breastfeeding issue can cause.

OAMER, What Happened Then: A blessing or a curse? I haven’t fully chosen my side of the fence on this issue.  I produced a lot of milk with all my babies. I had my freezer loaded with bags of frozen milk. I would have been the milk bank’s best donor if we had one back when I was breastfeeding. But, I also choked my babies and drowned them with my fast-let down and caused (my middle daughter especially) to vomit after almost every feeding which appeared to be all the milk I had just fed her. I thought it was normal, and kind of cool to be able to pump 200mls of breastmilk after having just breastfed. Nobody told me not to pump like a crazy woman. Nobody told me there were ways to manage this issue. But at the same time, I honestly don’t remember asking for help!! I just thought this is how it’s supposed to be right? Wrong!!!

I also attribute my ‘lack of knowing what to do back then’ to the fact that I was a very young mother. I had my first daughter when I was 24 years old. None of my other friends were having babies at the time so I didn’t really have anyone to talk to about my breastfeeding problems.  I am also the kind of person who likes a challenge and will try to figure it out on my own, even if it meanssubjecting myself to pain and torture (as my training partner at the gym can vouch for today)

OAMER.....What I Know Now: Overactive anything is never a good thing. Same goes for having an overactive milk ejection reflex (especially when your baby has a tongue tie).  Now I know that there are fabulous ways to manage this issue. You can block feed (sorry Dr Jack Newman, I recommend it all the time and it seems to be quite effective). Block feeding means limiting baby to one breast per feeding for a 2 hour window. Leaning back while feeding, letting your milk spray or drip after it lets-down....and not blocking it up with your hand. Frequent burping, and sometimes just expressing off some of the fore-milk can help  prevent baby from getting overly gassy. By using these management techniques, the supply usually starts to ‘calm’ down within a few weeks.  So simple, yet so effective.

Yeast infection, What Happened Then:  Remember when I mentioned my bleeding, cracked, sore damaged nipples with my first daughter? Well after a few weeks of breastfeeding , all that lovlieness eventually turned into a raging yeast infection......but I had no idea what the heck was going on. I just thought my breasts hurt because they were damaged from my little monster baby. Anything that touched my breasts made me cringe. My clothes, my bra, my breast pads, even the water pressure from the shower was too much to handle. I remember walking in the mall with my mom one day and saying to her “I didn’t know breastfeeding was supposed to hurt so much!” I can’t remember for certain, but I must have been 4-5 weeks post-partum at the time.  It was at this point I went to see my Family MD who thought it could be a yeast infection, but wasn’t sure. She told me to buy some Canestan cream and put it on my nipples. She also referred me to be seen by Dr Evelyn Jain (a MD who specializes in breastfeeding medicine) It took me a week or so to get into her clinic, but once I was there, I knew everything was about to turn around. Dr Jain looked at my nipples and handed me a little piece of paper that truly changed my breastfeeding experience from torturous to enjoyable for the first time in almost 6 weeks!! She gave me a prescription for compound nipple cream. This compound is a 1:1 mixture of fucidin (anti-bacterial) and clotrimazole (anti-fungal). I was to put this cream on my nipples after every feeding and not wash it off. Within a few days of using it, my nipples were healing, and felt so much better. I started to feel like my happy breastfeeding journey had finally begun!!!

Yeast Infection..... What I Know Now:  I know that breastfeeding isn’t supposed to be painful. Yes, the initial latch-on can sometimes be a bit uncomfortable, but after 15-20 seconds it eases off and all you should feel is pulling and tugging. Burning is bad. Stabbing knives in your breasts is bad, pink pearly nipples (as lovely as that may sound) is also bad!! All the symptoms I just listed are classic of yeast in the breast. The treatment is relatively simple. Usually we will start with the compound nipple cream and see how that works. If symptoms persist after a week or so, a MD will usually prescribe a course of oral diflucan. The diflucan usually kills off most of the yeast for good. In severe cases, one has to eliminate sugar and really watch their diet and even wash all bras in hot water with vinegar. Yeast can be a tricky infection to treat as the lactating breast can be the perfect breeding ground for spores to thrive in such a dark, moist environment. If I had known that the pain I was experiencing was yeast and could have been treated promptly and easily, I would have been a much happier mama much earlier on. But I am thankful to know now what I do in order to help and treat others who are experiencing the same pain.

Well that covers Part One of ‘I Know This Much Is True’.  Part Two will come out in a couple of weeks. I hope you have enjoyed reading about some of my own personal breastfeeding experiences. I know that we all have our own stories and journey’s to share. Please feel free to leave your own thoughts or comments at the end of the blog. 

Happy Breastfeeding!! Xoxo

Leanne Rzepa RN BN IBCLC

 

Posted on September 27, 2015 .

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 September 14, 2015 .

A FEW SMALL CHANGES CAN GO A LONG WAY!!!!

