Breastfeeding During Pregnancy

by Shari Criso, RN, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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Can I breastfeed throughout my pregnancy?

Breastfeeding during pregnancy is very normal. Throughout history and even today in many parts of the world, children survive because they continue to breastfeed throughout pregnancy. In MOST cases, it is extremely safe, completely normal, and very healthy to continue breastfeeding while you are pregnant with your next baby.

Where this whole concept of it being an issue came from is with people who have had recurrent miscarriages, and people who are bleeding early in pregnancy. Remember, when you breastfeed, there is a hormone called oxytocin released from your brain, and oxytocin can contract your uterus. If you’re a person with a history of early miscarriage or you’re bleeding in pregnancy, this may be a consideration. But for the vast majority of people, it’s completely fine to continue to breastfeed through pregnancy, not only at the beginning but throughout.

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What I find is that for most women, their toddlers will wean themselves during pregnancy, because as you get closer to the end, the milk is changing to more of a colostrum, getting ready for delivery. The taste changes and toddlers are like, “What’s this? This is not what it was before!” And there are others that are like, “I don’t care what this is, I want it anyway!” And that’s when you have people who are nursing two children at one time. And that’s totally fine.

One thing you do want to keep in mind if you’re tandem nursing is to make sure the newborn is always going first. That the baby is getting what they need first, and the toddler is getting more of a snack. Remember that your toddler is also eating solid foods at that point, and getting other nutrition, while your newborn needs to get the full majority of it.

I hope that answers the question, but overall, it is absolutely fine to keep nursing through pregnancy and beyond!

Shari Criso MSN, RN, CNM, IBCLC

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Find more from Shari supporting your parenting journey including infant feeding at on Facebook, My Baby Experts©

Thanks for Evenflo Feeding, Inc.‘s generous support for families in their feeding journey.

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Shari Criso 2016

 

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters.
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Breastfeeding When You Are Sick

by Shari Criso, RN, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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When it comes to breastfeeding, one of the myths that drives me absolutely crazy and could actually be dangerous for your baby, is the idea that if you as a breastfeeding mom are sick, that you should discontinue breastfeeding until you feel better.

This is advice that is often given to moms by their pediatricians or obstetricians and it’s actually the complete opposite of what you want to do!

When you breastfeed, your body passes along the antibodies of what you’ve been exposed to, directly to the baby. When you get sick, antibodies are created and immediately passed into your breastmilk. So what that means for you and your baby is that if you are breastfeeding and you have a virus or you are ill, your baby is actually immediately receiving specific antibodies for the exact illness you have at that moment. This will actually help keep your baby well, rather than make your baby sick.

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What CAN make your baby sick, is to stop breastfeeding during these times! Regardless of whether you are breastfeeding or not, your baby is going to be exposed to you, because you will be with your baby. They will have the exposure anyway, but without the protection of your milk they are much more vulnerable.

I’ll tell you a little personal story… when I had my first daughter my husband Joe and I got the flu really bad. We were sick in bed for days! We had this little 2 month old, and I was like “what am I going to do with her?” All we could do was put her in the bed between us, and just let her nurse, nurse, nurse, the whole time! Now, we were new parents at the time, and even with all the skills and knowledge that I had, we were still scared and nervous. I was so afraid she would get sick. That never happened! Here was this little one who just nursed away in this sick bed with my husband and me and never got sick herself.

This is very typical, very normal, and what you’ll usually see – and if they do get sick, the illness will be so much less than if you weren’t breastfeeding.

So whether it’s stomach flu, regular flu, or any other kind of illness, especially if you’re sick or anyone in the home is sick, make sure you continue to breastfeed, because that is going to be the best way to keep your baby healthy.

Shari Criso MSN, RN, CNM, IBCLC

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Find more from Shari supporting your parenting journey including infant feeding at on Facebook, My Baby Experts©

Thanks for Evenflo Feeding, Inc.‘s generous support for families in their feeding journey.

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The Serious Injury No One is Talking About: Diastasis Recti

by Nicole Nexon, MSPT
This post made possible by the generous support of Belabumbum

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Sometimes I feel like exercise has become a dirty word in the mommy sphere. I can understand that.

We get this message that we need to do everything – work, raise babies, maintain perfect households, create Pinterest worthy projects, not burn dinner… and erase any shred of evidence that our bodies have created life. Society settled on the idea that skinny = perfect and the backlash from that led to a movement of pride in our bodies. Which somehow turned in to “ real woman have curves “ and all kinds of craziness about skinny girls and curvy girls and…

It’s out of control.

And what has been missed in all of this is the truth of the matter – it’s not about skinny. It’s not about having curves or not having curves. It’s not about “mummy tummies” or thigh gap or muffin tops.

It’s about being healthy.

And not “healthy” in a way that has been co-opted by people meaning “stop eating junk food you fatty!” Healthy in way that allows people to live their lives in a manner they choose. Healthy in a way that allows you to lift babies and chase toddlers and carry laundry wherever you need to carry your laundry. Healthy in a way that makes you feel confident, that lets you sleep well and go about your life.

What happens when you’re injured…and you don’t even know it?

When I was pregnant with my second daughter, I began to feel a pretty distinct pain by my belly button. It was so specific that I was fairly certain I was developing an umbilical hernia. I brought it up with my midwife and was told it wasn’t a hernia. I was developing a diastasis recti – a split between the muscles and muscular tissue that runs down the center of the abdomen. The pressure inside from an expanding uterus/baby was just too much for the abdominal tissue to handle so the tissue and muscles were separating.

With my first pregnancy, I worked in an outpatient clinic that was less physically demanding. With this second pregnancy, my current position required a lot of physical lifting as a physical therapist in a subacute center for patients who were not sick enough for the hospital, not well enough to go home. I already had work restrictions due to the physical requirements of my job; working with those restrictions AND dealing with a developing case of Diastasis Recti made the restrictions even more difficult.

It was in this position that I recognized a growing group of people in need of support, awareness, and healing of Diastasis Recti: new moms.

Here were these women, trying to juggle new responsibilities, healing from the changes their bodies went through during pregnancy and subsequent post-partum recovery and there was little to no support or even awareness about the problems that Diastasis Recti presented.

Diastasis Recti can affect your body in some pretty drastic ways.

