Breastfeeding Help | The Leaky B@@b

Medications and Breastfeeding

December 17, 2012 By theleakyb@@b

by Star Rodriguez, IBCLC

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 So your doctor, nurse practitioner, or pharmacist may have outdated information.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).

Filed Under: and health concerns for mom, Breastfeeding, breastfeeding health, breastfeeding help, Featured, Relational Resource Tagged With: breastfeeding and medications, breastmilk, Dr. Hale, IBCLC, Infant Risk Center, LactMed, medications and baby, pills, working with your doctor

Supporting the Breastfeeding Family as a Whole

December 13, 2012 By theleakyb@@b

by Amber McCann, IBCLC

supporting the breastfeeding family as a whole

Recently, I was collaborating with a colleague as we worked through the nitty-gritty details of a challenging situation one of my clients was having. As an International Board Certified Lactation Consultant (IBCLC), I work with families to support their breastfeeding and, while my job is incredibly rewarding, it also requires a LOT of “detective” work. This case was challenging my skills and knowledge and I reached out for help. As we sorted through the facts and brainstormed ideas, my colleague said to me, “I’m realizing that you alway lean towards the side of the mom and I lean towards the side of the baby.”

The comment caught me off guard. I wasn’t offended because I make no apologies for the fact that connecting with mothers is my “sweet spot”. I also don’t believe that I nor my colleagues ever sacrifice one member of the breastfeeding relationship to the exclusion of the other. But it did cause me to think and reflect on how, as a professional, I approach the work I do. Do I miss critical pieces of the puzzle because I’m so focused on the mother’s well being? Do I forget the important role that dads and partners play in the family? Do I miss the most vulnerable person in the whole dynamic…the tiny baby herself? (*Cue dramatic soul searching)

I came to this realization:

Breastfeeding support that doesn’t recognize the family as a whole FAILS.

Breastfeeding is much more than one breast, one baby, one mother, and one belly that needs nutrition. It is also getting to know each other, communicating, finding balance between all parties, and connecting on an intimate and vulnerable level. While I certainly do not claim that these experiences happen only in breastfeeding families, I do believe that breastfeeding imparts benefits that go far beyond calories and weight gain.

For that reason, I think it is critically important that, as those who support breastfeeding, we see the breastfeeding family as a whole. Much of the conversation in breastfeeding support centers around whether someone is doing it the “right way”: no supplements, pacifiers, bottles, cribs, you have to wear your baby, don’t you dare give cereals before 6 months, breastfeed until they are two, breastfeed while you are pregnant, breastfeed, breastfeed, breastfeed, breastfeed…and if you don’t do it this way, you are a failure. It simply breaks my heart because, while each of these recommendations has value and impact in the broader issue of public health, these black and white messages often forget that, when it comes down to it, there are real people making real decisions for real families. We must move away from support that sees only the mother, only the baby, or only the breastfeeding.

Decision Making is Up to the Family

As a clinician, I must take a full health history of both the mother and baby in my care. Inevitably, this becomes what is, for many women, the first telling of their birth story to someone outside of their family. It is an incredibly raw and vulnerable experience. I learn of relationships, of history, of fears and of disappointment. I also hear of how she was proud of herself, of her strength and her tenacity. Every woman’s experience, both before and after birth, is wildly different. Each family is to be respected in their decision making. What is the right decision in birth, in breastfeeding…heck, even in what to do with their Saturday afternoon, is up to them, filtered through the lens of their experience, their history and their knowledge. There are things about the way I live my life that I believe deeply in, but this I believe more: Mothers are smart and incredibly capable of making the decisions that are best for their families. My job is to provide information, help them sort through their options and allow them to space to figure out what is best for them…even if what is best for them is not what I would have chosen.

She is About More than her Breasts

As advocates, sometimes we work so hard on the big picture ideas in regards to improving breastfeeding rates and cultural acceptance that we make the mistake of seeing each woman as one to be “conqured”…wishing only to “win her to our side”. Supporting breastfeeding on a macro level is tough work which takes huge volumes of energy, but what a disservice when we think of women as only check marks in the “initiated breastfeeding” or “exclusive breastfeeding for 6 months” columns.

Often, in an attempt to support breastfeeding, we forget that there is much more going on in this relationship than milk ejections and swallowing. The community supporting those with Insufficient Glandular Tissue and Low Milk Supply do this beautifully. Inspired by Diana West’s groundbreaking book Defining Your Own Success, these women champion the idea that THEY get to be the ones who decide what breastfeeding will look like for them, in light of significant challenges. We must look at breastfeeding women not as simply milk makers, but life makers and relationship makers and confidence makers as well.

Empower Parents for Long Term Impact

I’m absolutely convinced that the early days of of a baby’s life are critical to the formation of parenting confidence. What if, instead of throwing checklists full of things that not even well-rested people could handle, we instill confidence and a “we were made for this” kind of attitude. I’ve long maintained that birth and breastfeeding are the only two biological processes that we, as a culture, assume won’t work the way they were designed to. From the moment we announce our pregnancies, we are bombarded with messages that tell us that we simply aren’t up for the task, that out bodies will fail us, that we won’t be good enough, smart enough, mom enough. Why then are we surprised when those messages continue on into parenthood? For those we encounter as breastfeeding supporters, we can have a significant impact at a critical moment. Reminding a woman that her body was made for breastfeeding, encouraging her to follow her “gut”, and listening closely to her ideas about what could improve her outlook can all be vitally important. Moments like that set her up for future success. Feeling like “I am the most qualified person to care for my child” on Day 3 can often translate into the same feeling on day 5 and month 5 and year 5. Treating parents with respect and care and with the belief that they are wildly capable is critical.

The great Dr. Seuss was quite the philosopher when he penned, “A person’s a person, no matter how small” and I would echo with “A family is a family no matter how young.” As we seek to pour our professional and volunteer lives into these brand new families, we must remember that communicating about their value and worth are important building blocks to their long term confidence as parents. I’m privileged to be able to be one of the first professionals to look them in brand new parent (bleary and bloodshot) eyes and say “You’ve Got This!”

Amber McCann, IBCLC is a board certified lactation consultant in private practice with Nourish Breastfeeding Support, just outside of Washington, DC and the co-editor of Lactation Matters, the official blog of the International Lactation Consultant Association (ILCA). She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same. In addition, she has written for a number of breastfeeding support blogs including Hygeia and Best for Babes. She also serves as the Social Media Coordinator for GOLD Conferences Internationaland is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms. When she’s not furiously composing tweets (follow her at @iamambermccann) or updating her Facebook page, she probably snuggling with one of her three children or watching terrible reality TV.

Filed Under: baby, Breastfeeding, Breastfeeding and society, breastfeeding help, breastfeeding support, family, father, Featured, guest posts Tagged With: Amber McCann, baby and mom, Breastfeeding, breastfeeding dyad, Breastfeeding support, family, marriage, Nourish Breastfeeding Support, postpartum, relationships

The Basics of Tongue and Lip Tie: Related Issues, Assessment and Treatment

November 19, 2012 By theleakyb@@b

By Melissa Cole, IBCLC, RLC and Bobby Ghaheri, MD., Portland OR.

“Tongue-tie” has become quite a buzz word in some circles and is still quite unknown in others. Tongue-tie, professionally known as ankyloglossia, is a congenital condition in which the lingual (tongue) or labial (lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding and, in some instances, other health concerns like dental, digestive and speech issues. Mothers of infants dealing with feeding challenges are often desperate to find solutions; as awareness increases about tongue and lip tie, some mothers wonder if this is something their baby may be coping with.

Parents often want to know what some typical signs of tongue/lip tie are. Each mother/baby dyad is very unique and therefore tongue/lip tie issues can present differently for everyone. Some common symptoms that may point to the infant being tongue/ lip tied include: poor latch/inability to latch, sliding off the nipple, fatigue during feeds ,sleepy feeds, poor weight gain, clicking during a feed , maternal nipple pain/damage (can feel like the infant is compressing, chewing, gumming, pinching, scraping the nipple, etc), increased maternal nipple/breast infections, compromised maternal milk supply, dribbling milk at the breast/bottle, digestive issues (increased gassiness, reflux, etc due to extra are being swallowed and poor control of the milk during a swallow), and various other feeding related challenges. Some mothers and babies may cope with some of these issues, all of these issues or even none of these issues when a tongue/lip tie presents. We must keep in mind having a frenulum is not the problem; compromised tongue mobility and functionality that cause problems for the mother and/or baby are the problem!

Mothers are tech-savvy and often turn to the computer first to research what might be causing their feeding concerns. When moms go online, they will most likely encounter some discussion about how tongue and/or lip ties can cause feeding issues. If parents suspect a tongue/ lip tie then families will often want to see a provider in-person to have their baby evaluated and treated. Sometimes families are lucky enough to have a local provider well-versed in evaluating and treating oral restrictions like tongue and lip tie. However, many mothers may not have access to this expertise in their local communities. If you suspect that your infant may have a tongue or lip tie and you’re not able to find a provider in your community to evaluate and treat this condition, consider connecting with a local international board certified lactation consultant (IBCLC) that should be able to help connect you with additional resources. Another resource is the website for the International Affiliation of Tongue-Tie Professionals (IATP) (please note that the website is just about to be launched and may or may not be live at present, do check back if needed).

Tongue Tie

Tongue tie, released

Tongue and lip ties come in various shapes and sizes and can present uniquely in every baby. Many providers have only been trained to look for very prominent, classic tongue ties that often create a heart-shaped tongue. However, tongue ties can be sneaky and restrictions that are more posterior (toward the base of the tongue) cannot be easily visualized. Proper assessment and evaluation are key when identifying these types of ties because they can easily be missed at first glance. Not all providers know how to properly assess for all types of tongue and lip restrictions. While there are various assessment tools and tongue-tied classification scales that have been published, there is still no universally accepted standard of assessment and care when it comes to tongue and lip tie. This fluctuation in assessment and treatment standards can be extremely frustrating for parents trying to seek evaluation and care for their potentially tongue and lip tied infant. If you are unsure of whether or not your provider is adept at assessing or treating various types of tongue and lip tie you may want to ask your provider the following questions:

How do you assess for tongue/lip tie?
How often do you treat tongue/lip tie in your practice?
Do you treat posterior tongue ties?
How do you perform the procedure?
What type of follow-up care to recommend after the procedure?

