Baby Feeding and Finding Your Village- The Importance of Community In Reaching Your Breastfeeding Goals

By Jessica Martin-Weber

This post made possible by the support of The Village from Ameda, Inc.

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The US Surgeon General identified lack of support as one of the primary reasons families don’t reach their breastfeeding goals. Be that support in education about breastfeeding, support in health care, support in dealing with breastfeeding difficulties, support in social settings, and support related to employment environment, lack of support directly impacts breastfeeding goals.

For over 6 years, The Leaky Boob has been supporting families in their baby feeding journeys and we’ve seen exactly the impact support can have on breastfeeding goals. Here’s what we’ve learned:

  • Support helps the breastfeeding parent be prepared.
  • Support helps the breastfeeding parent better advocate for themselves and their child.
  • Support helps the breastfeeding parent be informed.
  • Support helps the breastfeeding parent identify problems and know when and where to go for care.
  • Support helps the breastfeeding parent not feel alone.

That last point matters more than you might think. Breastfeeding can feel like such an isolating solo act, particularly in an unsupportive environment and support can go a long way in combating loneliness that some experience as part of their baby feeding journey.

When I had my first baby, my breastfeeding supportive mom (community!) encouraged me to try a breastfeeding support group when I was having pain initially. As I walked in I felt uncomfortable right away but decided to give it a try anyway but by the end I knew it wasn’t for me. In fact, I was more anxious after that experience but not necessarily because of breastfeeding but rather it was a group that attracted families that felt frighteningly “crunchy” to me at the time (no lie, I’d probably fit in great there now). Personality and value differences made it not a good fit for me and that is ok. Unfortunately, at the time breastfeeding support was not so wide-spread and I ended up very alone and isolated in feeding my baby. Aside from my very supportive husband, neither my health care providers nor my friends were supportive or experienced with breastfeeding. Thankfully, my own mother was and though we were separated by more than a thousand miles, she continued to offer encouragement, information, and support. Just having that one experienced voice, even when her experiences were vastly different from mine, helped me in reaching my breastfeeding goals. Even with the support of my partner and my mother I felt alone in feeding my baby but I am so grateful for their support because I can only imagine how much more difficult it would have been without them. Not every support community is right for every individual, even when they’re shared experience and common interest based communities. Which is why there is a wide variety of options and increasingly so. Different people are going to have different needs and ways they experience community.

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To find a community that is right for you

Determine what you need. Just looking for clinical facts and information? Find encouragement being able to ask anything and everything? Inspired by hearing the stories of others? Love seeing images of baby feeding? Enjoy connecting in the day to day? Want it to be only about baby feeding? Need focused connection on a specific feeding related experience? Value feeding as what brings you together but want to share about anything and everything else? Figure out what works for you personally and look for options that fit your needs and personality.

Clarify your values. Is there certain language that you want to avoid? Is there a controversial topic that you have a strong position on that is a non-negotiable for you? Identify your personal values and have a clear understanding of them for yourself.

Recognize what you have to offer. Community isn’t just about getting the support you need, community works when everyone gives and receives. You have something to offer in supporting others, even if you don’t feel like it, your story matters and sharing it can make a difference for others.

Ask around. Breastfeeding rates continue to rise (2007 initiation rates were around 70%, in 2014 they were nearly 80%) so more and more people have at least some experience with breastfeeding. If you know someone that has had a baby, ask them where they found breastfeeding support, you’re likely to have better results than with just a google search.

Eventually I figured out what I needed in community, particularly in a baby feeding support community. A judgment-free atmosphere that supports people over methodology, embraces the wide diversity of feeding modalities and tools (exclusively from the breast, pumping, bottle-feeding, combo formula feeding, formula feeding, etc.), promotes information, and has an emphasis on the relational sharing of baby feeding experiences with the good, the bad, the ugly, and the funny was what I needed which is reflected in The Leaky Boob and the communities we partner with, such as this one.

Once we know that community makes a difference in reaching breastfeeding goals and in supporting parents in finding their confidence, it only makes sense that we would work to be community ourselves, supporting and encouraging each other along the way. It takes a village, after all, together, we are the village.

