Foremilk vs. Hindmilk: The Unnecessary Controversy

Foremilk vs. hindmilk seems to be quite a popular topic among breastfeeding mothers.  If I switch the baby too soon to the other breast, will he get the hindmilk?  How do I ensure that my baby is getting all of the fatty milk that he needs?  Sometimes I feel like too much breastfeeding information can add stress to a new mom.  And this is why….

All breastmilk, whether it is 1 minute into the feeding session or 25 minutes into the feeding session, has both foremilk and hindmilk.  As your baby drinks from the breast, she/he gets both the low-fat milk (foremilk) and the cream (hindmilk.)  The better your baby drains your breast per feeding, the more hindmilk she/he has access to, as this creamier milk hangs out back further in the milk ducts, so it has further to travel.

Here are some ways to know that your baby is getting enough breastmilk in the first few months:

• Your baby is feeding 8 or more times in a 24 hour period
• Your baby is gaining 4-7 oz. per week
• Your baby is having several wet a day
• Your baby is having several yellow-poop diapers a day
• Your breasts feel softer and more pliable after your baby feeds

If your baby is meeting the above criteria, then there is really no need to look at the clock or worry about if she/he is getting enough of the creamy hindmilk.  Follow your baby’s cues….she/he will let you know when she/he is full or ready to feed from the other breast.

Now, what if your baby has green, frothy poops, lots of gas, and chokes while breastfeeding?

Looking at these symptoms, the first question I would ask is, “Do you have enough breastmilk to feed an entire village?”  If the answer is yes, then what we are probably working with is an oversupply.   If the answer is no, then it is probably time to look into your diet to see if your baby is intolerant to something you are eating. (We will discuss this next week in a different article)

If you have a tremendous supply, your baby is probably drinking a lot of breastmilk.  Since the cream (fat) hangs out further away from the nipple, your baby has to take in more milk to bring down that cream.   When this happens, lactase (an enzyme in your baby’s tummy) is overwhelmed by the sheer quantity of breastmilk lactose it has to digest, so that lactose starts to ferment, causing gas.  By gently slowing down your milk supply, your baby won’t feel so full before she/he gets to all of the milk fat she/he needs, thereby allowing the lactase to breakdown a manageable amount of lactose.

How do you gently slow down your milk supply?

Lean back

If your baby is choking and sputtering while breastfeeding, it is possible that your flow is overwhelming her/him.  It’s like the garden hose has been turned on and there is no reprieve!  So, lean back.  Picture yourself in a lazyboy chair, with your feet up, all relaxed.  When you lean back, gravity naturally slows down your fast flow, thereby helping your baby tolerate your flow and control how much she/he is taking in at a time.  For more information on laid back breastfeeding, see our article Laid-back Breastfeeding: Physically and Mentally and the Biological Nurturing Web site.

Place your baby in an upright position

When your baby is in a more upright position (head higher than bottom) your baby can tolerate a fast flow more easily.  You can do this in many ways:

• Have your baby straddle your leg, almost sitting up, and leaning into your breast
• If your baby likes to feed in more of a cradle position, lower her/his bottom into your lap so that she/he is more diagonal (head above bottom)
• If you are using a breastfeeding pillow, place a blanket under your baby’s head so that it elevates it above her/his bottom

Breastfeed one side per feeding

Feed your baby from one breast per feeding.  This will help to gently slow down your milk supply, as your milk supply is based on how much milk is emptied at each feeding.  Now your baby will pull all of that fatty milk down through your milk ducts, thereby helping him/her to feel more full and satisfied before he/she takes in too much milk. 

Please note: When breastfeeding from one side per feeding, it is important to pay attention to your breasts.  If they begin to feel overly full and uncomfortable, you will want to offer that side to reduce the pressure.  Think of that side as dessertJ  If your baby is not hungry anymore, you may need to hand express or pump the skipped side for a minute or two, just to relieve the pressure.  Once you have been doing this for a while, your milk supply should regulate. 

