Oatmeal Stout Crockpot Coffee Cake- Lactation Booster!

by Carrie Saum

Summer is here.  And maybe your new little baby is here, too.  Snuggly and warm.

Oh, so warm.

Almost suffocatingly hot.

Dear God, is that a baby or a furnace you’re holding?  The temperature outside is a stifiling 100+ degrees and holding that little fireball while also living on the approximate surface of the sun might be a bit much for you.

But you want cake.

Except it’s summer and who has the time or energy or heat capacity to use an oven?

But you still want cake.

Enter your new BFF – The CrockPot.

Yep.  Make your cake IN THE SLOWCOOKER.

CrockPotOatmealStoutCake1

There is no need to turn your house into an incinerator while taking care of  your miniature lava ball on top of the erupting volcano we call Earth just to have a tasty and relatively healthy treat.

This recipe utilizes the amazing benefits of oats (with milk-boosting powers!), lowers the glycemic index with the use of coconut palm sugar, and gives you the fun milk-boosting benefit of stout beer without actually consuming it.  Plus, after baking it for several hours in a large pot, a majority of the alcohol dissipates so you don’t have to worry about you (or your other kiddos) getting a buzz when eating it.  All of this, just by using your crockpot.

Now, to be clear, this is a dense cake.  It’s almost more of a bread. Should we call it a cake bread?  Either way, it’s satisfying and just perfectly sweet.  You can add chopped up apples or nuts if you want to give it more texture.  I prefer to top my crockpot cake with a bit of homemade whipped cream, sweetened slightly with honey.

Ingredients:

  • 3 cups oat flour (You can make your own using old fashioned oats and your food processor or blender, which is the easiest and cheapest, IMO.)
  • 1.5 cups old fashioned oats
  • 1 cup coconut palm sugar
  • 2 Tbsp tapioca flour or arrow root powder (or wheat flour but it won’t be as milk boosting)
  • 1 tsp cinnamon
  • 1/2 tsp nutmeg
  • 1/2 tsp baking powder
  • 1/2 tsp baking soda
  • 1/2 tsp salt
  • 1.5 cups stout beer (like Guiness)
  • 1/3 cup oil or melted butter
  • 2 eggs
  • 1 tsp vanilla extract
  • 1 Tbsp honey (optional)

Instructions:

  1. In a large bowl, combine all dry ingredients.
  2. In a smaller bowl, combine all wet ingredients and blend thoroughly.
  3. Add wet ingredients to dry ingredients and mix until it begins to thicken.
  4. Pour batter into very well-greased or parchment paper lined crockpot. (I recommend parchment paper if you have a dark-colored crock.)
  5. Place kitchen towel over the top of the crockpot, and pull tight and flat.  Secure towel with the lid. (This will keep moisture from gathering and dripping onto your cake!)
  6. Cook on low for 3.5 hours.
  7. Once you can stick a knife into the cake and it comes out clean, it’s done!  Remove pot from heat source, and allow to cool for 30 minutes before eating.

CrockpotOatmealStoutCake2

The best way to store this is pre-cut in storage containers.  Once completely cool, you can slice it and use parchment or wax paper to separate the layers inside the container.  It’s easy to grab on the go, and you aren’t using up that valuable crockpot or counter space to store.  It refrigerates well, and also freezes well.  You can eat it in the morning with your yummy lactation tea, or as a late-night nursing snack while you cuddle your tiny newborn/thermal nuclear reactor.

What’s in your CrockPot?

Carrie

*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.

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If you like this recipe, check out this Kale Waldorf Salad or Roasted Cauliflower Soup over on Our Stable Table.

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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 the voice behind OurStableTable.com. She lives in Portland, Oregon with her husband and young son.
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Strawberry Fennel Salad

by Carrie Saum

It’s springtime, which means everything is blooming, alive, and vital. My body starts craving fresh green veggies, berries, and other seasonal vegetables. One of my favorite salads for this late spring and summer?  Strawberry and fennel with baby kale and goat cheese.  Salads are fast, easy to prep and it doesn’t take much to make them a little fancy.

