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Peanut Butter Chocolate Banana Lactation Smoothie

May 7, 2015 by 1 Comment
by Carrie Saum

During my 21 months of exclusive pumping, I kind of became obsessed with milk-boosting foods. There’s a fancy name for those foods, but I just call them Milk Movers.

Breakfast was and is the hardest meal for me, and after having a newborn with special needs that I pumped milk for eight times a day, breakfast became a handful of trailmix and a cup of coffee. This was not sustainable for many reasons, but not the least of which I needed MORE food, and balanced meals. My milk supply was barely adequate to begin with, so getting plenty of Milk Movers was imperative.

While I deeply desired to eat better, I had a hard time fitting in all of my responsibilities, including responsibly feeding myself. My bandwidth for anything beyond survival was pretty minimal in those days.  Adding in Milk Movers, which I definitely needed, seemed downright impossible. So, I began experimenting with foods that would be fast, nutritious, provide solid sustenance, and would not overwhelm me with too many steps.

Smoothies seemed like the best option. You basically just take a scoop of this and handful of that and put some kind of liquid in it and call it good, right? Right. I came up with a few recipes to keep handy, and tweaked them to feel like I was having an indulgent treat.  The healthy factor could just be a bonus.

My very favorite was this little gem. Full of protein, flavor, and it felt like a complete indulgence.

ChocolatePeanutButterBananaSmoothie

Ingredients:

  • 1 ripe banana, cut into small chunks and frozen solid
  • 1 cup oat milk
  • 2 Tbsp all-natural peanut butter*
  • 1 Tbsp coconut oil (optional but so good for you both!)
  • 1 Tbsp cocoa powder
  • 1 tsp ground flax seed
  • splash of vanilla extract

Directions:

  1. Put all of the ingredients into a blender and blend until smooth.
  2. Drink immediately and feel happy you are giving yourself and your baby great and delicious nutrition.

*If you can’t do peanut butter, almond butter will work just as well, and so will sunbutter. And if you are feeling really daring, you can add a handful of baby spinach and get some greens in there, too!

Also, I peeled and chopped a whole bunch of bananas once a week, then froze them in individual servings so I could easily grab them to make a smoothie. This was a total lifesaver. I didn’t have to think, I just had to blend.

All of you mamas are doing great work for your little babes. Keep it up.

Cheers to you!

*Note: It’s important to point out that most women aren’t going to need to eat food with the intention of upping their milk supply, if everything is working the way it is supposed to, your baby will know how to up your supply just fine themselves. Skin-to-skin and feeding on demand are the best ways to increase breastmilk supply to meet your baby’s needs. (Concerned you have low supply? Read this to help figure out if it is something you need to be concerned about.) For those women, galactalogues just happen and they don’t need to think about it. But some women, like me, do need a boost. As a mom who ended up exclusively pumping and indeed having low supply such that I ended up on medication solely to increase my milk production, I know what it’s like to look for anything, anything at all that would help my body make even just a little more milk to help feed my baby. With the support of my health care providers, we tried everything. It becomes “I will eat all the cookies, I will drink all the shakes, I will eat all the parfaits!” if it even just makes me feel like I’m doing something to address the low supply struggle, it is worth it.

If you love this smoothie recipe, you might like this recipe for Paleo Salted Chocolate Chunk Cookies or these Grain-Free Crepes Florentine over on Our Stable Table.

IMG_2895Carrie Saum brings a passion for wellness and over a decade of experience in health care to her clients. A certified Ayurvedic Wellness Counselor (AWC) from the Kerala Ayurveda Academy, she empowers individuals and families to achieve health and balance through time-honored practices and health knowledge.
Carrie has extensive first-hand experience in vast array of medical and service fields. With background in paramedic medicine, Carrie spent ten years serving in the non-profit sector managing organizations, programs, and orchestrating resources to meet health needs of people across the United States and abroad in countries such as Guatemala, Mexico, Kenya, and Zambia. As an AWC, Carrie currently coaches her clients and their families about topics including nutrition, weight loss, and stress management.In addition to her work as a wellness counselor, Carrie is a passionate “foodie” and author. She lives in Portland, Oregon with her husband and young son.
 

 

 

 

Filed Under: Article, Breastfeeding, breastfeeding support, breastmilk pumping, Featured, guest posts, Milk Supply, Pumping, recipes Tagged With: , , , , , , , , , , ,

Dear Kathleen- Nursing strikes, biting, low weight gain, and painful breastfeeding in pregnancy

April 14, 2014 by Leave a Comment
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.

Bfing tip low supply sleep on it

Dear Kathleen,

I need help!! I struggled to breastfeed my now 10 month old. After 3 months of struggle we made it and he has been breastfeeding beautifully. I work long hours and pump at work but have had a great supply. I just returned from a 5 day trip where I pumped and dumped and during that time my milk supply went from 24 oz a day to less then 15. Now my baby latches but cries after about 5 min on each side. He calms with expressed milk in a bottle. What do I do now to increase my supply back? I wanted to make it to a year and am heartbroken that I may have to stop sooner!! Help!!

Desperately yours,

Heartbroken for Milk

 

Hi there Heartbroken for Milk,

So sorry about your difficulty.  There are several things you can do.  First of all, I would make sure that you are using the best possible pump, like a Hygeia. If you don’t have a strong pump, you might consider either getting one or renting a clinical grade pump, like a Symphony, or an Ameda Platinum.  I would be sure that between pumpings and nursings that your breasts are being drained at least 7 times each 24 hours.  Having your breasts emptied less than this will keep your supply at the level it is at now.  The other thing I would suggest is More Milk Plus from Motherlove Herbals.  If you go to their website, you may be able to find a local distributor or order it directly from Motherlove.  This herbal product contains fenugreek and three other milk stimulating herbs.  Keep in mind that teas are a weak form of any herb and may not help much.  For a a short while you may also want to nurse before offering solids and once your supply increases, you can offer solids first, but again try to keep the number of nursings remain at a minimum of seven per 24 hours.  If your baby wakes in the night, welcome those nursings for now.

