Archive for the ‘lactation consultants’ 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!

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Guest Post–When Nursing Makes you Sick

October 8, 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!

When a woman thinks of birth and breastfeeding she expects it to be the happiest time of her life. Occasionally, to a mother’s dismay, she finds that breastfeeding brings on new challenges, feelings and experiences. She may experience feelings of pain with breastfeeding, or an unexplainable twist in her gut when her milk lets down. Unable to justify or validate what she is feeling leaves her at a loss and feeling confused. These feelings may be the result of a condition known as D-MER. D-MER stands for Dysmorphic Milk Ejection Reflex and it is treatable.

D-MER is caused by a drop in dopamine activity when oxytocin rises which creates a feeling of dysphoria in the mother (D-Mer.org). It is a physiological disorder, not a mental disorder. To understand D-MER better I have interviewed Renee Beebe, IBCLC. Renee Beebe is an International Board Certified Lactation Consultant who works with mothers who may be exhibiting symptoms of D-MER.

A mother asked Renee the following questions:

Q. “Dear Renee, when I nurse my baby I feel nauseated and a dull ache. What is causing this pain and what can I do about it?”

A. Renee’s answer is “
First of all let me assure you that you are not causing this situation.  It can be very disturbing to a mother to feel sick, sad or otherwise uncomfortable when breastfeeding or pumping.  After all, breastfeeding is supposed to be pleasant, right?  Various hormones increase and drop dramatically during the process of breastfeeding–particularly during the milk ejection reflex (commonly known as the let down).  Most mothers feel wonderful when the milk ejection reflex or MER occurs.  A few mothers, however, feel awful.  The good news is, the nausea or sad feelings usually dissipate after the MER is finished and it usually dissipates over time during the course of breastfeeding.  Some mothers may need to be on medication temporarily until the condition improves.  Others may find relief with breathing exercises or other coping methods”.  Please see www.d-mer.org for more information and support. You are not alone!

Q: How can I reach Renee Beebe, M. Ed., IBCLC for help if I think I may have D-MER?

A. “Mothers may call or email if they’d like support.  Most mothers call because it ensures I can answer them sooner.  I would encourage women to call before they have the baby to make a connection.  After the baby is born, if things aren’t going absolutely smoothly, call as soon as possible.  I can usually see mothers within 24 hours.  Often the same day.  I take calls 7 days/week till 9 pm.” Renee can be reached at 206-356-7252 or you can go to her website  http://www.second9months.com/.  This entire blog is now located at my new website!

Q. What is an IBCLC?

A. The International Board of Lactation Consultant Examiners (IBLCE) is the certifying body for lactation consultants.  It is the only certification available.  The exam is given once a year all over the world on the same day.  A lactation consultant should have the letters IBCLC after her name.  That is the only way you can ensure that she has achieved this minimum competency required by IBLCE.  The terms “breastfeeding specialist,” “lactation educator,” or “lactation specialist” really don’t mean much.  Usually those people have taken some valuable coursework, but don’t have the clinical hours required to actually sit for and pass the certifying exam.

Q. How did you become a lactation consultant?

A. After the birth of my first baby, I became involved with La Leche League for support.  where I was living at the time, breastfeeding was not the norm and La Leche League provided me with mommy wisdom and role models.  Soon I was helping other mothers and became a La Leche League Leader myself.   It was clear I had found my calling!  6 years later I had accumulated enough “helping” hours (2500!) to become certified as a lactation consultant.  I first took and passed the certifying exam in 1997.  I’ve been working as a lactation consultant ever since.

If you are experiencing negative feelings, pain, or nausea when you nurse your baby please know that you are not alone. Conditions such as D-MER are not caused by the mother. They are physiological in nature and beyond your control. Treatment is available for mothers with D-MER. Please visit www.D-MER.org for more information.

Written by Trina Baggett, Certified Birth Doula and Childbirth Educator.  www.atranquiljourney.com

Tongue Tie: More than “Just” a Breastfeeding Problem

October 2, 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 assume for a moment that breastfeeding is not important. That the oral development that breastfeeding provides is inconsequential. We will ignore, for just a moment, the fact that the act of breastfeeding helps develop the baby’s jaw, his facial muscles and properly shapes the palate to make room for his future teeth. We’ll ignore all of that so that I can give you a few other reasons to agree to have your baby’s frenulum clipped. Just in case the possibility of pain free, effective breastfeeding is not a good enough reason for you.

The reason I’m being just a bit sarcastic is because there are plenty of health care professionals out there who do not “believe in” freeing a tongue tied baby’s tongue “just” so he can breastfeed. “After all,” they say, “..you can just feed your baby pumped milk or formula from a bottle.”