Providers that routinely assess and treat babies for tongue and lip tie should be able to easily answer these questions and provide parents with enough information so that they can make an informed decision. Providers that may not be the best to assess or treat your baby include ones that rarely assess or treat for this condition, tell parents that the tongue tie will stretch or that it’s not a big deal, tell parents that they have never heard of it posterior tongue tie, or tell parents that this must be done under general anesthesia. Parents should always feel empowered to seek additional opinions and advocate for the needs of their child if they are struggling to find a provider that understands and treat oral restrictions.

Lip Tie

Lip tie, released

If a tongue or lip tie is present and parents wish to seek treatment, what can parents expect? Various types of providers treat tongue and lip tie including: ear nose throat doctors (ENTs), pediatric dentist, oral surgeons, pediatricians, naturopathic physicians, and others qualified to do minor surgery. In most all cases, releasing the frenulum for infants is an in-office procedure, with no sedation needed. In some rare cases, or in cases with older children, sometimes light sedation is used if the parents or provider feel that the older child would be too stressed while alert, but in infants this is usually not necessary at all. Some providers release the frenulum with sterile scissors, others use laser technology. The availability and types of providers in any given community will vary as will the course of treatment. In general, this is what we tell parents coming to our practice to expect (please note that other providers may perform the treatment slightly different ways):

What to expect when your baby needs a frenotomy/frenectomy:

In general, the procedure is very well tolerated by babies. We take every measure to ensure that pain is minimized.

1) For a typical frenotomy (an incision of the frenulum), a topical numbing gel is applied once or twice and occasionally, if a frenectomy (frenulum tissue is removed) is needed, a small amount of local anesthetic is injected. Often, ice chips are applied directly to the area before (and sometimes after), as this helps numb the area.

2) Crying and fussiness are quite common, and most children lose only a small amount of blood. They will frequently drool afterwards until the numbing medicine wears off.

3) Pressure and ice are held to help minimize any bleeding, and the child will be returned back to you, where you have the option of immediate breastfeeding, bottle feeding or soothing depending on your preference.

4) Tylenol may be used afterwards but is often not even needed.

5) You may notice some dark brown stools or spit-ups afterwards as some blood may get swallowed after the procedure.

There is very little risk involved with the frenotomy/frenectomy procedure. The biggest risk of the procedure is the potential for re-attachment to occur. In order to prevent this from happening, we work with the patient’s in our practice to keep the newly-released area open and healing well by encouraging specific mouth-work after the procedure. We encourage gently massaging/stretching the incised area, targeted oral motor work to help the tongue and mouth learning patterns, supportive bodywork, and other complementary healing modalities. By incorporating this type of gentle aftercare, we do see a reduction in reattachment and better progress overall.

Over the decades, it is no doubt that many breastfeeding relationships have probably suffered greatly due to undiagnosed tongue or lip restrictions. While more providers and parents are becoming educated about ties, we must be mindful not to think that every feeding challenge is created by a tongue or lip tie or that releasing restrictions will immediately improve the feeding situation. Sometimes there is immediate improvement after the procedure and sometimes it is a gradual process as the tongue is supported in moving in new ways. Feeding challenges can be complex and involve layers of issues. In addition, tongue/lip tie can create other issues that may need to be proactively addressed. Infants and mothers may cope with muscular tightness, nipple damage/pain, milk supply issues, infant weight gain concerns, etc. that need further support before and after a tongue/lip tie is evaluated and treated. Working with a qualified, experienced board certified lactation consultant or other care providers that are familiar with oral restrictions is highly suggested. Coping with feeding challenges in a tongue/lip tied infant can be an emotional and physical roller coaster for families. It is our goal in writing this article that all mothers and babies receive the care they need and that awareness in regards to tongue/lip tie issues will continue to increase worldwide.

For additional resources on tongue and lip tie, please visit Luna Lactation’s website resource page and scroll down to the tongue tie section.

Biographies

Melissa Cole, IBCLC, RLC is a board certified lactation consultant in private practice. Melissa has been passionate about providing comprehensive, holistic lactation care and education to parents and healthcare professionals for over a decade. She is an Adjunct Professor at Birthingway College of Midwifery in Portland, OR where she teaches advanced clinical lactation skills. She is active with several lactation and healthcare professional associations including La Leche League and the International Affiliation of Tongue-Tie Professionals. To contact Melissa feel free to email her at Melissa@lunalactation.com or follow her on Facebook and Twitter @LunaLactation. You can read more from Melissa at lunalactation.com.

Bobby Ghaheri, MD is a board certified ear, nose and throat specialist with The Oregon Clinic in Portland, OR. His interest in treating children with tongue and lip-tie stems from his ardent support of breastfeeding and was furthered by his personal experiences, as his youngest child benefited from treatment for it. He enjoys working with children and has an interest in traditional and non-traditional approaches to pediatric pain control. To communicate with him, feel free to email him at drghaheri@gmail.com or follow him on Twitter at @DrGhaheri. You can read more from Dr. Ghaheri at The Wrinkle Whisperer.

References

Coryllos, E., Genna, C. W., & Salloum, A. C. (2004). Congenital tongue-tie and its impact on breastfeeding. Retrieved from http://www2.aap.org/breastfeeding/files/pdf/bbm-8-27%20Newsletter.pdf.

Ghaheri, B., & Cole, M. (2012). General Information about Frenulum Procedures for the Infant (pp. 2).

Hazelbaker, A. K. (2010). Tongue-Tie: Morphogenesis, Impact, Assessment and Treatment: Aidan and Eva Press.

Kotlow, L. (2011). Diagnosis and treatment of ankyloglossia and tied maxillary fraenum in infants using Er:YAG and 1064 diode lasers. European archives of paediatric dentistry : official journal of the European Academy of Paediatric Dentistry, 12(2), 106-112.

Filed Under: breastfeeding difficulties, breastfeeding help, Featured, Nipples, Relational Resource, tongue tie/lip tie Tagged With: Bobby Ghaheri, Breastfeeding, breastfeeding tongue tie, frenotomy/frenectomy, IBCLC, infant lip tie, infant tongue tie, lip tie, MD, Melissa Cole, RLC, tongue tie

A Translation Guide for Navigating the Terrain Between Breastfeeders and Formula-Feeders

February 16, 2012 By theleakyb@@b

Talking about breastmilk or formula can be difficult to navigate with a loose, slippery, and uneven terrain. One second you think you have sure-footing and the next you’re on your butt.

I’m not going to deny that hurtful phrases come from breastfeeding supporters, occasionally in the form of personal attacks, and if you’ve personally experienced that, I’m truly sorry. Please know that most of us just want to get information out there, encourage others and want to see babies fed. Including me.

More often I see what are truly meant as innocuous statements of information and education that are simply misunderstood. All of us experience life through a variety of personal filters and we often have sensitive areas that automatically put us on our guard and we may take things as a personal attack when that’s hardly the intent. When it comes to feeding babies all those devoted moms doing their best have some serious passion.

An article is released sharing the findings of a new study that revealing some new findings about breastmilk or there may be some issues with formula and hundreds of comments pour in with things like “formula is the same thing, really and all the breastfed kids I know are sick all the time but my formula fed kids have genius IQs and are never sick” or “you know, not everyone can breastfeed so I guess I’m a bad mom because my breasts just didn’t work.” To add fuel to the fire there are the comments that say things like “See, this is why I’m so glad I gave my babies the best and breastfed.” And really, what does saying something like that do for anyone? Heaven forbid it be an article on a formula recall and the “so glad I breastfeed, breastmilk is never recalled” comments start flooding Facebook newsfeeds and loading the comments section on blogs and articles. Nothing like rubbing someone’s face in their scary circumstances and flaunting “sucks to be you!” If we’re not careful we cross the line from passionate advocacy into plain ol’ bullying.

Then there’s the mom celebrating her success in breastfeeding, sharing “So excited we’ve made it to 6 months without even one drop of formula! GO BOOBIE MILK! WOOT!” In that moment that mom is inviting everyone to a party at her house because she’s truly excited about her accomplishment. But just as sure as she’s about to pop the cork on that sparkling grape juice to pour a round for everyone someone says something like “I don’t know why everyone has to be so down on formula, it makes moms that use it feel bad.”

They probably don’t mean to be a Debbie Downer and they don’t intend to dismiss the celebration of that mom (or maybe they do, I can’t really say) but stirring in their internal narrative of parenting confidence are insecurities on this issue, perhaps closer to the surface than they realized. Instead of being able to celebrate with that mom, they are having to deal with their own less than happy feelings and defend, at least to themselves, their reality.

Thankfully, most of the time people can just say some encouraging and supportive words. Once in a while, far more often than I’d like, the communication deteriorates. Quickly. As though we’re trying to have an important conversation but lack the skills. Like we’re speaking different languages.

Maybe we need an interpreter? What follows is my light-hearted attempt at some translations to help us navigate these slippery slopes.

It’s not a put down on formula feeding mothers when breastfeeding advocates say:

“Breastfeeding is the normal way to feed a baby.”

What we don’t mean: “Formula feeding moms are less of a mother and less than normal.” We know that’s not true. We also know that breastfeeding isn’t (yet) accepted as normal in society. We certainly don’t mean that it is always easy or even possible for every mom. Or that formula feeding moms don’t deserve to be treated as normal, loving, caring mothers because we know they are normal, loving, caring mothers. Nope, none of those things are what we mean.

What we do mean: Breastfeeding is the biologically normal way to feed a baby. A mother’s body is programmed to breastfeed and a newborn baby is programmed TO breastfeed. Meaning that, barring any physical difficulties, babies are born ready to breastfeed; the delivery of the placenta signals the mother’s breasts to produce milk to feed, the mother’s body biologically responds to birth by producing milk, and human milk is (usually) the perfectly formulated food biologically for a human baby.

“I’m proud to breastfeed.”

We don’t mean: “I’m better than a formula feeding mom.” Just like being proud to be a mother isn’t a put down to those aren’t mothers, so being proud of breastfeeding isn’t a put down to those that don’t breastfeed.

