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What Does Pumping Past the First Birthday Look Like?

12 Jun

On our Facebook page, a mama asked about resources for moms that are pumping past one year. Unfortunately, there is very little information about this topic, most likely because so few moms continue to pump for their children after that magic first birthday “deadline”. The American Academy of Pediatrics states their recommendation as follows:

…exclusive breastfeeding for about the first six months of a baby’s life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby. (AAP 2012)

The final portion of the statement, “as long as mutually desired,” is a little vague, and so most people cling to that “12 months of age” as the definitive word on how long mothers should supply breastmilk for their babies. In contrast, the World Health Organization statement is:

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. (WHO 2015)

Recommendations aside, moms who exclusively pump, or who work full time and pump to supply breast milk to their children during separation, have many hurdles to overcome to continue providing their milk.

Typically, supply issues are a common concern. As the infant grows into a toddler, moms begin to increase the amount of solids they give to their children and decrease bottle feeds. The change in demand will effect the supply, since moms won’t feel so pressured to provide as many ounces, and begin to phase out a pumping session or two. A pregnancy can also negatively impact supply. “I think that I would have continued to pump until my supply dwindled to the point where it didn’t make sense anymore,” Amanda Glenn, author of Exclusive Pumping and Milk Supply, told me. For her, that meant only 1-2 ounces per day, but after the pregnancy, her supply dipped so much that she weaned her son. Moms also get really tired of pumping. I asked Alina L, another mom who pumped while working full time, what she thought about it. “Pumping is not fun,” she said. “I think everyone loves hitting that one year mark when they can ‘hang up the horns’.”

Most of the general rules about pumping for an infant also apply to pumping for a toddler. Moms need to fit pumping sessions in when they can, have enough pumping sessions to fill the demand of your child, and use relaxation and hands-on pumping techniques to get the most out of your breasts. Some things do get easier as your baby grows. “You don’t need to pump as often, as [a] toddler rel[ies] less on breastmilk and more on solids,” Amanda said. “Generally, you can schedule pumping sessions while they are sleeping, and toddler sleep tends to be more predictable than infant sleep.” For moms that pump at work and breastfeed directly from the breast when together, weekends can be a “catch-up” time in order to boost supply without worrying about the breast pump.

What about other challenges?

Alina told me that cluster-feeding and reverse cycling were common in her experience. “A lot of working moms are not prepped for the cluster nursing and nighttime nursing,” she said. “[They] also get trapped because baby wakes up at 5am and wanted[sic] to cluster feed then Mom cannot take a shower and get dressed. […] I used to suggest setting an alarm for 4am and do a dream feed with baby.” (A dream feed is when you put baby to the breast while they are sleeping, and they nurse without waking.) She does note that this will result in less sleep for mom, so it is a personal decision whether or not you choose to do this.

Many moms are concerned about their supply dwindling as they cut down on pumping sessions. I asked Alina if pumping was necessary to continue a breastfeeding relationship if the mom needs to work. “No,” she said, “you can always give formula during the day and breastfeed when you are together. And you have to be willing to get up at night.” Amanda began introducing cow’s milk after the first year, by mixing it with breast milk in the bottles. “I started adding a splash (literally about a tablespoon) to my son’s bottles, just to see what happened [and] if he’d take it. He took it just fine, and I gradually increased the amount until the bottles were completely cows milk,” she said. Alina noted that many pumping moms she knew continued pumping past one year due to allergies to things like cow’s milk. If allergies aren’t an issue, moms may not need to pump during separation and continue breastfeeding when together.

What final advice do these moms have for moms who pump past one year?

Amanda said, “I would say to keep going as long as it makes sense for YOU. You have given your baby a great gift by pumping for as long as you have, and you should keep it up as long as you think that it’s worth it and that pumping makes sense as part of your life. When it becomes a dreaded chore, or you want your pumping time back to do other things, or you cannot handle getting one more clogged duct, it’s 100% okay to stop.”

Alina brought up something I hadn’t considered. “First advice is to check [the] laws of [your] state. Some states only protect pumping moms until baby is age 1.” BABE is based in Texas, and there are no laws here that protect working moms at all. (As of this writing, a bill is being heard in the Texas Senate to fix this. Read more here.) Alina also advised that pumps need to be maintained, and tubes and membranes need to be replaced regularly. The manufacturer of your pump will be able to help you with that. Her final tidbit was that “[m]any women experience a supply dip starting at ovulation and continuing until cycle starts. Taking calcium/mag throughout the entire month steadily can help avoid this.”

Pumping and/or working moms! What is your best advice for pumping past one year? Give us your experiences! There are so few articles out there, but I know you are out there!

Amanda Glenn is the creator of ExclusivelyPumping.com. You can find her on Facebook at https://www.facebook.com/exclusivepumping

The opinions expressed belong to the interviewee and do not necessarily represent the views of Bay Area Breastfeeding and Education.