  • -Incontinence
  • -Irregular bowel movements,
  • -Lower back pain, spinal or hip injuries due to your abdominal muscle’s inability to support your body when you’re lifting or bending
  • -Pain during sexual intercourse
  • -Increased chance of sciatica or disc issues
  • -Increased chance of umbilical hernia
  • -Postural instability due to poor strength of the abdominal muscles

The effects are numerous.

Now it was MY body that was going to need to be supported.

My body that was going to need help carrying a car seat. A baby. My toddler. The laundry.

My body that was going to be more prone to injury- that would need me to completely rethink how I went about my day. I worked out through my pregnancy because I knew what was ahead of me. I knew my core was going to be compromised. I wanted to achieve a VBAC and I knew I would need endurance (among other things) to prevent a repeated OR experience. I went back to my books and read studies on exercise efficacy. I reviewed exercise programs for pregnant women, post partum women, and people who had just had abdominal or back surgery. I had a plan, and I HAD to be as physically strong as I could when I returned from maternity leave so I could perform my job effectively.

I ended up with a VBAC, a baby girl, and a three-finger diastasis.

*when I say “three-finger diastasis” I am describing how many fingers I can horizontally fit across the tissue separation. To find this, lay on the floor with knees bent and feet flat on the floor. Lift up your head slightly and contract your abdomen muscles gently. Find your belly button and make the “scout symbol” with your fingers…see how many you can fit in there. i.e. 1 finger, 3 fingers, etc. Check the same line down by your pelvis, and again up towards your ribs. Different points along your abdominal muscles may be different fingers of separation.

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I feel blessed that my passion and my education allowed me to understand what my body needs to function well and heal from my condition. I am grateful for my colleagues and friends with whom I can discuss ideas or count on to help me with the hands-on techniques I can’t perform on myself. I know I am lucky to have access to the information that I have.

I want other women to have this valuable access to connections and resources that are out there for those recovering from Diastasis Recti.

I want women to know that sometimes “mummy tummy” can actually be caused by a medical condition.

I want women to know that the media are not medical professionals and there is a wide range of “normal” when it comes to our bodies.

I want other mothers to know that exercise and eating well are available to them.

I want women to know there are safe exercise routines that WON’T injure a body healing from Diastasis Recti. That recovering doesn’t need to be a series of scary, out-of-reach experiences. They don’t need to spend hours in the gym (Though you certainly can, if you enjoy it!).

Recovering means that you can take a walk, be it pushing a stroller or wearing a baby. You can do squats in your living room, jumping jacks, and eventually pushups and planks. (But until you’ve healed from your diastasis, it is best to do modified planks so that you don’t further separate your diastasis or have your abdominal muscles work against you or push on that separation while you’re healing!)

I feel sad when I hear people say “I can’t workout because…”

I feel sad because they are being taught that only the big efforts count.

That’s not true.

I work with people for whom sitting at the edge of their bed is enormous effort, and standing requires assistance of others. When you see the enormous joy on a person’s face brought by these small yet enormous victories, you begin to understand the true beauty of the movement our bodies are capable of. What may seem like a small victory may be an enormous triumph-a giant step towards hope and healing.

Misguided emphasis on skinny and perfect or the fear of never being _____ enough WILL STOP US in our tracks.

Enough.

You are enough.

It’s ok to start small.

It’s ok to fail.

It’s ok to not be perfect.

It’s ok to be YOU.

It’s not about meeting someone else’s standards.

It’s about taking care of yourself, teaching your family that our bodies are a great gift and we should treat them well. It’s about understanding that you are worthy of the time and energy it will take to begin, to HEAL, and to build healthy habits that facilitate that healing and well being.

Let’s get moving, because moving not only transforms your body, but it transforms your mind, no matter what size jeans you wear.

Some Exercises to Get You  Started:

Some Other Tips to Start Healing:

  • Sitting with the best possible posture: (Pull your belly button in towards your spine. Keep breathing while doing this. Pull your shoulder blades onto your back. Keep breathing!)
  • Kegels/pelvic floor exercises (contracting the pelvic floor muscles-the ones you use to stop your pee, if that makes sense!).
  • Standing on one foot while brushing your teeth while pulling your belly button in towards your spine.
  • Stretching before you get out of bed.
  • Taking a walk or parking further from the store.
  • You can climb your stairs.
  • Swim.
  • Dance.
  • Work out with a DVD program or take a class.
  • If pregnant, getting an abdominal/belly support band to help support your abdomen and relieve pain you may be experiencing.
  • If in post partum recovery, gently binding your belly to help pull the muscles together and support you in those first few weeks of initial birth recovery.

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Where am I now? I’m down to a one finger split at my belly button. I am confidently back to work full time with no restrictions. I’m still doing pelvic floor exercises and modifying my workouts to protect and strengthen my abdominal muscles so I don’t re-injure or reinforce the Diastasis Recti. I’m teaching my daughters that exercise and eating well are ways to treat your body with respect, to give it what it needs so when you need your body to work for you, it will. I’m teaching them that strong is beautiful, that healthy allows you to follow your dreams, that food is a tool and a pleasure and size is just another physical trait that varies from person to person.

Final thought… can we all agree to stop using the words “mummy tummy” ? Please? Your tummy is awesome, mommy. Growing a human is beautiful. A body that shows the results of growing a human is also beautiful!

For more information on Diastasis Recti click here.

*Want to know where to get the great active wear featured in this post?  In our video and corresponding exercise photos, Nicole is wearing the Belabumbum maternity and nursing active wear.

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Nicole Nexon is a mother of two, working full time as a physical therapist. Nicole has her master’s degree in Physical Therapy, and has been working for 9 years in both the inpatient and outpatient fields of physical therapy. She is a complete nerd when it comes to the human body and wants to encourage others to take the opportunity to treat their bodies well at whatever stage of life they are in. She is also a Beachbody coach and has found it to be a great platform to spread her mission of health and wellness. In her spare time, Nicole enjoys traveling and snowboarding. You can follow her at www.facebook.com/nicolerosenex )
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Having Enough Milk for Your First Day Back

by Shari Criso, RN, CNM, IBCLC

This post made possible by the support of Evenflo Feeding

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As you are preparing to return to work, you’ll be wondering how much should I be storing and how far in advance do I need to prepare. As with anything, it is always best not to leave things to the last minute and pumping enough breast milk for your return to work is certainly at the top of that list!

Start several weeks prior to your first day back at work and calculate how many ounces you will need for your baby on the first day as well as your freezer stash.  