We do mean: Breastfeeding is important to us and sometimes it’s hard and comes with recognized challenges. We’re celebrating our accomplishment of something we value as important for ourselves. We’re also recognizing that there is a lot in our society that sabotages moms that want to breastfeed and combating that can be challenging.

“I love the bond I have with my baby with breastfeeding.”

We don’t mean: “Moms that don’t breastfeed aren’t as connected to their babies.” Feeding a baby is a deep connection no matter how it’s done and is just one way parents bond with their babies. Most of us know moms that formula-fed and are incredibly bonded to their children and don’t doubt for a second that formula-feeding moms deeply love their children.

We do mean: This is something we consider special and helps us feel connected to our child. That, to us, breastfeeding has a deep feeling of interconnection that goes beyond something we can explain but we try even thought words fail us. Feeding our babies with our milk and at our breasts is one way we feel deeply bonded to our babies.

“I’m so glad I’ve never had to give my baby formula” or “I’m so glad she’s not had 1 drop of formula.”

We don’t mean: “Formula feeding moms are lazy or giving their babies poison.” Nope, it’s not a commentary on what someone else does. We’re not saying that somehow formula feeding moms should be ashamed of giving their babies formula or that never giving a baby formula is some dividing line between the good moms and the bad moms.

We do mean: Like being proud of breastfeeding, not giving their baby formula just feels like a personal accomplishment. It is in no way a reflection of our opinion of anyone else’s choice or situation, merely an acknowledgment of a personal goal.

“Breastfeeding is beautiful!”

We don’t mean: “It’s perfectly beautiful all the time.” Finding something beautiful doesn’t mean it’s easy or right for everyone and it doesn’t even mean we always enjoy the experience.

We do mean: Not only do we NOT find it gross, we also think it is special, something wonderful, and to be celebrated. It is more than nutrition to us and is a beautiful experience we treasure even though it has plenty of challenges along the way. We also know that not everyone agrees with us, that’s part of why we say it though so we can hope to change negative cultural attitudes toward breastfeeding.

“Breast is best!”

We don’t mean: “The moms that breastfeed are the best moms and the moms that don’t are just ok or bad.” That’s not it at all. In fact, this slogan came first from formula companies when they were forced to acknowledge that breastmilk was a superior product to formula. They had to acknowledge that but had to find a way that could make formula sound normal and breastfeeding to sound like it was a parenting “extra,” an optional choice.

We do mean: Breast milk is the best food choice available for a baby and young child. Personally, I don’t care for this statement myself (you can find more on that here) but I know when people say it they aren’t intending anything other than their enthusiasm for breastfeeding and stating a simple fact: breast milk is good for babies. It’s not a put down towards anyone.

“I feel sorry for babies that aren’t breastfed.”

We don’t mean: “Those kids are just so screwed.” This comment makes me uncomfortable, I don’t like it. But I understand where it’s coming from and why it’s said. Those of us that breastfeed see the joy and delight our own children have in the experience, how they love breastfeeding. We are completely convinced it is special for both them and ourselves in a purely innocent, sweet way. While it can be very close to a put down, I don’t believe it usually is intended as such and we don’t actually full on pity children that didn’t get to breastfeed but rather mourn the loss of an experience we consider special.

We do mean: This is an awkward but genuine expression of sadness for those missing out on something we feel is so special. Should it be said? I don’t think so. But if it is I hope formula-feeding moms can understand it is most likely only because the speaker/writer truly believes every child should get to have the marvelous experience her own enjoyed so much.

“There need to be strict regulations regarding the manufacturing and marketing of formula.”

We don’t mean: “Formula-feeding parents are gullible and fall for the marketing of poisonous formula.” Voicing the view point that there need to be standards in how formula is marketed and that there should be strict regulations for formula as a product isn’t a reflection on the parents at all. It may reflect a cynical distrust that formula manufactures have anything other than a bottom line on their mind (Unsupportive Support- For a Profit). Ultimately though, those of us that believe that the manufacturing and marketing of artificial breastmilk substitutes in infant and toddler nutrition believe so for the good of the children’ receiving the product.

We do mean: Even if our children don’t receive formula, the children that do are worth higher standards of excellence. We demand transparency and better regulations for artificial breastmilk substitutes manufacturing for the babies that need it. Formula is necessary, the health of many children depend on it being manufactured with integrity.

Before you find yourself careening down a conversation on your butt, try to remember that most people aren’t trying to start something and those that are probably aren’t worth your time. As a breastfeeding mother, I promise, I’m not trying to push formula feeding parents down. We’re all just carefully trying to pick our way over the rocks, slippery spots, and potential jabs to enjoy the view life has to offer and with a little bit of sensitivity and understanding going both ways, we can all offer a hand to each other in spite of our differences.

Filed Under: Breastfeeding, Breastfeeding and society, breastfeeding help, breastfeeding humor, breastfeeding support, Featured, formula, guilt, humor, Jessica, motherhood, nursing, Parenting Tagged With: Breastfeeding, breastmilk, formula, mompetition, moms, support, Unsupportive support

Dear Nurse Julie- a letter to my labor and delivery nurse

January 30, 2012 By theleakyb@@b

Dear Nurse Julie,

You were in my life for about two and a half days 13 years ago, I’d never met you before nor have I seen you since. It may have been brief but you made a huge difference in my life and I owe you a deep debt of gratitude.

I had prepared so much for the birth, read everything I could get my hands on including an OB text book, took a childbirth education class, and practiced Bradley method relaxation for weeks at home with The Piano Man. We knew what we wanted for our birth and after a complicated pregnancy, we were prepared to fight for it. When I went into labor at 41 weeks and 4 days we were ready. The Piano Man was an amazing advocate for me, actively intercepting anyone that entered the room and questioning every procedure (no enema!) while helping me relax and focus on the work of birthing our daughter. Together, he and I made a great labor and birthing team. I’m pleased to say that 5 babies later and one on the way, we still do.

Our bags were packed, there was film in the camera (remember that? Cameras that used film?), we were so ready to have a baby. Except for one thing: we had done nothing to prepare for breastfeeding. The thought hadn’t even occurred to us. We knew that was how we were going to feed out baby once we had her in our arms but we read nothing, took no classes, and never even thought to see if there was anything we needed to know before breastfeeding. Both of our mothers had breastfed, we knew a few friends that had so really, how hard could it be?

All our nurses were nice enough and the birth was mostly amazing with some traumatic experiences. Earth Baby was born at 6.39am and we met you shortly after with the shift change. Instantly I felt connected to you, your smile, your warmth, and your genuine congratulations on our baby as if you hadn’t seen hundreds of births and newborns every week. After I was all stitched up, hydrated, and my blood loss dealt with you asked me an incredibly important question: “are you ready to breastfeed your baby?”

Nobody had mentioned it. I knew it was in my chart because something I had read about birth plans suggested to ask for it to be put in my chart. Still, you were the first to say anything about it. Having just lost a lot of blood with a partially retained placenta and manual DNC, I was feeling weak and more tired than I had ever felt in my life. Holding my baby, let alone breastfeeding her, completely wore me out. Like a dear in headlights I told you yes, but only because I remembered that it was the plan. Your response: “good, because she’s hungry and I think she’s ready to eat well for you” jarred me out of feeling my exhaustion and into the reality that my baby needed me to meet her needs. I really was ready to feed my baby.

I don’t remember how long you stayed in my room but somehow, you made me feel like I was the only mom that needed your attention. Perched on the side of my bed, you helped me get into a position I found comfortable, plumped plenty of pillows to support Earth Baby and I, encouraged me to drop the shoulder of the hospital gown, and talked me through latching Earth Baby for the first time. Your encouragement for how well we were doing, what a healthy strong latch Earth Baby had, and suggestions for positions made me feel like not only could I breastfeed my baby, I already was and doing great! You answered every one of my questions, no matter how basic or obvious the answer may have been, as though it was a pleasure to answer my important concerns with patience and care. Even when Earth Baby was latched and I was comfortable, you stayed and chatted, telling me about your 2 boys, that you had breastfed your second one but not the first, and telling me about how you were drawn to OB nursing and how you loved helping moms.

It showed.

Once I was moved to the postpartum wing, you continued to visit me. You’re ongoing support regarding everything I was experiencing from peeing for the first time after giving birth to changing my baby’s diaper to breastfeeding helped grow my confidence that I could, in fact, take this baby home and not kill either of us. When I told you my nipples were hurting you showed me how to position my baby’s chin lower on my breast so she took a big mouthful of nipple. When I was still drained from the birth, you explained different positions and helped me practice using them. Constantly considerate, you never touched me without asking and receiving my permission first and even then you rarely handled my breast choosing instead to carefully and patiently explain how I could do it myself. I can’t even begin to tell you how far that went in helping me not be afraid or feel strange about my own body. From the bottom of my heart I thank you for that gift, it has remained with me to today, growing stronger over the years.

When the grumpy nurse, who’s name I can’t recall because for the last 13 years I’ve referred to her as “grumpy nurse,” told me I was starving my baby because my breasts were empty and not meeting my baby’s needs, I cried. A lot. Earth Baby had lost over a pound in just a matter of 2 days and the grumpy nursery nurse that made me cry told me I’d never be sent home with my baby if I didn’t agree to give her formula. Oh the things I know now! All those fluids we had in labor… but back then I had now idea. I caved. Still weak from the blood loss, recovering from a 4th degree tear, and afraid my baby was hurting I agreed to a bottle of formula. My heart ached, I never meant to starve my baby and my fears were confirmed, I was already failing as a mother. She whisked my baby away, a satisfied smile on her face as she told me I was making a good choice for the good of my baby, and ran off with my daughter to feed her the bottle of formula. I sobbed. You came in shortly after and was surprised Earth Baby wasn’t with me. When I told you why I saw the storm clouds gather in your normally incredibly friendly eyes and you told me you’d be back. What I didn’t know is that you must have marched out to that nurses station, called our pediatrician, asked him about the situation, advocated for our breastfeeding relationship, asked him to call the nursery, and headed down there to get my baby back for me. When you walked in about 15 minutes later with grumpy nursery nurse and my daughter, I had already spoken with our pediatrician who called me to assure me our baby was going to be fine breastfeeding and at this point did not need any formula. He told me that he had spoken with you and trusted you that Earth Baby and I were doing great breastfeeding, that my milk was coming in, and that I was already a pro. I cried again. Someone believed in me.