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Tips for Mothers Who Exclusively Pump

10 Mar

A version of this blog appeared on the San Diego Breastfeeding Center blog. Reprinted with permission.

Whether exclusive pumping is a decision or a necessity due to surrounding circumstances, there are several things you can do to make your efforts more successful.

Start early

We know that the earlier after birth you begin expressing, milk production is set up for long-term success.  Hand expression of colostrum is often more effective than pumping in the early days and can increase your milk supply even when you begin using a pump.  You may not reach full production until around 10 days, so be patient as amounts in the early days may be very small. Here’s a fantastic video from Jane Morton at Stanford University, demonstrating Hand Expression

Pump often

In the beginning, plan to pump about 8 times in 24 hours, for anywhere from 15-20 minutes per session.  Once you have reached full production, you can generally decrease your number of pumping sessions to 6 or 7 times a day.  You may also find you can express for 10-15 minutes and be done.

Plan to rent a multi-user hospital grade pump and later purchase a single user double-electric pump to establish and maintain your milk supply.

Initially, a hospital grade pump is key to reaching full milk production.  Let’s put it this way: the hospital-grade pump is like the Ferrari and the double-electric you can purchase is similar to a Toyota.  The motor is far superior in the hospital-grade pump, but it is too expensive to purchase, therefore we recommend renting one.  The double-electric is much more affordable, yet is best for maintaining a supply, rather than bringing one in.

Ensure a good flange fit and consider having more than one flange size available.

A poor flange fit can cause breast and/or nipple damage and pain.  It can also decrease the amount of milk you are able to pump. Check out this article about finding the correct pump flange size.

Pump hands-free

Purchase a hands-free bra or make one out of an old sports bra but cutting small slits where the flanges would fit.  Your hands will now be free to massage that ‘hard-to-get-out’ milk that pools in the periphery of the breast.

Use hands-on pumping

You can maximize your pump output by using breast massage as you pump hands free. We LOVE this video on how to maximize your pumping output using breast massage!

Learn some relaxation techniques to promote milk let-down

Take some deep breaths after you turn on your pump.  Put on some relaxing music.  Think about how amazing your body is as it provides warmth and nourishment to your baby.  If you need a mental break, dive into one of your favorite magazines.  This will help the time fly by!

Focus on your baby

Whether you have your baby near or you have to be away, you can focus on your baby by thinking about him and listening to a recording of him cooing or making sweet baby noises.  Have an item nearby that smells like your baby and place a picture in your pump bag (or on your phone).

Prepare to store your milk

There are a variety of bags and containers to safely store your milk in.  Bags made specifically for milk storage take up the least amount of room and will lay flat in your freezer.  Click here for current milk storage guidelines

Set up a pump station at home and/or at work

Have everything you need for pumping within arms’ reach.  Also have some water available to sip on, the TV remote or a book if that is how you choose to relax, a snack, and perhaps your headphones.

Listen to The Boob Group podcast episode, Maximize Your Breast Pumping Sessions

Sometimes just listening to helpful ideas from other moms can help normalize your situation, as well as motivate you.  These moms have made pumping work for them and so can you!

And finally, keep up the great work!

Remember, whether you baby is going to the breast or not, every drop counts!  You are providing a life-long gift to your baby.  And every minute you spend providing breastmilk to your baby is worth it.

What tricks worked best for you while exclusively pumping?

A Personal Story: Tongue-Tied and Breastfeeding

2 Jul
BenjaminNursing Joy

Joy and Benjamin at 10 months

I recently had my third son this past summer and was looking forward to breastfeeding him just like I breastfed my other two sons. Having had wonderful breastfeeding experiences with my other two boys, I was quite surprised when I experienced pain while breastfeeding with this baby. I knew that the latch looked right from the outside, but something was not right if there was pain. Jane Bradshaw, my wonderful International Board Certified Lactation Consultant and friend, always told everyone that breastfeeding should never hurt, so I started investigating other possibilities. I noticed that my baby seemed to eat all the time with hardly a break. I would sit for two hours at a time on the couch with a baby that seemed to eat and eat and eat and not feel satisfied. He would sleep a bit and then wake up hungry again. He was getting milk, but it seemed to take him so long to get it. That in combination with the pain was wearing down this mommy quick. So I made an appointment with Jane to do a weight check and a breastfeeding snapshot to see exactly how much milk he was getting in a feeding and also have her look at his latch to make sure I was not missing any problem areas.

The first thing Jane checked was his tongue. She noticed that he did not stick his tongue out of his mouth and it did not rise very high when he cried. These were two very good signs of the possibility of a tongue-tie in combination with the breast pain and long feedings. Sometimes you can see the frenulum visually, but in my son’s case he had a very deep rooted tongue-tie that was not easily seen until the Ear Nose and Throat Specialist found it underneath the web-like tissue. Even my son’s doctor did not see the tongue-tie because it was one that was not commonly seen with an initial look in the mouth. Thankfully he was getting enough milk to gain weight, but I had to work harder with pumping and compressions to get all the milk to him in a feeding (not to mention the pain I was feeling!). Jane suggested a visit to the Ear Nose and Throat Specialist in Lynchburg, VA, Dr. Andrea Kittrell. I made an appointment and had the procedure done that day.

