What about My Freezer Stash of Breastmilk During a Power Outage?

As many breastfeeding moms prepare for Hurricane Sandy and her aftermath, we wanted to share a fantastic article written by our friend, Katy Linda of Stylin’ Momma.  Here’s all you need to know about what to do with your frozen breastmilk during a Hurricane, or any power outage for that matter. 

Our thoughts are with all of you on the East Coast who are bracing for this monstrous storm and hope Sandy is much weaker than expected.

Weathering a Storm with a Freezer Stash of Breastmilk

Reposted with permission by Katy Linda, IBCLC of Stylin’ Momma

As Hurricane Sandy approaches the east coast of the US, many moms are wondering, ‘What about my freezer stash?‘.  And with good reason.  There is concern about what this storm will do and how long people may be without power.  Many moms have worked hard to have frozen milk on hand for their babies, and the thought of losing that liquid gold is just too much to bear.

So how long can you go without power and still save that precious breastmilk?  Let’s see…

We know that the safest place to store breastmilk is in a chest freezer or deep freezer at a temperature of 0 degrees Farenheight. ABM Protocol #8

We also know that a freezer generally stays frozen for 24-48 hours without power, especially if it is full. via USDA

So, we know off the bat that breastmilk frozen in a full chest freezer is absolutely safe for 48 hours!  Great news.  The best way to protect your milk is to store it in the center of the freezer, where temperatures are more stable. This will ensure it stays frozen as long as possible.

And what if the power is out longer?  Let’s see –

Breastmilk is still considered frozen if there are ice crystals in it or it is a slushy consistency. via HMBANA’s best practice, 2005.

Wow.  So even beyond 48 hours we can look for ice crystals to tell us the milk is still frozen. Wonderful news. But what do we do when the milk is thawed and there are no ice crystals left?

Take a look at this:

“The data generated by the authors support the contention that milk is relatively robust. Milk that has been left unrefrigerated for less than 8 hours, or placed in the refrigerator for a day, is safe to use and retains a good portion of its nutritional value. Moreover, it appears that unpasteurized milk that has been accidentally thawed remains safe to use provided it has not been left too long in an unthawed condition. Based on these data, it appears that unpasteurized milk that has thawed in the refrigerator for up to 8 hours may be safely refrozen. Moreover, this data would seem to support the use of frozen milk to which fresh milk has been added and then refrozen. This should allow for more convenient storage and for the salvage of milk that mothers might otherwise have been told to discard.

 Rechtman DJ, Lee ML and Berg H. Effect of environmental conditions on unpasteurized donor human milk. Breastfeeding Medicine. Spring, 2006;  1(1): 24-26.

So it looks like thawed milk CAN be refrozen if necessary.

Let’s keep in mind that breastmilk is a living fluid, and is full of live cells and active immune factors and enzymes which can be, and are, damaged in the freezing process.  The BEST way to have breastmilk is fresh.  That is when the nutritional content is at its highest.  The more we change the temperature the more we denature the proteins, and we lose some of those important qualities.  You might consider leaving out the milk that would be used in the next 24 hours, then re-freezing the rest.

*** Keep in mind that this is to be used for emergency situations, not on a regular basis.  Since you don’t pump in a laboratory you may want to make sure the milk passes the sniff test before feeding it to the baby.  Breastmilk that is bad will smell BAD and you will know.  If it smells fine, it likely is.

Some tips to maximize the length of time your milk will stay frozen & safe -

1. Store milk in the center of a full chest/deep freezer. To help fill the freezer you can fill plastic bags or containers with water and freeze them into ice.

2. Group bags of milk into plastic container or larger bags to avoid leaking in case of defrost.

3. Avoid opening the freezer, this will allow warm/room temperature air in and speed up the thaw process.

4. Dry Ice can be added to the freezer to keep milk frozen for extended periods of time – More info can be found here.

5. Feed your baby directly from the breast as often as possible during the power outage, and avoid using the frozen milk when proper heating isn’t possible.

Stay safe and warm, and enjoy some downtime with your little ones.

*** This article was first posted on Stylin' Momma

Toddler Nursing and How it Helped Me Manage My Circus – Pt I.

Written by guest blogger, Andrea J. Blanco, IBCLC

When my first son was a baby, he absolutely hated car rides. On a trip to the bookstore, I came across Dr. Seuss’ “All Aboard the Circus McGurkus!.” I read that book to him every day and soon came to find the only thing to keep him calm during those car rides was my reciting lines from the book.

“The Circus McGurkus, the World’s Greatest Show. On the face of the Earth or wherever you go…” 

My son is seven now and I still remember most of the lines. So, when I asked a group of moms to give me one word to describe toddler nursing in preparation for this post, imagine my delight in realizing their answers could fit right into our beloved book:

“Amazing. Demanding. A Haven. Stupendous.”

“Loving. Convenient. Tantrum Fixer. Endless.”

Ok, so maybe no one said “stupendous”. But, you get the idea.

If you are the mom of a newborn, the mere thought of nursing a toddler probably seems really daunting, and my advice to you is the same advice I give to my clients: Take it one day at a time. Nursing isn’t a race and the person who goes the longest doesn’t win or lose. This is about your personal journey with YOUR baby and doing anything other than taking it day by day is rushing an already hurried adventure.

My son was ten months old when I first realized maybe I would nurse him past a year. I remember thinking there probably wasn’t going to be some alarm that went off to tell him (or me) that he was supposed to be finished with nursing because it was his 1st birthday. I remember feeling like maybe, in my heart of hearts, we would continue. And we did, but not without some questions.

Is it “ok” to nurse into toddlerhood? 