For example, if you will be away from your baby for 8 hours and will need to pump 3 times for 3-4 ounces each, that will be 9-12 ounces of milk needed for your first day back at work. If you add another 10 3oz bags for your freezer this will add an additional 30 ounces that you will ultimately need. In this scenario, in total you will need about 40 ounces of milk to be fully prepared.

Waiting to store this until the last week before you go back, will make it really difficult to achieve, and in this case I would recommend that you only focus on getting the 9-12 ounces pumped that you will need for your first day. You’ll have to catch up on the freezer stash later. Ideally, you will give yourself a minimum of 4-6 weeks to start pumping and storing.

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Pumping 1-2 ounces per day in addition to the ½ ounce of milk that you will continue to feed to your baby each evening (just to keep the bottle going) will give you more than enough over the 4-6 weeks to have all the milk you need for your first day back at work, plus your freezer stash.

For some moms this is not a problem and for others you may find it difficult to pump in between feeding your baby to get this extra milk.

One of the ways to work around this is to not try and pump between feedings, but to express a small amount, like a ¼ of an ounce from each side prior to each breastfeeding during the day. If you’re breastfeeding 8 times, and you express a ½ ounce each time, you will essentially be storing 4 ounces per day.  This is even more than I am even recommending you do, if you give yourself enough time.

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To view the whole video, click here.

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Shari Criso 2016

 

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. See the entire library of Shari’s My Baby Experts Video Program here.
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Normal Postpartum Bleeding and Discharge and the Return of Your Period After Giving Birth

by Dr. Kymberlee Lake

Most women know that there may be some bleeding after giving birth but often women are surprised by how much and how long and they aren’t aware of the difference between postpartum bleeding and discharge and menstruation. The first bleeding after you give birth is called lochia.

What exactly is lochia? 

Lochia is the discharge consists of blood from the area on the uterine wall to which the placenta was attached during pregnancy, the sloughed off endometrium (uterine lining which makes a bed for the fetus) which gets considerably thickened during pregnancy, blood and mucus from the healing cervix,  and dead (necrotic) tissue. Your blood volume increases by approximately 50% in pregnancy, all that extra blood also has to go somewhere after birth. Most women will experience blood and lochia discharge for 3- 6 weeks though that time span can very from pregnancy to pregnancy and can be directly influenced by a healing mother’s activity level.

Why do we have lochia and where does it come from?
The blood in the lochia comes mainly from the large raw area left in the uterine wall after the placenta detaches from it. While bleeding from this area is controlled by contraction of the uterine muscles immediately after delivery, it takes on the average about two weeks for this area to heal. It is important to remember that this is a wound and it is possible to do too much before it has healed and reopen the wound, causing fresh bleeding. You will experience this bleeding for around four to six weeks postpartum.

For the first few days it will be a heavy flow (kind of like a heavy period) and will be  colored dark red, with some clotting.  About the end of the first week the flow should start to taper off, becoming lighter in saturation and color; as time passes, it will fade to a brown, yellowish or even almost-white discharge. 

One thing to remember is that the placental area as well as the sites of sloughing endometrium are raw and open during this time and bacteria can easily spread from the vagina. So, the use of tampons should be avoided – sanitary pads are the best options to be used during this time. 

What is normal and when should I be concerned?
You might notice a ‘gush’ of blood with clotting when you stand up – this is very normal. Also, if you’re breastfeeding, you might notice that you lose more blood after feeding baby; this is caused by your hormones doing their work to help shrink your uterus back to it’s pre pregnancy size. The lochia is sterile for the first 2-3 days but then becomes colonised by bacteria giving off a typical distinct lochial smell which is normal and should not be confused with the bad odor from lochia in postpartum infection. – 

If the discharge smells foul, you’re still noticing a lot of blood loss after the first four weeks, or the blood is bright red, these are signs of infection and you should speak to your health care provider as soon as you can. This is especially true if you also have a fever (no matter how slight)  or are generally feel ill. Likewise, if your blood loss is so heavy that you’re going through more than a pad an hour, you should get medical help immediately – this can be a sign of a hemorrhage. If in question and something feels “off” it is worth a call to your health care provider for advice.

Types of Lochia
Depending on the color and consistency, lochia can be of three types:

  • Lochia Rubra: Lochia rubra occurs in the first 3-4 days after delivery. It is reddish in color – hence the term ‘rubra’. It is made up of mainly blood, bits of fetal membranes, decidua, meconium, and cervical discharge.
  • Lochia Serosa: The lochia rubra gradually changes color to brown and then yellow over a period of about a week. It is called lochia serosa at this stage. The lochia serosa contains less red blood cells but more white blood cells, wound discharge from the placental and other sites, and mucus from the cervix.
  • Lochia Alba: The lochia alba is a whitish, turbid fluid which drains from the vagina for about another 1 – 2 weeks. It mainly consists of decidual cells, mucus, white blood cells, and epithelial cells.

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Do women who give birth by c-section still have lochia?
Many women believe that the flow of lochia is less after a cesarean section since the uterine cavity is cleaned out after the birth of the baby. This is not true. The flow of lochia is not dependent on the type of delivery –  The amount and duration is the same in both cases.

Return of Menses
There’s no hard rule as to when your period will return post-baby – it can vary from woman to woman, and pregnancy to pregnancy. Here are some general guidelines

  • Women who bottle-feed can see their menstrual cycle return within six weeks of birth – and most will have menses back by ten to twelve weeks.
  • Women who exclusively breastfeed may not get their period back for some time. When you breastfeed, you body releases the milk-producing hormone prolactin, which, in turn, keeps our levels of progesterone and estrogen low. Progesterone and estrogen are the hormones responsible for signaling ovulation and menstruation. Night nursing directly effects these levels, a decrease in breastfeeding at night may lead to a return of menses.

Once your period returns, it can take even longer for it to get into a regular cycle. If you are bottle feeding it can take around six months, while exclusively breastfeeding your baby can take 12-18 months. But keep in mind that this does vary from mom to mom and pregnancy to pregnancy. Even with exclusive breastfeeding on demand and no artificial nipples, there are women who see a return of their menses as early as 6 weeks while others may not breastfeed and still experience a considerable delay. Each woman is different. Some women experience lighter flows and/or less cramping with their menses after having a baby, others experience the same, and still others may experience an increase. The range of normal variations is considerable but very heavy bleeding, soaking a full size pad in 1-2 hours, may indicate a problem and should be addressed with your health care provider. There are a variety of factors that contribute to possible changes with the return of your period but keep in mind that diet, physical activity, and your menstrual products can all contribute to cramps and duration.