No one likes to see their baby in pain and worries about having any kind of procedure done that would cause it. My son cried a little when he came back to the room from the procedure, but the pain afterwards was very minimal. He breastfed immediately and I felt a difference right away! No pain from nursing at all, right there at the doctor’s office. Jane gave me some post-procedure exercises to do with him to help him learn to use his tongue better, and he was soon sticking out his tongue with gusto and enjoying the new-found freedom to move his tongue. Feedings improved dramatically and there was NO pain.

Jane told me that tongue-ties are very common, and most are undiagnosed because moms give up breastfeeding because of the pain. Many people live with the pain of breastfeeding and just assume that it is normal and something to have to struggle through in order to give your baby the best food, breastmilk. I think of many friends and family members who pushed through with breastfeeding and eventually gave up around six months because it hurt too much or the baby was not gaining enough weight because they thought they didn’t have enough milk. I agree with Jane, it’s not supposed to hurt! I wish they would have gone to an IBCLC and got a solution to ease their pain so that they could enjoy the incredible bonding experience of breastfeeding their baby for as long as possible, not to mention the tremendous benefits of breastmilk for their baby. If you have pain from breastfeeding, make an appointment with Jane Bradshaw or another IBCLC in your area today to find relief.

Ben and Mom Joy-001Thank you to our guest blogger, Joy Rhodes.

Virtual assistant to Jane and Mom of three boys.

Round Two: 10 Tips for Nursing Your Newborn While Chasing a Toddler

7 Jun

Tears streamed down my face

as I sat in the recliner nursing my one week old son, holding my 18 month old daughter and watching my mom drive away.   Though breastfeeding was much easier the second time around, I was unsure how I was going to manage with a toddler and a newborn.  I had visions of my busy toddler coloring on the walls or playing in the toilet while I was sitting every 2-3 hours (or more often) nursing my son.  How I wish I knew then what I know now!

“Breastfeeding the second time around was SO much easier. Probably because I had the confidence. I breastfed my first for 2 years, so I ‘knew’ I could do it again. I just felt way more comfortable, and I knew the early pain was normal and would get better in a few days. It’s been tough because my toddler still needs attention, but the baby needs to eat! So we’re working on it and figuring it out together. But overall, it has been way easier and more comfortable the second time around.”   Beth, pictured above

  1. Prepare them.  Depending on your toddler’s age, consider taking her to a sibling preparation class.  Classes vary but usually include watching a video about becoming a big brother or big sister, diaper changing and swaddling practice on dolls, a craft project and sometimes a visit from a real newborn.  Read more about preparing your child for baby’s arrival here.  This is a great list of books geared toward sibling prep, and click here for children’s books about breastfeeding.
  2. Feed them.   Have healthy finger foods available for your toddler to snack on during some of your nursing sessions.  Put together little baggies of their favorites that are easy to grab and go.
  3. Surprise them.  How many times have you remarked your toddler has too many toys?  Pack some of them away in plastic tubs for awhile then pull them back out during the times you are caring for the baby.  Designate those as the breastfeeding toys.
  4. Contain them.  As I remarked above, I was concerned what my toddler would get into while I was nursing.  Create a nursing nest in a safe space where you can keep an eye on your toddler.  Installing a gate is an easy way to create a boundary.
  5. Include them.  Encourage visitors ahead of time to make sure and pay special attention to your toddler as the baby is a magnet!  I even suggest in my sibling class that visitors bring a treat to big brother or sister.
  6. Involve them.  Making the baby off-limits to big brother or sister will only cause them to resent the newborn.  Show them how to be gentle while staying close to prevent any accidental head bops or eye pokes.  Let them “help” with diaper changes, baths, retrieving clothes or your nursing pillow.
  7. Spend quality time with them.  Your time will be divided but your love is not.  Steal lots of moments to hug and kiss on your toddler.  When your partner gets home, hand over the baby and take big brother or sister aside to read a book with them, play a game, take a walk around the block or start their bedtime routine.   Plan toddler “dates,” such as a trips to the park or library, where the whole family can get out and brother or sister understands that the baby can be fun, too.
  8. Pack for them.  Take a trip to the dollar store, and pick up a few items like stickers, notepads, colors, pens, etc, and a little bag or basket to pack them in.  Make it the special bag that only comes out at nursing times.
  9. Expect regression from them.  For reasons they don’t even really understand, your toddler may regress to more baby-like behavior after the new baby comes.  If they are potty-trained, they may even regress in that area.  Refrain from disciplining this behavior and understand it is temporary and perhaps the toddler’s way of expressing “I need an extra, extra hug so I can feel like I am still important.”
  10. Embrace flexibility.  Learning to be flexible is a requirement for motherhood as our kids don’t always fit into the neat little boxes our culture creates for them.  Anticipate the diaper blow-outs right before you walk out the door.  Be ready for the toddler melt-down in the store.  Carry an extra shirt to change into after the unexpected spit up.  And most of all, look forward to the intangible rewards being a mom brings, whether you have one, two, or five!

