Search Results for: peer counselor

The WIC Breastfeeding Peer Counselor program- why you should care

It’s déjà vu for me today, Leakies.

Last year, right around this time, I wrote an article for this very site about how a representative was proposing that we removing funding from the WIC breastfeeding peer counselor program, The High Life of a WIC BReastfeeding Counselor.  That was struck down, and quickly, but sadly enough, threats to the program loom again.

In case you don’t know what the breastfeeding peer counselor program is, it’s an awesome program at WIC where breastfeeding or former breastfeeding moms are hired and thoroughly trained to provide breastfeeding advice and support.  In fact, our training is so awesome and the program is so respected that the organization that tests people to become registered lactation consultants, IBLCE, allows it as one of the few ways to gather the hands on hours required to take the examination.  The program helps both new moms and moms-to-be with a variety of breastfeeding issues.  We teach classes, we do one-on-one counseling, and we assess moms and babies who are having issues.  We can catch issues early and fix them or refer to someone who can.  We run support groups and work with businesses and hospitals to make the community a more supportive place for women who do choose to breastfeed.  We run warmlines.  Some of us do home or hospital visitations.  Many of us are IBCLCs.  What we do, in a private practice setting, would cost you a LOT of money.  Yet, for the women who qualify for WIC, these services are totally free.

And although we are all breastfeeding advocates, we’re not going to force you to breastfeed or look down on you if you don’t.  We will encourage you and help you, but we will not force our goals or ideals on you, and we will not look down on you if you don’t breastfeed for as long as we would or in the way that we would or even at all.  There’s something pretty amazing, though, about seeing a new mom who really, really wants to breastfeed, so incredibly tired and sore and unhappy and on the verge of giving up light up when she is given the tools needed to make things work for her.  And these tools are sadly unavailable in many other places.  Many doctors aren’t all the breastfeeding savvy.  Hospitals that have lactation consultants often only have them there part time, or they are too overbooked to give moms the time that they need.  La Leche League meetings can be at times that a new mom can’t manage – especially if she’s also working.

Money for breastfeeding support within WIC was already cut once this year.  This is pretty sad, given that the Surgeon General’s call to action to support breastfeeding was issued just a year ago.  We know the numerous benefits of breastfeeding, and we know that while so many moms want to breastfeed, a significant amount simply aren’t meeting their goals.  Mother to mother support is proven to be a huge help.  And when that support is trained and qualified to bust myths and give realistic advice while not being judgmental, that’s even better.

A House subcommittee yesterday passed a bill for funding for WIC that has no money earmarked for peer counselors. That, combined with the lowered budget overall, means that a lot of ladies will be losing their jobs and a lot of moms will be losing what might be the only education and support they have for breastfeeding.  While my office is amazing and everyone is supportive of breastfeeding and decently educated, and while I believe that WIC has taken steps to ensure that is the norm, there are many agencies that only maintain a counselor because that money is earmarked.  The peer counselor in those offices may be the only person there well versed in breastfeeding and holding the solutions to common issues.  If we take her away, there will be a lot of moms that switch to formula – not because they want to, but because they feel like they have no choice in the matter.

So why should you care?

Well, if you believe that women should be supported in their breastfeeding endeavors, you want breastfeeding peer counselors to keep their funding.  If you are someone who doesn’t care about breastfeeding but wants government spending to decrease, then you want breastfeeding peer counselors to keep their jobs.  You see, we help women to be healthier and have healthier babies, which translates into less money spent on state insurance and less spent on purchasing formula.  If you’re a business owner or manager, you want us to keep our funding, because by helping moms to keep breastfeeding and continuing to confer that specifically tailored immune protection, your employees’ babies are at their optimal health, and your employees will be at work more often, increasing productivity.

I urge you to sign this petition and consider letting your elected officials know that cutting funding to this program is ridiculous and short-sighted.  It may save some money short term, but it will have significant consequences long term.

 

 

 Star Rodriguiz, IBCLC, is a breastfeeding peer counselor for a WIC in the Midwest and has just started her private practice as an IBCLC (her Facebook page is here, go “like” for great support).  She also sits on the  breastfeeding task force in her town, is helping her  community’s Early Head Start redefine  their breastfeeding support, and is the  driving force behind a local breastfeeding campaign.  In  the remainder of her free  time, she chases around her nursling and preschooler.

 

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The High Life of a WIC Breastfeeding Peer Counselor

Yesterday, The Huffington Post ran the story “Virginia Foxx Proposes To Cut Breastfeeding Support Funds.” In light of the news regarding a proposal to cut funding to the Women, Infants and Children (WIC) for the breastfeeding peer counselor program in the USA, my friend (and helping admin. on TLB Facebook) Star shares her perspective as a peer counselor.  Star, like almost all peer counselor in the WIC program, works part time supporting women in breastfeeding meaning she receives no benefits.  Her response to the proposition of Rep. Foxx indirectly addresses the very serious implications of such a proposal: we do not value breastfeeding as a culture.  We claim we do but then, as Star says, we do not walk the walk. Additionally an action such as this demonstrates that we don’t understand the very nature of breastfeeding education and support which is a major contributing factor in why so many women that start out breastfeeding are no longer breastfeeding within a few weeks or months.  We should be examining how to make support for breastfeeding more available to women, not less so.  I’m proud to present this guest post from Star.

Hi. I’m Star, and I’m a breastfeeding peer counselor for WIC.

However, if Representative Virginia Foxx from North Carolina has her way, I won’t be able to say that for much longer. “All this money is being spent on salaries, benefits and cell phones for a program the federal government has no business doing,” Foxx was quoted as saying on Wednesday.

You caught me, Virginia Foxx. I am living the high life on government money while performing a totally unneeded job. I’m so glad you exposed my career as the farce that it is. Thank you.

All sarcasm aside, let’s talk about what I do.

First of all, let’s have a (really brief and as non-boring as possible) history of the peer counselor program. WIC used to be seen as “that formula distribution center for poor people.” WIC decided, in the early 2000s, that they needed to get serious about promoting the normal way of feeding a child – breastfeeding. So they initiated a pilot program of peer counseling. After all, their research showed that mother to mother support made a huge difference in breastfeeding. They would hire women – women who were or had been on WIC that the other moms could relate to, who had successfully nursed babies. They would provide training and education and these peers would give support and advice. They would also, they hoped, get more mothers to breastfeed.

It worked. It worked so well that WIC decided to roll it out around the nation.

So what do I do, exactly?

Well, it’s not as glamorous as Virginia Foxx makes it out to be. First of all, my salary is a pittance. Most peer counselors make between $8 to $10 per hour. I get no sick days, no health insurance, no paid vacation time, no 401k. I run a Facebook group that is only peer counselors, and I have never heard one of them discuss the awesome benefits or salary of the job, so I’m pretty sure that this is country wide. I get to bring my child to work with me until she’s two, but that’s my office and not reflective of every WIC everywhere. Sometimes my boss buys cookies. I once got a t-shirt.

