Bottle-feeding Tips- A Bottle-feeding Overview for The Breastfeeding Family

by Amy Peterson

This post made possible by the support of EvenFlo Feeding

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Moms who breastfeed often feel afraid, or even sadness, at the thought of introducing a bottle. The truth is bottles are a tool, a useful tool, and they don’t need to be scary, even if you need to use a bottle in the early days because breastfeeding isn’t going well. If you think your baby is lazy, you need someone to evaluate what’s going on because it’s not laziness, it’s something we’re not recognizing. It is a sign of something else. In the meantime, pump your milk and feed your baby. The bottle can be a tool you use to protect your breastfeeding journey, not to end breastfeeding.   

It can feel overwhelming when it comes to picking a bottle for your breastfed baby. Many bottles claim to be “more like mom,” but that is a marketing gimmick. Babies are unique, and a bottle that works for one baby may not work for another, siblings included. Below are some tips that may help parents looking for a bottle for their breastfed baby.

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Think of how a baby latches on the breast. There are many ways to evaluate if breastfeeding is going well. As it relates to picking a bottle, we specifically observe the baby’s mouth. It should open widely, resting the lips on the areola. The lips will roll out (flange) and be visible, with the corners of the lips sealing against the breast. Your nipple will reach far into your baby’s mouth. This is what you want to mimic with a bottle latch.

There are three predominant nipple shapes: narrow, gradually sloped wide, and classic wide.  Any shape is okay so long as your baby has a similar latch on the bottle nipple as on the breast. The right nipple for your baby should a) reach deeply into your baby’s mouth, b) allow the lips to open and rest on a portion of the base, and c) allow the lips to form a complete seal.  On a narrow nipple, let your baby latch and then wiggle it in deeper into your baby’s mouth so the lips are almost “kissing” the collar. On a gradually sloped wide, again, wiggle the nipple in deeper, then observe to see if your baby’s mouth remains opened widely rather than slipping to the tip.  On a classic wide, make sure your baby’s lips can rest on a portion of the base and form a complete seal rather than sucking on the nipple length like a straw.  

You will probably want to buy two or three nipples to try. Rather than reading packaging claims, look at the nipple. Ask yourself, “Will this nipple reach deeply in my baby’s mouth so the lips can rest on the base? (yes) Will this nipple shape help hold my baby’s lips open? (yes) Does it look like my baby will suck on this like a straw? (no)” Try different shapes until you find the shape that allows for a good latch for your baby.          

Start with a slow flow nipple. However, it is important to note that there is no industry standard for “slow,” and flow rates vary greatly between brands. It is also important to note that dripping is different than flow. Bottles that are advertised as “no drip” may flow very fast compared with other bottles that do drip.  With any bottle, you can control dripping by letting your baby latch on to the bottle before tipping it up so milk fills the nipple. You can’t control flow, but you can try different brands to see how your baby responds, and you can tip the bottle down and let your baby rest if he looks overwhelmed when swallowing Balancing Breast and Bottle lists bottle brands from slowest to fastest flow.  

The million dollar question—which bottle nipple is best for my breastfed baby—has no absolute answer. It all comes down to how your baby latches and swallows with a specific nipple.

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

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.

Nipple Pain in Breastfeeding

by Jessica Martin-Weber

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The Leaky Boob is committed to providing free information, support, and community. You can be a part of making that possible by joining our circle of support. Any and all support amount makes a difference.

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This post is generously made possible by Bamboobies

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All kinds of advice and myths abound when it comes to breastfeeding and preparing nipples for the experience or what to do when there is pain. Dire warnings and emphasis on getting a “good latch” can make it seem as though it is tricky, inevitably painful, and consuming. (Do you need to worry about your baby’s latch? See here for more on what to look for in a good latch and what to do if it is causing problems.)

But there’s good news! While some do experience nipple pain, many do not and for those that have pain, there is usually an answer and steps that can help resolve the underlying cause. Breastfeeding shouldn’t hurt but that doesn’t mean it won’t and it doesn’t mean that if it does it is your fault or that you did something wrong. Seeing a professional breastfeeding helper such as an IBCLC (International Board Certified Lactation Consultant) may help identify the cause of the pain and find a resolution that will help you reach your breastfeeding goals.

Here are a few points on nipple pain in breastfeeding and tips for how to handle such pain. It is our hope that nobody goes through pain in feeding their babies but if you do, most of the time it doesn’t have to stay that way.

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Is it serious? Figure out if this is the type of pain that indicates an issue or is within the range of normal sensitivity with initial latch. If it lasts for 30 seconds or so and doesn’t bother you when you’re not breastfeeding or pumping then it is possible it isn’t serious and just an adjustment period while your nipples are a little sensitive. If it is toe-curling, swear-worthy pain that makes you hold your breath and try not to scream obscenities or toss your baby far, far away from you, then it is serious and you need to be seen by an expert professional breastfeeding helper. Any tissue damage, cracking, bleeding, scabbing, inflammation, bloody expressed milk, etc., will require proactive treatment and you need to see a health care provider. Keep in mind that if your pain tolerance is high, you may push through pain that is a warning sign that something is wrong, don’t wait too long to get help from a breastfeeding helper such as an IBCLC.