Getting enough green leafy veggies can also be a challenge for breastfeeding or pumping mamas, and we need those powerful plants to bring nourishment to our babes. Iron is a key component to maternal and infant health, and pregnancy and breastfeeding can take a massive toll on our iron stores. It’s important to keep that in mind as we care for our tiny people and also care for ourselves.

One key component of iron absorption that is commonly overlooked is the necessity of vitamin C. Vitamin C plays a powerful role in assimilation of iron in the body. Think about it this way: Your body produces milk, but the milk doesn’t do much without a way to move it. We use our babies mouths or breast pumps to deliver the milk to the right place so it can be utilized.   In the same way, iron needs vitamin C to deliver it to our bodies’ cells for maximum benefit.  (If you’re interested in learning more about the important role of iron and vitamin c, read this great info from the CDC.)

This salad uses plenty of fresh, iron-rich green veggies, and seasonal strawberries, which are loaded with vitamin C. The addition of fennel provides a gentle boost to your milk supply as well as slightly sweet, bright crunch with a hint of licorice flavor that makes all of the flavors pop.

FennelLactationSalad

If you’re steering clear of cheese, I suggest ripe avocado to add creaminess and healthy fat.  I also have a bottle of pomegranate balsamic vinegar that I use for things like this.  As far as berries are concerned, I tried this with blueberries because we went berry picking last summer and found ourselves with five pounds of blueberry goodness.  IT WAS AMAZING.  I regret not getting a photo of it. But strawberries are a great addition to this salad, and have enough vitamin C to help your body absorb the iron in the greens.

If you use baby kale, this salad stays fresh for 48 hours in the refrigerator, so it’s convenient to make one large salad and snack on it for a couple of days. If baby kale is too much for you or your little one, try baby spinach for a milder flavor and tender texture. It just won’t keep longer than a few hours once it’s dressed.

Ingredients:

  • 4 cups baby kale (Baby kale is more like spring greens and less like…kale.)
  • 10 fresh strawberries, sliced and halved
  • 1 small fennel bulb, sliced thin (I recommend a mandolin)
  • 3-4 oz goat cheese crumbles, or one small avocado, diced
  • small handful of microgreens (optional)
  • 1 Tbsp chia seeds (optional)
  • red wine vinegar
  • extra virgin olive oil
  • balsamic vinegar
  • Herbs d’Provenance
  • Salt and pepper

Preparation:

  1. Combine all prepped produce in a bowl.
  2. Top with goat cheese and herbs and chia seeds if you’re using them.
  3. Drizzle with olive oil and vinegars. Finish with a few shakes of salt and pepper.
  4. Let everyone know you’re a salad magician.

We don’t need to make this harder than it absolutely has to be, mamas.  Keep it simple, easy, and tasty.  The fact that it’s packed full of nutrition just makes it that much better.

It’s Not Easy Being Green,
Carrie

If you like this recipe, check out this Kale Waldorf Salad or Roasted Cauliflower Soup over on Our Stable Table.

*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.
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 the voice behind OurStableTable.com. She lives in Portland, Oregon with her husband and young son.

 

 

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What I Want You To Know About Why My Son Can’t Eat- FPIES

By Carrie Saum Dickson

This guest post shares the feeding journey of 16 month of Echo as told by his mother. A breastfeeding, pumping, allergy story of a little boy with a bright spirit and a mom and dad with steadfast hearts and commitment. Their story is beautiful, inspiring, challenging, humbling, educational, and so very raw. Be sure to go on to read part 1 and part 2 of their story as well.

Carrie and Echo FPIES

Shortly after birth, my sweet little boy, Echo, had a stroke. We struggled to breastfeed and I ended up exclusively pumping for him. But that was hardly the extend of his feeding difficulties. You see, my son can’t eat. For a while there he couldn’t eat anything, now he has a few safe foods. But he still really can’t eat. He’s 16 months old.

My son’s name is Echo and he has FPIES.