I know, I know. Try not to die of jealousy, everyone.

Now let’s look at a typical day in the life of me. I get to work, check voicemail, counsel prenatal moms about the benefits of breastfeeding, what to expect, and what to do when they go back to work. I rent our breastpumps. I do feeding assessments if moms are concerned about baby not getting enough. I call clients. I evaluate latches. I teach classes. I leave notes in the files so that other staff knows what is going on with the client. I do everything an IBCLC through a private practice or hospital might do, I just do it much cheaper. (Please note: not all WIC counselors are IBCLCs. I am not, although I am taking the exam this summer. I am not trying to say that I currently should or could make the same amount of money as one. I will say that IBLCE had very stringent requirements for the counseling hours that you need before you sit the exam, though, and currently WIC and LLLI are the only two ways to get that experience that don’t require a career in medicine or a mentorship, though, so we must have pretty awesome training.)

At four, I go home and leave all my work behind me.

*bursts into hysterical laughter*

At four, I do clock out. Then I turn on my cell phone – MY cell phone, Representative Foxx, the one that is not paid for by the company, thank you very much – and I run my own warmline for my clients. Sometimes, I don’t get a lot of calls. Sometimes I do. I have taken calls that have lasted hours. I have taken middle of the night calls. I have taken texts. I have taken calls on major holidays, most notably Christmas Eve. I took a call when my daughter was in the hospital and I was frazzled and upset and kind of really wanted to let it just go to voicemail.

I have been paid for zero of those calls.

I also make calls, from home, from the road (when someone else is driving.) I stuff envelopes with breastfeeding information. I ask local businesses to donate prizes to the mom’s group. I advocate at businesses. I talk to the media.

I rarely get paid for any of that, either. I probably could, but I have never asked. I have never asked because I’d rather have the extra money in the budget go to helping my moms breastfeed. I would rather we buy a pump for an exclusively breastfeeding mom who is returning to work at 4 weeks postpartum doing 12 hour days than line my pocket.

I didn’t take this job for the money. I took it because I have a passion for breastfeeding and helping families. I took it because helping low income mothers who can’t get help elsewhere fulfills me in a way that working in a large clinic or hospital (and, yes, I’ve had offers for once I get my board certified status) would.

I took this job for the clients I have. Man, they are amazing. I have students, and full time workers. I have moms who have babies in the NICU who are totally committed to breastfeeding, despite the challenges. I have moms whose babies never latched who have pumped and struggled for months on end because this is that important to them. I have moms with breast injuries that keep them from producing enough milk who still do as much as they can.. I have mothers who have lost their babies and are still pumping, donating milk, for other babies. My clients are diverse and wonderful. They are black and white and Asian and Hispanic. They are lesbian and straight. They are teen moms and forty somethings. They are incredible parents and they humble me every single day.

I took this job because I care.

But why should you? Maybe you’re not a breastfeeding advocate, or maybe you do think that WIC should have their funds cut. After all, we’re in a bleak economy, right?

Let’s look at what happens if the peer counselors no longer have funding. Well, clearly, we all lose our jobs. So there’s that burden on the economy. Some of us will go on assistance programs ourselves. Some of us will just spend less, negatively impacting our local economies.

In many WIC offices, the peer counselor is the knowledgeable one about breastfeeding. So when she’s not there to answer a phone or see a mom, the breastfeeding rates drop. The money WIC spends on formula increases. Let’s not forget, either, that many a baby has issues with formula.. WIC pays for more costly formulas if you have a doctor’s note. Some of those formulas are $40-$50 a can. Cans last roughly two days to a week. Nice little burden for us taxpayers there.

But wait. There’s more.

Research shows that statistically breastfed babies are healthier than formula fed babies. They have less chance of a number of serious illnesses. They also have immune protection specifically tailored to their environment, so when the other kid at daycare has the flu, they may not get it. So more people on WIC formula feeding = more children that are on WIC getting sicker. Know how many kids on WIC are also on Medicaid? A lot. Medicaid is getting ready to expand in 2014 under health care reform, too. Sick kids = higher taxpayer burden.

And let’s not forget the cost that illness has on the workforce. A sick kid has to go somewhere, and it can’t be daycare. Who stays home with that kid? Mom or Dad, right? So that leaves a business short staffed. Many WIC participants are working jobs with pretty stringent attendance requirements, too. So Mom or Dad loses the job. Suddenly, they need more assistance and contribute to the economy less.

It’s a snowball effect that winds up spending more taxpayer dollars… All because I lost my job.  All because the peer counselor program was cancelled and moms didn’t receive the support they needed to breastfeed.

This idea was struck down yesterday. However, these are tough economic times, and the idea of cutting funds for this may emerge again. You can see how your representative voted here (http://clerk.house.gov/evs/2011/roll431.xml) and then you can send them a letter, e-mail, or even call them to congratulate them or condone them for their vote. You can also send Representative Foxx a note telling her how you feel about cutting breastfeeding support. And if you’re not sure who your representative is, look here (http://www.house.gov/zip/ZIP2Rep.html)

Finally, you can share this with your friends. You can post it to Facebook, or just talk to them about it. Advocating doesn’t have to be hard, but it will absolutely make a difference.

On behalf of those of us working for moms, I thank you.

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How Lubrication Can Improve Breastmilk Pumping

by Kristine Phillips Keller

This post made possible by the support of Ameda

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I learned the answer to this question the hard way with my oldest son. I was not much of a reader but breastfed because both of my sisters did the breastfeeding thing. If they could do it, so could I. However, in hindsight, I pretty much did everything wrong that I could have done. I wanted a nursery (I needed sleep, right?), I wanted pacifiers (he can’t just suck on me or I won’t get any sleep) and I wanted bottles (dads need to help too, right?). I thought, surely I can make all of this work. Boy was I wrong!

Not only did I go into it uneducated, I also have flat nipples. I honestly thought they were broken as they never became fully erect prior to years of nursing/pumping. I also have really naturally dry skin. Early on, I had damage but didn’t realize how bad it was until it was visible, right at Stage III damage (which means skin is literally gone). I was in such pain that I would cry when my boys would cry because I knew what was coming. I would fear nursing them because of the toe curling pain that it took to get them latched on. For the most part, after a minute or two it became bearable. Other times, the entire feeding was excruciatingly painful for me.

At six weeks with my first, I gave into pumping full time. I asked for help from family repeatedly to try and figure out what I was doing wrong and what I could do to correct the latch. No one seemed to be able to offer me the advice that I needed to make direct breastfeeding work and I just didn’t have it in me to bear that kind of pain any more. However, I still wanted to give them my milk…so I continued on with pumping & still continued to have cracked, bloody nipples until a good 10-11 months of pumping.