Somewhere I still have the picture of you and I and Earth Baby just before we were discharged. My face is red from crying having just gotten Earth Baby back. You had told me that we were going to be fine, that I was a natural, that Earth Baby was lucky to have me as her mom, and that you enjoyed working with me. That’s what you told me. Some many had dismissed me as a young mom and at 20 I was, but you stuck with me respectfully teaching me as though my age was of no consequence. What you taught me without directly saying so was that I could feed my baby, my body was amazing, I didn’t need to be afraid of my breasts, and I could advocate for myself and my baby. My husband believed in me but I knew he was just as clueless as I was. But you? You were not only an experienced mother, you were a nurse that saw mother after mother with new babies and you believed in me. If you said I could do it, I probably really could.

Today, 13 years later, I owe a lot to you. For starters, my breastfeeding relationship with Earth Baby which lasted a year and then extending on to 4 (now almost 5!) babies. Thanks to you, today I now help support other mothers with their birthing and breastfeeding journeys. Thank you for supporting me even when I wasn’t sure how to support myself. Thank you for giving me the courage to be the kind of mother I naturally was but was insecure about stepping into. Thank you for being kind and encouraging when I was most vulnerable. Thank you for making a difference in my life and the lives of my children. You have touched more than you know. I want to be like you and just love helping moms.

I hope it shows.

Sincerely,

Jessica Martin-Weber

The Leaky Boob

Filed Under: Breastfeeding, breastfeeding help, breastfeeding stories, breastfeeding support, Breastfeeding the newborn, Featured, Jessica, Letters from The Leaky Boob, Parenting, postpartum Tagged With: Breastfeeding, breastfeeding a newborn, Breastfeeding support, hospital, L&D nurse, Newborn, OB nurse

Tips and Tricks from the pros- Moms and IBCLCs on biting and breastfeeding

January 23, 2012 By theleakyb@@b

My journey with biting and breastfeeding has been full of ups and downs. I shared some of my story in this post about how I handled Earth Baby biting me by going against my instincts and flicking her on the cheek which led to a nursing strike and then weaning. After that experience I began looking for more gentle ways to respond to my baby biting while at the breast and found some methods to be very effective for our family.

Biting comes up so often in conversations about nursing I decided to see what others would suggest to stop the behavior and save the boobs. Sending out my question to the great world of Twitter, I got some great replies from some wonderful IBCLCs.

Practical tips for dealing with biting from tweeting IBCLCs

@NortoriousStar, Star Rodriquez, IBCLC (Facebook)

“I usually tell clients that their baby had to break suction to bite, so if they have a biter, to pull them off as soon as that happens. You have to pay attention and be fast, but removing the breast when they think about biting? That works well as negative reinforcement. The fact that you’re removing the breast is negative reinforcement. Not all babies bite because they are done…and if they seem to want to nurse afterward, I usually waited a 2-3mins (and up to 5 if they actually bit.) It was a more gentle negative.”

@FeedYourBaby, Denise Altmen, IBCLC (website)

“Rub the baby’s gumline with a cold/damp textured washcloth using gentle pressure right before (breastfeeding).”

@NurtureNormally, Melissa, IBCLC (website)

“Take a break when it happens. Prevent w/pre-feeding cold. Pre-feed cold: cooling/numbing baby’s gums with a damp, frozen cloth. Some moms make BM “popsicles” for this purpose. Or make BM ice cubes and put them in a mesh feeder. Numbs gums so baby is more comfortable before a feed. Also, some moms are able to begin to recognize when a feeding is ending (when most babes tend to bite) and end feed b4 bite. Feeding slows significantly. Also, some babes tend to “quiver” their jaws before a bite and moms can use that as a signal.”

@Stylin_Momma, Katy Linda, IBCLC (website)

“I’d focus on comfort of the baby. Frozen wet wash clothes, ice cube in a mesh feeder, etc. If you can get them comfortable before they nurse, they’re less likely to bite. Also, check latch, babies can change position to their comfort level when teething, and sometimes a quick adjustment can make a world of difference.”

@BreastfeedingNY, Deidre McLary, IBCLC (website)

“Swift, firm, consistent response: unlatch, say “NO, biting hurts”, put baby down, walk away. Don’t reward behavior by keeping baby nursing. Take short break, separate. Baby learns biting = END of bfing session.

@DianaIBCLC, Dianna Cassar-Uhl, IBCLC (website)

“Press baby in, he’ll have to open mouth to breathe. Toddler? Firmly say ‘no bite!’ and put him on floor facing away.”

After sharing how flicking Earth Baby on the cheek to stop her biting led to early weaning at 10 months, I asked the Leakies on The Leaky B@@b Facebook page for their experience and any tips they had to gently stop biting. Here’s a sample of their comments and you can find the original thread by following this link.

Leakies share how they handle biting

Kayla: We stop immediately.

Rose: Take him off (usually after forcing his teeth apart as he clamps rather than just bites) and sit him down next to me. I then tell him no I’m a stern voice and say ‘that hurts mummy, we don’t hurt people we love people.

Claire: my son never bit (thankfully) !! *phew*

Alishia: When mine bit me I would take her off and tell her in a calm but firm voice “no.”

Jennifer: My older daughter only bit me a few times, and never on purpose. I pulled back instinctively from the pain, but didn’t make a big deal out of it. She also bit my shoulder (hard!) when she was teething, so I know it was just her way of dealing with the discomfort of her teething.

Tonia: I say ouch, no bite and take the boob away, for 5-10 minutes and put the baby down. It only takes 2-3 times, I’ve done it with all 3 of my kids.

Jennifer: I just have to say, “OW!” and my little gal has a freak attack. People told me to flick her on the cheek and I was uhm, no. Poor little punkin’ doesn’t like just OW so I can’t imagine what flicking would do to her!

Tracy: My kids didn’t bite until they were older, over a year. so we ended the nursing session immediately when biting occurred.

Hayley: I’ve heard to pull their head into your boob and that is meant to work, never tried it as ds didn’t bite.

Kate: I found that my children mostly only bit me near the end of the feed when they were no longer hungry. So if they bit, that was the end of the feed for then. Worked great, hardly ever bitten.

Elle: I tell her no say ow & take it away for a few minutes. She only bites when she is sleeping now, and I’m learning when to take it out & when to leave it be.

Ashley: I tried the flick method and my demon seed laughed and bit me again. That’s what I deserve I guess.

Amy: I pop him off the boob, say “we don’t bite the boobie!” And give a break for a little while then try again… Still working on it.

Brandilynn: I slip my pinky between his gums so he can’t bite down any harder and tell him no biting mama, he can’t nurse if he’s going to bite me right now and take him off.

The Hook Up: my little one bit quite a few times. I always gasped (not on purpose, but it did startle him!) and firmly said NO and showed a mean face. He got it after a time or two, and there was no physical “punishment.”

Laura: I’ve always just yelped and yanked off for a minute. I’ve had to pry my little guy off a few times because he’s got a mean streak and will bite when he’s in a bad mood.

Kit: With my DD, what had it come and go fairly quickly was to detach her, sit her facing me, and tell her “no, we don’t bite. That hurts mommy and mommy doesn’t like it.” When she would pout, I’d give her a hug, tell her that she can’t do that because it hurts, and put let her relatch. I had to be consistent and it took a few weeks, but it worked, and it stopped completely. We nursed for another 4 months or so after our last biting incident.

Jessica: My method is to scream, “Ow! Ow! Ow! Ow! Kovi, please stop!” lol. I can’t say it’s terrible effective, but it’s the only thing I can manage to say/do at all.

Vicki: I used to put my finger in DD’s mouth to unlatch her, then progressed to pushing her head into my breast and now at 19 months saying no very very firmly and pinching her nose. She usually laughs at me though but only bites when teething now.

Leanne: I just yelped which startled baby enough to stop then relatch and carry on. If it happened again I would remove baby and put boob away for a minute. It did work eventually! Biting really hurts!

Karen: Well, first I yelped “Aaaahhh” and it startled him enough to break suction. Then I looked him in the eye and said, “Ouch, biting hurts!” Babies are usually empathetic enough to understand the sad and hurt look on Mom’s face.

Misty: When he bites I tell him no and sit him on the floor. He cries for a few seconds then I pick him up and let him nurse again. Normally, this stops the biting.

Tristen: I have put my son down, I also flicked his cheek and felt how wrong it was. I have had to step back and realize he only bit when dealing with teething pain so I addressed the teething pain and the biting all but stopped.

Jeanette: Sometimes I gently pinch my Daisy’s chin. She just laughs at me. If I ‘close up shop’ she gets mad and cries. I always, always give in and put her back on the boob. If she does it at night while we’re laying down, I know it just isn’t time for her to go to sleep yet. I haven’t really gotten her to stop biting (not that its that often) and I don’t think I will. I am just happy that we are still nursing strong at 16 months!

Nichole: When mine bit I gently pulled them off, placed my fingers to their lips and said no bite in a firm tone.

Jenna: I told both my daughters ‘ouch, that hurts’ and made a sad face. After a few times of that, they stopped. I think it was just a phase anyhow.

Erica: We used Kellymom’s smush the face into the boob technique.

Elisa: Sometimes just ignoring it works. My son thought it was funny when I would say ouch, or yelp. So I just didn’t say anything, unlatched him and put him down. He stopped within days.

Lauren: Biting led us to a 2 day wean at 1 yr and 2 days. She ripped open my nipple for the second time and it became too painful to nurse. I tried holding her nose to get her to unclench as well as yelling no. (she’d been biting for over two weeks and drawing blood) Nothing worked. My aunt, who nursed three babies, gave me the advice to yell no and set them down far away from you, ending the nursing session. I think this would have worked but we never got the chance to try it because I received the advice the day we weaned for good.