Another note: Always pay attention to your baby’s feeding cues.  Around 2-3 months of age, many babies end up needing to feed from both sides again.  This means it is time to start offering both breasts during a feed again.

Herbs

Sage tea is a great way to gently reduce your supply.  Since each mother reacts to herbs differently, it is important to try this slowly.  One mom I worked with noticed that her supply decreased by 50% every time she drank sage tea, so she only drank it when her supply had drastically increased over time.  Another mom I worked with drank a cup once a week and noticed that it kept her supply in balance.  Again, pay attention to your body and work with a Lactation Consultant if necessary. 

Breastfeeding Multiples

Every time I meet a mom with twins, I am completely in awe of how she is functioning on a day to day basis.  While my boys were practically Irish twins, I still had mastered breastfeeding and sleep by the time my second son arrived.  So when I stumbled upon this article, 10 Tips for Breastfeeding Multiples, I just had to share with my readers.

All rights reserved by viernulvier via FlickrFor those with singletons, there are a few gems for you, like ‘find your breastfeeding cheerleaders’ and ‘set up a nursing station’…which, by the way, I like to refer to as the Breastfeeding Basket.

For those with multiples, I love that this article breaks breastfeeding down into a few critical tips to get breastfeeding off to a great start.

In my humble opinion, the only other thing I would add to this list is to find a Breastfeeding Multiples class, if there is one in your area.  While a typical prenatal breastfeeding class is helpful, one specifically for multiples should also cover breastfeeding premature babies, as well as the unique situations that breastfeeding mothers of multiples may face.

And, definitely don’t forget to:

• Pick up Karen Kerkhoff Gromada’s book, Mothering Multiples, and check out her website.
• Find a lactation consultant in your area that you can speak to prenatally, if possible.
• Find a twins club in your area

My Newborn Is So Sleepy!

How am I supposed to breastfeed my newborn, 8+ times in 24 hours, if I can barely keep her awake?

Why does my newborn fall asleep as soon as he starts to breastfeed?
How can I keep my newborn awake while breastfeeding?

These are very common questions that I get asked from moms on a weekly basis.  Newborns are so sleepy.  And if they've had a long, challenging journey into the world, they are often even sleepier!

So, what is a new mom to do to keep her little one active and efficient while breastfeeding?

In order for your baby to gain sufficient weight and to stimulate an adequate (and hopefully copious!) milk supply, your baby needs to breast feed 8 or more times in a 24-hour period.  Many newborns are very sleepy in the first few weeks, making it difficult to keep them awake to have really ‘efficient’ feeding sessions.  An 'efficient’ feeding session may be characterized by active sucking at breast for a total of 15-20 minutes, with less-vigorous sucking throughout the rest of the feeding.  You should hear swallowing throughout the feeding, as well.  Your baby should also be meeting his/her diaper counts and gaining weight that is appropriate for his/her age.

If your baby seems to fall asleep often at the breast and is not having 8 or more ‘efficient’ breastfeeding sessions 8 or more times in 24 hours, you can use the following techniques to help him/her until he/she begins to stay awake on his/her own.

Tips fo keep your newborn awake while breastfeeding:

1. Loosen his/her clothes or undress him/her down to his/her diaper.  Skin-to-skin contact will keep him/her warm while feeding.
2. Dim the lights in the room.  Newborn babies are very sensitive to bright lights and they may cause him/her to close his/her eyes and fall asleep.
3. Gently rub the palm of his/her hand with your thumb.  Babies have a feeding reflex there and this stimulation often helps to rouse them and remind them to keep feeding.  This also works if you rub along your baby's backbone or his/her foot.
4. Use breast compressions (picture squeezing your breast like an orange and holding it for 10 seconds at a time.) This should give your baby a squirt of milk in his/her mouth and wake him/her up.
5. Switch to the other breast when your baby begins to lose interest in active nursing (this is called switch nursing.)  As soon as your breast is removed from his/her mouth, this should wake him/her up.  Also, when he/she latches on the other breast he/she should get the benefit of another let-down as he/she vigorously sucks.  You can do this every few minutes, if needed.  Your baby should eventually begin to stay awake on his/her own.
6. Burp and change your baby’s diaper.  Sometimes this change of position will rouse him/her enough to go back to breast and try again.

