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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
Apr282014

Mother Kicked Out of LA Fitness for Breastfeeding in the Locker Room

It happened again in San Diego!  How is this possible?  Another nursing in public incident that clearly violated California state law!  An incident where a mother felt violated and shamed for nursing her baby in a public place.  Another reason that reinforces the need for our San Diego Nursing in Public Task Force.

 

Here is Monique Golueke’s story, in her own words.  

 


"It had been over a year since I had been to the gym and after what happened today, it's not likely I'll be returning, at least not to LA Fitness. I was so excited to attend a step class alongside one of my best gals.

On April 22, 2014, I reinstated my membership, paid the fees, and signed my boys up for the unlimited Kids Klub pass. Forty-five minutes into our class, I was notified that the boys had been crying and they weren't able to settle down. I swooped them up and took them directly to the ladies’ restroom/locker room where I washed both of their little hands. My 9-month old still seemed upset so I decided to nurse him while my toddler sat next to me and played with my phone. About five minutes later, I was approached by an LA Fitness employee.  She told me that we needed to leave and that children were not allowed in the locker room.

I explained that I was nursing my son and she responded by saying that since I was new I probably didn't know the rules. She told me that an "elderly" woman had complained. Upon signing back up for the gym, there was no mention of the rules regarding the children.

When approached, I felt completely mortified, embarrassed and ashamed. I asked the employee where I should be nursing and she told me that there was a bathroom located in the kids club. Escorted out I felt embarrassed, ashamed and humiliated.  Keep in mind that there are no signs posted stating that children are not allowed in the ladies’ restroom/locker room. My intention was to nurture and care for my children in a safe and friendly environment.

Escorted me out-what now?

They were more than happy to accept my money, then send me on my way.

I decided to call corporate and notify them of what happened and also have my account deactivated, I also asked them to refund my money. They were apologetic and handled the situation by having the manager from the Oceanside location contact me.

The manager called me and asked what had upset me: the fact that I was breastfeeding or the fact that the kids were in the locker room. I barely understood what he was asking. It was clear he didn't understand the legality of the situation. He told me that if I ever wanted to return to LA Fitness, I was welcome to nurse my baby in the restroom located in the Kids Klub.

I'm not positive but I think the only place to sit in the restroom that he was referring to is on the toilet. 

At that point, I decided to again contact Corporate and inform them of the absurd conversation I had with the manager.  They were apologetic and explained that if they needed to contact me they would. The conversation was strange and at this time I was heated and enraged. The woman didn't really say much."

 

------------------------------------------------------------------------------------------------

 

After Monique shared her story in a private Facebook group, women from all over San Diego county banded together to organize a peaceful nurse-in in front of the Oceanside LA Fitness, showing their support for Monique as well as upholding a mother’s right to nurse in public.

Click here for the video from ABC 10 News showing the Nurse-In at LA Fitness.

Jill Greuling, Vice President of Operations for LA Fitness, issued this statement to 10News: 

"We support the right of women to breastfeed in our facilities. When Mrs. Golueke voiced her intention to do so to one of our staff, she was offered space in the Kids Klub or, as an option, the separate restroom within the Kids Klub and a chair if she wanted more privacy. The staff member initially spoke to Mrs. Golueke to let her know that children are not allowed in the locker room area. This conversation occurred because another member observed her in the locker room with small children and reported it to us.”

Unfortunately, this statement is untrue.  Monique was ONLY offered to breastfeed in the Kids Klub restroom and that is a significant problem.  The CA law states that a women is allowed to breastfeed her child, anywhere she and her child  are authorized to be.  If children are in fact not allowed in the locker room at LA Fitness, then the law doesn’t protect Monique in that area of the gym.  The issue is with the statement from the staff member who recommended that Monique breastfeed her baby in the Kids Klub bathroom.  This is not an appropriate place to breastfeed a child.  It is unsanitary and demeaning.  It is important for all LA Fitness staff to know that this is not an appropriate recommendation and that, instead, mothers should be alternatively told that they may breastfeed in the lobby or in a comfortable spot in the Kids Klub.