Ginny: Whenever my boys nipped me when nursing I would gently slide a finger between their mouth and my breast to break the latch and say a stern ‘No!’. I’d then lay them next to me for 30 seconds before re latching them. I found this worked well and continued to breastfeed both sets of twins to over 12 months.

Victoria: I was told by my breast feeding support group to take the baby off the breast, put them down & in a firm voice tell him not to bite because it hurts. This wasn’t very effective at first until I started putting him down & walking away out of the room. When he realized that he wasnt getting milk or mummy he soon stopped.

Amanda: I would blow quickly on his face to get him to stop and then put him down. If he came back we would try it again. It only took a couple of tries before he stopped.

Amanda: I always said ouch and would take them off and say ouch that hurts mommy, then put them back on.

Maureen: It makes me terrified to put my nursling back on after he bites, but I realized that he only bites when he’s done and just wants to play- so paying attention to when your nursling bites is a good idea. I also yell every time because I can’t help it! It hurts! I wish I didn’t!

Jessica: I just push my breast further into her mouth, most of the time she bites because her latch is lazy and she’s not paying attention. That makes her open wider and latch better, which in turn stops the biting.

Ginny: I yelp and say no biting.. and put it away for ten minutes or so.

Chelsea: When I realized my daughter was starting on that phase, I waited, finger ready, and popped her off as soon as she began to bite down. I didn’t even set her down, just said, ”That hurts Mama” very calmly, and waited a few minutes before resuming nursing. She would get so upset at her dinner being interrupted, but it only took a couple of times for her to realize that biting accomplished exactly the opposite of what she wanted it to. I figured out incredibly quickly that the worst thing I could do was react a lot-she thought it was funny. But I couldn’t stand the thought of hurting her feelings, so popping her off was the most I could bring myself to do.

Natalie: I wish I could say I reacted all nice and calm. In reality I was reading while she was nursing, so the bite was completely unexpected. I screamed and bopped her on the forehead, she popped off the boob and cried a bit, I apologized to her and said “We don’t bite Mommy.” She resumed nursing and never bit me again.

Nicole: I firmly tell her no, put her down somewhere safe and give her something she can chew on. Sometimes I give her a cold teething ring before nursing if I know she is teething to help prevent bites. We seem to have this issue for about a week right before/after a new tooth.

Amanda: I went with my instincts (which I have learned are never wrong when it comes to mothering) and let out a gentle “ouch”, made a very sad face, and said, “that hurts mommy”. I also paid attention to when it was happening.. often it was when I was watching TV or looking at my phone while nursing, Emmaline wanted eyes on her, my hand ruffling her hair or massaging her ear.

Amy: I was told to press my baby’s face into my boob; forcing him to break the latch since he couldn’t breathe. I’ve had yet to do it.

Ariel: just unlatch him/her every time they do it for 5-10 seconds.

Stacy: The first time my son bit me I immediately took him off the breast for a few minutes. I only had to do this a few times before he figured out that biting = no boobie.

Margaret: I yelp, “OUCH” and pull him off. Usually it results in tears. Its never resulted in a nursing strike even though I yelp pretty loud (I’m not one of those people that can hold it in when I’m hurt by surprise). He’s still nursing even though i’m 11w pregnant and dried up!!!!!

Richain: My first only bit a couple of times but learn quickly that mommy wasn’t kidding around. He would bite, I would say OUCH! That hurt mommy! I would separate him and remove him from my lap to the floor (safe place) for a minute then pick him back up and nurse again. He was a quick learner… biting means nursing time is cut short. My second nursling has not bitten yet… but teething has started

CaryAnn: Honestly? I couldn’t handle it and began weaning. I tried “no biting!” a few times first.

Lori: With my oldest, he bit me at 7mos and we stopped nursing and started pumping til 1 yr. With Judah, I just put up with the biting. I have tried “no bite”, stopping the feeding, pinching, flicking, and he still bites. He started biting at 3mos and just turned a year. It’s not intentional/malicious, so I guess you just get used to it.

Krista: I just pull them closer in to me..so they are forced to release their bite (my little one would bite and not let go!). Then I say firmly, “No biting.” You just want to get their attention and interrupt their eating. They’ll look at you like, “what’s going on? Why’d you stop?” Do that enough times and they should get the hint.

Marilyn: Say OW LOL I push her face into my boob a bit, makes her let go because she thinks she can’t breath. then I look at her and say We don’t bite, that hurts mama. She onlyseems to bite when she is semi interested so I usually stop the feed right then and there too. resume later.

Lucile: With my first child I’d say: “no biting, biting hurts” for the first bite. For the second bite in a row I’d repeat it and add “if you keep biting I’ll take it away.” The third bite I’d put her down and say “OK, you’re done.” Sometimes she cried, but I drew the line at being a chew toy! With my second, I’m more aware that she bites when she’s having teething pain or is bored with nursing and feeling devilish. I can usually anticipate a bite and detach; if not I do the same as above. I usually give her something she CAN bite and say “if you want to bite, chew on this.” In my experience, biting comes and goes, so you may have to repeat this lesson several times.

Erin: I bring the baby in very close (covering the nose so she’ll let go) and then end the feeding right then. I also found that *most* of the time I could prevent the biting by paying attention. A baby who is actively nursing can’t bite, and my kids all have bitten me when they were done nursing and just hanging around. So I became very vigilant and watched for an end to the active suckling. One of my kids actually got a “naughty look” on her face right before she was going to bite. And I found that if I was multitasking while nursing, my kids were more likely to bite because I wasn’t giving them my undivided attention. So I just watched them closely, and ended the feeding with a frown if they bit. They learned pretty fast that if they wanted to nurse, then no biting.

Aimee: Mine only bit if there wasn’t really any interest in nursing right then (shallow, lazy latch), so I just closed up shop and tried again later. Easy for everyone involved.

Marta: Jonathan has been very gentle over the past 13 months, but there have been bitings here and there. I immediately remove him when that happens. Although sometimes I know his biting/painful latch is related to teething, and then I usually just go with it, because I know he didn’t intend to do it, he is just in pain himself.

Fonta: I was taught by my midwife to push the boob into their face which smothers them for an instant and they always let go and it only takes a few times…very effective and still loving.

Sarah: I’ve definitely got a little nibbler on my hands. She’s almost 10 months and has had teeth since 4 months. I just pry her mouth open and unlatch her and set her down on the floor. She gets the point quickly! And typically only bites when she’s teething or not really interested in nursing. The worst is when she’s falling asleep. Oouuuch!!

Carissa: My little one only bites after she has finished feeding so I just make sure I detach her when she has stopped actively suckling. I’ve tried saying no firmly and detaching her as soon as she bites, but because she’s already full she doesn’t care. The thing I’ve noticed is the more I react the more she enjoys doing it… She giggles and bites harder if a yelp!

Colleen: Take her off and set her on the floor. A baby cannot nurse and bite at the same time. Clearly she was just playing or wanting my attention.

Cheryl: With my LO, I just put up with the biting. From what I’ve seen, biting can be a sign of frustration (at least, past the exploratory stage – mine is 17 months and still does it!) so when she bites, I take the boobies away and try to remove whatever is frustrating her before she nurses again. It usually works – even a sippy of milk to quench her thirst helps sometimes, if she is frustrated by not getting enough milk. When she does bite, I either slip my finger in her mouth to release the bite or pull her towards my breast, basically smothering her with it LOL but she has to open her mouth to breathe, so she lets go. She is doing it less and less now, the more I do that.

Shauna: When my 14 month old bites I put my pinky inside his mouth and gently pull his lip in a fishhook type motion which distracts him and he let’s go and I try to communicate ”gentle, no biting please” sometimes it works

Anna: In a light hearted voice I said ” oh?! You’re finished???” and take him off and our my bra back on. He looked confused then I’d bring him back to the breast… If he did it again, I’d repeat. I never caused him any distress but he got the hint – if he but I thought it meant he was finished!

Melissa: Nothing. Absolutely nothing has worked for my son. So every feeding, without fail, he bites. And now that I’m pregnant too, the pain is unbearable, but I don’t have the heart to wean my baby.

April: I have to be VERY attentive and just stop it before it happens.

Rebecca: I jumped because I wasn’t expecting it… Was chatting at the time to a friend. But since I just tickle her feet (10month old) as she is very ticklish… And makes her laugh. I Don’t make a big deal of it and couldn’t upset her because I know she doesn’t understand that it actually hurts me.

Molly: With our girls I yelped (not exactly a plan, it hurts!) and blew in their face. That was unpleasant for them while nursing but not painful. If they bit more than once in a session they were done. All three figured it out fairly quickly, even at 3, 4 and 5 months when they got their first teeth.

Nicole: The first time my little one clamped down on my boob I yelled ow pretty loud because it shocked me. She let go really quick and looked up at me to see why I yelled. She’s done it a few times after that so I just tell her no biting and put her down. She’ll cry for a bit then we’ll resume. Pulling her into my breast doesn’t work. She actually pushes her face into my breast before she bites sometimes (advance warning for me).

Michelle: It doesn’t work immediately but I always push on their teeth/gums and tell them no bite every time.

Kasey: The first time I told her No Bite! In a firm voice and she cried so hard. I felt terrible. She has done it a few times since but not like that first time so I am hoping I got the point across.

Tamara: Watch for circumstances that tend to lead to biting like being really tired, being at the end of a feed (baby being satisfied), teething pain or frustration. Watch for the baby to pull to the tip of your nipple. My experience is that they usually pull to the tip before biting.) When you notice any of those things, unlatch the baby. Really watch baby every time for common factors that proceed the biting. If you can’t get ahead of the biting and she clamps down, first don’t pull away. Pull baby close. This prevents extra pain, and a lot of babies will unlatch at this point. If she doesn’t unlatch at this point, unlatch her yourself. Find something that you say every time it happens. I said, “No bite. When you bite, you don’t eat.” (If they bite while latched, they’re not eating anyway.) Then wait a few minutes before offering the breast again. If that means rehooking the nursing bra, pulling your shirt over the breast so that baby can’t relatch, do that. If baby is interested in resuming the feed after a minute or two, offer the breast and repeat what you said earlier. (I would say, “Remember: No biting. When you bite, you don’t eat.”) If baby relatches and bites again, follow the process again except completely end the nursing session. My experience is that if it’s not a problem of baby being in pain, they bite when they are finished eating anyway. You will go through the process several times before the baby gets it. (Tristan continued to do it for a while but gradually got to where it rarely ever happened at all–like once a month when teething was a problem or when he hadn’t napped enough–until he just hasn’t done it at all for a long time.) It’s a learning process, so remember to have patience and love in your demeanor no matter how much it hurts.