What is the cause? It could be a number of causes from baby’s physiology such as a high palate or tongue-tie (frenulum restriction) to your anatomy such as flat or inverted nipples, bifurcated nipples, or Raynaud’s syndrome (vasospasms), or from a pathology such as a bacterial infection or yeast overgrowth, to a damaging latch. Unfortunately sometimes the case is baby just needs to grow more and it will take time but there may be ways to improve things until that time comes and a breastfeeding helper should be able to help you with that.

What’s the treatment? Working with an experienced breastfeeding helper, once the cause is determined, the first step is to address the underlying cause. This may mean changing positioning and learning latch techniques (such as this “Flipple” technique for latching), a prescription to treat thrush or a bacterial infection, using a device to pull flat or inverted nipples out, a procedure to correct frenulum restriction, therapeutic suck training, and a number of other possibilities. We should start with the easiest to implement first, such as positioning and latch but an early diagnosis can mean resolving the underlying cause for the nipple pain quickly and getting back to reaching those breastfeeding goals.

How to heal? Pain, particularly pain that was ongoing for a while, usually means some tissue damage that’s going to need to heal and until it does, the pain will continue. Treating the underlying cause of the pain is essential for complete healing but there are ways to encourage healing even as the cause is addressed.

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Air drying is important for healing, as much as possible, allow your nipples to air dry before closing up your bra. Air is healing and having the area dry prevents bacteria and yeast from growing in a dark, damp environment. Additionally, rinsing them several times a day (not after each feeding but frequently) can also reduce possible irritation from baby’s saliva.

A good nipple cream, one that is plant based, breathable, and safe enough to leave on during breastfeeding can not only help with healing but can prevent chapping in the early days of breastfeeding as a preventative measure. Wiping off an ointment from sensitive and damaged tissue is painful and can cause further injury so picking one that is safe for baby to ingest in tiny amounts is ideal. Apply after every feeding after allowing the area to dry and pick nursing pads that won’t stick to damaged tissue and your nipple cream.

Your own breastmilk may help your nipples heal. Breastmilk is full of good things that can expedite healing, including stem cells! Be careful though, the sugars in breastmilk will feed a yeast overgrowth, making thrush worse.

Air and sunlight may help nipples healing from thrush as yeast thrives best in dark, damp areas. Make the environment hostile for yeast by exposing your nipples to sunlight and taking a probiotic and cutting out refined sugar.

Heat or cold packs can provide comforting relief, it’s personal, some will love these and others will find them uncomfortable for addressing nipple pain. For those with Raynaud’s Syndrome there is no cure or way to permanently resolve the problem but a heat pack like this one may help minimize the symptoms, apply immediately after feeding.

Cold shredded carrots in the bra (will stain!) promotes healing and is soothing. After breastfeeding or pumping, put shredded carrots stored in the refrigerator in your bra (if you don’t mind your nursing pad turning orange, they can help hold the carrots in place).

Protect the nipples with a nipple shield may be necessary. Nipple shields should be used with caution and hopefully with the guidance of an experienced breastfeeding helper such as an IBCLC because there is a risk of lowering milk supply with using a breast shield (not everyone experiences this, just a factor to be aware is a possibility), but they can be a good option for some to help with tissue healing for a short time.

Take a break if you need to. Sometimes damaged tissue just can’t heal until it has the chance to rest. Regularly empty your breast to protect your supply and have breastmilk for your baby, be sure that you’re using the proper flange size so as not to potentially cause more damage.

 

What are your tips for preventing and healing nipple pain and tissue damage?

Share with us in the comments, together we can support each other in reaching our baby feeding goals.

 

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If this resource was helpful for you, consider helping The Leaky Boob by giving back. Help us keep our information, support, and resources free by becoming a patron and get access to exclusive content just for our supporters. Join here today.

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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.

How Lubrication Can Improve Breastmilk Pumping

by Kristine Phillips Keller

This post made possible by the support of Ameda

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I learned the answer to this question the hard way with my oldest son. I was not much of a reader but breastfed because both of my sisters did the breastfeeding thing. If they could do it, so could I. However, in hindsight, I pretty much did everything wrong that I could have done. I wanted a nursery (I needed sleep, right?), I wanted pacifiers (he can’t just suck on me or I won’t get any sleep) and I wanted bottles (dads need to help too, right?). I thought, surely I can make all of this work. Boy was I wrong!

Not only did I go into it uneducated, I also have flat nipples. I honestly thought they were broken as they never became fully erect prior to years of nursing/pumping. I also have really naturally dry skin. Early on, I had damage but didn’t realize how bad it was until it was visible, right at Stage III damage (which means skin is literally gone). I was in such pain that I would cry when my boys would cry because I knew what was coming. I would fear nursing them because of the toe curling pain that it took to get them latched on. For the most part, after a minute or two it became bearable. Other times, the entire feeding was excruciatingly painful for me.

At six weeks with my first, I gave into pumping full time. I asked for help from family repeatedly to try and figure out what I was doing wrong and what I could do to correct the latch. No one seemed to be able to offer me the advice that I needed to make direct breastfeeding work and I just didn’t have it in me to bear that kind of pain any more. However, I still wanted to give them my milk…so I continued on with pumping & still continued to have cracked, bloody nipples until a good 10-11 months of pumping.

Around that same time, I was talking with my sister about all of the bloody milk that I was dumping because, even though I was no longer nursing, I still had pretty bad damage on both of my nipples. I just thought that’s how it was going to be for me. She then asked me if I was lubricating before I pumped. My response to her was, “Isn’t that what you do when you have sex?” She laughed & then said yes but that the pump shields were dry. Babies have moisture in their mouth for lubrication but there is no moisture on the pump shield prior to pumping.

I mean, would you ever expect to drive a car with NO lubrication and have things go well? ABSOLUTELY NOT! There must be lubrication to prevent friction… and to prevent damage. After all, isn’t that what our healthcare is supposed to be about these days, preventative care? Well, let me tell you…the difference was night and day. I went from having constantly damaged, bloody nipples to pain free/damage free nipples overnight. It was such a relief to know that there was something I could do to prevent this pain and discomfort.

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I started working for WIC 2.5 years ago as a peer counselor and have since applied theory to moms that come to me with damaged or sore nipples. If you lubricate before you latch, you lessen the probability of damage happening from the initial suck (regardless of whether it’s baby or the pump). That lubrication gives both something to slide against instead of that reverse pressure working against dry skin.

I’ve asked numerous breastfeeding professionals and no one seemed to know of any literature that puts emphasis on “lubricating BEFORE nursing or BEFORE pumping”. The only reference that I’ve seen is to use breast milk on sore nipples AFTER nursing. If it works after, why not try it before?

Lubricant suggestions: (you may need to try a few different ones to decide which is most comfortable for you.)

  • Your breastmilk
  • Nipple cream/ointment (suggest vegan and edible, rather than animal based)
  • Coconut oil
  • Olive oil
  • Almond oil
  • Infant massage oil
  • Avoid synthetics such as traditional baby oil

Some moms have found that regularly lubricating their breasts and pump horns before pumping greatly reduces the amount of discomfort they experience which in turn helps them let down easier and respond better to the pump.  There’s no need for pumping to be a painful or uncomfortable experience, experiment with different lubricant options to find what works best for you.  I hope this simple tip helps you in your breastfeeding and pumping journey as it has helped me.  How about we pass along this little known tip and prevent the damage in the first place?

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What pumping tips do you have to share to help other moms?

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Kristine Thanks to her sister, Kristine breastfed/exclusively pumped for her two boys now 3.5 and 8 years old, she pretty much did everything wrong when it came to breastfeeding but managed to get the pumping thing right (after a while).  After experiencing discrimination she contacted WIC about becoming a breastfeeding peer counselor and begin training to become an IBCLC. She sits for the IBCLC exam this summer and looks forward to continuing to help mothers reach their breastfeeding goals.

Breastfeeding Confession: I don’t love breastfeeding

by Jessica Martin-Weber

This post made possible by the support of EvenFlo Feeding

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As I was nearing the end of my pregnancy with Sugarbaby, now 4, I had noticed a few women commenting online that they hated breastfeeding or at least didn’t love it. Not that they were stopping or refused to do it but that they didn’t have any of the warm fuzzy feelings they’d heard others talk about and they were looking forward to experiencing themselves. Often with their confession came the question: “does this make me a bad mom?”

My heart ached with them. I had felt the same.

I watched as some people responded making suggestions as to how they could maybe enjoy the experience more, or how it may take some time to get to that place, some sharing how much they love breastfeeding and are sorry the poster didn’t, and sometimes a few responding that they could relate. These women would respond that they were really struggling or felt broken, or questioned that maybe they didn’t love their child enough and that there was something wrong with them.

And again my heart ached with them.

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I was 35 weeks pregnant that week, preparing for a new nursling. Expecting baby #6, I was fairly confident that everything would be fine with breastfeeding. Not overly so, as I know each breastfeeding experience is different but there was no doubt in my mind that I’d be breastfeeding and that if there were any challenges we’d be able to work through them with our incredible support system. Still, there was this tiny part of me that wasn’t really looking forward to it. Maybe even dreading it a little. Which is almost heresy coming from the person that started The Leaky Boob.

Feeling for those women struggling I posted this status update on The Leaky B@@b Facebook page: 

“I don’t *love* breastfeeding. Nope, I don’t. It doesn’t give me warm, fuzzy feelings. I don’t look forward to sitting down with my nursling. I don’t particularly care for the sensation. But I breastfeed and I actively advocate and educate about breastfeeding. Why? Because I believe it’s the biologically normal way to feed a human infant. I don’t see myself as a martyr, just doing what I need to do to care for my children. I also don’t think this makes my a bad mom any more than the fact that sometimes I really hate making dinner. Or breakfast. Or lunch. Or changing diapers and doing laundry. What about you? Anyone else not “love” breastfeeding? What’s your breastfeeding confession?”

Responses started pouring in and in less than an hour there were close to 200 comments. The first 20 or so comments (I didn’t count, it could be a dozen or 50) are either people sharing they can relate, thanking me for such an honest confession because they felt less alone or freakish, sharing that it’s a love/hate relationship for them, the random “don’t like seeing people breastfeeding in public” (what’s that doing there?), the super excited ones that LOVE it and can’t relate, and the true confession of wanting to go out drinking (one brave soul shared that). Most of the 200 responses were from women grateful to hear my confession, thanking me for letting them know they weren’t alone and weren’t a bad mom for having these feelings. Then came the handful of comments saying that status was terrible and would discourage moms from breastfeeding. A few said that if they had seen that post when they were first breastfeeding and things were rough it would have made them want to quit. They asserted that we shouldn’t lie but we have to be selective with our words so as not to scare someone off. A few came down hard saying they were disappointed to see a post like that on TLB and called into question if I really support breastfeeding with posts like that.

I told my #4 nursling at the time that I didn’t like breastfeeding. Apologizing that I was gritting my teeth through her nursing sessions, I stroked her cheek and told her that even though I didn’t love breastfeeding I did very much love her and so she was worth it. Too young to understand, I felt my little girl sleeping in my arms and my chest tightened as the truth of my love for her surged through me making it hard to breathe. In that moment I vowed that even if I never loved breastfeeding I would focus on how much I love my daughter while she’s at my breast and I could take pleasure in how much she enjoyed breastfeeding even if I didn’t personally enjoy it.

Going into breastfeeding my 6th baby, my feelings about breastfeeding had changed, the skin-crawling, teeth gritting feeling was gone and while I still couldn’t say that I personally loved it I truly and deeply loved how much my baby loves to breastfeed. As her mother, there is an expansive satisfaction in making her happy that overwhelms even my own discomfort. She went on to breastfeed for 4 years and no, I don’t regret doing so. I don’t see myself as a martyr, just as a mother who, like most parents, has to give up some of my own personal comfort for a time for the benefit of my child. Though I’m not breastfeeding now, when I was, when my baby would grin up at me briefly letting go of my nipple, a little dribble of milk coursing down her cheek, I feel privileged to share and be the source of this moment she enjoyed so much. I will continue to support and advocate for breastfeeding and I will continue being honest about my own breastfeeding journey and feelings because in the long run we all need the kind of support to be who we really are if we’re going to grow.

I followed up with this that day on Facebook: (edited here)

“So sometimes breastfeeding isn’t an amazing experience, sometimes it is. We can be honest about our feelings with ourselves and with others and need to have safe places to do so. If that’s announcing loving the experience or sharing that it’s a struggle not enjoyed, it’s important to have that place. Even for me. Being brave enough to be honest enough to admit the hard stuff is where true support is found. When I first started breastfeeding and hated it deeply it wasn’t helpful to only hear how wonderful it was for everyone else. I needed to hear a balance of the good, the bad, and the ugly. I didn’t believe anyone actually enjoyed it, they just said they did it because it was expected. Today, 6 nurslings later, I’ve learned that it’s complicated and that’s ok. Everyone’s experience is different and nobody should have to hide it because what we need is to be honest, supportive, and real. Some things are going to encourage you, some are going to discourage you, either way, own YOUR experience.”

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What about you? Have you had times where even if everything was working fine, you just didn’t enjoy breastfeeding? Why do you continue?

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Jessica Martin-Weber

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.

Weaning Off Formula back to Exclusively Breastfeeding

by Shari Criso MSN, RC, CNM, IBCLC

This post made possible by the support of EvenFlo Feeding

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“Supplementation with formula does not have to be the end of breastfeeding and it may be very possible to transition to exclusively breastfeeding if that is your goal.”

First of all Amy, great job at making it to the 8 week mark! It is a big deal and something to be very proud of. From your questions it is clear that you’re just about exclusively breastfeeding but now we need to help you over that last hump.

What I tell all my clients is that if all you’re supplementing is 1-2 feedings per day of formula and breastfeeding the rest of the time, then in most cases you probably don’t need to do any at all! It is obvious that your body is quite capable of producing adequate amounts of breastmilk, however the continued supplementation will not give your body the opportunity to catch up. What you need to do is feed a little more frequently so that your body can kick inn and start to make more.

If all you’re doing is one or two supplemented feedings a days and your baby is gaining weight adequately, I would immediately start cutting out formula supplementation and begin to encourage your body to make more milk. Those few ounces that you have been supplementing can usually be made of with more frequent feeding or were not really necessary anyway, as many supplemented babies are over fed and encouraged to gain weight faster than they need to.

Typically, it is when I see moms that have been supplementing for weeks and weeks with very little breastfeeding that I am more concerned about the status of their milk supply and the need to build that up slowly by cutting back formula supplement slowly over time with careful evaluation throughout.

However, for you Amy, what I would recommend is to stop the supplementation, increase the frequency of your feedings, allow your baby to stay on the breast longer, drain the breast completely by switching sides multiple times during a feeding (feed both sides and then return to the first side again), do lots of skin to skin and wear your baby as much as you can, and basically let the baby guide you right now.

As for how hungry he is, treat it as a growth spurt. In my online breastfeeding program “Simply Breastfeeding,” I have an entire chapter on growth spurts and what to do when your breastfed baby is going through one. These are times during the breastfeeding journey when you actually are not making enough and it is very NORMAL! These are times when you baby is growing and your body is attempting to catch up with your baby’s needs for more milk. The only way that it can do that is to respond to your baby’s signal of hunger, which is what happens when they start feeding very frequently. During these times, allowing your baby to nurse as long as they want and as often as they want for a few days is the answer. With frequent and “on demand” feedings, your body will kick in very quickly and start to get the message, “Oh…MAKE MORE MILK!”

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Regardless of the reason in the beginning or whether the initial supplementation may or may not have been necessary, it does not mean that you need to continue doing it indefinitely. For most mothers it is a lack of understanding about how much their baby’s need to be eating, how much and how fast they need to be gaining, and how the body responds and makes more milk that causes them to continue to supplement unnecessarily and eventually add more formula which further decreases their breast milk supply. What may start off as a true need under certain circumstances is then replaced with an issue that has been unknowingly created and unnecessarily continued.

Another important thing to understand is that babies should not be weighed weekly. This is huge! When moms and dads ask me, “How much should a baby be gaining every week?” The answer I give is somewhere between 4-8 ounces per week on average. The key point here being, ON AVERAGE. That means, under normal circumstances you are not bringing your baby in every single week to weighed. This is because one week you may only have a weight gain of 2 ounces and you are going to think something is wrong. Then the next week your baby is going to gain 10 ounces cause they had a growth spurt. This is why weighing your baby every week and monitoring so closely can cause you to think your baby is not growing appropriately and cause unnecessary supplementation.

The best way to monitor that your baby is doing well is to keep watching for those wet and poopy diapers, looking out for all the signs that I talk about in my DVD program on how to make sure your baby is getting enough milk, and weighing your baby monthly.

So after a month’s time you’ll go back to weigh the baby, you divide that gain by four weeks, and now you can say to yourself, “Okay, did they gain somewhere between 4-8 ounces a week on average?” If the answer is yes then you’re pretty much in the right spot. Babies grow at their own pace and we cannot be too rigid with this. Breastmilk is just too important to sacrifice that quickly. Just as a baby that truly needs to be supplemented must be addressed and few for their well being, your breastmilk supply and breastfeeding relationship is critical to their short and long term health and must also be protected and supported appropriately.

I recommend that you go back and watch my program and pay particular attention to the chapter on growth spurts. Work with your pediatrician and treat this time just like you would a normal growth spurt. With the right support, patience and understanding of what is normal, I believe you will be on your way to exclusively breastfeeding your little one in no time!

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Find more from Shari supporting your parenting journey including infant feeding on Facebook, or her classes at My Baby Experts©

Thanks for EvenFlo Feeding, Inc.’s generous support for families in the their feeding journey.

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Shari Criso 2016

For over 23 years, Shari Criso has been a Registered Nurse, Certified Nurse Midwife, International Board Certified Lactation Consultant, nationally recognized parenting educator, entrepreneur, and most importantly, loving wife and proud mother of two amazing breastfed daughters. You can find her on Facebook or her own personal site.

Seven Points To Know About Breastmilk Supply Issues

by Jessica Martin-Weber

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This post is generously made possible by Bamboobies

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For the most part, if you decide to breastfeed, the experience will be: have boobs, feed baby. A process that has worked long enough to get us to this point in civilization, as mammals, generally speaking we will produce enough milk for our young. If everything is working normally, our breasts are going to make the milk our babies need. Lactating after giving birth is, for our species, normal, like breathing.

Which is well and good. But for as normal as it all may be sometimes there are issues with breathing and sometimes there are issues with lactation. Sometimes those issues are related to milk supply.

Before you worry about it or before you tell someone else to worry about it or not to worry about it, there are a few things that may be helpful to know. This is all just the tip of the iceberg, we’ll have more on this topic in the future but for now this is just a quick overview of breastmilk supply issues and not intended to be health care or replace medical care. If you are experiencing any problems with your supply, please see your healthcare provider and an experienced, professional skilled breastfeeding helper.

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1. Supply issues are real. Though biologically speaking it is normal to produce milk for our young, the fact is some will experience issues with supply. While they aren’t as common as it may seem, supply issues aren’t made up, they really do happen. Dismissing the concerns about supply can actually cause more supply problems as it may lead to feelings of isolation, failure, pain, grief, anger, and depression. If someone is concerned about their breastmilk supply, getting help is the right thing to do. They may discover that there is no evidence of supply issues and they can let go of their worry or they may find there is in fact a problem and take steps to address it to adequately care for their child(ren).

2. There is more than one type of supply issue. Often when talking about supply issues people assume it is low supply or not producing enough milk. Low supply is indeed a very concerning issue but it isn’t the only supply issue that may be experienced. Pumping supply, oversupply, and temporary supply issues (ovulation/period, illness, pregnancy, separation, etc.) are other supply issues that may present challenges for breastfeeding families. From poor weight gain to recurring mastitis to not reaching breastfeeding goals, the effects of supply issues cover a wide range and all of them matter.

3. Don’t borrow supply issue trouble. Yes, supply issues are real but before stressing about or trying to fix a supply issue, it is important to know if there is one (see related: Help, My Milk Supply Is Low, Or Is It?). This can be difficult to do if we don’t understand normal human lactation or normal baby behavior. For example, if you heard that I was pumping up to 24 ounce every pumping session at one point and you pumped 1-4 ounces in a session, you may think you have low supply (tip: this wouldn’t mean you have low supply- this means I had oversupply, one I manufactured to pump enough to skim the fat off to feed my very sick baby with two holes in her heart). Or if you found that your baby was extremely fussy and wanting to breastfeed every 30 minutes suddenly and you didn’t know what cluster feeding was and that it was common for babies to increase their feeding sessions during times of rapid growth, you may fear that your breasts suddenly weren’t making enough milk. Understanding the range of normal in human lactation is crucial!

4. There are multiple reasons for supply issues. Physiologically speaking, most breasts should have everything necessary to make plenty of milk (statistically less than 2% of breasts are equipped for adequate milk production) though there are some theories that this number is increasing. But a lack of milk making tissue isn’t the only cause of low supply. Other reasons for low supply include, but are not limited to, fluids in labor, tongue tie (frenulum restriction), high palate, hormone imbalance, diabetes, gut health, scheduled feedings, retained placenta, excessive pumping, ineffective sucking, health issues, some medication, early sleeping through the night, and the list goes on.

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5. Supply issues can create other issues. Yes, even perceived supply issues can create other issues. Confirmed supply issues even more so. Postpartum depression, anxiety, mastitis, gas, poor weight gain, breast tissue damage, unwanted and unnecessary supplementing, early weaning from the breast, etc. Those encountering issues with supply need more support and care on both a social level and from health care professionals.

6. Supply issues aren’t all doom and gloom. For starters, it doesn’t have to be all or nothing when it comes to feeding our babies. There are ways to address supply issues including methods to boost supply, supplement at the breast, train baby to suck more effectively, and reducing oversupply. Identifying the type of supply issue, the cause, and then the most effective methods for improving the supply issue (i.e. skin-to-skin helps low supply, decreasing pumping duration and frequency helps oversupply, hands-on-breast compressions and proper flange sizes can help pumping low supply, and magnesium can help temporary low supply caused by fertility cycles) along with supplementing techniques to encourage breastfeeding (i.e. paced feeding and at the breast supplementing) may all work together to turn things around.

7. There is support for supply issues. I often hear from breastfeeders with supply issues that they feel broken and alone. Supply issues can directly impact a parent’s confidence, causing them to question their competency in parenting when the most elemental aspect of parenting, feeding the child, is so difficult and overwhelming for them. While it can feel lonely when you’re dealing with supply issues, we don’t have to be alone. From social media groups to in person breastfeeding support groups to specialized breastfeeding helpers in the healthcare field, there is support for those experiencing supply issues. Working with a breastfeeding helper such as an IBCLC may help resolve the issue more quickly.

 

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Jessica Martin-Weber

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.

The Breastfeeding Parent’s Gratitude List

By Jessica Martin-Weber and the Leakies

There are many reasons to be grateful for breastfeeding including ease of access, financial savings (though, let’s be honest, we’re not always saving that much money with breastfeeding), and happy babies. But there are reasons far beyond that. It is always helpful and good for us to cultivate gratitude and with breastfeeding, it can be really easy to do. To help us get started, we asked the followers over on The Leaky Boob Facebook page and The Leaky Boob Facebook Group. Here’s the list we came up with:

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I’m grateful for breastfeeding because it means I have a good excuse to sit down.

I’m grateful for breastfeeding because without it I wouldn’t have an excuse to whip my breasts out around strangers.

I’m grateful for breastfeeding because now I know what it is like to have my chest head butted by a 9 month old.

I’m grateful for breastfeeding because even though I’m fine breastfeeding in front of others, I appreciate the chance to escape to a quiet room every once in awhile to have to feed the baby.

I’m grateful for breastfeeding because it means I have to shop for new clothes that will let me get a boob out.

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I’m grateful for breastfeeding because it means I get extra breaks at work to pump and relax, LOL!

I’m grateful for breastfeeding because I get the chance to cuddle my adventurous kiddo that otherwise doesn’t ever sit still.

I’m grateful for breastfeeding because it guarantees one satisfied family member at meal times!

I’m grateful for breastfeeding because it means I get a break in chasing after the toddler and my partner has to take over while I feed the baby and scroll through Facebook.

I’m grateful for breastfeeding because it is portable and always ready, it’s the perfect food-on-the-go.

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I’m grateful for breastfeeding because having a tiny human being shriek hysterically for me to get my shirt off has made me feel so needed.