At this time, the San Diego Nursing in Public Task Force is sending a letter to the LA Fitness Corporate office kindly requesting that they create a breastfeeding-supportive policy statement for their members, including a list of appropriate areas where mothers may breastfeed their children in their facilities (not including a bathroom.)  We will also be offering language that they can share with their staff members on how to kindly respond to a mother who is breastfeeding her child in a place where her child is not authorized to be.

We will keep you posted!


Monday
Apr212014

Was it Something I Ate? Food Sensitivities in the Breastfed Baby

Witten by Lindsey Hurd, MS, RD, LDN, IBCLC, and Owner of Angel Food Lactation & Nutrition, LLC

From a gassy gut to red inflamed skin, breastfeeding moms often question the influence of their diet on behavior and symptoms in their little one. There’s no denying the influx of food sensitivities and allergies in children and adults, but what about the smallest members of our society? In my practice, I see many families who have infants showing signs of food intolerance, often times leading to symptoms such as eczema, bloody stools, sleeplessness, reflux, digestive discomfort from gassiness, abdominal pressure, and the infamous mucus-filled stool. “Is it something I ate?” mom asks. “Is it a virus or bacterial infection?” “Where did this come from? She was fine a week ago!” The world of food sensitivities is vast and perplexing, yet we are beginning to find our way as we learn more and more from our families each day. Over the next few months, I will be sharing a little insight into theories of why we are seeing this influx, how babies receive components of mom’s diet in her milk, and what we can do about it. 

 

What’s With The Influx??

There are many theories aiming to define the cause of food allergies, however none have been proven as fact. Some include the hygiene hypothesis, the dietary fat hypothesis, antioxidant hypothesis, and the vitamin D hypothesis. The hygiene hypothesis discusses our hygiene habits, from our current water system to the use of cleaners and hand sanitizers & soaps. This may contribute to the lack of exposure to pathogens (germs) and therefore suppressing the development of our immune system possibly leading to a greater risk of allergies and sensitivities. The fat hypothesis, vitamin D hypothesis, and antioxidant hypothesis dive further into our dietary intake and focus on quantities of healthy fat consumption and fresh fruit/vegetable intake as compared to a diet consuming highly processed foods, lacking key nutrients that are necessary for optimal functioning of the body.  Regardless of the exact cause, we know the increase in food sensitivities is real. 

 

Maternal and Infant Immunity

Mothers and babies, although becoming two at birth, are still incredibly connected in their need for one another.  In pregnancy, mom begins to share healthy bacteria, or microbiota, and immune boosting antibodies to her baby en utero. That’s right, before she is even exposed to her new environment! Mom’s amniotic fluid contains these bacterial warriors specifically made for her baby as she learns what she will need to survive in her future environment. As she initiates her swallowing reflex, practicing for her big job of feeding, she begins to lay down the start of her future microbiome. Once baby is earth-side, she relies on her mother’s breast milk to continue this amazing level of immune support as she slowly becomes dependent on her own body to provide protection. 

How does one establish immunity you ask? Mom absorbs something called antigens, or substances that stimulate the production of antibodies from her environment by way of her digestive system and through her nose, mouth, and respiratory system, etc. This creates antibodies to help her fight off any offending bugs or substances that may harm the body. When a mom is breastfeeding, she passes these antibodies on to her baby. Through her breast milk, she offers immunity toward anything that may be harmful in their specific environment. This explains how mom can get sick, but baby remains healthy or contracts a much smaller version of the illness. Given that part of mom’s immunity is based on antigens present in her digestive system, it makes sense to imagine how food can cause the production of antibodies. This is especially true if she is sensitive or intolerant to a certain food. In turn, baby receives these antibodies from mom’s milk and responds to the food in a similar fashion. 

 

How Do I Know If I Am Intolerant To Foods?

Many children and adults will become intolerant or sensitive to certain foods at multiple points in their life, however these sensitivities come and go with variability in its duration. The key signs of childhood or adult food intolerance are usually digestive or dermatologic in nature. This includes diarrhea, constipation, excessive gas, abdominal pain/bloating, variability in stool appearance, and alterations in skin appearance such as eczema, rash, acne, etc. Many times, adults have experienced these symptoms for so long they are unaware of its presence or feel it is normal for their bodies. Treatments and medications may be chronically used, masking the underlying problem. Therefore, dietary modifications are not pursued, leaving the gut-wrenching effects of these ‘repeat offenders’ present in the body.  

