breastfeeding help

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

October 14, 2014 by theleakyb@@b 3 Comments

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.

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.

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.

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.

Filed Under: Article, Breastfeeding, breastfeeding difficulties, breastfeeding help, breastfeeding stories, breastfeeding support, Breastfeeding the newborn, breastmilk pumping, breastpump, Featured, guest posts, Leakie to Leakie, motherhood Tagged With: breastfeeding difficulties, breastmilk, exclusively pumping, FPIES, FPIES and breastfeeding

Leaving the parenting island and asking for help

July 7, 2014 by theleakyb@@b 1 Comment

by Jessica Martin-Weber

Parenting Island AKA Poop Rock.

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

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

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

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

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

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

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

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

Filed Under: Article, birth, breastfeeding difficulties, breastfeeding help, Featured, Jessica, motherhood, Parenting Tagged With: asking for help, asking for help strengthens community, breastfeeding help, child birth, depression, no man is an island, Parenting, parenting help, poop rock, takes a village

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

April 14, 2014 by theleakyb@@b Leave a Comment

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

Dear Kathleen,

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

Desperately yours,

Heartbroken for Milk

Hi there Heartbroken for Milk,

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

Best wishes too you!

Kathleen

Dear Kathleen,

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

Thank you for your help,

Not Ready to Wean

Dear Not Ready to Wean,

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

Good luck!

Kathleen

Dear Kathleen,

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

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

Sincerely,

Wounded Nipple

Dear Wounded,

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

Kathleen

Dear Kathleen,

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

Thank you,

Unpleasant Breastfeeding

Hi Unpleasant Breastfeeding,

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

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

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

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

Best wishes!

Kathleen

Dear Kathleen,

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

Yours truly,

Worried but hopeful

Hi Worried,

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

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

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

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

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

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

Best wishes to you and your baby!

Kathleen

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

Filed Under: Article, Ask the IBCLC, Breastfeeding, breastfeeding difficulties, breastfeeding help, Featured, Pregnancy, Relational Resource Tagged With: Ask Kathleen Huggins, ask the IBCLC, biting and breastfeeding, breast pump, Breastfeeding, breastfeeding challenges, breastfeeding help, Breastfeeding support, breastfeeding troubleshooting, IBCLC, Lactation Consultant, low milk supply, nipple cream, nursing strike

Dear Kathleen- Too much and not enough, weaning and supply during monthly cycle

February 19, 2014 by theleakyb@@b 2 Comments

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

Dear Kathleen,

I have weaned my nursling, it has been 7 days since his last feed and lefty still isn’t getting with the program! I have a lumpy, very sore, left breast and am unsure what to do. Is this normal? What can I do to relieve the pain and discomfort?

Thank you!

Lumpy Lefty

Hi there Lumpy,

Yes, it can take while for both breasts to involute after weaning, even if weaning was gradual. Your left breast will soften soon, but in the meantime you can try the following suggestions. You will want to try and avoid any breast stimulation to either breast. This means taking backward showers or tub baths, avoiding heat to the breast and any stimulation during lovemaking. You can use Tylenol or ibuprofen to ease any discomfort. Some mothers use cool packs on the breasts for 10-15 minutes a few times a day and some even place chilled cabbage in their bras to help with the swelling and discomfort. While some mothers chose to express milk from the breasts, this may provide temporary relief, but that will most likely lengthen the total time it takes to dry up completely.

To speed the softening, you can drink sage or peppermint tea. Earth Mama Angel Baby sells their “Organic No More Tea” which contains these herbs or you can buy dried sage leaves in most health food grocery stores. Steep a couple of teaspoons of sage in boiled water storing it in your refrigerator. Drink 2 to 3 cups a day for up to three days. None of these herbs should not be used if you may be pregnant. Most mothers do nothing other than wearing a supportive bra and giving it a bit more time. Please know that it is quite normal for mothers to be able to express drops of milk for many months after weaning.

Feel better soon!