Kari: Mine only bites with teething, thank God he still has no teeth. But I pinch his nose and he pulls off, and doesn’t continue to do it.

Rachel: I learned to stand on guard with my finger near his mouth… I could tell when he was about to clamp down and would insert my finger, remove him, and walk away.

Melissa: I flicked my first nursling too, worked great, but my second was sensitive so I would cry from pain and refuse to nurse for a minute or two and then relatch while holding his hand and teaching “soft touches”. Worked great, so that’s what I’m doing with number 3 too.

Lorna: Using baby signing to signal pain helps get the message across too.

Tracie: I tapped my babies on the nose and said no. This worked with all 9 of mine.

Stephanie: I would unlatch my son, sit him down, adjust my shirt, tell him my breasts were in time out, get a cup of water for myself, and come back. It only took 3-4 times for him to get it, but I left the room so he could see the result of biting.

Kinberely: I thought that with my son it was a cue to end nursing but when I’d unlatch he’d route around to feed again, think he is hungry just teething too.

Heather: Easy, I tickle them!! they get distracted, giggle and let go!

Katherine: The first time my soon bit me I didn’t even think before I flicked him. He cried but never bit me again. I felt horrible though. With my daughter she has bit me a few times, the first time was right after her sister was born and I was so sore that all I could do was cry which freaked her out. My husband had to take her and was more upset it than I was, I was sad that I scared her but it hurt SO much. She has nipped me a few more times but each time I tell her no, tell her to be gentle with mommy’s breasts, and have stopped nursing her for a minute so she understands that if she’s not gentle I’ll take the breast away. She hasn’t bit me in a few weeks so I think she got the point. She’s moved on to putting her fingers in mouth or holding hands with her sister while they nurse. Way cuter than biting.

Ma Ma: The first time I pressed her into the breast to make her release and said no and showed the sign for no. She was teething her first two teeth at the time. A couple days later she bit down pretty hard! I said no and signed it then sat her down on the floor (I was in the chair) she cried and didn’t nurse for two days (except for at night when she was half asleep). That nursing strike scared me so bad and I thought she was gonna stop nursing at 8 months…I remember sitting in bed with her that second night saying it was ok and mama wanted her to nurse. She would move in and then shake her head and cry I was crying too. I finally think she just understood and it was ok but just not to bite because when I finally got her to latch (while she was crying) she tested the nipple with her Lil gums and then when she went to with her teeth I said “no teeth…hurts mama” we got passed that and now she’s 13 months old and we’re nursing strong.

Aliza: Wow Jessica, a very similar thing happened to my 10 month old, she bit, and I screamed very loud… and she never nursed again, I had to pump for another 7 months. She finally tried nursing again recently at 22 months! But at that point there was no more milk.

Dorothy: It’s depended on his level of understanding. Generally, a quick re-latch did the trick. Though if he was cutting a tooth it often took several tries. Once I could tell the difference between accidental biting and purposeful biting, I would simply end the nursing session with a “NO BITING!” (Stern not loud). Generally, I’d unlatch, cover-up, if he cried I’d make him wait 5 minutes and let him back. Sometimes he was done but decided my nipple was a better toy. I could tell because he’d unlatch and go play.

Kivy: I’m exactly where you are. “pressing the baby into the breast” seems to work and be more gentle, but honestly, it freaks me out when she gasps for air. She seems less bothered than by the flicking, but it’s more disturbing for me.

Amber: Flicking worked wonders for me. Didn’t slow any of my 3 down for nursing, but it curbed the biting. I’m so very sorry that it didn’t work for you. I’ve heard the putting them down, away from you, works too. I could imagine that might traumatize the right child too though. I imagine it’s all about your child and what work for them.

Adventurous Shoestrings: After trying bad advice, I called my local LLL chapter and received a great tip. I told my then 7 month old “no biting” before our nursing sessions. If he bit after hat, I would break the latch and say “biting hurts mommy.” I would end the session and reoffer if he wanted to nurse. I also tried offering a teething ring before nursing or right after a biting incident. It worked for us.

Paula: I didn’t have too much trouble with dead on biting, but there was lots of messing around. I just kept removing the boob each time it happen and talked sternly. If you bite me I can’t nurse you. Eventually, I had to wean the first at almost three because he sort of forgot how to nurse when the milk dried up during my pregnancy with the second. The second I nursed til almost 4, and just had to gradually shorten the time, because, frankly, I was done. But the removing the boob thing really checked the naughty stuff. I mean when they start chomping and look up at you and smirk, you know, they know that they are pushing it. But it is so cute.

What you chose

Remember, it may take a combination of approaches to stop your nursling from biting and it can be done gently, without flicking or scaring your child. Be consistent and as patient as you can with the process. You don’t need to be a martyr, it’s ok to want the breastfeeding relationship to be mutually positive and beneficial for both you and your babe. Setting boundaries, even with a young one, that respect your physical person are important and won’t damage your relationship with your child, in fact, it can be very healthy for both of you and be a critical part for a long lasting, pleasant breastfeeding experience.

Caution

Sometimes I see it recommended to numb the baby’s gums with a numbing agent designed for teething just before bringing them to the breast. My concern with this would be the potential problem that can come from a child swallowing the numbing agent, losing feeling in their tongue and throat. The potential risk for choking and poor latch don’t seem worth the attempt when there are other safe and effective options available. If you choose to use a numbing agent on your child’s gums to help with teething pain, waiting until after a feeding is probably the safest time to do so.

All images used with permission and generously shared by the Leakies on The Leaky B@@b Facebook page.

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What time would you share with someone that has just started dealing with biting at the breast?

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Filed Under: Breastfeeding, breastfeeding difficulties, breastfeeding health, breastfeeding help, breastfeeding stories, breastfeeding support, Facebook, Featured, Jessica, Leakie to Leakie Tagged With: biting, Breastfeeding

Breastfeeding and biting- mistakes, surviving, and what I’ve learned

January 23, 2012 By theleakyb@@b

After working out how this whole breastfeeding thing works, most breastfeeding dyads settle into a sweet, easy breastfeeding relationship. Mutually satisfying and safe, mom and baby usually find comfort in the breastfeeding journey they share. And then one day, SNAP! Or maybe CLAAAAAAAAAAAAAMP! Instead of the wood nymph, rainbow farting unicorns breastfeeding experience, you’ve got a surprisingly powerful yet small jaw with or without teeth gripping your nipple, a sick feeling in your stomach, and a barely stifled screech of pain.

A regular concern and related questions we see on The Leaky Boob Facebook page is dealing with biting. It’s scary, putting your breast into another person’s mouth and hoping they don’t decide to chomp down. Particularly when that person doesn’t understand why that would be a bad thing or even that it would cause you pain. In my own breastfeeding journey I have had plenty of biting babies. I’ve examined my breast with deep teeth marks, red and throbbing from clamped jaws, and had tears sting my eyes as I gasped for breath when my nursling has decided to go at my boob as if it was a steak. I’ve even had blood drawn and the skin broken. Yep, I’ve been bitten and yep, it hurts, and yep, I’ve lived to tell about it.

The truth is, bite happen. Er, make that bites happen.

With my very first nursling, 13 years ago, I acted on the advice to flick my baby on the cheek when she bit me. At first I couldn’t do it and just yelped and told Earth Baby no bite. That didn’t work. She bit me only a few more times but the last time I was frustrated and fed-up and went with what I had been told to do: flick her on the cheek and tell her no. Her face immediately reflected the confusion and betrayal she felt, up to that point I had never intentionally hurt her and she had no idea what she did to deserve such treatment. Neither did I. As she wailed and refused to nurse I knew that I should have trusted my instincts to not hurt my baby. She never nursed again, that traumatic experience led to a nursing strike that led to weaning at 10 months. My sensitive little girl just couldn’t trust me. I pumped for another two months in order to reach my goal of a year but Earth Baby never accepted my breast again.

So what’s a mom to do? Fearing a nursing relationship with a potential piranha could be enough to discourage anyone from breastfeeding. It’s no wonder that many women decide they are going to breastfeed only until the first time baby bites or teeth come in and then that’s it. All or nothing. Stop or be bit or worse, injure your own child to stop them from biting. It doesn’t have to be that way though. For starters, why borrow trouble? Not all babies bite and some that do don’t do so roughly so it’s possible that you’ll never even experience a piranha on the boob. Secondly, there are ways to handle biting should you have a nursling that wants to sink their teeth into something, namely, you. It doesn’t have to be the end, in fact, it can actually be the beginning of the give and take that all relationships eventually need to develop. Working through biting can strengthen your bond, give you confidence as a mother, and give you and your nursling a new dimension to your relationship. Like all hard times, it’s worth working through.

But how? How do you work through it? What do you do if you fear feeding your little one because of the possible nip or down right full on chomp? There may not be one simple strategy for everyone but asking other moms that have been there what worked for them is a great place to start. Seeking the advice of a professional lactation consultant is another. I did both and have compiled the suggestions and experiences here, browse through and see what you think might work for you.

It also helps to understand why a baby or toddler might bite in the first place. It is important to understand they are not biting to be mean or malicious, they don’t even understand that concept. In fact, they don’t understand that biting even hurts until we teach them. Unfortunately for mom, our natural response to hollar ouch may not teach baby that it hurts but rather that biting gets a funny reaction from mom. Others may be frightened by moms initial reaction and require comforting or even refuse the breast entirely for a time being afraid of another outburst. Controlling our response, admittedly difficult to do, and utilizing other strategies may be more effective and less traumatizing for both mom and baby. Remember, babies and toddlers don’t bite to be mean and if you can, identifying the reason they are biting can help you figure out how to respond.

