Breastfeeding and COVID-19 Research and Resources

Updated June 19, 2020
Compiled by The Leaky Boob, theleakyboob.com, Facebook.com/TheLeakyBoob

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This resource list is an evolving work in progress. If you are aware of some resources or materials that should be included, please comment with the link.

 

Health Organizations Recommended Practices and Protocols:

Considerations for Inpatient Obstetric Healthcare Settings

  • CDC (Centers for Disease Control and Prevention)

 

Evaluation and Management Considerations for Neonates At Risk for COVID-19 – Caring for Newborns

  • CDC (Centers for Disease Control and Prevention)

“…the risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team, and decisions about temporary separation should be made in accordance with the mother’s wishes.”

 

Breastfeeding advice during the COVID-19 outbreak

  • WHO (World Health Organization)

 

ABM STATEMENT ON CORONAVIRUS 2019 (COVID-19)

  • ABM (Academy of Breastfeeding Medicine)

 

Pregnancy, childbirth and caring for newborns: Advice for mothers during COVID-19

  • Public Health Agency of Canada

 

Clinical Management of COVID-19

  • WHO (World Health Organization)

 

Infant and Young Child Feeding in Emergencies, including COVID-19

  • United States Breastfeeding Committee 

 

 

Pregnancy, Birth, and Breastfeeding and COVID-19 Specific Resources:

 

SARS‐CoV‐2 and human milk: What is the evidence?

  • Wiley Online Library
    • Kimberly A. Lackey, Ryan M. Pace, Janet E. Williams, Lars Bode, Sharon M. Donovan, Kirsi M Järvinen, Antti E. Seppo, Daniel J. Raiten, Courtney L. Meehan, Mark A. McGuire, Michelle K. McGuire

 

New Studies Investigate How COVID-19 May Impact Breast Milk and Pregnancy 

  • University of California San Diego School of Medicine – Michelle Brubaker

 

Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records.

  • The Lancet
    • Huijun Chen, PhD – Juanjuan Guo, MS – Chen Wang, PhD – Fan Luo, PhD – Xuechen Yu, MD – Prof Wei Zhang, PhD – Prof Jiafu Li, MS – Prof Dongchi Zhao, PhD – Dan Xu, MS – Qing Gong, MS – Jing Liao, PhD – Prof Huixia Yang, MD – Prof Wei Hou, PhD – Prof Yuanzhen Zhang, BS 

 

Antibodies in Infants Born to Mothers With COVID-19 Pneumonia

  • Jama Network
    • Hui Zeng, MD – Chen Xu, BS – Junli Fan, MD – Yueting Tang, PhD – Qiaoling Deng, MD – Wei Zhang, MD, PhD – Xinghua Long, MD, PhD

 

Guidelines for Healthcare Facility Management of Perinatal Care of Persons with COVID-19 of Suspected COVID-19

  • Bryna Sampey

 

Skin-to-Skin Care and COVID-19: downloadable file

 

Breastfeeding and coronavirus disease-2019: Ad interim indications of the Italian Society of Neonatology endorsed by the union of European Neonatal & Perinatal Societies

  • Wiley Online Library
    • Riccardo Davanzo – Guide Moro – Fabrizio Sandri – Massimo Agosti – Corrado Moretti – Fabio Mosca

 

COVID-19, Pregnancy and Breastfeeding: What We Know Is Reassuring

  • Helpful blog post with compilation of materials explained

 

Mother-Infant Contact and Breastfeeding Should Remain Top Priorities during COVID-19

  • John Hopkins Nursing, Dr. Cecília Tomori

Breastfeeding, Separation, and COVID-19 Specific Resources:

When Separation is not the Answer: Breastfeeding Mothers and Infants affected by COVID‐19

  • Wiley Online Library
    • Cecilia Tomori – Karleen Gribble – Aunchalee E.L. Palmquist – Mija-Tesse Ververs – Marelle S. Gross

 

COVID-19: Separating Infected Mothers from Newborns: Weighing the Risks and Benefits

  • Harvard Medical School – Melissa Bartick, MD, MS, FABM

 

Mother-Baby Separation for COVID-19 Not Evidence-Based, Experts Say

  • MedScape – Troy Brown, RN 

 

Should New Mothers With COVID-19 Be Separated From Their Newborns

  • The Hastings Center
    • Stowe Locke Teti – Christy Cummings – Louise P. King – Cynthia C. Coleman – Kayla Tabari – Christine Mitchell 

 

 

Maternal Mental Health, Separation, and COVID-19 Specific Resources:

COVID-19 and maternal mental health: Are we getting the balance right? 

  • MedRxiv (The Preprint Server for Health Sciences) – CHS (Cold Spring Harbor Laboratory – BMJ – Yale
    • Anastasia Toplidou – Gill Thomson – Soo Downe

 

Effects of COVID-19 pandemic on anxiety and depressive symptoms in pregnant women: a preliminary study

  • Taylor & Francis Online
    • Ferit Durankuş – Erson Aksu

 

 

Breastfeeding and Separation Resources, General:

Rights of Children in Relation to Breastfeeding in Child Protection Cases: downloadable file

 

 

Helpful Breastfeeding Resources, General:

Exclusive breastfeeding for the first 3 months of life may reduce the risk of respiratory allergies and some asthma in children at the age of 6 years.

  • Wiley Online Library – Gayla Bigman

 

 

Working with Health Care Providers Resources:

Breastfeeding Empowering Language in Medical Settings

  • Mom2Mom Global- Amy Smolinski

 

The SHARE Approach—Essential Steps of Shared Decisionmaking: Quick Reference Guide

  • AHRQ(Agency for Healthcare Research and Quality

The SHARE Approach is a 1-day training program developed by the Agency for Healthcare Research and Quality (AHRQ) to help health care professionals work with patients to make the best possible health care decisions. It supports shared decisionmaking through the use of patient-centered outcomes research (PCOR).