What is FPIES? According to The FPIES Foundation:

Food Protein-Induced Enterocolitis Syndrome (FPIES) is a type of food allergy affecting the gastrointestinal (GI) tract.  Classic symptoms of FPIES include profound vomiting, diarrhea, and dehydration. These symptoms can lead to severe lethargy, change in body temperature and blood pressure. Unlike typical food allergies, symptoms may not be immediate and do not show up on standard allergy tests.  Furthermore, the negative allergy evaluation may delay the diagnosis and take the focus off the causative food.  Nonetheless, FPIES can present with severe symptoms following ingestion of a food trigger.

I will tell you this: I’m a fierce mama bear. I will not let my son be defined by a stroke or FPIES or anything else over which he has no control.  He is a strong, charismatic, people-loving, joyful being. He walks confidently into a room full of strangers, waving and smiling as though the world has been expecting him all along, and is ready to receive him. He is so much more than a diagnosis or cluster of symptoms. Echo is pure light. We do our best to make the world safe for him. Sometimes we fail. With every trip we’ve taken and guest we’ve hosted, Echo has experienced acute reactions each time despite our vigilance. But we walk a very fine line between taking calculated chances and raising Echo in a bubble.

This. This new normal. Echo, at 16 months old, has two handfuls of safe foods and resists eating, all while laughing and giving kisses and shaking his head “no”.  Me? I’ve made peace with the pump. Peace with my life in this moment, with the ever-changing new normal. My son has one constant and safe food source that he never turns down (mommy’s milk!), and it brings me great peace of mind. We’ve learned to keep participating in life, even when my mom innocently asks if there’s a mute button for the pump motor, or when Echo enthusiastically licks the trash can and we know we will be up all night.  I’ve learned I can do anything for ONE MORE DAY, which in this case adds up to almost 500 days. Especially if it’s for my son. I’m grateful and proud that my body still impossibly provides most of what Echo needs. The dark clouds of survival lift and retreat when I remember this: I am lucky to be his.

Echo FPIES I am the voice

Here are three things I want you to know from my experience:

  1. FPIES scary and effing HARD. Have you ever tried to keep a toddler from eating food? It’s impossible. And sad. And no matter how careful we are, Echo often manages to find something and then we hold our breath until we know he’s okay. Leaving the house is stressful, play dates are almost impossible, and no space (except ours) is safe for him. Leaving him with a sitter is always a test of faith and competence. Finances are continuously tight. As it turns out, shipping donor milk, taking the max dose of Domperidone, (which insurance does not cover), and keeping up with medical bills all require quite a bit of cash. Also, it really takes a toll on a marriage, even a solid, seasoned one. Many families don’t make it through these rigorous trials with chronically ill children intact, even with proper support. Try not to judge us when we all seem a little fragile.
  2. FPIES is exhausting. When Echo experiences a reaction, he is in continuous pain, nobody sleeps for two days, and we have to take extra care with him. It requires total gut rest and a diet of only precious breast milk for days. I hate that he suffers so much, and it takes us all about a week to fully recover. We get little sleep and even less respite. We are hyper-vigilant everywhere we go because food is, well…everywhere. So, if you see Lance or me getting hyped-up when Echo gets food on his finger or there are crumbs on the floor or freak out when you pull out the goldfish crackers, please don’t think we’re crazy. And please don’t take offense when we start cleaning up after your kid or respectfully wiping their hands and faces before they play with Echo.
  3. FPIES is a real thing, and it’s rare. I’m part of online support groups where moms have been diagnosed with Munchausen Syndrome when they take their very sick children into the ER after an especially bad reaction, and some parents have had their children taken away because the doctors don’t even know what FPIES is or believe the parents when they explain it. (The parents eventually get their kids back when the doctors and social workers see that the reactions happen no matter whose care the child is under.) Although I refuse to dwell in fear of this happening, it is still something that happens. And the only way it stops happening is if you guys know about FPIES.