Kathleen

Dear Kathleen,I’m on the verge of tears, disappointed in myself. My little guy is 4 months old and I returned to work last month, we are exclusively breastfeeding and I pump when I’m at work. This month my monthly cycle returned and I’m experiencing a drop in my milk supply with it. Is this normal? Why is this happening? I feel so bad, I can’t pump nearly as much as I could before and sometimes he seems very frustrated at the breast. Will my supply come back up when my period ends? Is there anything I can do? I’m having to use the milk I have stored and I’m afraid that if my supply doesn’t come back up I won’t be able to keep up with my son’s needs. Even if it does come back up after my period, if it’s going to be like this every month I’m really concerned that I won’t have enough of my milk when I’m at work and that he’s going to wean early if he’s frustrated even at the breast. Please help!Sincerely,

Could Cry

Hello Could Cry,

I am so sorry that you are worried and upset! Let’s see what we can do. I am hoping that you are getting in at least 7 nursing and pumping each 24 hours and that you are using the best pump possible. If you are not using a Hygeia or another pump with strong suction such as a rental pump, I would suggest that you try and get one. I know that many insurance carriers that are providing pumps to nursing mothers, but many are offering mothers poor quality pumps. For an example, the Ameda pump has very low suction unless you are using it as a single pump.Try to nurse right before leaving for work every day and be sure that you care giver doesn’t feed the baby for two hours before your expected return. In that way you can nurse just as soon as you get home. Some mothers find that their babies are simply being overfed while they are apart. Your baby only needs about 1 1/2 ounces per hour for a good feeding at this age. That means that if it has been 2 hours since the last feed, he will only need 3 ounces by bottle. If your care provider is overfeeding the baby, let her know that the doctor has recommended that amount. Using a slower flow nipple can also help slow the feeding and leave your baby a bit more satisfied.When you are home with the baby, try to nurse more often. Keep in mind that babies at this age do not give early hunger cues. If your baby uses a pacifier, put it away and offer the breast when you see finger sucking and it has been 2 hours or more since the last feeding. Welcome night time feeds, as nursing in the night increases your milk making hormones the most. When at home you can also pump right after any of your morning nursings and use that milk to feed the freezer.

Yes, when a mother begins ovulating, it is common for milk production to decline somewhat until the next period starts up again. With that being said, you can try taking 1000 mgms of calcium and 500 mgms of magnesium every day once you have ovulated and until your period returns. You can also use herbs to stimulate your production, so long as your breasts are being drained 7 times a day. Fenugreek can be found in any health food store and the lactation dose is 3 capsules three times a day, not what is written on the bottle. For a stronger herbal remedy, I recommend More Milk Plus from Mother Love Herbals. You can visit their website and find a local distributor. More Milk Plus contains fenugreek and three other milk stimulating herbs.I do hope this has been helpful to you and that you find ways to continue nursing for as long as you and the baby like.

Best wishes,

Kathleen

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

Filed Under: Article, Breastfeeding, breastfeeding difficulties, breastfeeding help, breastfeeding support, Featured, Milk Supply, Relational Resource, Weaning, Weaning Tagged With: Ask an IBCLC, Ask Kathleen Huggins, breastmilk pumping, deae kathleen, low milk supply, pumping at work, weaning

Dear Kathleen- on nipple damage healing and pumping

January 14, 2014 by theleakyb@@b 3 Comments

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

Dear Kathleen,

My nipples are a wreck following a shallow latch and then thrush with my 8 week old. After working with an IBCLC that helped fix my daughter’s latch and take care of the thrush, things are improving. However, my nipples are still cracked and bleeding and I think they just need a break to heal. The IBCLC I work with suggested I just pump for a little bit until I’m healed and I’m ok with that. I feel like I’m a bit lacking in the pumping department though and only got 4 ounces the first time I tried with a hospital grade double electric pump and my daughter downed that pretty quickly. How often should I be pumping to keep up my supply? How long should I expect healing to take? How do I pick a bottle that won’t encourage my daughter to prefer the bottle over me?

Thank you so much for your help!

Sore Nipples

Hello Sore Nipples! I am so sorry to hear that you are still struggling at this point in time! Sounds like you have been through a rough go. Yes, you and your L.C. are on the right track. A break from any more trauma is certainly in order. I am happy to hear that you have a clinical grade pump. I do hope you have the right size flanges for more comfortable pumpings and for removing the most amount of milk possible. If your nipples are swelling very much in the tunnel, I would suggest getting the next size flange for more comfortable and effective pumping. Another product, “Pumping Pals”, slipped into any flange, makes pumping even more comfortable and for some moms even more efficient. You might want to visit their website to see what I mean. The company is very helpful in getting you the right size flanges to use in your kit and they are fairly inexpensive. With that being said, still many pumps still leave quite a bit of milk on the breast. For that reason, I suggest “Hands-on Pumping”, that is using your hands to help remove the most milk possible at each pumping. Please watch Dr. Jane Morton on Stanford University’s website on breastfeeding issue and see her mini-lecture and video of hands-on pumping.

