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Pumping 201- working, exclusively pumping, volume, and weaning

October 22, 2012 by
Breast pump, Hospital grade breastpump

Hygeia EnDeare

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

 

Working

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

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

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

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

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

 

Exclusively Pumping Moms/ Moms Separated from Babies

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

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

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

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

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

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

 

Weaning Off Pumping

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

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

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

 

 

 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
Filed Under: Article, Bottle Feeding, Breastfeeding, breastmilk pumping, breastpump, Featured, Pumping, Relational Resource, tutorial, Weaning Tagged With: , , , , , , , ,

A market for breastfeeding support- The Family Friendly Business Initiative

September 18, 2012 by

Supporting breastfeeding as a marketing tactic?

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

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

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

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

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

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

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

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

 

 

Filed Under: Article, Breastfeeding, Breastfeeding and society, Breastfeeding in public, breastfeeding support, family, Featured, Jessica Tagged With: , , , , ,

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

August 7, 2012 by
by Star Rodriguiz, IBCLC
Selecting a pump, fitting flanges, and how and when to pump.

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

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

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

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

Choosing a pump:

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

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

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

So, ok.  I have a pump.  Now what?

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

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

Image credit

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

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

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

 

How long and how often?

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

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

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

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

 

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

In Search of the perfect latch

June 27, 2012 by

Sugarbaby 1 week old. Photo by Kelli Elizabeth Photography

“I’m really scared of breastfeeding.”  Pregnant with her first my friend subconsciously rubbed her 34 week belly as I made dinner and we chatted.  Puzzled, I asked her why.  She said she googled and learned that it can be so painful, particularly if they don’t have a good latch.

“How do you get a good latch?” she asked me.  She went on to explain that she had read different blogs and forums about how hard it was to get a good latch, women with bleeding nipples, and babies not gaining weight.  She wondered what was the secret to a good latch and what if it didn’t happen for her.  It’s true that these issues do happen and probably far too often but here she was, weeks away from having her little baby, scheduled to take a breastfeeding class in the next couple of weeks, and worried that she was facing a world of pain if she couldn’t get this elusive latch and not find the secret for it ever to happen.

Earlier that same day I had coffee with a good friend, an IBCLC at a local hospital.  The topic of the elusive perfect latch came up and she surprised me by telling me that she thinks we make too big deal about the latch.

“If mom isn’t in pain and baby has plenty of soiled and wet diapers, why do we need to mess with anything?  Sure, if there’s a problem such as pain or a dehydrated baby then we need to fix what we can but so what if that bottom lip is curled in if it’s not bothering anything.”

In other words, if it’s comfortable and it’s working, it’s a good latch.  There is a wide range of normal.

I love this woman, she often says exactly what I’m thinking.

In general, if everything is working right, babies are ready to breastfeed and mom’s breasts are ready to feed.  It just works and we really don’t need to mess with it, it doesn’t have to be this complicated endeavor.  Maybe it will be difficult but we don’t have to expect trouble.  More often than not moms need support simply because breastfeeding isn’t so common in our society and women don’t see breastfeeding as a part of normal life making the learning curve steeper than it would be if seeing breastfeeding was commonplace.  There would be less stressing about the perfect latch if more women saw what it looks like when a baby is at the breast as they go about daily life.  Their moms, sisters, aunts, friends, coworkers, or even strangers breastfeeding would have already demonstrated a baby feeding well.  The wide range of normal would be seen and experienced.  Today a woman may never see another woman breastfeeding until she’s feeding her own baby for the first time.  Seeking out support she may look online or join a breastfeeding support group, seeing breastfeeding dyads in a very specific setting that she had to find.  If she is experiencing difficulty with pain or ineffective milk transfer for her baby, because she hasn’t been exposed to breastfeeding pairs, she may not even realize that the way her baby is latched could be what’s causing the problem or that it may even be a fairly simple fix.  When there are issues such as poor weight gain for baby or bleeding nipples the first thing to consider is a poor latch.  After I shared a few pictures of Sugarbaby’s latch on Facebook, there were several comments and I received several emails from moms stating that they never knew saw what a latch looked like and had endured pain in breastfeeding because they didn’t realize something was wrong.  Side note: if you are ever experiencing pain with breastfeeding that is more than a brief moment of discomfort or lasts beyond initial latch please seek out help, pain is usually an indication of a problem than can be corrected.  This doesn’t mean you’re doing something wrong, it just means you probably need help.

 I talked with my friend Star Rodriguez, IBCLC of Lactastic Services and WIC peer counselor for the following lists.

When do you need to consider latch issues and improving your nursling’s latch?

  •  When breastfeeding is painful beyond the initial latching.
  • When there is tissue damage to your nipples.
  • When there are weight gain issues for the baby.

What latch pointers can moms try?

  • Mom is in a comfortable position and has brought the baby to her level to her instead of leaning down to the baby.
  • Baby has wide open mouth.
  • Baby’s body is facing yours and baby’s arms are not pushing away at you.
  • It is best to let the breast fall naturally if possible.
  • If large breasted or when milk first comes in, it may be helpful to hold your breast with your hand.
  • Aim baby’s nose toward the nipple; if necessary to encourage a wider mouth, tickle the very top of the baby’s upper lip with your nipple.
  • Latch should be asymmetrical. Chin will touch the breast, nose will be unobstructed. You do not need to push your breast away from your baby’s nose in a good latch.
  • You will hear or see baby swallowing – short sucks/swallows at first, longer ones as milk starts to let down.
  • If using a nipple shield, ensure that the nipple and surrounding tissue is being pulled into the shield.

