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Disclaimer/Disclosure

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.

Thursday
Mar262015

Do's and Don’ts of Using the Nipple Shield

Written by Robin Kaplan, M.Ed, IBCLC

Is your baby having a difficult time latching?  Is breastfeeding incredibly painful?  Do you have a cracked nipple that just won’t heal?  Then most likely you have been recommended to try a nipple shield.  While the nipple shield can often be a terrific temporary tool to help with these situations, it is important to know how to use them correctly, as well as have an exit strategy for how to discontinue usage as soon as possible.

 

What is a nipple shield and why is it used?

 

Nipple shield

A nipple shield is a thin piece of silicone that is placed on your nipple so that your baby can feed at the breast.  For the baby who cannot latch on easily (due to prematurity, difficult birth, tongue tie, etc) the nipple shield provides a definitive shape for mom’s nipple, making it easy to latch onto.....all baby has to do is open his/her mouth and start sucking.  For the baby who is compressing mom’s nipples while breastfeeding (due to a tongue tie, lip tie, torticollis, receded chin, difficult birth, etc.) causing pain and cracked nipples, the nipple shield provides a temporary barrier so that the baby can still breastfeed while allowing mom’s nipples some relief and time to heal.  Sometimes the nipple shield is offered to a mom just because she has flat nipples.  In most cases, this isn’t really necessary, since a baby who latches on deeply doesn’t care whether mom has flat or erect nipples.

 

Is there a correct way to use the nipple shield?

YES!  Just as with the baby who latches on to the bare breast, when a baby is latched on with the nipple shield, he/she will only be able to stimulate mom’s milk, keep up her milk supply, and effectively transfer milk if he/she has the entire nipple shield in his/her mouth.  If the baby is sliding off and on the nipple shield while feeding, the baby will not be able to transfer milk well and can also cause mom a lot of nipple pain.  

 

Depending on how long your nipple is, you might have to invert the shield before putting it on, so that your nipple goes further into the shield before latching your baby.  Our DIY Breastfeeding YouTube Video, Latching: Using a Nipple Shield, demonstrates how to do this.

 

 

What are the pros and cons of using the nipple shield?

Pros:

  • Mom’s nipple has an opportunity to heal without having to introduce a bottle too early to her baby.
  • Premature babies who have not yet become super coordinated at latching on to mom’s bare breast and who tire quickly are able to breastfeed more easily.
  • Babies who are unable to latch onto mom’s bare breast, for a variety of reasons, are able to breastfeed while the underlying challenges are addressed.

Cons:

  • Babies may not be able to effectively transfer milk using the nipple shield, so baby might need supplementation even if mom’s milk supply is able to meet his/her need.
  • Mom’s milk supply could potentially decrease if baby isn’t effectively stimulating her milk supply.
  • Mom might get recurrent plugged ducts and/pr mastitis due to ineffective milk drainage.
  • Babies can become very dependent on the nipple shield, which can make it difficult to wean from.  This can make breastfeeding in public a bit of a challenge.

 

How can I wean my baby from the nipple shield?

Babies can become very obsessed with the nipple shield, so sometimes it can be challenging to wean them from it.  This is why you always want to have an exit strategy.  

  • If you are using the nipple shield as a temporary band-aid while your nipples heal, try to use it for only a few days and maybe not for every feeding.  If one side is less damaged than the other, only use the shield on the more damaged nipple.  
  • If you are using the nipple shield to help with latching difficulties, attempt each day to latch your baby without it.  You never know when he/she is going to figure out how to latch without it and the daily practice should help speed up that process.  Sometimes moms find it helpful to latch the baby with the nipple shield at the beginning of the feeding and then try the ‘bait and switch’ move to encourage the baby to latch back on without it once he/she has a little milk in the belly.
  • If you are using the nipple shield due to baby’s inability to breastfeed well because of a tongue tie, lip tie, general chompiness, torticollis, etc., you absolutely want to schedule an appointment with a lactation consultant to help remedy these underlying issues.  The use of the nipple shield might help temporarily, but it may increase your risk for breastfeeding challenges later on, which can be more difficult to fix as the baby gets older.  A great IBCLC should be able to assess what is causing these breastfeeding challenges, as well as provide you with other practitioners who can help remedy the situation, such as an ENT, pediatric dentist, chiropractor, craniosacral therapist, etc.

 

Thursday
Mar122015

You’re Invited to our Grand Opening Event

We’ve finally settled into our new space and it feels just like home now!  Please join us at our Grand Opening Event for an afternoon of snacks, special offers, raffles, games, and kid-friendly activities.  

 

Meet all of the amazing practitioners in our office:  

Dr. Stan Hom (family chiropractor)

Kiersten Markham (Doula)

Sarah Burns (Doula)

Victoria Loring (Holistic Nutritionist)

 

 

RSVP: Grand Opening Facebook event page

Pop in, stay for a while, and help us celebrate our new home!

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!