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Drawing from a diverse background in the performing arts and midwifery, Jessica Martin-Weber supports women and families, creating spaces for open dialogue. Writer and speaker, Jessica is the creator of TheLeakyBoob.com, co-creator of BeyondMoi.com, and creator and author of the children’s book and community of What Love Tastes Like, supporter of A Girl With A View, and co-founder of Milk: An Infant Feeding Conference. She co-parents her 6 daughters with her husband of 19 years and is currently writing her first creative non-fiction book.
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Leaving the parenting island and asking for help

by Jessica Martin-Weber
Parenting Island and asking for help

Parenting Island AKA Poop Rock.

 

I was struck by the beauty of that island looking rock from afar on the shore in San Francisco.  Then my friend told me it was so pretty because it was covered in bird poop.  Poop Rock.  Reminded me a lot of parenting, pretty from afar but sometimes lonely and covered in poop when you get up close.

Don’t lecture me, I know parenting is wonderful, I love it but that doesn’t mean it’s not sometimes really hard and stinky like a rock covered in poop.

Last week, my good friend Cindy was battling pneumonia.  It was horrible and scary.  Her husband is in the military and away at the moment so she and her 4 children are on their own as she struggles to get well.  I couldn’t get to her, we’re over 8 hours from each other in different countries, but I wish I could.  Every time I saw her share something of her struggle I was moved, inspired, and ready to jump in the van (that broke down 4 days after I wrote this).  Through Facebook, I feel like I get to keep up with my friend and in some small way offer support.  I wish I could do more.  Yet even so sick and all the way in Canada, my friend reminded me of something incredibly important: we all need help from time to time.

Asking for help is one of the hardest needs to voice sometimes.  Or all the time.  People judge and are judged for even needing help and we all feel it.  There is such shame attached to needing help or even encouragement.  We’re all supposed to pull ourselves up by our bootstraps and in made for TV moments, triumph over whatever challenges we face.  Alone.  Without resources.  Without bragging. Without getting anything we don’t deserve because by our own blood, sweat, and tears we paid for it or worked for it or fought for it all on our own.  We talk about the strength of the human spirit and applaud those that figure out how to go it without help.  And anyone that is worn out, broken down, or overwhelmed must be less of a person.  Even in a safe place, like The Leaky Boob Facebook, mothers (and sometimes dads too) may take the bold step to admit they are struggling but do so with trepidation, beating themselves up for being a “horrible parent, feeling like a failure” before someone else does, all because they find parenting hard sometimes.

This cultural attitude of glorifying individualism and self-sufficiency is hard enough when children aren’t involved, but when we become parents it’s not just us any more.  Our pride can get in the way of seeking out desperately needed help.  Pregnancy and childbirth set the precedent in parenting without help and while I love doulas and highly recommend having doula support for birthing women (I have for mine), traditionally the role wasn’t a paid position but one filled by a family member, friend, or a member of the community.  There seems to be a growing sense of shame in needing help from someone who isn’t designated as a paid professional.  We see it in infant nutrition all the time, mothers struggling but too embarrassed to admit breastfeeding isn’t working as well as it “naturally” should as she struggles with pain and a frustrated baby or families not knowing where to turn when they need an alternative.  In fact, the number one reason mother’s don’t reach their personal breastfeeding goals is lack of support.  Support = help.  But it certainly isn’t isolated to the area of infant nutrition, pregnancy, and child birth.  Parenting dilemmas such as health care, child care, discipline, education, financial stress, housing, safety, you name it, are often hindered by our own pride in asking for help.  As though needing a helping hand occasionally, let alone for a long season, is an indication of inadequacies or failure.  Afraid it reflects badly on us and our abilities, many parents forgo voicing their need for support and actual help because we know people will say things like “you shouldn’t have had children if you couldn’t handle it” (what are parents supposed to do, put the kids back from where they got them?), we suffer quietly and so do our children.  Sometimes it’s major roadblocks that threaten the health and safety of the family, particularly the children, others deplete personal internal resources and reinforce feelings of failing over every day aspects of parenting that may wear us down.  Either way, while learning to deal with hardships and having the experience of overcoming them on our own once in a while can be empowering, is this isolation really what we want to be the norm?