If your baby continues to have difficulties staying awake for a full feeding at breast, it is worth it to have a lactation consultant observe your breastfeeding session.  

Most of this sleepiness is very temporary and you will be amazed by how efficiently your baby will breastfeed as he/she becomes older and stronger

Managing a Toddler and a Newborn

This is Kim, Robin’s sister-in-law. I have three amazing daughters, one which was just born 4 days ago. In my 4.5 years of being a mom, I’ve read a fair amount about parenting and have gotten some really great (and some really terrible, uninvited, and/or borderline-criminal) advice along the way. I thought I’d share some of the highlights with you from time to time.

When my second daughter was born, my first was 22 months old. Like most moms adding another child to the family, I was concerned about how I would manage two little ones and how my first would react to a new baby joining our family. I sought out tons of advice and suggestions, and I’ve included the ones I found most helpful below. Now, as a caveat, I think these suggestions are great when the older sibling is a toddler. Some of them probably work no matter what the age, but obviously some will not apply if you have a preschooler or older, or if you’re having your kids super close together. So, try what makes sense to you, and disregard what won’t work - which, incidentally, is my approach to all parenting advice.

Before the baby is born:
Quick summary: Before the baby was born, we had two main objectives: We wanted to make sure that our first child 1) was aware she was getting a new sister and viewed it as a positive experience and 2) had already learned concepts like patience and independence.

Introducing the concept
We wanted our first child to understand that our lives were going to change, but to view this change positively. So, we made sure she was prepared, had some sense of exactly what would change, and knew that her role as big sister was important and appreciated. Here are some things we did:

* Once I started showing, we told my first about the baby coming. She didn’t really understand what we were talking about, but it was good to start getting the thought in her head and introduce her to the idea gradually.

* We talked about the new baby when it made sense, but not constantly. A toddler’s concept of time is different than ours, so spending so much time talking about something that’s not happening for months would most likely have bored, annoyed, and confused her. However, if we saw a baby at the park, I would say, “Your baby sister is going to be small like that!” or “When your baby sister comes, Grandma is going to come visit! Won’t that be fun?” We always kept the conversation positive.

* We got some positive books about being a big sibling and read them every now and then. Our two favorite titles: My New Baby and I’m a Big Sister (also comes in Brother). I really like the first book because it doesn’t have any words. You can make up your own story about what it’s like to have a new baby, and more importantly, you can let your child narrate and get a sense of how they’re approaching becoming a big sibling. I enjoy both books because they are POSITIVE about the experience and don’t assume that the older child will have feelings of jealousy or anger. If that ends up happening after the baby is born, deal with it then. Don’t put the idea in the kid’s head before it’s even a problem!

* We encouraged my first to be a part of the preparations for the new baby. We let her “try out” the bouncy chair and sit in the crib. She picked which books would stay in her room and which would go into the bookcase for the new baby. This will helped foster the idea that being a big sib is an important and fun job, and reassured her that she was still very much a valued member of our family.

Tomorrow’s post will be the continuation of Kim’s journey of managing her toddler and newborn.

Encouraging Independence and Patience:
The fact is that when there’s a newborn in the house, everyone else takes a back seat. Since I was either nursing or attached to a pump for like 80% of the day, I needed my first to be able to entertain herself and do things for herself. However, I didn’t want her to feel displaced by the baby or feel like the baby caused all the changes (even though she basically did). So, we started practicing patience and independence before the baby came. Here are some things we did:

* We introduced and practiced activities that she could do independently, such as drawing, puzzles, and playdough. This way she got used to playing on her own for an extended period of time before it was directly related to me being busy with her sister. If she asked for help, I would kindly redirect her to doing it herself. ESPECIALLY IMPORTANT both before and after baby: when my daughter was doing activities herself, I was always watching and providing specific feedback and praise that let her know I was paying attention and still interacting with her. An example: “Wow, you drew a red truck! Do you want to add some wheels?”