You may be thinking, “Yikes, that’s me!!” If so, congratulations! You have just identified the first step in removing or minimizing your digestive and/or skin related woes from your daily life. Better health is right around the corner for you and your baby… the next step is to determine what the offending food(s) might be. This process is most successful with daily self-reflection of dietary intake and physical symptoms. As always, seeking assistance from a Registered Dietitian specialized in food sensitivities will not only offer reliable, evidence-based information, but also help you navigate through your day-to-day life with new eating patterns! 

As you work through the removal of offensive foods, of equal importance is achieving the optimal gut environment… Next month, we will discuss how food sensitivity alters the maternal and infant digestive system, ways to restore balance, and how mom’s digestion relates to breastfeeding. This is a fascinating concept; you won’t want to miss it! 

 

Can’t wait a month to find out more? Visit www.angelfoodlactationandnutrition.com to schedule a Skype consult with Lindsey and begin your journey toward better health and a happier baby today! Want to stay connected between posts? Find Angel Food Lactation & Nutrition on Facebook at www.facebook.com/angelfoodlactationandnutrition for current articles, events, fun discussions and more!

Also, check out The Boob Group podcast episode, Breastfeeding the Dairy Intolerance Baby, for more information about food intolerances and breastfeeding.


Wednesday
Apr162014

Breastfeeding Your Baby with Jaundice

Written by Danielle Blair, IBCLC

The term jaundice gets used a lot regarding babies.  It can have many different meanings depending on the context.  From the Mayo Clinic website:

“Infant jaundice is a yellow discoloration in a newborn baby's skin and eyes. Infant jaundice occurs because the baby's blood contains an excess of bilirubin, a yellow-colored pigment of red blood cells.”

 

 

Types of Jaundice 

Baby's livers are immature, and they may not break down the bilirubin efficiently after birth.  Some amount of jaundice is considered normal for healthy babies.  We expect the bilirubin levels to rise slowly in the first several days after birth before peaking and then decreasing.  This type of jaundice is called “physiologic jaundice” and typically requires no treatment other than good feeding management.  Physiologic jaundice can be intensified in breastfed babies by mild dehydration that often occurs before milk volumes increase, which then can lead to “breastfeeding jaundice”.  In the case of physiologic or breastfeeding jaundice, the baby's skin may appear slightly yellow, often just on the face or torso.  A second peak of jaundice known as “breast milk jaundice” may occur during the second week of life.

In some cases, bilirubin levels rise very rapidly in the first 24 hours after birth.  This is not considered normal and can be a sign of infection or improper liver function, and merits immediate evaluation by a doctor.  Babies born before 38 weeks gestation, babies with bruising from delivery, babies with different blood types than their mothers (also known as ABO incompatibility), and breastfed babies are at increased risk of clinical jaundice.

 

 

Test for Jaundice

Bilirubin levels are determined by blood testing.  The levels that are considered normal depend on the baby's relative risk of jaundice and the number of hours since birth.  For example, a premature baby will be considered clinically jaundiced and require treatment at a lower bilirubin level than a full-term baby.

 

Treatments for Jaundice

If bilirubin levels rise very quickly after delivery, a baby may be monitored closely for good feeding, and may need treatment such as phototherapy (often called “bili lights”) or assistance with feeding to ensure that the baby takes in enough fluids to flush out the bilirubin.  A baby with very high bilirubin levels will likely have very yellow or orange colored skin from head to toe.  He may be very sleepy and feed poorly.  In rare cases, prolonged high bilirubin levels can cause brain damage.  This is why some cases of jaundice may require treatment.  

If your baby has elevated bilirubin levels, you may be encouraged to breastfeed more frequently, to use breast compressions to help baby take in more milk, or to offer some expressed breastmilk in addition to breastfeeding.  

For the baby who is not feeding well or is very sleepy, expressing milk and feeding in another way, such as by spoon, dropper, tube/syringe, or bottle, may be a temporary solution to help baby take enough milk volume to prevent severe jaundice.  Offering expressed milk in addition to breastfeeding can also help keep bilirubin levels under control in high-risk babies.