Best wishes too you!

Kathleen

 

Dear Kathleen,

My 10 month old bit me and I yelped, which made her cry. That was 6 days ago and since then she’s completely refused to nurse. She was exclusively breastfed before introducing solids and has never had formula. She won’t take a bottle and will only drink water from a sippy cup. I tried offering expressed breastmilk in an open cup but she wouldn’t have it. I’ve been mixing express breastmilk into her food but that’s all she’s been having. My supply is going and I can only pump a few oz a day. I’ve tried nursing her asleep, warm baths, skin-to-skin, everything, but she still refuses. Everything I’ve read says 10 months is too early to wean and that nursing strikes are temporary, but every day I feel more hopeless. I offer every couple of hours. She has three meals a day. I’m worried she’s missing out on essential nutrition, and even if I had to give formula I don’t know how I’d get it into her. I miss breastfeeding so much, I just want it back. 

Thank you for your help,

Not Ready to Wean

 

Dear Not Ready to Wean,

Tough situation!  At this point, be sure that you are expressing milk at least 7 times each 24 hours with an excellent pump to keep your production high.  You are certainly been doing the right things with co-bathing and lots of skin to skin.  I would offer your milk with an ordinary cup rather than a sippy cup with your guidance and see if she prefers that over the sippy cup.  I would also suggests seeing if she will nurse while asleep or very sleepy maybe while you lie down together in a darkened room.  Final words, hang in there.  Nursing strikes usually end as suddenly as they begin!

Good luck!

Kathleen

 

Dear Kathleen,

My son is 8 1/2 months and exclusively breast fed, and the last couple months has a side preference when he wants to relax or fall asleep. He has 6 teeth and is still in the teething process. My problem is, he bit his preferred nipple 3 times in 24 hours, drawing blood the first couple times. Now, I am trying to give it some time to heal, but he has a total meltdown when I don’t let him nurse on that side! 

Any suggestions to help him through this while I attempt to heal would be much appreciated! 

Sincerely,

Wounded Nipple

 

Dear Wounded,

I hope that you are expressing your milk very often with an excellent pump, at least 7 times each 24 hours.  I would also suggest feeding on that side using other positions that irritate the wounded nipple less, like “football” hold or having him straddle your thigh and then come onto the breast.  If the nipple is open after 5 days, it may then be time for an antibiotic as bites can easily become infected and then not only are they slow to heal, but you can also develop mastitis.  There are other healing remedies like Motherlove’s Nipple Cream which you may be able to find if you visist Motherlove’s website.  It contains several healing herbs and can work quickly unless there is already bacteria in the wound.  Also, you may want to learn more about biting.  If you visit my website, Kathlenhggins.com, I have a blog about “biting”.  This needs to stop!

Kathleen

 

Dear Kathleen,

I still breastfeed my just 2 year old and am 15 weeks pregnant. Breastfeeding is now VERY painful contributed by a very poor latch I think (there are teeth marks left behind on my nipples). It is no longer pleasant for me and I find myself feeling anger and resentment during feeding. The problem is my toddler is not ready to stop, she feeds on waking and before sleeps so it in entrenched in those routines. No amount of distraction, food or drink offerings or cuddles can stop endless sobbing and clawing at me. I’m at a loss.  

Thank you, 

Unpleasant Breastfeeding

 

Hi Unpleasant Breastfeeding,

There are a few things you can try.  First of all it is very common for nipples to be tender during pregnancy.  They may improve as your pregnancy continues.  With that and the marks from your toddlers teeth, it is no surprise that you are suffering through nursings!  There is nothing that can be done about your pregnancy nipple soreness, but you can help the problem with your toddler’s latch. Because the baby’s mouth tends to drag down the breast tissue, it may be important to lift her upwards by using a pillow and lifting your breast upward.    Experiment with other nursing positions to see which positions are more comfortable and which  avoid letting her chin rest on her chest, trying to get her head tilted back a little more.  Try and offer your breast with the nipple pointing downward and wait for a wide open mouth before latching. Feel free to use lanolin after nursings.

With all that being said, if you are still wanting to stop nursing, you can do that too! If you are only nursing in the morning and just before sleep, you and your partner can both help out.  She really is mostly weaned at this point!

For now, I would suggest tackling just one nursing at a time.  When she wakes, start of new routine of an early breakfast and some sort of play or other activity. Without telling her  “No”, let her know you are “saving the milk” until nap time, using whatever words she understands. Think of all the things she loves to do and substitute any of those things, Once you have that morning one gone, pick another, maybe the nighttime or nap time nursing. One the week-end, or in the evening, let your partner work his magic, with you out of sight.  Go take a walk. Perhaps Dad can help her off to sleep at night by making a new routine, like reading a book and rocking him for awhile.   A bath, a story and more rocking can certainly be a new way to distract her and soon you will have weaned. On the other hand, maybe one nursing a day is pleasant for the both of you.

See how changing the latch works. Move slowly on this, taking the nursings out just one at a time over a period of time until you are feeling better and she is adjusting.

Best wishes!

Kathleen

Dear Kathleen,

I have a soon to be 5 months old infant who is breastfed since birth and the biggest challenge is his weight, he only weighs less than 13 lbs and his birth weight was 6 lbs 12 oz. I’ve fed him every 2 hours and now sometimes 3 hrs to 4. When I pump I only produced 2 oz total from both breasts which the pediatrician isn’t happy and is very concerned that he’s probably not getting enough milk.  He spit up a lot, lots of urinations and some common bowel movements but his doctor isn’t satisfied and we keep having to go back for a weekly or biweekly weight check and now the doctor wants me to start giving him rice cereal now which I’d rather wait til he is 6 months old so I dont know what to do.  I don’t want to do formula. This is my 4th child and my 3rd child to breastfeed.  With my last 2 children I breastfed and did produced good amount of milk but this time I’m not sure if I’m producing enough milk which is very discouraging for me.  I took fenugreek for 3 months but I wished I had known I should have taken blessed thistle along with fenugreek.  Any suggestion on how I can increase my milk supply? Could it be his latch?  It still hurts when he latches on and sucks on my nipples.  I’m trying to stay positive but I feet like a failure that my baby is probably not getting enough milk from me because of his very low weight for his age.  With my other two nurslings I had a wonderful lactation consultant but that was 7 years ago and we have moved, I don’t even know how to find a good consultant.  Please help!

