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The content on this website (http://sdbfc.com) is the property of Robin Kaplan, M.Ed., IBCLC, except in the case of guest blog posts, which have been posted with permission of the authors credited.

The information and opinions provided on this blog are not a substitute for medical advice or consultation with a qualified medical professional; nothing contained on this website shall be presumed or shared as medical advice at any time.

Links to other websites and blogs that may be of interest to you, the reader, are provided; this does not imply endorsement of or collaboration between Robin Kaplan and the owners/authors of those websites and blogs.

Monday
Mar022015

Breastfeeding After Breast Reduction - It IS Possible!

Written by Ashley Treadwell, IBCLC

 

Many women wonder if they will have a full supply after having a breast reduction.  While the basic answer to this question is “we don’t know yet” - there are many factors, as well as things she can actively do, that can affect her ability to breastfeed successfully.  In this article, we will discuss what those activities are and how a mom can maximize her supply when breastfeeding after a breast reduction. We will also look at what long-term supplementation can look like, if it is necessary.

It is important to remind you that breastfeeding does not have to be an “all or nothing” endeavor!  We need to re-define what “success” means when it comes to breastfeeding after a breast reduction. Anytime a woman has a physiological factor that can affect milk supply, we always want her to understand that ANY amount of breastmilk is amazing.  Whether she is able to provide 10% or 100% of what her baby needs, she is doing a fantastic job.    

 

What Factors Will Affect My Ability to Breastfeed Exclusively?

An initial factor is how the surgery was performed.  Fortunately, surgeons are currently performing breast reduction procedures in a manner that protects as much of the lactation function as possible - increasing a woman’s chance for breastfeeding later in life.  If a large amount of breast tissue has been removed, or the ducts that deliver the milk to the nipple openings are severed, breastfeeding may be negatively affected. There are many different types of procedures and it isn’t always possible to tell which type was performed by simply noting the shape and placement of a woman’s scars.  If you have had a breast reduction surgery and don’t know the specific type that was performed, the best way to gather this information is to contact the surgeon who performed the procedure.  The most popular surgery performed in the United States is one that is also known to have the best implications for breastfeeding later in life. In this procedure, the areola isn’t completely removed and, therefore, connection between the nipple and breast tissue/ducts is partially protected.  If the procedure involves removing the nipple completely and then surgically reattaching it, your chances of exclusively breastfeeding can be decreased.

Another factor that will affect your milk production is when the procedure was performed.  The longer the time between the birth of your baby and the procedure, the better your chances will be to develop a full milk supply.  Also, your milk supply is likely to increase with each subsequent birth - so if you are not able to exclusively breastfeed a first baby, there is still a good possibility you will be able to with a second or third child!  These factors are each important because with both time and breast stimulation, breast tissue can actually re-grow and re-connect.  This can be very encouraging for first-time moms to hear - that even if they are not able to provide their first baby with 100% of their breastmilk needs, all the hard work they are putting in is likely to pave the way for a larger milk supply with later children.

 

What Can I do to Maximize my Milk Supply - Before and After my Baby Arrives?

Something ALL moms can do to best prepare to breastfeed a baby (those who have had reduction procedures and those who haven’t!) is to educate themselves prior to the baby’s arrival.  Take a breastfeeding class taught by an International Board Certified Lactation Consultant (IBCLC) and find out which resources are available in your area.  Free support groups are a wonderful place to get help and support, as well as connect with other moms who are currently breastfeeding.  We encourage women to attend our breastfeeding support groups while still pregnant - it’s a great way to familiarize yourself with breastfeeding women. A breastfeeding class will teach you what normal breastfeeding looks like in the first few weeks - this knowledge can help to reduce a lot of stress and anxiety.

Find an IBCLC who is knowledgeable about helping women breastfeeding after a breast reduction.  Most offer prenatal consults that will specifically address what you can do to maximize your milk production, including different herbs available to help with supply.  And even if you don’t meet with one prior to birthing your baby, she can be there as soon as baby arrives to help, if needed.

Once your baby arrives, the very best thing you can do is to breastfeed that baby constantly!  The more stimulation your breasts receive in the early days, the better your milk supply will be.  Babies feed frequently in the early days - knowing the signs that baby is getting enough are important.  We have great information in a blog post about how to know baby is getting enough in the first week - I’ve Had My Baby, Now What? Breastfeeding During the First Week.