There are myths out there that after a certain age (I’ve heard as young as 4 months), your breastmilk loses all value and *poof* you’re making water. This couldn’t be further from the truth. Yes, by the toddler years, your baby will be able to eat a wide variety of foods, but your breastmilk is still perfectly suited for his growing needs. In this second year of life, your breastmilk’s most important role takes center stage: continuing to support an immature immune system. It is the ultimate immune booster and is packed with tailor-made antibodies to help your toddler fight off all those germs she’s picking up at the playground (“Sweetie! What is that in your mouth?!”) and on all those playdates (“No, honey, that is NOT your water bottle.”).

Will I still be nursing every 2-3 hours?!

For one whole year, you have been at your baby’s beck and call. You, sweet mommy, are AMAZING. Don’t let those words, which fit perfectly in a Dr. Seuss story, scare you! While some mothers find it’s easier at times to nurse when the toddler wants it (remember, “Tantrum Fixer” is also up there), you are now living with a busy little bee who is newly mobile and has time for a lot of things, but sitting still and nursing isn’t top priority. Consider yourself her pit stop. Discovering the new world is about the most fun thing ever, but being so independent is also frightening. No, you won’t be nursing for hours on end like you did when your baby was younger. Instead you will be her home base. You will be what grounds her and tells her that it’s ok to go explore. And you will be that sense of reassurance in the same way you have been for the last year – by nursing.

Why would anyone want to nurse a toddler?

Aside from the very real health benefits, nursing a toddler is like being Mary Poppins. Let’s face it – we aren’t dealing with the most reasonable age group. They want what they want when they want it and still aren’t verbal enough or patient enough to understand why that can’t always be. They have teeth coming in, separation anxiety, bumps and bruises all over, difficulty understanding why you don’t understand what they’re saying and their veryadamant point of view, timeouts to protest, physics experiments to practice [by flinging things across the room]. Nothing softens those blows like curling up on Mommy’s lap and taking in the scents, sounds and feelings of the familiar: Love. Whether you are at home with your children or working outside the home, the reconnection that happens when you take a break with your little one is incredible. Sometimes, we don’t have 30 minutes to try and solve the problem (and often times, reasoning with a toddler no matter how much time we have just doesn’t work). But, just like Mary Poppins, we too have a magic potion we’re able to use to our advantage. Breastfeeding in the time of the Toddler Meltdown is often all it takes to defuse the situation.

The Technical Stuff. Did you know that, along with many other health agencies, the American Academy of Pediatrics recommends nursing for a minimum of 1 year and “continuation of breastfeeding for as long as mutually desired by mother and baby”? The World Health Organization recommends breastfeeding for “up to 2 years or beyond.” And, while it may not be common in the United States, considering the natural age of weaning worldwide is somewhere between 2.5 to 7 years, nursing into toddlerhood is really just a part of normal nursing.

In his book, Dr. Seuss introduces us to the Juggling Jot, “who can juggle some stuff you might think he could not”. Now when I read the original, longer version to my sons (If I Ran the Circus), I’ll be inclined to think that maybe, just maybe, he was really talking about the mom of a toddler as that Juggling Jot (he does, after all, juggle 22 question marks, 44 commas and also 1 dot). I, for one, am so thankful I was able to continue nursing past one year. Juggling my life, plus the life of my toddler and my family, would have been much more challenging had I stopped.

Come visit me again for Part II of Toddler Nursing, where we’ll talk about what to do when you have little support, how your milk supply will change while nursing a toddler, and how to handle tricky situations, like nursing a toddler in public.

Andrea Blanco is an International Board Certified Lactation Consultant at The Milk Collective Lactation Care, working with families in the Miami/Ft. Lauderdale area. She is the proud mom of 2 loving, spirited boys, who teach her humility, patience, humor, and the rules to more sports than she thought she’d need to know every day. When she’s not helping families achieve their breastfeeding goals, you can find her on the sidelines, at karate tournaments, or with her toes in the sand. She can also be found at themilkcollective.co, on Instagram @themilkcollective_ , facebook.com/themilkcollectivelactation or by email at: andrea@themilkcollective.co.

Have you enjoyed nursing your toddler?  

What advice do YOU have for other moms who are thinking about breastfeeding into toddlerhood?

When a Toddler Bites While Nursing

Written by guest blogger, Leigh Anne O'Connor, IBCLC

Nursing a toddler is a confounding joy! He demands you sit. He does gymnastics and yoga while slurping your sweet nectar. Nursing is a great tool to calm a wild child or heal a skinned knee or a broken heart. These little people are growing rapidly. One day they are crawling, the next they are waddling toward the stairs or the dog food dish.  One day they mumble “mama” and “gaga” and then they learn the power of “NO!!” 

Another big change going on in the little body is the mouth – teeth are multiplying like bunnies in there. If a baby is latched correctly, his teeth are covered by his tongue.  Ah, but the older nursling has teeth on top and bottom! Yikes! As he is feeling those incisors pushing through his flesh nothing will sooth that sensation like biting down on something nice – like a breast!  Ouch! 

So, what is a mother to do?

Just as when a baby of any age bites the hand, (or breast that feeds him), the thing to do is not scream,  “ You little demon, you nearly amputated my breast!” Nor is it to cry out and run weeping into the streets or punt him across the room – though these ideas may make sense at the time. You take the little chomper off your breast and calmly, but firmly, tell him “No, you may not nurse if you bite.” Put him down off your lap and remain as emotionally neutral as you have it in you to be. This should neither be a game nor a horrifying experience. Biting is simply an unacceptable behavior.  After a brief period of being ignored he will either go on about his business or he may plead to have more sweet milk.  If you do offer the breast again tell him in no uncertain terms, “If you bite me again, you may not “nonnie” (or whatever word you use to nurse) again.” I do not mean forever – just at this time of the day.   A time or two like this should tame your little piranha.

