Archive for the ‘Working and Breastfeeding’ Category

IUD’s and Milk Supply

October 24, 2011

About 6 weeks to 2 months postpartum, your health care provider will bring up the subject of birth control. Even though sex may be the farthest thing from your mind! Your doctor has your mental and physical health in mind when he talks to you about a birth control method. It can be devastating emotionally and physically to get pregnant again before you are ready.

There are many birth control methods that are compatible with breastfeeding and have absolutely zero risk of harming milk production. Condoms and other barrier methods are safe and effective when used appropriately. But these methods are considered “risky” to many doctors because they rely on patient compliance and errors can occur. More and more doctors, therefore, are encouraging new mothers to use an IUD for birth control.

There is a relatively new IUD on the market, that definitely can and does create problems for breastfeeding mothers. It’s called Mirena. The Mirena IUD releases small amounts of synthetic progesterone over time. Progesterone is the hormone that keeps you from lactating during pregnancy. It follows that progesterone, even a small amount, could cause a reduction in milk supply for a breastfeeding mother.

There is no research that I know of to back up this claim. But I have stories from breastfeeding moms.  I would bet that there are many others who didn’t put 2 and 2 together and just believed that their milk ”dried up” all by itself or because they had returned to work. Since the resumption of birth control and going back to work often occur at about the same time, a mom could easily assume that being away from her baby for 8 hours per day is what caused the drop in milk production. So who knows how many mothers quit breastfeeding because of the Mirena? I believe the number is much, much larger than is reported.

Margie called me because her milk supply had plummeted to practically nothing. Her baby could not breastfeed, but she had been pumping since his birth so she has always known exactly how much milk she produced.

After Margie’s milk came in, she was able to pump 4 ounces every 2 hours—with a hand pump! She continued pumping regularly and always had more than her baby could eat. When her baby was 2 months old, her doctor recommended the Mirena IUD. She agreed that it sounded like a good birth control method for her. She noticed a gradual, slight dip in her milk supply within a week. She thought maybe it was because of the hand pump, so she tried a professional grade pump. Her supply continued to decrease, so she rented a hospital grade pump. There was no improvement. A mere six weeks after the IUD was inserted, her milk supply had practically vanished—down to 2 oz per day. She had the IUD removed.

Maggie is now working hard, with my guidance, to increase her milk production. There is no doubt in her mind (or mine) what caused her supply to plummet. It makes me sad that anyone would have to go through what she has gone through. Especially since it was completely avoidable.

So what should you do about birth control? Talk to your doctor about options. Let him know that breastfeeding is important to you and that you want to avoid risking your milk supply. Explore all options—keeping in mind that any birth control method is largely a “back up” method if you are fully breastfeeding and your baby is under 6 months old. . Avoid any birth control method that relies on hormones. Remember that you will be breastfeeding for a relatively short period of time in your child’s life. The Mirena and other hormonal methods may be a good choice for you when your baby is older and is not reliant on your milk for nourishment. Lastly, if you have already instituted birth control that includes hormones, and you are concerned about milk production, please call me for help!

Note: Many breastfeeding mothers use the Mirena IUD with no noticeable effect on breastfeeding. Unfortunately, it’s impossible to predict how an individual mom’s milk supply will react to the introduction of progesterone.

See also, “Breastfeeding and Fertility”   This link will take you to the latest version of my blog and website.  I hope you enjoy the new look!

Nipple Confusion…Really?

September 7, 2011

I have never, in all my years of breastfeeding help, seen a case of nipple confusion. There, I said it. For many years I thought I saw it. I bought the whole concept that introduction of bottles too early would cause a baby to reject his mother’s breast. That somehow the baby would get “confused” and suddenly not know how to breastfeed.

So what made me change my tune? The babies themselves. They proved to me over and over again that the idea of nipple confusion is nonsense. They showed me that they are infant mammals and that mammals are hard-wired to do this thing we call breastfeeding. And they showed me that they are born to be adaptable and perfectly capable of adjusting to a wide variety of challenges that life doles out on a daily basis.

But, please… don’t listen to what I have to say about this. Listen to the babies. They taught me. Maybe they can teach you too!

