Archive for the ‘Milk Supply’ 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!

Pacifiers and Newborns

March 6, 2011

Nearly every new mother I see asks the question, “Is it ok for my baby to use a pacifier?”  Here is the simple answer: Yes and no!

What these mothers want to know is whether pacifier use will interfere with breastfeeding. I can say with confidence that I have never seen a baby prefer a pacifier over a breast filled with nummy milk! In addition, in over 20 years of helping resolve breastfeeding issues, I have never named the pacifier as the source of the problem.

Even though pacifiers are not necessarily the cause of breastfeeding difficulties, they should be used with caution—especially during the first few weeks of life. Newborns don’t necessarily know when they are hungry or thirsty. Thankfully, they don’t need to figure that out. All they know is they need to suck.  Frequently! When that suckling is at the breast, it ensures that babies get plenty of milk and moms have an abundant milk supply.

Conversely, when a baby uses a pacifier to get her sucking needs met, there is a danger that she will not spend enough time at the breast. My primary concern about pacifier use is this: All that sucking requires energy.  Newborn sucking is actually an aerobic exercise.  A baby exhausted from sucking on a pacifier may not have the energy to obtain nourishment from the breast. In addition, she may “fool” her parents into thinking she is getting enough to eat, as she falls asleep while using a pacifier.

Occasional pacifier use for very brief periods of time will not likely interfere with breastfeeding. But keep in mind that a pacifier is a breast substitute and use with caution. If your newborn baby needs to suck, she probably needs to eat!

Breastfeeding and Work: Jane’s Story

January 9, 2011

Jane contacted me because she had returned to work and she was worried about her milk production. Her baby, Ernie, was 3 months old and she’d just started working 3 days/week. We set up a phone consultation and she shared the following:

  • Away from her baby 8:30 a.m. To 4:00 p.m.
  • Pumps twice a day at the office for about 25 minutes each time.
  • Tries to pump at home so she can increase her supply as her baby grows.
  • Leaving 4 bottles of milk at the day care each day.
  • Ernie drinks 2-3 bottles at day care.
  • Feels rested and Ernie is thriving.
  • Eating milkmakers cookies for milk production.

I talked to Jane about a strategy to help with her milk production. But first I pointed out that she was pumping more milk than Ernie was drinking! I also assured her that Ernie’s milk intake is not going to increase much in the next few months. Breast milk is very efficient. Six month olds generally drink about the same amount as 3 month olds. This was good news!

My suggestions included:

  • Breastfeed baby when dropping off and picking up at day care.
  • Pump 3x/day for 15 minutes or so. (less tiring and stressful)
  • Leave 3 bottles at day care each day instead of 4.
  • Eliminate pumping when at home.
  • Try eating milkmakers while pumping to help with the let down reflex.

Jane was relieved to learn that she was meeting her baby’s needs. She was also thrilled that she did not have to pump extra at home to keep up with Ernie’s growth. In addition, even though she lives 3000 miles away, she has a lactation consultant that can help her if she encounters difficulties in the future.

Are you returning to work soon?  Wondering how to pump enough milk for your baby, get all your work done AND get a decent amount of sleep?  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.”  I will help you develop a customized plan for meeting your baby’s needs while you’re at work or school.

Breastfeeding and Fertility

January 4, 2011

New mothers are often concerned about getting pregnant again before they are ready. With good reason! To address that concern, health care providers often counsel new mothers to begin a birth control method 6 weeks after the birth of a new baby. But if that mother is breastfeeding, an invasive birth control method may not be necessary.

Breastfeeding has many benefits to mothers—one of which is a delay in the return of fertility. Many mothers enjoy a year or more without periods after the birth of their babies. Breastfeeding as a birth control method is referred to as the lactational ammenorrhea method or LAM. When a mother is using LAM, any artificial method of birth control can be considered a back- up method. LAM is over 98% effective* when ALL of the following conditions are met:

Your baby 6 months old or younger. Although you may remain infertile long after 6 months, the reliability of this method decreases with the age of the baby—probably because of the introduction of solid foods and the fact that your baby is sleeping longer stretches at night.

Your periods have not returned.

Your baby has nothing by mouth except the breast. In other words, the baby is not supplemented with other foods or formula and is not using a pacifier for long periods.

Your baby is breastfeeding at least every 3 hours during the day and at least every 6 hours at night. There IS a benefit to waking at night with your baby! If your baby is up frequently during the night, you’re protected from another pregnancy!

We all know mothers who got pregnant while they were breastfeeding. We also know plenty of women who have become pregnant while using oral contraceptives. Both methods are 98% effective or more when used correctly. No birth control method can be 100% reliable if it is used incorrectly.

It is important to discuss birth control options with your partner and your doctor. Some common birth control methods (those using hormones) can decrease milk supply. It is a subject that has not been well researched, so your health care providers may not be aware of the risk. Your lactation consultant or La Leche League Leader can help you sort out your choices that are compatible with breastfeeding.

*Please note: It is unknown whether pumping your milk for your baby provides the same protection as exclusive breastfeeding.


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