Archive for the ‘Latching’ Category

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.

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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!

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 Requires Swallowing!

February 24, 2011

This video (though a bit blurry!) illustrates audible swallows by a newborn.  The regular, rhythmic “kuh” sound is produced with each swallow.  Notice the baby’s jaw drop right before the sound.  The position of the baby is perfect and he is getting an excellent meal!

Breastfeeding Help Long Distance

February 5, 2011

This young mother called me at the urging of a friend who already knew and trusted me. Breastfeeding was very important to Marissa, but she didn’t know how she could go on with so much pain. Normally, I would have seen this mom and baby in person. She lives in another city, however, and she felt most comfortable working with me. I gave her guidance over the phone several times over the course of a few weeks. Since her baby was gaining weight and she had a great milk supply, she just needed some minor adjustments to make breastfeeding comfortable.

Here is a portion of her story:

After a few weeks of breastfeeding, I felt defeated. My nipples were cracked and bleeding. Each nursing was becoming more painful, and I was beginning to dread feeding my baby. After every feeding my son would spit up blood. I was beginning to accept this as my breastfeeding fate when I decided to call Renee. On the phone, she was able to describe in detail the way my son should be properly latching on. While we were talking, I could hold him in the positions she was describing to me, and get a complete visual understanding of how to get him to latch on properly. She also recommended that I visit her blog and watch a video of a baby getting a good latch. Within a day or two my nipples were healing, nursing was no longer painful, and I was able to finally enjoy these beautiful moments with my son.

Five months later, Marissa and her baby are still happily breastfeeding!

Note: Lactation help in person is optimal for helping mom and baby breastfeed. It is often necessary in order to complete an accurate assessment. If Marissa’s pain had not quickly resolved after our phone conversation, I would have recommended lactation consultant in her area who could have helped her face to face.

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.”

Breastfeeding in Public-The First Time

October 31, 2010
This is a short story from client who learned something very important from her baby: Breastfeeding can happen anywhere and any time without any special gadgets or preparation.

The first few weeks of breastfeeding Bernie were very draining for me. I was constantly worried that he wasn’t getting enough, taking any unsatisfied looks from him personally and feeling isolated due to the long nursing sessions. I started taking Bernie for daily walks in my neighborhood within days of getting home from the hospital so at three weeks, I thought we could make it three miles around Green Lake without having to stop.   Although I was occasionally pumping, I had not prepared a bottle for this walk and instead fed him before we left and figured I’d feed him again as soon as we got home.  Bernie lasted one mile around the lake before he decided to make me and everyone around us know that he was hungry.  My mother-in-law was along for the walk. Had I been alone, I would have hid behind a tree, but she encouraged me to nurse him on a bench along the trail.
I had never breastfed in public and I wasn’t comfortable with the idea.  I wasn’t sure I could actually do it.  As I fussed nervously with my scarf to properly hide myself, Bernie just placed his legs around my leg, turned his head and latched on without me having to do anything. It was a big turning point for me. In that moment, I realized that we were doing alright and breastfeeding will continue to go well because I’m not in this alone. Bernie is as determined as I am to make it work.

Breastfeeding Challenges-Andrea’s Story

October 30, 2010

This story is generously shared by Andrea and her daughter, Ainsley.  Thank you both for your story and your determination to breastfeed!

When I was pregnant, I worried about everything. Everything, that is, except for whether I’d be able to breastfeed. Since many of my friends and my own sister had breastfed their children, it was a given that I would do the same. I pictured myself breastfeeding my daughter Ainsley, sitting on the beach in front of my house with her tucked inside a sling, contentedly drinking while we enjoyed a special bond.

To my relief, Ainsley latched on within minutes of being born, awake, alert and happily feeding. My heart soared, relieved that we were on the path to having the breastfeeding relationship I’d envisioned. The second time she latched, though, it hurt. The nurses said, “It’s supposed to hurt.” I knew this wasn’t true and it quickly became clear something was wrong. Very soon my nipples were bleeding and the pain was intense. My confidence faltered. I developed fear about feeding, dreading whenever the clock — or my baby — suggested it was time to feed. Sometimes I’d even let her sleep an extra hour or two beyond what was suggested, just so I could give my nipples a break.