I would like to talk to you more about the condition of your nipples. If your nipples are still cracked, I would like you to consider treating them with an oral antibiotic. Mothers with injured nipples longer than 5 days are at a much greater risk of developing mastitis; 75% of moms with open nipples go on the develop a breast infection because of the bacteria in the open areas. And this seems much more common during the cold weather months. There was a great study done by two Canadian physicians some time ago that showed the consequences of wounded nipples that were untreated leading to mastitis. Also, nipples are more difficult to heal when they are infected with bacteria. For both of those reasons, I suggest speaking with your midwife or doctor about getting treatment for at least 10-14 days. I don’t think most doctors are aware of this connection, but with your nipples being in this shape so late in the game, I am convinced they are colonized with bacteria. Yes, I am sure that this makes you worry about yeast, but yeast is much easier to treat than a case of mastitis, which can also lessen your overall milk production.

I do think that getting 4 ounces is about what a baby at this age requires at each feeding. You will want to aim for about 8 pumpings each 24 hours. If you are not getting at least 3-4 ounces when you pump, you may want to also consider using some herbs. You can use fenugreek capsules that are available at most any health food store, 3 caps three times a day. This is probably different that the dose given on the bottle. I actually find that mothers do quite well using Mother Love’s More Milk Plus, a combination of milk stimulating herbs. You can visit their website and see if there is a local distributor or order them on-line directly from Mother Love. Nursing teas are a very weak form of any herb, so I don’t recommend them as the primary way to stimulate higher milk production.

Babies typically down a bottle in no time flat and may still act hungry! This can lead parents to believe that the baby may need more milk. Four ounces with a slow flow nipple, might help some but keep in mind that many nipples that are labeled as slow flow, really aren’t! Hopefully, the baby takes 5-10 minutes to drink 4 ounces of milk. There is an old saying, “It takes 20 minutes for the brain to know when the stomach is full!” So true! If you are very worried that the baby will come to fall in love with the bottle flow, you might reconsider and have one nursing every 24 hours, but I leave that to your discretion. I think for most babies, if there is a healthy supply of milk, they should return to the breast without too much of a problem.

I wish you every success and very soon! You are quite a determined mom!

Best wishes,

Kathleen

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

Filed Under: Article, Articles from the professional experts, Breastfeeding, breastfeeding difficulties, breastfeeding help, breastfeeding support, Featured, Milk Supply, Nipples, Pumping, Relational Resource, Thrush Tagged With: Ask Kathleen Huggins, Breastfeeding, Lactation Consultant, mastitis, nipple damage, pumping, thrush

Dear Kathleen- Leakies ask an IBCLC

December 4, 2013 by theleakyb@@b 2 Comments

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

Dear Kathleen,

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

Thanks!

Bewildered in pumping land

Hi Bewildered!

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

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

Happy pumping,

Kathleen

Dear Kathleen,

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

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

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

I welcome your advice and encouragement.

Love,

Disappointed but hopeful

Hello Disappointed,

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

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

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

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

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

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

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

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

All the best,

Kathleen

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

Filed Under: Article, Articles from the professional experts, Bottle Feeding, Breastfeeding, breastfeeding difficulties, breastfeeding help, breastfeeding support, breastmilk pumping, breastpump, Featured, formula, Pumping, relactating, Relational Resource Tagged With: Ask an IBCLC, Ask Kathleen Huggins, breast pump, Breastfeeding, breastfeeding help, breastfeeding troubles, breastmilk pumping, IBCLC, pumping, relactating, storing breastmilk, The Nursing Mother's Companion

Tips for Breastfeeding in a Soft Structured Carrier

August 21, 2013 by theleakyb@@b 8 Comments

This post made possible by the generous sponsorship of ErgoBaby Carriers.

Babywearing and breastfeeding often go hand in hand; breastfeeding encouraged and even made easier by babywearing and babywearing encouraged and even made easier by breastfeeding. There can be a learning curve to figuring that out though but worth taking the time to see if it is something that would work for you. Once I got the hang of breastfeeding in a carrier it made it so much easier to chase around my other children (I have 6 total, keeping up is a big job!) and meet my baby’s needs too.

Whatever carrier you have or prefer, breastfeeding is likely possible while babywearing. Today I’m sharing some simple tips for breastfeeding in a soft structured carrier using an Ergo. The below video was shot last fall at the ABC Kids 2012 show, a simple demonstration of breastfeeding in a carrier.

Tips for breastfeeding in a soft stucture carrier:

1. Be confident. Fake it until you are.

2. Be patient. It may take time and practice and being patient with the process will help in the long run.

3. Practice at home when baby isn’t hungry so you don’t feel stressed or rushed.

4. Release strap on side you’re going to feed from.

5. If necessary undo back clip.

6. Loosen and lower waist if you need to get the baby still lower to the breast.

7. Wear a low cut stretchy neckline and pull breast out the top to avoid wrestling with pulling your shirt up with baby on you.