Here are the stories of just a few of the many, many babies who teach me every day:

Case 1–Baby could not latch on to breast. Nipple shield was given to mom to help with latch and milk transfer. Baby used nipple shield for 4 months. By 5 months of age she had completely transitioned from the shield and was happily breastfeeding all by herself.

Case 2– Twins born prematurely. Neither could breastfeed at birth and needed a lot of help to suck at all. Eventually they learned to bottle feed well. Mom pumped for 3 months so these babies could have her milk. At 3 months, as mom was bathing with one of the babies, he rooted and latched and suckled. Encouraged, she tried to nurse the other twin and he did the same thing. They never looked back.

Case 3– Mom pumped and bottle fed for 3 months because baby was unable to breastfeed after birth. She was told the baby probably never would. She called me as a last resort. I showed her how to hold the baby and support her breast, and baby latched on and breastfed like she’d been doing it all along.

Case 4—Baby born tongue tied and unable to latch. The parents were referred to a Dr. who clipped the frenulum, but didn’t clip enough so the tongue was still restricted. By the time the mother had called me, her milk supply was severely compromised. She worked on her milk production, finally got her son’s tongue properly released and continued to pump and bottle feed. Another lactation consultant told her “your baby has learned to like the bottle better” and he would never breastfeed. The baby and mom had other ideas. At 11 weeks this baby was 100% breastfed.

Case 5–(My favorite). This baby girl had been born with a cleft palate so she was unable to breastfeed or even use a regular bottle. Mom pumped for 4 months until the palate was repaired, hoping to breastfeed after her baby had healed from surgery. But she wasn’t successful. Finally, she called me at 7 months. When baby was sleepy, mom was able to coax her baby to the breast using a nipple shield. She suckled a bit then came off. I suggested she keep trying—that she had proved to us she could do it. A few months later I received an email from an elated mom telling me her baby had figured it out and at long last really breastfeeding!

I have many more stories of mothers and babies who persisted and triumphed. What about you? Do you have a story to share? Feel free to let us know by commenting here!

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

More about Milk Supply

August 24, 2011

You probably already know that certain foods and herbs can increase milk supply. Oatmeal, fenugreek* and blessed thistle* and many others all have a reputation for helping mothers overflow with milk.

But many people don’t know that some foods can actually decrease milk production. There is no need to worry about small amounts of any of the following foods, but if you’re struggling with low milk supply already, avoid ingesting large quantities of the following. On the other hand, if you are one of those mothers with an over-abundance of milk, or if you are in the process of weaning, you may find the following foods helpful!

Parsley is a diuretic. Nibbling on a sprig of parsley after a meal tastes refreshing and will not harm your milk supply. You may wish to avoid dishes with large amounts of parsley, however, if you are breastfeeding and you are concerned about milk production. One dish to avoid in the immediate postpartum period is tabouleh. Once your supply is established and everything is going well, and occasional plate of tabouleh is probably OK.

Peppermint and spearmint can adversely affect milk supply. Drinking an occasional cup of peppermint tea should not be a problem. You’d have to drink very large amounts daily to decrease your supply. Altoids and other candies made from peppermint oil are a different story. Mothers who enjoy many of these candies each day have noticed a drop in milk production.

Sage and oregano can negatively impact milk production. Sage tea is a common remedy for over-production.

The topical application of cabbage leaves. Cabbage can work wonders to relieve breast engorgement, but don’t over-do it! Applying cabbage more than once or twice a day can decrease your milk supply. Topical creams made from cabbage extract can have the same effect.

Beer and other alcoholic beverages are often touted as milk-supply boosters. “Have a beer! It will help you relax and make your milk come in.” Have you heard that one? It is absolutely false! In fact, alcohol inhibits your milk ejection (let down) reflex. This makes it harder for baby to get your milk. Over time, this can decrease your milk supply. Is an occasional drink ok? Yes! Just be sure to have that drink after you have fed your baby.

