Tag Archives: Baby

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!

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

Does my baby have Oral Motor Hypotonia?

26 Nov

Oral-Motor Hypotonia and the Role of the Speech Pathologist

by Leah Jolly, BA, IBCLC, RLC 

I never thought a speech pathologist would be in my circle of breastfeeding support, but just a few days after the birth of my first son, we were referred to one. At our first appointment with the speech pathologist, Ellen Carlin, we discovered through thorough hands-on testing that our son had oral motor hypotonia, a condition of weakened muscles of the mouth. We were quite surprised when our second son was born a few years later and had the same latch difficulties, so we headed back to Ellen Carlin and received the same diagnosis. Both boys had weekly therapy with Ms. Carlin and a home therapy program we learned at our visits. When I tell other Leaders and breastfeeding professionals about our experiences with speech pathology and breastfeeding there is always a list of questions. The following questions and answers are from an interview with Ellen Carlin and will be helpful to others in understanding how speech pathologists play a role in breastfeeding help and support. Ellen Carlin is a speech pathologist practicing in The Woodlands, a suburb north of Houston. 

What training/background does a speech pathologist need to work with breastfeeding babies?

 A speech pathologist must have an interest in working with infants and obtaining additional trainings in oral motor function and intervention techniques. The speech pathologist should be a master’s level therapist, ASHA Certified and have a Certificate of Clinical Competency. Oral motor training is the key and the Beckman Techniques for evaluation and exercises, as well as Susan Evans Morris feeding training are very comprehensive trainings for oral motor evaluations of infants. Speech pathologists working with breastfeeding babies should have hands-on experience in these evaluation and therapy techniques. Additional training in sensory systems and head/neck and trunk support as well as knowledge of a variety of oral motor techniques and theories are also recommended.

What types of conditions do you most often diagnose and treat for breastfeeding babies? 

Most often babies are referred by doctors or lactation consultants when positioning attempts have been unsuccessful, the infant presents with an unsuccessful latch, for suck/swallow coordination issues, leaking of milk during feeding, and general feeding difficulties that are not responding to normal courses of treatment/support. Upon evaluation infants may be diagnosed with oral motor hypotonia, coordination disorders and/or feeding difficulties and mismanagement. 

What types of therapies/treatment are available with speech pathologists?

Treatment for infants who have been found to have feeding difficulties begins with a thorough hands-on evaluation. By testing range of motion and reflexes of the mouth, tongue, cheeks, palate and jaw, the speech pathologist can determine what exercises are needed to improve strength and range of motion for appropriate function of the muscles.  The parents are trained to use their infant’s individual exercise program and encouraged to use the exercises on a daily basis.

 In your practice, how does breastfeeding impact the outcome of oral motor conditions?

Once the infant is able to efficiently breastfeed, the oral exercise program may be weaned. Normal use and function of the oral muscles needed for breastfeeding, will keep the muscles toned in a typical developing infant. What I find in my practice is that once the infant’s oral motor strength improves and normal function is regained, feeding skills and speech/language skills will also develop normally. Keep in mind that children with other neurological difficulties may need additional support throughout development.

What is an oral motor evaluation?

The oral motor evaluation consists of two evaluation sessions. During the first session medical history is obtained and the mother discusses problems the baby is having. This is important because difficulties may not be occurring at every feeding and the mother can describe sensations or pain she is having during the feedings. A thorough history is taken to evaluate if birth traumas or other complications of pregnancy or birth may have contributed to the feeding difficulties. Next, the oral reflexes are evaluated to determine where muscle weaknesses exist and a feeding observation of the infant is obtained. The speech pathologist looks at the latch, jaw motions, tongue placement, lip seal, suck/swallow/breathe pattern and overall feeding behavior.

The reflexes are tested by stimulating different regions of the mouth with the finger while looking for tongue movement reflexes, suck reflexes, suck/swallow/breath patterns and jaw motion reflexes. This helps determine where weakness/dysfunction are occurring and which exercise will be helpful.  The areas of oral strength ranging between 79% and 0% are identified, and an exercise program is initiated. Parents are trained to use the exercises and are instructed to use the exercise program daily. The second evaluation session is scheduled following a week of exercise use. The infant’s oral strength is reassessed and parent information is collected regarding feeding progress to determine if additional exercises are needed. Typically the exercise program is a ten week program.

What “red flags’ would a Lactation Consultant or doctor be looking for when referring an infant to speech pathologist?

*Absence of a gag reflex – infants should have a strong gag reflex, which is protective in nature.

*Reflux diagnosed – may signal difficulty with suck/swallow/breath triad. (The infant is getting too much air in tummy during feedings.)

*Multiple apnea and /or bradycardia episodes

*Difficulty with grasping the nipple after 35 wks GA – they don’t have the strength to produce a good latch on.

*Length of time to feed (2 oz. in 20 min is too long)

*Absence of 1:1:1 ratio for suck/swallow/breath denotes disorganization of oral musculature.

*Infants with a poor lip-seal, leakage of milk around lips (bib soakers) or milk coming out of nose.

*Snack and snoozers – mom’s report that the infant is always eating because he can’t stay awake to finish a feeding. (Infant doesn’t have the muscle strength to finish a feeding then wakes up hungry – falls asleep- wakes up hungry….)

*Infants who are loud feeders – they display inconsistent tongue suction during feedings

*Infants who clamp down on the nipple causing nipple pain, trying to stop the milk flow due to difficulty managing it.

*Infants who refuse the breast and will only drink from a bottle-may start and stop crying at the breast.

*Infants that require maximum flow nipples or cross cut nipples

*Poor non-nutritive sucking patterns

*Infants for which positioning techniques do not help with feedings.

When to call a Lactation Consultant (IBCLC)

22 Nov

Breastfeeding should be an enjoyable experience for both mom and baby! Although breastfeeding is natural many factors play into the ease to which mom and baby learn and adapt to these new skills. Lactation Consultants are trained medical professionals who can evaluate the source of your breastfeeding challenges and offer ways to improve the outcome for both you and your baby.  Below is a list of common issues lactation consultants can assist with:

A mom who:

v Has Sore nipples

v Has Mastitis or plugged ducts

v Is Engorged

v Has flat or inverted nipples

v Is Ill or needs surgery

v Has a low milk supply

v Wishes to breastfeed an adopted baby

v Needs to take a medication while breastfeeding

v Plans to return to work

v Experiencing stress about breastfeeding

Or a baby who:

v Refuses to latch on

v Is jaundice

v Is not gaining weight well

v Is fussy at the breast or between feedings

v Is premature or is a late preterm

v Spits up frequently

v Has physical challenges that impair breastfeeding

Or anytime you feel breastfeeding is not going well!