Another reason toddlers bite is if they have a cold and cannot breathe so well while nursing. Some saline spray or nursing in a steamy bathroom or bedroom with a humidifier can help open up those little nasal passages.  

Some moms say that her baby bites if she is pregnant or if her milk supply is low (which can be caused by being pregnant). I cannot count how many women have called me to discuss their newly biting toddler. We run through the list of possibilities.

“Are you pregnant?” I ask.

I can almost see through the phone the look of surprised possibility on her face.

“Well, I don’t know. I don’t think so. Well, maybe. I gotta go now!”  

A couple days later my phone rings. “You were right! I am pregnant!” She had run to the drug store to buy a pregnancy test.

If your baby really chomps down hard you can hold him tight to you so that he is forced to open his mouth. Another approach is to put your finger in his mouth   between the teeth and break the latch.

Many moms think this is a time to wean. It can be scary. And, if you talk about it you can be led to believe that this is a sure sign to wean. It is just a stage that some – not all, I promise – toddlers go through.

As you negotiate your way, nursing an older baby in a world where most babies are weaned by their first birthday, you step lightly in your discussions with other mothers. Sometimes you find you are part of a secret society. You find these other mothers who nurse their toddlers and you laugh together at the antics and the sweetness of nursing a talking, opinionated human. You share your battle scars, which can sometimes be teeth marks on your areola.

Here are a few other great articles about how to deal with a toddler who bites while nursing:

Teething and Biting by Anne Smith, IBCLC

Nursing a Teething Toddler by LLLI

Here is some advice from our Facebook readers:

Marie: A firm no and gentle tap on his cheek usually disctracted him.  If he continued to bite, then we stopped nursing for a minute.  If he was done, he’d go and play.  If he still wanted to nurse, I would try again.  A third bite meant we were done.  Also, I would use phrases he understood like, ”Biting gives Mommy owies.  We do not bite.”

Chloe: We have one serious bite at 8 months.  It was at the zoo.  I had to unlatch him and leave him with a friend to go to the restroom and deal with the blood.  That was traumatic enough that he didn’t do it again.  Sometimes he gets a little wild while nursing if something strikes him as funny, but he calms right down if I unlatch him for a minute.

What tips do you have for a mother whose toddler is biting while nursing?

Leigh Anne O'Connor is Lactation Consultant in Private Practice in New York City, as well as a La Leche League Leader. Her blog is Mama Milk and Me.  She lives with her husband, Rob, and their three children, Phoebe, Chloe & Finn.

I Never Knew I Had Insufficient Glandular Tissue

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Jennifer Thomson's memoir about her battle with Insufficient Glandular Tissue.  If you would like to submit your story as well, please email me at robinkaplan@sdbfc.com.  Thank you so much, Jennifer, for sharing your story with us!  I know that your words and wisdom will provide endless support to other breastfeeding moms!

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When I went for my first prenatal check up, the midwife asked me if I intended to breastfeed. I immediately replied, “I’m really looking forward to it!” Those words have haunted me for years.

My first child and I had a rocky start to breastfeeding. After her traumatic birth at almost 35 weeks, I didn’t even see her for over 15 hours and she was too weak to breastfeed in earnest for the first couple of weeks. I was so in shock after my bout of preeclampsia and sudden C-section, I nearly forgot about breastfeeding entirely until a nurse wheeled in a pump and said I’d better get started. I never got engorged, and could only pump 3-10 mls of colostrum and then milk, not that I could tell when it had “come in” other than a change in color. I dutifully pumped what I could for my little 4 pound preemie, and the nurses in the NICU were very supportive and would hold my tiny syringes of milk until I got there each morning so that I could witness a gavage feed of only breastmilk once a day. It was something, and it did make me feel a bit better.

Living in an area that has no shortage of lactation specialists and breastfeeding support, I did everything they said and nothing seemed to make a difference. Several weeks in, my mom asked one of them when I was going to get engorged. The lactation specialist responded that she didn’t expect that I ever would. No one ever mentioned why. I was so confused – everything I ever read or could find said anyone who wants to breastfeed can and should. Most people had problems with latch, or engorgement, or blisters, not an absence of milk. I blamed the C-section, the early arrival of my daughter, the traumatic birth experience, the fact that she was in the NICU for three weeks, the medicine they pumped into me for the 5 days following her birth. But the truth is I knew that there was something wrong with me and my breasts. If I went too long between pumping sessions, I would leak and could feel engorgement in some areas of my breasts. Why could I feel individual ducts, and why weren’t they everywhere?

After a few weeks I ended up on Reglan, which helped a bit, but made me depressed and I didn’t need any help in that department. Several lactation consultants vaguely mentioned Domperidone, so I started my own research and ordered some from New Zealand. It worked, at least somewhat. I was able to pump an ounce from each breast every 4 hours and I nursed my daughter as much as she was willing. By the time she was 3 months old, I grew tired of wrestling with her at the breast. She didn’t want to nurse unless it was the middle of the night. I found myself getting so angry with her denial of me that I needed to stop trying to force her to breastfeed in order to save my own sanity. She preferred the bottle, and that was that. So, I pumped and gave her 2 ounces of breastmilk followed by 4 ounces of formula until she was 8 ½ months old and I just couldn’t do it anymore.