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Please be aware that your first egg (ovulation) will be released two weeks before your period starts, so if you have unprotected sex without realizing that you are ovulating, you could get pregnant before you have even began menses again. It’s a good idea to speak to your healthcare provider about contraception even before you start thinking about sex again, so you can be confident in your choice ahead of time.

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Kymberlee Lake- headshot

Kymberlee is a Physician/midwife, Therapeutic foster/adoptive parent with 6 kids ranging in age from 31 to 3 and three grandchildren. She is living life to the full with MS in the Pacific NorthWET.  As an international travel enthusiast and fan of teleportation you can find her under the name “Dr_Kymberlee” live streaming and on social media, or on her often neglected blog, TheMamaMidwife.com
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Traumatic Birth: Resources for Healing and Protecting Breastfeeding

by Tanya Lieberman
This post was made possible by the generous support of MotherLove Herbal Company.

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Having intrusive thoughts about your birth?  Flashbacks?  Feeling disconnected from your baby?  Do you steer clear of hospitals, or try to avoid talking about your birth?

Many women experience trauma related to childbirth, and estimates range from 18% to as high as 34%.  One third of women who experience traumatic births go on to develop Post Traumatic Stress Disorder (PTSD).

Yet despite its widespread nature, the experience of birth-related trauma can be an isolating one, as mothers are encouraged to focus on their babies and quickly “get over” their birth experience.  Trauma can affect a mother – and a partner’s – ability to connect with their baby, carry out normal activities, and can also impair breastfeeding.

In this post we’ll discuss traumatic birth – what it looks like, how it impacts breastfeeding, and where you can turn for help.

 

What’s a traumatic birth?

 

According to PATTCh, a birth trauma organization co-founded by noted childbirth author Penny Simkin, a traumatic birth is defined as one in which a woman experiences or perceives that she and/or her baby were in danger of injury or death to during childbirth.

It’s important to note that it is the mother’s experience of the events, regardless of what happened or the perceptions of other people, that determines whether she experiences trauma.

Here are some characteristic features of births that may lead to an experience of trauma, according to the Birth Trauma Association:

  • An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).  [Note that it’s the mother’s perception that is important, whether or not others agree.]
  • A response of intense fear, helplessness or horror to that experience.
  • The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
  • Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.
  • Bad memories and the need to avoid any reminders of the trauma will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on guard all the time).

Some common triggers, according to the Birth Trauma Association, are: lengthy labor or short and very painful labor, induction, poor pain relief, feelings of loss of control, high levels of medical intervention, traumatic or emergency deliveries (e.g. emergency cesarean section), impersonal treatment or problems with staff attitudes, not being listened to, lack of information or explanation, lack of privacy and dignity, fear for baby’s safety, stillbirth, birth injuries to the baby, NICU stay, poor postpartum care, previous trauma (such as sexual abuse, domestic violence, trauma with a previous birth).

How can traumatic birth affect breastfeeding?

Breastfeeding can be healing for many mothers after a traumatic birth, and may also repair the relationship between a mother who feels estranged from her baby.  But a traumatic birth may also cause breastfeeding problems.

A traumatic birth can delay on the onset of a mother’s mature milk (“milk coming in”), known as lactogenesis II, sometimes by several days.  This effect is well documented, and often leads to a cascade of breastfeeding problems including jaundice, poor feeding due to sleepiness, poor milk removal, and low supply.

While research on the independent effect of Pitocin on breastfeeding is not sufficient to draw direct conclusions, according to Linda Smith, author of The Impact of Birthing Practices on Breastfeeding, its effects on factors related to breastfeeding are more clear.  Pitocin increases the risk of other interventions, such as IV fluids and cesarean section, which are associated with breastfeeding problems.  Linda Smith also notes that induction of labor often causes babies to be born earlier, and “early term” babies are known to be at higher risk of breastfeeding difficulty.

 

What are some steps you can take after a traumatic birth to minimize the effects on breastfeeding?

There are many steps a mother and her provider can take to minimize the effects of a traumatic birth on breastfeeding:

Skin-to-skin.  Skin-to-skin contact lowers stress hormones, promotes the release of hormones important to lactation, and helps establish a bond between mother and baby.  Some mothers are too overwhelmed by their traumatic experience to practice skin-to-skin, but for those who can it should be encouraged.

Frequent feeding and in some cases pumping.  Frequent feeding and in some cases pumping, may help to speed the onset of mature milk.  If a baby is not feeding well, pumping can protect a mother’s milk supply and prevent or lessen the downward spiral noted above.

Find support to ensure that breastfeeding is not painful.  In research on the relationship between traumatic birth and breastfeeding, authors Beck and Watson found that mothers who had traumatic births and who didn’t have the emotional reserves to work through breastfeeding pain were less likely to meet their breastfeeding goals.  So finding someone who can help you feed without pain is important.

Focus on your motivation.  Beck and Watson also found that the mothers who were very determined, and those who were motivated by a desire to “make up” for a baby’s less than optimal arrival, were more likely to meet their breastfeeding goals.  They suggest setting short term goals and finding respectful support.

Supplementation when medically necessary.  A brief period of supplementation is sometimes necessary in order to bridge the time before your mature milk arrives.  Ideally this would be donor breastmilk, but it is not often available for these situations.  See the Academy of Breastfeeding Medicine protocol for supplementation.

Know where to get good help once home.  Since mothers are generally sent home from the hospital before their milk comes in, they should plan to seek help if their milk is not in by 72 hours (the period defined as normal for the onset of lactogenesis II).  This may head off further difficulty.

If breastfeeding doesn’t work out, connect with your baby in other ways.  As noted above, breastfeeding can be healing to many mothers after a traumatic birth.  But some mothers are truly too overwhelmed to initiate or continue breastfeeding.  In these cases, consider other ways to connect with your baby, such as infant massage, skin to skin, and babywearing.

 

What are some resources for recovery for mothers and partners experiencing birth-related PTSD?

Connecting with other moms.  Connecting with other moms helps you see that you’re not alone.  There are a number of online communities for mothers experiencing birth-related trauma, including Solace for Mothers, Birth Trauma Association’s Facebook page, and Baby Center.

Self care.  A number of forms of self care can aid in healing, including: getting adequate sleep, exercise, yoga, bodywork and massage.  Getting help with cooking, cleaning, and baby care from family, friends, or a postpartum doula may also help you heal.

EMDR (Eye Movement Desensitization and Reprocessing) therapy is considered by trauma experts, including the U.S. Departments of Veterans Affairs and Defense and the American Psychological Association, to be a front line treatment for PTSD.  EMDR involves thinking about the traumatic experience while experiencing a stimulus engaging both sides of your perception.  This might mean moving your eyes back and forth, listening to a tapping sound in alternating ears, or feeling a tapping on alternating knees.  EMDR typically reduces symptoms after just a few sessions. To find a certified EMDR professional, see the EMDR Institute or the EMDR International Association.

Cognitive Behavioral Therapy (CBT) is a form of therapy which addresses beliefs caused by trauma and helps to counter conditioned-fear responses related to the traumatic experience.  To find a CBT therapist, search the websites of the National Association of Cognitive Behavioral Therapist’s or the Association for Behavioral and Cognitive Therapies.

Medications.  You may want to discuss medication options with your healthcare provider.  A summary of medication options is provided here.

Care for partners.  Partners can experience trauma related to childbirth as well.  Encourage partners to seek help if they are experiencing trauma

For more information, listen to Motherlove Herbal Company’s podcast interview.  You may also be interested in this podcast interview on traumatic birth with Dr. Kathleen Kendall-Tackett, president-elect of the Trauma Division of the American Psychological Association.

 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.
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Dear Kathleen- on nipple damage healing and pumping

We receive hundreds of emails and messages daily from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past few weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

Dear Kathleen,

My nipples are a wreck following a shallow latch and then thrush with my 8 week old.  After working with an IBCLC that helped fix my daughter’s latch and take care of the thrush, things are improving.  However, my nipples are still cracked and bleeding and I think they just need a break to heal.  The IBCLC I work with suggested I just pump for a little bit until I’m healed and I’m ok with that.  I feel like I’m a bit lacking in the pumping department though and only got 4 ounces the first time I tried with a hospital grade double electric pump and my daughter downed that pretty quickly.  How often should I be pumping to keep up my supply?  How long should I expect healing to take?  How do I pick a bottle that won’t encourage my daughter to prefer the bottle over me?

Thank you so much for your help!

Sore Nipples 

 

Hello Sore Nipples!  I am so sorry to hear that you are still struggling at this point in time! Sounds like you have been through a rough go.  Yes, you and your L.C. are on the right track.  A break from any more trauma is certainly in order.  I am happy to hear that you have a clinical grade pump.  I do hope you have the right size flanges for more comfortable pumpings and for removing the most amount of milk possible.  If your nipples are swelling very much in the tunnel, I would suggest getting the next size flange for more comfortable and effective pumping. Another product, “Pumping Pals”, slipped into any flange, makes pumping even more comfortable and for some moms even more efficient.  You might want to visit their website to see what I mean.  The company is very helpful in getting you the right size flanges to use in your kit and they are fairly inexpensive. With that being said, still many pumps still leave quite a bit of milk on the breast.  For that reason, I suggest “Hands-on Pumping”, that is using your hands to help remove the most milk possible at each pumping.  Please watch Dr. Jane Morton on Stanford University’s website on breastfeeding issue and see her mini-lecture and video of hands-on pumping.

I would like to talk to you more about the condition of your nipples.  If your nipples are still cracked, I would like you to consider treating them with an oral antibiotic.  Mothers with injured nipples longer than 5 days are at a much greater risk of developing mastitis; 75% of moms with open nipples go on the develop a breast infection because of the bacteria in the open areas.  And this seems much more common during the cold weather months.  There was a great study done by two Canadian physicians some time ago that showed the consequences of wounded nipples that were untreated leading to mastitis.  Also, nipples are more difficult to heal when they are infected with bacteria.  For both of those reasons, I suggest speaking with your midwife or doctor about getting treatment for at least 10-14 days.  I don’t think most doctors are aware of this connection, but with your nipples being in this shape so late in the game, I am convinced they are colonized with bacteria.  Yes, I am sure that this makes you worry about yeast, but yeast is much easier to treat than a case of mastitis, which can also lessen your overall milk production.

Mastitis risk with damaged nipples

I do think that getting 4 ounces is about what a baby at this age requires at each feeding.  You will want to aim for about 8 pumpings each 24 hours.  If you are not getting at least 3-4 ounces when you pump, you may want to also consider using some herbs.  You can use fenugreek capsules that are available at most any health food store, 3 caps three times a day. This is probably different that the dose given on the bottle.  I actually find that mothers do quite well using Mother Love’s More Milk Plus, a combination of milk stimulating herbs.  You can visit their website and see if there is a local distributor or order them on-line directly from Mother Love. Nursing teas are a very weak form of any herb, so I don’t recommend them as the primary way to stimulate higher milk production.

Babies typically down a bottle in no time flat and may still act hungry!  This can lead parents to believe that the baby may need more milk.  Four ounces with a slow flow nipple, might help some but keep in mind that many nipples that are labeled as slow flow, really aren’t!  Hopefully, the baby takes 5-10 minutes to drink 4 ounces of milk. There is an old saying, “It takes 20 minutes for the brain to know when the stomach is full!”  So true!  If you are very worried that the baby will come to fall in love with the bottle flow, you might reconsider and have one nursing every 24 hours, but I leave that to your discretion. I think for most babies, if there is a healthy supply of milk, they should return to the breast without too much of a problem.

I wish you every success and very soon!  You are quite a determined mom!

Best wishes,

Kathleen

Kathleen-HigginsKathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  
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Dear Kathleen- on breastfeeding moms and nutrition

Daily, we receive hundreds of emails and messages from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past two weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

 

Dear Kathleen,

Somebody recently mentioned breastfeeding moms having poor quality milk because they eat junk.  I am feeding my 6 week old but I don’t eat particularly healthy and I am worried now that my milk may not be as good as I first thought and she may be missing out on vital nutrients – I will of course start eating much healthier (every time I feed I crave something sweet) but I am worried that for the first 6 weeks of her life she was not getting the best milk. Any advice would be greatly appreciated.

Thanks in advance.