 

For more information about FPIES, visit these websites:
The FPIES Foundation
http://fpiesfoundation.org/fpies-medical-literature

From the American Journal of Pediatrics: The Mother of All Food Allergies
http://www.jpeds.com/article/S0022-3476%2803%2900273-7/fulltext

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Feeding Echo, Part 2- Solids, Vomit, More Pumping, Donor Milk, and FPIES

By Carrie Saum Dickson

This guest post shares the feeding journey of 16 month of Echo as told by his mother. A breastfeeding, pumping, allergy story of a little boy with a bright spirit and a mom and dad with steadfast hearts and commitment. Their story is beautiful, inspiring, challenging, humbling, educational, and so very raw. Be sure to go on to read part 1 and part 3 of their story as well.

Echo eating solids

We began introducing solids when Echo turned six months old. My career focuses on healing the body and restoring vitality through nutrition, and I was excited to begin this work with my son.   I was ready to share the burden of feeding my baby with the rest of the food-eating world, namely organic fruits, veggies and properly-raised protein.

I was already planning a pump burial ceremony the day after Echo’s first birthday. My enlightened, supermom-self felt extreme gratitude to be able to exclusively give Echo breast milk for six months, and I could find the grace to pump six more. I know it is a precious gift so many moms are unable to give their babies and I felt genuinely humbled. But with my supply waning and the freezer stash quickly diminishing, I was ready to have help feeding my son. I was also ready for some sort of life again, a life that did not revolve around pumping and keeping up my supply. Plus, my nipples were starting to look kind of horrific, my areolas worn paper-thin in spite of my best efforts to keep them in good shape. My favorite mantra of “I can do this for ONE MORE DAY” felt as thin as my areolas. I was officially over it.

Happiest Echo 8 months

Echo’s first solid food was avocado and he LOVED it. He got it all over his face and hands and in his hair. Then we tried pastured egg yolk with grated grass-fed liver. I’ve never seen such a look of joy on his face. My baby was a total foodie at heart, just like his mommy. He wasn’t a huge fan of winter squash, but that was okay. He liked everything else we gave him.

We traveled to Texas for Christmas and Echo threw up a couple of times. It happened a little while after eating, which was weird, but we chalked it up to travel and maybe a stomach bug.

We came home, gave Echo avocado again, he threw up exactly two hours after eating it. Then he continued vomiting uncontrollably for the next 90 minutes and even threw up bile. We communicated with his doctor intermittently over the next 12 hours, assuming he was allergic to avocado. Echo bounced back in 48 hours, and a few days later we gave him his favorite, egg yolk. Exactly two hours after ingesting the egg yolk, the vomiting began again and this time it was much more severe. Echo became extremely lethargic. We communicated with his doctor continuously throughout the night. I gave him sips of watered-down breast milk and Lance and I took turns soothing and cuddling him.

We saw Echo’s doctor the next day and she brought up Food Protein Intolerance-Entercolits Syndrome, or FPIES for short. She tested Echo’s stool for blood, and it returned positive. We researched FPIES and his symptoms fit exactly, but nobody wanted to jump to a diagnosis. A few days later, Lance gave Echo a carrot to teethe on and precisely two hours after introducing the carrot, Echo threw up. That confirmed it. Our son was allergic to food. I wept unabashedly in front of his doctor on the day we received the FPIES diagnosis. Staring down the tunnel, that watery light of hope ending my relationship with the pump, began to flicker and fade as I realized there was no real end to pumping in sight. Not only that, but my baby was very sick and I could do very little to change that for him. I felt completely undone and powerless. The impossibility of pumping for the next 2.5 years loomed big and the dark clouds of survival rolled back to cover me once more. I would not break up with my pump any time soon. But more than that, my baby was sick. The kind of sick you can’t fix, or treat, or hope away.

