Everything You Need To Know About Postpartum Bleeding And Periods After Childbirth

by Dr. Kymberlee Lake

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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.
Stages of lochia postpartum bleeding lunapads reusable menstrual pads
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.

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.

Cloth pad for postpartum bleeding
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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cloth pads for periods and postpartum bleeding
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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Pumping Breastmilk and What You Need To Know

By Amy Peterson, IBCLC

This article made possible by the generous support of Earth Mama Angel Baby.

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Not every mom needs to pump. When baby is with mom for feedings and transferring milk effectively, there is no need to pump. But there are times when pumping breastmilk is important:

  •      Baby needs more milk (a supplement for one or more feeds)
  •      Mom wants to increase her supply
  •      Mom and baby are apart for feedings, such as when mom is at work or school
  •      Mom wants to have someone else participate in feedings
  •      Anytime mom will miss a feeding

In these circumstances, using a breast pump helps maintain or increase the milk supply for future feedings, and the pumped milk offers the perfect food for baby. This article touches on choosing between the different types of breast pumps, general pumping guidelines, and tips for increasing milk supply if necessary.

When possible, choose a pump that meets your unique situation. If you’ll only miss a feed or two each week, a manual pump or single electric is plenty. If you need to pump for several feedings a day, a high quality, double electric pump is a better choice.  If your baby is hospitalized or you need to dedicate time to increasing your supply, a hospital grade/rental pump is the best choice.

You can get a breast pump from many different places: box stores (Babies ‘R Us, Target, WalMart, etc.), online, a friend, thrift store, or possibly through your insurance company. Buying a used breast pump or borrowing a pump is usually not recommended. Most brands are considered single user items. These pumps do not control for the transfer of bacteria or germs between the pump motor and the milk, putting the baby’s health at risk. If you know the pump brand has a closed system, you could consider purchasing a new collection kit with tubing. Even so, you may not know if the pump is working less effectively than when purchased new, potentially putting your supply at risk.

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It is also important to note that not all women respond well to pumps and not all pumps work equally well for every lactating individual. This is why we have options. There are various contributing aspects that may impact how well a pump performs such as flange size, suction strength, type of suction, etc. If a pump is not working well for you it is possible that another would. Some breasts prefer one pump over another and some breasts prefer manual expression.

Most breast pumps have two settings. One button controls the vacuum, and the other button controls how fast the pump cycles (sucks). These settings let you fine tune the pump to mimic your baby’s suction and rhythm. For maximum milk production, use the highest comfortable suction. Use a fast cycling rate until your milk flows, then adjust to your comfort level; this mimics how your baby sucks before and after a let-down. A few brands of breast pumps have a built in feature that begins with fast cycling and adjusts slower. Some moms find they have better milk flow when they reset the button and continue with fast cycling.

Here are some general pumping guidelines to get you started:

  •      Pump for any feeding you will miss. Your milk supply is based on supply and demand, and pumping for each missed feeding tells your body to keep producing milk during that time.
  •      Pump the amount of milk your baby needs.  For example, if your baby takes 3 ounces of milk, pump 3 ounces total (1 ½ ounces from each breast).  If you pump what you need in 4 minutes—you can stop pumping.
  •      Pump between feedings to build a bottle. You can combine the milk from several pumping sessions to make a larger bottle of milk.
  •      Pump at night or in the early morning hours when your supply is highest.
  •      A gentle breast massage routine, called hands-on pumping, has been proven effective in increasing the amount of milk a mom can pump. Check it out here.

For moms who are not able to pump enough milk and who want to increase their supply, there are additional pumping tips:

  •      Pump until your milk stops flowing, and then pump two more minutes. This limited extra pumping is enough to tell your breasts to make more.
  •      Pump more often. Leave your pump set up (where your toddler can’t reach it!). Pump for 5-10 minutes once or twice an hour.
  •      Use the hands-on pumping technique listed here and above.
  •      Know that pumping alone may not increase your milk supply. Work with a breastfeeding helper who is knowledgeable about other targeted methods to boost supply.
  •      While you work on increasing your milk supply, feed your baby. You can combine your breastmilk with donor milk or formula to be sure your baby is getting enough. Some moms choose to feed breastmilk separate from formula to avoid wasting any breastmilk if baby doesn’t finish the bottle. As long as your guestimate is cautious, it is safe to mix; the milks will mix in baby’s belly anyway.

While pumping is an important aspect for many families in reaching their breastfeeding goals, how much is pumped is not a reliable sign of milk production. As with most areas of parenting, take your cues from your baby. When baby is growing well and reaching milestones within range then how much you pump doesn’t need to be a concern. If you see signs of dehydration or poor weight gain, speak with your child’s healthcare provider.

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Happy pumping mamas! You’ve totally got this and we’ve teamed up with Earth Mama Angel Baby to support you in your pumping journey with a giveaway of Earth Mama Angel Baby’s Milk-to-Go kit for Leakies in the USA. A $40 retail value, this kit includes:

One pair of Booby Tubes® (one pair) for cold or warm therapeutic use, 1 box of Organic Milkmaid Tea (16 tea bags) a fragrant comforting blend that supports healthy breast milk production, safe Natural Nipple Butter (1 fl. oz.), Happy Mama Body Wash (1.67 fl. oz.), one Eco-friendly Reusable Insulated Bag, and a tasty recipe for Organic Milkmaid French Vanilla Chai.

Use the widget below to be entered!

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a Rafflecopter giveaway

Amy Peterson is a mom of 4, IBCLC, Early Intervention coordinator, and retired LLL Leader. She works alongside a speech-language pathologist, and together they co-authored Balancing Breast and Bottle: Reaching Your Breastfeeding Goals. They have also written a series of tear-of sheets available through Noodle Soup: Introducing a bottle to your full-term breastfed baby, Pumping for your breastfed baby, Pacifiers and the breastfed baby, and Bottle pacing for the young breastfed baby. Amy’s passion is helping others find fulfillment and confidence in parenting, regardless of feeding method. Visit Amy’s website at breastandbottlefeeding.com.

 

 

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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.

The Stages of Lochia table image

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.

____________________

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.

Young Woman Biting Her Finger Nail

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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