I kept a two week supply of Domperidone on hand in case I needed it one day for another baby, wishing and hoping all the while that maybe I was normal but it was the circumstances that caused my low milk supply. Two years later I was pregnant again, but this time I was under the care of a perinatologist from the beginning, did not develop preeclampsia, and was able to carry my second daughter to 38 weeks. I did have another C-section, but this time I was prepared, awake during the surgery, and was in my room breastfeeding 45 minutes after my full-term baby was born. What a difference! She had great latch from the first try and was happy as a clam nursing for hours on end. I wasn’t engorged, but my baby seemed content and I could tell when my milk came in. But she started to lose weight, and fast. She nursed around the clock, but didn’t seem content once she was a few days old. I went to see the lactation consultants at the hospital where I delivered, and they told me I had to give her a supplement at that point. This is a big deal since this is a breastfeeding-friendly hospital, so they have to buy formula for cases such as mine. She filled a syringe with formula, attached a tube to it and taught me how to have her latch around my nipple and the tube and to gently push it in as she sucked. I didn’t even need to – she sucked so hard she got the formula herself. She looked relieved as she drank and promptly fell asleep, satiated at last. I was crushed.

So, by day 5, I was back on Domperidone. It worked again in combination of around the clock nursing and pumping, and by the time she was 8 weeks old she started to refuse the bottle. I was forcing it on her like I had tried to force my first child to breastfeed. I was so worried that she wasn’t getting enough food that it didn’t occur to me that she might actually be getting enough breastmilk until a friend pointed out that it was possible. I stopped bottlefeeding, and she stayed happy and growing. I couldn’t believe it. By the next growth spurt, though, I couldn’t quite keep up so I started giving her 3-4 ounces of formula at bedtime. That did the trick, and I still felt pretty good about the whole thing.

I took Domperidone for a full 12 months. I was shocked to find that at her first birthday my supply was as high as it had ever been and my daughter was still happily breastfeeding around the clock. I don’t think I ever had much more than an ounce or two in my breasts at a time, but it was enough. The biggest difference was that because we started out strong, even with an SNS supplement, she always preferred breastfeeding. My supply dwindled over the next year, without the Domperidone and as nursing became less and less frequent. By her second birthday, I noticed she wasn’t swallowing at the breast anymore and there were only drops coming out. She didn’t care. These two things on my chest that I had deemed useless countless times were hers and she loved them. She still breastfed just as often even though nothing came out. She still breastfed to go to snuggle, to calm down and reset her day. She still demanded to nurse before bed and upon waking in the morning. Somehow, through all the trauma of my breastfeeding experience, she was just like any other breastfed child. It’s been three months since I dried up, and she still asks to nurse a couple of times a day. We did it, together.

Today is the first day I have ever heard the term “insufficient glandular tissue”… there is a name for this? I asked around to see if it was common to be missing what I called “breast tissue” and I never really found an answer anywhere. I am relieved to hear that I am not alone. That being said, I am so thankful for the support I did receive from my perinatologist, my obstetrician, countless lactation consultants, my primary care physician, my cardiologist, the hospital where I delivered, my husband, my friends, Dr. Jack Newman, the New Zealand pharmacy, the local compounding pharmacy, and the area where I live that has lactation rooms all over the place. I want to share my story so that other women in this predicament know that they aren’t alone, that they can have a breastfeeding relationship with their child even if they aren’t making enough milk. One lactation consultant told me once that I was breastfeeding, no matter how much I needed to supplement. It seemed at first like a silly thing to say. But it stuck with me. You are breastfeeding and your child is breastfed if they are receiving a drop of breastmilk. Just ask my two year old, who still thinks my empty breasts belong to her.

Jennifer Thomson

My Battle with Insufficient Glandular Tissue

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Nikki Williams' memoir about her battle with Insufficient Glandular Tissue.  If you would like to submit your story as well, please email me at robinkaplan@sdbfc.com.  Thank you so much, Nikki, for sharing your story with us!  You are an incredibly dedicated mom and a true breastfeeding warrior!

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When I developed in puberty my breasts were never perky and upright; even at 16 they were pendulous and looked like they had already nursed a dozen kids, even though I am relatively slim, and the shape wasn't inherited because my mother had no breasts to speak of (I was not breastfed in part because my mother believed she would make no milk because she was barely an AA cup.)  They have always been a source of embarrassment for me, but I resisted getting a breast lift and areola reduction because I wanted very much to breastfeed and I knew that could cause problems.  To add insult to injury, my breasts are also fibrocystic, meaning they are lumpy all the time and burn and throb in the week before my period starts. 

In June 2008, my breasts were burning and swelling as they usually do before my period, but my period never came- I was pregnant, but it took me seven weeks to figure it out.  Throughout my pregnancy, I was able to fit into the same bras- the only breast changes I noticed were dark, peeling nipples.  I checked my bra every day for signs of colostrum, but it never came.  My water broke and labor didn't start for a few days, so my midwives had me try to use a pump to induce contractions.  Nothing even came out in the several hours I pumped. 

Labor did eventually begin and I had a perfect, natural water birth ending with a beautiful, long, skinny daughter.  I really strived for a natural birth to maximize breastfeeding success, because I just had this deep feeling that something was wrong with my boobs.   Because my nipples are tiny and flat and my breasts lack fullness, the first latch didn't happen for several frustrating hours, but finally it happened and I just waited for my milk to come in.  My nipples were cracked and bleeding by 24 hours- my home nurse said my latch was great, my daughter was peeing and pooping meconium, everything was fine.  I got a prescription for Canadian Nipple Cream and a nipple shield to help shape my shapeless nipples.  

Day two and Day three:  No engorgement.  No yellow poops.  Baby was definitely a "nipper napper," so chilled out- never crying, always sleeping.  Nipples still agonizing.  Back to another LC, who checked for tongue ties and said everything was great, and that I could prod my daughter's rectum to remind her of that body part and that it has to do something.  I did, and nothing happened.  
 