I’m grateful for breastfeeding because hooking up to a machine to suck my boobs is just such an unforgettable experience.

I’m grateful for breastfeeding because it means that feeding the baby is one thing that I won’t have to plan while driving 10 hours each way to spend Thanksgiving with family!

I am grateful for breastfeeding because of the meltdowns that I avoided by whispering in my 2 year old’s ear “want some booby?”

I’m grateful for breastfeeding because taking a shower is way more enjoyable than washing extra bottles. Or it would be if I got to take one.

I’m grateful for breastfeeding because with safe cosleeping, I can feed and sleep at the same time.

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I am grateful for breastfeeding because it saves me money so I can buy more wine and brownies.

I’m grateful for breastfeeding because I really am eating for two so a second piece of pie is totally reasonable.

I’m grateful for the terror it saves me of not having to go downstairs in the dark in case there are ghosts.

I’m grateful for being able to breastfeed my children for the fact that I can hold them more them anyone else and make the ‘they are hungry’ excuse if I don’t want someone holding them.

I’m grateful for breastfeeding because it means I (personally) don’t have to drug my toddler when he’s teething. Oxytocin for the win!

I’m grateful for breastfeeding because now I know what it is like to smell like sour milk all day, every day.

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Jessica Martin-Weber

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.

Breastfeeding, Your Partner, And Sharing the Journey

by Sarah Saucedo

This post is generously made possible by Bamboobies

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When you are considering breastfeeding your baby, it may seem like it will be a one-woman show. The notion that you will be the sole provider for your new baby’s nutrition may seem a bit overwhelming. However, that doesn’t need to be the case! Your partner can play a key support role in your breastfeeding success.

In the first couple days postpartum, having help to make the most of “lying in” should be a priority. “Lying in” simply means the days or week following delivery where mom and baby should be breastfeeding, bonding, doing skin to skin and little else. Your partner can help make this transition easier with a few simple acts:

  • Make sure any therapy or breastfeeding essentials are within your reach and ready to use (nursing pads, nipple balm, therapy pillows)
    • If using reusable nursing pads – make sure they are clean and ready to go
    • Heating or cooling the therapy pillows depending on your liking
  • Make sure you are hydrated and fed
    • Always have a water bottle on your nightstand
    • Place easy-to-grab snacks like protein bars or fruits that don’t need to be refrigerated, like bananas and oranges, within your reach
  • Help with any pain medications or dressings that you may have from your delivery; this can be a big help-especially if you had a cesarean or particularly hard labor.

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Once you are comfortable enough to move around the house more, there are plenty of ways that your partner can still be helpful and supportive in your breastfeeding journey. Here are a few:

  • Stock a nursing station or stations in you favorite spot(s), so you have what you need when you need it. Snacks, wipes, burp clothes, a full water battle, nursing pads and something entertaining, like a good book or magazine are essentials. Fueling you body and mind while the little one eats is multitasking at its finest.
  • Use a bottle to feed baby pumped breastmilk. This can give you some time to take that much needed shower, read a book, or even sleep if your partner is able to pick up a night feeding. It may seem trivial but these little acts of self-care go a long way in the postpartum period.
  • Clean the pump parts and bottles (they add up!)

Having your partner’s support doesn’t need to stop when you venture out of the house, either! Your partner can be just as involved in your breastfeeding journey whether out to eat, shopping, or at a sporting event.

  • Provide emotional support when you need it. It can be a huge boost to your confidence! Knowing that they support you and your breastfeeding journey can be the key to making a possibly anxious situation (like your first time out of the house) as smooth as possible.
  • Check to make sure the diaper bag is fully stocked with all your favorite breastfeeding supplies (pads, nipple balm, and nursing shawl) and whatever baby needs is also helpful. Don’t forget an extra diaper or two and a change of clothes for baby. You might want an extra shirt, too, just in case!

Bringing a new life into the world is challenging and exciting. Having a partner that supports your feeding choices makes everything a little easier. Also, don’t be afraid to ask for help. Chances are, your partner will be looking for ways to be involved with baby and you during your breastfeeding journey as well. Happy breastfeeding!

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Sarah is a mom of two wonderful boys, and is expecting her third child in March! She is bamboobie’s support maven as well as a Certified Lactation Educator and Counselor and is passionate about all things breastfeeding. 

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

by Dr. Kymberlee Lake

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Most women know that there may be some bleeding after giving birth but often women are surprised by how much and how long and they aren’t aware of the difference between postpartum bleeding and discharge and menstruation. The first bleeding after you give birth is called lochia.

What exactly is lochia? 

Lochia is the discharge consists of blood from the area on the uterine wall to which the placenta was attached during pregnancy, the sloughed off endometrium (uterine lining which makes a bed for the fetus) which gets considerably thickened during pregnancy, blood and mucus from the healing cervix,  and dead (necrotic) tissue. Your blood volume increases by approximately 50% in pregnancy, all that extra blood also has to go somewhere after birth. Most women will experience blood and lochia discharge for 3- 6 weeks though that time span can very from pregnancy to pregnancy and can be directly influenced by a healing mother’s activity level.