 

 

Some signs that baby isn’t getting enough are: baby not gaining weight after the 5th day of life, baby not having the recommended number of pee and poop diapers per day, or baby is well under birth-weight by 2 weeks of age.  If you are experiencing any of these issues, it is important to seek out the help of an IBCLC.

 

If Long-Term Supplementation is Necessary - What are My Options?

 

 

It may be the case that some amount of supplementation is necessary for a woman breastfeeding after a reduction, especially for her first baby.  If this is true - there are many options available.  Whether mom has little to no supply, or close to a full supply, the best way to supplement a baby to establish a wonderful breastfeeding relationship is to feed the baby the additional milk at the breast.  There are supplemental nursing systems (SNS) available that are made for this specific situation - an IBCLC can help a mom learn how to use this.  If mom doesn’t want to supplement baby this way, but does want baby to have time at the breast, she can still feed the baby at the breast and then follow up with another feeding method - like a slow-flow bottle.  If having baby at breast is important to mom, we do recommend that a bottle isn’t introduced until baby is latching well at the breast - some time after week 3.  Prior to then, mom can supplement using a SNS, and then move to some combination of that and a bottle after the baby is 3-4 weeks of age.  Supplementation can either be with mom's pumped milk, donor milk from another breastfeeding mother, or commercial formula. Here is our YouTube video showing one way a mom can supplement her baby at the breast: Supplementation: SNS at Breast

 

 

 

What Resources are Out There to Help Women Who Want to Breastfeed After a Breast Reduction?

Having support and help both before and after the birth of your baby is crucial and can have a lasting effect on your breastfeeding experience.  We encourage all moms, whether they’ve had breast surgery or not, to look for breastfeeding support in their communities.  Women who are breastfeeding after a breast surgery may need additional support and information specific to their unique situation.  One of our favorite places for support is the website Breastfeeding After Breast and Nipple Procedures.  Here you can find links to health care providers in your area who specialize in helping women post breast surgery, as well as a community of women who are in your same situation.  Robin also interviewed Diana West for The Boob Group podcast episode: Breastfeeding After Breast Reduction Surgery.  

 

Additional Resources:

Defining Your Own Success. Breastfeeding after Breast Reduction Surgery by Diana West.

La Leche League articles about breastfeeding after breast reduction surgery

 

 

 

 

Sunday
Feb222015

Using YouTube to Help Achieve Comfortable Breastfeeding Positions

Written by Ashley Treadwell, IBCLC

In the beginning, breastfeeding can feel somewhat awkward and uncomfortable as new moms learn how to get their baby properly latched on.  As an IBCLC, I see a lot of new moms breastfeeding their babies sitting straight up or hunched over, looking very uncomfortable.  Heck, I did this as a new mom myself!  I remember the constant aches in my neck and shoulders from sitting in contorted positions for long periods of time.  Breastfeeding is something moms do very frequently in the early weeks and months - it should be comfortable.


Out of all of the breastfeeding positions, there are two that happen to be our favorite - the side-lying and laid-back breastfeeding positions.  We like these positions for so many reasons - the laid-back position often helps a baby achieve a deeper latch, and both positions are extremely comfortable for both mom and baby and promote lots of rest and relaxation.  This is great for moms as their bodies need good rest to recover from delivery and is great for babies as the best milk transfer often happens during sleepy, calm times.  Sometimes a mom may find that she is having a difficult time replicating these positions on her own - so we decided to provide a video demonstration!  Here are two videos showing the laid back breastfeeding position and the side lying position.  For mom breastfeeding videos, check out our YouTube channel: DIY Breastfeeding!

 

Breastfeeding Positions: Laid Back Breastfeeding

 

Breastfeeding Positions: Side Lying Breastfeeding

 

What is YOUR favorite breastfeeding position?

Thursday
Jan222015

Our New Low-Cost Breastfeeding Clinic

Written by Robin Kaplan, M.Ed, IBCLC

 

My background is in social justice and urban education.  For the years before I started the San Diego Breastfeeding Center, I worked in inner-city elementary schools and for non-profits, including AmeriCorps, to help bring well-deserved resources and education to underserved communities who needed it the most.  Because of this, one of the biggest challenges I have faced since I started SDBFC was trying to figure out how I could make my expertise and support accessible to ALL breastfeeding mothers... not just the ones who could afford my services.  I have seen over and over again local moms posting on Facebook about how desperate they are for breastfeeding help, yet cannot afford to see a qualified IBCLC and this absolutely breaks my heart!  