 

 

Current and Ongoing Studies:

ISRHML Activities and Guidance related to COVID-19

  • ISRHML (The International Society for Research in Human Milk and Lactation)

 

 

Additional Resources:

Safe Handling of Containers of Expressed Human Milk in All Settings During the SARS-CoV-2(COVID-19) Pandemic

  • National Library of Medicine – National Center of Biotechnology Information
    • Kathleen A Marinelli – Robert M Lawrence

 

Publishers Provide Scholarly Content Free on Project MUSE During COVID-19 Crisis

  • Project Muse

 

Is there a resource or research you’d like to see included here? Please let us know.

 

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Looking to Increase Your Pumping Output? Try Parallel Pumping!

by Jessica Martin-Weber with Dr. Kathleen F. McCue, FNP-BC, IBCLC-RLC
This article made possible by the generous support of Littlebeam Nursing Pillows.

Not every lactating parent will find it necessary to pump to reach their breastfeeding goals. Many, however, do find it necessary. Whatever the reason for pumping breastmilk- whether it is to supplement your baby with your milk when you are away from them, to supplement at-the-breast feeds regularly, or in order to donate – efficiency and sufficient milk supply are certainly desired. While the primary way to increase breastmilk supply is to empty the breasts fully and frequently, and usually nothing is quite as good at that as your baby, sometimes other strategies are helpful particularly if you’re looking to increase your pumping output. It is important to note that output isn’t the same as supply and sometimes it is just about getting the milk that is in the breast, out of the breast! Typically, if everything is functioning normally, our sweet, soft, warm, cuddly babies are much better at emptying the breast than a cold, whirring machine pressed against your breast sucking mechanically. Letting down to a breast pump may take time and practice and there are several different aspects of milk let down with a pump that can help such as proper flange fit, lubricating flanges, and utilizing the suction and speed settings on the pump to customize cycles that encourage let down and expression. Without that cuddly, sweet, soft, and warm baby, trying to get letdown can be, well… a let down.

But what if you could have the cuddly warm baby help with both emptying the breast and having more of an output with the pump?

Rather than feeding baby directly from the breast, then pump, then bottle-feed (also called “triple feeding”), pumping one side while baby is latched on the other can cut down on a step if supplementing with mother’s milk is necessary. Pumping one side while baby is latched on the other is called “parallel pumping.” Parallel pumping may cut down on work, save time, and may lead to increased output. Parallel pumping is the breastfeeding version of working smarter, not harder. It is believed parallel pumping yields such results because having baby latched helps with initial letdown (ever leak from one breast when baby is latched and breastfeeding from the other breast?), trigger additional letdowns to the pump, and double stimulation increases the body’s response and increases milk production- much like having twins. My own personal experience with parallel pumping was such that even when my own babies no longer needed my milk, I was responding so well with parallel pumping that I continued in order to donate my milk to other babies. It made pumping seem like less of a time commitment in order to donate as I was able to do it when I was already sitting to feed my baby, and it took less time to pump while having an even higher output.

*Keep reading for tips on getting started with parallel pumping.

The technique of parallel pumping works so well and with such efficiency that many parents have tried it with excellent results. Dr. Kathleen F. McCue conducted a study that is being published in Clinical Lactation journal that looked at satisfaction with the technique of parallel pumping. 

Some comments from patients:

“I was able to sit there and nurse him and also pump so that my husband can do the next feeding, which was fabulous.”

“I felt a sense of accomplishment the first time I did it. [Like,] ‘Okay, look at this. It’s working really well.’ She got into the football hold. I was able to pump, and it did feel like it was maximizing time.”

“Once you get the mechanics down it felt good in a way to feel like you were being efficient, like an efficient use of time.”

“I feel like I’m getting the pumping done simultaneously. Because I’m only pumping one breast at a time I can have one clean flange waiting… for next round. It actually takes a little bit of pressure off of me and I feel like I’m getting more done.”

“It is just efficient, because if my daughter only wanted to nurse from one side then normally what I would do is that I would feed her and then get her down sleeping, and then pump the other side. So, if I could just pump while she was nursing, it’s more efficient that way. That was nice not to have to then, after I get her down, then sit down and have to pump for another 15 minutes.”

Now you have heard how well parallel pumping works, it’s time to get started!

  • Get comfortable feeding your baby with a variety of holds. Many find the football hold most comfortable for parallel pumping but try different holds and get comfortable with them to see what best works for you.
  • Pillows are your friend. Support your baby’s body with pillows. A versatile nursing pillow such as the Littlebeam Nursing Pillow will allow you to find the best position that works for you and your baby. Use as many pillows as necessary to support your baby at your breast.
  • Choose your pump. A double electric pump may be most efficient even though you’re only using one side to parallel pump. However, some find a single electric or manual pump to be sufficient. A passive silicone suction pump may be a comfortable, effective option as well.
  • Set up and be familiar with your pump before trying to parallel pump. A few pumping sessions with just the pump can go a long way in making the experience of parallel pumping a smooth one. Remember, it isn’t always best to crank the speed and suction all the way up, particularly if it makes you uncomfortable or causes you pain. Instead, use the highest comfortable vacuum setting with the highest speed to encourage letdown, slowing the speed when letdown is achieved. Adjust multiple times through the feed/pumping session for best results.
  • A hands-free-pumping bra is the way to go. Free up your hands to support your baby, use the pump controls, utilize hands on pumping/breast massage, or even just to be able to take a drink while you feed the baby and the pump.
  • Get comfortable. Find a spot that is comfortable with plenty of room for you, the baby, and your pump. 
  • Don’t wait for late hunger cues. Set up before baby is too hungry by catching those early hunger cues and get situated before baby is upset and “hangry.” Have flanges and milk storage container (bottle or bag) washed and ready to go between feedings/pumping sessions.
  • Position pump first. Have the pump placed on your breast before bringing your baby to your breast. It is much more challenging to get the pump in place with a squirmy baby on the other breast.
  • Distraction. Some babies find the pump to be a distraction and may hit or kick the pump, yank tubing, or simply stop feeding to look at it. Have something for baby to focus on such as a nursing necklace or safe toy.
  • Have baby prime the pump! Latch baby before starting to pump then turn on the pump (remember, not too strong- pain interferes with letdown!) and pay attention to your baby. Before you know it, your milk will be flowing!