Around that same time, I was talking with my sister about all of the bloody milk that I was dumping because, even though I was no longer nursing, I still had pretty bad damage on both of my nipples. I just thought that’s how it was going to be for me. She then asked me if I was lubricating before I pumped. My response to her was, “Isn’t that what you do when you have sex?” She laughed & then said yes but that the pump shields were dry. Babies have moisture in their mouth for lubrication but there is no moisture on the pump shield prior to pumping.

I mean, would you ever expect to drive a car with NO lubrication and have things go well? ABSOLUTELY NOT! There must be lubrication to prevent friction… and to prevent damage. After all, isn’t that what our healthcare is supposed to be about these days, preventative care? Well, let me tell you…the difference was night and day. I went from having constantly damaged, bloody nipples to pain free/damage free nipples overnight. It was such a relief to know that there was something I could do to prevent this pain and discomfort.

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I started working for WIC 2.5 years ago as a peer counselor and have since applied theory to moms that come to me with damaged or sore nipples. If you lubricate before you latch, you lessen the probability of damage happening from the initial suck (regardless of whether it’s baby or the pump). That lubrication gives both something to slide against instead of that reverse pressure working against dry skin.

I’ve asked numerous breastfeeding professionals and no one seemed to know of any literature that puts emphasis on “lubricating BEFORE nursing or BEFORE pumping”. The only reference that I’ve seen is to use breast milk on sore nipples AFTER nursing. If it works after, why not try it before?

Lubricant suggestions: (you may need to try a few different ones to decide which is most comfortable for you.)

  • Your breastmilk
  • Nipple cream/ointment (suggest vegan and edible, rather than animal based)
  • Coconut oil
  • Olive oil
  • Almond oil
  • Infant massage oil
  • Avoid synthetics such as traditional baby oil

Some moms have found that regularly lubricating their breasts and pump horns before pumping greatly reduces the amount of discomfort they experience which in turn helps them let down easier and respond better to the pump.  There’s no need for pumping to be a painful or uncomfortable experience, experiment with different lubricant options to find what works best for you.  I hope this simple tip helps you in your breastfeeding and pumping journey as it has helped me.  How about we pass along this little known tip and prevent the damage in the first place?

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What pumping tips do you have to share to help other moms?

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Kristine Thanks to her sister, Kristine breastfed/exclusively pumped for her two boys now 3.5 and 8 years old, she pretty much did everything wrong when it came to breastfeeding but managed to get the pumping thing right (after a while).  After experiencing discrimination she contacted WIC about becoming a breastfeeding peer counselor and begin training to become an IBCLC. She sits for the IBCLC exam this summer and looks forward to continuing to help mothers reach their breastfeeding goals.
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Pump Like a Pro – Double Up

by Wendy Bell, CLE
Editor’s note: A big thanks to Snugabell for their support of TLB and all breastfeeding women; please be sure to take a moment to thank Snugabell on their Facebook page  for their show of support! You can also follow Snugabell on Twitter and Instagram: username @snugabell. Be sure to check out their special at the end of this article.

 

Breast pumping tips Snugabell PumpEase

 

Have you heard moms complain that they just don’t let down for the pump? Or they do, but they don’t get as much milk as they think they should?

These are pretty common complaints! Never fear, we’ve got you covered.

First, if your instinct tells you that there’s something bigger at play, connect with someone trained in breastfeeding support. (This starts at the grassroots with organizations like Breastfeeding USA and La Leche League, which offer trained volunteer peer counselors, then escalates to moderately trained pros like CLCs, CLEs, etc-, and the very best, top-notch support you can get comes from an IBCLC. Asking your OB, midwife, or any other provider may leave you with dated or incorrect info, so try and connect with someone who’s got breastfeeding-specific training.)

Next…if you feel like you’re doing ok with breastfeeding in general, but you’re just not getting along with your pump, you’ve got options! Check out our other tips – there are LOTS of ways to get into a good pumpin’ groove. One of the BEST ways to help your body let-down for the pump and (sometimes!) yield a little more milk is to pump on one side while your baby nurses on the other. Your baby will work that sweet suckling magic that gets your letdown going, which will carry over to the pump side. Tandem pumping and nursing is a great time to do a visualization (like we described here), so that you can repeat the same visualization and experience those same cues when your baby isn’t present and you’re pumping on both sides.

You’ve got all the benefits of the baby at the breast, AND your body is learning to get along with your pump. Win-win!

 

Pumping Pro Tip 5

To celebrate their SUPER exciting collaboration with Destination Maternity and A Pea in the Pod, Snugabell is sending PumpEase customers one of their fabulous Wet Bag absolutely FREE.  Details hereThe PumpEase design will securely hold your pump in place and is guaranteed to accommodate any breast pump on the market. The PumpEase bra like the one shown above makes multi-tasking a breeze for busy moms. Visit www.snugabell.com for more information about PumpEase

 

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Surviving Holiday Breastfeeding

by Star Rodriguez, IBCLC

 

Ho, ho, ho!  Merry Christmas/Chanukah/Kwanzaa/Winter Solstice, readers!  It’s the most wonderful time of the year!!!  There’s snow! (Unless you’re in a place that doesn’t have cold, snowy winters, in which case, can I spend mine with you?  Or mail you some snow, at least?  Like, maybe all of it?)  There’s cookies!  There’s a festive holiday air that we all love!

Oh, yeah, and if you’re a breastfeeding mom and baby, there’s some possible, holiday-related pitfalls.  In this article, I’ll address some of them.  Hopefully, some of these tips will help keep your holidays happy.

 

Help!  My baby is suddenly super fussy and nursing all the time!

So it’s the holidays, and you’re spending them with, well, pretty much everyone you’ve ever met.  Ladies with babies are extra popular at the holidays.  We all want to hold, kiss, snuggle, and love your babies…and then hand them back as soon as they are fussy.

With traveling, and new people, and being passed around, it is totally normal for your baby to get a little overstimulated and cry often.  When breastfed babies get upset, they enjoy nursing.  It’s comforting for them, and allows them to calm down, and settle.  And then they might fall asleep.  At the breast.  While you’re holding them.  And then they wake up the second you set them down.  And this cycle repeats for what seems like FOREVER.

This doesn’t mean you have to stay awake, half dead from sleep deprivation.  One of the easiest things to do in this case is let your baby fall asleep while nursing.  Then, keep cuddling your baby until your baby is in a nice, deep sleep.  It usually takes babies at least 10-15 minutes to get there.  After your baby is in that deep sleep, though, you can generally put them down and go sneak off for your own holiday enjoyment.  Or just go take a nap.  Whatever.

 

Help!  My baby seems to be nursing less!