8. Slip hand in top or side of carrier to free breast and latch baby. Can use two hands usually if needed.

9. Large breasted women may find a rolled up receiving blanket placed under the breast helpful for support.

10. If baby has trouble latching, leaning forward may help give a little more space.

11. Once latched tighten straps for hands-free Breastfeeding.

12. If you feel you need more coverage snap one side of the hood. Leave the other open so you can see in easily.

13. Once baby is done eating, slip hand in to put your breast away.

14. Tighten strap and waist to raise baby back to the safest position with the top of their head easily kissable.

Breastfeeding carries on!

Filed Under: Article, Babywearing, Breastfeeding, breastfeeding help, Breastfeeding in public, breastfeeding video, Featured, Jessica, NIP, Sponsor, video Tagged With: babywearing, babywearing and breastfeeding, Breastfeeding, breastfeeding in a baby carrier, Ergo, how to breastfeeding in a baby carrier video, love carries on

Medications and Breastfeeding

December 17, 2012 by theleakyb@@b

by Star Rodriguez, IBCLC

This post made possible in part by the generous support of Rumina Nursingwear.

It can be really confusing taking medications or having procedures done while you are breastfeeding. Most of the time, if you look at the package insert or online, most medications simply say that you should ask your doctor or not take them while breastfeeding. Then you might hear something completely different from friends, or relatives, pharmacist, or from your doctor. So what do you do?

Well, luckily, there are a bunch of fantastic resources for breastfeeding moms.

First, I want to tell you that research on breastfeeding and medications has come a long way in the past few years. So your doctor, nurse practitioner, or pharmacist may have outdated information. I am not trying to say that you shouldn’t respect your provider or that they don’t know what they are talking about. That’s absolutely not true. However, the amount of breastfeeding patients or customers that they see is probably relatively small, so their continuing education is often focused elsewhere. If you are wondering if information that you were given is correct, you have every right to research that yourself and then bring that information back to your provider so you can make an informed decision together.

Medications moving into milk depend on several things, and, sometimes, even if they do, they do not enter the bloodstream of the baby. Describing the hows and whys of that could literally take me twenty (probably boring to most people) pages, so I’ll cut to the more important things: how to tell what your medication is ranked, taking you baby’s age into account, resources for information, and supply issues from medications.

Drugs are typically ranked in L categories. These categories are, as per Dr. Thomas Hale:

L1 – Safest. These drugs either don’t reach the baby at all or have been proven to be safe in large studies.

L2 – Safer. These drugs have either been studied to a lesser degree with little to no side effects on the baby, or, after taking the evidence into account, the likelihood of this drug being problematic to your baby is pretty remote.

L3 – Moderate. This category is where most drugs start. L3 drugs either have no studies done, or studies have been done showing minimal problems to the infant if the mom is taking it. This is the category where it’s really a risk/benefit situation. What are the risks of the drug in your breast milk versus the risks of feeding formula?

L4 – Possibly Hazardous. We know that this drug can have adverse effects on the baby. However, there might be some situations where use of this drug is justified. For instance, if someone is in a life-threatening situation. For the most part, though, we want to avoid these medications.

L5 – Contradicted. You can’t use these while breastfeeding. We know that they have significant, documented, negative impacts on babies. If you have to take a L5, you cannot breastfeed while it is present in your milk.

Sometimes the classification of medications can vary based on where you are in your breastfeeding relationship. In the first week of breastfeeding, due to the difference in colostrum versus mature milk, it can be a little easier for medications to pass into milk in greater quantity. If you can avoid a drug during that time, you should. However, maintenance medications, pain relievers used for surgical deliveries or painful vaginal deliveries don’t need to be avoided.

In the later stages of breastfeeding, after solids are introduced, most babies begin to take in a little less milk – and in the toddler stage, that often lowers again. So if you are nursing in a later stage, some medications that were once not ok can be acceptable again.

So now that you have a basic idea about how drugs are coded, where do you find this all out?

LactMed is a website that has a bunch of information about drugs and breastfeeding. It doesn’t have the L classification, but it does talk about the drug’s potential effect on lactation. For instance, if you look up Sudafed, it talks about how it might lower production of milk. LactMed also has a free Android and iPhone app. I haven’t tried out the app itself yet, though, so I’m not certain what, if any, differences there are.

Medications and Mother’s Milk is a book that is updated every 2 years. Many libraries have it, as do most pharmacies, hospitals, WIC clinics, and doctor’s offices. It is written by Dr. Thomas Hale, and has a wealth of information on drugs and breastmilk, including the L classification.