Reasons a baby or toddler may bite while breastfeeding and tools to stop it

Teeth are beginning to move and cut through the gum. This hurts, the most painful time being before the teeth actually erupt. Babies figure out pretty quickly that counter pressure helps relieve some of that discomfort and so they chew fingers, teething rings, corners of a blanket, anything they can find. Including your boob. Offer teething options, try comfort measures before putting them to the breast, be sure it’s feeding they want and not chewing time they are looking for, and pay close attention to their behavior at the breast. Often, biting can be headed off before it even happens.

Bored and all done feeding. This happens at the end of the feeding. Being all done but not necessarily ready to move on, your baby or toddler may bite out of distraction and boredom. Since they aren’t requiring milk any more, a lazy latch replaces an effective and safe no-biting latch and bam, you get bit. Pay attention to changes of their jaw and tongue to stop the session before they bite. Most babies will have a change in their sucking patterns once they’re really done feeding. Slowing down, head shaking, jaw tension, looking around, falling asleep, etc. can all be signs that they’re actually done. Break latch and move on to cuddles and hopefully you’ll avoid being bitten.

Not opening wide enough or needing to adjust latch. In this case they are hungry, they want to nurse but as time progresses and changes, such as teeth, happen the latch needs to progress and change. If the latch isn’t wide enough a baby or toddler is likely to bite. This usually happens near the beginning of the feeding. Unlatching and readjusting their latch, showing them what you want them to do by modeling a wide open mouth with tongue forward, and reminding them gently before each feeding session can help with this. A different position that causes them to have to open wide to take in the nipple can also make this easier.

Physical limitations can cause biting. Tongue tie is one example on the baby’s part, over active milk ejection reflex is another on mom’s part. This is particularly true for younger babies biting or clenching with their jaw. Seeing an IBCLC is the most effective measure for helping solve these type of biting issues.

Along with boredom, distractions can lead to biting. Whether they are startled or just curious about what’s going on around them, biting can occur with distractions. In this case, helping them focus can go a long way in reducing biting, try a teething necklace or something else for them to hold and play with while at the breast.

Saying “hey, look at me!” Maybe you’re multitasking and they want your attention solely on them. Biting can be a way of getting your attention on them. This is probably just a phase, meeting their need for connection with you, make it a priority to look into their eyes, talk with them, caress their head, etc. Remember, they don’t do this to be mean or demanding, they do it because they legitimately need this time with you, you’re their world!

What I do now

I honestly can’t remember if Lolie, my 3rd baby bit me ever but I know The Storyteller (#2), Squiggle Bug (#4), and Smunchie (#5) all did. Never again did I flick my baby to teach them not to bite, I utilized other strategies using a combination of tools. Kathleen Huggins’ book The Nursing Mother’s Companion gave me some great tips on dealing with biting and when I find I need reminders I still reach for my trusty breastfeeding resource, I love and use Kathleen’s suggestions. Heading off biting when possible has been by far the most effective. If they did bite on the breast I try to break their latch by sliding my pinky into the corner of their mouth along side my nipple. If, for some reason, that doesn’t work or their grip is too strong for it to work, I pull my baby into my breast which will cause them to let go. I don’t care for that move personally, it just makes me a little uncomfortable to block their airways if even for just a second which is why I don’t try it first. However, it is effective and safe and my babies have never seemed to be frightened because of it. With my younger babies I just make eye contact and say “ouch, no bite please” and offer the breast again, keeping a careful eye out that they’re are indeed interested in continuing the feeding of if the bite because they were done anyway. Knowing that they have to change their latch to be able to bite and pull their tongue back, I pay attention for any subtle changes and break their latch before they have a chance to bite again. If they don’t seem to really be interested in continuing the session, we move on to other activities and wait for cues that they are ready to eat again later. For older babies I sit them up an say “ouch, no bite please” and place them on the floor near by, offering a toy for them to play with. If they still desire to breastfeed they will let me know and I’m willing to try again, reminding them to open wide (which I demonstrate) and saying “remember, no bite.” Again, paying close attention for any subtle shifts in their latch, I aim to remove them from the breast before they have a chance to bite. If there is a second attempt, I repeat telling them no bite and then tell them “all done nursing right now” and move on to our next activity. Depending on each child’s personality, I may have to repeat this 1-6 times but it rarely is a stage that lasts long. For me, resorting to tactics such as hair pulling, flicking, or biting back are simply not an option, I can’t intentionally inflict pain on my child, particularly when I know there are other effective options at my disposal. I never want my child to associate fear being hurt by me, particularly at the breast. I’m so grateful I found other methods and have been able to successfully end biting without the devastating results Earth Baby and I experienced.

All images used with permission and generously shared by the Leakies on The Leaky B@@b Facebook page.

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What have your experience, positive or painful, been with biting and breastfeeding?

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Filed Under: Biting, Breastfeeding, breastfeeding difficulties, breastfeeding help, breastfeeding stories, Featured, guilt, Jessica Tagged With: bfing, biting, Breastfeeding

Your Guide to Relactation

December 13, 2011 By theleakyb@@b

Stopped breastfeeding and want to start again? Here’s our guide to relactation.

What is relactation?

Relactation is re-establishing breastfeeding after stopping breastfeeding, or after a period of very little breastfeeding.

Why would I want to relactate?

Mothers decide to relactate for many reasons, but most want either to resume the breastfeeding relationship, or provide more breastmilk, or both.

What are my odds of successfully relactating?

There is little research on relactation, but the available studies strongly suggest that, with proper support, most mothers can partially or fully relactate. Below are some studies that offer some encouraging findings about the success of relactation. It’s important to bear in mind that in most of these studies mothers received help in relactating from trained breastfeeding support people.

One study of 139 Indian mothers who had stopped breastfeeding for at least ten days found that 84% were capable of either full or partial relactation:

61% fully relactated
23% partially relactated (formula supplements reduced by half)
16% were unable to relactate

A recent survey of 84 relactating mothers of infants (on average, 2 months old) in Korea found:

75% of mothers fully relactated (defined as 90% or more breastmilk feedings)
25% of mothers either partially relactated or did not relactate

An older survey of 366 U.S. mothers, mothers reported that:

More than 50% established full production within one month
25% required more than one month to establish full production
The remaining mothers breastfed with supplements until their babies weaned

A study of 50 mothers of hospitalized infants under four months old, found:

92% of mothers fully relactated
6% partially relactated

What factors will influence my success in relactating?

The research on relactation confirms what you might already suspect. The following factors are associated with more success at relactating:

A younger baby
A shorter gap between weaning and relactating (sometimes called a “lactation gap”)
The willingness of the baby to take the breast
Having assistance from trained breastfeeding support people

These factors may influence your chance at meeting your goals, but each mother/baby pair is different, and relactation may still be possible even you don’t meet the most favorable criteria.

How long will it take?

Based on the research above, Nancy Mohrbacher, IBCLC, in Breastfeeding Answers Made Simple, recommends that mothers plan for relactation to take one month.

How should I measure success? What goals should I set?

You may want to spend some time reflecting on your motivation for relactating. Is it important to you to provide as much breastmilk as you can? To have the feeling of closeness you have with breastfeeding?

You might set a goal of full breastfeeding, or you might set a goal of partial or any breastfeeding. Some moms, who don’t think that their babies will return to the breast, set a goal of pumping and providing as much breastmilk as they can by bottle (exclusive pumping). Some mothers want the breastfeeding relationship back, and aren’t concerned with how much milk they provide.

Interestingly, one survey of relactating mothers found that “Milk production was less often a goal and, when so specified, it was likely to influence the mother to evaluate her experience negatively and to result in difficulty in achieving a total milk supply.”

There is no right or wrong way to set goals for relactation. And you may not want to set any goals at all.

How do I relactate?

There are two, related parts to relactation: bringing back a milk supply, and bringing the baby back to the breast. These are interrelated projects, as the best thing for your milk supply is to have a baby nursing frequently, and a baby is more likely to return to the breast if there is plenty of milk there.

But the first, and probably the most important thing, is to seek some support.

Get support.

We strongly recommend seeking out sources of support for this process. As we note above, the mothers in the studies cited above were typically receiving skilled help with relactation, and this may have influenced their success rates.

You may want to consult with a lactation consultant (IBCLC), La Leche League leader, a breastfeeding-friendly pediatrician, or other trained breastfeeding support person (see links at the end of this guide for sources of support). A well-trained support person can help you uncover reasons why breastfeeding stopped, troubleshoot as you work on relactating, and connect you with good resources to help you meet your goals.

Trained help is important, but don’t underestimate the power of support from other moms, family, and friends. Having more people on your team can make a big difference in breastfeeding success. You may find attending a La Leche League or other support group meeting helpful. WIC breastfeeding peer counselors are another good source of mom-to-mom support. You may also want to discuss your goals and motivation with some friends or family members (especially your partner), and ask for their support and encouragement. Relactation requires time and effort, and having support is key.

Explore what happened.

It helps to explore why breastfeeding stopped. If it was a problem with basic breastfeeding management (poor advice, infrequent feeding, etc.), relactation may be a simple project of restarting what you were doing before. If breastfeeding ended because, in spite of “doing everything right,” you didn’t produce enough milk, and your baby became unwilling to breastfeed, there are more issues to explore. If you stopped because of pain, learning more about latch, and exploring the possibility of issues like tongue tie, are worthwhile topics to consider.

You may find it helpful, particularly in cases of unexplained milk supply problems or behavior in your baby, to explore these issues with a lactation consultant (IBCLC). You’ll find a link to find one at the bottom of this guide.

Bring back your milk supply.

Empty your breasts frequently. If your baby is willing to nurse, feeding frequently is the single most effective thing you can do. Aim for at least 10-12 feedings every 24 hours. Feed on both sides, and feed long enough to drain each breast well.

If your baby isn’t taking the breast, or is doing so infrequently, use a pump to stimulate your milk supply. Ideally you should pump at least every three hours (though many mother find it more manageable to take a break at night). Double pumping provides more stimulation than pumping one side at a time.

Ensure effective feedings. If your baby is nursing, make sure that he or she is taking the breast deeply into the mouth, and that you feel comfortable when nursing. A shallow latch and/or pain can mean that your baby isn’t feeding as effectively as possible. Get help correcting this from a trained breastfeeding support person.