*Please seek the advice of a board certified lactation consultant (IBCLC) before experimenting with ANY herbs to help with milk supply issues. Herbs are medicines and many have potential side effects and even can cause severe allergic reactions. In addition, it is important to understand the history and underlying cause of your particular situation in order for any treatment to be effective.

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

Breastfeeding and Work: New Research

July 27, 2011

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

It is commonly understood that breastfeeding mothers returning to work face multiple challenges. Balancing work and motherhood, carving out time to pump at work and maintaining adequate milk production are all topics that any employed, lactating mother can discuss at length. Studies have shown over and over again that employment outside the home reduces breastfeeding duration.

A new study just published in the Journal of Human Lactation (August, 2011) has shed some new light on this topic. It sought to understand the relationship between breastfeeding and occupational type (professional, administrative, service, sales, etc.) and postpartum employment status. The researchers asked about initiation of breastfeeding as well as duration of breastfeeding. The subjects in the study included thousands of women in the U.S. from all walks of life.

Instead of boring you with all the statistics and methodology, I’ll just summarize the results. This study found that neither postpartum employment status or occupational type was a significant predictor of duration of predominant (mostly) breastfeeding. However, and this is big, full time workers were less likely to initiate breastfeeding in the first place! There was no significant difference in breastfeeding initiation between part time workers and mothers with no postpartum employment.

Mothers who were employed full time and chose to continue breastfeeding were also less likely to continue breastfeeding beyond 6 months compared to part time workers and “stay at home” mothers. Again, there was no difference in breastfeeding duration between part time workers and non-employed mothers.

Even when mothers have part time jobs that enable pumping breaks, access to lactation consultants, and other amenities, milk production can still be a problem when relying on a breast pump for a large part of the day. Other research has demonstrated that the strategy associated with the longest duration of breastfeeding after returning to work was breastfeeding the baby during the work day. Access to the baby is the number one strategy for maintaining breastfeeding for the longest amount of time.

How does all this relate to you? If you’re breastfeeding and plan to return to work, the following strategies will help you continue your breastfeeding relationship until you and your baby are ready to wean.

  • Don’t go back to work for as long as possible.
  • When you start back to work, just work part time if possible. Even if it’s only for the first year. Consider job sharing.
  • If you must go back full time, find a way to work from home part of the day or a day or two per week.
  • Does your employer offer onsite day care? If so, go for it!
  • Get childcare close to your job so you can have access to your baby.
  • Find a care provider who will bring your baby to you at lunch so you can breastfeed.
Obviously not every mom can enjoy all of the above options.  You can only do what you can do! But if you apply some creativity to your work situation, you may be able to improve your situation somewhat–which may be just enough to make long-term breastfeeding easier!

Breast Engorgement and Cabbage Leaves?

July 25, 2011

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

Let’s be honest. Overly full, engorged breasts are uncomfortable and sometimes downright painful. Fortunately, under normal circumstances true engorgement can be prevented with frequent breastfeeding in the first few days/weeks after the birth of your baby. Some breast fullness and tenderness is to be expected in the first week postpartum as your breasts prepare to provide nourishment for your baby or babies. It may feel like you have enough milk to feed the entire neighborhood, but keep in mind that much of the swelling you are experiencing is simply that—swelling. It’s not just milk “coming in” that is making your breasts feel so full. After the birth of your baby; water, blood and lymphatic fluid rush to your breasts in preparation for breastfeeding. With adequate breastfeeding, the discomfort usually passes in a day or 2. Many mothers don’t experience anything but mild fullness.

Currently, however, many mothers in the U.S. experience births that are anything but “normal.” Epidural anesthesia requires that mother receive an IV of fluids. Inducing labor with pitocin requires extra fluid. C-sections require IV’s. If a mother receives any extra fluids via IV, she will continue to retain the fluid for some time even after the birth of her baby. That extra fluid often results in swollen ankles, fingers and even breasts!

The edema in the limbs may be noticeable right away; but the breast swelling will probably not be apparent until day 3-5. When breasts are full in a normal way as the milk “comes in,” your baby will still be able to latch on and breastfeed. The breasts will feel full, but the areola will be soft and compressible. True engorgement is very different. Your breasts are hard. The skin is stretched and shiny. The areola is hard and taut. There is no way a baby can latch on to your breast. Pumping is usually ineffective since the tissue is not malleable. It’s like trying to use a pump on a wall!