But the truth is we all benefit when we help each other, yes, even when we admit we need help and ask for it.  Not only individually are we strengthened, our communities are too.  It can be risky though, by admitting our struggles, we’re opening ourselves up for criticizing judgment or worse, being ignored and that is more than hard, it’s down right terrifyingly heart breaking.  Most parents would do anything including swallowing their pride to care for their children, there’s not a job we wouldn’t work or begging we are above when it comes to the safety and provision of our children.  That fear though, the fear of judgment or of not mattering enough for someone to even notice, can be paralyzing and parents may, unintentionally, cause suffering for their children simply because the cultural attitudes about asking for help have effectively silenced them for issuing the call when most needed.  Yet almost no parent would say their child deserved less.

Asking for help is something I continue to grow in along with knowing how to offer help, carefully avoiding judgment.  Including learning how to have grace without judgment for myself.  The journey hasn’t been easy and I’m still learning.  How does one master admitting you can’t do something on your own?  That you don’t have it all together and need others?  I’m not sure yet but I know it has gotten easier for me simply by looking at my children, I never want them to be afraid to ask for my help when they encounter difficulties.  They have not only been my inspiration in seeking out help when I need it, but sometimes my teachers.  They have shown me the joy that comes from helping and being helped, the agony that comes from pride getting in the way.  From communicating my need for help during difficult pregnancies to admitting I don’t know how to handle certain parenting situations, to finding a mentor in understanding child development when my children were driving me crazy to even asking for financial support because we lack the funds required to help our daughter reacher her dreams, though Jeremy and I work hard for our family, admitting we can’t always do it on our own and that we’re not an island but in fact need the village, our children are the ones that have benefited the most from us humbling ourselves to say three little words: “help me please.”  Accepting our limitations is the first step in being able to strengthen each other.  I firmly believe that in strengthening, supporting, and yes helping, parents makes for a healthier community that is stronger, more creative, and more skilled.  What a gift we can give our children.

My friend Cindy, has posted on Facebook a few pleas for help with her children so she can rest.  Yes, she could keep trying to go it on her own, likely prolonging her illness and a lower level of care for her children while she tries to recover.  There are risks to her not recovering, potentially problematic for those around her.  Worse, she could end up in the hospital and her children in the custody of someone else for an indeterminate amount of time.  It is to her health benefit, the benefit of the health care system, the benefit of her children, and the benefit of her friends for her to ask for help.  Her recovery will be aided and the community circles around her will be stronger as a result.  Relationships are being fortified as her friends respond to her pleas and offer their support not only physically but emotionally and spiritually as well.  I am so incredibly proud of her asking for help.  Knowing her personally I know that she is a capable, strong, and hard working woman, talented as a journalist and an attentive and loving mother.  This moment of needing help (and the next one that comes her way) are not a reflection of her capabilities, simply a moment where her humanity is evident.  And she has already paid it forward and will do so again.  Because she gets that we need each other.  We all do.

 

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

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.  
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Dear Kathleen- Leakies ask an IBCLC

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

Dear Kathleen,

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

Thanks!

Bewildered in pumping land

 

 

Hi Bewildered!

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

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

Happy pumping,

Kathleen

 

TLB meme breastmilk storage

 

Dear Kathleen,

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

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

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

I welcome your advice and encouragement. 

Love,

Disappointed but hopeful

 

 

Hello Disappointed,

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

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

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

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

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

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

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

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

All the best,

Kathleen

 

 

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

 

 

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In Search of the perfect latch

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. 

 

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Nipple confusion, bottles, and alternative feeding options

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.
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Your Guide to Relactation

 

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 MotherwearMotherlove 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.

 

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

by Star Rodriguez

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

 

 
 Star is a breastfeeding peer counselor for a WIC in the Midwest.  She sat the IBCLC  exam for  the first time this summer, and is anxiously awaiting the end of October.   She also sits on the  breastfeeding task force in her town, is helping her  community’s Early Head Start redefine  their breastfeeding support, and is the  driving force behind a local breastfeeding campaign.  In  the remainder of her free  time, she chases around her nursling and preschooler.
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