If better feeding management does not work, your baby may need phototherapy to help break down excess bilirubin in the bloodstream.  A “bili blanket” is a pad with UV lights that is wrapped around the baby, allowing baby to stay with mom and continue breastfeeding.  “Triple lights” are arranged in an isolette to allow as much of baby's body as possible to be exposed to the UV lights to bring down elevated bilirubin levels as quickly as possible.  For triple lights, a baby will typically be admitted to a NICU or special care nursery.

Sometime supplementation with formula is necessary to keep a jaundiced baby well-hydrated and to help treat the jaundice.  Formula should only be used if an insufficient volume of breastmilk is available.

 

Also, don't forget to check out our Boob Group podcast episode, Breastfeeding the Jaundiced Baby

 

Did your baby have jaundice?  

What methods did you use to help your baby get rid of it?

Monday
Apr072014

I’ve Had My Baby - Now What? Breastfeeding During the Second Week

Welcome to our new series, I’ve Had My Baby - Now What?  This is a guide with basic information to help you navigate the first days, weeks, and months of breastfeeding your new baby.  

Today we’d like to talk about the second week of your baby’s life, and what breastfeeding looks like.  What can you expect for normal behavior from your new baby, and when do you know there’s a problem that you should seek professional help for?

 

Now that my milk has increased in volume, what should feedings look like?  How much does a baby need at each feeding and how long should it take?

Most moms will see their milk change from the first low-volume colostrum to the fuller-volume mature milk somewhere between day 3 and day 5.  So by week 2, there is often more milk for baby to take per each feeding.  However, in the early days of the second week, a baby only needs about 1.5 ounces per feeding.  By the end of the second week, the baby will need 2-2.5 ounces per feeding.  Feeding length should still be determined by baby and when baby seems satisfied, but most little ones at this age should be able to get a full feeding in 30 - 60 minutes.

 

How much weight should my baby gain in week 2 of life? When should they regain their birth weight?

It’s normal for all babies to lose some of their birth weight in the first few days of life.  Once mom’s milk transitions to the fuller volume milk between day 3 and day 5, baby should gain ½ - 1 oz per day.  Most babies who are breastfeeding well will reach their birth weight by 10-14 days.  If your baby doesn’t regain their birth weight by 14 days, it might be a good idea to seek the help of a lactation consultant.

 

My baby seems to prefer one of my breasts over the other, and even has a difficult time latching onto the other one - is this normal and what can I do?

It is common for babies to prefer one side over the other.  They have often been lying in one position in utero, which can cause tightness in their necks and jaws.  Sometimes a long and difficult labor can affect the baby’s ability to latch onto one side - if the pushing section was long and baby was in birth canal for many hours - the compressions to his head may affect him in this way.  Often babies will work it out in the first few weeks, but if your baby continues to struggle, we often recommend body work for the baby, in the form of Craniosacral Therapy or Chiropractic care.

 

My baby starts choking shortly after starting to breastfeed.  What is causing this and what can I do?

Some moms find that their milk “lets down” very quickly.  When a baby begins to feed, the stimulation of the nipple releases hormones for mom to signal her body to “eject” the milk from the milk ducts.  When this happens quickly and forcefully, sometimes the sudden flow can take the baby by surprise and they may come off the breast coughing and sputtering.  If all is going well, the baby should learn to manage this within the first couple of weeks.  Feeding in a laid-back position can also be very helpful to slow down your let down. If your baby continues to struggle with a forceful letdown, it could indicate that there is something happening anatomically that is preventing him from being able to adapt.  This would be a good time to visit with a lactation consultant.

 

My 2 week-old baby is suddenly famished!  He went from eating every 2-3 hours to wanting to eat *constantly*!  He never seems satisifed and is fussy at the breast. Does this mean my milk supply is decreasing?

All babies go through a growth spurt around 2 weeks of age. The behavior above describes what a baby will act like during these growth spurts. It’s a natural occurrence to help build your milk supply to help keep up with the baby’s increasing needs.  Growth spurts usually last 48-72 hours.  As long as your baby is continuing to have plenty of wet and dirty diapers, there is no reason to think that your milk supply is faltering.

 

There may be times when things aren’t going the way they should.  If you find this, please contact an International Board Certified Lactation Consultant to help you.  Some signs that you might need some additional help:

  • Sore, cracked, bruised, or bleeding nipples.