Day five:  No feelings of letdown, no engorgement, no leaking...but some milk visible around my daughter's mouth.  I heard swallowing when she was awake to feed.  Still no bowel movements.  Red crystals in the diapers, which I started needing to change less frequently.  My nursing diary says I have spent 18 out of the last 24 hours nursing.  I cried with pain with each feeding.  

Day eight: We took her to get her professional photos taken, and she urinated all over the white fluffy beanbag she was posed on.  I'll never forget how dark and smelly that urine was.  But we were congratulated on no poop accidents in the studio!  

Day 11:  Something was wrong- my daughter had not pooped since the day of her birth.  She was so sleepy. I took her to the pediatrician, who weighed her.  She had lost a full pound from her birth weight.  She saw she was dehydrated and rushed out of the room to return with a case of formula.  I broke down.  I had been cruising kellymom.com while nursing (still 18 out of each 24 hours), trying block feeding, fenugreek, anything.  I was doing everything right.  The pediatrician said she didn't know what was with all of these new mothers who made such a big deal about breast milk.  I asked for a syringe or something because I was not going to feed her with that pre-mixed nipple-confuser bottle.  The doctor gave me a prescription for daily weight checks, an order to exclusively pump for 24 hours to see what I was producing, and a periodontal syringe that I could use to finger feed my daughter.  It was, and still is, the worst day of my life.  I exclusively pumped 20 minutes every 2 hours for 24 hours- I managed to collect 4 ounces.  

My daughter came alive on formula.  Her eyes opened for the first time in several days.  With her mouth moistened, my nipples were able to finally heal.  I was horrified that I had been starving my daughter while bragging to everyone how content she was.  That's something I'll never get over, as long as I live.  

In a daze, I went to visit my husband's cousin, who exclusively pumped for her son.  When she pumped, she had to use 8-oz bottles, which she would fill in 20 minutes.  I told her what was happening to me, and she mentioned she had a huge stash of breast milk in her freezer that she was about to throw away because her son was rejecting it in favor of formula.  I said I would take it.  It was several gallons' worth.  I cried and cried with relief.  During that visit, my daughter had her first bowel movement since her birth.  It was about 10 percent breast milk (2 weeks worth), then 90 percent hard nuggets of dark green formula, and she filled two diapers as I watched and rejoiced.  

That donated breast milk lasted me for two months.  In those two months, I had an appointment with an OB/GYN for an issue I had with my bladder during pregnancy.  During the exam, he asked me how motherhood was going, and I broke down right there with my legs in the stirrups. I told him about my nursing difficulties.  He stopped and asked if I would like him to have a look with the ultrasound machine.  I was confused, but a few minutes later he was giving me a breast ultrasound.  He said that he hadn't done this before, but he knew what a lactating breast should look like, and mine did not look like a lactating breast.  He pointed out that my glands were clustered all around my nipple, and where there should be glands and ducts radiating out and up into my armpits, I had only fat.  That would explain it.

I dug out my copy of The Breastfeeding Mother's Guide to Making More Milk and flipped to the section about insufficient glandular tissue, a section I had skipped over gleefully in my pregnancy.  There I was, there was my chest in a sketch.  I was redeemed!  It was really not my fault!  Now I was angry that I had been led to believe that I was not doing something right by the various LCs that I had visited with.  Why didn't any of them make me show them my whole chest?  Why didn't any of them touch my breasts?   Why didn't any of them ask me if my breasts had changed during pregnancy?  

Furious google searches and research dominated my life.  I had started to use a bottle by now because the 1-oz serving through the periodontal syringe was not working anymore.  My husband was able to feed her while I banged the keyboard.  Packages of domperidone began arriving from Fiji. I found the Medela SNS and obtained it from one of the LCs I had visited, annoyed that this hadn't been offered to me right away.  I was almost immediately more annoyed with the SNS, however, and more late night research led me to the Lact-Aid SNS, which was so expensive to me at the time that I rinsed and re-used the baggies. I dominated the refrigerator with frozen milk, thawing milk, tubes, bottles, bags.  The SNS affair lasted a few weeks at most.  I couldn't endure it.

It was all very annoying and demeaning at the time.  Twiddling with a SNS and searching for more donated breast milk via Milkshare consumed my life.  I don't remember my daughter's infancy until she was three months old, when I found a long-term donor and relaxed about finding donated breast milk.  She had a son exactly my daughter's age who was born through a traumatic cesarean, but she was struggling with oversupply.  Here we were, complete situational opposites, bonding over the same horrible postpartum feelings.  She ended up donating over 20 gallons of milk to me- enough for six ounces a day for a year.  

I found several other donors here and there through Milkshare and word of mouth, bringing my total to about 30 gallons of donated milk over a year.  That's actually not very much as far as a baby's consumption goes.  To bridge the gap between that and the four ounces of milk I was making per day, I began making the Weston A. Price homemade kefir formula. My daughter struggled on the store-bought formulas- another slap in the face for me.  Chronic constipation.  Poop that smelled like a steel mill.  Anal fissures.  Suffering. I couldn't find enough donated breast milk.  Many would-be donors saw my seemingly healthy, older baby and declined to donate to me, preferring a newborn or sick child instead.  Making the homemade formula was my meditation- I was still able to honestly say that I was making my daughter's food.  She flourished on the combination of me, my donating friends, and my homemade formula.  Finally I was able to relax and be her mom.    