Want more on parallel pumping? Watch the following video with Dr. Kathleen McCue.

How to Select a Breast Pump and Get It Through Your Insurance

by Jessica Martin-Weber with Leah De Shay, IBCLC, and Lauren Bennet, BSN

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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 article made possible by the generous support of Aeroflow Breastpumps.

Get Paired with your perfect pump through Aeroflow Breastpumps

Disclaimer: This information is not to replace the advice of your health care provider. If you are experiencing breastfeeding difficulties find IBCLC. Not everyone needs to pump, successful breastfeeding is not dependent on pumping if there is no need to pump. This article is simply for information, not promoting any specific pump but rather promoting finding the right pump for your needs.

Selecting a breast pump can be an overwhelming task. It can be confusing to sort through the various pumps on the market, what you need, the terminology, and what to look for in a pump. I talked with IBCLC and mom Leah De Shay, and BSN and pump specialist, Lauren Bennet about the basics of selecting a breast pump and, if you’re in the USA, getting your pump through insurance. You can see the entire conversation here:

I’m frequently asked what is the best pump and while I know people are hoping I’ll give them a specific brand and model of pump, the truth is my answer is way more open:

The best pump for you is the pump that helps you reach your breastfeeding goals within your budget, comfort, ability to operate, and that suits your pumping lifestyle and needs.

There is no one pump I can say is the “best” and while I may have my favorites (and it hasn’t always been the same with each baby), my favorites have been based on what has worked best for me at that time recognizing that my breasts and my lifestyle and pumping needs may not be the same as the next person.

Ameda Finesse breast pump

Ameda Finesse

So how do you figure out what pump you should get?

Fortunately, there are a good number of pumps on the market and it is very likely that there are a few that would be just right for you. Though you can’t know for sure what will work best for you until you try it and sometimes one pump may not be a good choice for you while another one could be ideal, there are steps you can take to get you closer to the perfect pump. Just because one pump works great for your best friend doesn’t mean that your breasts will respond the same to that exact pump or even that one particular pump doesn’t work well for you but another may. The best you can do is see what worked for other people and gather as much information as you can on the various pumps available to you before you make your decision. If you’re feeling confused, the pump specialist at Aeroflow may be able to help you further but for now, we’ll break down the terminology, ask questions to help you determine your pumping lifestyle needs, and share how to get your pump covered through your health insurance as part of the Affordable Care Act. For more in depth information, watch the above video.

Lansinoh Smartpump

What does it all mean?

There’s a lot of terminology used in association with breast pumps and if you don’t know what these concepts mean, it can sounds like a foreign language. This is just a quick look at some of the most frequently used terms:

Manual– a hand pump, doesn’t require electricity or batteries as it is powered manually.

Double Electric– a breast pump that can pump two breasts simultaneously with an electric powered motor.

Closed System– barrier designed to protect pump motor and tubing against moisture, mold, and pathogens.

Personal Grade– not a specific designation but usually used to mean a lower suction level, open or closed system, FDA approved as a single-user, limited pumping hours (usually 300-500), and available to consumers directly through retailers and DMEs (Durable Medical Equipment suppliers) usually with a maximum suction level of 25—300mmhgs.

Hospital Grade– not a specific designation but usually used to mean higher suction levels, closed system, FDA approved as multi-user, and longer life/higher pumping hours and limited availability such as renting through a hospital.

Multi-user– FDA approved for multiple users with their own individual kits.

mmHg– suction level.

Motif Duo Breast Pump

Your Pumping Lifestyle and Needs

While it may be tempting to get the pump with the most bells and whistles, the strongest suction level, and the highest dollar amount, reality is that may not be what you need or even the best pump to help you reach your goals. Keep these factors in mind when you assess your pumping lifestyle and needs:

  • How often do you plan to pump? Is it for working 40 hours a week away from your baby (approx. 3x/day) or to exclusively pump, or once a day as a breastmilk donor, or just for the occasional date night?
  • Will your pump need to be easily portable? Will you be lugging it back and forth frequently or will it be mostly stationary?
  • What will your pumping environment be? A relaxed, private setting, or an open cubicle or your car? Will you be multitasking or able to just focus on pumping? Does it need to be quiet? Will you have limited time available or however much time you need?
  • What type of power source will you need? Will you have access to an outlet?
  • Are there flange size options or will the standard available sizes work for your breasts?
  • How long do you intend to pump? Six weeks, six months, a year, or longer?
  • Will you be dependent on your pump and need to have access to replacement parts quickly?
  • Are you going to be more comfortable with independent speed and suction control or will preset options give you more confidence?
  • Will you need more than one pump?
  • Are there other factors unique to you and your situation you need to consider?

Medela Starter Set

Picking Your Pump

After you determine your pumping lifestyle and needs, you can begin to look at the various pumps available to you taking these factors into consideration. At the end of the day, picking the pump that is best for you is just as important as knowing how to use your pump correctly (i.e. don’t just crank it to the highest setting!). Remember, higher suction isn’t always better, longer cycling isn’t necessarily better at emptying the breast, and bells and whistles may not be what you need. In fact, higher suction can mean less milk output, particularly if the suction level causes pain. Your comfort is key in how you will respond to a pump. The pump that is best for you meets the criteria that fits your pumping lifestyle and needs.

Get your pump through your insurance

The Affordable Care Act means that many insurance plans now cover breast pumps. Each insurance company and even each policy can vary in what is covered, the options available, the criteria that must be met, and timing.

It can all be a bit overwhelming. Fortunately, Aeroflow Breastpumps has streamlined the process, simplifying everything. Typically it takes between 3-5 days to hear back from a Breastpump Specialist from Aeroflow and depending on your insurance provider and policy, you can typically get your pump anywhere from 30-60 days before your due date and any time up to a year after giving birth.

 

how to pick the best breast pump

Here’s what you do:

Submit your medical insurance information with a few other demographics and a dedicated Breastpump Specialist will verify your insurance coverage.