Yours truly,

Worried but hopeful

 

Hi Worried,

It’s understandable that you are worried, when I plot out your baby on the World Health Organizations Breastfed Infant Growth Charts, which you can find on line, I see that we was born on the 15th %tile and he seems to now be on the 3rd %tile.  I think you can offer him more calories without having to resort to formula.  I don’t know when you are pumping in relation to a nursing, so that doesn’t help me much.  Your baby needs more milk which has more calories, so I agree that cereal is not the answer.

I would suggest a few things.  First of all, you need to aim for 7-8 nursings each 24 hours. I would not allow the baby to go without nursing for 3-4 hours.  Watch for early hunger cues, like finger sucking and offer your breast whenever you notice this.  If your baby uses a pacifier, I would put it away.  Welcome night time feedings as mothers produce more milk in the night time.  If he sleeps through the night, I would wake him before you go to bed, or even wake him after five hours of sleep.  During the day and evening, I would try and double pump after most of these nursings for 5-10 minutes and offer him that milk after the next nursing.  This milk will be very high in calories and help him gain more weight.  While not knowing what pump you have, be sure that it is a good one, like a Medela or Hygeia or you could even rent a clinical grade pump for awhile if you have doubts about the pump you are using.  If your nipples are larger than a penny, be sure to use a larger sized flange, like a size 27mm.

Next, I would add a strong herbal galactagogue, like More Milk Plus from Motherlove Herbals.  If you go to their website, you may be able to find a local distributor or order it directly from Motherlove.  It contains, fenugreek, Blessed Thistle, and two other milk stimulating herbs.  It usually takes 48-72 hours to kick in.  A second herb you can add is GoLacta.  Go to their website for ordering information, Using both of these together can really boost your supply.  At this point, I would like to see a daily weight gain of 1/2 ounce per day.  That is normal for this age.

If your periods have already resumed, you may see that your supply lessens between the time you ovulate and when your period resumes.  If that is the case, you can take 1000 mgms of Calcium and 500 mgms of magnesium every day until your period starts.  I am assuming that you are not on any estrogen containing birth control which definitely lessens milk supply,

If your baby is spitting up, that suggests reflux to me which can cause some babies to limit their nursings.  I would avoid any of the following the following foods and beverages; these include chocolate, all citrus fruits and their juices (including strawberry, pineapple and kiwi), the gassy veggies like onion (onion powder), garlic (garlic powder), peppers, cucumbers, cauliflower, cabbage, broccoli, and Brussels sprouts.  It may be your baby is reacting to the foods you’re eating, eliminating the most likely culprits first and then testing them by adding them back one at a time could help you figure out if one of these are the cause.  If this baby has the same Daddy as the others, and they had colic symptoms, you might also consider a trial off of all cow milk products for a short while to see if that helps with the spitting up.  Cow milk products can be an allergen which runs in certain families.

Lastly, if you want to find a lactation consultant, go to ILCA.org and scroll down to “Find a Lactation Consultant”, enter your info and some name should pop up.  If you have private insurance, they should cover the cost.

Best wishes to you and your baby!

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.  
Filed Under: Article, Ask the IBCLC, Breastfeeding, breastfeeding difficulties, breastfeeding help, Featured, Pregnancy, Relational Resource Tagged With: , , , , , , , , , , , , ,

Breastfeeding after a C-Section

July 29, 2013 by 21 Comments
by Star Rodriguez, IBCLC- this post made possible by the generous support of Rumina Nursingwear.

 

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

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

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

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

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

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

Miranda Kerr breastfeeding

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

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

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

________________________ 

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

________________________ 

 

 

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

Filed Under: Article, Articles from the professional experts, birth, Breastfeeding, breastfeeding support, Breastfeeding the newborn, Featured, New article, postpartum, Relational Resource Tagged With: , , , , ,

It doesn’t have to be all or nothing

March 25, 2013 by
by Kari Swanson

full term breastfeeding

My daughter was placed on my chest immediately after my obstetrician finished stitching up my c-section incision. She latched onto my breast and started breastfeeding right there in the operating room. Last month we celebrated her third birthday. She knows that babies have mama milk. She also knows that big girls have mama milk until they are ready to stop having mama milk. I expect that sometime between now and the time she is around 5 years old she will gradually wean.

Some might consider the fact that my daughter is 3 and still receiving breastmilk to be extreme, but anthropological evidence indicates that this is biologically normal for a young hominid primate. That being said, it is probably no surprise that I consider myself to be a lactivist. I believe that human breastmilk is the biologically normal food source for human infants and I volunteer as an admin on The Leaky B@@b in order to support other breastfeeding mothers and to help normalize breastfeeding in a culture that has largely lost sight of the real reason women have breasts.

What may come as a surprise to some is that my daughter and my son before her received formula in addition to breastmilk. Why? Because I work full time outside of my home and I am among the unlucky few who truly do not respond well to breast pumps. For whatever reason my body just does not give up the gold for a machine despite my supply being more than adequate. After a time, despite numerous tips and tricks, pumping whenever and wherever I could, I ceased to be able to pump enough milk to entirely meet my babies’ nutritional needs while they were separated from me while I worked.

With my daughter I was fortunate to be able to spend 3 months home with her after she was born, and to spend 3 months thereafter working half time. I pumped at home before returning to work and I pumped before work, during work, after work, and on non-workdays once I returned to work. I had a small stash of milk in the deep freezer when I returned to work, but it was quickly depleted. When I first returned to work and pumped I easily had enough milk by the end of the day to send to the daycare without dipping into my frozen milk stash.