Alas, now I had to go back to work.  Within a few weeks of returning to work, my period returned and my milk supply dropped.  I had a 50-mile commute one way, and I would pump with one hand on the wheel and the other on a flange, and after 20 minutes of zoning out on the Capital Beltway, I would look down and see only a few drops not even in the bottle, but still in the flange.   I was also bloated and 10 pounds heavier from domperidone, and almost $1000 lighter from that and the industrial-size bottles of goat's rue tincture, a better pump, and all the SNS doodads.  It wasn't worth it.  I stopped the galactogogues.  I quit pumping at work.  I didn't offer the breast to my daughter one day when she turned six months, and she never indicated she wanted to nurse again.  That was that.  No cabbage leaves required. Easiest weaning in history.

When my daughter was one year old, I became a doula.  I was inspired by the gal who gave me all that milk- her birth story was so hard to hear and I vowed that someday I'd help her heal the way she helped me- and I was indeed able to attend her homebirth after cesarean as her doula and friend.   Now I love helping other women overcome breastfeeding problems.  It is so ironic that I only breastfed exclusively for 11 days and for 6 months total, but I am one of the biggest supporters and champions of breastfeeding that I know.  I KNOW I know more about IGT and primary lactation failure than many lactation consultants, and that hurts me.  I would have never gotten a diagnosis of my condition if I hadn't happened to be in a room with an ultrasound machine one day. 

I am so pumped (no pun intended) to see the publicity and coverage that IGT is getting these days.  As of now, I won't be having another child in part because I do not want to go through lactation failure again, but if it does happen, I will be so prepared and I will be the poster child.  My only regret is stopping nursing altogether and not giving the SNS a better try, but I have to be gentle with myself considering it was the best I could do at the time.  And I think I did pretty darn good!  My daughter is healthy, athletic, graceful and still skinny and long, the way she was born and meant to be! 

Nikki Williams

Entertaining a Toddler While Breastfeeding a Newborn

I cannot begin to tell you how excited we are about the 100 or so amazing questions submitted to our article, What Breastfeeding Topics Would You Like to Know More About?  From inquiries about breastfeeding after reduction surgery to dealing with a teething infant, our blog calendar is now FULL for the rest of the year, just answering your questions!  YAY!!! 

For the rest of the year, Thursday will be the day we delve into our readers’ questions, adding to our series, Help A Breastfeeding Mama Out!  We will also answer your questions on our ‘Ask the Experts’ segment on The Boob Group online radio show.

Here is our question of the week:

Dear SDBFC,

I would love to learn more about nursing a second baby with a toddler running around. I remember how hard it was with C and how it consumed everything for the first couple weeks getting my daughter to latch, and nurse, and stay awake to nurse...and I am due in October when C will be two and the thought of doing that with her running around terrifies me. Any tips?
 

Alicia
 

Dear Alicia,

Absolutely!  I remember like it was yesterday bringing home my newborn from the hospital and introducing him to his 15 month old brother.  Those first few weeks were a whirlwind, trying to figure out breastfeeding again and trying to entertain my toddler, whose world had just been turned upside down.

Tips for Entertaining a Toddler While Breastfeeding a Newborn

Tip #1: Enlist all family members and friends to come hang out with your 2 year old as much as possible.  It can be a difficult transition for an older child when a new baby arrives, so we tried to make sure that our older son had lots of attention in the beginning.  Let’s just say that Ben went to the park, the zoo, and the grandparent’s house quite often those first few weeks after his brother was born, which left me many hours to work on breastfeeding and get to know my new little one. 

Tip #2: Have a box of special toys that can only be played with when you are nursing your newborn.  My son was so excited to pull out these new exciting trains, books, and cars whenever I sat down to nurse.  I could see his face light up as I pulled out this box several times a day.  I also included small snacks in this box….ones that he could eat on his own.

Tip #3: Learn to nurse in a carrier, wrap, or sling as soon as possible.  This was an absolute lifesaver.  Let’s be honest….even with a new baby in the house, the older child (or children) still run the show J  So, I learned very early on to nurse my younger son in the ergo…at the park, at the zoo, on a walk, etc.  Then I was hands-free to make sure that Ben didn’t slip through the cracks on the playground’s play structure, all while nursing my younger infant.  It was awesome!

Here are some fantastic tips from a few of our Facebook followers:

From Nubia: puzzles : ) coloring, reading. If nothing works, their favorite tv show.

From Andrea: reading books, singing songs, talking about what you're going to do with your toddler whilethe  baby naps, give them a snack too!

From Beverly: Snacks, story time, flash card app on the cell phone

From Crystal: Cell phone!! The kid loves angry birds...hehe!

From Amber: Hand them a tampon in the wrapper. No joke. Entertainment for a good 20 minutes!

From Chrissy: Have a special basket of things they get only when mommy breastfeeds...give that time to your toddler to help make them feel special..read them their favorite story, or sing them some songs..bring out some instruments and have fun! It’s also beneficial to your nursing little one to hear you reading that story or singing those songs. You could also have some sensory bottles...look them up online. You can make an ocean bottle and various noise maker bottles with different textured things in water bottles that they can shake up and look at or use as instruments

From Ariel: I love reading books to my toddler while I nurse. When I'm in a pinch, sesame street on youtube is actually quite fun, too. But I always try to go for the books first! :)

Lastly, here are a few articles and podcasts discussing this exact topic:

/blog/2011/10/6/advice-for-a-breastfeeding-mom-with-an-older-toddler.html

http://www.theboobgroup.com/managing-a-toddler-while-breastfeeding-a-newborn/

Thanks so much for your question, Alicia!

Warmly,

SDBFC

Breastfeeding Expectations for the First Month

Do you remember what breastfeeding was like during those first few weeks after your baby was born? 