Your Breastpump Specialist will contact you to explain your benefits and your pump options, including possible upgrades and using your FSA or HSA funds to cover an upgrade.

They’ll ship your breast pump!

Find out online if you qualify for a free breast pump through your insurance.

Things Aeroflow Breastpump Specialist does for you:

  • Contact insurance agent and verify coverage.
  • Coordinate with your doctor to get your prescription to your insurance company.
  • Help you understand the different benefits of the variety of breast pumps.
  • Make sure your pump ships at the right time. Some insurance companies limit when a breast pump can ship (for example 30 days before your due date).
  • Handle all the billings with your insurance company.

Aeroflow provides a number of services and resources as well as products that may be helpful to you in reaching your breastfeeding goals. Picking a pump and navigating insurance coverage can be overwhelming but it doesn’t have to be!

 

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Leah De Shay graduated from La Sierra University with a degree in Psychology and Speech Pathology and Audiology. She completed her post-baccalaureate work in lactation at University of California, San Diego and went on to get her CLEC (Certificated Lactation Educator Counselor) certificate, and completed her IBCLC (Internationally Board-Certified Lactation Consultant). Leah has since worked in various health care systems, including as Director of the Welcome Baby Program, Providence. She currently serves patients throughout southern CA as the coordinator for infant feeding at LOOM and the Lactation Specialist at Growing Healthy Together. In addition to her clinical practice and as a busy mom herself, Leah also assistant teaches for the UC system. 

 

Lauren Bennet is a graduate of the Medical University of South Carolina and a Registered Nurse (BSN), and practiced as an intensive care nurse for 3 years. Currently, Lauren leads an incredible group of passionate and fun people at Aeroflow Breastpumps as the team lead managing the breast pump specialists. In her free time, she enjoys hiking, camping and being outdoors in and around Asheville, NC. 

 

 

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 wereallhumanhere.com, freelance writer, and co-founder of Milk: An Infant Feeding Conference. Jessica lives with her family in the Pacific Northwest and co-parents her 7 daughters with her husband of 23 years.
 

Pumping Basics Part 1- What The Experts Say To Do To Get Started Pumping Your Breastmilk

by Jessica Martin-Weber with Rene Fisher, IBCLC

This article made possible by the generous support of Ameda.

Ameda Finesse Double Electric Breast pump

When my baby was 4 weeks old, it was time for me to get started pumping not only for my baby to be able to receive my milk when I had to be away from her for work, but also for me to donate my milk to other babies.

To help me get started pumping, I spoke with Rene Fisher, IBCLC from Ameda, Inc. She helped me pick out a pump, the new Ameda Finesse Double Electric, and got me all set up. Via video chat and live stream, Rene got me all ready to go and before I knew it, I was filling milk storage containers with my milk. Thanks to Rene’s help, for the first time ever, after pumping through 6 babies, I’m finally using the right size flanges and pumping pain-free. See what I learned in the video and points below.

Setting Up Your Pump

Carefully read your instruction manual and ensure you have all the parts you need. Follow the directions for preparing your pump and setting up. Wash each part that comes in contact with your breast and milk including the flanges, milk storage containers (unless you intend to pump directly into bags such as the Store and Pour Ameda breastmilk storage bags), valves, and diaphragms. Do NOT wash the tubing. Plug in your power adaptor or install batteries. Wash your hands and assemble the kit (tubing, flanges, diaphragms, valves, milk storage containers, etc.).

Determine Your Flange Size 

Flanges are the horn shaped pieces that hold the pump and storage containers to your breasts. Correct fit of the flanges can prevent tissue damage and improve the effectiveness of your pump. All nipples are different and dynamic and the size of your flange may determine how you respond to pumping. Too small may cause pain and stress, reducing your output to the pump. Too large may cause too much areola and breast tissue to be engaged and not enough stimulation for let down or may result in reduced output. If your nipple presses against the flange or rubs, you may need a larger size. If there is a significant amount of space around your nipple and additional breast tissue is entering the flange which may rub, you may need a smaller size. Because nipples are dynamic, they may change during pregnancy, breastfeeding, and pumping. You may even need a different size flange mid-pumping session. See this video below and the information here to help you determine correct flange size.

Beginning: Set Up

If possible, set up in a quiet, relaxing space. Have a drink and a snack. Get as comfortable as possible, having read the manual prior to beginning.

Beginning: Positioing

Position the flange centered over your nipple, pressing in lightly to create a seal. Without a seal there will be no suction. If you are double pumping you can use your arms to help hold the flanges to your breasts but you may want to use a hands-free-pumping support.

Beginning: Before You Start

Relax. Close your eyes. Take a few deep breaths. Think of your baby. Focus on why you’re pumping rather than the output itself. You may want to watch a video of your baby, look at a photo, or smell their clothing.

Beginning: Turn Your Pump On

To get started with pumping, if your pump has individualized speed and suction settings, set your pump on the highest speed and, following the instruction manual for your pump, turn your pump on at the lowest suction level. Gradually increase suction strength to the highest comfortable level. Pumping should never hurt. It is not necessary to go to the highest level if it is painful for you and doing so could interfere with the milk ejection reflex and let down and result in reduced milk output to the pump, potentially causing tissue damage.

Beginning: Let Down and Expression

Stimulate let down with a high speed and the highest comfortable suction. Once let down begins (marked by spraying or flowing milk), reduce speed. You may feel ready to increase the suction level but only do so the the highest comfortable level. When the flow of milk slows to drips or a trickle, return to a higher speed and the highest comfortable suction level to stimulate another let down. It is possible to get up to 9 let downs in a 20 minute pumping session by adjusting speed and suction levels. It may be helpful to observe your baby’s pattern at the breast and mimic it as closely as possible with the pump during your pumping sessions.

When To Pump

When you pump for the first time will greatly depend on why you are pumping. If your baby is in the NICU and there is clinical separation from birth, you will need to begin as soon as possible and plan to pump 8-12 times within a 24 hour period for exclusively pumping. If you are pumping to return to work at 6 weeks postpartum, it is advisable to wait until 3-4 weeks postpartum and your milk supply and breastfeeding are established to protect your supply. If possible, introduce pumping gradually for partial separation giving at least an hour before breastfeeding again after pumping (though let your baby feed at the breast whenever they want to!). Many breastfeeding parents find they get more milk pumping first thing in the morning. Pumping one side while baby is latched and feeds from the other can also lead to more let downs while pumping.