Remember how we talked, up in the last few paragraphs, about everyone holding/kissing/snuggling your baby?  Well, sometimes, when babies are passed around, they get sort of distracted and stop thinking about eating.  If you’re wondering how that happens, remember the last time you were really, really busy.  Lots of stuff was going on.  Maybe you felt hungry once or twice, but as you got caught up in other things, you pushed it away and your hunger probably abated a little.

Well, that can happen with your baby, too.  Now, I’m not encouraging you to put this theory to the test by not feeding your child, but, at the holidays, it sometimes happens.  If you notice this has occurred, try to take your baby aside, somewhere quiet and less distracting, and nurse.  Be prepared for your baby to possibly cluster feed over the next night or day.  This is ok; it is your baby’s way of catching up after missed feedings.

In this particular case, the best defense is just making sure that you’re nursing your baby regularly at gatherings, though.

 

Help!  I’m nervous about breastfeeding in front of my family and friends!

Sometimes, you are the nervous one, who is worried about exposing yourself.  Sometimes you’re in a home that’s not incredibly breastfeeding-friendly.  Either way, this can make you feel very anxious about the holidays.

In this situation, there are many things you can do.  Some people just decide to not care, and nurse just the way they do at home.  Gathering up the confidence to do this often leads to a great experience for moms, and little to no negativity from the people surrounding them.  If you’re not sure that’s for you, try breastfeeding in front of a mirror and see how much really shows.  With your baby at the breast you may be more covered than you realized and after practicing in front of a mirror be ok with breastfeeding wherever you are.  However, not everyone will be comfortable with this, and that’s ok.

You can also use a cover or nurse in another room.  Covers have the advantage of not making you have to go away from where the action is.  Some babies don’t like them, though, and will pull them up so that they can see what is going on around them.  Some homes are warm, and the cover leads mom and baby to feel too hot.  Nursing in another room can reduce all of those negatives, but, again, you’re missing fraternizing with others, and that’s what the holidays are for.

I also, as with almost any nursing in public endeavor, recommend a cami under a regular shirt.  You pull the top shirt up, the bottom shirt down, and they cover pretty much everything, even your stomach.  See this video for how that can work.  Special breastfeeding tops make it easy too and and an Undercover Mama is a nice option as well.

You can also try making your holiday trips short, if possible.  Many moms can go to an event for 2-3 hours and just nurse before and afterwards.  That may allow you to get out without having to worry about nursing at all.

 

Help!  I have a sick relative insisting on handling my baby!

First of all, babies are not super delicate if they are healthy, full term newborns without any health issues.  As long as your relative washes their hands and uses sanitizer, doesn’t have something horrible like pertussis, and doesn’t get all up in your baby’s face, it will probably be fine.  Feel absolutely free to bring sanitizer with you and insist on its use if that makes you feel more comfortable.  This is your baby, and you can ask people to have good hygiene before touching.

However, not everyone is ok with letting any sick person handle their baby, or, maybe your baby is immune compromised in some way.  The best thing that I have found for this is, “I’m so sorry.  My pediatrician is concerned about me exposing (baby’s name) to germs right now.  Let me hold (baby) for you, and you can take a look at her.”

You can also wear your baby.  I’ve found that, when baby is strapped to your breasts, people are a lot less likely to get too close or to ask to hold or touch the baby.

 

Help!  I have a lot of traveling to do!

Holiday travel by car, for me, would involve ten hours of driving, so I feel your pain on driving with babies.  Air travel is usually easier; look for nonstop flights, nurse your baby during takeoff, and try to get nonstop flights when at all possible so that you can minimize your time on the plane.  Arrive early enough to get through TSA, and I highly recommend a baby carrier for traveling through the airport.  If you are bringing pumped milk, know the TSA guidelines for pumped milk.

If you are driving, think outside the box.  If it’s a long drive, can you drive most of it during the part of the day or night that your child sleeps most?  Can you bring a support person to help entertain the baby?  Can an older sibling help?  Take as many breaks as you need, and allot for them in the time that you are driving.

 

Help!  My relatives give unsolicited breastfeeding advice!

I get questions every year from people basically asking me how to tell their relatives to back off.  They hear things like, “Are you STILL nursing that baby?”  “I don’t know why you can’t give a bottle!” “We used to give babies rice cereal in a bottle and they slept much better than yours does!”

First, remember that this is your baby, and parenting decisions are up to you to make.  Other than that, people handle this very differently.  Some moms just let it go in one ear and out the other.  Remember, most of these people legitimately are about you and your baby and are probably just unfamiliar with current research.

Some people will come equipped with research showing that breastfeeding is acceptable and a good idea.  Many of my clients use snippets from the AAP or WHO – “The AAP recommends nursing until at least a year” or “The WHO recommends nursing until two years old,” can both be good.  A simple, “My pediatrician thinks this is a good idea for us,” can also be a really great way to shut down opposition.

It may make you feel better to argue, debate, or reply sarcastically (and I will admit that there have been many times that I have done just that) but it’s rarely a great solution.  Although, this particular example has always amused me.

If you can pull off sarcasm that well, absolutely do.

 

 

Help!  My relatives keep trying to sneak my baby food!

Make your expectations clear when you first get there if you think this will be an issue. “We are not doing solid foods yet.  My baby only gets breast milk.  Please do not feed our baby.”  You can also mention allergies: “We are concerned about allergic reactions in our baby, so we are starting solids gradually and in a very specific way.  Maybe instead of feeding the baby, you can change diapers/take her for a walk/rock him/et cetera.”  Giving people something else that they can do with the baby is often the easiest way to get them to stop stuffing things in his or her mouth.

 

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 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
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Medications and Breastfeeding

by Star Rodriguez, IBCLC 

This post made possible in part by the generous support of Rumina Nursingwear.

 

It can be really confusing taking medications or having procedures done while you are breastfeeding.  Most of the time, if you look at the package insert or online, most medications simply say that you should ask your doctor or not take them while breastfeeding.  Then you might hear something completely different from friends, or relatives, pharmacist, or from your doctor.  So what do you do?

Well, luckily, there are a bunch of fantastic resources for breastfeeding moms.

First, I want to tell you that research on breastfeeding and medications has come a long way in the past few years.  So your doctor, nurse practitioner, or pharmacist may have outdated information.  I am not trying to say that you shouldn’t respect your provider or that they don’t know what they are talking about.  That’s absolutely not true.  However, the amount of breastfeeding patients or customers that they see is probably relatively small, so their continuing education is often focused elsewhere.  If you are wondering if information that you were given is correct, you have every right to research that yourself and then bring that information back to your provider so you can make an informed decision together.

Medications moving into milk depend on several things, and, sometimes, even if they do, they do not enter the bloodstream of the baby.  Describing the hows and whys of that could literally take me twenty (probably boring to most people) pages, so I’ll cut to the more important things: how to tell what your medication is ranked, taking you baby’s age into account, resources for information, and supply issues from medications.