Not being able to help these mothers goes against everything I have been taught and everything I stand for.  

No one should be denied qualified breastfeeding assistance and support because of their financial situation.  While I have loved offering community-based breastfeeding support groups, when a mom is faced with a complicated breastfeeding situation, it is almost impossible to receive the necessary attention and follow-up when there are 10-20 other moms in the room, who happen to also be looking for their own support.  

When I founded SDBFC, my 5-year plan was to be able to offer reduced-fee consultations to mothers who needed low-cost options.  Well, we just celebrated our 5-year anniversary and I am thrilled to announce our new low-cost breastfeeding clinic!

 

 

Here are the clinic details:

At our 90-minute low cost breastfeeding clinic, up to three moms/babies will meet with a lactation consultant (IBCLC) and receive assistance with their breastfeeding challenges.  

 What takes place at the clinic:

  • Baby is evaluated for tongue tie and lip tie
  • Breastfeeding position and latch are assessed
  • Baby is weighed before and after the feeding to see how much breastmilk was transferred
  • Mom is given a personalized Plan of Care

 

Reasons why a mom would want to attend the clinic:

  • Baby not latching or nursing well within 24 hours of birth
  • Tongue tie or lip tie
  • Nipple pain/damage
  • Baby is gaining weight too slowly
  • Mom feels like she doesn’t have enough milk
  • Nursing multiples
  • Nursing a preemie
  • Recurrent plugged ducts/mastitis

 

Requirements: Mom qualifies for WIC, baby has MediCal, or mom or dad must be active duty military.

Cost: $25 

Registration: Mandatory, as space is limited to 3 moms per clinic (www.sdbfc.com/consultations)

 

My sincere hope is that this is just the beginning of SDBFC making connections with more local communities by providing judgment-free, affordable breastfeeding support for any mom who needs it!  We have many more plans in the works and we are excited to get started!

 

If you have any local connections to organizations that work with low-income pregnant or new moms, please send me an email (robinkaplan@sdbfc.com) so that I can send them information about our new clinic!  

 

Monday
Jan052015

Join Our Nursing in Public Task Force

Are you passionate about protecting a mother's right to breastfeed in public?

Are you curious about what the San Diego Nursing in Public (SDNIP) Task Force does to resolve NIP harassment incidents?  

Do you want to become more involved with the SDNIP Task Force?

Do you want to learn how to start your OWN local NIP Task Force?

 

Well, look no further!

 

 

 

On January 15, 2015, from 4-4:30pm PST, we will host our first SDNIP Task Force Town Hall Meeting on Google+ Hangout On Air. During our Town Hall meeting, we plan to:

  • explain the steps in which a mother can resolve a NIP harassment incident
  • enlist a group of core volunteers to assist with supporting local NIP victims and expanding the SDNIP Task Force resources
  • provide information for others who wish to start a Nursing in Public Task Force in their own communities.  

We will be collecting questions prior to the event, so please post your questions on our Event Page.

If you are unable to watch the Town Hall Meeting live, we will also place its recording on our website and YouTube channel the following day. 

 

 

Who knows…. Maybe joining our town hall meeting will inspire the nursing in public advocate deep inside of you!

 

Do you know someone who might be interested in learning more about the Nursing in Public Task Force?  Feel free to share this information on Facebook, Twitter, Google +, or by good old email!

 

Tuesday
Dec092014

On-Demand vs. Scheduled Feeding: Which is Best for Baby?

Written by Ashley Treadwell, IBCLC

Google can be an amazing resource - but it can also provide WAY too much information for a first-time mom.  One of the questions we get often from our clients is what is the best way to feed a breastfed baby - let the baby demand when to feed or try to shape their feedings into a structured schedule?  Moms hear a lot of differing information about when to feed their babies in the early weeks - every 2-3 hours, 8-12 times in a 24 hour period, etc.  It can be confusing to know what this means exactly - is it every 2 hours or every 3 hours?  What if baby goes longer than 3 hours?  What if baby seems hungry before 2 hours?  What if baby wants to feed 15 times a day, or maybe only 7?  How do you know when you should feed your baby?  Here’s the short answer:

 

WATCH YOUR BABY, NOT THE CLOCK.

 

On-demand feeding is absolutely the *best* way to feed your baby in the early days, weeks, and months.  As time goes on, your baby is likely to start to shape his/her own behavior into a somewhat more-predictable schedule, but trying to make/force/help them to do that before he/she is ready only makes for a stressed out mama and a cranky baby.  