Sincerely,

Not a Health Nut

 

 

Dear Not a Health Nut,

Hello!  This is a great question and one that I am sure many mothers wonder about.  The bottom line is that that the quality of your milk is generally not affected by your diet.  Mothers who live in poverty stricken areas around the world and here in the U.S. are able to provide nutritious milk to their infants.

Many mothers find that their appetite is low right after giving birth. Eating small nutritious snacks throughout the day will provide sufficient calories for you.  The fat stores accumulated during pregnancy will provide some additional reserves.

With that being said, eating nutritious foods will help you feel good and maintain your health. Try and avoid eating “empty calorie” foods like sodas, candy and chips! A poor diet will not effect milk production but is more likely continue at your own expense, leading to fatigue and listlessness! To Dieting during the early weeks is not recommended; as most mothers who are eating nutritious foods will gradually lose the weight they gained during pregnancy.

There is no set number of calories that is necessary during lactation.  In the past, there was a recommendation of eating 500 calories above a mother’s regular diet but now this is not thought to be the case.  On the other hand, some mothers, like those who are nursing multiples may need additional calories.  Most mothers supporting nursing multiple babies may need more calories but in many of these cases, she may naturally feel more hungry.

Nutrition and breastfeeding

Dieting

It is not advisable to begin a weight loss program until after two months post partum and weight loss should be limited to 1-2 pounds per week.  Low carb diets are also not recommended as they can cause some dehydration, constipation, fatigue and sleeping problems.

Vitamin and Mineral Supplements for Mothers

It is recommended that mothers get 1000 mgms of calcium (calcium carbonate, being the least expensive with the highest concentration)per day.  This can also be achieved by drinking 3 glasses of milk per day or having several servings of cheese or yogurt.  If you don’t like milk or cow’s milk products, you can either take a calcium supplement or eat other calcium rich foods each day.  These include goat milk or cheese, bone containing canned fish, whole grains or whole grain flours, nuts, seeds and dried fruits.  Green leafy vegetables, with the exception of brocolli, are poorly absorbed. Other calcium rich foods include tofu or soy milk or cheeses, and lime based corn tortillas.

If you eat a vegan diet, which excludes egg and milk products, it is recommended that up to 4 mgms of vitamin B12 be taken daily to avoid deficiencies.  While mothers can take a supplement she can also include foods rich in this vitamin.   These include goat milk and/or cheese, canned fish, whole grains and whole grain flours, green leafy vegetables, nuts, seeds, and dry fruits.  Also, tofu or soy cheese, tortillas made with lime-processed corn.

Iron supplements may be necessary if you are anemic following the birth of your baby for your own health.  Some mothers develop vitamin B deficiencies, experiencing depression, irritability, impared concentration, loss of appetite, and tingling or burning feet.  A daily B complex supplement or taking Brewer’s yeast mixed with juice or milk can reverse these symptoms.

Supplements for Babies

Vitamin D, actually a hormone produced by sunshine is now recommended for breastfed babies.  This vitamin is important for several reasons.  It promotes the absorption of calcium in the baby’s intestinal tract. It is also an important part of a baby’s immune system keeping the baby less prone to infection.  Most recently, a lack of vitamin D has been associated with rickets, a bone softening disease.  There is also an association of low vitamin D with Type-1 diabetes, multiple sclerosis, rheumatoid arthritis and cancer.

Many babies are born already vitamin D deficient. While babies can get vitamin D from sunlight, assuring that they get enough is complicated by the latitude, season, altitude, weather, time of day, air pollution, and how much skin is exposed and whether sun screen is applied.  While a baby who is exposed to sunlight for 30 minutes per week wearing only a diaper or for two hours a week fully clothed without a hat.  Some babies in higher latitudes need even more light.

Because sun exposure is associated with skin cancer later in life, the American Academy of Pediatrics now recommends that all breastfed babies receive 400 International Units of vitamin D throughout childhood.  Formula fed babies do not need this supplement.  Most formulations of vitamin D are combined with other vitamin preparations which are unnecessary for the breastfed baby and may be difficult to give to the baby.  One company, Carlson Laboratories, offers a vitamin D supplement, Baby Ddrops and are available at health food stores and on-line pharmacies.  The baby only requires a single drop, which can be placed on the mother’s nipple for easy ingestion.

Best  wishes to you and your baby!

Kathleen

 

 

Kathleen-Higgins Kathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  
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Dear Kathleen- Leakies ask an IBCLC

Daily, we receive hundreds of emails and messages from Leakies looking for help and information in their breastfeeding journey.  As so many seek support from us, we are so honored to have the support of Kathleen Huggins, IBCLC and author of The Nursing Mothers’ Companion.  Kathleen is jumping on board with The Leaky Boob to have a regular article answering Leaky questions every month.  The questions will be selected from the huge pool we get in every day to try and help cover the wide range of topics about which Leakies are asking.  These questions are from real moms and represent hundreds of requests for more information in the past two weeks.  Please understand that this is simply the professional opinion of one International Board Certified Lactation Consultant in an informal setting and is not intended to replace the care of a health care provider.  Kathleen is offering support and information, not diagnosing or prescribing treatment.  For your health and safety, please seek the care of a qualified physician and/or IBCLC.  Kathleen does have limited availability for phone or online consultations, see her website for more information.

Dear Kathleen,

After pumping, is it ok to feed the baby that milk and then if baby doesn’t finish to save the rest by putting it in the fridge?

Thanks!

Bewildered in pumping land

 

 

Hi Bewildered!

Pretty hard to work to express milk for your baby and then have to toss it out!  Some health care providers say to dump partially drank bottles, or give it at the next feeding.  I think that placing back an unfinished bottle of breast milk back into the refrigerator is just fine. I would suggest removing the nipple and screwing on a clean lid to keep the bacteria from the baby’s mouth to a minimum.  By using a fresh nipple for the next feed you will keep more germs from mixing in with that bottle of milk. I would recommend using the milk within the next 24 hours.  One very small study of just a few moms found that milk could be placed in the refrigerator for up to 36 hours at 4-6 degree Centigrade.  Storing milk in the back of the refrigerator is recommended. If you use the milk a second time, and there is still leftover milk, it is probably best to dump it out.  When milk has gone bad, it does have a rancid smell.