What other tips can you share for moms going from one to two?

Lactation Derailment Can Begin in the Hospital: 10 Tips for Avoiding a Trainwreck

29 May

I must preface this blog by explaining that

fourteen years ago I became a mother/baby nurse, and ten years ago I became the resident childbirth educator and “breastfeeding counselor” on staff at a local hospital.  We did not have an IBCLC on staff, so I was IT until we hired another educator.  My training as a nurse, some time as a member of La Leche League and my own personal breastfeeding experience was all I had in my arsenal.  Though I wasn’t “official,”  I worked the position of a lactation consultant.  And it wasn’t easy…so many moms…so little time…so many interventions.  That being said, please read the following with the understanding that I have been “on the other side,” doing my best as a nurse to help fresh babies latch…bending over beds as an educator positioning babies and sandwiching breasts for moms who were too sleepy on pain medication post-cesarean to do it themselves.

A week ago, I had the privilege of visiting a new family in the hospital to provide assistance with breastfeeding.  She has given me permission to share my observations.

When I arrived, I had dad undress baby down to diaper and in skin to skin with mom.  The baby was only 36 hours old and very sleepy after a long labor and difficult delivery.  Mom, Dad and I chatted for a moment then got to the business of latch.  The baby would not wake up.

A nurse came in to give mom pain medication.

Though I was not surprised at the baby’s behavior, he appeared jaundiced, and I knew it was important to get colostrum into him.  So, we proceeded to hand express and collect colostrum to spoon/syringe feed him.

Then the baby photographer came in to show the picture previews.

Mom asked her to come back later.  (Reminder:  Mom is sitting in hospital bed with her breasts exposed.) We continued hand expression and then fed the colostrum back to the baby.  He began to exhibit some hunger cues, so we put him back to the breast.

The OB came in to check on mom.

Once again, latch attempt without success.  More hand expression.

Knock, knock? Have you had a chance to look at your pictures? Baby photographer again. (Are you kidding me?)

More teaching, more skin to skin….fed baby more colostrum.

A different nurse came to check on mom.

Another latch attempt…

The first nurse came back to tell mom the baby’s procedure had been delayed.

We wrapped up latch attempts (and the baby) as we knew the nursery nurse would be coming to get the baby soon.  He was happily sleeping in Grandma’s arms as we discussed a care plan.

Persistent photographer, back again, insisting on showing the pictures.

I wrote out mom’s care plan.

Nursery nurse came to retrieve baby.

I ensured mom had my number for questions, planned to follow up with a home visit, and I made my exit.  Did you count the number of interruptions?  How long do you think I was there?

Eight interruptions in one hour and fifteen minutes. 

I left there concerned about derailment and feared I would encounter a trainwreck at her home visit.  Fortunately, when I arrived, breastfeeding was going well and she needed very little assistance from me at the follow up.

Now, I realize everyone that came in just saw me as a visitor.  They weren’t aware of who I was or why I was there.  However, my presence aside, feeding her newborn was mom’s priority, but what was the priority for the people that kept interrupting?  Definitely not feeding a 36 hour old, sleepy newborn who appeared jaundiced.

How can a mom even think about getting breastfeeding established when she is being bombarded by staff from all sides?  It’s sensory overload.  As a private practice lactation consultant, I see the outcome of this all the time….the trainwrecks…the result of the cascade of interventions.

What steps can you take to avoid the trainwreck?

  1. Take a prenatal breastfeeding class so that you know what’s normal for the early days of breastfeeding.
  2. Hire a Doula to minimize birth interventions which can lead to troubles breastfeeding.
  3. Find a breastfeeding friendly pediatrician who will support your breastfeeding goals.
  4. Research local resources for breastfeeding help that are available to you once you get home such as La Leche League or private practice lactation consultant that is an IBCLC (International Board Certified Lactation Consultant).
  5. Prepare your partner to be the gatekeeper after delivery to minimize interruptions in your breastfeeding. You may also want your partner to accompany your newborn to the nursery to keep watch and ensure your feeding preference is respected.
  6. Hand express your colostrum and feed back to the baby. Doing this up to 6 times a day can increase and speed copious milk production.
  7. Reinforce your desire to breastfeed without any supplementation to every nurse that you have contact with.
  8. Room-in with you baby to keep your baby close and to learn his hunger cues.
  9. Better yet, keep your baby “on” you to facilitate skin to skin contact which has been shown to stabilize temperature,
    heart rate and oxygenation. You are your baby’s best habitat!
  10. Ask to see the lactation consultant…and keep asking….getting help early is so important!

What if you told me “I don’t like being a mom”?

22 May

If you told me you didn’t like being a mom, I wouldn’t judge you.