Infant Risk Center is a website that has a bunch of information regarding pregnancy, breastfeeding, and the risks to infants of various things. It is directly connected to Dr. Hale, who is the foremost authority on breastfeeding and medications. The site itself can sometimes be a little difficult to find the specific information that you’d like. However, Dr. Hale also has an app (it is a paid app, but it has a HUGE amount of information, so if you’re a provider, or you regularly work with breastfeeding moms, I can’t endorse it enough. For the mom who is occasionally taking medication, it’s probably not necessary, though.) The Infant Risk Center is also staffed Monday – Friday 8am – 5pm CST to answer questions about breastfeeding (and pregnancy) and medications, and the people working it are knowledgeable, helpful, and generally wonderful.

When looking at medications, it is important to consider whether they can impact supply. For instance, as I mentioned, Sudafed can be problematic in that area. Generally, if a medication is meant to dry something up, or impacts your hormones (like birth control), you should exercise caution in using it. Before anyone worries, you can still take birth control. You may want to use an IUD, the mini pill, or Depo Provera if you are not planning to use barrier methods. With Depo or the Mirena IUD, I usually tell moms to ask to be on a month of the mini-pill first; some moms just have sensitivities to hormones, and those sensitivities can impact supply. Depo can’t be removed once injected, and Mirena is expensive to place and uncomfortable to remove, so it is good to have an idea if you will react that way. Also, hormonal birth control should not be started until at least 6 weeks postpartum after milk supply is established.

I hope this information helps you work with your health care provider to determine the best choice for you when you need medication.

___________________________________________

Did you have to take medications while breastfeeding? Was it easy for you to find good information on them?

___________________________________________

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

Filed Under: and health concerns for mom, Article, Breastfeeding, breastfeeding health, breastfeeding help, Featured, Relational Resource Tagged With: breastfeeding and medications, breastmilk, Dr. Hale, IBCLC, Infant Risk Center, LactMed, medications and baby, pills, Rumina, working with your doctor

Supporting the Breastfeeding Family as a Whole

December 13, 2012 by theleakyb@@b

by Amber McCann, IBCLC

supporting the breastfeeding family as a whole

Recently, I was collaborating with a colleague as we worked through the nitty-gritty details of a challenging situation one of my clients was having. As an International Board Certified Lactation Consultant (IBCLC), I work with families to support their breastfeeding and, while my job is incredibly rewarding, it also requires a LOT of “detective” work. This case was challenging my skills and knowledge and I reached out for help. As we sorted through the facts and brainstormed ideas, my colleague said to me, “I’m realizing that you alway lean towards the side of the mom and I lean towards the side of the baby.”

The comment caught me off guard. I wasn’t offended because I make no apologies for the fact that connecting with mothers is my “sweet spot”. I also don’t believe that I nor my colleagues ever sacrifice one member of the breastfeeding relationship to the exclusion of the other. But it did cause me to think and reflect on how, as a professional, I approach the work I do. Do I miss critical pieces of the puzzle because I’m so focused on the mother’s well being? Do I forget the important role that dads and partners play in the family? Do I miss the most vulnerable person in the whole dynamic…the tiny baby herself? (*Cue dramatic soul searching)

I came to this realization:

Breastfeeding support that doesn’t recognize the family as a whole FAILS.

Breastfeeding is much more than one breast, one baby, one mother, and one belly that needs nutrition. It is also getting to know each other, communicating, finding balance between all parties, and connecting on an intimate and vulnerable level. While I certainly do not claim that these experiences happen only in breastfeeding families, I do believe that breastfeeding imparts benefits that go far beyond calories and weight gain.

For that reason, I think it is critically important that, as those who support breastfeeding, we see the breastfeeding family as a whole. Much of the conversation in breastfeeding support centers around whether someone is doing it the “right way”: no supplements, pacifiers, bottles, cribs, you have to wear your baby, don’t you dare give cereals before 6 months, breastfeed until they are two, breastfeed while you are pregnant, breastfeed, breastfeed, breastfeed, breastfeed…and if you don’t do it this way, you are a failure. It simply breaks my heart because, while each of these recommendations has value and impact in the broader issue of public health, these black and white messages often forget that, when it comes down to it, there are real people making real decisions for real families. We must move away from support that sees only the mother, only the baby, or only the breastfeeding.