We chose to stop all food trials, (with the exception of coconut oil, which has no protein in it), until Echo turned one. Resting his gut seemed like a wise move, and gave Lance and I time to come to terms with our amazing miracle boy who needs meticulous care and consideration. It also gave us time to come up with a strategy for feeding him, and space to deal with the long-term ramifications of FPIES. With each new food introduction, the rules for trialing it are stringent: one food at a time for 18 days in a row, followed by a three day break and reintroduction on the 21st day. No grains, no soy, no cow’s milk, no corn derivatives and no processed or combined foods. All of this in hopes of healing and reducing the strain on Echo’s gut. Eating out, eating in, traveling, playdates, childcare, the zoo, splash pads, children’s museums, playgrounds…they are all latent with food. Our home is safe from Echo’s trigger foods, but the rest of the world is not. Echo even reacts to grass and leaves that he sneaks in his mouth while we are outside playing, which turned us both into helicopter parents. Lance and I both mourned the loss of freedom we all would experience, but mostly the loss of freedom and exploration for Echo.

One More Day Carries Pump Hygeia

At eight months, my supply tapered way down, and no amount of herbs, tea, extra pumping sessions or positive thoughts brought it back. Under the supervision of my doctor, I tried Domperidone as a last resort. It worked for the most part, however, I still needed to supplement with donor milk. This was another hurdle. Echo mildly reacts to specific foods in my milk and I wanted to find a donor who would be willing to follow the same specific diet I do to give my son the best chance at healing his gut. One of my oldest friends, Allison, stepped forward and offered to be a consistent, diet-compliant donor and ship the milk overnight from Texas to Oregon every month.

Allison wasn’t the only person to step forward and help us. My three closest friends have also provided safe milk for Echo’s supplementation. With their help, Echo has remained in the 70th percentile for weight. Our vibrant, close-knit community have all helped us stay afloat. They’ve prayed, rallied, provided meals for Lance and I, given us date nights, an understanding and compassionate place to vent, and most importantly, a safe haven for our son. Company picnics and nanny-shares and beach weekends with our friends are possible because our remarkable little tribe cares enough to share the burden of Echo’s well-being.

Carrie lance and echo

 

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Feeding Echo, part 1- Breastfeeding Trauma, Exclusively Pumping, and FPIES

By Carrie Saum Dickson

This guest post shares the feeding journey of 16 month of Echo as told by his mother. A breastfeeding, pumping, allergy story of a little boy with a bright spirit and a mom and dad with steadfast hearts and commitment. Their story is beautiful, inspiring, challenging, humbling, educational, and so very raw. Be sure to go on to read part 2 and part 3 of their story as well.

skin to skin newborn

It’s 8:30 on a Wednesday night. My husband, Lance, is in our son Echo’s room, feeding him his bottle and reading a bedtime story. Bedtime is later than usual tonight. After working a full day building my practice as an Ayurvedic Wellness Counselor, taking Echo to an early evening doctor’s appointment and cooking dinner for the three of us, time slipped away from me. Echo ate his dinner late, too. We are all tired and cranky from a day that held too much activity and not enough down time.

I’m washing baby bottles in the kitchen when I hear Lance frantically yell through the monitor, “Carrie! Carrie! It’s happening again!”. I slip the bottle I’m washing back into the soapy water and hurry to Echo’s room. Echo, Lance, and everything within a three-foot radius is covered in vomit. I grab a towel for Lance, take our crying one-year old son, and try not to cry, too.

I draw a bath while Lance peels off his vomit-soaked clothes and climbs in the tub. I undress Echo and give him to Lance and go clean up Echo’s bedroom. I strip the double bed, break out the sanitizer and get down on my hands and knees to make sure I don’t miss anything. I study the vomit: color, consistency, quantity, and make notes to share with Echo’s doctor. The details are important.

I go back to the bathroom to get my sweet, smiley and spent little boy, put him in fresh pajamas while Lance showers. We start the bedtime routine all over again. We play peek-a-boo and pretend to eat his toes and we all feel a little better after laughing. I go back to the kitchen, finish washing Echo’s bottles, and sit down on the couch with my trusty pump as Lance kisses me goodnight and heads to bed himself. It’s 10:15. Exhausted, discouraged and hurting, I massage my right breast, which seems to constantly be clogged these days, and allow myself a good ugly cry. I leave the fresh-pumped milk out on the counter so I don’t have to waste precious minutes heating up a bottle in a couple of hours when I’m sure Echo will wake.