Let’s say you are pondering that question yourself. And you don’t want to put your baby through even a second of pain—however minor—if you don’t have to. And, up until the moment your lactation consultant told you your baby is tongue tied, you’d never heard of such a thing. Why should your baby have a frenotomy (clipping the frenulum) when it’s only going to help with breastfeeding and breastfeeding is such a short time in your baby’s life? I’ll tell you why. Because freeing the tongue with a quick clip now may help your baby avoid health problems in childhood and even into adulthood.

The tongue is a very strong muscle and that frenulum is an inelastic cord that is constantly pulling on the floor of the mouth and/or the lower gum ridge (called the alveolar ridge) when the tongue tries to move normally. Without normal tongue movements the oral cavity does not develop properly and since one body part is connected to the other, problems can occur in the rest of the body as well. Here are some effects of tongue tie that are not breastfeeding related.

  • Ineffective oral hygiene
  • Tooth decay
  • Crowding of teeth—especially lower teeth
  • Orthodontia
  • Lisps and other speech impairments
  • Excess saliva production–frenulum pulls salivary glans to unnatural position.
  • Fatigue with speaking
  • Shame, embarrassment with speaking
  • High, arched or “bubble” palate
  • Choking
  • Reflux
  • Snoring
  • Sleep apnea
  • Headaches

So now you know. If your baby is tongue tied and you have been wondering if a frenotomy is “just” for breastfeeding, wonder no more. Your baby will thank you some day!  

See also, “My Baby is Tongue Tied?”

My Baby is Tongue Tied?

October 1, 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!

“My lactation consultant told me my baby is tongue tied and she needs to get her frenulum clipped so she can breastfeed. What is a frenulum? Why does my baby need this procedure?”

The frenulum is a (usually) thin, fibrous band that connects the underside of the tongue to the floor of the mouth. The mere existence of a lingual (tongue) frenulum is not an indicator of a problem. The important thing is whether the frenulum restricts the movement of the tongue in a way that interferes with its normal functions.  If it does, your baby has a condition known as tongue tie or ankyloglossia.

One of the vital roles of the tongue for a baby is for feeding. Your baby depends on her tongue for creating a vacuum, sustaining a vacuum, moving the milk to the back of her mouth and swallowing. These things are important whether a baby is breastfeeding or bottle feeding. But when a baby is breastfeeding, the function of the tongue is more critical because incorrect tongue movement/placement equals sore nipples for mommy!

How do you know if your baby is tongue tied? Take a minute to observe your baby with this questions in mind:

  • Does your baby have a hard time latching on?
  • Do your nipples looked creased or flattened after breastfeeding?
  • When your baby cries, does the center of his tongue look “’stuck” to the floor of his mouth with just the edges curling up?
  • When your baby sucks on your finger, do you feel the lower gums either constantly or intermittently?
  • Does your baby seemed stressed with a fast flow of milk?
  • Do feedings take a long time? Or is baby feeding very frequently and never seems satisfied?
  • Does your baby have symptoms of reflux?

If the answer to any of these questions is yes, Your baby may be tongue tied! Check with an experienced lactation consultant to be sure. She will examine the baby—paying particular attention to assessment of tongue function. She will also observe the baby feeding. After a thorough evaluation, the lactation consultant may recommend that the baby have the frenulum clipped.

The clipping—called a frenotomy—is usually performed by a doctor or dentist. The doctor will assess tongue function, may observe a feeding or ask you detailed questions about feeding. You should be given instructions to stretch your baby’s tongue periodically after the procedure to ensure that it heals properly. Sometimes a topical anesthetic is used, but not always. The pain the baby experiences is mild and brief (similar to biting your tongue) and bleeding is minimal. After this very quick procedure (it literally takes about 1 second!) most mothers and babies notice an immediate difference in breastfeeding.

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!

Breastfeeding Support in Seattle!

June 19, 2011

Please note:  This blog and all of its content and subsequent content can now be found on my website!  Please visit www.second9months.com for more blog posts and updates. 

I am happy to announce a new service!  Renee Beebe at The Second9Months is offering a weekly drop-in support group every monday morning at Dragonfly Holistic Healing in the Fremont neighborhood of Seattle. This is a fantastic opportunity to ask questions, weigh your baby, check your baby’s latch and meet other breastfeeding moms. My intern and I will both be there, so you will definitely get some individualized help.  We meet every monday, 10:30 -11:30 a.m.  The details can be found on my facebook page or on you can go directly to the flyer online.  There is no need to RSVP.