What can a mom do to try to improve a painful or ineffective latch?

  • If baby isn’t opening mouth wide enough, attempt to show baby by opening your own mouth wide.  Many babies will subconsciously mimic this.
  • Make a “breastwich” with your hand in the shape of a C behind the areola to help baby get a bigger mouthful.
  • Get baby as naked as possible for skin-to-skin or lightly dressed.
  • Hold baby securely, a snug, close hold will help.
  • Pull baby in quickly when mouth is open wide.
  • It is common to experience some discomfort at latch in the first few weeks of breastfeeding.  It should go away as the feeding continues.  If it does not end after around 30 seconds, you may need to remove the baby from the breast and reposition the baby.  Break the suction by placing your little finger into the corner of the baby’s mouth and trying to latch again.  Some lactation consultants can show you ways to fix a latch without taking the baby off the breast, but those are easier to learn from being shown rather than told.  You may need to put the baby in a different nursing hold or position.

When should a lactation consultant be called?

  • Repositioning doesn’t work
  • If there is sudden soreness after there has been painless nursing
  • If you feel stabbing or burning pain in breasts or at latch
  • If you have cracked or bleeding nipples
  • If your latch is not painful but your baby is not having a good amount of wet and dirty diapers

Check out these other resources on latch:

11 Common Pitfalls When Latching a Newborn

 

Latching and positioning resources

Latching: Thoughts on Pressing Baby’s chin down

 The Mother-Baby Dance

 

Coming soon a photo gallery of latched on babies and their mother’s commentaries on their latch experience illustrating the wide range of normal and potentially problematic latches. 

 

Filed Under: Article, Breastfeeding, breastfeeding difficulties, breastfeeding support, Breastfeeding the newborn, Breastfeeding the newborn, Featured, Nipples, Relational Resource Tagged With: , , , , , , ,

An overview to making an educated choice about formula

March 5, 2012 by

Star and I worked together on this post as a result of seeing a need to answer some questions and provide information on infant formula.  I believe that breastfeeding advocates and educators often provide only “formula is bad” kind of information that isn’t helpful for the parent that seriously needs to consider formula options for their child.  This article is intended to be a resource for those that will be using formula and would like information as they go about making their decision and for those that want to offer genuinely supportive support to all families, regardless of the feeding method employed.  There will be further information on formula available soon but for now, we hope this is helpful for those that need it.  It is my hope that breastfeeding advocates and educators will be able to provide quality information on formula when necessary and do so in a supportive manner.  Let’s truly support families and be a safe source of information on infant nutrition, free of judgment and profit-making agendas.  If you are a breastfeeding mom that needs to supplement with formula or switch entirely over to formula, be sure to consult not only with your child’s doctor but also an IBCLC in making your formula choice.  ~Jessica 

What are the questions and why do we need to look at them

Babies and breastmilk go together perfectly.  Breastmilk is the optimal, normal standard of infant nutrition, and I love the fact that I am in a profession where I can help mothers to achieve their goals where breastfeeding is concerned.  While I am a hugely passionate breastfeeding advocate I am not anti-formula.  Something that seems to confuse some people but it boils down to respecting the fact that we all make choices in feeding our babies, and sometimes formulas are a part of that choice.  Formula feeding moms love their babies just as much as breastfeeding moms do and want their babies to grow and thrive.  During some hiccups in my own breastfeeding relationships, I used commercial infant formulas as a supplement and I am thoroughly unashamed of that fact.  However, formula can be such a dirty word in infant feeding communities, and there’s a lot of confusion over it.  What kinds are there?  Which formulas are better than others?  Should I use commercially made formulas or make my own?  And how do we mix them?

 

The different types of formula

First of all, let’s address the varieties of formula.  There are three major types that are available: cow’s milk based formulas, soy formulas, and protein hydrolysate formulas.  Cow’s milk is the least expensive and most common.  They are nutritionally appropriate for most babies and engineered to be as close as possible to breastmilk recognizing they can not completely replicate all that is breastmilk.  However, some babies may not do well on these.  Some common reasons for not using cow’s milk formulas are allergies to the protein in the cow’s milk or the family’s desire to avoid animal products for their babies.

The next variety of formula is soy.  Soy formulas are not recommended for preemies.  They do not contain animal proteins, so they are useful in some medical situations or if a baby has issues with those proteins.  They can also be used by families who adhere to a lifestyle that avoids animal products.  A review by the AAP in 2008 found very few medical reasons to utilize soy formula.  There are also concerns that soy could interfere with the thyroid, immune system, or the reproductive system.  Those concerns have not yet been proven to be warranted, although the AAP did advocate for further testing.  Bottom line?  Unless your baby needs soy formula or you have some family reason that you are choosing to avoid animal products, it is probably not necessary.

The last of the three major commercial varieties is the protein hydrolysate formula.  These are also called hypoallergenic formulas.  Really, these will generally be ordered by a doctor to combat an issue like allergies to both the soy and the cow’s milk formulas.  Most people aren’t buying these over the counter because they’re just such an amazing choice.  They’re typically very expensive and needed only in specific cases.