I determined how much milk my daughter needed in her daycare bottles using an iPhone app called “Breast Milk Calculator.” The app uses the baby’s weight, age and number of feedings in the previous 24 hours to suggest how much milk he or she needs per feeding. Using the app I determined exactly how many ounces she needed per bottle. The number of feedings was based on the number of hours she was away from me and how frequently she would normally nurse.

But, just as it had when my son was a baby, my pumping output dwindled over time. Eventually I was pumping less than an ounce per side per pumping session. I used up my entire frozen milk stash. Despite my best efforts at around 6 months I was no longer able to pump enough to send only breastmilk in my daughter’s daycare bottles. So, I sent as much breastmilk as I could and to make sure she had sufficient nutrition I sent formula too.

When my daughter was a newborn she, like her brother, needed supplementation. They both had jaundice and they both lost more than the usual amount of weight after birth. Although her condition was better than her brother’s had been (he was a very sleepy 37 weeker with more severe jaundice), my daughter was also a slow gainer. So, the IBCLC we saw recommended supplementation while I built up my own supply. When my son was a newborn he received formula supplementation, but my daughter received donor breastmilk, or as we referred to it “Auntie milk”—because our milk donor was my sister who was still breastfeeding her toddler son at the time my daughter was born.

By the time my daughter was in daycare full time and my pumping supply could not keep up with my daughter’s demands my sister’s son had weaned. I considered donor breastmilk, but decided against it. My strong, healthy baby did fine on formula, and I felt that the relatively limited supply of donor milk in my area should be available to babies for whom formula was not an option, babies whose mothers could not breastfeed them at all or whose health really warranted the exclusive use of donor milk. So, we chose formula instead.

I already knew exactly what formula I would choose for my daughter if I reached this point, because I had read quite a bit of research about formula before I had my son. I looked up numerous scholarly research articles and reviews of the literature about formula on PubMed. At that point I knew I wanted to breastfeed, but I had been given the somewhat unhelpful advice that my desire to breastfeed and to go back to work full time were “setting [myself] up for failure”. So, in case that was true I did all of that research about formula and based my decision on what I had read. (Bear in mind that my son was born in 2004 and donor milk was not as prevalent, except from milk banks by prescription and at a rather high price.) Despite many assertions otherwise, infant formula is an acceptable, nutritionally adequate alternative to breastmilk and is a much better choice than the milk of any other mammal or milk made from plants.

Eventually both of my babies received only formula in their daycare bottles. Both times the amount I was able to pump became miniscule compared to the amount they needed and the stress and frustration of pumping so little became too much for me, so I stopped. They both did fine on the formula they received part of the time, so I felt comfortable giving them as much as they needed while they were separated from me. My daughter had breastmilk exclusively, either at the breast or in bottles, for more than 6 months. They were around the same age when they started receiving formula alone in their daycare bottles: 7-8 months. Despite this both of my babies continued to breastfeed whenever they were with me. They never experienced nipple confusion, expressed a preference for the bottle, or had nursing strikes. They both stopped receiving formula when they no longer needed bottles at daycare.

So, yes I am a lactivist. I believe breastmilk is the biologically normal food for human infants. But, breastfeeding doesn’t have to be all or nothing.

 

You can read more from Kari over on her site and enjoy her thoughtful, thorough writing and beautiful photography.

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Did you respond well to breast pumps?  Have you had to supplement?  If so, what did you use?  Were you able to supplement and still reach your breastfeeding goals?

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Filed Under: Article, baby-led weaning, Breastfeeding, breastfeeding difficulties, breastmilk pumping, child led weaning, Children and breastfeeding, extended breastfeeding, Featured, guest posts, Leakie to Leakie, Milk Supply, motherhood, Parenting, Supplementing, Weaning 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: , , , , , , , , , , ,

Unsupportive Support- For a profit

December 1, 2011 by

In recent years offering breastfeeding support has gained popularity.  Which is a good thing, strange though it is to say.  In fact, it’s uncouth to not be supportive of breastfeeding in light of the magnitude of research showing breastfeeding to be so beneficial to babies and mothers.  So magazines, websites, even businesses now offer frequent support with articles on breastfeeding, pages devoted to trouble shooting potential breastfeeding problems, staff experts responding to breastfeeding questions, and even live support available online or to call in to speak to someone.  In theory it sounds great and in some ways it is.  But even in offering support there are opportunities for unsupportive support.  And this time it’s a little more unsettling because it comes with resounding financial gains to those offering the support raising the question, is it even support at all?  This time in the series on unsupportive support we’re taking a look at the murky waters of advertising support, marketing, and profits.  (We’ve already looked at how breastfeeding advocates can offer unsupportive support here.)

 

How not to support and how to avoid being unintentionally unsupportive- part 7.

Unsupportive support is…

Breastfeeding help hotlines or websites breastfeeding pages sponsored by formula companies.

This one is controversial and I kind of understand why.  But the way I see it this is one of societies most insidious forms of unsupportive support.  It looks like support.  It sounds like support.  It is even advertised as support.  Except it’s run by a company that profits when breastfeeding moms quit breastfeeding.  Maybe I’m cynical but when a company’s profits can be directly tied to how well moms that intended to breastfeed fare in reaching their goal, it just seems a little hard to believe that there are altruistic motives in supporting those moms.  When a website that is supposed to be addressing questions about breastfeeding is plastered with a formula company’s brand with images of smiling, peaceful babies presumably fed with their product all the while supporting content that uses carefully selected language about how hard and difficult it can be to breastfeed and give your baby the best, it’s underhanded marketing to someone looking for help.  This isn’t support, this is marketing, make no mistake.  Formula companies are smart, they would not waste their money sponsoring and creating these sites and helplines if they didn’t feel it increased their branding opportunities and bottom line.  I believe women are smart, they can make their own decisions but I also know that there are times when a decision can be influenced one way or another and when someone is in need of help that super happy looking formula fed baby sure is enticing and the wrong information given to address her particular need could be all that is required for the mother to become a regularly paying customer.  Which is exactly what this form of unsupportive support is counting on.

Free formula samples in breastfeeding support bag in hospitals and doctor offices.