 

*This event is a great place to “fine tune” your technique and ask questions.  It is not meant to take the place of an actual consultation for breastfeeding problems.  If you need more help than can be provided in a group setting, I will recommend that you make a private appointment with a lactation consultant.

Crying Babies

March 15, 2011

You may wonder why a lactation consultant–someone who considers herself somewhat of an expert in the art and science of breastfeeding–is writing an article about crying babies.  I have been moved to address this topic because every day parents ask me about hunger cues, sleep and crying.  Specifically, new parents want to know, what does that cry mean?

Crying is your baby’s way of letting you know that something is not right.  She may be hungry or thirsty, lonely, cold, afraid, uncomfortable or maybe she doesn’t even know.  She just knows she needs something–now!  Parents are sometimes told to ignore their baby’s cries–particularly as a way to “train” the baby to sleep longer or go longer between feedings.

There are probably dozens of books written about babies and sleep–many of them promising that your baby will “sleep through the night” if you follow the rules outlined by the authors.  Thankfully, there is a different point of view!  The following quotes are from pediatricians who have written about babies and sleep. The name of the book follows each quote:

“A crying baby’s needs are so simple, and they are so simply supplied.  A baby cries to communicate to you his need for the touch, warmth, comfort, security and love that only you can provide.  Why would anyone deny such a simple, human request?…When a baby fails to call out for his parents when he is in distress at night, it cannot be because he has ‘learned’ a useful behavior.  It is more likely that he has just given up on his parents.”  Dr. Paul Fleiss, Sweet Dreams.

“Putting your baby through cry-it-out sleep training isn’t the worst thing you can do to him, but it’s far from the best.  We know of no studies on short-term effects or even …long-term effects of crying it out in humans.  But studies of parent-infant separation involving ‘crying’ in nonhumuan primates show that the hormonal stress response of babies in these situations can be ‘equivalent to or greater than that induced by physical trauma.'”  Dr. Jay Gordon, Good Nights.

“Letting the baby cry undermines a mother’s confidence and intuition…not responding to a baby’s cries goes against most mothers’ intuitive responses. If a mother consistently goes against what she feels, she begins to desensitize herself to the signal value of her baby’s cries. …  A mother who restrains herself from responding to her baby gradually and unknowingly becomes insensitive….Once you allow outside advice to overtake your own intuitive mothering you and your child are at risk of drifting apart.”  Dr. William Sears,  Nighttime Parenting.

Finally, my favorite quote from Dr. Lee Salk, author and child psychologist wrote,  “There’s no harm in a child crying: the harm is done only if his cries aren’t answered … If you ignore a baby’s signal for help, you don’t teach him independence… What you teach him is that no other human being will take care of his needs.”  (Lee Salk)

Breastfeed Twins? Yes!

January 12, 2011

If you’re expecting twins, you may be wondering…Is it possible to breastfeed twins? Can my body make enough milk for two babies? Can I really nourish my babies without using formula? The answers are yes, yes and yes!

Your Dr., your doula and your childbirth educator may all have told you, “Most women can’t make enough milk for 2 babies.” Don’t believe them! If your body is equipped to breastfeed one baby, it is highly likely that you will have sufficient milk for 2.

Arnie and Ashley

Last week I met with the parents of these 2 babies to help them with breastfeeding. They told me I was the first professional to say that they could expect to fully breastfeed their twins. They attended a prenatal twins class and the instructor told them “…hardly anyone is able to breastfeed twins without supplementing…” Immediately after giving birth, the nurses in the hospital told the mom, “you are going to have to supplement. They will starve if you only breastfeed.” The next day the pediatrician saw them in the hospital and told the mom, “Your milk isn’t in yet. You need to supplement.” Their doula who considers herself an expert on twins said, “I have never seen a mom 100 percent breastfeed twins.” Well, guess what! After some guidance and adjustments to their routine, these babies are now breastfeeding with no supplementation.

You body is made to breastfeed! It expects to breastfeed. And when you are carrying twins, your body knows you have twins and transmits the information to your breasts. Before you even give birth, your breasts are gearing up for double duty! In fact, research shows that moms of twins produce more than twice as much milk as moms of singletons. Now that’s preparation!

Remember the concept of supply and demand. The more your babies breastfeed, the more milk you produce. If your babies can’t breastfeed immediately after birth (or if one baby can’t breastfeed), use a hospital-grade pump to encourage and maintain milk production.

Will breastfeeding twins be challenging? Of course! Having twins is not easy. You will be learning about 2 babies at once and learning about breastfeeding at the same time. Without a doubt, there will be a steep learning curve. Once you and the babies have figured it out, however, breastfeeding two will be as easy as breastfeeding one!


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