I personally remember feeling somewhat clumsy and awkward, as if my son and I were trying to master a new dance without stepping on each other’s toes.  Our rhythm was slightly off.   I constantly relied on my breastfeeding pillow and there was absolutely no dependable schedule.  I was forced to switch off my Type-A brain and learn to go with the flow, which was quite a challenge for me, to say the least!

Yet, as the months went by our breastfeeding relationship changed.  In most ways, it improved immensely, as I became a more confident mother and caregiver.  In other ways, different nuances surfaced, which taught me that breastfeeding, like parenting, is constantly in a state of motion and sometimes in need of modifications.

Listening to other breastfeeding mothers, I realized that my experience was super common.  We all found that our breastfeeding relationships with our children changed dramatically from the time our babies were born to the time they eventually weaned.  Breastfeeding a 6-week old was drastically different than breastfeeding a 9-month old or toddler, and all of the months in between.  And, what helped make these transitions manageable was knowing now common and normal these experiences truly were.

Today, on The Boob Group online radio show, I am excited to announce a NEW SERIES called Breastfeeding Expectations! 

For the next 12 months, we will be following three new mothers along their breastfeeding journeys, learning how they cope with breastfeeding challenges and settle into a breastfeeding rhythm with their babies.  Jenn, Anney, and Cherri have graciously offered to share their stories, including both their successes and their struggles, as we document what it has been like for them to breastfeed their babies.

Please click here for the first episode of Breastfeeding Expectations: The First Month

For additional resources about breastfeeding during the first month of your baby’s life, check out Breastfeeding Expectations: The First Month on The Boob Group web site.  Also, join The Boob Group Facebook Page and sign up for The Boob Group Newsletter to stay informed about upcoming episodes, blog articles, and giveaways!

What did breastfeeding look like for you and your baby during that first month?

What challenges did you face and how did you overcome them?

What did you enjoy the most during that first month of breastfeeding?

Newborn Hands: Why are they always in the way while breastfeeding?

Oh, those sweet little newborn hands.  Such a love/hate relationship we breastfeeding mothers have with those hands.  We love to hold and kiss those sweet-smelling hands, yet when it’s time to breastfeed, those annoying little clawing paws won’t get out of the way!  The minute our breast is out and ready to feed, those newborn hands are like defensive linemen, blocking any entry into our baby’s pecking mouth.

So, what’s the deal with those hands? 

Why is it that immediately when our baby realizes he is starving, his hands get in the way?

 Fun fact #1: Did you know that your baby has been using his hands in this fashion while in utero?  Ultrasounds show babies bringing their hands to their faces before swallowing amniotic fluid.  This is actually a process in the feeding pattern, which explains why babies bring their hands to their mouths when they are hungry. 

Fun fact #2: Did you know that if your baby’s face is not touching your breast as you initiate a breastfeeding session, he will use his hands to find your nipple?  Newborns have incredibly poor eyesight and use all five senses to locate and latch on to the breast.  Those little hands are searching for your breast to help bring it closer to his mouth.

So, what’s a mom to do when her baby is crying to eat, yet his hands are blocking every chance she has to put her breast in the baby’s mouth?

• Let your baby suck on his fingers to calm himself at the breast.  When he moves his hands, he is already at the ‘restaurant’ and will be ready to breastfeed.
• Try not to tuck your baby’s hands under his body or swaddle him while breastfeeding.  Tucking his hands can disorient him.  Think about if you were trying to eat with your hands tied behind your back.  You would most likely feel off-centered and clumsy.  Babies need their hands to keep them stable, just like we need our arms to our side or in front of us when we eat.
• If you have sore nipples and the thought of your baby clawing them makes you yelp just thinking about it, then keep your baby’s face touching your breast.  Try laid-back breastfeeding to assist with this.  In this position, you can wrap your baby’s hands AROUND your breast and he will come in with his face instead.
• Catherine Watson Genna, one of the most amazing lactation consultants I have ever met (and also the head researcher in an infant hand-use while latching study) recommends this technique in the Lactation Matters article, An Interview with Catherine Watson Genna, “Sometimes babies do get caught in a ‘reflex loop’ of sucking their hand, moving away, and then sucking their hands again. Moving the baby slightly so his face touches mom’s breast can interrupt this loop and get the baby to move his hands away and look for the breast with his mouth again.”  More information can be found in her article, Facilitating Autonomous Infant Hand Use During Breastfeeding

So, maybe those roaming little hands are actually helping our babies to become better breastfeeders.  Who knew?

Do All Exclusively Breastfed Babies REALLY Need Iron Supplements?

When I read a policy statement from the American Academy of Pediatrics stating that exclusively breastfed babies need to be supplemented with iron starting at 4 months, I have to wonder…

Are they saying that my perfect nutrition for my baby is no longer PERFECT? 

Are they saying that what my body produces is suddenly SUB PAR? 

This caused me to do a little research.  What IS the deal with iron in breast milk? 

Does my 4 month old really need those nasty-tasting drops?

According to my research, I found that not all exclusively breastfed babies need iron supplementation.  In general, babies are born with enough iron in their system to last at least 6 months, of not until they have tripled their birth weight. (Riordan and Wambach, Breastfeeding and Human Lactation)  According to the Womanly Art of Breastfeeding, there is not a lot of iron in breast milk, yet there is not supposed to be, as it is more completely absorbed from breast milk than in supplements or formula.   Also, breast milk contains a protein, called lactoferrin, which binds to the extra iron that the baby cannot use, keeping it from feeding harmful intestinal bacteria.  Iron supplements, for a baby who is not iron-deficient, can often overwhelm the lactoferrin, causing an overgrowth of intestinal bacteria, resulting in diarrhea and possible microscopic bleeding.  WHAT???