Like most things in life, changing the way we do things in even the simplest manner, can make a significant, positive difference. The same holds true for Breastfeeding.  I have been working in the Breastfeeding world for over 15 years and have seen how our practice and knowledge shared with patients 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 really make a huge difference for Breastfeeding moms, yet they are quite suttle in their doing. These suttle adjustments and slight changes in a way mom holds her breast or positions her baby 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 latch, and maintain a latch at the breast. Moms are generally taught to cup their breast like the letter C (which is correct) BUT to keep their fingers well away from the areola. Using this technique, I prefer mom’s to bring their C-hold to around 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 allow baby to take a bigger mouthful of breast tissue when latching him boldly to the breast. 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!!!)  and the nipple will also touch the roof of his mouth faster 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 almost have a 100% latching success rate using this technique!!!

Tip #2) 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 (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 will drop more weight of the breast onto baby’s lower jaw, which will ensure better drainage and therefore more efficient feeding.

Tip #3) 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 rolling fingers forward!!!

I believe that hand expression is an essential skill that all nursing mother’s should have. You never know when you maybe without your breastpump 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 go 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!!!

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 practice. Or perhaps, you are already using some of these techniques!  As I have said before, 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 you and our Breastfeeding mothers.

Thank you!!!

Leanne Rzepa RN BN IBCLC

 

 

 

Posted on August 22, 2015 .

Tongue Ties and Low Milk Supply, Do The Two Go Hand-in-Hand

Tongue ties and low milk supply.......we usually find the latter with the former. But what should we correct first? Is it the tongue tie alone that causes low-milk supply? Or can low milk supply be a phenomenon on its own when there is a tongue tie present?  For starters, most parents have never even heard of a tongue tie. But mothers are almost always concerned about the quality of their milk supply.

 Let’s start by explaining the former.  A tongue tie is when the frenulum, that band of tissue under the tongue is tight. When a baby is tongue-tied, the frenulum can at times extend right to the tip of the tongue (anterior tongue-tie), or be quite tight and restrictive at the base of the tongue (posterior tongue-tie) Bottom line is, a tongue tie limits the full range of motion of the tongue and can often interfere with breastfeeding.

Tongue ties can cause sore, damaged nipples and lessen a baby’s ability to feed efficiently. Babies with tongue ties often compensate for their poorly functional tongues by using their jaws to feed.  The jaw muscle will tire out quicker than the tongue, so babies often become ‘chompy’ at the breast, and tire out faster. At times, you will see their lower jaw quiver from exhaustion. A lot of parents think their babies are cold and shivering when they see this behaviour. But in reality, that poor jaw muscle just can’t keep going any longer. Other times, babies with tongue ties will make a clicking sound or keep popping off the breast because they can’t maintain proper suction.

Once a mother has developed sore damaged nipples, it’s almost impossible for her to achieve a proper latch. If she continues to latch her baby incorrectly, she will quickly fall into that dark deep black hole of breastfeeding hell. That’s when a Lactation Consultant should be on speed-dial!!! Actually, the LC should have been consulted at the first inkling of nipple pain. But most mothers think that some pain while breastfeeding is normal and they should just tough it out and eventually things will improve.  In some, but very few instances, everything resolves, but most of the time, help and support are needed!!!!

Quite often a tongue tie will be diagnosed in the hospital and a frenotomy (releasing the tight frenulum) will be performed prior to discharge. But at times, they are missed and don’t get detected until a week or two or three later!! If the latter is the case, breastfeeding has usually suffered and a lot of mothers have given up or have switched to combined feeding.

Ricke et al. (2005) reported that breastfeeding infants who were tongue-tied were 3x more likely to be exclusively bottle-fed at 1 week than matched control infants with no tongue-tie.

So how can such a small, tight little connection under a babies tongue lead to low milk supply which is a major breastfeeding challenge? The two go hand-in-hand due to the following. If your baby has a restricted tongue and cannot move it to its full functional potential, damaging effects to milk supply will occur (and we are not just talking about the ability of the baby to stick its tongue out past the lower lip). The tongue has a variety of functions. It needs to move from side to side, it needs to cup the breast, it needs to move in a wave-like motion, it needs to lift up........If the tongue can’t do all these necessary functions, then it won’t do a very good job at removing milk from the breast. If the milk isn’t removed from the breast effectively at every feeding, then the body thinks it can slow down milk production and at the end of the day, supply diminishes. A baby that is feeding off a breast with a low milk supply will start to become fussy and frantic and is unable to become satiated. As a result, he starts to feed much more frequently in order to help build up the supply. But unfortunately, he won’t be able to do this very well if his poor little tongue can’t move the way he wants it to.

This is usually when I get a call from a distressed mom. Or at times it will be a father!!! If I get a call from a father I know there is major trouble on the breastfeeding-front. The issue is usually presented to me as a fussy baby who feeds all the time, may or may not be gaining weight appropriately, and a mother with sore damaged nipples. She usually has no idea that her baby may be tongue tied.