 If you told me you weren’t sure you liked your baby, I would believe you.

Being a mom is the hardest job in the world…add on feelings of anxiety, sadness, irritability, panic, loss of control and it becomes virtually impossible.

While many women experience some mild mood changes during or after the birth of a child,

15 to 20%

 of women experience more significant symptoms of depression or anxiety.(1)

If it is so common, then why don’t we hear more about it? 

“There is a lingering stigma associated with discussing any kind of depression, but the stigma associated with PPD [post-partum depression] is especially fierce.  These days, it’s probably easier for a man to talk about problems with his penis than it is for a new mother to admit that (in her own eyes, anyway) she is a failure at the one task for which women are supposed to have instinctive gifts.”  (2)

  • Did you know that symptoms of post-partum depression can develop any time in the first year after birth?
  • Did you know that many moms think being depressed is normal in the midst of adjusting to life with a newborn?
  • Did you know that “approximately 1 out of every 8 women experiences significant depression, anxiety, intrusive repetitive thoughts, panic, or post traumatic stress?”(1)
  • Did you know that many medications used to treat post-partum mood disorders are safe to take while breastfeeding?
  • Did you know that help is just a phone call away?
  • Did you know that

YOU ARE NOT ALONE?

One Mom’s Story:

“I dealt with depression in my early 20’s to the point of suicidal ideations.  I took medication long enough to get me through my last semester of college then took myself off of it due to outside pressures.

When I got pregnant, I don’t recall being told that I would be at greater risk for post-partum depression.  After the birth of my first baby, it took weeks for me to feel “normal,” whatever that is.  Pregnant with my second when my first was only 9 months, there was no down time.  Then, baby number three…three under three I felt I was drowning.  I didn’t know how to feel any different.  I thought, ‘My fault…what was I thinking?  Of course any mom in my situation would feel like I do.  This is my new normal, right?’

When my fourth was a newborn, I would take my other three to daycare, and on the way home I would go through a drive through, go home and try to eat my feelings away and then go to bed with the baby and stay there until it was time to pick them up.

My faith is the only thing that saved me during the six year roller coaster ride.  All along my husband, knowing something was not right, kept urging me to get help, but this was my new normal….I didn’t think there was anything ‘wrong’ with me.  I was simply the product of 4 babies and one miscarriage in 6 years.  I needed to just ‘get over it,’ pray more, go to church more, spend more time with God…

At the end of that six years,  all the ‘babies’ were weaned and potty trained.  I felt good.  Better than I had in a long time.  We had just moved into a new house and were getting settled.  Finally felt like a ‘good’ mother.  My energy level was up, the house stayed clean, life was good.

Then, surprise….baby number five.  I enjoyed my pregnancy, had a fabulous labor and birth.  Things stayed good for a long time.  This was the first baby I had while being a full time stay at home mom.  I loved it. 

Then she began to wean…slowly but surely, the sadness, anxiety, irritability, and depression started to invade.  I felt out of control….I was going crazy.  I sank to an all-time historical low.  Spent my days on the couch….such a blur I don’t even remember most of it. 

At that point, my husband insisted I get help.  I was so ashamed.  Why?!  I don’t know.  I reluctantly made an appointment and nervously and tearfully shared the past 11 years of my life.  And guess what?  There was no judgment.  Lightening did not strike, mountains did not crumble into the sea.  I left with counseling and a prescription.  The nurse told me that it could take 2-4 weeks to start feeling better.  I was a new person in two days.  I wish I could go back and tell myself that getting more help sooner would be worth it.  I feel I finally listened to what perhaps God was trying to tell me all along…”Pray, spend time with me AND let me work through the doctors to help you. It’s OK.”

Am I less of a mom?  Am I less of a wife?  Am I less of a friend? Am I less of a professional?  No, I’m not.  I know I risk judgment…but this is my story…and if it helps just one mom, it’s worth the risk.  I didn’t need post-partum depression to make me a stronger person.  I am not implying that to be a good mom you have to endure its’ clutches.  But my journey through the valley has made me the me I am today – wife, mom, friend, professional.  I can spot post-partum depression a mile away….

I am not saying that medication is the only way to feel better.   But GET HELP.  If you are a husband, partner, mother, friend, HELP HER…she doesn’t recognize it.  If you are a mom, DON’T WAIT.  Those are years of my life, my husband’s life and my children’s lives I can NEVER get back…” 

As lactation consultants with Bay Area Breastfeeding, Leah and I are in a unique position to recognize waving red flags as we see mom in the safe environment of her own home.  Our approach sets mom at ease in a very vulnerable, intimate time of her life, allowing her to lower her guard and be honest with us and herself about how she is really feeling.  If we encounter a mom who is struggling, we feel comfortable voicing our concerns and encouraging her to seek help and perhaps sharing a personal experience.  You see, the story above is my story.  I urge you, if you can answer yes to any of the following questions, seek help so you don’t lose those precious moments that you can never get back… 

Are you feeling sad or depressed?