Another controversial one.  Some see removing formula samples from hospital bags and doctor offices as removing a woman’s choice in how she feeds her baby.  I don’t understand that argument, the choice is still there, you just have to pay for it upfront.  Concern is that not giving out free formula samples is being unsupportive to those that choose to formula feed.  That just isn’t the case, not handing formula out to each woman that comes through their doors and gives birth would be more supportive of formula feeding moms in that it would lower the overall expense of formula by the formula companies no longer spending millions on the free samples hospital program.  Those free samples aren’t free anyway.  They are absorbed in the price of the product, it’s all a part of their business plan.  Again, a company would not waste their money handing out free product if it did not yield a return on their brand and profits.  Make no mistake, they aren’t handing out free samples to help moms, they are handing out free samples to hook buyers and to give the impression that the hospital endorses their product.  These companies are smart, and they should be, they have shareholders and employees to take care of.  Formula has it’s place, that’s not the issue here.  Nor is there any judgment on formula feeding.  Rather the problem is that marketing tactics masquerading as support undermine breastfeeding and do so for a profit.  This study reveals how this is unsupportive with numbers such as “Women who didn’t receive the free samples were 3.5 times more likely to be breastfeeding exclusively after 2 weeks…”  (Read more about how the numbers really break down from PhD in Parenting.)  Tacticts to get formula into the hands of moms when they are most vulnerable, exhausted, and in that crucial time when milk supply is being established in those early weeks isn’t supporting them in their attempts to breastfeed.  Nor is it supporting formula feeding families either, instead, these samples going to everyone leaving the hospital with a new baby drives up the price they have to pay at the register for the next 2 years of formula buying.  For those that truly need assistance buying formula to feed their baby, there are options through aid programs that can and should be utilized if necessary and while in the hospital formula should be covered by insurance.  Hopefully more and more states will make the decision Rhode Island made recently to refuse to allow formula samples to continue sabotaging breastfeeding and both breastfeeding moms and formula feeding moms can find some real support from formula companies just by having them back off, stop undermining breastfeeding, and maybe even lower the register cost for their product by not sending the free stuff home with those that really want to breastfeed.  Better idea for support?  Sending the name and number of a lactation consultant home with the mother, free access to a lactation consultant during her hospital stay,  independent breastfeeding resources, and the information on a breastfeeding support group would be real support.

 

If you don’t want to breastfeed then don’t.  I’d encourage you to try it before you completely make up your mind but if you don’t want to do that, nobody’s going to force you.  Your body, your baby, your choice.  And I hope nobody undermines your attempts to formula feed.  Free samples and formula company support advice isn’t about choice, it’s about marketing.  There is a distinct difference there.

If you want to breastfeed beware of the unsupportive support that aims to line someone else’s pockets.  Formula isn’t evil and it can be a needed tool in feeding our babies but it can also sabotage any breastfeeding relationship.  The companies that make it aren’t inherently evil either but they are watching out for their shareholders and bottom line profits before they are concerned about women experiencing breastfeeding success.  The more women that breastfeed, the more it cuts into their profits.  Their marketing tactics are getting more aggressive as breastfeeding gains more mainstream attention and accolades.

Still, some truly supportive support receives financial gain for those offering the support.  Lactation consultants do and should get paid for the work they do.  Even this site earns some income through the sponsorship of the companies whose ad buttons you can see on the side.  So is earning a profit from supporting breastfeeding really only self-serving?  I don’t think so and I don’t think I’m saying that to defend myself.  I don’t think it’s self-serving and thus unsupportive support, for one important reason: there is nothing to gain from a woman not reaching her breastfeeding goal.

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Did you receive samples of formula and did you use them?  Do think formula samples can undermine a breastfeeding mother’s efforts?

Do you feel formula companies can be trusted to dispense advice and support on breastfeeding?

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Filed Under: Article, Breastfeeding, Breastfeeding and society, breastfeeding support, Featured, formula, Jessica Tagged With: , , , , , , , ,

Unsupportive Support- Cultural breastfeeding ignorance: toddlers and introducing solids

November 28, 2011 by

breastfeeding beyond a year

I bet at least half of those reading this are uncomfortable with that picture.

I get that society isn’t comfortable with breastfeeding in many ways, despite all the lip service given to “breast is best.”  So it’s not a big surprise that socially speaking most people don’t even have a basic idea of what’s normal or healthy with breastfeeding.  With this in mind much of what is unsupportive support comes from this place of ignorance and lack of exposure to normal, healthy breastfeeding.  It is my hope that time will change this problem because we have allowed our emphasis on the sexual nature of breasts to replace a general understanding of normal human biology.  However, waiting won’t change the unsupportive support spreading as a result of this collective ignorance of society so those unintentional acts must be addressed.  Continuing the series on unsupportive support, let’s take a look at a few of these common issues stemming from society’s lack of understanding of normal and healthy breastfeeding.

Does this one weird you out too?

 

How not to support and how to avoid being unintentionally unsupportive- part 6.

Unsupportive support is…

Ever asking “Isn’t he too old for that?” or “If they can ask for it they’re too old, it’s just gross.”

First thought that goes through my mind when I hear this: “Aren’t you too old to be so rude?”  Manners, people, try them.  This is not your child, this is not your choice.  Plus, the answer is no, the child isn’t too old.  Wherever you draw the imaginary cut off line for breastfeeding, it’s just that, imaginary.  What is it you’re really afraid of anyway?  That it somehow becomes sexual?  Remember, that fear is founded in an adult perception of breasts, not a child’s.  Are you concerned that the child will grow overly dependent on breastfeeding and need to breastfeed when they are in college?  Please, in cultures where it is common for children to wean on their own timeline, this is unheard of.  And even if it were to happen, wouldn’t that make it their problem, not yours?  Still, I’m not going to give this concern any more energy, I’ve never once met someone that had a college-age child breastfeeding.  You may be out of touch with what normal duration breastfeeding looks like, sometimes called “extended breastfeeding” but I have to ask, extended beyond what?  The minimum recommendations?  Extended beyond society’s distorted perception of normal breastfeeding?  Extended beyond your personal comfort level?  Extended beyond the imaginary cut off line for breastfeeding  The major health organizations in the world encourage mothers to breastfeed for at least 2 years and they recommend women continue as long as it is mutually agreeable.  Mutually.  Between the breastfeeding mother and the breastfeeding child.  Not you.  It’s up to them so butt out.  Babies start using the only communicating tools they know to start asking for it as soon as they are born, you can read here about normal newborn behavior.  A mother responding to her child’s signs of hunger = good parenting, not a bad habit.  It’s important that you recognize and get comfortable now with this thought: “My opinions aren’t always right for everyone and sometimes I should just keep them to myself.”