Drugs are typically ranked in L categories.  These categories are, as per Dr. Thomas Hale:

L1 – Safest.  These drugs either don’t reach the baby at all or have been proven to be safe in large studies.

L2 – Safer.  These drugs have either been studied to a lesser degree with little to no side effects on the baby, or, after taking the evidence into account, the likelihood of this drug being problematic to your baby is pretty remote.

L3 – Moderate.  This category is where most drugs start.  L3 drugs either have no studies done, or studies have been done showing minimal problems to the infant if the mom is taking it.  This is the category where it’s really a risk/benefit situation.  What are the risks of the drug in your breast milk versus the risks of feeding formula?

L4 – Possibly Hazardous.  We know that this drug can have adverse effects on the baby.  However, there might be some situations where use of this drug is justified.  For instance, if someone is in a life-threatening situation.  For the most part, though, we want to avoid these medications.

L5 – Contradicted.  You can’t use these while breastfeeding.  We know that they have significant, documented, negative impacts on babies.  If you have to take a L5, you cannot breastfeed while it is present in your milk.

 

Sometimes the classification of medications can vary based on where you are in your breastfeeding relationship.  In the first week of breastfeeding, due to the difference in colostrum versus mature milk, it can be a little easier for medications to pass into milk in greater quantity.  If you can avoid a drug during that time, you should.  However, maintenance medications, pain relievers used for surgical deliveries or painful vaginal deliveries don’t need to be avoided.

In the later stages of breastfeeding, after solids are introduced, most babies begin to take in a little less milk – and in the toddler stage, that often lowers again.  So if you are nursing in a later stage, some medications that were once not ok can be acceptable again.

So now that you have a basic idea about how drugs are coded, where do you find this all out? 

LactMed is a website that has a bunch of information about drugs and breastfeeding.  It doesn’t have the L classification, but it does talk about the drug’s potential effect on lactation.  For instance, if you look up Sudafed, it talks about how it might lower production of milk.  LactMed also has a free Android and iPhone app.  I haven’t tried out the app itself yet, though, so I’m not certain what, if any, differences there are.

Medications and Mother’s Milk  is a book that is updated every 2 years.  Many libraries have it, as do most pharmacies, hospitals, WIC clinics, and doctor’s offices.  It is written by Dr. Thomas Hale, and has a wealth of information on drugs and breastmilk, including the L classification.

Infant Risk Center is a website that has a bunch of information regarding pregnancy, breastfeeding, and the risks to infants of various things.  It is directly connected to Dr. Hale, who is the foremost authority on breastfeeding and medications.  The site itself can sometimes be a little difficult to find the specific information that you’d like.  However, Dr. Hale also has an app (it is a paid app, but it has a HUGE amount of information, so if you’re a provider, or you regularly work with breastfeeding moms, I can’t endorse it enough.  For the mom who is occasionally taking medication, it’s probably not necessary, though.)  The Infant Risk Center is also staffed Monday – Friday 8am – 5pm CST to answer questions about breastfeeding (and pregnancy) and medications, and the people working it are knowledgeable, helpful, and generally wonderful.

When looking at medications, it is important to consider whether they can impact supply.  For instance, as I mentioned, Sudafed can be problematic in that area.  Generally, if a medication is meant to dry something up, or impacts your hormones (like birth control), you should exercise caution in using it.  Before anyone worries, you can still take birth control.  You may want to use an IUD, the mini pill, or Depo Provera if you are not planning to use barrier methods.  With Depo or the Mirena IUD, I usually tell moms to ask to be on a month of the mini-pill first; some moms just have sensitivities to hormones, and those sensitivities can impact supply.  Depo can’t be removed once injected, and Mirena is expensive to place and uncomfortable to remove, so it is good to have an idea if you will react that way.  Also, hormonal birth control should not be started until at least 6 weeks postpartum after milk supply is established.

I hope this information helps you work with your health care provider to determine the best choice for you when you need medication.

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Did you have to take medications while breastfeeding?  Was it easy for you to find good information on them?

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 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
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Fitness and Breastfeeding

by Star Rodriguiz, IBCLC

fitness, fit moms, fitness for moms, walking, breastfeeding and fitness

Moms can burn 500 calories a day while breastfeeding.  So that’s all you have to do, right?  Just breastfeed?  And the weight will all magically fall off and you will look like Giselle?

Breastfeeding can absolutely help you to lose weight, but many moms find that they need to embark on a plan of diet and exercise, too.  (And, just for good measure, please let me remind you not to begin a diet/exercise plan without consulting a medical professional and all that jazz.  Also, don’t rush into physical activity right after having a baby, take the time you need to really heal and adjust to having a new baby, pushing your body too soon could lead to further health issues.  Most moms find they need to wait at least 6 weeks, often closer to 12 weeks postpartum before they start exercising.)

BUT WAIT!  There are a lot of things that people talk about with diet and exercise and breastfeeding that make doing it seem…well, like maybe not the best idea.  So what’s the reality?  Can you safely breastfeed and lose weight?  Or exercise?

I am so glad that I just asked that for you.  The short answer is yes!  Of course!  But the long answer is addressed below, as we unmask three very common breastfeeding myths…

Myth #1You need to eat A LOT to make milk, and drink A LOT, too.

Ok, so here’s the deal.  When you are breastfeeding, you should eat to hunger and drink to thirst.  So, if you’re hungry?  Eat something.  If you’re thirsty?  Drink something.  You may find yourself ravenous, or you may find that your appetite has changed little.  Listen to your body’s cues.  There’s probably little to no need to shove extra food in your mouth or force yourself to drink excessive amounts.  In fact, over drinking water has been linked to a lowered supply.  You may find yourself thirstier, and if you genuinely feel that you need to drink, do it.  Just don’t force a specific amount down your throat in hopes that you will increase supply.

Now, that doesn’t mean you should rejoice and eat whatever, whenever.  Eating a mostly healthy and balanced diet is important.  Few of us are going to be able to eat perfectly all the time, though, especially with a new baby.  So I always tell my clients to continue to take a multivitamin, like their prenatal, throughout the breastfeeding relationship.  Moms probably need some extra Vitamin D, too.  (See this study for more information.)  Most moms can safely take 4000-6000 IUs a day.  This will not only help you, but can help to increase the Vitamin D in your breastmilk, too.  However, you should check with your doctor before increasing any dosages or starting any new vitamins.

Myth #2- You can’t cut calories while breastfeeding.

Not entirely true.  You probably should wait to diet until at least 6-8 weeks, and you shouldn’t go from eating, say, 2500 calories a day to 1500 overnight.  But as long as you have an established supply, decrease your calories slowly, and go no lower than 1500-1800 calories per day as appropriate for your body type, you can absolutely work on losing some weight.  1-2 pounds a week is a pretty safe range of loss, whether or not you are breastfeeding.