How Long To Pump

Many breastfeeding parents find that 15-20 minutes is adequate time to pump. Some may find it takes longer but with the right pump and proper flange fit, 15-20 minutes will be plenty for most. Utilizing hands on pumping or breast massage while you pump can help encourage your breasts to empty fully, signaling your breasts to produce more milk for your baby. When you pump will depend on your reasons for pumping, how long you are away from your baby, and the amount of milk you need. Every breastfeeding parent and baby are different, figure out what works for you. For more on when and how long to pump, see here.

 

Mother of 4, Rene Fisher has been an IBCLC since 1998. Rene has worked in private practice before going on to be a hospital Lactation consultant for 10 years where she was responsible for nurses and patient education and hands on assistance with breastfeeding mothers. Rene got started in lactation support as a La Leche League Leader 1993 and became a member of La Leche League Area Professional Liaison Department from 2000 -2010. Today, Rene supports families in reaching their baby feeding goals working with Ameda breastfeeding products.

 

 

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, freelance writer, and co-founder of Milk: An Infant Feeding Conference. Jessica lives with her family in the Pacific Northwest and co-parents her 7 daughters with her husband of 21 years.
 

Happy Sex Life – Happy Family, Good Clean Love

by Wendy Strgar

 

goodcleanlove.com

(Facebook livestream on The Leaky Boob with Jessica and Jeremy, parents of 7, featuring Loveologist, Wendy Strgar.)

It has been almost two decades since the birth of my fourth and last baby and yet, even 20 years later, I still remember the cold snap that overtook my marriage in the months that followed her birth. It wasn’t like the previous three kids hadn’t taken a cumulative toll on our sex life. But it was also easy to blame our degenerating intimate life on the overwhelming demands and exhaustion of raising four kids. Over time, it became clear that there were actually many other more important factors contributing to the sexless state of our marriage, and more importantly, that the lack of intimacy we shared was creating deep fissures in the foundation of our loving connection.

It was mind boggling for me, as I suspect it is for most every new parent, just how much of our attention is consumed by the fragility and wonder of a new life – often more than we think it is. In ways that I didn’t expect, a powerful internal conflict grew with each child I had, and worse still, lived at the epicenter of the ongoing and escalating conflicts I had with my partner. Who got to do their own thing, whether occupationally or personally, became our ground of competition. With each new baby the challenges of meeting my own needs and knowing my own desires left me feeling lonely and often angry at my husband. Our experience of growing a family was so different. His inability to understand my ambivalence about full-time mothering and my longing for myself isolated us from each other. And not surprisingly, it was our sex life that was held hostage by our ongoing estrangement in our relationship.

 

Wendy Strgar

 

This loss of a sex life is so common to new parents that it’s cliché. In fact, of all life transitions having a baby tops the list for the disruption of a woman’s libido and a couple’s sex life – sometimes for years. Of course there are many factors at play here – everything from hormones to how couples communicate and show up for each other after the birth of a new baby plays a big role. But even more important than many people realize is how a lack of sexual education and communication skills weighs on our ability to adapt and grow together intimately.

Initially, our sex life falls apart innocently with the many challenging circumstances of growing a family.   But often what becomes clear is just how our limited sexual education manifests and undermines our ability to both identify and express our sexual needs. Without realizing it, our deficit of sexual know-how degenerates into low sexual self-esteem and turns into a battleground of hurt feelings. I remember early in my marriage how little I understood about my own arousal mechanism and how uncomfortable we both were when it came to using words to describe our sexual preferences. Erroneously, I believed that my partner should just know what kinds of touch felt best or which positions worked for me – which was strange, because I didn’t know them myself.

The truth is that what we have no language for is often not available to us. And it is not surprising that so many relationships suffer from ongoing sexual dysfunction issues issues like pain with sex, the inability to orgasm, ongoing vaginal dryness or for men, premature ejaculation and the inability to maintain erections. In fact the sexual health issues are shared almost equally between male and female partners.

We struggled with this combination of sexual inexperience for more years than I would like to admit, which often created more frustration than our fledgling relationship could hold. We often degenerated into hurtful sexual blaming that made both of us feel impotent and afraid to engage. Living with persistent sexual frustration often evolves into an approach-avoidance game where everyone loses and one, or both, partners starts putting one foot out the door.

As our sex life starts to slip away, we don’t realize the impact it is having on the cohesion in the whole relationship. We forget how much emotional release that our physical intimacy brings. I often call it the glue that keeps all the rest of the mess intact, but we know that not engaging sexually undermines the health and longevity of the relationship in so many other ways.

Finding your way out of this downward sexual spiral is possible and deserves your attention. What helped us was both recognizing how much we didn’t want to lose the intimate space we had taken for granted, and developing the curiosity to learn more about our own sexual response. The more confident I became in my own ability to express my sexual needs, the more I could bring to our intimacy and stop blaming him when it didn’t work.

As he saw my willingness grow, and wasn’t worried about my wrath, he had time and space to figure out what helped for him to last longer. With practice, I also got better at finding ways to wake up my arousal which made it possible to throw out the entire idea of needing to “be in the mood.” The more I trusted my capacity to generate a sexual mood, the more we were able to synch up our sexual desires.

During all the baby years I usually had to think my way into desire. It never just came to me, but it became easier and easier to remember how much softer life was for everyone when we took care of our sexual needs first.

 

Wendy Strgar is an award-winning entrepreneur and the founder and CEO of Good Clean Love, a pioneer in the organic personal care product industry. She is a popular blogger and author of two books. Sex That Works: An Intimate Guide To Awakening Your Erotic Life, published by Sounds True Publishing in June 2017, is the companion to her first popular book, Love that Works: A Guide to Enduring Intimacy. Wendy has been featured in many publications including The New York Times Book Review. For more information about Wendy’s relationship help books, visit her author website.