Sneaking food to a small child without asking their parents permission or arguing with them about their choice to wait to introduce foods.

It boggles my mind how often I read “I can’t trust my mother-in-law/uncle/brother/grandpa/etc. with my 3 month old, they insist on giving him tastes of food, even stuff like ice cream or dangerous choking hazards!”  People, it’s not your kid, not your turn to make these kind of decisions.  Grandparents, aunts, uncles, shoot, friends get to spoil a kid, it’s true.  When my kids are older I don’t care if my parents take them out for ice cream for breakfast when they get to have them on their own.  It’s their grandparent prerogative and I support it on occasion.  But that has to be something discussed and approved (even with disapproval) and the limits recognized and respected.  Giving a baby foods that their parents, you know, the people that are responsible for them, take them to the doctor, are reading the most up to date information on what babies need, and are up at night with them, haven’t approved is not only disrespectful but it’s dangerous.  Between ruining a virgin gut (google it), risking allergen exposure, and introducing textures they may not be physically developed enough to handle and thus pose a potential choking risk, there is absolutely no good reason EVER to sneak food to another parent’s child.  And arguing with them about their decision for the health and safety of their child, even if you think they are wrong or extreme, is not helping either the parent or the child.  If you’re truly concerned do your research before bringing it up.  In order to offer support that’s actually helpful, you need to be familiar with current information and research as well as possible controversy.  In the end you have to respect their decision or you will remain that person they can’t trust.  And yes, they can’t trust you which means they will never be comfortable leaving their child in your hands.  Coming to terms with “I am not the person(s) ultimately responsible for this child, I do not have the authority or position to make this decision and must respect the people that do.”  By the way, this goes for formula fed babies too.  Allergies, food sensitivities, immature digestive tracts, and choking hazards are real concerns for them as well.  This is their long term health you’re messing around with and you don’t have that right or responsibility.

 

Breastfeeding is the biologically normal way to feed a small infant and child.  Just because we’re not used to it as a society does not mean that there is something wrong with it.  Before critiquing the mother willing to go against societal norms to do what she truly believes is best for her child, please educate yourself as to why she would do that in the first place.  Or at least express your thoughts and concerns by asking respectfully why she has chosen a certain path over another.  When it comes to decisions regarding that child’s health step carefully.  There is controversy surrounding just about every health decision parents are faced with today, cut them some slack and just respect that they are thinking people that may be ok with discussing their decision but deserve to be respected in them even if you disagree.  Please don’t let cultural ignorance determine how you feel about something or how you respond to something.  Challenge yourself, is the problem really what that mother is doing or is the problem that as a society we just can’t imagine anything other than what we’ve grown accustomed to.  Push yourself outside of your comfort zone and offer real support, not ignorant social judgments.

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Have you received comments about your child being “too old” to breastfeed?  How did you respond?

Are there people around you that you can’t trust because they don’t respect your parenting choices?

Have you ever had someone feed or almost feed your child something you felt was dangerous?

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Filed Under: Article, baby-led weaning, Breastfeeding, Breastfeeding and society, breastfeeding support, Breastfeeding the newborn, breasts, child led weaning, extended breastfeeding, family, Featured, Jessica, Parenting Tagged With: , , , , ,

Baby Explains- Normal Newborn Behavior

August 18, 2011 by

By Diana Cassar-Uhl, IBCLC 

 

Dear Mommy,

Thank you so much for breastfeeding me!  You probably already know that your milk is designed especially for me, and is better than anything else you could feed me.

I know that right now, you feel like your friends who aren’t breastfeeding their babies seem to have an easier time of things.  Those other babies sleep soundly and longer between feedings, they drink so much, and they don’t fuss to eat all the time like I do!  I can tell you’re getting a little bit frustrated, and I hear all the advice you’re getting … my grandma says you weren’t breastfed and you turned out just fine, my daddy says he feels like he can’t do anything to soothe me, and that lady with the cold hands that you call “doctor” gave you a can of something that she says will help me grow faster.  You’re tired and frustrated because taking care of me just seems too hard, but please mommy, before you give up this yummy breastfeeding thing, let me explain some of my behavior to you.  It might help you feel better.

First, if you and I were separated after I was born, for any reason (maybe it was hospital protocol that I be left under a warmer, maybe you were recovering from surgery), I’ve got some catching up to do, because I probably lost more weight than my friends who got to stay close to their mommies.  It’s OK … I’m really good at letting you know when I need some more calories, but it’s important that you let me breastfeed lots and lots, even if my grandma says “he just ate!!”  In my first few days, the nurses at the hospital might tell you I’m hungry and your body can’t make enough milk for me … but mommy, that colostrum from your breasts is some awesome stuff!  It’s packed with protein, which binds to any bilirubin in my body (elevated bilirubin causes jaundice in more than half of newborns) so I can poop it on out.  It’s also a great laxative, which makes it easy for me to get all that black, tarry meconium out of me and we can move on to the seedy, yellow-brown poops that are much easier to clean off my sweet tushie.  Now, the colostrum is really thick and sticky, and I’m so small and still figuring out how to move my tongue, and we’re both still trying to get comfortable together, so it might take me 20 minutes or longer to suck out just ONE TEASPOON (5-7 mL) of that liquid gold.