Some popular programs have developed breastfeeding options to help moms lose weight safely while breastfeeding.  Weight Watchers and My Fitness Pal both have breastfeeding options.

Myth #3Exercising while breastfeeding will make my supply lower/make my milk gross or sour!

Let’s talk about exercise decreasing supply, first.  If you are constantly working out to exhaustion (and you’re probably not.  I did P90X for about a month when I was in the third month of breastfeeding my daughter, and it didn’t fall into the exhaustive, supply-diminishing category,) yes, you may see some reduction in supply.  Regular, moderate exercise, however, might actually increase your production, although that’s not guaranteed.  Even high intensity exercise when it’s balanced well with adequate caloric intake, is fine and many mothers experience no trouble with high intensity work outs.

Raise your hand if you’ve heard that your baby won’t drink your milk if you have been exercising, because lactic acid will build up and sour your milk.  The entire premise for this was one study with a whole lot of issues. Further studies have not been able to replicate this, and have, instead, pretty clearly shown that babies don’t refuse the breast after exercising.  Anecdotal evidence, while not “official,” shows that many breastfeeding mothers experience quite the satisfied customer in their breastfed baby following even intense work outs.

One thing you do need to worry about while breastfeeding and exercising is wearing a supportive bra that isn’t too tight.  Some sports bras can be really, really binding.  You want to avoid that, obviously, to keep from having issues with plugged ducts and the like.

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Have you heard any other breastfeeding and fitness myths?  Did you lose weight or become more fit while nursing?  Let us know in the comments!

 

 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
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Pumping 201- working, exclusively pumping, volume, and weaning

Breast pump, Hospital grade breastpump

Hygeia EnDeare

by Star Rodriguiz, IBCLC
Previously, in Pumping 101, we talked about some basic pumping tips.  In this article, we’ll look at pumping when you return to work or school and pumping exclusively, either by choice or for a health condition. Hopefully, these tips will help anyone facing these situations to successfully provide breastmilk for their child(ren).  Just like before, if a certain situation applies or doesn’t apply to you, feel free to skip to or past it.  

 

Working

This is probably the most common reason that I see for pumping.  Although we touched on it a little in the last article, we’ll go a bit more in-depth here.

First, know that federal law provides all overtime eligible workers (so, typically, anyone on an hourly salary) with the right to pump at work.  You are required to be given a private place that is not a bathroom to pump and reasonable amounts of time to do it until your baby is a year old.  If your state has a better law than the federal one (and you can find breastfeeding laws by state here) then employers have to go by that instead of the federal law.  Most moms should pump for 10-15 minutes every 2-3 hours.  To build up a store, I usually tell mothers that they can pump one time a day when their milk first comes in.  If moms do this fairly regularly in the beginning, even the mom returning to work at 2-4 weeks can have a decent store built up.

Most women pumping in the workforce should be utilizing at least an electric, double sided pump.  If you are pumping for twins, a hospital grade pump may be worth your while since you are pumping for two.  Pumping breaks aren’t usually very long, so you want to pump quickly and efficiently.  However, some women find that their schedule makes it difficult to take full 15-20 minute breaks at a time.  For those mothers, a swing pump or hand pump might work better, just because they can be taken out quickly without a lot of set up required.  For instance, some of my clients have been waitresses that have limited time some nights to pump, law or not.  Those clients sometimes find that using a hand pump for five minutes at a time can help.  Since this does not pump as efficiently and probably will not empty the breast, you will probably need to pump more often than every 2-3 hours, and I always advise that you do pump with a good electric pump at least once a shift.  If you are part time and working 4-5 hour shifts, you may be able to get away with just hand pumping as long as you are nursing often at home.

Many moms wonder how much milk to leave when they are away from their babies.  This can be a hard question to answer.  Some babies will eat as little as possible while separated from their mothers (and will make up for it when they are with their mommy by nursing more often), but some will want to eat more often – usually because they miss mommy and are comforted by her milk and sucking.  It’s good to remember that from 1 month to 6 months, your baby’s stomach is around the size of a strawberry and holds 2-3 ounces at a time.  Most babies will take in around 25 ounces a day until 6 months.  Therefore, store milk in 2-3 ounce increments, use slow flow nipples, and instruct your provider in baby led bottle feeding.  To get a rough estimate of the amount your baby will need, divide 25 by the number of times the baby nurses in a day, and consider about how many feedings your baby usually takes in during the time you will be apart. Most people will try to ensure that they have a couple of extra 2-3 ounces bags per day, too, just in case.

You may be thinking, “Well, MY baby eats/ate WAY more than 3 ounces at every feeding!”  And your baby may have been an exception.  However, a lot of babies are simply overfed by faster flowing bottles or are wanting more milk or to suck out of comfort.

 

Exclusively Pumping Moms/ Moms Separated from Babies

There are many reasons to exclusively pump.  Some moms have babies with issues that cannot latch. Some moms have a history of sexual abuse that makes latching difficult.  Other moms simply prefer to pump rather than latching.

In the colostral phase, when your body is producing small amounts, using hand expression can really help out.  Hygeia has some really awesome hand expression cups that I love (and a great article on hand expression), but you can also express into a small cup or spoon.  Babies take in a very small amount at birth (their stomach size is that of a marble) and colostrum is sticky and can cling to pump parts, making you feel like you’re not getting a lot.  Moms who are pumping should pump about 8-12 times a day (or the amount of times a baby typically nurses.)    You should pump for 15-20 minutes.  Some women can decrease their amount of pumps after awhile, but most have limited success when they pump under 7-8 times a day.

I prefer to have exclusively pumping moms use hospital grade pumps.  You can buy them, but they are quite expensive.  Renting is often a better option.  They can be found for rental in many drug stores, and many WICs also have them.  WIC can be a great pump resource, and lots of women are WIC eligible even if they aren’t aware of it.  Hospital grade pumps have the best control on suction and speed.  Do not assume that cranking up the suction and speed will get you the most milk.  You should start on a low to medium setting and play with it to see what your body responds to best.  Regardless, a double sided electric pump is pretty key to an EPing mom.

If you are pumping for a preemie or a baby with health conditions that might compromise immunity, be sure to ask your child’s provider how they prefer for you to store your breast milk.  Otherwise, many moms use reusable bottles, ice cube trays, or plain zippered storage bags to store their milk.  It can be less expensive than purchasing the breastmilk storage bags themselves.

Another good idea is to get, or make, a handsfree pumping bra.  You can buy some neat ones including PumpEase hands-free pumping bra or a Rumina Pump and Nurse tank or you can make your own by cutting slits into a sports bra.  The handsfree ones have the advantage of being able to be quickly snapped on and off.  They also tend to be prettier.  That sounds like a silly reason, but can be helpful, especially if you are pumping when you intended to actually nurse your baby.