* I started taking a while to do things and asking her to wait. At first, this seemed silly since I could have done when she asked immediately, but again, this was getting her used to the concept of having to wait for things. I didn’t have to frame it negatively. For example, if she asked, “Mommy, can I have some juice?” I would say, “Yes, in one second. Just let me finish this article I’m reading.” Then if she waited patiently, I would be genuinely appreciative (again, with specific feedback): “Thank you so much for waiting. I really appreciate how patient you were.”

* We started working on independent self-care. Anything I could think of that she could do herself, we started practicing. This included: putting on her own shoes, climbing into her carseat and buckling the top buckle, getting cups and utensils herself from a low-level cabinet, filling her own water cup from the fridge. Again, specific and genuine praise whenever possible. “Did you buckle your carseat yourself? Wow, you are such a big girl! I’m really impressed!” My daughter LOVED to do things herself, so this wasn’t a tough sell. And when her sister arrived, she was already well-practiced at these tasks and it saved me a ton of time and energy when I was suddenly trying to take two kids to Safeway.

After the Baby is Born
Quick Summary: After our second was born, our goal was to integrate her into the family while changing our oldest’s life as little as possible. We felt this would minimize any feelings of jealousy and would lead to a strong bond between them. This started when my oldest first came to meet her sister at the hospital and continues today.

At the hospital:
* We had a framed picture of our family of 3 displayed prominently in the room to show our oldest we were thinking of her while we were away.
* When our oldest came to visit for the first time, Grandma came in first and took the baby, then Dad brought our oldest in. That way, when she came in to see me for the first time, my arms were open to hug her and give her attention. Her first visual was not “I’ve been replaced by a baby.”
* We had a present for her on-hand that was “from her sister” (for us it was a book). At first I thought this was totally patronizing to her, but man did she LOVE it! Baby sister made quite the first impression!

At home and beyond:
* We made every effort to keep the normal routine. Big sister still went to school even though I was on maternity leave, and we kept up our regular playdates.
* I wore the baby whenever possible in a baby carrier so that I still had hands free to interact with my oldest. (“Why yes, lady at the park, my boob is out since I’m nursing a newborn in a wrap and using my free hands to help my daughter off the swing! Your point is....”)
* Continued specific feedback and praise for all examples of patience and independence.
* One-on-one time with our oldest as much as possible, both with Dad and with Mom. We wanted to make sure that our oldest felt special for being a big sister, not forgotten.


So, there you have it folks. Again, these are the suggestions and tactics that worked best for our family. Our girls have a great relationship. I could, of course, conclude 100% that it was my “excellent parenting and preparation” that led us to this point, but it’s also possible that we could have done none of this and they’d still be best friends, or we could have done all of it and we’d still be trying to prevent the oldest from smothering the youngest in her sleep. But you have to start somewhere, right?

Common Concerns While Breastfeeding - Sore Nipple Therapy for the Breastfeeding Mom

Help!  I Think My Nipple Just Fell Off!

Welcome to our newest blog series…. Common Concerns While Breastfeeding. These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls I receive. Rather, these are the questions that come from clients and friends in the middle of the night, by text or by email, that don’t necessarily warrant a lactation consultation. They can often be easily resolved with a few simple tricks. So, I would like to share those tricks with you! 

12 hours before sore nipples! Painful, sore nipples are the worst thing EVER when you are a breastfeeding mom! My youngest son is almost 5 years old and I can still remember crying every time he woke up to breastfeed that first week of his life.  There are so many horror stories about painful nipples out there that some women are petrified of breastfeeding. 

Well, my friend, let me give you the low down about sore nipples and how to prevent and overcome them!  With a few simple tips, and the support of your ‘circle of breastfeeding support’, you should be able to avoid painful nipples, or at least know how to get your nipples back on track.

Symptoms:

• One side of the spectrum is nipple tenderness. This is normal. When’s the last time you had hours of nipple stimulation in a 24 hour period? My guess is NEVER or NOT SINCE THE LAST BABY WAS BORN.