By the time we were home, it seemed like all we did was feed. I would breastfeed, painfully, and she would cry—not satisfied. Knowing that the early days of breastfeeding were critical ones, I called a recommended lactation consultant, Renee Beebe, for a home visit. Seeing the damage already inflicted on my nipples, she urged me to exclusively pump until my nipples healed. I hoped for smooth sailing from that point forward.

Pumping was difficult—I barely got enough milk. Furthermore, when I began breastfeeding again, I noticed Ainsley’s fussy behavior at the breast was getting worse. Sometimes she’d scream and cry until I removed her; other times, she’d fall asleep the minute she latched on. I called Renee back for help. It soon became clear that the latch problem was exacerbated by another underlying issue — low milk supply.

I had to supplement with formula, as my pumping output couldn’t keep up with her demand. The first few times I made the formula, I cried. I felt like a complete failure as a new mother.

I ate and drank everything I could to help boost the supply. I ate oatmeal every day, and snacked on Milkmakers cookies. I took a variety of herbs in many forms. Everything helped a little, but still, I didn’t have enough milk. I knew I had to try everything in my power to make this work before calling it quits, and I so persevered.

In the following weeks, I saw other specialists, including an occupational therapist trained in newborn feeding issues. No one could find any sucking or anatomical problems. Clearly, supply was the main issue. To preserve the breastfeeding relationship as best as I could, I began supplementing at the breast using a supplemental nursing system. The SNS was awkward the first few times, But soon I became a pro at taping the tube to my breast and latching her on. Over the next few days, Ainsley became more content at the breast, getting the milk flow she needed to feel satisfied.

At the same time, I started a medication to help boost milk production. Within just a few days, I noticed an increase. One night I pumped 4 oz in one sitting, and I was so proud that I took a picture of the milk I pumped! Slowly but surely, Ainsley took less and less milk from the supplementer. The formula became a thing of the past, and pretty soon, the supplementer as well.

Today, Ainsley is nearly three months old, gaining weight at an excellent pace, and thriving. I am so proud that we made it this far with breastfeeding. Was my supply low because of our struggles in the early days? I may never know. I still worry that I won’t be able to keep up with her as she grows. But for now, I am going to enjoy every moment of our breastfeeding relationship. I am going to sit on a park bench facing the beach, nursing and nourishing my daughter, relishing the moment.

My Baby Won’t Latch!

September 19, 2010

I hear this phrase several times a week. It troubles me because it implies that the baby is unwilling breastfeed. Nothing could be further from the truth.

You baby was born to breastfeed! She is hard-wired to seek comfort and nutrition from you breasts. This is, after all, how babies survive! When a baby is unable to latch and breastfeed it simply means that she is unable to latch and breastfeed—not that she is unwilling!

If your baby does not breastfeed right away, you may feel that there is something wrong with your breasts, or your baby doesn’t want to breastfeed or even that your baby doesn’t like you. None of these things are even remotely true, however. Your baby is most comforted by you—the scent of your skin, the sound of your voice and the rhythm of your heart and breathing.

There is no need for panic if your baby doesn’t latch immediately after birth. Let your baby snuggle skin-to-skin on your chest. Let her nuzzle against your breast. Encourage her as she scoots around searching for your nipple.

If your baby is attempting to latch on and is unable to grasp the breast or maintain her latch, she may be having some simple coordination problems. Seek the help of a lactation consultant. These things usually work themselves out over time, but you will need support and guidance to ensure your baby gets plenty of your milk while she’s learning to breastfeed.

See also, “Your Baby is a Mammal”

A Perfect Latch

June 21, 2010

Perfect Latch in Football Hold

Here is a beautiful example of a football hold latch. This baby is just 5 days old, but he knows exactly what to do!

How do we know this latch is perfect?

His nose is tilted away from mom’s breast.

His chin is tucked in firmly to the underside of the breast.

Baby’s top lip barely covers mom’s nipple.  Baby’s mouth is assymetrical in relation to mom’s areola. The areola is clearly visible above the top lip but the lower part is covered by baby’s mouth.  (Note:  The appearance of the latch will differ slightly with each mom due to anatomical variations.)

Baby’s mouth is open wide.  The corners of his lips are not touching.

Most importantly, baby is drinking and mother is comfortable!  Click here to see this baby in action and hear the swallows!


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