But it’s OK, mommy!  You know, there is really nowhere I’d rather be than in your arms, hearing your sweet voice and smelling you  — even though you haven’t had a shower since before I was born, you’re just delicious to me.  And something else you should know about me … even though I have a really cute “Buddha belly” that looks all chubby, the capacity of my stomach on the day I’m born is just 5-7 milliliters – that’s the size of a small marble!  You’re the smartest woman in my whole world, so I know you see the connection here!  The amount of colostrum in your breast is exactly the capacity of my tummy!  My stomach walls on my first day of life are very rigid and won’t stretch; this is why, if anyone tries to feed me with a bottle, I’m going to spit most of it back up again, even though I eagerly suck at it.  See, mommy, I only have two ways to send and receive information from my brand-new world – I can cry, and I can suck.  I can’t see much, and all these sounds are so much louder than when I was inside you, and I can use my hands to help me orient myself on your breast, but crying and sucking are pretty much how I make sense of everything.

From the Heart Photography – Tiffany Hileman

I know it seems really confusing, mommy, that I would want to suck and suck and suck even though my tummy is full.  When I suck, lots of great things happen for both of us.  I keep my own digestion moving by triggering the involuntary digestive muscles in peristalsis – moving the contents of my stomach along because I’m still moving my mouth and tongue, which are the beginning of my digestive tract.  When you let me do all this suckling at your breast, I can very easily regulate how I suck, depending on why I’m sucking at any given moment.  You can probably feel when I’m suckling nutritively and swallowing lots of milk, and when I’m kind of relaxed about it, feeding sort of like I’m savoring a bowl of ice cream … you know how sometimes, you scrape just a tiny bit onto your spoon, because you want it to last a long time?  To me, you’re better than ice cream!  But on a bottle, it’s impossible for me to suck and not get whatever’s in there, and that’s confusing to me, so I might keep sucking because that’s what my instinct is telling me to do, or I might realize my tummy hurts (because even on day 10, my stomach capacity is only a ping pong ball) and I’ll cry and cry because all I really know is crying and sucking!

A word about these instincts I feel … I really can’t help it, mommy, that I want to suckle so much.  It’s just how I came out, and there doesn’t seem to be much that I can do about it.  Please believe me, I’m not trying to trick you!  In a few weeks, this need lets up a tiny bit, but for now, suckling is my M.O.  But, do you want to know something really cool?  I’m not the only one who benefits!  When I suckle at your breast in these early days, your body actually activates prolactin receptors!  Isn’t that amazing?  In my first two weeks, the higher I make your prolactin levels go (my suckling triggers a prolactin surge in your body), the more of these receptors get activated in your breasts, and the higher your potential milk production will be for as long as you choose to breastfeed me.  That’s one reason your lactation consultant tells you to wait on introducing that bottle or that binky– this prolactin receptor thing only happens for the first 10-14 days.  After that, the prolatcin surges when I breastfeed are much smaller, so the more receptors there are to gobble up what prolactin is there, the more easily you’ll make all the milk I need.

Besides prolactin, there’s oxytocin, another hormone I activate when I am at your breast.  Oxytocin is part of what makes you so addicted to me!  It’s “the love hormone” and it helps you feel relaxed and content when we’re breastfeeding.  Go ahead, mommy, exhale and relax!  It’s OK!  Oxytocin release is triggered by nipple stimulation, not necessarily milk removal (though when things are going well, my stimulation of your nipples usually means I’m removing milk!).  Now, I know this might sound a little awkward coming from your baby, but I need you to know something about oxytocin.  There are only three events in your life that trigger oxytocin release: nipple stimulation (like when I’m breastfeeding), labor (the oxytocin released during childbirth stimulates uterine contractions, which is why nipple stimulation might be suggested when labor stalls, and also explains why sometimes, after you breastfeed me, you feel an increased expulsion of lochia and maybe some cramping), and … orgasm!!  Isn’t neat that the same hormone plays a part in making me, birthing me, and feeding me, and it’s a hormone that makes you feel GOOD to do all three?

Mommy, I know you are trying your very best for me and you’ve been worried about whether your body can satisfy my appetite.  I know you’re used to being able to measure everything, and your breasts don’t have markers on them to tell you how much milk I got.  Maybe you used a breast pump, and that confirmed your worries that there isn’t much milk there – but mommy, please understand that a good pump can mimic me, but your body wasn’t designed to have all these wonderful hormone surges for a cold piece of plastic with a noisy vacuum motor.  You know that feeling you get when you hold my warmth and weight, smell how delicious I am, and nom nom nom on my fat cheeks?  That feeling helps you make milk!  That feeling is part of the whole system that was designed to make you need to be close to me, just as much as I need to be close to you.  And mommy, I know you’re very busy, and important, and there’s so much you used to do before I came, and I know right now, it feels like you’ll never do those things again, and our house is getting messy, and maybe that scares you.  But please know, every moment you spend holding me, every time you gaze lovingly at me, and every hour you spend breastfeeding me in these early days is so important to me, because you’re all I know.  I love daddy and grandma and all of our friends, but I’m designed to be happiest and least stressed when I’m with you.  Can you wear me in a sling or soft carrier after I’m milk-drunk?  I really like listening to your heart beating while I sleep, and you are warm and soft and smell so good.  That space between your breasts is perfectly sized for my head, and there’s nothing I like better than the feel of your skin against mine.  Well, maybe there is something I like better … I love it when you sleep next to me after we’ve been breastfeeding.  Oh, mommy, when you nurse me while lying down, you relax and your milk flows so nicely, and I feel like you’re so happy to be with me, and I’m very special to you because you don’t have to run off and do something else as soon as I’ve let your breast go.

And mommy, I have a promise to make to you.  I can’t say for sure when it will happen, but there will come a day when I need you a little bit less intensely.  My feedings will get more organized, my weight gain will stabilize, and sometimes, I’ll even like when my daddy or grandma or other loving person holds me.  But today, I need you.  You’ll always be my number one, even after we’re done breastfeeding, but I will learn, like you did, to defer my needs and to trust others to meet them once you and I get a good thing going.  Thank you so much for all you’ve done for me so far. Until you start giving me an allowance, I hope my good health, sweet smiles, coos, and giggles will sustain you!