Do you feel more irritable or angry with those around you?

Are you having difficulty bonding with your baby?

Do you feel anxious or panicky?

Are you having problems with eating or sleeping?

Are you having upsetting thoughts that you can’t get out of your mind?

Do you feel as if you are “out of control” or “going crazy”?

Do you feel like you never should have become a mother?

Are you worried that you might hurt your baby or yourself?

Please click here for a post-partum depression self-evaluation.

And Get Help Now.

References:

1Postpartum Support International

2The Ghost in the House: Motherhood, Raising Children and Struggling with Depression

A BABE Mom’s Story: 6 Tips For 6 Months

14 May

  Three weeks into her breastfeeding journey

we had the privilege of meeting this sweet momma and her precious little boy.  Our first contact was November 15, 2011.  She was our fifth client but our first real challenging case.  Over the phone, she described that she was having some pain and nipple damage with latch and decided it was time to get help as she suspected what she was experiencing was not normal.  This was her third baby to breastfeed yet the first time to experience this situation.

Baby was ready to eat soon after we arrived, so we had her proceed with breastfeeding in her normal fashion.  As she readied herself and the baby for latch, she was relaxed and calm.  We then got our first look and could hardly believe what we saw.  To date, we have yet to encounter nipple damage as severe as hers!  There were actual craters in the center of each nipple.  Leah and I could not believe she had made it this far.

Our assessment revealed that the baby had

a very shallow latch.  His mouth would stay open no longer than a millisecond to achieve latch, and once he did latch, his lips stayed pursed on the breast.  Our impression was that his jaw and mouth were hypertonic (increased muscle tone).  At rest, he kept his lips tight, and we could not even properly assess for tongue-tie (which we suspected right away because of the nature of mom’s damage) because his mouth was so tight!

Over the course of the next five or six weeks

we worked with Linda in person, via email and over the phone to assist her in getting to a comfortable and enjoyable place with breastfeeding.  Using a combination of breast rest, APNO, pumping, finger feeding, bottle feeding, chiropractic, time, and a lot of patience and determination, we were thrilled to hear from her late December that healing was complete and breastfeeding was finally pain-free!

Sweet, little Sam is now six months old.  He never had one drop of formula…how did she do it?  Keep reading for his mom’s advice:

1.  Let it go:  I had a hard time accepting that my house wasn’t always tidy, the laundry and dishes piled up, and gathering my hair into a ponytail was as close to “styling” as I could manage.  It took me a while to figure out that it is OK to not be able to accomplish everything I could pre-baby.  None of those tasks are as important as being able to meet the basic needs of my family and myself.

2.  Don’t be afraid to ask for help:  Asking for help doesn’t come easy for me but I learned to not be shy about telling others what needed to be done.  My husband was great at taking over the jobs he could do while I concentrated on my needs and the needs of the baby – but I needed to be sure to ask!  Something as simple as asking someone to look after the baby (and my 2yo and 4yo!) so I could take a shower or just have a few minutes to myself to eat a big bowl of ice cream in peace made all the difference in my outlook on life.

3.  Trust your instincts:  I think everyone who knew I just had a baby had an opinion on how I should be feeding the baby.  I had to believe in myself and my ability to know what will work for me versus what doesn’t feel right for my family.  My grandmother probably meant well when she told me that babies do just fine on evaporated milk, but after thanking her for her concern, I forgot she ever mentioned it.  I also had to trust my instincts enough to know that I needed outside help.  I figured that since this was my third, I should have known what to do on my own when he had problems – I didn’t.  My only regret was not getting outside help sooner.  I could have saved myself some addition pain.

4.  Find a cheerleader:  Having immediate family members and lactation consultants to tell me that I was doing a good job was priceless.  Affirmations are important – I needed to be reminded that I am strong and I could do it and that the sacrifices I was making were for the new little person I just brought into the world.

5. Set short term goals:  Even though it was baby number three for me, I was feeling overwhelmed about surviving the whole newborn period.  So I aimed to just make it through the week, the day, the next feeding session, or past whatever other hurdles were getting me down.  Once that was behind me, I would give myself a pat on the back, consider it an accomplishment and set a new goal.

6. Believe that does get easier:  It can be so hard to see past the present, but the first few weeks really are the most difficult.  I knew that if I could just make it past the hump, things would start to get better.  I had to cling to the knowledge that one day soon I would feel human again.  Six months down the road, I am grateful I stuck it out.

What most helped you get to where you are in your breastfeeding journey?