When I come to see a client, one of the first things I do, (after taking a thorough history) is assess tongue function. If I feel an anterior or posterior tie, I explain what that means to the parents right then and there. It’s amazing to see the relief on their faces when they say “OMG, so that’s what’s been causing all these problems?”  So I assess the latch and make any necessary adjustments, ensure there is good milk transfer, and point out some of the ‘less obvious’ jaw/sucking movements that co-inside with a tongue tie.

Generally the breastfeeding care plan goes as follows: Referral to a breastfeeding clinic, where a physician who is trained in performing frenotomies can release the tongue tie. Frenotomy usually provides immediate relief from nipple pain and usually improves the latch right away thereby increasing milk transfer. Then we have to come up with a plan to build mom’s milk supply. The babies weight gain or loss, will determine what kind of plan I will put together. I usually perform a test-weigh for these babies to help determine the need for supplementation or medications/herbs to help build the supply. And of course.....we work on the latch. One of the most important things related to breastfeeding, is to ensure that mom is latching her baby the correct way.

If her nipples are quite sore and damaged, her body will not allow her to be ‘fast and bold’ when latching. Speed is key and the faster she is at getting her baby onto the breast, the deeper, more effective the latch will be. If her nipples are quite damaged, a prescription strength compound nipple cream will also be recommended. This cream is a life-saver!!!!!

At times, these moms will be prescribed motillium to help increase supply. Even though positive results are generally seen right after frenotomy,  it takes a few days, to a week, for the baby to realize the full potential of his new and improved tongue. Therefore, the milk supply doesn’t magically improve overnight. It takes time, and an herbal or prescription medication generally helps to build the supply a little faster. Pumping is also recommended post-breastfeeding to help increase supply. Whether she can pump a few drops to a few ounces, additional stimulation and milk removal will help the supply increase.

So for all you Mommies out there experiencing pain while feeding and low milk supply, please seek breastfeeding support sooner than later. Make sure your baby has his/her tongue properly assessed to rule out tongue-tie as a possible cause for your challenges. Remember that knowledge is empowering!! I hope I have been able to share and empower you today!!!!

Please feel free to e-mail me at anytime with your questions or concerns!!!

Happy Breastfeeding

Leanne Rzepa RN BN IBCLC

Posted on August 5, 2015 .

Mama called the doctor and the doctor said..........

Lately I have been working with mother's who have been given the strangest breastfeeding advice by the their Doctor's. At times, I have to stop myself from laughing because the recommendations that have been given are quite comical and yet, quite scary all at the same time!!

As a new mother trying to navigate through the wonderful, yet confusing world of breastfeeding, we naturally look to our health care professionals for sound advice. But over the years, I have found that unless ones provider is knowledgeable in breastfeeding medicine/support, it can often be detrimental to the breastfeeding dyad to actually act upon some of this (and I use the term loosely) advice. 

For example, I had the pleasure of working with a new a mother whom I will call N this past weekend. She is the mother to an almost 4 month, beautiful, little boy.  She contacted me because she was concerned that she had developed mastitis for the third time in the past few months. A few days earlier, her Doctor examined her and found an area of hard, plugged ducts on the outside of the right breast. The effected area was also slightly warm and red. These were her only reported symptoms. N's Physician diagnosed her with mastitis and prescribed her oral antibiotics........for the third time in the past few months. He also recommended that she stop breastfeeding altogether and switch to formula.

Ummmmm.......just a second here..........I didn't realize that having 'mastitis' 3 times in a few months warrants ceasing to nurture ones infant??!!! To put a little more icing on the cake, the Doctor also suggested that perhaps the baby had a bacteria in his mouth that was causing N's breasts to repeatedly become infected. This was when I had to stop myself from laughing. But to be perfectly honest, i was upset!!  I was angry that N had been given such horrendous medical advice!! This poor mother had been in pain for days!! She had been massaging, and expressing, and using cabbage leaves, and pumping to help alleviate her plugged ducts. At times the plugged areas would soften, but they always returned. If N hadn't listened to her own mother's intuition and sought out another opinion, she may have taken her Doctor's advice and quit breastfeeding.

Firstly, Mastitis can not be diagnosed as such unless there is accompanied fever. Otherwise, she just has plugged ducts....which still requires proper treatment and management.......but not antibiotics. Thankfully, N had not started taking her antibiotics and waited until i saw her to complete a thorough breast exam and come up with a better plan. As it turned out, she did had have some pretty plugged milk ducts on both breasts that were most likely due to a couple of milk blisters located on both her nipples. Together, we came up with a plan that involved treating the milk blisters and working out those blockages in her milk ducts. Needless to say, she was one happy mama by the time I left her home!!!!

So please take this case as an example of when you need to listen to your intuition. If you feel that your Doctor is recommending something that just doesn't sound right to you,  take a few moments and seek out a second opinion, preferably from an IBCLC or a health practitioner who specializes in breastfeeding medicine.  It may be the best decision you can make for you and your baby.

Remember........knowledge is EMPOWERING!!!!!! 

Happy Breastfeeding!!!!!

 

Posted on July 6, 2015 .