The Serious Injury No One is Talking About: Diastasis Recti

by Nicole Nexon, MSPT

This post made possible by the generous support of Chunkabuns

 

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Sometimes I feel like exercise has become a dirty word in the mommy sphere. I can understand that.

We get this message that we need to do everything – work, raise babies, maintain perfect households, create Pinterest worthy projects, not burn dinner… and erase any shred of evidence that our bodies have created life. Society settled on the idea that skinny = perfect and the backlash from that led to a movement of pride in our bodies. Which somehow turned in to “ real woman have curves “ and all kinds of craziness about skinny girls and curvy girls and…

It’s out of control.

And what has been missed in all of this is the truth of the matter – it’s not about skinny. It’s not about having curves or not having curves. It’s not about “mummy tummies” or thigh gap or muffin tops.

It’s about being healthy.

And not “healthy” in a way that has been co-opted by people meaning “stop eating junk food you fatty!” Healthy in way that allows people to live their lives in a manner they choose. Healthy in a way that allows you to lift babies and chase toddlers and carry laundry wherever you need to carry your laundry. Healthy in a way that makes you feel confident, that lets you sleep well and go about your life.

What happens when you’re injured…and you don’t even know it?

When I was pregnant with my second daughter, I began to feel a pretty distinct pain by my belly button. It was so specific that I was fairly certain I was developing an umbilical hernia. I brought it up with my midwife and was told it wasn’t a hernia. I was developing a diastasis recti – a split between the muscles and muscular tissue that runs down the center of the abdomen. The pressure inside from an expanding uterus/baby was just too much for the abdominal tissue to handle so the tissue and muscles were separating.

With my first pregnancy, I worked in an outpatient clinic that was less physically demanding. With this second pregnancy, my current position required a lot of physical lifting as a physical therapist in a subacute center for patients who were not sick enough for the hospital, not well enough to go home. I already had work restrictions due to the physical requirements of my job; working with those restrictions AND dealing with a developing case of Diastasis Recti made the restrictions even more difficult.

It was in this position that I recognized a growing group of people in need of support, awareness, and healing of Diastasis Recti: new moms.

Here were these women, trying to juggle new responsibilities, healing from the changes their bodies went through during pregnancy and subsequent post-partum recovery and there was little to no support or even awareness about the problems that Diastasis Recti presented.

Diastasis Recti can affect your body in some pretty drastic ways.

  • -Incontinence
  • -Irregular bowel movements,
  • -Lower back pain, spinal or hip injuries due to your abdominal muscle’s inability to support your body when you’re lifting or bending
  • -Pain during sexual intercourse
  • -Increased chance of sciatica or disc issues
  • -Increased chance of umbilical hernia
  • -Postural instability due to poor strength of the abdominal muscles

The effects are numerous.

Now it was MY body that was going to need to be supported.

My body that was going to need help carrying a car seat. A baby. My toddler. The laundry.

My body that was going to be more prone to injury- that would need me to completely rethink how I went about my day. I worked out through my pregnancy because I knew what was ahead of me. I knew my core was going to be compromised. I wanted to achieve a VBAC and I knew I would need endurance (among other things) to prevent a repeated OR experience. I went back to my books and read studies on exercise efficacy. I reviewed exercise programs for pregnant women, post partum women, and people who had just had abdominal or back surgery. I had a plan, and I HAD to be as physically strong as I could when I returned from maternity leave so I could perform my job effectively.

I ended up with a VBAC, a baby girl, and a three-finger diastasis.

*when I say “three-finger diastasis” I am describing how many fingers I can horizontally fit across the tissue separation. To find this, lay on the floor with knees bent and feet flat on the floor. Lift up your head slightly and contract your abdomen muscles gently. Find your belly button and make the “scout symbol” with your fingers…see how many you can fit in there. i.e. 1 finger, 3 fingers, etc. Check the same line down by your pelvis, and again up towards your ribs. Different points along your abdominal muscles may be different fingers of separation.

 


I feel blessed that my passion and my education allowed me to understand what my body needs to function well and heal from my condition. I am grateful for my colleagues and friends with whom I can discuss ideas or count on to help me with the hands-on techniques I can’t perform on myself. I know I am lucky to have access to the information that I have.

I want other women to have this valuable access to connections and resources that are out there for those recovering from Diastasis Recti.

I want women to know that sometimes “mummy tummy” can actually be caused by a medical condition.

I want women to know that the media are not medical professionals and there is a wide range of “normal” when it comes to our bodies.

I want other mothers to know that exercise and eating well are available to them.

I want women to know there are safe exercise routines that WON’T injure a body healing from Diastasis Recti. That recovering doesn’t need to be a series of scary, out-of-reach experiences. They don’t need to spend hours in the gym (Though you certainly can, if you enjoy it!).

Recovering means that you can take a walk, be it pushing a stroller or wearing a baby. You can do squats in your living room, jumping jacks, and eventually pushups and planks. (But until you’ve healed from your diastasis, it is best to do modified planks so that you don’t further separate your diastasis or have your abdominal muscles work against you or push on that separation while you’re healing!)

I feel sad when I hear people say “I can’t workout because…”

I feel sad because they are being taught that only the big efforts count.

That’s not true.

I work with people for whom sitting at the edge of their bed is enormous effort, and standing requires assistance of others. When you see the enormous joy on a person’s face brought by these small yet enormous victories, you begin to understand the true beauty of the movement our bodies are capable of. What may seem like a small victory may be an enormous triumph-a giant step towards hope and healing.

Misguided emphasis on skinny and perfect or the fear of never being _____ enough WILL STOP US in our tracks.

Enough.

You are enough.

It’s ok to start small.

It’s ok to fail.

It’s ok to not be perfect.

It’s ok to be YOU.

It’s not about meeting someone else’s standards.

It’s about taking care of yourself, teaching your family that our bodies are a great gift and we should treat them well. It’s about understanding that you are worthy of the time and energy it will take to begin, to HEAL, and to build healthy habits that facilitate that healing and well being.