  • Baby is still well under birth weight near 14 days of life.

  • You suspect your baby may be tongue-tied.

  • Painful, recurrent engorgement.

  • Oversupply.

  • Baby is having problems stooling.

  • Overly gassy, fussy, or colicky baby.

  • Breast infection - mastitis, abscess, or thrush.

For  more information about what normal breastfeeding looks like in the first few weeks, check out our article, What Every Mom Should Know About Breastfeeding During the Early Weeks, which highlights our brand new brochure!

 

Join us next time when we discuss weeks 3-6!

 

Thursday
Apr032014

What a Difference a Tongue Tie Revision Can Make

To help parents understand a bit more about how tongue and lip ties can affect breastfeeding, over the next few weeks we will be featuring stories from moms whose babies experienced these challenges.  We would like to extend a HUGE thank you to the brave mamas who submitted their stories for our blog!  We know you went through a ton of challenges and we are so appreciative that you were willing to share your stories!  If you have a story you would like to share on our blog, please send it to robinkaplan@sdbfc.com.

For more information about tongue and lip ties and how they can affect breastfeeding, please see our article:Does Your Baby Have a Tongue or Lip Tie?

 ---------------------------------------------------------------------------------------------

Written by Nina Jacobs 

Aubrielle was born on August 3rd, 2013 at 36 weeks due to my preeclampsia. She was 5lbs 13 ounces of tiny beautiful joy. I knew from the moment I found out I was pregnant that I wanted to breastfeed (my goal being for a year). I had no idea then, that it would be such a wonderful, beautiful, bonding, humongous part of my life. We were in the hospital for 5 days because of Aubrielle being considered a "late premie" and all of the meds I had to come off of to make sure I didn't have a seizure. Aubrielle was immediately diagnosed with a severe tongue tie by the pediatrician and two lactation specialists. We made an appointment to have her tongue tie snipped at 4 days old with ENT. In the mean time, she was latching, and eating as best as her little mouth could while we supplemented with pumped milk and feeding her through a tube and syringe. 

 

When we arrived at her appointment, the ENT doctor asked us if she was latching. She was with a nipple shield. He said that she was so small and fragile and because she was able to latch, he would not perform the operation on his daughter if it was him. So, we went home. We spent the first month figuring everything out. We didn't keep to any schedule and just took cues from her. Aubrielle would eat for 40-70 minutes and ask to eat again 2-45 minutes later....all day and all night. I didn't know any difference and just was rolling with it. 

 

At her one month check up, she wasn't gaining THAT much weight. She was still under 5% (the same that she was born at). We chose not to supplement and to reschedule the tongue tie procedure because the pediatrician was outraged that she didn't get her tongue tie snipped and that she was feeding so frequently.   She would still fall asleep every time she ate and by the time she woke up she would be starving again. By the time we called to reschedule her procedure, they couldn't see us until she was 9 weeks old. Around her 6 week growth spurt, I came to the doctors office crying. It seemed like she was literally eating every second that she was awake. They still couldn't see us until 9 weeks. We pushed through and never supplemented.

 

At her two month check up she was still in the 5% for weight. We finally had the procedure done. It was awful... more blood and tears than I expected and I could tell that she was in pain every time she began to eat for 5 days after the procedure, even with the tylenol we were giving her. But, oh.my.gosh. The difference in her eating, her behavior, and my supply was NIGHT AND DAY. Instead of eating for 70 minutes she would eat for 20. She didn't fall asleep every time and was clearly satisfied after each feeding. It was the hardest, best thing we did. I wish we would have pushed for it at 4 days old. For three days after the surgery we had to "sweep" in between her tongue and bottom of her mouth, and for the first two days it would start to bleed a little, but nursing always stopped the bleeding. In fact, in the doctor's office, that is how they had us stop the bleeding. 

 

Before tongue tie revision            After tongue tie revision

 

 

We still used the nipple shield until she was 5 months old, which is when she took it off, threw it on the ground herself, and kept eating. Now at 6 months plus, she is a happy, healthy, thriving, nursing baby who went from the 4th percentile at her two month check up (a week before her surgery) to the 30th percentile at her 4 month check up. She has tripled her birthweight  at 6 months and only eats every 2-3 hours during the day, and only wakes up once at night to eat. 



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