IUD’s and Milk Supply

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!

Breast Engorgement and Cabbage Leaves?

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

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!

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

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!

Breastfeed Twins? Yes!

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!

Breastfeeding and Work: Jane’s Story

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.

Milk Supply and Fluid Intake

A mother who is struggling to provide enough milk to her baby will go to great lengths to increase her supply. She will hang on to every word of every well-meaning friend, relative or health care provider. Unfortunately, much of what she hears may be untrue or even potentially harmful to her health!

The number one myth I hear over and over again is that one must drink milk to make milk. This is not only false it makes no sense. Think about other mammals. Do you know of any adult mammal who drinks milk? Of course not! Mammals produce milk for their infants. When they mature and wean, they no longer need their mother’s milk. Think about dairy cows. They are prolific milk producers. And not one of them drinks milk!

What about water? A client recently reported that a nurse in the hospital said “…the more water you drink, the more milk you will produce…” When I met with her on day 6 she was practically drowning herself—drinking gallons of water each day—thinking it would help her baby gain weight. Her baby had lost weight because he was not breastfeeding correctly which led to a decrease in milk production. No amount of water could have helped with that situation.

It is, indeed, important to stay hydrated. You are losing fluids every day due to regular metabolic functioning in addition to milk production. If you are truly dehydrated, your milk supply may be affected. In those situations, drinking more water can help you recover a dwindling milk supply. But excess water can flush important nutrients from your body, so don’t overdo it!

As a general rule, try drinking a glass of water each time you sit down to nurse your baby. If you feel thirsty, you are already dehydrated, so don’t wait to get thirsty before you have a glass of water. Don’t like drinking water? Try herbal tea, flavored waters, diluted fruit juice, or sparkling water. Taking good care of yourself will allow you to take good care of your baby!

See also “Breastfeeding and Milk Supply“

Emma’s Breastfeeding Saga

When I was pregnant, I had lots of thoughts about my future breastfeeding life. I was planning on being one of those out-on-the-town moms–baby nursing happily while in a sling or sitting together under a tree in one of Seattle’s local parks. My biggest concern was how long to breastfeed–not if I could breast feed. But things turned out differently.

Solomon was a sleepy baby and didn’t breastfeed regularly. When he did breastfeed, it was very painful. The nurses told me pain was normal. The pain was so bad I would make my husband stand on my feet during feedings to counteract the nipple pain Still, I was determined to breastfeed.

At the first pediatrician visit, we learned that Solomon was jaundiced. He needed to be on a light bed. After one day on light thereapy, his jaundice was worse and we had to start supplementing with formula. We met with a nurse “lactation specialist” and she suggested supplementing at the breast with a feeding tube. She showed me how to feed Solomon with a tube taped to my breast. The temporary supplementation helped Solomon gain weight and eliminated the jaundice problem so we stopped.  Breastfeeding was still excruciating.

After a week of exclusive, frequent breastfeeding, my nipples were badly damaged AND we learned that Solomon wasn’t gaining weight. I was so discouraged! Finally, at the urging of our doula and pediatric clinic, we hired a lactation consultant to help us. Renee noticed tension in Solomon’s jaw and neck. She pointed out that his jaw was slightly asymmetrical. She suspected that he was tongue tied and explained how all these things contribute to poor feedings. Finally, after watching Solomon breastfeed, she determined that my milk supply was low and that he wasn’t doing a great job of taking the milk that I had. No wonder he wasn’t gaining weight!

Renee urged me to temporarily stop breastfeeding and use a pump to allow my nipples to heal and increase my milk production. She referred me to a Dr. who specializes in helping babies who are tongue tied. In addition, she recommended a physical therapist to help Solomon with his tight jaw and neck muscles. I fed Solomon as much breast milk as possible and took a combination of herbs and medications that support milk production.

Solomon’s latch got better immediately after the frenotomy (clipping the frenulum to release the tongue) but it was still slow progress. The body work helped relax his jaw. And, gradually, my milk supply increased to meet my baby’s needs. Finally, at 2 months, I was ready to breastfeed full time, but every time I did, the pain increased.

At Renee’s suggestion, I began to feed Solomon at the breast one feeding a day, then two, and so on until I was totally able to completely breastfeed without pain. I still have worries about losing my milk but so far, into month three, he’s gaining weight and I’m beginning to store milk for when I return to work.

Looking back, I wish I would have hired Renee right after Solomon’s birth. I know we could have gotten off to a better start. We could have identified his challenges and resolved them sooner. I would have been able to focus on being a mom and enjoying my baby.

I’m so happy that we persevered through those early, dark days. Thank you, Renee, for helping us become a success story!

Community and Internet Resources

www.nestinginstincts.org Comprehensive care from pregnancy through breastfeeding.  Classes, doulas, lactation consultations and placenta encapsulation.  Seattle area.

www.milk-makers.com Delicious cookies that help boost milk supply.  Sign up for informative, monthly newsletter.

www.pollywogbaby.com Information and products for infant reflux and GERD.  Free downloadable parent handout.

www.hadleystilwell.com Beautifully tailored clothing for working, breastfeeding and pumping.

www.fertilefoods.com Resource for fertility issues, pregnancy, breastfeeding and overall nutrition.

www.zoelotus.org, www.rubymoonwellness.com Acupuncture and massage for fertility, pregnancy, breastfeeding and beyond.  Seattle area.

www.soundgardenhealing.com Acupuncture specializing in fertility issues.

Bella Materna, comfortable and supportive  bras, panties, camisoles and more for pregnancy, breastfeeding and beyond.

Seattle area birth doulas:

Jan Martinka: www.janmartinka.com

Joy MacTavish: www.sounddoula.com

Down to Earth Doulas: www.downtoearthdoulas.com.  se habla espanol.

Serene Doulas: www.serenedoulas.com A team of 3 doulas providing comprehensive care.