Decision Making is Up to the Family

As a clinician, I must take a full health history of both the mother and baby in my care. Inevitably, this becomes what is, for many women, the first telling of their birth story to someone outside of their family. It is an incredibly raw and vulnerable experience. I learn of relationships, of history, of fears and of disappointment. I also hear of how she was proud of herself, of her strength and her tenacity. Every woman’s experience, both before and after birth, is wildly different. Each family is to be respected in their decision making. What is the right decision in birth, in breastfeeding…heck, even in what to do with their Saturday afternoon, is up to them, filtered through the lens of their experience, their history and their knowledge. There are things about the way I live my life that I believe deeply in, but this I believe more: Mothers are smart and incredibly capable of making the decisions that are best for their families. My job is to provide information, help them sort through their options and allow them to space to figure out what is best for them…even if what is best for them is not what I would have chosen.

She is About More than her Breasts

As advocates, sometimes we work so hard on the big picture ideas in regards to improving breastfeeding rates and cultural acceptance that we make the mistake of seeing each woman as one to be “conqured”…wishing only to “win her to our side”. Supporting breastfeeding on a macro level is tough work which takes huge volumes of energy, but what a disservice when we think of women as only check marks in the “initiated breastfeeding” or “exclusive breastfeeding for 6 months” columns.

Often, in an attempt to support breastfeeding, we forget that there is much more going on in this relationship than milk ejections and swallowing. The community supporting those with Insufficient Glandular Tissue and Low Milk Supply do this beautifully. Inspired by Diana West’s groundbreaking book Defining Your Own Success, these women champion the idea that THEY get to be the ones who decide what breastfeeding will look like for them, in light of significant challenges. We must look at breastfeeding women not as simply milk makers, but life makers and relationship makers and confidence makers as well.

Empower Parents for Long Term Impact

I’m absolutely convinced that the early days of of a baby’s life are critical to the formation of parenting confidence. What if, instead of throwing checklists full of things that not even well-rested people could handle, we instill confidence and a “we were made for this” kind of attitude. I’ve long maintained that birth and breastfeeding are the only two biological processes that we, as a culture, assume won’t work the way they were designed to. From the moment we announce our pregnancies, we are bombarded with messages that tell us that we simply aren’t up for the task, that out bodies will fail us, that we won’t be good enough, smart enough, mom enough. Why then are we surprised when those messages continue on into parenthood? For those we encounter as breastfeeding supporters, we can have a significant impact at a critical moment. Reminding a woman that her body was made for breastfeeding, encouraging her to follow her “gut”, and listening closely to her ideas about what could improve her outlook can all be vitally important. Moments like that set her up for future success. Feeling like “I am the most qualified person to care for my child” on Day 3 can often translate into the same feeling on day 5 and month 5 and year 5. Treating parents with respect and care and with the belief that they are wildly capable is critical.

The great Dr. Seuss was quite the philosopher when he penned, “A person’s a person, no matter how small” and I would echo with “A family is a family no matter how young.” As we seek to pour our professional and volunteer lives into these brand new families, we must remember that communicating about their value and worth are important building blocks to their long term confidence as parents. I’m privileged to be able to be one of the first professionals to look them in brand new parent (bleary and bloodshot) eyes and say “You’ve Got This!”

Amber McCann, IBCLC is a board certified lactation consultant in private practice with Nourish Breastfeeding Support, just outside of Washington, DC and the co-editor of Lactation Matters, the official blog of the International Lactation Consultant Association (ILCA). She is particularly interested in connecting with mothers through social media channels and teaching others in her profession to do the same. In addition, she has written for a number of breastfeeding support blogs including Hygeia and Best for Babes. She also serves as the Social Media Coordinator for GOLD Conferences Internationaland is a regular contributor to The Boob Group, a weekly online radio program for breastfeeding moms. When she’s not furiously composing tweets (follow her at @iamambermccann) or updating her Facebook page, she probably snuggling with one of her three children or watching terrible reality TV.

Filed Under: Article, baby, Breastfeeding, Breastfeeding and society, breastfeeding help, breastfeeding support, family, father, Featured, guest posts Tagged With: Amber McCann, baby and mom, Breastfeeding, breastfeeding dyad, Breastfeeding support, family, marriage, Nourish Breastfeeding Support, postpartum, relationships

A Translation Guide for Navigating the Terrain Between Breastfeeders and Formula-Feeders

February 16, 2012 by theleakyb@@b

Talking about breastmilk or formula can be difficult to navigate with a loose, slippery, and uneven terrain. One second you think you have sure-footing and the next you’re on your butt.

I’m not going to deny that hurtful phrases come from breastfeeding supporters, occasionally in the form of personal attacks, and if you’ve personally experienced that, I’m truly sorry. Please know that most of us just want to get information out there, encourage others and want to see babies fed. Including me.