When pumping or feeding your baby a bottle, be sure to always start by washing your hands well.  Also, make sure that all of the pump parts are washed thoroughly in warm soapy water or in a dishwasher and if wet, left to dry on a clean paper towel. Also, try and store just small amount of milk for your baby; maybe just 2-3 ounces per bag or bottle. In that way, there will be less leftover milk to deal with.Hi Bewildered!  Pretty hard to work to express milk for your baby and then have to toss it out!  Some health care providers say to dump partially drank bottles, or give it at the next feeding, but I think that placing back an unfinished bottle of breast milk back into the refrigerator is just fine. I would suggest removing the nipple and screwing on a clean lid to keep the bacteria from the baby’s mouth to a minimum.  By using a fresh nipple for the next feed you will keep more germs from mixing in with that bottle of milk. I would recommend using the milk within the next 24 hours.  One very small study of just a few moms found that milk could be placed in the refrigerator for up to 36 hours at 4-6 degree Centigrade.  Storing milk in the back of the refrigerator is recommended. If you use the milk a second time, and there is still leftover milk, it is probably best to dump it out.  When milk has gone bad, it does have a rancid smell.

Happy pumping,

Kathleen

 

TLB meme breastmilk storage

 

Dear Kathleen,

As a first time mommy (I have a two week old girl), I’m really struggling to seek out why things to happen and don’t happen… maybe you can help? 

To make a long story short, I wanted to nurse my little one since day one she was born. However, I have flat nipples so not only was it extremely painful when she would latch on, but it was also challenging, frustrating and depressing because I refused to even give her a bit of formula. The pain was so strong when she would latch that I would cry every single time and I knew she could feel my frustration because she would stop and look at me. I even dreaded watching the clock because I knew that in a few minutes it was going to be time to nurse again. As the days passed, my baby lost almost 3 pounds under her birth weight because I thought she was getting enough milk from me but it turns out I was barely making any. That made me so sad; I felt like a HORRIBLE mother so because I wanted her to get better, my husband and I decided we give her formula. After she gained a few pounds (almost back to her birth weight), I tried nursing her AND giving her formula but she would no longer latch on to me. She obviously likes the bottle nipple better because she can actually latch on without struggling. I tried everything I could. I’ve tried pumping and nothing comes out. Maybe one drop– if not, two. I’m honestly broken yet content she’s healthy once again. I’ve humbly given up on nursing because my husband and I feel it’s the healthiest decision for her and I. She won’t get frustrated and I won’t dread seeing her precious innocent face. We’re just bottle feeding her now but a lot of questions are going through my mind such as will be baby still be healthy with formula?

I did everything I could and I STILL am. Even though my milk is drying, I’m striving to keep it going by taking some pills that will help my milk come down. I’m doing this with the hope that once my milk comes down FULLY, I’ll be able to pump and mix it with her formula. 

I welcome your advice and encouragement. 

Love,

Disappointed but hopeful

 

 

Hello Disappointed,

I am sorry that you didn’t get the help you needed and suffered so much both physically and emotionally.  Unfortunately at this point, with your milk nearly gone, you need to make a final decision.

I do have questions for you, but in this Q&A format, I can only wonder.  Did your breasts grew during pregnancy?  Is less than an inch of space between them?  If the answers to these questions is no, then you may have insufficient glandular tissue which limits the amount of milk that can be produced.  That could explain the initial weight loss.

Yes, you can relactate but that takes a lot of time and effort and, in my opinion, you need to make a commitment to either go full steam ahead or let it go.  If you decide to relactate, you will need a rental grade pump and pump at least 8 times every 24 hours including during the night, using a double pump kit for about 15-20 minutes.   While some people may suggest teas, cookies and other herbs such as fenugreek, I think you need bigger guns!  You should consider taking the medication Motilium (Domperidone) that is available through compounding pharmacies with a prescription from your OB or midwife. If you are going to get some, I would suggest getting a month’s worth to start.  The typical starting dose is 30 mgms three times a day but can be increased to 40 mgms four times a day.  You can read more about taking Motilium on Dr. Jack Newman’s website.  Understand that pills, or herbs alone will not restart your production.  Your breasts must be stimulated and drained at least eight times each 24 hours.

If you start the Motilium and want to get more, it may be less expensive ordering it on-line through a New Zealand pharmacy.  There is a less expensive version, Domperon (a generic) that is $.12 per pill.  Under the care of your health care provider and with a prescription you can order Domperon online and delivery takes about 10-14 days to get a shipment.

Being only 2 weeks into this, unless you have insufficient glandular tissue, I think you could bring back your supply with the medication and pumping.  If you decide to move forward and your milk supply is equal to what your baby requires, about 3-4 ounces per feeding, I would urge you to consider an appointment with an experienced lactation consultant. Who knows, your baby may be able to nurse completely or with a formula supplement!

While breastmilk is the biological norm for human infants, your baby needs food and formula will provide her with the nutrition she needs.  What are missing are the live cells that protect her from illness and certain other factors in breast milk that protect against other conditions. As you are finding out, formula is also quite expensive.

While nursing is a loving and bonding experience, you can capture some of this with bottle-feeding. Please be sure to always hold your baby for feedings.  It isn’t long before babies can hold their own bottles and so many bottle-feeding parents take advantage of this.  Bottle-feeding requires both hands and I believe a majority of mothers hand over the bottle to the baby as soon as the baby can hold his own bottle. I think this allows the baby to bond with the bottle instead of their parents.  This may also be the reason that so many bottle-fed babies become overfed and overweight.  Parents simply fill the bottles to the top and the baby just sucks it down.  Consider trying baby-led bottle feeding if you need to continue with bottles and here’s some information about bottle feeding the breastfed baby.

So now the decision is up to you.  I know you will decide what is right for you and your baby, no matter which way you go.

All the best,

Kathleen

 

 

Kathleen-Higgins Kathleen Huggins RN IBCLC, has a Master’s Degree in Perinatal Nursing from U.C. San  Francisco, founded the Breastfeeding Warmline, opened one of the first breastfeeding clinics in  the United States, and has been helping breastfeeding mothers professionally for 33 years.  Kathleen  authored The Nursing Mother’s Companion in 1986 followed by The Nursing Mother’s Guide to Weaning.  Kathleen has also co-authored Nursing Mother, Working Mother with Gale Pryor, Twenty Five Things Every Breastfeeding Mother Should Know and The Nursing Mothers’ Breastfeeding Diary with best-friend, Jan Ellen Brown.  The Nursing Mothers’ Companion has also been translated into Spanish.  Mother of two now grown children, Kathleen retired from hospital work in 2004 and after beating breast cancer opened and currently runs Simply MaMa, her own maternity and breastfeeding boutique.  She continues to support breastfeeding mothers through her store’s “breastaurant,” online at The Leaky Boob, and in private consultations.  