Let’s get moving, because moving not only transforms your body, but it transforms your mind, no matter what size jeans you wear.

Some Exercises to Get You  Started:

Some Other Tips to Start Healing:

  • Sitting with the best possible posture: (Pull your belly button in towards your spine. Keep breathing while doing this. Pull your shoulder blades onto your back. Keep breathing!)
  • Kegels/pelvic floor exercises (contracting the pelvic floor muscles-the ones you use to stop your pee, if that makes sense!).
  • Standing on one foot while brushing your teeth while pulling your belly button in towards your spine.
  • Stretching before you get out of bed.
  • Taking a walk or parking further from the store.
  • You can climb your stairs.
  • Swim.
  • Dance.
  • Work out with a DVD program or take a class.
  • If pregnant, getting an abdominal/belly support band to help support your abdomen and relieve pain you may be experiencing.
  • If in post partum recovery, gently binding your belly to help pull the muscles together and support you in those first few weeks of initial birth recovery.

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Where am I now? I’m down to a one finger split at my belly button. I am confidently back to work full time with no restrictions. I’m still doing pelvic floor exercises and modifying my workouts to protect and strengthen my abdominal muscles so I don’t re-injure or reinforce the Diastasis Recti. I’m teaching my daughters that exercise and eating well are ways to treat your body with respect, to give it what it needs so when you need your body to work for you, it will. I’m teaching them that strong is beautiful, that healthy allows you to follow your dreams, that food is a tool and a pleasure and size is just another physical trait that varies from person to person.

Final thought… can we all agree to stop using the words “mummy tummy” ? Please? Your tummy is awesome, mommy. Growing a human is beautiful. A body that shows the results of growing a human is also beautiful!

For more information on Diastasis Recti click here.

*You are strong, and Chunkabuns knows it. Check out their “Mom Strong” Tee-shirts (and matching “Strong Like Mommy” shirts for baby! ♥♥♥) and other clothing options for mom and baby at www.chunkabuns.com

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nicole nexon image
Nicole Nexon is a mother of two, working full time as a physical therapist. Nicole has her master’s degree in Physical Therapy, and has been working for 9 years in both the inpatient and outpatient fields of physical therapy. She is a complete nerd when it comes to the human body and wants to encourage others to take the opportunity to treat their bodies well at whatever stage of life they are in. She is also a Beachbody coach and has found it to be a great platform to spread her mission of health and wellness. In her spare time, Nicole enjoys traveling and snowboarding. You can follow her at www.facebook.com/nicolerosenex )

Picking Bottle Nipples for the Breastfed Baby

With Amy Peterson, IBCLC

This post made possible by the support of EvenFlo Feeding

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Lots of breastfed babies will also use a bottle. Most of us have heard that introducing a bottle can potentially have a negative impact on the breastfeeding relationship. But thankfully, we can control these risks.

Lower risks

Latch:  The way your baby latches on the breast needs to be similar to the bottle. Look at your baby while s/he is feeding at your breast.  Notice how the bottom lip flares, and the top lip rests in a neutral position. Observe how the corners of the mouth seal on the breast, and how milk doesn’t leak from the lips while baby feeds. Pull down baby’s lip slightly and see the baby’s tongue cup or curves around your nipple. We look for these same characteristics when baby sucks on a bottle nipple.

gradual wide leaking bad

Not a good latch: Averted gaze (no eye contact), top lip rolled in, leaking at corners, latched more toward the tip.

wide abrupt good no leak

Decent Latch: Eye contact, flared lips, deep latch near collar of bottle, relaxed posture, no leaking at corners.

 

Flow preference: You want your baby to prefer the flow of your breast over the flow of a bottle. There is no standard flow rate for bottle nipples, so you might have to try more than one bottle to find a similar swallow pattern. Most babies will use a slow flow nipple, but slow flow isn’t best for every baby–match your own flow. For detailed information, Balancing Breast and Bottle lists bottle flow rates in Appendix C.

Milk supply:  Anytime the baby takes 2 ounces from the bottle, ideally you will be able to pump this amount so your body knows how much your baby is taking and can maintain your supply. But don’t worry if you don’t pump exactly what your baby eats every time, baby is likely more effective at removing milk from your breast than a pump will be. Adding a pumping session may be necessary to ensure you’re producing the amount needed for your child’s bottle feed.

 

breastfeeding and bottle feeding

Good latch: Eye contact, flared top and bottom lips, no leaking, medium depth latch, relaxed posture.

 

Reduce risks by picking a nipple shape

One way to reduce bottle risks is in choosing the nipple shape we use to bottle-feed our baby.

Nipples have three general shapes: narrow, wide-abrupt, and wide-gradual.  

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Narrow neck nipples fit narrow neck bottles, and most have a gradual transition from nipple length to base where the baby’s lips can slide easily to latch deeply.

Wide neck nipples fit wide neck bottles.  Wide, abrupt shapes have an abrupt transition (like a 90 degree angle) between the nipple length and nipple base. Make sure your baby is able to rest their lips opened widely on the nipple base, not suck on the nipple length like a straw. Also, make sure your baby is able to fully seal the lips without gaps in the corners of the mouth.

Wide, gradual shapes gradually blend from the nipple length to the base. This shape may help the baby’s lips to rest on a portion of the base, and help the lips to form a complete seal. Make sure your baby is able to keep the nipple inserted deeply during feeding, rather than sliding down to the tip of the nipple.

 

Best does not exist

Different bottle nipple shapes work for different babies. One bottle will not be best for all babies, but you can find which bottle is best for your baby.  Therefore, beware of marketing and packaging claims. You’ve probably noticed many bottles claim to be best for breastfed babies, or to look just like the breast. But neither of these statements matters. How your baby latches onto the bottle nipple matters, not the packaging claims. You have found the right nipple when the nipple tip reaches deeply into the baby’s mouth; tongue cups the nipple; lips open widely and rest on a portion of the base; lips form a complete seal.

Additionally, now that you know that one bottle will not be best for every baby, don’t be swayed when you hear which bottle is “best” from other moms; what’s best for their baby might be terrible for your baby. You will need to look at your baby’s latch and then decide.