More often I see what are truly meant as innocuous statements of information and education that are simply misunderstood. All of us experience life through a variety of personal filters and we often have sensitive areas that automatically put us on our guard and we may take things as a personal attack when that’s hardly the intent. When it comes to feeding babies all those devoted moms doing their best have some serious passion.

An article is released sharing the findings of a new study that revealing some new findings about breastmilk or there may be some issues with formula and hundreds of comments pour in with things like “formula is the same thing, really and all the breastfed kids I know are sick all the time but my formula fed kids have genius IQs and are never sick” or “you know, not everyone can breastfeed so I guess I’m a bad mom because my breasts just didn’t work.” To add fuel to the fire there are the comments that say things like “See, this is why I’m so glad I gave my babies the best and breastfed.” And really, what does saying something like that do for anyone? Heaven forbid it be an article on a formula recall and the “so glad I breastfeed, breastmilk is never recalled” comments start flooding Facebook newsfeeds and loading the comments section on blogs and articles. Nothing like rubbing someone’s face in their scary circumstances and flaunting “sucks to be you!” If we’re not careful we cross the line from passionate advocacy into plain ol’ bullying.

Then there’s the mom celebrating her success in breastfeeding, sharing “So excited we’ve made it to 6 months without even one drop of formula! GO BOOBIE MILK! WOOT!” In that moment that mom is inviting everyone to a party at her house because she’s truly excited about her accomplishment. But just as sure as she’s about to pop the cork on that sparkling grape juice to pour a round for everyone someone says something like “I don’t know why everyone has to be so down on formula, it makes moms that use it feel bad.”

They probably don’t mean to be a Debbie Downer and they don’t intend to dismiss the celebration of that mom (or maybe they do, I can’t really say) but stirring in their internal narrative of parenting confidence are insecurities on this issue, perhaps closer to the surface than they realized. Instead of being able to celebrate with that mom, they are having to deal with their own less than happy feelings and defend, at least to themselves, their reality.

Thankfully, most of the time people can just say some encouraging and supportive words. Once in a while, far more often than I’d like, the communication deteriorates. Quickly. As though we’re trying to have an important conversation but lack the skills. Like we’re speaking different languages.

Maybe we need an interpreter? What follows is my light-hearted attempt at some translations to help us navigate these slippery slopes.

It’s not a put down on formula feeding mothers when breastfeeding advocates say:

“Breastfeeding is the normal way to feed a baby.”

What we don’t mean: “Formula feeding moms are less of a mother and less than normal.” We know that’s not true. We also know that breastfeeding isn’t (yet) accepted as normal in society. We certainly don’t mean that it is always easy or even possible for every mom. Or that formula feeding moms don’t deserve to be treated as normal, loving, caring mothers because we know they are normal, loving, caring mothers. Nope, none of those things are what we mean.

What we do mean: Breastfeeding is the biologically normal way to feed a baby. A mother’s body is programmed to breastfeed and a newborn baby is programmed TO breastfeed. Meaning that, barring any physical difficulties, babies are born ready to breastfeed; the delivery of the placenta signals the mother’s breasts to produce milk to feed, the mother’s body biologically responds to birth by producing milk, and human milk is (usually) the perfectly formulated food biologically for a human baby.

“I’m proud to breastfeed.”

We don’t mean: “I’m better than a formula feeding mom.” Just like being proud to be a mother isn’t a put down to those aren’t mothers, so being proud of breastfeeding isn’t a put down to those that don’t breastfeed.

We do mean: Breastfeeding is important to us and sometimes it’s hard and comes with recognized challenges. We’re celebrating our accomplishment of something we value as important for ourselves. We’re also recognizing that there is a lot in our society that sabotages moms that want to breastfeed and combating that can be challenging.

“I love the bond I have with my baby with breastfeeding.”

We don’t mean: “Moms that don’t breastfeed aren’t as connected to their babies.” Feeding a baby is a deep connection no matter how it’s done and is just one way parents bond with their babies. Most of us know moms that formula-fed and are incredibly bonded to their children and don’t doubt for a second that formula-feeding moms deeply love their children.

We do mean: This is something we consider special and helps us feel connected to our child. That, to us, breastfeeding has a deep feeling of interconnection that goes beyond something we can explain but we try even thought words fail us. Feeding our babies with our milk and at our breasts is one way we feel deeply bonded to our babies.

“I’m so glad I’ve never had to give my baby formula” or “I’m so glad she’s not had 1 drop of formula.”