Pump after feedings. If your baby is nursing, try pumping after feedings with a hospital grade breastpump. Since milk supply seems to be calibrated based on how empty your breasts get, pumping after feedings can be an effective way to increase milk supply.

Use breast compression. When nursing and/or pumping, use breast compression to fully empty your breasts and keep your baby engaged while nursing. This is a particularly effective way to get good feedings with a baby who is sleepy at the breast.

Consider a supplemental nursing system (SNS). Using an SNS allows a baby to receive formula supplements at the breast while stimulating your milk production by nursing. There is also some evidence that substituting feeding methods other than bottles – such as cup, spoon, SNS – increases the chances of relactation success.

Use the power of skin. Holding your baby skin-to-skin (your baby in just a diaper on your bare chest) boosts your milk making hormones. And it feels great!

Take a galactagogue. There are both herbal supplements and prescription medications which increase milk supply. Some herbs are particularly helpful with glandular and hormonal causes of low milk supply. Consult with a lactation consultant and/or your health care provider about which may best suit your needs.

Bring your baby back to the breast.

Get skin-to-skin. Skin-to-skin contact is immensely powerful in establishing breastfeeding, and it can significantly aid the process of relactation. Hold your baby (wearing only a diaper) on your bare chest as often as you can. You may find that he or she begins to self attach (see next point).

Use Baby-led Breastfeeding, Laid Back Breastfeeding positions, and co-bathing. Research is increasingly pointing toward the importance of baby’s innate feeding instincts in the establishment and re-establishment of breastfeeding. Babies are able to crawl, scoot, and wiggle their way to the breast all on their own from birth, and new research is showing that babies retain this instinct long after the newborn period. Baby-Led Breastfeeding involves positioning babies in a way that allows them to crawl to the breast. Biological Nurturing, or Laid-Back Breastfeeding, involves reclining to breastfeed. See more about the Laid Back Breastfeeding position and its ability to take advantage of babies feeding reflexes. Some lactation consultants have also found that taking baths with your baby (called remedial co-bathing) can help in re-establishing breastfeeding.

Ensure a good latch. As mentioned above, a deep latch will allow your baby to receive the most milk, and will keep you comfortable. Seek help from a trained support person if getting a good latch poses a challenge.

Breast compression. Keep your baby engaged at the breast by squeezing your breast when your baby is nursing. This is particularly effective if your baby is sleepy at the breast.

Consider a nipple shield. Some babies who have had many bottle feedings will nurse if the mother uses a nipple shield, as it makes the breast feel more like a bottle. For some babies, it can be hard to wean from nipple shields. Seek help from breastfeeding support person for assistance in using and weaning from a nipple shield.

Use a supplemental nursing system. SNS can persuade babies to return to the breast because they get a greater flow when they nurse. And as noted above, they can help increase milk supply by keeping all sucking at the breast. Seek help from breastfeeding support person for assistance in using one.

Focus nursing around strategic times. Try nursing when supply is higher, such as nighttime and morning. Offer the breast for comfort when you know that your baby is already full, or when your baby is sleepy.

Consider pre-feedings. Some babies will nurse if the “edge” has been taken off their hunger. Try giving your baby an ounce of formula just before attempting a feeding at the breast.

Ensure that your baby continues to thrive.

If you are reducing formula supplements while relactating, we’d suggest:

Reducing formula supplements gradually. Kelly Bonyata, IBCLC, of kellymom.com recommends initially reducing formula supplements by one ounce per day (not per feeding).
Doing frequent weight checks to ensure that your baby continues to grow normally. Checking for swallowing and monitoring diaper output can also provide some information about your baby’s intake.

What are some good resources for more information and support?

International Lactation Consultants Association. Find a lactation consultant (IBCLC) using their zip code finder.

La Leche League can provide support through leaders and group meetings.

The Breastfeeding Mother’s Guide to Making More Milk. An outstanding book on increasing milk supply

Lowmilksupply.org. Comprehensive online source of information on increasing milk supply

KellyMom.com: Relactation and Adoptive Breastfeeding: The Basics

Relactation: review of experience and recommendations for practice, World Health Organization

Tanya Lieberman is a lactation consultant (IBCLC) who has helped nursing moms in hospital and pediatric settings. She writes and produces podcasts for several breastfeeding websites, including Motherwear, Motherlove Herbal Company, and the Best for Babes Foundation. Tanya recently authored Spanish for Breastfeeding Support, a guide to help lactation consultants support Spanish- speaking moms. Prior to becoming a lactation consultant she was senior education policy staff to the California legislature and Governor, and served as a UN civilian peacekeeper. Tanya is passionate about supporting nursing moms, and especially to eliminating the barriers so many moms face in meeting their breastfeeding goals. She lives in Massachusetts with her husband, her 8 year old son and her 1 year old daughter.

This resource page was made possible by Motherlove Herbal Company.

Filed Under: adoptive breastfeeding, Articles from the professional experts, Breastfeeding, breastfeeding difficulties, breastfeeding help, Featured, relactating, Relational Resource Tagged With: Breastfeeding, breastfeeding again after stopping, breastfeeding help, relactating

Once Upon a Time- A tale of a journey towards being an IBCLC

October 26, 2011 By theleakyb@@b

by Star Rodriguez

Once upon a time, I was a brand new mom-to-be and I was going to breastfeed. I was determined and informed and ready to go.
And then I had my baby and everything went crazy. If there was a breastfeeding complication, I felt like I was hit with it. I had horrifically bad advice and support. We made it 14 months, but it was a serious struggle. In that struggle, there were a few beacons of awesomeness – my pediatrician, who was not well informed on breastfeeding but was totally willing to admit that and send me elsewhere for realistic help , and a couple of IBCLCs. There were also a few terrible people, including nurses and an IBCLC.
At one point during the whole ordeal, I remember thinking, “You know, I’m going to look into being an IBCLC, because women need help, and if this is any indication, they’re not getting it.” At the time, the requirements dictated what I thought was an absurd amount of contact and lactation specific education hours for me to be able to do it, so I put the thought from my mind and moved on.
Fast forward three years, and I have baby #2. The incorrect information and bad support in the hospital persisted. Luckily, I was no longer a novice – but even as an educated mom who had breastfed before, I found myself getting a little nervous about the scary picture the nurses painted as my daughter – delivered at 42 weeks by c-section following hours of IV fluids – lost “an excessive amount of weight in the first 24 hours.” A simple Google search found research papers identifying IV fluids as a determining factor in inflated birth weights – however, none of the nurses at the hospital where my daughter was delivered professed to know anything about that.
It was then that my interest in promoting correct, evidence based lactation support came back to the forefront. I was lucky to obtain a job as a Breastfeeding Peer Counselor at WIC, and I decided to use those counseling hours to take the IBCLC exam. You know, eventually. Like 2012. I would take some college classes to meet the 2012 requirements for the exam (here are the official requirements, criticized by many for being slanted towards those with a medical background – ie, nurses and doctors.)
In August, a series of random events occurred that left me with ability – and a need – to spend more time at work. What was very part time increased and I began to wonder – what if I sat the IBCLC this year? After doing all sorts of math, I realized that getting all of my contact hours (I needed a thousand) was possible, if only just. I talked to my boss and family, and decided to go for it. Thus began a crash course in everything lactation related. I felt, for quite some time, like my life revolved around working and studying. I read everything from textbooks on lactation to research papers to statistics texts to Medications and Mother’s Milk. I joined study groups online and made flash cards and attempted to memorize the difference in looks between a herpes blister on the breast versus poison ivy versus eczema. There is a ridiculous amount of knowledge on breastfeeding out there, and some of it is quite different based on where you are globally. Since the IBCLC is an international exam (so your certification can be used anywhere in the world) there were certain things that I had to condition myself to think of in a global context instead of in an American one. I also had to fit in 45 hours of lactation specific education.
I sat the IBCLC exam on July 25th 2011. It was probably the most daunting test of my entire life, and I quite honestly am still not certain how I did on it. Most people who take the IBCLC exam pass; however, the exam grading process is very complex. It’s graded on the “Nedelsky” method, which is incredibly complex. Not only that, but during the exam, all candidates are given sheets allowing them to dispute questions that they consider unfair or incorrect. These sheets are all taken into account and certain questions can be thrown out based on them. Candidates do not know, going into the exam, what percentage will be passing; it varies by year and is not known until the day the results are released. All in all, it takes the International Board of Lactation Consultant Examiners about 3 months to get the results out. For me, this will be Friday October 28th. Candidates can use a code sent to them to check pass/fail status on IBLCE’s website, but they do not get the full breakdown of their results until they receive them in the mail.
For those of you considering taking the test, I urge you to go for it. It was a scary and huge endeavor, yes, but it was also so very worthwhile. Just be certain that you are adhering to the new guidelines for 2012 and beyond, and be aware the IBLCE changes them semi-regularly. For those of you reading this who, like me, are awaiting results, I hope you did a fantastic job, and I raise my hypothetical glass to you. Based on my experiences, we need driven, passionate, educated people in the lactation world, making a difference for new moms and babies.

Star is a breastfeeding peer counselor for a WIC in the Midwest. She sat the IBCLC exam for the first time this summer, and is anxiously awaiting the end of October. 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.

Filed Under: Breastfeeding, breastfeeding health, breastfeeding help, Featured, guest posts Tagged With: Breastfeeding, breastfeeding help, IBCLC, IBCLC exam, Lactation Consultant

The High Life of a WIC Breastfeeding Peer Counselor

June 16, 2011 By theleakyb@@b

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.

Filed Under: Breastfeeding, breastfeeding help Tagged With: Breastfeeding support

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References

A Translation Guide for Navigating the Terrain Between Breastfeeders and Formula-Feeders

Dear Nurse Julie- a letter to my labor and delivery nurse

Tips and Tricks from the pros- Moms and IBCLCs on biting and breastfeeding

Breastfeeding and biting- mistakes, surviving, and what I’ve learned

Your Guide to Relactation

Once Upon a Time- A tale of a journey towards being an IBCLC

The High Life of a WIC Breastfeeding Peer Counselor

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