Exclusively pumping moms can sometimes find that they have some chapping of the breasts.  Sometimes this is from the flanges sticking to the skin.  This can be alleviated by using something to lubricate the flanges.  My favorite thing to use is olive oil.  You can also apply lanolin to your nipples between pumpings to help the chapping.  The lanolin used in breastfeeding products will not need to be washed off of the breast when you pump.

 

Weaning Off Pumping

If you’ve been pumping for your baby for some time for any reason and you decide you want to stop, it can be confusing as to how.  Unless there is some medical reason, you never want to stop pumping “cold turkey.”  This can lead to engorgement and sometimes plugged ducts and/or mastitis.  There are a few ways you can stop pumping.  You can cut out a session at a time, every few days (usually, I say every 2-5 days.)  You can also decrease the time spent pumping in all of your sessions.  For instance, if you pumped for 15 minutes every session, you might decrease it to 12 minutes each time, and then, in another 2-5 days, decrease it further.

Please keep this is mind: not all of these time frames will work for all women.  Some may need to decrease more slowly; some can decrease more quickly.  Pay attention to how you feel.  You don’t want to compromise your health by trying to wean too fast.

Some women find that using cabbage leaves, peppermint, or taking over the counter cold or allergy medications can help to dry up their milk more quickly, if you are weaning altogether along with weaning from pumping.

 

 

 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
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A market for breastfeeding support- The Family Friendly Business Initiative

Supporting breastfeeding as a marketing tactic?

That’s what the Family Friendly Business Initiative is hoping businesses of all sizes will see in their project.  Providing families a way to find local businesses that have pledged to be a supportive space for breastfeeding mothers, the Family Friendly Business Initiative just asks participating businesses to provide a welcoming attitude and a comfortable clean environment for breastfeeding moms.  Companies that agree to participate get listed on the Initiative’s website, marked on a google map display to make finding them easier, shared on the Initiative’s Facebook page, listed in materials given to new moms in the local hospital, and given a decal to display identifying their location as a safe place for breastfeeding mothers.  In addition to the website, there is an app in the works which will make finding businesses in the Initiative an easy option in the palms of breastfeeding moms on the go.  For most businesses, it’s a business growth opportunity that may be too good to pass up.  It’s simple, easy, a medically endorsed community initiative, and full of benefits for the companies that choose to participate in the form of free marketing.

And based on a quick informal poll on The Leaky B@@b Facebook page, there’s a market for it too.

For some women, breastfeeding their child wherever they are, whatever they are doing is no big deal.  They are unfazed by the possibility of being asked to coverup or move.  But each woman has her own comfort level and many would prefer to find a place that is known to be “safe” for breastfeeding moms and where she and her little one can be left in peace.  For some, this challenge can be so overwhelming that they’d rather stay home than risk finding themselves out and about in a potentially hostile environment.  Moms that are afraid to leave the house due to concerns about finding a comfortable and welcoming place to breastfeed their baby are in jeopardy of either lowering their supply if they feel they must supplement which could lead to them not reaching their breastfeeding goals or increased risk of postpartum depression if they feel trapped in their home.

The Family Friendly Business Initiative is helping businesses that fit the bill connect with moms that are in need of breastfeeding friendly environments.  Mothers are a significant portion of the spending demographic, businesses know this, so for them to provide a safe place for moms to breastfeed without fear of harassment or discrimination can provide a boost to not only the family but the business and community as well.

In most states, mothers have the right to breastfeed their children wherever they have the right to be but, unfortunately, that doesn’t always mean they experience a warm welcome from businesses and employees or other customers.  Due to a lack of awareness of the laws supporting a mother’s right to breastfeed her child, some have experienced subtle or overt forms of discrimination and harassment so far as having businesses calling the police on breastfeeding mothers.  Repeatedly incidents make national or even global news where a business has told a mother to stop breastfeeding on their premises or leave.  Such experiences can intimidate mothers who desire to breastfeed into not leaving the house or compromising her breastfeeding goals.  These actions undermine the message health care professionals and scientists are giving moms that there are risks to artificial breastmilk substitutes, society isn’t walking the talk.

As a WIC breastfeeding peer counselor in Ames, Iowa, Jennifer Pitkin knew this reality first hand in her work to support moms in their breastfeeding journey.  Time and time again she heard from women that were afraid to breastfeed in public and would use formula if they had to go out, over time their breastmilk supply diminishing as a result.  For many of them, pumping was much harder than formula (and since not all moms respond well to pumps, not always a viable option) so they would switch for those feeds that happened while doing errands and shopping.  Talking with her local La Leche League and her retail manager husband, Jennifer was inspired to tackle this problem from a different angle and the Family Friendly Business Initiative was born.

Today, a year after this inspired idea to support moms and the businesses that support moms, the grass roots Family Friendly Business Initiative has grown to 4 local chapters and increasing interest from other states.  The participating businesses communicate their status as a Family Friendly Business to their employees including a letter displayed in the workers area explaining laws supporting breastfeeding and a mother’s right to do so in public.  These businesses may or may not designate an area specifically for breastfeeding mothers and the Family Friendly Initiative lists what kind of accommodations are available for families.  At this time 25 out of 28 businesses contacted have agreed to participate and while not all of them initially were sure about the opportunity, after some education most have enthusiastically joined.  It’s fairly simple for a company to be involved with many advantages not the least of which is a positive impact on the economy.  This medically endorsed community project supported by the Iowa Breastfeeding Coalition has been well received by Iowa State University, which is widely displaying the Family Friendly Business Initiative decals supporting both their faculty and their student breastfeeding population.  There is optimism that the Initiative will be well received by not just small businesses but large corporations as well.  Encouragement from costumers for companies to join can help influence these businesses to make participation in the Initiative a priority and make a difference for families in your area.

If you would like to see the Family Friendly Initiative in your area, email [email protected].  Another reference for businesses that welcome breastfeeding can be found at You Can Breastfeed Here.

 

 

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Pumping 101: who, what, when, where, and how – part 1

by Star Rodriguiz, IBCLC
Selecting a pump, fitting flanges, and how and when to pump.

I don’t know many mothers nowadays that go their entire breastfeeding relationship without ever pumping.  For some, it’s a matter of being separated from their baby for things like work or school and needing to pump.  Some moms exclusively pump (Note: I will never, ever disparage a mother’s choice, but as my own public service announcement, I do encourage all moms who can to try to put the baby to the breast before deciding to exclusively pump.  I know there are a wide variety of reasons moms would rather pump, but, for many people, it does wind up being easier to nurse than pump all the time.  Obviously, this isn’t true for everyone in every circumstance.)  Some mothers would just like some time apart from their babies and want to pump milk to do that.  Some elect to pump to donate their milk to other babies that may not be able to get all they need from their own mother for whatever reason.