So what can you do if your breasts become so engorged that you feel like you have 2 bowling balls on your chest? Try using cabbage leaves to relieve the swelling so that milk can be removed by the baby or a pump. Cabbage? Really? Yes! This is one of those times when folk wisdom can be helpful.

Green cabbage contains sulfa compounds which pass through the skin, and constrict vessels–relieving inflammation. This reduction of inflammation and swelling allows the milk to flow. To use the cabbage to relieve engorgement, rinse the leaves thoroughly in cold water (leaves should not be cooked). Place a leaf or two on your breasts under your bra. Change the leaves as they wilt. Most mothers notice immediate relief using this method.

A couple words of caution: This technique is not recommended for women who are allergic to sulfa or cabbage. It’s also important to not over-do the cabbage cure. There are reports of decreased milk supply with excessive cabbage use.

If you find yourself in the difficult situation of clinical engorgement, you need help! Contact an experienced lactation consultant right away. In the meantime…try some cabbage!

Alcohol and Breastfeeding

July 3, 2011

It is well known that alcohol consumption during pregnancy can harm the developing fetus. The placenta is not a barrier for toxic substances and even moderate drinking can cause devastating brain damage. But what about breastfeeding? Does that glass of wine you enjoyed with dinner pass into your breast milk? Do you need to be cautious about drinking alcohol?

The short answer is “yes.” The alcohol you consume enters your bloodstream almost immediately and, therefore, is in your milk rather quickly. Even though the alcohol does transfer to your milk, the amount of alcohol your baby experiences is much less than the amount you drink. Unlike the placenta, the breast provides some protection from most toxins in your bloodstream. According to Dr. Thomas Hale, the dose of alcohol in milk is less than 16% of the mother’s milk.

The amount of alcohol in your milk will peak 30 to 60 minutes after you enjoy your drink. After that time, the milk alcohol level decrease rapidly as long as you don’t have another drink. Alcohol is not stored in your milk. It quickly dissipates as your blood-alcohol level decreases.

There is no need to “pump and dump” (how I hate that phrase!) if you enjoy an occasional alcoholic beverage. But it is a good idea to time your drink for just after a breastfeeding session. That way most of the alcohol will be out of your bloodstream by the time your baby wants to breastfeed again.

After 40 weeks of abstaining, you may be excited about that first glass of wine. A note of caution from someone who has been there. Be careful! Many sleep-deprived mothers find alcohol packs a much bigger punch than before the pregnancy. If you choose to imbibe, take it slowly. Start with 1/3 to ½ of what you used to drink.

What about alcohol and milk supply? Some mothers are told to drink a beer so their milk will “come in” faster. Perhaps your wise, old grandmother advised you that beer would increase your supply. On the contrary, research has demonstrated that alcohol inhibits oxytocin release. Since oxytocin is responsible for your milk ejection reflex or let down, alcohol consumption actually decreases the amount of milk released from the breast during a feeding. Over time this can lead to a reduction in your milk supply.

Drinking during breastfeeding is a personal choice—one of many decisions that you will make as a mother. The bottom line is that alcohol in moderation, keeping in mind the timing of your drink, is probably not harmful. The American Academy of Pediatrics lists alcohol as “usually compatible” with breastfeeding. Excessive drinking while breastfeeding can, however, lead to developmental delays.

In summary:

    • Alcohol enters milk freely, but in lesser amounts than is in your bloodstream.
    • The peak level of alcohol in breast milk is 1/2-1 hour after it’s consumed.
    • If you choose to drink alcohol, time your drink for right after the baby nurses.
    • There is no need to pump and dump.
    • Waiting about 2 hours after having a drink is a general guideline to ensure complete metabolism of alcohol. (Based on a 180 lb. female)
    • Your milk is the best thing for your baby. Planning your alcohol consumption is advised over using formula to replace milk that may contain a small amount of alcohol.