And, my biggest RED FLAG went off when I found a Letter to the Editor of Pediatrics, called Concerns With Early Universal Iron Supplementation of Breastfeeding Infants.  In this article, the executive committee of the Breastfeeding Section of the AAP states that they have “major concerns about universal iron supplementation at 4 months in breastfeeding infants” and that the authors of the above policy “acknowledged that this report was submitted for review to the AAP Section on Breastfeeding, but they did not mention that we disagreed and provided our additional recommendations 2 years ago.”

HMMMMM!  So, clearly my breast milk is much more perfect than the AAP was trying to make it sound and universal iron supplementation of exclusively breastfed babies over 4 months is NOT ideal.

So, how would you know if your baby actually needs iron supplements?

Which babies are more at risk for iron-deficiency anemia? (according to www.kellymom.com)

• Babies who were born prematurely, since babies get the majority of their iron stores from their mother during the last trimester of pregnancy.
• In addition, there is evidence that babies whose birth weights are less than 3000 grams – about 6.5 pounds – (whether term or premature) tend to have reduced iron stores at birth and appear to need additional iron earlier.
• Babies born to mothers with poorly controlled diabetes.
• Theoretically, babies born to mothers who were anemic during pregnancy could have lower iron stores, however medical studies do not show this to be a problem. Babies born to mothers who are anemic during pregnancy are no more likely to be iron deficient than those born to mothers who are not anemic during pregnancy.
• Babies who are fed cow’s milk (instead of breast milk or iron-fortified formula) during the first year of life.

If your baby falls into one of these categories, you have the right to ask for your baby’s hemoglobin to be tested for anemia, rather than automatic iron supplementation.  And, if your baby does test positive for anemia, there are many Iron-only drops that you can give your little one.  No need for that multivitamin because your breast milk has all of those vitamins already in it!

In addition, when your little one is over 6 months and ready to start solid foods, consider those with a healthy dose of iron, like the ones listed on one of my favorite baby food sites, Wholesome Baby Food.  No need to try that boring white rice cereal, just because it is fortified with iron!

Common Concerns While Breastfeeding - Help! I’m Engorged!

Welcome to our 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!

Check Out My Cleavage!

I remember the first time I knew my milk had ‘come in.’ It was 4am.  My son was 4 days old.  And I woke up to my breasts looking like I had visited the local plastic surgeon a few hours prior.  I immediately woke up my husband and announced with pride, “Take a look at this cleavage!”  Even without a bra I had cleavage!  It was amazing!

Several hours later, those taut, perky breasts had become quite sore and I was searching for any remedy to help soften their powerful fullness.  I knew that they weren’t engorged, but I also didn’t want to get to that point of challenging return.

What is engorgement?

Photo by Lindo Nkwanyana on Unsplash

While breast fullness between days 2-5 postpartum is normal, your breasts should still be somewhat pliable.  Think of a full balloon.  While a balloon is taut, you can also squeeze it and shape it.  This is how your breasts should feel as your body transitions from making colostrum to your ‘fuller milk.’ 

Engorgement is much more severe.  When your breasts are engorged, they can feel heavy, tender, and/or painful.  Sometimes engorged breasts will look tight and shiny, as if the skin is being stretched beyond its elasticity.  Engorged breasts can become so congested that it is difficult to even remove the milk. Engorgement is most common those first few days postpartum or as your baby gets older and begins to sleep for more consecutive hours at night.

What causes engorgement?

Engorgement is caused by milk stasis (milk not moving out of the breast.) There are many reasons that a mom might become engorged.

• Several birth interventions, which may result in lots of IV fluids in the hospital

• Poor latch where the baby is not removing milk efficiently – definitely see a lactation consultant for this issue

• Subsequent children - I was a lot more 'full' with baby #2, than with baby #1. Your body has a memory and your milk often comes in more quickly and forcefully with each subsequent baby

• Your little one slept longer at night than usual

• Skipped feedings

• Inflammation

• Low immunity (caused by lack of sleep, stress as a new mom, stress of going back to work, etc. – Can you imagine that????)

How can I reduce my breast fullness or engorgement?

• Breastfeed frequently and effectively from both breasts. In those first few weeks, your baby should be breastfeeding 8 or more times in 24 hours, actively sucking for about 30-40 minutes per feeding session

• If your baby cannot latch because your breasts are so engorged:

  • Use ‘Reverse Pressure Softening’, which pushes the excess fluid away from your nipple, helping your baby latch more easily.

  • Hand express or pump on a low setting before latching your baby, to help your breasts to become more pliable and easier to latch onto.

• To reduce inflammation, treat your breasts as you would a swollen ankle – ice packs/frozen peas in between feeding sessions to help reduce the swelling.

• Use warm compresses right before breastfeeding. The warmth will help to open your blood vessels and hopefully help your milk to begin dripping, thereby making it easier for your baby to latch on.

• Take a warm shower and lean forward. The gravity and warmth should help reduce inflammation. Use very gentle massage only, as deep massage can cause more inflammation.

• Take care of yourself and your immune system – rest, drink lots of water, eat immunity-supporting foods

• Eat cucumber and watermelon to reduce all-over body swelling (like your hands and feet)

• If your baby isn't latching well or removing milk efficiently, you may find it helpful to pump for about 10-15 minutes after breastfeeding to remove the backed-up milk in your breast.

• Ask your doctor/holistic practitioner for recommendations for inflammation-reducing medication, herbs, and homeopathy.

If your breast engorgement foes not resolve within a few days, becomes worse and turns into plugged ducts or mastitis, definitely call a lactation consultant for some additional assistance!