• Middle of the spectrum is painful feedings with maybe some cracking. This shouldn’t happen, but it could have been the result of a poor latch here and there. Have a lactation consultant or a support group leader take a look, just to make sure.

• The opposite side of the spectrum is bleeding and cracked nipples. RED FLAG!!! This is not supposed to happen. This is your body’s way of telling you that you could use some assistance from a lactation consultant to see what is causing this pain. Don’t wait!

Prevention:

Look at this gorgeous latch!

• Nice wide latch – you don’t need your whole areola in your baby’s mouth, but the latch should be more than just on your nipple.

• Your baby’s lips are flanged like a fish’s mouth

• Don’t push on the back of your baby’s head to bring him/her to the breast. Instead, try a laid-back feeding position. Bring your baby’s torso into yours. His/her head will follow.

Treatment:

• Express breast milk on your nipples after your baby has fed and then let the ‘girls’ hang out for a few minutes.

• Some sort of nipple chapstick: Organic coconut oil, organic nipple cream, etc.

For those breastfeeding parents with cracked and bleeding nipples, you might need to try a few other options

• Hydrogels – wet wound management to place on your nipples in between breastfeeding

• All-purpose Nipple Ointment – can be prescribed by your physician to be made at a compounding pharmacy. This link, from breastfeeding expert, Jack Newman, includes the ingredients to give to your care giver.

• Don’t hesitate to call a lactation consultant! When a baby is latching correctly and his/her tongue is doing what it should, a mom’s nipples should not become cracked and bleeding. A lactation consultant should be able to figure out the cause of your pain and offer suggestions of how to fix the situation, ASAP!

Does traveling cause a dip in milk supply?

A close friend of mine was at a breastfeeding support group recently and was told that many moms see a dip in their milk supplies when traveling with their babies. My friend speculated that this may be a reaction to the stress of traveling with an infant. I told her I would look into this, since I couldn't fathom why traveling would make a mom's milk supply decrease. A mom's milk supply could surely decrease when traveling WITHOUT her infant, but why WITH her infant? After some internet and article searching, I couldn't find any scientific reasons that would cause this phenomenon. But, since a few moms have seen this happen, I thought I would offer some advice on how to make sure that this doesn't happen to you.

5 WAYS TO MAINTAIN YOUR MILK SUPPLY WHEN TRAVELING WITH AN INFANT

1. If traveling by plane, nurse your baby during take-off, landing, and turbulents. This will relieve the pressure in your baby's ears, thereby relieving your stress level.

2. Keep to your baby's regular feeding schedule. If this means you will have to nurse in public, practice before you go on your trip so that you are confident and comfortable. A baby wrap is a great way to nurse discreetly in public.

3. If you plan to go out and have someone else watch your baby, pump before you leave so that you are not full and uncomfortable while away from your baby. A hand pump should suffice for this moderate use.

4. Some babies have a difficult time sleeping away from home, so plan to take a few naps during your trip, so that you can make up for some lost sleep during those restless times.

5. Don't plan too many activities during your trip. Try to keep your stress level down, which will preserve your milk supply, making for a happier, more content baby....maybe even a rested and relaxed mommy!

Happy travels!

Welcome to The Sanity Spot

Sleep deprivation, diapers, feeding, crying.....sound a little familiar? And not just describing your baby??? All within a matter of minutes, your life has completely changed and sometimes all you want is for it to go back to the way it was.... pre-baby! But then, that sweet little baby of yours (or your three and four year olds, in my case) just look at you with those adoring eyes and you are brought to tears as your heart fills with so much emotion that it is impossible to describe. Welcome to motherhood... the most rewarding and, definitely, the most difficult job you will ever have in your life!

So sit back, put your feet up, lay your baby (infant, toddler) on your chest, and smell his/her sweet scent while he/she sleeps for a few moments. It is all about being present, in the moment (if you will), and taking a deep breath. For it is those moments you will remember the most. Hey, if we remembered all of the difficult times, we would never have any more kids.