Picking bottle nipples - evenflo cobranded

Buying bottles

If you are having trouble finding a bottle your baby accepts, make sure you have tried all three types: narrow, wide-abrupt, and wide-gradual.  A lot of moms tend to buy various bottles marketed for breastfed babies, and then end up with a bunch of wide-abrupt shapes. Make sure you try the other shapes.

Chances are you will own more than one type of bottle, either bottles you have experimented with, or baby shower gifts that your baby can’t achieve a good latch with. Don’t despair.  As your baby grows, the mouth grows as well.  Nipples that do not work for young babies often work well when the baby’s mouth is bigger, say 4 months or so. Feel free to try the other nipples you have when your baby is older, and check the latch again.

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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.

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.

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.
Stages of lochia postpartum bleeding lunapads reusable menstrual pads
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.

Cloth pad for postpartum bleeding
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

Pumping Breastmilk and What You Need To Know

By Amy Peterson, IBCLC

This article made possible by the generous support of Earth Mama Angel Baby.

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Not every mom needs to pump. When baby is with mom for feedings and transferring milk effectively, there is no need to pump. But there are times when pumping breastmilk is important:

  •      Baby needs more milk (a supplement for one or more feeds)
  •      Mom wants to increase her supply
  •      Mom and baby are apart for feedings, such as when mom is at work or school
  •      Mom wants to have someone else participate in feedings
  •      Anytime mom will miss a feeding

In these circumstances, using a breast pump helps maintain or increase the milk supply for future feedings, and the pumped milk offers the perfect food for baby. This article touches on choosing between the different types of breast pumps, general pumping guidelines, and tips for increasing milk supply if necessary.

When possible, choose a pump that meets your unique situation. If you’ll only miss a feed or two each week, a manual pump or single electric is plenty. If you need to pump for several feedings a day, a high quality, double electric pump is a better choice.  If your baby is hospitalized or you need to dedicate time to increasing your supply, a hospital grade/rental pump is the best choice.

You can get a breast pump from many different places: box stores (Babies ‘R Us, Target, WalMart, etc.), online, a friend, thrift store, or possibly through your insurance company. Buying a used breast pump or borrowing a pump is usually not recommended. Most brands are considered single user items. These pumps do not control for the transfer of bacteria or germs between the pump motor and the milk, putting the baby’s health at risk. If you know the pump brand has a closed system, you could consider purchasing a new collection kit with tubing. Even so, you may not know if the pump is working less effectively than when purchased new, potentially putting your supply at risk.

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It is also important to note that not all women respond well to pumps and not all pumps work equally well for every lactating individual. This is why we have options. There are various contributing aspects that may impact how well a pump performs such as flange size, suction strength, type of suction, etc. If a pump is not working well for you it is possible that another would. Some breasts prefer one pump over another and some breasts prefer manual expression.

Most breast pumps have two settings. One button controls the vacuum, and the other button controls how fast the pump cycles (sucks). These settings let you fine tune the pump to mimic your baby’s suction and rhythm. For maximum milk production, use the highest comfortable suction. Use a fast cycling rate until your milk flows, then adjust to your comfort level; this mimics how your baby sucks before and after a let-down. A few brands of breast pumps have a built in feature that begins with fast cycling and adjusts slower. Some moms find they have better milk flow when they reset the button and continue with fast cycling.

Here are some general pumping guidelines to get you started:

  •      Pump for any feeding you will miss. Your milk supply is based on supply and demand, and pumping for each missed feeding tells your body to keep producing milk during that time.
  •      Pump the amount of milk your baby needs.  For example, if your baby takes 3 ounces of milk, pump 3 ounces total (1 ½ ounces from each breast).  If you pump what you need in 4 minutes—you can stop pumping.
  •      Pump between feedings to build a bottle. You can combine the milk from several pumping sessions to make a larger bottle of milk.
  •      Pump at night or in the early morning hours when your supply is highest.
  •      A gentle breast massage routine, called hands-on pumping, has been proven effective in increasing the amount of milk a mom can pump. Check it out here.

For moms who are not able to pump enough milk and who want to increase their supply, there are additional pumping tips:

  •      Pump until your milk stops flowing, and then pump two more minutes. This limited extra pumping is enough to tell your breasts to make more.
  •      Pump more often. Leave your pump set up (where your toddler can’t reach it!). Pump for 5-10 minutes once or twice an hour.
  •      Use the hands-on pumping technique listed here and above.
  •      Know that pumping alone may not increase your milk supply. Work with a breastfeeding helper who is knowledgeable about other targeted methods to boost supply.
  •      While you work on increasing your milk supply, feed your baby. You can combine your breastmilk with donor milk or formula to be sure your baby is getting enough. Some moms choose to feed breastmilk separate from formula to avoid wasting any breastmilk if baby doesn’t finish the bottle. As long as your guestimate is cautious, it is safe to mix; the milks will mix in baby’s belly anyway.

While pumping is an important aspect for many families in reaching their breastfeeding goals, how much is pumped is not a reliable sign of milk production. As with most areas of parenting, take your cues from your baby. When baby is growing well and reaching milestones within range then how much you pump doesn’t need to be a concern. If you see signs of dehydration or poor weight gain, speak with your child’s healthcare provider.

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earth-mama-angel-baby-nov-2016

Happy pumping mamas! You’ve totally got this and we’ve teamed up with Earth Mama Angel Baby to support you in your pumping journey with a giveaway of Earth Mama Angel Baby’s Milk-to-Go kit for Leakies in the USA. A $40 retail value, this kit includes:

One pair of Booby Tubes® (one pair) for cold or warm therapeutic use, 1 box of Organic Milkmaid Tea (16 tea bags) a fragrant comforting blend that supports healthy breast milk production, safe Natural Nipple Butter (1 fl. oz.), Happy Mama Body Wash (1.67 fl. oz.), one Eco-friendly Reusable Insulated Bag, and a tasty recipe for Organic Milkmaid French Vanilla Chai.

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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.