Why do we have lochia and where does it come from?

The blood in the lochia comes mainly from the large raw area left in the uterine wall after the placenta detaches from it. While bleeding from this area is controlled by contraction of the uterine muscles immediately after delivery, it takes on the average about two weeks for this area to heal. It is important to remember that this is a wound and it is possible to do too much before it has healed and reopen the wound, causing fresh bleeding. You will experience this bleeding for around four to six weeks postpartum.
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For the first few days it will be a heavy flow (kind of like a heavy period) and will be  colored dark red, with some clotting.  About the end of the first week the flow should start to taper off, becoming lighter in saturation and color; as time passes, it will fade to a brown, yellowish or even almost-white discharge. 

One thing to remember is that the placental area as well as the sites of sloughing endometrium are raw and open during this time and bacteria can easily spread from the vagina. So, the use of tampons should be avoided – sanitary pads are the best options to be used during this time. 

What is normal and when should I be concerned?

You might notice a ‘gush’ of blood with clotting when you stand up – this is very normal. Also, if you’re breastfeeding, you might notice that you lose more blood after feeding baby; this is caused by your hormones doing their work to help shrink your uterus back to it’s pre pregnancy size. The lochia is sterile for the first 2-3 days but then becomes colonised by bacteria giving off a typical distinct lochial smell which is normal and should not be confused with the bad odor from lochia in postpartum infection.

If the discharge smells foul, you’re still noticing a lot of blood loss after the first four weeks, or the blood is bright red, these are signs of infection and you should speak to your health care provider as soon as you can. This is especially true if you also have a fever (no matter how slight)  or are generally feel ill. Likewise, if your blood loss is so heavy that you’re going through more than a pad an hour, you should get medical help immediately – this can be a sign of a hemorrhage. If in question and something feels “off” it is worth a call to your health care provider for advice.

Types of Lochia

Depending on the color and consistency, lochia can be of three types:

  • Lochia Rubra: Lochia rubra occurs in the first 3-4 days after delivery. It is reddish in color – hence the term ‘rubra’. It is made up of mainly blood, bits of fetal membranes, decidua, meconium, and cervical discharge.
  • Lochia Serosa: The lochia rubra gradually changes color to brown and then yellow over a period of about a week. It is called lochia serosa at this stage. The lochia serosa contains less red blood cells but more white blood cells, wound discharge from the placental and other sites, and mucus from the cervix.
  • Lochia Alba: The lochia alba is a whitish, turbid fluid which drains from the vagina for about another 1 – 2 weeks. It mainly consists of decidual cells, mucus, white blood cells, and epithelial cells.

Do women who give birth by c-section still have lochia?

Many women believe that the flow of lochia is less after a cesarean section since the uterine cavity is cleaned out after the birth of the baby. This is not true. The flow of lochia is not dependent on the type of delivery –  The amount and duration is the same in both cases.

Return of Menses

There’s no hard rule as to when your period will return post-baby – it can vary from woman to woman, and pregnancy to pregnancy. Here are some general guidelines:

  • Women who bottle-feed can see their menstrual cycle return within six weeks of birth – and most will have menses back by ten to twelve weeks.
  • Women who exclusively breastfeed may not get their period back for some time. When you breastfeed, you body releases the milk-producing hormone prolactin, which, in turn, keeps our levels of progesterone and estrogen low. Progesterone and estrogen are the hormones responsible for signaling ovulation and menstruation. Night nursing directly effects these levels, a decrease in breastfeeding at night may lead to a return of menses.

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Once your period returns, it can take even longer for it to get into a regular cycle. If you are bottle feeding it can take around six months, while exclusively breastfeeding your baby can take 12-18 months. But keep in mind that this does vary from mom to mom and pregnancy to pregnancy. Even with exclusive breastfeeding on demand and no artificial nipples, there are women who see a return of their menses as early as 6 weeks while others may not breastfeed and still experience a considerable delay. Each woman is different. Some women experience lighter flows and/or less cramping with their menses after having a baby, others experience the same, and still others may experience an increase. The range of normal variations is considerable but very heavy bleeding, soaking a full size pad in 1-2 hours, may indicate a problem and should be addressed with your health care provider. There are a variety of factors that contribute to possible changes with the return of your period but keep in mind that diet, physical activity, and your menstrual products can all contribute to cramps and duration.

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Please be aware that your first egg (ovulation) will be released two weeks before your period starts, so if you have unprotected sex without realizing that you are ovulating, you could get pregnant before you have even began menses again. It’s a good idea to speak to your healthcare provider about contraception even before you start thinking about sex again, so you can be confident in your choice ahead of time.

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cloth pads for periods and postpartum bleeding
Kymberlee Lake- headshot

Kymberlee is a Physician/midwife, Therapeutic foster/adoptive parent with 6 kids ranging in age from 31 to 3 and three grandchildren. She is living life to the full with MS in the Pacific NorthWET.  As an international travel enthusiast and fan of teleportation you can find her under the name “Dr_Kymberlee” live streaming and on social media, or on her often neglected blog, TheMamaMidwife.com