 

What is Demand Feeding and What Are the Benefits?

 

 

Feeding your baby “on-demand” simply means not worrying about the clock.  You feed your baby whenever he/she shows you that he/she is hungry.  Common ways your baby will show you this include licking his/her lips, sticking out his/her tongue, rooting around, sucking on his/her hands, etc.  Feeding your baby on-demand also means that you don’t “time” the feedings, (15 minutes per side, etc.) but that you allow your baby to feed until he/she is  satisfied.  It can be confusing to know when a baby’s had enough - some good cues are a baby who de-latches him/herself from the breast and doesn’t try to get back on, or falls asleep at the breast and feels very relaxed and loose when you lift his/her arm.

There are a LOT of benefits to on-demand feeding.  In the immediate days following birth, putting a baby to breast at any and all hunger cues is excellent for bringing in a full milk supply.  Simply, the more breast stimulation a brand-new mom gets, the better her milk supply will be.  On-demand feeding is also a good way to ensure that baby will get enough milk to grow properly.  Mothers have different storage capacities in their breasts, and all babies take in different amounts - even the same baby will take differing amounts throughout a day.  

 

 

We have no way of knowing exactly how much a baby takes at each feeding, so how can you be sure the baby took enough to sustain him/herself until the next scheduled feed?  Another thing to keep in mind is that there is so much more to breastfeeding than just the nutrition and calories your baby consumes.  Breastfeeding is warmth, comfort and nurturing - things that should never be withheld from our children.  In my opinion, the best benefit is one of the biggest pros to breastfeeding in general: once breastfeeding is going smoothly, you don’t have to time, track, measure, or log.  You just snuggle your baby and follow his/her lead.

*** There is ONE small parameter that we often recommend during the first few weeks postpartum with respect to on-demand feeding.  Some babies are very tired for the first few weeks and may not wake up on their own to feed 8 or more times in 24 hours.  This is most common for babies born prematurely, babies with jaundice, babies with tongue ties, and babies who are having a difficult time gaining weight.  Ineffective and infrequent feedings can cause slow weight gain and can possibly cause mom’s milk supply to not come in as fully as possible.  Therefore, to help babies get back to birth weight by 2 weeks of life, we recommend that parents wake their babies to feed at least every 3 hours during the day and at least every 4 hours at night for the first few weeks.  If your baby is back to birth weight by two weeks, then this parameter is lifted and on-demand feeding can commence!

 

What About Scheduled Feedings?

On the other hand, scheduled feeding can sometimes be sabotaging to a breastfeeding relationship, as well as to your baby’s overall health and growth pattern.  Scheduled feedings are when a parent chooses a timed feeding interval based on things like baby’s weight or age, and only feeds baby at these intervals, regardless of baby’s cues or readiness.  As pointed out above, when a baby feeds at the breast, we don’t know how much the baby is taking - so there is no way for us to know how long baby can go before he/she needs to feed again.  In the early days, if your baby is not put to the breast when hungry, it can have a negative impact on your milk supply.  Later on, it can affect baby’s sleep patterns, as well as their growth and development.  Scheduled feeding also doesn’t allow for growth spurts - a time when your baby will ask to feed much more often than normal, helping to increase your milk supply as your baby grows bigger.  If your baby isn’t allowed to feed more frequently during these times, your milk supply may not be able to meet your baby’s growing need.  Lastly, not putting your baby to breast when baby is asking to feed causes your baby to miss out on the non-nutritive benefits like the bonding and comfort your baby craves.

One of the biggest challenges we hear from mothers about on-demand feeding is that they feel overworked and tired from being available at all times.  This is a common stress for many moms in the early weeks, but be encouraged - it passes.  It will seem like your baby is feeding ALL.THE.TIME in those first 6 weeks or so, but it will pass. As time goes on, your baby will begin to form his/her own schedule - or at least you’ll grow better accustomed with his/her pattern and behaviors.   A great solution to this is to learn to breastfeed in a carrier as that will allow you to not be chained to the couch when your baby is hungry.  Check out how to do that on our YouTube Channel: DIY Breastfeeding.  Another great solution for the over-tired mom is to bring your baby into your bed at night.  This often helps all to get more rest.  If you have any concerns about safely co-sleeping with your baby - check out these guidelines here.  


When did you notice that your baby’s feeding schedule became more predictable?