More Than Meets the Eye: How Doulas Help Moms Breastfeed

12 May

May is International Doula Month…

Source Unknown

As lactation consultants, we are thrilled to work along side our local Houston area doulas.  It is well-supported by research that labor and birth interventions can interfere with the natural course of breastfeeding, and it is also well-supported by research that the incidence of birth complications is reduced by having a doula present at your birth.  However, a doula is more than just “present” at your birth, patting your hand through contractions.  She

  • is passionate about coming along side you during one of the most important and special times in your life,
  • meets with you throughout your pregnancy and builds a relationship with you and your partner to establish trust,
  • provides ongoing education on the labor, birth and postpartum process,
  • assists you in creating a birth plan,
  • actively networks, seeking out the best resources for you,
  • advocates for you at a time when you are most vulnerable,
  • supports you during your labor and birth,
  • acts as a gatekeeper for mom, partner and baby after the birth, and much more…

Doulas are in a unique position to recognize early on any potential breastfeeding challenges.  They understand the importance getting help early.  In our experience, moms with doula support are extremely committed to pursuing breastfeeding even through tough issues.   Cole Deelah, a South-Houston doula, childbirth educator, and midwife apprentice, describes perhaps why we have found this to be true:

“A doula can oftentimes be the mother’s first exposure to breastfeeding education. I encourage the moms that I work with to attend a La Leche League meeting, refer them to area breastfeeding workshops and classes, and offer breastfeeding books from my library, including The Womanly Art of Breastfeeding, Breastfeeding With Comfort and Joy, and others. A doula also has a lot of time during the prenatal period to educate moms on different helpful positions, what a successful latch and nursing looks like/feels like, local resources, products that might help in the journey, and what is normal/not normal when breastfeeding. And finally, in those first few moments after birth, a doula can help protect the new parenting space, help with initial latch-on, and minimize outside distractions and interference from others. In the first few days after birth, a doula is completely accessible to the new family and can oftentimes be whom the family calls when something doesn’t seem right with the breastfeeding relationship. The doula then has the opportunity to offer additional resources, like a lactation consultant, so as to ensure to the best of abilities, a successful breastfeeding relationship!” (Read more about Cole on her blog, Wonderfully Made Bellies and Babies.)

Three other doulas join Cole in the Houston Doula Cooperative, Nicole Yunker, Lourdes Resendez, and Kimberly Foster.  Read about their co-op here.

Also serving the greater Houston are are the TLC Doulas.  This group is made up of Kathleen Wilson, Dorin Jordan, Amanda Moore, Jessica Gonzales and Rowan TwoSisters.

Now hear from a mom about how her doula helped her breastfeed:

“Hi! I’m LaKendra a proud supporter of breastfeeding, midwives, doulas and all those great non intervention assets surrounding pregnancy and birth. I’m sharing my experience with you regarding Lourdes Resendez who is not just a doula but someone who has really become a special person to me and my 8 month old daughter! Growing up, I knew absolutely no one who breastfed and my family did not support me saying negative things like I’m starving my baby, I’m not producing enough milk, I need to let somebody else feed her, my milk doesn’t have everything she needs like formula, only”white” people do that, I could go on and on about the ignorance and negativity that surrounded me but you get my drift. Kennadi latched on great right after birth and Lourdes took us in for about 3 weeks as I established a great milk supply with her support, I had me a few cups of mothers milk tea on a daily basis which actually was sort of tasty to me, but she gave me that extra boost I needed to get going and staying confident in my decision!! And because of that great start, she’s still exclusively breastfed! Which as a working mom I take to heart because you really have to be dedicated pumping on lunches and breaks, but it’s been a great journey and I don’t plan on stopping anytime soon!”

…How are you celebrating your doula?

No Perfect Houses Allowed: Preparing For Your Lactation Consultation

9 Apr

*Don’t clean! As lactation consultants,  our focus is on mom and baby.  We won’t be looking at the piles of laundry or dishes in the sink.  Leave the tidying up for the in-laws and even then wait at least a month…..

*Dress For Comfort Not Style.  PJs are totally ok!  Just wear a top with easy access so you won’t have to worry about it getting in the way of your breastfeeding efforts.

*Tuck Your Pets Away.  Or ask us before the visit if we mind the pets being out.  Sometimes dogs and cats are so friendly they want to be in middle of the consult.  Although Rover and Mr. Whiskers are cute, they can be a distraction for momma, and we want you to feel relaxed throughout the consult and not concerned about the pets sniffing out the new visitors and their strange bags. 🙂

*Expect to Breastfeed.  But don’t hold off a feeding if your baby is hungry before we arrive.  They are usually always willing to eat again.  It’s helpful if you can text us when you expect the baby to feed next, and we may be able to adjust our schedule around the feeding!

*Pick a location.  Decide where you will be most comfortable breastfeeding…couch, recliner, bed…and have pillows, burp cloth, receiving blanket and a bottle of water within reach.

*Write Down Your Questions.  Don’t try to remember them…your new mom brain won’t let you.  Take a couple of minutes the day of the consult to make a list of questions and concerns you may have.  We won’t leave until we know that you have had all of your questions addressed. 

*Plan payment.  Feel free to ask ahead of time the specifics about fees and payment methods so it’s not a source of worry and surprise for you at the conclusion of the visit.  You or preferably your partner may also want to contact your insurance company to see if any of our services are reimbursable to you or can be applied to a flex spending account.