We don’t mean: “Formula feeding moms are lazy or giving their babies poison.” Nope, it’s not a commentary on what someone else does. We’re not saying that somehow formula feeding moms should be ashamed of giving their babies formula or that never giving a baby formula is some dividing line between the good moms and the bad moms.

We do mean: Like being proud of breastfeeding, not giving their baby formula just feels like a personal accomplishment. It is in no way a reflection of our opinion of anyone else’s choice or situation, merely an acknowledgment of a personal goal.

“Breastfeeding is beautiful!”

We don’t mean: “It’s perfectly beautiful all the time.” Finding something beautiful doesn’t mean it’s easy or right for everyone and it doesn’t even mean we always enjoy the experience.

We do mean: Not only do we NOT find it gross, we also think it is special, something wonderful, and to be celebrated. It is more than nutrition to us and is a beautiful experience we treasure even though it has plenty of challenges along the way. We also know that not everyone agrees with us, that’s part of why we say it though so we can hope to change negative cultural attitudes toward breastfeeding.

“Breast is best!”

We don’t mean: “The moms that breastfeed are the best moms and the moms that don’t are just ok or bad.” That’s not it at all. In fact, this slogan came first from formula companies when they were forced to acknowledge that breastmilk was a superior product to formula. They had to acknowledge that but had to find a way that could make formula sound normal and breastfeeding to sound like it was a parenting “extra,” an optional choice.

We do mean: Breast milk is the best food choice available for a baby and young child. Personally, I don’t care for this statement myself (you can find more on that here) but I know when people say it they aren’t intending anything other than their enthusiasm for breastfeeding and stating a simple fact: breast milk is good for babies. It’s not a put down towards anyone.

“I feel sorry for babies that aren’t breastfed.”

We don’t mean: “Those kids are just so screwed.” This comment makes me uncomfortable, I don’t like it. But I understand where it’s coming from and why it’s said. Those of us that breastfeed see the joy and delight our own children have in the experience, how they love breastfeeding. We are completely convinced it is special for both them and ourselves in a purely innocent, sweet way. While it can be very close to a put down, I don’t believe it usually is intended as such and we don’t actually full on pity children that didn’t get to breastfeed but rather mourn the loss of an experience we consider special.

We do mean: This is an awkward but genuine expression of sadness for those missing out on something we feel is so special. Should it be said? I don’t think so. But if it is I hope formula-feeding moms can understand it is most likely only because the speaker/writer truly believes every child should get to have the marvelous experience her own enjoyed so much.

“There need to be strict regulations regarding the manufacturing and marketing of formula.”

We don’t mean: “Formula-feeding parents are gullible and fall for the marketing of poisonous formula.” Voicing the view point that there need to be standards in how formula is marketed and that there should be strict regulations for formula as a product isn’t a reflection on the parents at all. It may reflect a cynical distrust that formula manufactures have anything other than a bottom line on their mind (Unsupportive Support- For a Profit). Ultimately though, those of us that believe that the manufacturing and marketing of artificial breastmilk substitutes in infant and toddler nutrition believe so for the good of the children’ receiving the product.

We do mean: Even if our children don’t receive formula, the children that do are worth higher standards of excellence. We demand transparency and better regulations for artificial breastmilk substitutes manufacturing for the babies that need it. Formula is necessary, the health of many children depend on it being manufactured with integrity.

Before you find yourself careening down a conversation on your butt, try to remember that most people aren’t trying to start something and those that are probably aren’t worth your time. As a breastfeeding mother, I promise, I’m not trying to push formula feeding parents down. We’re all just carefully trying to pick our way over the rocks, slippery spots, and potential jabs to enjoy the view life has to offer and with a little bit of sensitivity and understanding going both ways, we can all offer a hand to each other in spite of our differences.

Filed Under: Article, Breastfeeding, Breastfeeding and society, breastfeeding help, breastfeeding humor, breastfeeding support, Featured, formula, guilt, humor, Jessica, motherhood, nursing, Parenting Tagged With: Breastfeeding, breastmilk, formula, mompetition, moms, support, Unsupportive support

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

Leaving the parenting island and asking for help

by Jessica Martin-Weber

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

Dear Kathleen- Too much and not enough, weaning and supply during monthly cycle

Dear Kathleen- on nipple damage healing and pumping

Dear Kathleen- Leakies ask an IBCLC

Medications and Breastfeeding

This post made possible in part by the generous support of Rumina Nursingwear.

Supporting the Breastfeeding Family as a Whole

A Translation Guide for Navigating the Terrain Between Breastfeeders and Formula-Feeders

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by Jessica Martin-Weber

This post made possible in part by the generous support of Rumina Nursingwear.

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