It’s 11:00 before I climb into bed, my right breast still hard and hurting with unexpressed milk. I know my sweet little Echo will wake up several times tonight, either from pain or hunger, and I’ll sing to him and soothe him the best I can in those long nighttime hours.

Echo has eaten green beans 10 days in a row now without any reaction, and we began to hope that maybe this would be a Pass. That his diet would expand to something other than breast milk, coconut oil and spinach.   This latest vomit episode signals the end of the green bean trial and one more food to add to the Fail column, of which there are many. And more than that, it means we have to start over from scratch with a new food, and all of the trepidation and hope that comes with it. I fall fitfully asleep worried about my baby, my boobs, and this betrayal of my son’s body called FPIES: The Mother of All Food Allergies.

Echo’s relationship with food has been fraught with difficulty from Day Two. When he was 36 hours old, he stopped breathing while nursing and continued to stop breathing every 10 minutes for the next 16 hours. In the hospital, he received his nutrition through an IV for almost three days. We didn’t know it at the time, but Echo was experiencing non-breathing seizures due to a stroke he suffered sometime shortly after birth. None of the doctors could tell us what caused it, and they chalked it up to happenstance.

Echo stroke NICU Exclusively pumping

My relationship with feeding my son has also been fraught with difficulty. Resuscitating him when he turned blue at my breast brought on PTSD and panic attacks for months. Over a year later, I still feel a faint, tiny, cold fist of fear in my chest when I remember it.

My first experience with a breast pump was sitting next to Echo’s bed in the Pediatric ER while a team of medical personnel worked furiously to keep him from crashing every 10 minutes while my eyes continuously leaked tears of terror and exhaustion. I pumped every 3 hours around the clock, even when I could not hold him for two days as my milk (miraculously) came in. I continued to pump, proud of my body for rallying to feed my baby, in spite of the circumstances and in spite of my fear. My body could do this one thing for my newborn son, and it did it well through bone-crushing exhaustion and fear.

Around four months old, Echo began making great strides in his stroke recovery. The muscle weakness on the left side of his body that affected his latch retreated. We weaned him off one of his anti-seizure meds. He woke up to the world around him, alert and happy and contagious with laughter. He also rejected the breast entirely. We had worked up to three nursing sessions a day and I was sad and frustrated when he wanted nothing to do with it. He looked terrified and scared every time I put him to breast. I told him aloud “we can do the hard things together, baby”, the phrase which I used to affirm us from pregnancy on, and resolved silently to myself as I hooked up my pump, “I can do this for ONE MORE DAY”. Grace always showed up to help me through those difficult early days of weaning and extra pumping.

 

exclusively pumping

I wondered if Echo remembered his first seizure and in my gut, I knew forcing the breast was re-traumatizing him. So, we stopped nursing. Many of the dark clouds our little family had been surviving under, lifted. We enjoyed lots of cuddles and closeness with bottle-feeding and we allowed this breast feeding-free world to be our new normal. I developed an even closer relationship with my pump. It went with me everywhere, even places my baby couldn’t. I tried hard not to resent the extra dishes, the double duty of pumping and bottle-feeding, my miniscule supply of free time, and the total loss of freedom to just take my baby and have a day away from home without first planning how much milk to bring and where I could pump in privacy.

Carrie and Echo skin to skin

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

Breast pump, Hospital grade breastpump

Hygeia EnDeare

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

 

Working

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

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

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

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

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

 

Exclusively Pumping Moms/ Moms Separated from Babies

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

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

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

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

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

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

 

Weaning Off Pumping

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

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

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

 

 

 Star Rodriguiz, IBCLC, began her career helping women breastfeed as a breastfeeding peer counselor for a WIC in the Midwest.  Today she is a hospital based lactation consultant who also does private practice work through Lactastic Services.  She recently moved to the northern US with her two daughters and they are learning to cope with early October snowfalls (her Facebook page is here, go “like” for great support). 
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