*Get Your Pump Out.  If you are using a pump at the time of the consult, have it available for us to look at so we can make sure the fit is good for you and provide you tips for getting the most out of your pumping sessions.

*Talk With Your Support Person.  And ask them if they might be available to listen in on the consult and watch techniques.  Having another set of eyes and ears present ensures that when we leave you will feel confident in their ability to give you gentle reminders of the techniques and tips you learned during the consult

*Get Baby in Skin to Skin.  Plan to have your baby dressed in just a clean diaper and spend a few minutes with her on your chest, heart to heart, before our arrival. Babies who are held in skin to skin just prior to feeding go through a specific set of feeding behaviors which generally enables them to latch and breastfeed more efficiently.

*Relax.  And give yourself a pat on the back for seeking help.  While we can’t always provide an immediate fix (sometimes those magic lactation wands just don’t work), our goal is to leave you with a plan, feeling empowered and more confident to take charge of your breastfeeding journey.

Before You Breastfeed: 10 Tips for New Breastfeeding Moms

2 Apr

1. Learn about and use Laid-back breastfeeding technique. This approach taps into your baby’s feeding instincts. Your baby is capable of latching and feeding well at the breast.

2. Have a list of things others can do to help you when they come to visit. If visitors must come in the early weeks have a list posted on the refrigerator of small tasks that YOU would find helpful and reduce your stress. Usually someone else holding the baby is not as helpful as someone running a load of laundry or fixing a meal or changing the sheets on your bed. Don’t be afraid to ask for help; your job is to spend time with your baby learning about her, feeding her and resting.

3. Spend as much time as possible in skin to skin. Having skin to skin time with your baby has amazing effects on the both of you. Science has proven that skin to skin contact with mom and baby stabilizes baby’s temperature and heart rate, helps mother identify early feeding cues, and helps mother bond more deeply with her baby.  Get comfy in a recliner or bed, have baby down to diaper and lay her on your chest heart to heart. You can put a blanket over her back and just relax. Baby may rouse and search for the breast or may fall comfortably to sleep with the familiar sound of your beating heart.

4. Learn about how to know your baby is feeding well. One of the biggest concerns new mothers have is whether or not their baby is getting enough from breastfeeding. Following are some signs to look for:

  • Your baby has adequate diaper output.
  • Your baby wakes to nurse on their own.
  • Your baby is alert and active when feeding.
  • You hear or see baby swallowing as they feed.
  • Your baby is gaining weight well.
  • You may also notice your breast feel softer after a feeding and/or you may notice a let down during a feeding or milk dripping from the other breast.

5. Find or recruit a support system. One of the major reasons women quit breastfeeding before they expect to is a lack of support from family and friends, and research tells us the spouse/partner plays the biggest role. If you are struggling in the early weeks, having family members and supportive friends to lean on and who will encourage you will help you reach your breastfeeding goals.

6. Find a breastfeeding support group early on. Breastfeeding support groups, like La Leche League or hospital based groups, are a valuable resource for help and support in the early weeks of breastfeeding.

7. Don’t forget to take care of yourself. Often times moms are so exhausted they forget to eat or drink frequently. Having snacks that you can grab quickly are life savers. You will feel your best if you are also making sure you are resting often and getting plenty to eat and drink.

8. Get help early on if things are not going well. Many moms are reluctant to get help or not sure where to find help with breastfeeding issues, but getting help early is so important! Many times minor issues can turn into major problems if help is not found early on. Getting qualified help is the key when facing challenges. An International Board Certified Lactation Consultant (IBCLC) is the highest accredited breastfeeding helper and has proven skills to assist in many of the common breastfeeding challenges. But not all Lactation Consultants are IBCLC’s so be sure to ask!

9. Take a prenatal breastfeeding class. Find a class that is taught by an IBCLC, and attend early in your third trimester.  Often times, classes taught in other locations besides hospitals will focus on prevention of problems and provide more practical breastfeeding information rather than teaching “this is how we do it at XYZ Hospital.”  Consider a private class to get the most customized experience.

10. Build your portable nursing nest. Whether you decide to have a special place to nurse your baby or nurse in different locations throughout the house, having a basket of self-care items within hand’s reach is invaluable.  Here’s a list of things you may want to include in your portable nursing nest:

  • Water bottle – If you forget it, you will feel like you just trekked through the Sahara…
  • Healthy snacks – High protein, high fiber, tasty snacks to keep you satisfied…
  • Cell phone – You will get very adept at texting while nursing…
  • iPod, mp3 Player – Relaxing music…increased relaxation helps those breastfeeding hormones flow better…
  • Burp cloth – For little spits and leaking milk…
  • Breast pads – Disposable or reusable…
  • Lanolin – Your choice of nipple cream, such as Earth Mama or MotherLove, all-natural ingredients…
  • Book/Magazine – Or these days, Kindle, Nook or eReader…
This is YOUR time with YOUR baby…learning together…slow down, relax and enjoy!
*photo courtesy of www.007b.com