If you’re too tipsy to safely hold your baby, you’re probably too tipsy to breastfeed! Use some previously pumped, alcohol-free milk instead.Important notice:  

This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

 

Breastfeeding Myths Galore!

June 19, 2011

These are things that I see or read every day: From my clients, from professionals and websites focusing on newborn issues. I know that one post cannot squash these myths completely, but if this helps just a few moms obtain correct information, I’ll be very happy! Each one of these statements could be an entire post. As time goes on, I hope to link each myth with a thorough explanation as to why it’s a myth. But for now, read these and remember they are MYTHS!

Breastfeeding is painful for the first few weeks.

Engorgement is normal and is a sign that everything is going well.

There is not enough milk during the first few days after the birth, so most babies need some formula until the milk “comes in.”

Many women do not produce enough milk.

A baby should be on the breast for a certain amount of time.

A mother should wash her nipples with soap before feeding the baby.

Pumping is a good way of knowing how much milk you have.

If your breasts don’t feel full, that means your milk supply is inadequate.

If a mother is planning to breastfeed, she should buy a pump.

Infant formulas are almost the same as breast milk.

Doctors know a lot about breastfeeding.

Some babies are lactose intolerant.

Nipples need to “toughen up” in order to breastfeed.

If you give a baby a bottle, he will not like the breast any more.

If you breastfeed you will sleep less than if you bottle feed.

You can’t eat your favorite foods if you breastfeed.

You can’t have a glass of wine if you breastfeed.

Breastfeeding makes your breasts sag.

Breastfeeding takes a lot of time.

Dads can’t bond with the baby if baby is breastfed.

If you breastfeed, everyone can see your breasts.

After 6 months, breast milk provides no more benefit to the baby.

If you have twins or more, you will definitely need to use formula.

If your baby is gassy or cries a lot, it means he is allergic to your milk.

Your baby will sleep longer at night if you give her a bottle of formula.

If your baby doesn’t breastfeed in the first week, he probably never will.

If you have flat nipples, your baby won’t be able to breastfeed.

If your nipples are too big, your baby won’t be able to breastfeed.

If your breasts are too small, too big, too (fill in the blank), you won’t be able to breastfeed.

Have you encountered any myths about breastfeeding? Have you heard some things that just don’t sound right? Please, post them here in the comments box. I would love to hear from you!

Important notice:  This blog and all its content and subsequent content is now at www.second9months.com.  Please visit there often for updates and new posts!

Sharing Breastpumps: Is it Safe?

April 26, 2011

Please note:  This blog and all its content and subsequent content can now be found at www.second9months.com.  Please visit often.  Your comments are always welcome!

Smart moms shop around and look for bargains. And when we’re talking about items for the nursery and other new baby gear, hand-me-downs are often as good as new and can save you a lot of money. When it comes to purchasing a breast pump, however, think twice about buying used or sharing with a friend.

The FDA defines breast pumps as single-use devices —not designed for sharing. Most professional-grade pumps are “open systems.” This means that there is no barrier between the milk collection kit and the pump motor. (Rental pumps are “closed systems” and designed for multiple users.) If a mother has used the pump when she has had cracked or bleeding nipples, or mastitis, it is possible that blood or bacteria may have entered the motor. According to the FDA, …”a breast pump should only be used by one woman because there is no way to guarantee the pump can be cleaned and disinfected between uses by different women.”  

In addition, pathogens from some infectious diseases can be found in human milk. Diseases such as hepatitis and cytomegalovirus (CMV) have serious health implications for you and your baby—but a mom may be unaware that she is infected. So even if you know and trust the previous owner of the pump, there is a risk that it is unsafe.

When my clients purchase used pumps, they always assure me, “I bought a new pump kit so I know it’s safe.” Unfortunately, buying a new kit is not the answer. It’s possible for tiny droplets of milk or air-born pathogens to get into the motor and cause cross contamination to the next user. Even though there are no documented cases of mothers or babies being infected via a second-hand pump, why take a risk? “You should never buy a used breast pump or share a breast pump…. The money you may save by buying a used pump is not worth the health risks to you or your baby. Breast pumps that are reused by different mothers can carry infectious diseases…” (FDA website)

Here’s the good news: All Hygeia breast pumps have FDA clearance as multi-user pumps. There is a filter between the pump kit and the motor that eliminates the risk of cross-contamination. Hygeia pumps are effective, affordable AND shareable! If you’re interested in purchasing a Hygeia pump, or have questions, contact me via phone or email.  