Whatever your reasons, there is little more confusing to mothers than pumping.  I mean, it sounds simple.  Pump + breast = milk in bottle, right?

It appears to not be that easy for most women, though.  A significant amount of the inquiries I receive have to do with pumping, and the whens and whys and hows.  So this column is going to be a very general guide to pumping.  There will be a part 2 that deals with specific situations, so if you’re wondering specifically about work or school or NICU, that will be addressed soon.

Also?  If you already have a pump, or you know the differences, feel free to be all Choose Your Own Adventure and pop ahead to the rest of the article for some other basic pumping know how.

Choosing a pump:

There are a lot of pumps and brands and they can get very daunting.  There are four main varieties that I see most often.

  • Hospital grade electric pumps.  You need one of these if you are separated from your baby or having a hard time breastfeeding.  People will probably disagree with me on these, but I also think if you want to exclusively pump, or you have twins that you are pumping for, you are best served with this.  That doesn’t mean that pumping won’t work for you in any other way, but this is the best for those purposes.  These pumps are double sided (so you can do both breasts at once) and they are the top of the line.  They are also certified for multiple users.
  • Single user electric pumps.  You probably need one of these if you are pumping on a regular basis (i.e. for work or school that is full time.)  Some moms that exclusively pump or have twins use them, too.  A very, very few are certified for multiple users.   They are also double sided.
  • One sided electric or battery powered pumps.  These are good if you’re working on a part time basis (and I’m saying probably 25 hours or less a week) or just want to be able to pump and go out some times.  They are for a single user, and the motors are typically a little weak.  So, really, if you are pumping a lot, this is not for you.  I am unaware of any of these that are certified for multiple women.
  • Manual pumps.  There are generally two types here: piston pumps and one handed pumps.  I prefer one handed – piston pumps made me feel like I was doing some serious arm workouts.  They can be used in the beginning to relieve engorgement (although I usually hand express first) or to begin building a store (I tell my clients to pump about once a day with one of these as soon as their milk is in, but many of my clients are going back to work really, really quickly.  If you’re not, this may not be necessary for you.)  Manuals are best if you are not going to be away from your baby often.
  • Hand expression.  Ok, it’s not a pump.  But knowing hand expression can seriously help you.  You can use it to express colostrum if you are separated from your baby; you can use it if you forget your pump at home one day; you can use it to relieve engorgement; you can use it if you just don’t like pumps.  In basic hand expression, you put your fingers about two fingertip lengths back from the base of your nipple on opposite sides of your breast, gently press in towards the chest wall, and roll your fingers out towards your nipple.  You may have to move your fingers slightly forward or backward to find the spot that works for your body, but when you find it, you will see milk come out easily.  This video is an excellent demonstration of hand expression.
Editor’s note: When selecting a breast pump use caution with second hand breast pumps.  If you choose a used pump, potentially a significant cost reduction (maybe even free!), be sure that any second hand pump you choose has a closed system and is approved for multiple users and purchase your own personal accessory set.  There is a risk with open system pumps of mold growth in the motor (impossible to see without pulling the pump apart and voiding most warranties) and possible communicable disease exposure.  Even if it is from someone you trust and the pump has been well cared for, open system pumps can have dangerous mold growing that is not visible.  For the health of you and your baby, avoid second hand open system pumps.

TLB's pump of choice, the multi-user, recyclable double electric Hygeia EnJoye

So, ok.  I have a pump.  Now what?

First of all, you need to make sure your flanges fit well.  By flanges, I mean the plastic part that goes directly on to your breast.  There are a million names for them.  Each company has different ways that they size their flanges, but, typically, something around a 24mm comes with it, and sometimes there’s also something around a 27mm.  I refer to these as the littler one and the bigger one.  The 24 mm fits very, very few women in my experience.  The 27 does a little better, but you may have to get an even larger size.  Smaller ones are available, too, but it’s generally a very small percentage of women that need these.

Just like they all have different sizing, they also all have different preferred fits.  Check with the pump’s manufacturer to see what they recommend, but, generally, the nipple should be pulled into the tunnel without a lot of surrounding areola tissue and it should not rub the sides of the tunnel.  Keep in mind that your nipple will probably get a little bigger while pumping.

Image credit

Another good tip is that if you are pumping a lot and the plastic from the flange is making your breast uncomfortable, you can coat the flange lightly with some expressed milk, nipple ointment, coconut oil, or olive oil.  Please note: if you have a preemie or sick baby, check first with your pediatrician before using anything other than breastmilk.  It’s usually not an issue, but it’s never bad to ask before introducing something new into an ill or tiny baby’s food, even in miniscule amounts.

Secondly, do some breast massages before you pump.  It may feel silly to some, but massaging your breasts can help make your milk let down faster.   It’s also helpful to do compressions while pumping; in breast compression, you will put your hand on your breast in a c-hold and gently squeeze it, moving your hand to different areas of the breast to help all of the ducts to release as much as they can.

It can also be beneficial to make sure your flanges are warm before putting them on your breast.

 

How long and how often?

So, once you’ve started pumping, how long do you do it?

I have heard estimates everywhere from five minutes to one hour, and while there’s some variation depending on why you’re pumping, with a decent electric pump, most women can get the majority of milk out in 8-15 minutes.  It may take you longer than that with a manual, and with a single sided electric.  I don’t usually recommend that my moms go longer than 20 minutes, though.  They tend to have some soreness if they are regularly doing over 20 minutes of pumping at a time.  If you’re pumping to relieve engorgement only, you probably just want to pump for a couple of minutes.  And hand expression varies so much by mom that assigning time frames to it is downright impossible if your aim is to empty the breast.

And as for how often, that depends, too.  If you are exclusively pumping or pumping for a preemie, recommendations are usually every 2-4 hours.  This is round the clock, excepting a 4-5 hour stretch of sleep at night.  As your baby gets bigger, you may be able to have a longer stretch of sleeping time at night; this varies per woman.  For someone who is in work or school, every 2-4 hours probably also works.  A good rule of thumb if you are nursing at the breast, too, is to count how many times your baby nurses in a day, and to be sure to make up that amount with a combined amount of nursings and pumpings (so if you nurse 9 times, and you nurse 5 times at home, you should pump 4 times at work.)

As always, every mom’s situation is a little different, and if things aren’t going as planned, seek out the help of a trained professional, like an IBCLC.

 

 Star Rodriguiz, IBCLC, is a breastfeeding peer counselor for a WIC in the Midwest and has just started her private practice as an IBCLC (her Facebook page is here, go “like” for great support).  She also sits on the  breastfeeding task force in her town, is helping her  community’s Early Head Start redefine  their breastfeeding support, and is the  driving force behind a local breastfeeding campaign.  In  the remainder of her free  time, she chases around her nursling and preschooler.
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