Love,

Baby


 

Many thanks to the hundreds of readers that shared so many beautiful photos of their newborn babies.  There is just a small sampling here but you all have incredible photographs of your beautiful babies.  Thank you for being willing to share and to all the photographers of these precious images!

 

Diana Cassar-Uhl, IBCLC and La Leche League Leader, has written articles for the La Leche League publications Leaven and Breastfeeding Today, and is the author of the La Leche League tear-off sheet Vitamin D, Your Baby, and You. She is a frequent presenter at breastfeeding education events. Excited about her work toward a Master of Public Health, Diana hopes to work in public service as an advisor to policymakers in maternal/child health and nutrition. Diana, mother to three breastfed children, has served as a clarinetist on active Army duty in the West Point Band since 1995. Diana enjoys running, writing, skiing, and cross-stitching when she finds herself with spare time.  She also writes at Normal, like breathing. 

 

Filed Under: Article, Articles from the professional experts, birth, Breastfeeding, Breastfeeding the newborn, breastfeeding twins, Featured, guest posts, Photos, postpartum, Relational Resource Tagged With: , , , , , , , ,

Nipple Shields: life-saver, supply -wrecker or just another tool for nursing mothers?

August 9, 2011 by

 by Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM

I confess, I didn’t know what a nipple shield was back in the day when I was still a very smart but breastfeeding “knowledge- challenged” pediatrician. I did know that whatever they were, they were bad. Very bad. “Never” use them under any circumstances. Ever.

Later, when my niece was born, in a hospital hundreds, nay thousands, or millions of miles away from me, imagine my horror as I found out that she needed a nipple shield to latch. This was bad. I didn’t know why. But it had to stop. So, as unsupportively as I could imagine (in retrospect) I told my sister to stop using that thing! I hadn’t met my niece yet, but I knew that she was less than 5 pounds soaking wet and that nipple thingy was going to ruin her chances of getting into the Ivy League.

One of my dearest friends in the world needed to use a shield when her second child was born. She asked for one when her third was born and was told “no” by the staff caring for her in the hospital. To me, it just was further proof that their use was fraught with problems.

I’m smarter now, at least I’m less breastfeeding-challenged, and I know better than to use the words “never” or “always” and to deny to a request without providing education and informed consent. And I’ve heard too many stories of success to discount the benefits of nipple shields for some mothers and babies. But the fact remains that we have no guidelines for nipple shield use. We have few studies rigorously done that show they are effective.

A nipple shield is a gadget that is placed over the nipple and areolar area. It looks sort of like a nipple (sort of), or a sombrero, but is made of plastic and there are different types. You can get them online and over the counter. The problem with them stems from studies (with flaws in the method in which they were done) that concluded that the use of the shield could decrease milk supply, were associated with more supplementation, and lead to early weaning.

That meant that if they were to be used, the dyad using them would need to be carefully followed, but many mothers were getting them and no follow up was scheduled. I’m not sure the logical result of that should be a compete ban on their use, but, well, they were highly discouraged. Of course, those studies were with older versions of the shield, and other research (with flaws in the method in which they were done) with newer versions of the shield suggested this wasn’t as a big a problem as we thought. But many of those same concerns exist. We honestly don’t know the short-term or long-term effects of nipple shield use.

Nipple shields are often given out in the nursery for “flat” nipples. My guess (no data, so definitely flawed study method) is that the nipples are puffy. And if that’s the case, this might be something to try.

They are often given out for a poor latch as a quick fix to a more complex problem, but we need to remember basics: skin to skin, baby-lead latch, biological nurturing. And asking for help from someone who is board certified in lactation, an “IBCLC.” The shield should not be a first step.

If it’s given to you because your nipples are sore, then in addition to the shield, we need somebody to fix the underlying problem and be your cheerleader and you heal and transition back to the breast. (Find a Lactation Consultant!)

So, suggestions:
If you are given a nipple shield ask why. Informed consent for any intervention means that you are given the required information, in an understandable manner that allows your voluntary participation and that helps in making a decision for a course of action. Questions you can ask to help fulfill informed consent: Why am I getting this thing? How long do I use it? How will it help? Might it hurt? What other things might I try? What type of follow up do I need?

If you are given a shield, and it works, well, cool. You need follow up by somebody who knows something about breastfeeding so we can work on the underlying issue that initially caused the need for the shield.

If you were given a shield and don’t like it, well, let’s get you some assistance and fix whatever the issue is that requires a gadget to fix it so we can go gadget-less.

Shields are meant to be temporary solutions. If you are still using it when your baby is months old, we really should be able to help you stop using it, if you want us to.

If you are given a shield, it works well, you baby is growing and you’re happy but everyone around you is like “ooooooh, those things are bad’ you have my permission to hear everything that that person says after that in the voice of Charlie Brown’s teacher (you remember that voice, or am I showing my age?)

Resources:
Baby led- breastfeeding:http://www.geddesproduction.com/breast-feeding-baby-led.php
Biological Nurturing: http://www.biologicalnurturing.com/
Skin-to-skin http://massbfc.org/providers/SkinToSkin.pdf
Find a lactation consultant: http://www.ilca.org/i4a/pages/index.cfm?pageid=3432

Health professionals’ attitudes and use of nipple shields for breastfeeding women. http://www.ncbi.nlm.nih.gov/pubmed/20524842
Nipple shields: a review of the literature. http://www.ncbi.nlm.nih.gov/pubmed/20807104

 

 

 

Dr. Jenny Thomas, MD, MPH, IBCLC, FAAP, FABM is a general pediatrician and International Board Certified Lactation Consultant in southeastern Wisconsin. Find her sound, evidence-based and helpful advice on parenting at www.drjen4kids.com and Lakeshore Medical Breastfeeding Medicine Clinic.

Filed Under: Article, Articles from the professional experts, Breastfeeding, breasts, Featured, New article, Nipples, Relational Resource Tagged With: , , , , , , , , ,
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