 

Standards and regulations

Formula is held to certain standards of nutrition by the FDA.  (Note: this is different than being approved or regulated by the FDA.  However, there are standards of nutrition that must be met or the FDA will take action.)  Therefore, there is typically not significant difference between generic and name brand formulas of the same type.  There are pretty negligible differences between organic and nonorganic formulas, too.  Basically, with organic formulas, there is a certain standard for the production of the ingredients in the formulas.  Organic formulas have not been proven to be better for babies.  They are sometimes sweetened with organic cane sugar, which can make them taste sweeter.  This might be a problem – babies could develop a taste for sweeter foods or overeat due to the taste – but these are theories that have not been proven with peer reviewed research.

Homemade formulas are touted by many people and websites, but they are not something that I would ever recommend to a client or anyone else, for that matter.  There absolutely are risks associated with feeding an infant commercial formula, but there are even more risks to non-commercial formula.  No health body that I’m aware of recommends homemade formulas.  With commercial formula, you are getting something that is built to have the most optimal nutrition possible when breastmilk is not an option.  With homemade formula, there are a plethora of risks, running from nutritional imbalances to severe infections from pathogens in the ingredients.  In the days before commercialized formula, babies had to be supplemented with other things to keep away conditions like scurvy and there were deaths due to babies ingesting contaminated products.  Do it yourself is awesome for cleaning products or baby food or many other things.  It’s not good for your baby, though.  This is particularly true in a young baby with an immature gut, or digestive tract where the risk of illness from contaminated formula is even higher.  This post takes a thorough look at goat’s milk and homemade formula as alternatives for infant nutrition if you’d like more information.

 

Preparation and safe handling

Preparation of commercialized formula can be a problem, too. We often think that women in developing countries where there is unsafe water or not enough money to purchase the correct quantity of formulas are the ones at risk of incorrect preparation.  Of course, that does happen.  But we also see preparation issues in developed countries, too.  We may not hear about them as often but they certainly occur.

The only kind of formula that is sterile and can pretty much be put in a bottle, heated, and be good to go is ready to feed liquid formula.  Some health organizations recommend that babies under 3 months be fed only ready to feed for this reason.  However, most people use powdered infant formula.  Powdered infant formula is not sterile.  If you have a baby with immune system issues, or an ill baby, it is preferable to use ready to feed.  Using powdered formula in the right way can really help to make it safer.  You want to prepare formula on a clean surface, with freshly washed hands, and put it in clean, sterile equipment.  The World Health Organization recommends that you use water that has been boiled and then allowed to cool for no more than 30 minutes.  You should mix this water with the powdered formula (the EXACT AMOUNT called for on the can.  There are generally scoops with the formulas, and you should use the correct amount of level scoops) and then cool it to a suitable temperature by running the feeding implement (bottle, cup, whatever) under cool/cold water or placing it in cool or cold water.  It should be fed to the baby right away and leftovers should be discarded.  For more information, see the WHO guidelines for the safe preparation, storage, and handling of powdered infant formula.

 

Social issues and real support

Now that we’ve talked about types and preparation – and if I didn’t cover something that you have a burning desire to know about, please, comment or message myself or Jessica and I will find it out for you – let me step on a soapbox for a minute.  We know that breastmilk is optimal nutrition and that formula is recommended by the World Health Organization as the 4th best option for infant nutrition (following milk from the mother’s breast, expressed milk from the mother, and donated milk from another lactating woman).  But we simply cannot go on acting like formula is a poisonous, horrible thing that only uneducated, mean parents feed to their poor defenseless babies.  Some of the horrible comments that I have seen about formula and formula feeding mothers lately are ridiculous.  Would it be awesome if all babies everywhere could get breastmilk, either from their mothers or from donated milk?  Sure.  Is that likely to happen in the not too distant future?  No.  (Look here and here for information on being a donor or if you need donated milk for your baby.)  If we can meet moms where they are and provide the information they are seeking without judgment, we can be a trusted source for education and support and moms won’t have to turn to the formula companies as their primary origin of information.

I am the first person to step up and say that formula should be better regulated, that marketing should be reined in, that we deserve the best possible product for the smallest and most defenseless of our citizens.  But those are issues with the formula companies or manufacturing, not issues with mothers who can’t or won’t breastfeed.  Every mother I have ever met has a wide variety of factors and reasons that came into play when she chose how to feed her baby.  Discounting those things or casting blame or shame on her for them quite frankly sucks.   A real advocate supports women in general and knows that not everyone will make the same choice as her.

 

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

Rumina Handsfree Pumping and Nursing Tank Giveaway

March 2, 2012 by

Today we have a giveaway from TLB sponsor Rumina Nursingwear.  Read on for details on this opportunity and an interview with the company founder Dawn Alva.  I love this company and had the pleasure of meeting Dawn and her staff this past fall.  Their commitment to supporting moms extends beyond their customers and sales to ongoing support of WIC and Milk Banking.  I hope you take the time to get to know this company and consider using their product knowing that doing so helps them help so many other moms.

TLB:  Tell us about how Rumina came to be, the inspiration, the meaning of the name, and the vision of the company.

Dawn: Rumina was inspired by my infant son. From the beginning, my son and I struggled with breastfeeding. First we had difficulty with latching then he seemed to just get irritated and frustrated at the breast. Eventually after a few months of trying he decided he preferred the bottle. I didn’t want to give formula because I knew of all the benefits of breast milk but pumping came with its own set of challenges.

As a working mom, I had to return to work. Prior to returning to work I was trying to pump every 2-3 hours for about 30 minutes at a time, trying to build up a supply. I was nervous about getting enough time to pump. I searched for a hands-free solution to help but there was nothing available at that time that worked for my body. My nipples weren’t in the “right” location for the holes or the garment didn’t stay up, defeating the hands-free purpose. Plus I hated undressing at work to pump! Every time I sat there holding the pump, I worried about how I could be the mom I wanted to be and continue my demanding job. I became so overwhelmed that after 2 1/2 months of nursing and 4 months of exclusively pumping, I stopped short of my personal hope of at least a year.

The vision of Rumina started after I emerged from my “mommy fog,” I became dedicated to developing a solution that would meet the needs of breastfeeding moms who pump in one comfortable and supportive garment. Our vision as a company is to help moms reach their own unique breastfeeding goals. While I was not able to reach my own breastfeeding goals, it’s truly amazing to hear when Rumina assists other moms reach theirs!

Rumina is a Roman Goddess of Breastfeeding and Women, the Goddess who causes the milk to flow. Her name is related to an old Latin word for breast, rumis or ruma and translates to “the Nourisher”, “She Who Breastfeeds” or “Mother’s Breast”. Rumina is the protectress of all nursing young. (http://www.thaliatook.com/OGOD/rumina.html)

 

TLB:  What would you like TLB readers to know about Rumina?

Dawn:  Rumina is working hard to support our community and establish long term relationships with our local WIC and Milk Banks. We really want to not only support these great resources and amazing organizations but to help increase the awareness and needs of these organizations and offer ways moms can help contribute.  Read more about the WIC Peer Counselor program and how we support it here.

 

TLB:  What has been your personal experience with breastfeeding and how has it factored into developing your company?

Dawn:  My personal experience with breastfeeding was a struggle. The struggle has been a reminder that as we move forward as a company we want to help moms through their own breastfeeding experience. We want to offer great, quality products that helps support hands-free pumping but we also want be a sounding board for moms who are struggling or have questions. We want to provide resources and connect moms to great communities like The Leaky Boob where they can find support and other moms going through similar experiences. Breastfeeding moms are amazing and we have a lot of offer each other!

 

TLB:  What is your favorite breastfeeding and pumping tip?

 Dawn:  There are so many great breastfeeding and pumping tips, like hand expressing after pumping to completely drain the breast and help increase your milk production as well as relaxing while breastfeeding and pumping, something I think I personally forgot…often. But my number one favorite breastfeeding and pumping tip I encourage is to drink plenty of water. Sometimes we moms get so busy and so overwhelmed by baby and life we sometimes forget to drink enough water which greatly help with our overall well-being and milk production.

Dawn and her son Bryce


This giveaway is for one mom randomly selected from the entries to receive a free all-in-one Hands-Free Pumping Bra & Nursing Tank in their size and color preference, a $48 value.  The Rumina Hands-Free Pumping Bra & Nursing Tank has a built-in bra that is the perfect layer for a busy mom’s active life. Wear it on its own or layered under work and casual tops.  The patent pending design is perfect for moms who have to be away from their child but want to continue and give their very best.  The tank has all the functions you’ve come to love in a nursing tank plus all the functionality a breastfeeding mom needs throughout the day.

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This giveaway is now closed.

To be entered, please leave a comment on this post.  This entry is REQUIRED in order to be entered for a chance at the giveaway.  Please be sure head over to the Rumina Nursingwear Facebook page and/or Rumina on Twitter and thank them for their support of TLB and this giveaway opportunity.  Let’s be sure to show our appreciation.

For a second entry share this giveaway in some public forum (Facebook, Twitter, parenting forum, etc.) and return with the url of where you shared it and leave that in a comment (and don’t forget to tag them!).  Please note, you can share it where you like and as many times as you like, but only one will count for a second entry.

Important: only a possible two entries per person, any additional entries will be deleted and abuse will possibly result in all of an individual’s entries being deleted.  Please be patient in waiting for comments to show up as some have to be moderated from the spam filter.  Thank you.

That’s it – two simple tasks and you’re entered twice for a chance at a great giveaway.  Thanks to Rumina Nursingwear for their generous giveaway and sponsorship of The Leaky Boob, providing support for breastfeeding moms everywhere.  This giveaway will remain open through Thursday, March 8, 2012 and is open to international entries.  At the close of this giveaway, Rumina will be offering a discount code for all Leakies so even if you aren’t the lucky winner, you can get your own top for 20% off.  Good luck and have fun!

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Congratulations to Brianna!

“What a great company! Love the name. I struggled with my first daughter going to school full time and pumping and keeping up my supply. Very hard work. Appreciate anything that makes that job easier.”

Thanks everyone that entered!  Rumina has generously offered a 20% off discount code for Leakies this week, it’s good through Thursday, March 15, 2012:

TLB20

Rumina’s support and giveaway is greatly appreciated, it is a pleasure to partner with such a wonderful company.

Filed Under: Breastfeeding, giveaway, Sponsor Tagged With: , , ,

Nipple confusion, bottles, and alternative feeding options

February 6, 2012 by

On January 17, 2012 in the United States, Medela, best known for their pumps, launched their latest “feeding innovation”, the Calma.  The Calma is a bottle that seeks to eliminate nipple confusion and flow preference by making a bottle fed baby work for its milk, similar to how your little one must compress and suck at your breast to get milk out.  According to Medela, this “supports an easy transition from the breast to the teat and back.”

As a registered International board certified lactation consultant, I am very skeptical of these claims.

I have often heard that nipple confusion is a myth, foisted on mothers to keep them stuck to their brand new babies, to keep them from leaving the house, to subjugate us all.  This is simply not true.  Nipple confusion happens.  I have seen numerous cases of it in my practice.  Babies become nipple confused for three reasons – flow preference, difference in movements, and difference in feel.  Medela has the right idea on part of the equation.  Babies that are given a lot of bottles in the early period can decide that it’s not that fun to work a breast when this plastic thingy is way easier.  Most bottles, even the slowest flowing, flow faster than milk from a breast.  However, your baby also moves their mouth differently to get the milk from a bottle than from a breast.  The jaw and tongue movements are not even close to the same, and trying to transfer the movements from one to another can frustrate and upset your baby.  After all, if your baby is new, this whole eating thing is new, too.  Why complicate it?  There’s a bonus too: a baby nursing at the breast will develop their mouth in a way that will help with prettier smiles and better speech, too!

The third part of the equation is the different feel.  If you are giving your baby a softer breast and a harder silicone, they may very well like the way that a bottle feels more – especially since that silicone is, again, delivering milk faster and the mouth movements are different.   Medela hasn’t really done anything to cure that.  I’ve seen and felt the Calma, and, I assure you, it will not be mistaken for breast tissue anytime soon.

The easiest way to prevent nipple confusion is by waiting to introduce a bottle until four to six weeks (three to four at the earliest) and to simply offer the breast more than the bottle.  Some families have other situations, though, that don’t make the whole four to six week thing possible.  So what is a modern mom to do?  For many of us, it is not feasible to never give milk from anywhere but the breast.  We have work, and school, and other children, and obligations, and, man, sometimes Mommy just needs a day (or an hour or two) off.   But babies still have to eat during that time!  And what if your baby has issues with latching at the breast, or you are inducing a supply, or you need to do some supplementing?

Luckily, being a modern mom means that we have some awesome options available to us.  There is spoon feeding, where you can hand express colostrum or milk directly into a spoon and give it to your baby.  This works best in the beginning, when your baby isn’t taking in much milk yet – it would be a fairly long process for a family feeding an older infant.  To spoon feed, you simply use a clean spoon, hold the baby in an upright position (like sitting) and put the spoon at the lower lip, giving small amounts and letting the baby go at their own pace.  A spoonful can be considered a full feeding if you are dealing with a newborn.

Cup feeding is another option.  Cups are widely available, cheap, and easy to use.  Your infant won’t take the cup from your hands and drink like a big kid, of course, but will instead lap at the milk kind of like a baby animal might.  There are special cups sold for cup feeding, but it might be easier and cheaper to just use a shot glass.  With cup feeding, like spoon feeding, you’ll hold the baby supported and upright.  You’ll put the cup to the lips and tilt slightly so that the baby can easily lap at the milk (not so it’s pouring into his or her mouth.)  Allow the baby to eat at his or her own pace.  It may take a while, but that is ok!  Babies shouldn’t be gulping down their feeds – when they do, they often overeat, which can hurt their tummies and set a bad precedence of wanting more than they need.

You can also use what’s called a supplemental nursing system, or SNS.  SNSs are generally a bottle type thing hooked to a long tube.  You put the milk in the bottle part, and then you can do one of two things with the tube.  First, you can use it on the breast, either by sticking it in a nipple shield (which you should only use if followed by a lactation consultant for sizing and to negate any potential complications that might arise) or by taping the end near the nipple so that the baby gets an extra boost of liquid while nursing.  This can be really helpful if you’re relactating or increasing a milk supply, if your baby needs to be supplemented but is nursing well, or if you have a preemie or baby with suck issues that maybe doesn’t milk the breast as effectively as they should be.  You can also use a SNS to finger feed your baby.  With that, you attach the tube to your finger, and the baby sucks the finger to get the milk.  A lactation consultant can even help you use this method to train or retrain your baby to suck properly.  SNS systems can be hard to clean, so please carefully read the instructions and check with a health care provider for any extra precautions you should take if you have a preemie or immune compromised baby.

If you have an older baby (4 months or so) that’s just now getting around to taking milk in another way, you can try forgoing bottles altogether and working on cup training or using sippy cups.  Sometimes the difference is interesting enough for an older baby who has rejected bottles.  As with any of the other methods, the goal is to allow your baby to learn and go at their own pace.  Be prepared for this to be a messier endeavor with an older baby who is starting to show some independence.  You will probably have to help them to hold and tilt the cup – they may not be content with the idea of you holding it all yourself, and you may have some spills in the process.

But what if none of these methods work for you?  Maybe your care provider is balking, or you are annoyed and uncomfortable with one or all of the methods, and you really, really just want to use a bottle.  In that case, instead of purchasing the reportedly $15 a piece Calma, I would try Fleur at Nurtured Child’s method of baby-led bottlefeeding.  In fact, any time you are bottlefeeding, you should use this method.  It is the ideal way to feed a baby from a bottle and encourage any care-takers that will be feeding your baby with a bottle to utilize this method as well.  In choosing a bottle, there is no really good evidence that I have seen showing that a certain bottle or nipple is better than another for breastfeeding.  There are a lot of nipples that are supposed to be similar to your breast in look and feel, but in my time in the bottle aisle, I never saw any that made me go, “That looks EXACTLY like my boob.  That one, right there, with the wide base and medium sized nipple!!”  My kids never really liked the wide bottomed nipples, although they are often touted as being awesome for breastfeeding babies.  When it all boils down to it, most of that is hype.  When selecting a bottle, select the one you think might work that is in your budget.

If you are giving milk due to a breastfeeding problem, be sure to discuss methods and supplements with a medical professional with good lactation training.  Ask a lot of questions.  If supplements are ordered, get a LOT of information on them.  Why do you need to supplement?  How long does your medical professional want you to supplement?  How much should you supplement?  How often should you supplement?  Can you use your own expressed breast milk?  What is the plan of action for weaning from supplementing?  If your baby isn’t nursing well at the breast, you will likely need to do some pumping along with the supplementing to keep your supply healthy while you work through the problem.  Find out how often you need to pump and how you should store your breastmilk – especially if your baby is hospitalized and you are transporting it.

There are other feeding options for more serious problems, such as cleft lip/palate as well. That type of situation needs to be followed very closely by a lactation professional and physician to ensure that the baby’s unique situation is being addressed.

If you are going to be separated from your baby for another reason – work, school, or just going out – remember to think of your magic number.  This is the number of times your baby breastfeeds in a normal day (and, yes, that can vary.  Just take an average.)  You want to be sure that you are replicating that amount of times by a combination of pumping and nursing.  This will help to keep your milk supply plentiful.

In the end, there is no product on the market that can magically be just like your breast and provide your baby the exact same experience.  Luckily, there are many options for your baby and your family that will help you to achieve your breastfeeding goals.

 

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

Boobs- Function and Pleasure

December 22, 2011 by

My life is all about breasts, it seems.  I am an IBCLC, and I spend at least 32 hours a week providing breastfeeding services to moms.  I am also a nursing mother – my nursling and I are going on 18 months right now.  And then there’s the flip side of my breasts.  My second job, you see, is modeling for a boudoir and fashion photo company, Red Petti.  This means that I regularly spend a few hours a month getting dolled up and photographed in lingerie for campaigns.  My breasts are very functional and very attractive all in one.

The dual nature of the human breast is one that we have a really, really hard time with in most Westernized countries.  Breastfeeding moms are asked to cover up or kicked out of various places, yet we use bikini clad models to sell any number of things.  With the vastly sexualized nature of the breast, is it any wonder that I have client after client who is concerned that nursing will feel sexual to her, or that she won’t be able to still be attractive if she’s nursing?

Sometimes I hear the advice of “Just retire the sexy for a little while, because you only nurse a short time in the grand scheme of things.”  And this is true.  You do only nurse for a little while.  But that doesn’t mean that you can’t use your breasts for sexiness and functional purposes.  After all, let’s face it – your sexuality is why you have a baby, in most cases.  Babies don’t end that, or no one would have more than one.

So understand that breastfeeding is not sexual, although it can be very sensual (and by sensual I mean that it engages your senses, and the flood of hormones can make you feel very relaxed and happy.) The contact with the breast in breastfeeding is very different than sexual contact, so it is not an arousing experience for most women. There is nothing to be ashamed or embarrassed about in using your breasts in feeding your child – it is their primary biological function. And if that biological function doesn’t come easily, don’t feel like a failure – see a trained lactation professional to help you learn. Most trained lactation professionals can give you some advice or referrals if you’re having a difficult time with sexual behavior while nursing, as well.

On the flip side, just because you have become a mom doesn’t mean that you are no longer fabulous or sexy or desirable.  That doesn’t end the second you have the baby, although it’s easy to forget that.  It may take you awhile to lose the pregnancy weight (although breastfeeding may help!) and you may have a few stretch marks or some loose skin, but so what?  You are magnificent and gorgeous.  And while you’re nursing, you may even have a fuller, more voluptuous chest.  Enjoy it while it’s around.

Audre Lorde once said, “I can’t really define it in sexual terms alone although our sexuality is so energizing why not enjoy it too?”  She wasn’t talking about the breast, but it works for that, too.  Sexuality doesn’t define our breasts – if anything, the nurturing act of breastfeeding inherently does.  But it’s ok for your breasts to have dual roles, and you can and should enjoy them both.

 

 

 Star is an IBCLC and breastfeeding peer counselor for a WIC in the Midwest.  Star also supports breastfeeding locally by sitting on the  breastfeeding task force in her town.  She is helping her  community’s Early Head Start redefine  their breastfeeding support, and is the  driving force behind a local breastfeeding campaign.  In  the remainder of her free  time, she chases around her nursling and preschooler.
Filed Under: Article, body image, Boobs, Breastfeeding, breasts, Featured, guest posts, motherhood, sex Tagged With: , , ,

Your Guide to Relactation

December 13, 2011 by

 

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

What is relactation?

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

Why would I want to relactate?

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

What are my odds of successfully relactating?

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

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

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

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

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

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

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

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

  • 92% of mothers fully relactated
  • 6% partially relactated

 

What factors will influence my success in relactating?

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

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

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

 

How long will it take?

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

 

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

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

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

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

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

 

How do I relactate?

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

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

Get support.

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

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

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

Explore what happened.

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

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

Bring back your milk supply.

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

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

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

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

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

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

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

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

Bring your baby back to the breast.

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

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

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

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

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

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

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

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

Ensure that your baby continues to thrive.

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

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

 

What are some good resources for more information and support?

  • Lowmilksupply.org.  Comprehensive online source of information on increasing milk supply
  • KellyMom.com:  Relactation and Adoptive Breastfeeding:  The Basics

 

 

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

This resource page was made possible by Motherlove Herbal Company.

 

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

Nipple Shields- Q&A

November 16, 2011 by
by Deirdre McLary, IBCLC

Nipple shields can be a useful tool in breastfeeding when they are needed.  Knowing when and how to use them is important.  Here we take a look at some common questions about nipple shield use.

 

1. Who might need a nipple shield and will they know before their baby is born?

In both childbirth and breastfeeding I like to start out with a baseline of “normal”.  As women, we are made to do these things, and to do them well!  All babies and moms are capable of bonding right after birth, of getting off to a best start and of moving forward into a long lasting and complication free breastfeeding relationship.

For some women the support and knowledge is not always there and challenges present themselves early on.  This is why it is important for women to recognize potential breastfeeding problems while still pregnant, and to arm themselves with knowledge and support ahead of the game.

In my childbirth classes and prenatal breastfeeding classes I always recommend mom take a close look at her breasts and nipples in the privacy of her home.  Get to know your nipple shape and what to look for!  Are there any blemishes and moles that exist, are your nipples flat, inverted, particularly large or small in diameter, what is the shape of your breasts, are they symmetrical, have you had any surgical procedures that might affect breastfeeding?

Familiarize yourself prenatally with your anatomy so that when bigger breast changes come (when milk comes in) you can know what is normal for you vs. what might be new and surprising looking.

Most babies can successfully latch on to most nipple types.  Mother and baby are a perfect pair! A nipple shield should always be a last resource for a baby who will not latch for some reason.

The important thing to remember is that if a baby won’t latch or there are painful nipples, there are other things going on that an IBCLC or lactation consultant can help you with instead of turning to a nipple shield.

 

2. Do all women with flat or inverted nipples need nipple shields?

No.  Most just need support and resources for help.  “True” inverted nipples may cause complications due to adhesions at the base of the nipple that bind the skin to the underlying tissue.  There is a nipple “pinch” test that can help a mom determine if her flat or inverted nipples are “truly” inverted (with a true inverted nipple the nipple will retreat inward when pinched rather than protrude outward).

Most flat and inverted nipples do protrude with a little exercise and routine.  Some techniques are; pumping, Supple Cups (little thimble shaped devices that help “train” a nipple to protrude), stimulation, Hoffman exercises, (loosening skin and stretching the nipple by placing thumb & index finger on opposite sides of nipple base, then pressing inward, then pulling away) or breast shells.

 

3. What, in your opinion, is the most common unnecessary reason nipple shields are used?

Painful nipples or inexperience.  If your nipples are painful and getting a good latch is difficult, there is an underlying reason! Let’s get to the cause of it rather than cover it up with a tool that may only add to your problems.

 

4. What is the most common necessary reason nipple shields are used?

It can vary.  Each mother-baby pair is unique.  What applies to childbirth applies to breastfeeding – judicious use of intervention may be necessary and life saving if done appropriately.  Nipple shields are just another tool out there, and in my experience they should be a short-term solution and used under the guidance of an experienced IBCLC or lactation consultant.  There are real reasons to use one that may save a mom from having to turn to unwanted bottles and formula and may in fact help to preserve and support a long term breastfeeding relationship.  Used wisely they can be a very useful tool.

 

5. Tongue tie comes up often, are nipple shields a good way to handle
tongue tie?

The best way to handle a tongue tie is to have a thorough evaluation and seek advice on if a release procedure is appropriate or if perhaps a better course would be gentle body work by a reputable cranial sacral massage therapist.  After the referral out for support, if baby is still having difficulty latching – the same rules apply … “why” is the latch still poor?  What’s going on?  Let’s solve that riddle.  Using a nipple shield may be an appropriate, temporary, tool to get over the hump of transition, but it is not the only solution out there.

When breastfeeding creates trauma and frustration for baby, creating a positive atmosphere at the breast is crucial to preserve a long lasting and successful breastfeeding relationship.  If baby associates breastfeeding with struggle, pain, fatigue and/or anger you risk turning baby off to the whole experience. A nipple shield can be a protective measure here.

Getting several opinions and references from other moms too when dealing with a tongue tie is wise.  Talk to folks about it!

 

6. What should be considered before reaching for a nipple shield?

Everything else!  Really.  Have you assessed your own latch technique, baby’s mouth, palate, tongue, your nipple size?  Do you understand the mechanics of proper latch, what to look for, how wide a baby’s mouth should be, lips flanged nicely, tongue well extended and applied?  Do you understand normal newborn feeding cues? Have you tried different positions, laid back, side lying?  Different holds – football hold or cross-cradle for better control of your breast and baby’s head? Have you seen a lactation consultant or a La Leche League leader for help?

 

7. If a mom can’t find an IBCLC to help her in determining if she needs a shield, how to use it and when to stop, what can a mom do and where can she find help?

What about La Leche League or WIC Peer Counselors?  Maybe there are local support groups mom just isn’t aware of yet?  Ask around to midwives, at the health food store, local “meet up” groups and yoga studios. What have other moms in your neighborhood done when they’ve had breastfeeding trouble?

Does mom have a good breastfeeding book or two?  I recommend all expectant moms have a good breastfeeding book on hand before baby is even born.  And then write the name of a local IBCLC or LLL Leader and group meeting times right on the inside of the book so all your breastfeeding “go to” resources are in one place!  Mark the book up, put Post-its on pages that talk about issues you may be struggling with or curious about.  Titles I like are LLL’s Womanly Art of Breastfeeding, Dr. Jack Newman’s Ultimate Breastfeeding Book of Answers, and Nancy Mohrbacher’s Breastfeeding Made Simple.

The internet can be of help here as well.  First I’d head to other Leakies … see if they know of any lactation professionals in your area.  Mother-to-Mother support is the best!  Some new mother will have your back and provide you with the perfect gem of wisdom and support.

The internet is also a fantastic resource for videos and websites by all the great breastfeeding gurus out there.  And then there’s Skype.  Find an IBCLC who uses the internet a lot for her business and she no doubt will offer Skype services.  Obviously nothing compares to hands on face-to-face IBCLC support, but if that is impossible to find locally, Skype and email can be a handy 2nd best!  Just be sure to check the lactation consultant’s credentials, get references, and practice internet safety.

 

8. What are some reasons to try to wean from the shield as soon as possible?

This is a question about risk and why nipple shields can present a problem.  For one, they can be habit forming.  Babies are not dumb.  We all fall into comfortable habits and hold strong opinions about what we prefer and when and how we like change. Babies are no different.

When using a nipple shield it is best to remember it should be a short term solution and that you should continue to try to latch baby on without the shield often and frequently each day.  The best time to do so is typically after baby has suckled with the shield so baby is in a calm, and after you’ve had your first “let down” so milk is flowing.  The remove the shield and try to latch without it.

There is also the risk that a nipple shield may not be fitted or applied correctly and may yield poor latch technique, thereby limiting the stimulation necessary to create a strong milk supply.  Listening to baby swallowing, listening for a good “suck, suck, swallow” rhythm, watching for the swallow (milk transfer) can bring confidence baby is on well and milk is flowing.  And of course, continuing to count and watch diapers each day.

 

9. How does a mom know when to start weaning from the shield?

Again, each mother/baby pair is unique and what works for one may not be best for another.  This is where touching base with your lactation consultant will come in handy, and trusting that your baby will communicate with you when she’s ready.

I’ve worked with moms who struggled with a shield habit for months, lamenting its use – to only be shocked one day when baby suddenly at 5 months took the breast without the shield like they were a pro at it all along!

Babies are smart little cookies.  When they’re ready they will work with you to create the change (losing the nipple shield) you desire.  Be patient, as it can take some time.

 

10. How does she go about weaning off the shield?  

Part of weaning off a nipple shield goes hand and hand with what the risks are and why you are using it in the first place.  I think for the most part, when the time presents itself (when nipples have healed, when milk supply is abundant, when baby is calm and growing fat & happy, when mom has more confidence and a rhythm to her day) a mixture of  time, patience, persistence and compassion will bring about the transition.

I recommend that you try in a regular, methodical way.  Each time you bring baby to breast, if the timing is right, just after the milk starts to flow (after your initial let down) when baby knows milk is flowing, try removing the shield and see if baby will continue to latch without it.  Don’t give up!  It can take a few weeks for sure.

 

11. Anything else a mom needs to know about using nipple shields including potential risks/benefits or how to clean?

How to clean?  Nipple shields are dishwasher safe and like your breasts, don’t need to be sterile for baby to use.  Soap and water rinse in between uses are fine if you’re out and about and/or if a dishwasher is not available.  Also, shields come in varying sizes and brands so don’t be locked into a single brand/size. Know there are options out there.

I think a final statement about nipple shields should be what questions to ask yourself before you start using it.  Be your own best advocate …  ask yourself “why”? Why do I need this? Who gave me the nipple shield advice?  There are a lot of people out there who just want to dole out nipple shields like they’re candy!  Ask yourself, was it given to you on Day 1 at the hospital after a vague assessment by a busy staff person who may not even be a qualified lactation consultant?  Was the nipple shield recommended by a trusted sister who swore by it for her children but has different circumstances than you?  Were you wandering the aisles of a baby store and thought, “hey, maybe this will help my sore nipples”?  Did the recommendation come from an experience IBCLC who spent personal one on one time with you to assess what your breastfeeding circumstances, challenges and goals are?

Trusting that with care and proper instructions a nipple shield can be a useful tool, but also knowing when and how to avoid it will be a mother’s best wisdom when and if the subject of using one comes up.

Deirdre McLary is an IBCLC, RLC, CD, Birth, Breastfeeding & New Parent Expert. Deirdre is the founder of Breastfeeding Arts & Birth Services. Since 1997, she has served New York City and metro area families with all their birthing and breastfeeding needs. She is a certified labor support and postpartum doula, a childbirth educator, a La Leche League Leader and a board certified lactation consultant (IBCLC). When not helping individual families throughout the tri-state area, she can be found hosting a weekly Breastfeeding Cafe drop-in group locally in Nyack, NY, teaching childbirth and breastfeeding classes in Soho, NYC, and hosting & commentating on several live chats on Twitter and Facebook as a lactation and doula expert (#LCChat, #BirthGenius or #DoulaParty). Visit Deirdre’s website at www.breastfeedingarts.com or email her at BreastfeedingArts@gmail.com

 

Filed Under: Article, Breastfeeding, breastfeeding difficulties, breastfeeding support, Featured, guest posts, Nipples, Relational Resource
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