 

 

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Breastfeeding after a C-Section

by Star Rodriguez, IBCLC- this post made possible by the generous support of Rumina Nursingwear.

 

During my pregnancies, I planned for a natural childbirth.  No medications, vaginal, et cetera.  It was going to be awesome.

Except that then I wound up with two c-sections.  So that was unexpected.  And scary.  And threw a big wrench in the whole breastfeeding thing.  I’d planned to have my baby skin to skin minutes after birth and after a natural delivery where I’d have a vigorous, hungry baby.  Now I was exhausted and itchy and pukey and I could barely move.  I had no game plan for this scenario.

My first c-section led to a lot of problems with breastfeeding.  The lovely IBCLCs who helped me fix my breastfeeding relationship actually inspired me to begin this career path.  In this article, I will pass along information that will (hopefully) help you if you are going to be having a c-section and plan to breastfeed.

With most c-sections, mom will get a lot of fluids.  This often translate into an inflated birth weight for baby.  Subsequently, your baby may pee a lot and appear to lose a lot of weight as it gets rids of the fluid (this can also happen if a mom has a lot of IV fluids and delivers vaginally; it’s just even more common in c-sections, though.)  Most doctors and nurses are aware of this, but some are a little less familiar.  Most hospitals have a cut off on weight loss for babies but not all hospitals take the inflation into account, some don’t.  If your hospital does not, and you are asked to supplement, bottles are not always your friend.  Nipple confusion and flow preference are real things.  Not all babies will have an issue, but we don’t know which ones will.  So instead of a bottle, try finger feeding, cup feeding, spoon feeding, supplemented at the breast with an SNS, or something of the like.  You can also ask if your baby can be supplemented with your milk.

Some c-section moms experience a delay in their mature milk coming in.  C-sections are not linked with delayed copious milk production, but traumatic births are.  Some c-sections can be very traumatic.  Also, c-sections are more likely to offer longer separations between mom and baby; some theorize that the less stimulation in the early hours can delay things slightly, too.  The moral of this story is to try to get your baby to the breast as soon as possible.  More and more hospitals are having skin to skin in the operating room for non-emergency c-sections.  If not, ask that your baby be brought to you right away when you are in recovery.  If your hospital has a lactation consultant or breastfeeding expert, see if they can come see you as soon as possible, too, to assist in that latch, especially since you might be tired or not feeling well.  If you still have issues with delayed milk, pumping can help.  Sometimes a 24 hour burst of pumping after most feedings can ramp up milk production and make your body get its act together.

C-section moms can have a lot of soreness.  First of all, don’t ignore the medications that they offer if you’re in pain.  The normal pain relievers prescribed in hospitals are fine for breastfeeding moms to take.  If you’re worried, ask your doctor or nurse.  They will be happy to check for you.  If you are sore and tired, it is often tempting to have someone else feed the baby while you sleep.  No one but you can make that decision, but in those early weeks, skipping feedings can be a problem.  If you do need someone else to feed your baby, again, I highly suggest not using a bottle.  When soreness is a factor, trying an alternate position can also help moms more comfortable in those early days.  C-section moms are often told to use the football hold, and while it is a hold that I love, every mom is different.  If you nurse in a different hold or position that works for you and your baby, great!  In my experience, about 50% of moms that love the football hold post c-section.  The side lying hold is also a great one (where you lie down and pull your baby in to your breast – Miranda Kerr famously released a Tweet of her nursing her newborn this way) but is not always possible right away, since you are probably going to find it hard to impossible to move.

Miranda Kerr breastfeeding

Support for a c-section mom is key.  You just had surgery, and recovery can be hard.  Breastfeeding naturally has a learning curve, and those two things together can feel so overwhelming.  Make sure people are around to help you out the first week or so.  My mother, for instance, made us dinner every single night for a week with my second baby.  It was the greatest thing ever.  I was so not up to cooking yet; I was still trying to figure out how to recover from surgery and handle two kids.  Just make sure that you are getting supportive support, and not unsupportive support and be willing to protect your boundaries, it can make a difference in your breastfeeding journey. 

Finally, many of the moms I see that are up and moving around regularly after surgery do better at breastfeeding.  This is totally anecdotal, and it could just be that those moms didn’t have it as hard as others for whatever reason.  But I do encourage moms to do what they can to feel like a normal human being again.  Walk if you can.  Those fluids that I talked about earlier?  They are still in your body, too, and some can hang out in your breasts, making it harder for the baby to latch well.  Moving can help your body to eliminate those  fluids.  Although I tell you to try to return to some semblance of normal as soon as you can, I am not telling you to overdo it.  Go with your body and how it reacts.  With my second baby, I was ready right away to walk after my c-section.  I felt great.  The second they allowed me, I had a nurse in there helping me up.  Anddddddd then I projectile vomited and almost passed out.  When I thought about it later, I was so gung ho to move nownownow that I ignored a lot of signs that I wasn’t ready yet (sporadic dizziness, nausea, and just a general unwell feeling.)  Don’t force yourself to do things too early and don’t make yourself sick or hurt.  Also, remember to eat and drink to hunger and thirst.  This will help your body to heal and produce the milk that you need.  You don’t have to force yourself to eat extra, just eat what you need.

And if possible, relax.  Be gentle with yourself and your new baby.  Having a newborn is challenging.  Having a newborn and recovering from surgery is that geography between rock and hard place.  Postpartum recovery is important not only to your health but in reality to your entire family, read this on how important taking time to heal birth is for your whole family.  To take care of your baby well you must take care of you.  Your recovery matters and your healing is a key piece in the continuation of your breastfeeding journey.

________________________ 

Did you have a c-section?  Did it impact breastfeeding?  If you had a c-section and breastfed, what helped you and how would you encourage other c-section moms?

________________________ 

 

 

StarbabyStar Rodriguez, IBCLC, RLC is a provider in the Central Lakes, MN area.  She provides services online at Lactastic Services and in person.  She also blogs for The Leaky B@@b and volunteers her services to loss mothers at Stillbirthday.

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