See also: “Are Used Breast Pumps a Bargain?”

Using Stored Breast Milk

April 16, 2011

The milk that we buy at the grocery store has been pasteurized and homogenized. The pasteurization process kills all the bacteria and live cells in the milk—making it safe for us to drink, but also less stable. Homogenizing the milk blends in the fat so that it doesn’t separate and float to the top. Most of us don’t have experience using fresh milk straight from the source. Fresh milk from any mammal—including humans—looks very different from the milk we buy at the store.

After your milk has been expressed and it has been sitting on the counter or in the refrigerator for a while, the fat will begin to separate. You may notice a thin layer of cream on top of milk that looks quite watery. That is perfectly normal. Your milk has not gone “bad.”

Since fat content varies by the time of day, the fat layer may range from just barely visible to a half-inch or more. Milk fat content also varies widely among mothers, so expect to see a difference. Any amount of fat you see in the milk is perfect! There is no need for concern that your milk isn’t “good enough” for your baby.

To Use Stored Milk:

  • Shake the milk gently before giving it to your baby in order to mix in the cream.  It’s normal to see little bits of fat floating in the milk after mixing.
  • If it’s been refrigerated, you can gently warm it to room temperature in a bowl of hot water. You may not even need to warm it! Many babies are just as happy with cold milk.
  • Frozen milk can be thawed in container of hot water.  If you have time, it can be thawed slowly in the refrigerator.
  • Never use a microwave to thaw or warm your milk. Important nutrients will be destroyed if the milk gets too hot.

For additional information, see Breast Milk Storage Guidelines.

Breastfeeding and Work-Clothing Crisis?

March 30, 2011

My friend and teaching partner, Holli Harris,  generously shared the following article.  Thank you, Holli, for your contribution and insight!

If you plan to combine breastfeeding with a job, double the need for breastfeeding and pump-friendly clothes. It’s one thing to not want to bare your breasts to your family and friends, and/or want to retain your sense of pre-motherhood style, but it’s another situation completely when you require combining the need for looking professional with quick and discreet access to breasts for pump (or breastfeeding) breaks in often semi-private locations…and in a situation where every minute away from work counts.   It’s no wonder there is a steep decline in breastfeeding when women return to work.

I think it was while pumping in a hotel room naked because I was wearing an impenetrable wool sheath dress/suit, that the inkling of HadleyStilwell was born. No wait, maybe it was the time I was sitting in a parked car with an unbuttoned blouse and a shawl for a semblance of privacy. I can’t remember anymore. At any rate, if you plan to breastfeed for a year,  you will get more mileage out of investing in wardrobe staples that mix and match with your current wardrobe and with each other than you did with maternity clothes that you wore for about six months.  And my goal with HadleyStilwell designs is that you will want to wear them whether or not you are still breastfeeding. Lately I’ve been wearing the Signature Tunic with the matching skirt and either the Signature Jacket for more formal situations, or dress it down with a denim jacket, or switch out the skirt altogether for leggings or wide bottom pants. The other piece I’ve been living in this winter is the Fleece Cowl Neck Nursing Tunic.   It’s like wrapping a blanket around yourself except that it’s also tres chic…

HadleyStilwell designs help busy moms breastfeed or pump outside the home, not to mention provide quick pulled-together looks, but it’s not just about the clothes. Read Milk Notes for detailed guidance on combining breastfeeding with work, and watch for guest posts from various experts.–Holli Harris

Do you need help preparing to return to work?  Wondering how to combine breastfeeding with your work life? You don’t have to live in Seattle to receive expert guidance from a lactation consultant. I am available for phone consultations for moms anywhere. You may reach me at www.second9months.com.  Send me an email and I’ll call you the same day to set up a “meeting.”


Follow

Get every new post delivered to your Inbox.

%d bloggers like this: