Help a Mama Out: Nurturing Your Breastfeeding Relationship when Back at Work

Help a Mama Out Topic of the Week: What are your favorite ways to nurture your breastfeeding relationship when you work outside the home?  

Sarah – When I was working out of the home, I pumped at the times my daughter would take a bottle.  Then, when I came home I would exclusively nurse her.  She was fine with 2 or 3 small breastmilk bottles a day, then nursed the rest of the time.  She always preferred the breast and when it came time to wean, I was nervous….but at 13 months she just did and that was that!

Alicia – Comfort nursing on the weekends and morning nursing cuddle time.  I always nurse as soon as we get home from work/daycare.

Alyssa – My favorite part of my working day (as a teacher) was when I sat down in the glider at daycare and nursed my son before taking him home for the night.  We were always so happy to see each other and it helped wipe away any headaches from the day.  Plus, I developed a friendship with his teacher and got to hear all about what he did that day, which was way better than just reading a quick note on a daily info sheet!

Jeanne – Co-sleeping helped us and a feed before I leave and ASAP when I get home.  I also pump 3-4 times at work and always demand feed when I’m home. 

Katie – We nurse in the evenings, when she wakes up in the middle of the night, and at least once more before I leave for work.  It’s funny, as soon as I pick her up after work, I think her mind lights up with ‘milk!’ because she immediately wants to nurse regardless of when her last feeding was.  I can tell that she misses that when we’re a part, as do I.

Janell – As soon as I get home, he’s on the boob.  The rest of the night, he is on the boob.  We spend all weekend with him on and off the boob.  Time consuming, but I love the connection time and it forces me to sit down and breathe with my son.

Rachel – I sit with my daughter every evening after work.  Even if she goes to sleep, we spend the entire evening and night together because we co-sleep.  I make a point to forget about all of the housework I have to do and just relax with her because I know that she won’t be little forever!

Rachelle – One of my favorite things is when I get home from work, I shower (I’m a paramedic).  After I shower, I fill the bath and my husband brings me the baby and we usually relax and nurse for 20-30 minutes.  It is my wind-down time and it is quiet with few distractions.  I love it! 

Sarah – If possible, try to arrange a mid-day nursing session.  I used a local daycare that I was able to visit at lunch and nurse, rather than pump.  It greatly helped my supply and we were able to EBF for 13 months without any supplementation.

Amanda – I asked out childcare provider not to feed our little one within 90 minutes of when I planned to pick up.  That way I could nurse as soon as I got there.

Breastfeeding Misconceptions: Does Baby Weight Loss Mean Mom Doesn’t Have Enough Milk?

How many times have you heard a so-called ‘fact’ from a family member, friend, healthcare professional, or online resource that has your ‘mama-radar’ going off at warp speed?  Maybe something just doesn’t sound right.  Maybe it goes against all of your mama-bear instincts.  Maybe it is completely contradictory to what you heard the previous day.  Well, it’s time to start busting those myths and misconceptions! 

Today, we start our new series called Breastfeeding Misconceptions. 

Every month we will be BUSTING common breastfeeding myths and misconceptions, hopefully making your breastfeeding experience that much easier!

Myth #1: If your baby loses weight in the first week, it means your milk supply is low. 

Not true!

 

All babies lose weight after birth:

A newborn baby takes in approximately 5-7ml of colostrum per feeding in the first 24 hours.  Babies are burning more calories than that as they attempt to breastfeed and expel that sticky, gooey meconium.  Nature has provided the perfect amount of colostrum in those first few days to nourish your baby and while the quantity is small, the quality is jam-packed with every calorie, immunological property, protein, vitamin, and laxative that your newborn needs to poop and pee.  Babies are expected to lose weight in those first few days.  That doesn’t mean that mom’s supply is low.

Babies typically lose weight until mom’s ‘fuller milk’ comes in:

The amount of colostrum continues to grow as your milk transitions to ‘fuller milk’, which comes in around 2-5 days (depending on baby’s access to breast, effective sucking, birth interventions, etc.)  Typical colostrum amounts are about 5-7 ml per feeding in first 24 hours, 7-15ml per feeding from 24-48 hours, and 22-27ml per feeding from 48-72 hours.  Your baby will most likely lose weight until your ‘fuller milk’ comes in, but that doesn’t necessarily mean that you don’t have enough milk.  What parents want to look for is that their baby is peeing and pooping (at least 1 of each per day of life) and baby’s weight loss plateaus once mom’s fuller milk has come in. 

Here’s a great graphic of a baby’s stomach from Babies First Lactation and Education

Delayed milk supply doesn’t equal low milk supply:

There are several situations where a mother is at a higher risk for a delayed milk supply.  As mentioned in this Best for Babes article, there are a number of factors that increase a mother’s risk for delayed milk supply.  Some are beyond our control (or difficult to control): diabetes, obesity, thyroid problems, hypertension, PCOS, preterm birth, and anemia.  There are also factors related to birth that can influence when a mother’s fuller supply comes in: cesarean birth, receiving lots of IV fluids, prolonged pushing stage, stress, cascade of interventions, hemorrhaging, mother-baby separation, just to name a few.  If you are at a higher risk for having a delayed milk supply, it can be very helpful to speak with a lactation consultant within the first 24 hours after your baby is born.  She can teach you ways to hand express and pump to help speed up the process of your fuller milk coming in, thereby DECREASING your risk for a low milk supply.

Lots of fluid during labor can cause greater weight loss in babies:

Studies have shown that mothers who have long periods of birth interventions (epidural, Pitocin, eventual emergency cesarean, etc.), tend to have more fluids during labor, thereby inflating baby’s birth weight and causing a large drop in baby’s weight in the first 24 hours.   In those first 24 hours, we are looking for 1 pee and 1 stool (as a minimum.)  For those babies that pee and stool multiple times in the first 24 hours, their weight loss is going to be greater, but that is not an indicator that mom’s supply is low. It just means they had a lot of fluids to expel after birth.  Here are a few articles that explain this phenomenon. Dr. Jen: Newborn Weight and The Boob Group: Birth Interventions and Their Impact on Breastfeeding.  

Baby may lose weight (or gain weight really slowly) because they are having a difficult time transferring mom’s milk:

There are many reasons why a baby might lose weight, sometimes continuing past the first week of life, even when mom has a full supply.  Some of these include: engorgement (causing baby to have difficulties latching on), tongue-tie or lip tie, baby is recuperating after a difficult labor, baby is jaundiced, premature baby, etc.  Again, when baby is losing weight due to these situations, it doesn’t always mean that mom’s supply is low. If her baby is having a difficult time transferring milk, then she should definitely meet with a lactation consultant to make sure she is doing everything she can to protect her milk supply until her baby can start to efficiently transfer milk from her breast.

Supplementation doesn’t equal formula:

If your milk supply is delayed, if your baby has elevated bilirubin, if your baby has lost more than 10% of his/her birth weight, that doesn’t automatically equal FORMULA supplementation.  Mom may actually have enough of her own milk to supplement her baby with until baby’s weight is back on track.  All she has to do is hand express or pump and see what extra she has.  If mom doesn’t have enough of her own milk to supplement, then the hand expression or pumping (in addition to breastfeeding) will help to bring in her milk supply more fully.  In the meantime, moms have other options.  A mom can use milk bank breast milk or donor milk, if she prefers.  For terrific information about milk banks, check out Human Milk Banking Association of North America and for milk sharing, check out Eats on Feets.  The most important take away of this all…. When supplementation is necessary, it is imperative for a mom to increase her breast stimulation to help bring in her supply more fully.  When her baby is getting a supplementation from another source, it is saying to mom’s body that she doesn’t have to make that amount of milk, which is totally not the case.  The sooner mom’s fuller milk comes in, the sooner supplementation can decrease, so spend the extra time and effort… it will be worth it in the end.

Important note: When you might become concerned about your milk supply

While all of the above statements should illustrate why a mother should not be told that she has a low milk supply early on, there are some situations that might indicate that mom has a low milk supply (either temporarily or more long term.)  If you are experiencing any of these situations, please connect with an IBCLC as soon as possible, as sometimes this can be a very temporary situation, as long as measures are taken quickly to protect mom’s milk supply.  Here are some indicators that mom’s supply might be low:

• Breasts did not grow and/or areola didn’t get darker during pregnancy

• Breasts don’t feel heavier or fuller by 5-7 days postpartum

• Fuller milk hasn’t ‘come in’ by 5-7 days postpartum

• Baby is continuing to need supplementation to gain weight and mom is not making enough to supplement with her own milk

• Mom has insufficient glandular tissue

Common Concerns While Breastfeeding: Why are my nipples white?

Are you feeling a burning sensation in your nipples that creeps up into your breasts?  Does this happen most often IN BETWEEN feedings, rather than during your breastfeeding session?  Have you noticed that your nipples turn white as soon as your baby pulls off?

What you might be dealing with are vasospasms!

Raynaud’s syndrome, or a vasospasm, is a common phenomenon that affects up to 20% of women of childbearing age.  It was originally described as affecting the body’s extremities (hands and feet), but now has been described as affecting many other vessels, including the nipples.  The symptoms are often confused with thrush, as both cause a burning sensation in the nipples, yet they are completely different from one another. 

Thrush is a yeast infection that can be treated with antifungal treatments (see your article Common Concerns While Breastfeeding: Yikes!  Why are my nipples burning?).  Vasospasms are constrictions of the blood vessels that usually occur as a result of exposure to cold and are not an indication of an infection.  Vasospasms will not be resolved with antifungal treatments.

What are vasospasms?

Imagine sitting cross-legged and your foot ‘falls asleep.’  Your foot becomes numb as the blood leaves the area.  As soon as you start banging your foot on the floor and ‘waking it up,’ the blood flows back into your foot, causing a sensation of pins and needles.  This is the same philosophy with nipple vasospasms.  Essentially, as soon as your baby’s warm mouth leaves your nipple, the cold air triggers a vasospasm, causing the blood in your nipple to escape and leave the area.  This causes blanching, or whiteness of the nipple, since the blood is constricted.  Then, as the blood comes back and starts to flow better, the nipple is ‘woken up,’ causing a burning sensation.  This can be extremely painful and frustrating, as the throbbing can be felt throughout the entire day and night.

Symptoms for vasospasms:

• Nipples turn white as baby pulls off from feeding (due to the restricted blood flow to the nipples)
• As blood flows back into the nipples, they turn from white to blue, purple, or red, accompanied by throbbing, burning pain.
• Nipples throb in between feedings, especially when mom feels cold or if she feels a let-down, rather than during a feeding.

It is important to rule out the following, as they can also cause vasospasm-like symptoms:

• Poor latch that compresses and/or pinches the nipple
• Tongue-tie
• Sensitivity to nipple creams
• Thrush/breast infections
• Pregnancy

*** None of these can be treated with vasospasm remedies

Once you have ruled out other causes of vasospasms, you can begin to treat them.

How to treat vasospasms:

• Avoid vaso-constricting substances, such as nicotine, caffeine, and alcohol
• Try to keep your nipples and breasts warm in between feedings.  Wool breast pads, such as the ones made by LanaCare, can be fantastic
• Try herbal and vitamin supplements to help increase blood flow and reduce symptoms.  My favorite daily regiment is 5000IUs of vitamin D3, 200mg of vitamin B6, the minimum dosage of Natural Calm Magnesium, and Nordic Naturals Omega 3 vitamins.
• Acupuncture – since vasospasms are caused by lack of blood flow to the nipples, acupuncture can help move your blood and keep it from being stagnant in your body
• If none of these measures help with the pain, speak with your doctor about nifedipine, a calcium channel blocker that has vasodilatory effects.  Nifedipine, as any medication, has risks of side-effects.  These side effects include dizziness, headache, and tachycardia, so please consult your primary healthcare provider.

As always, it can be very helpful to meet with an IBCLC to determine whether your nipple pain is due to vasospasms or to another breastfeeding issue.  You can find an IBCLC in your area on the International Lactation Consultant Association website.

Common Concerns While Breastfeeding - Yikes! Why Are My Nipples Burning?

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!

Why Are My Nipples Burning????

Oh, those itching and burning nipples and breasts.  It takes all of your will power to not walk up to the closest tree and rub your front side on it, like a bear would rub on a tree to get rid of fleas.  The itching can feel insatiable.  This is often your first sign that you have thrush, which is a yeast infection of a mucus membrane, your breasts being one of them.

How did I get thrush?

Well, just like a vaginal yeast infection, thrush is caused by an overgrowth of yeast in your gut.  Breastfeeding moms may often find that they get thrush after a dose of antibiotics.  This is because antibiotics kill NOT ONLY the bad bacteria in your gut, but also the good bacteria.  Yeast loves when there is an absence of good bacteria in your gut, so it decides to multiply and aim for any mucus membrane. 

Moms and babies who also have inflammation, such as a food intolerance which limits the absorption of important nutrients, or are just temporarily dealing with a compromised immune system, are also more susceptible to thrush. 

What does thrush look like?

• Burning, itchy nipples and breasts

• Red or pink nipples and areola

• Painful feedings after a time period of painless feedings
  

• And thrush doesn’t just affect the mom.... babies can get thrush as well.  When your baby has thrush, he may have white, cauliflower-textured spots in his mouth along the gum line or on his cheeks.  He may also have a raging diaper rash.  Babies with thrush may cry while breastfeeding because the milk stings the sores in their mouths.  And to complicate matters more, your baby may show no signs of thrush at all!

How does one get rid of thrush? 

• First and foremost, make sure that the pain you are feeling is not due to a less-than-perfect latch. Also, if the burning happens to only occur after the feeding, not during the feeding, it might be worth it to see if you have Raynaud's, which is a vasospasm of the nipple.

• Remove sugars (including most fruit and fruit juices) from your diet for about a week. Yeast grows on sugar, so removing it from your diet restricts yeast growth. It might help to eliminate dairy as well.

• Consider starting a course of a high-quality probiotics to help recolonize your gut, and your baby’s gut, with good bacteria. I would recommend choosing a probiotic from the refrigerator in the herb section of a natural food store. Probiotics are alive and begin to die off when at room temperature, so don’t purchase anything sitting on a shelf, unrefrigerated.

• You will want to wash all of your bras and underwear in a distilled white vinegar rinse cycle. Also, soak anything that goes in the baby’s mouth, like a bottle nipple, in apple cider vinegar before rinsing it in soapy water. The vinegar should help kill off the yeast hanging out on these items.

• All Purpose Nipple Ointment (APNO) - if that pesky thrush will not go away after trying the above recommendations, Jack Newman has a protocol for getting rid of thrush. You can ask your primary care physician for a prescription for this to bring to a compounding pharmacy. Midwives often have recipes for this as well, that you can make with over-the-counter medications.

• If all else fails, you can ask your physician for Diflucan, which is the same medication used to clear vaginal yeast infections.

• Lastly, definitely discuss this issue with your pediatrician or a lactation consultant. He or she may have some other recommendations to help remedy the out of control yeast.

Help a Mama Out: Surviving the First Few Weeks of Breastfeeding

What tips do you have for surviving the first few weeks of breastfeeding?

Maren: Lots of skin to skin to get those endorphins going so you can take advantage of all that delicious oxytocin (which will make you want to keep breastfeeding, even with things might be tough!)  Take advantage of all of the support you can – it will help normalize the experience so that you feel totally confident in your decision to breastfeed.  And know ahead of time that there is definitely a learning curve, but it only gets better and better, so hang in there!

Amanda: Make sure to talk to your partner about how you need him/her to support breastfeeding and encourage you, even when you get discouraged and feel like giving up!

Jamie: Get the latch correct right away!  Take advantage of the lactation consultants at the hospital and ask for a referral even if you don’t think you will need one.

Andrea: Trust your body!  Skin to skin, lots of water, and lots of rest.

Heather: Surround yourself with at least one supportive person.  I would never have made it through those weeks without the support of my husband.

Alicia: Hire a postpartum doula.

Juli: Surround yourself with women (and men!) who support breastfeeding.  It gets easier – it is definitely worth pushing through the tough parts in the beginning!

Billie: Make really good friends with the lactation consultant and local breastfeeding support group before delivery.  They will be able to offer so much support in those first few weeks.  Trust your supply.  Make sure you are comfortable!

Monica: I went to classes and read books, which helped, but nothing prepares you for the real thing.  Get help early, if you need it.  Hiring a lactation consultant was the best thing I did.  Keep telling yourself you will try it for one more day and one day it will become second nature.  Coconut oil worked wonders on sore nipples.

Christine: OMG… best advice I got was to rub breastmilk around your nipples after every nursing session!  My cracked tatas healed within 2 days of doing that!

Chelle: If it hurts and you are dreading the next nursing session, don’t just tough it out!  Get help ASAP before it gets worse or turns into an issue that makes you quit! Take a prenatal class.  Breastfeeding is natural, but that doesn’t mean you will naturally know what to do.

Sarah: Don’t expect anything else from yourself.  Set up what you can ahead of time and find someone else to do everything else that needs to be done.  Establishing your breastfeeding relationship is your job.

Jen: Get a Netflix subscription and ignore the dirty dishes!

Danielle: Don’t do anything but rest, breastfeed, nap, and eat.  Nothing else matters right now.

Abbey: Celebrate every success, no matter how small it seems!

Desiree: Find support!  And be patient…it’s not always easy, but it’s most certainly worth it! 

Sofia: Learn the basics!  Before birth is possible!  Proper latch, how milk supply works, most common myths about breastfeeding, how to know if your baby is getting enough, why it is REALLY important to feed on cue rather than a schedule, why baby doesn’t need ANYTHING else but your breastmilk, etc.

Amanda: Don’t give up! Get help and support!  Spend as much time as you can with your baby (in bed if you can.)

Priscilla: Relax.  Don’t listen to anyone that’s not helpful. Determine your own needs for comfort.

Joanna: Expect to care for your baby and get others to help with meals and housework.

Thanks to everyone who responded to our questions on our San Diego Breastfeeding Center and The Boob Group Facebook pages.  Check back every Tuesday for a new Help a Mama Out tip!

To find an international board certified lactation consultant, visit www.ilca.org

Here are a few more articles on our website, specifically dealing with breastfeeding a newborn:

Advice for a Newly Breastfeeding Mama’s Partner

Breastfeeding Expectations for the First Month

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

Advice for the New Breastfeeding Mom

Supplement Options: Donor Breastmilk, Milk Banks, and Formula

This past week, we released one of my most favorite episodes on The Boob Group: Low Milk Supply: Donor Milk, Milk Banks, and Formula.  I had the esteemed pleasure of interviewing Amber McCann, an International Board Certified Lactation Consultant, fierce supporter of all things mothering, and dear friend.  I wanted to know what options were out there for mothers who needed to supplement their babies, as well as the pros and cons of each.

I pulled out the most salient points for this blog article, but you can click here to listen to the Boob Group episode in its entirety: Low Milk Supply: Donor Milk, Milk Banks, and Formula.

What are your options if you need to supplement your baby?

When feeding an infant, the World Health Organization lists a hierarchy:

• Milk taken directly from the mother’s breast
• Expressed milk from baby’s mother
• Expressed milk from another mother (wet nurse, donor milk, milk from a milk bank, etc.)
• Breastmilk substitute (formula)

Is it safe to offer your baby another woman’s breastmilk?

Making the decision as to what to feed your baby should never be taken lightly.  It is important when one is considering offering donor breastmilk to their baby to balance the risks and benefits.  You should always consider asking the potential donor mom for a copy of her prenatal blood work to check for sexually transmitted diseases and other potential pathogens.  It is also important to ask questions about lifestyle choices, such as alcohol use, smoking, diet, medication use, etc.  Eats on Feets has a Resource Guide with great lists of questions for both the donor and recipient of expressed breastmilk, as well as an extensive list of health considerations.

What are the main benefits of using donor milk?

• It’s breastmilk!  It has everything your baby needs, nutritionally and immunologically.
• It has every benefit that a mother’s own milk would have.

What concerns may arise when using donor milk?

• A number of pathogens enter into human milk if a mother is infected, however few diseases can be transmitted through human milk, itself. 
• The main diseases that cause concerns are HTLV, HIV, and CMV.  CMV is typically only a challenge for premature infants.  Fortunately, HTLV can be deactivated by freezing and HIV by flash heating.

Where can a mother find someone to donate milk?

• Start with your own social group.  If you have friends or friend of friends who are breastfeeding, there is always a chance that they or someone they know has an excess supply in their freezer or would be willing to pump for you, if they knew there was a need.  All you have to do is ask!
• Informal milk groups, such as Eats on Feets and Human Milk for Human Babies
• Milk Banks

What are milk banks?

Milk banks are non-profit organizations where breastfeeding moms can donate breastmilk, should they fit the milk bank’s criteria.  The Human Milk Banking Association of North America requires that their donors be in good health, not regularly on most medications or herbal supplements, willing to undergo additional blood testing, and be willing to donate at least 100 oz.  Donated human milk is pasteurized and then either sold to hospitals to feed critically ill babies or to families who purchase directly from the milk bank. 

How should I choose between donor milk, milk from a milk bank, or formula?

This is such a hard decision and definitely not one to take lightly!  What is most important is to look at your needs, your baby’s needs, what you feel most comfortable supplementing with, and what’s the best choice for your family.  So, sit down, research all of your options, and choose with your heart and knowledge. 

As a follow up to this article, several moms submitted stories about their experiences using donor milk or donating to a friend or milk bank.  Stay tuned, as we share them during the rest of the week!

If you have a story about using donor milk or donating breastmilk to a friend or milk bank, and you want to share it with our readers, please email it to me at robinkaplan@sdbfc.com.

Did you have to supplement your baby with donor milk, milk from a milk bank, or formula? 

How did you choose which supplement to use?

Update on 2013-01-24 15:36 by Robin

Here's your Call to Action:

Too many breastfeeding mothers have no idea that human milk sharing is an option and we want to change that!

If you are a breastfeeding mother and have used donor milk or have donated your own milk, we would love to hear your story!  Other breastfeeding moms need your support!  Just knowing that someone else out there went through a similar experience.... well, that can make all of the difference in how a mother views her own breastfeeding experience!  Your stories are beyond powerful!  They need to be heard!

If you would like to have your stories posted on our website, as well as The Boob Group's website, please send your story to robinkaplan@sdbfc.com.  

We will begin posting your stories as soon as we receive them! 

Toddler Nursing Part III - Super Breastfed Baby!

Written by guest blogger, Andrea J. Blanco, IBCLC

My seven year old is really, really into the Super Diaper Baby series. So much so (embarrassing story for which I will pay for dearly in 10 years coming up right now) that the other day, he fished through all the dirty clothes to find 8 (yes, 8!!!!) underwear to put on simultaneously along with a cape so that he could reenact parts of the book. I’m not entirely sure why clean underwear couldn’t be used, but hey, welcome to the gnarly world of 7 year old boys. I’m still getting adjusted.  Anyway, whenever he yells “SUPER DIAPER BABY!!” all I hear is “SUPER BREASTFED BABY!!!” (you better have read that in your booming announcer voice; if not, please go back and reread).

Super Breastfed Baby is not a baby anymore. He’s a toddler who can leap off everything, get all bruised up and bounce right back up. He can run amazing distances while laughing hysterically at you chasing him and fall over 15 times, but who’s counting? He scoffs at the mere thought of you trying to clean. Or sit. Or cook. Or sleep. He knows what he wants and isn’t taking no for an answer. This is the breastfed baby magnified – the one that I was reminded of as I read some of your comments to Toddler Nursing Part I and Toddler Nursing Part II of the Toddler series. Super Breastfed Baby is who we’re going to tackle today.

The Scenario: You and Super Breastfed Baby are home and you are trying to get things done around the house.

I hate to say it, but nothing about this will ever get easy. But it can get easier. Having a child, nursing or otherwise, around the house means being very strategic in all that you do. Your toddler wakes at 7, you say? Well then, 6:15 is the time to set the alarm so you can chop veggies for tonight’s dinner, put a load of laundry in the washer, and prepare a to-do list for your partner. Waking earlier than your little one doesn’t work for you? Try naptime or after bedtime. When they’re awake what they want is to be entertained. By you. Because you’re the awesomest. EVER. And no one else can compare to the way YOU entertain them. And when you aren’t in the entertaining mood? You still have breasts. Which they love. All I keep thinking as I’m typing this paragraph is “That which you resist, persists.”

It’s easy to get caught up feeling like “I HAVE TO DO THIS NOW”, but sometimes, if you stop for a second and give in to Super Breastfed Baby’s demands (of nursing or block building or nursing while block building), you will find that time to do what you were looking to do suddenly appears afterwards. And if it doesn’t appear? And you still have to vacuum? Rip a play out of my dear friend’s book and wear your baby right around naptime. She vacuums the floors, makes the bed, washes the dishes and sometimes even mows the lawn with her toddler strapped to her back in the Ergo. Most times he’s too busy loving the view, but sometimes, her little superhero falls asleep while she’s at it. 

The Scenario: You and Super Breastfed Baby are, well, just home.

You may have noticed that when you’re home or *gasp* sitting down, your normally easy to distract child becomes Mr. Grabby Pants (which definitely feels like a superhero quality), demanding to nurse every. five. minutes. This one is a little trickier to fend off because mommy sitting = easy target. Most toddlers nurse that frequently out of boredom and/or familiarity. If you’re like most moms, for the last year, most of you and your baby’s breastfeeding took place either sitting or laying down. So it just means that your little princess was paying attention and now that she sees you sitting or laying down again, she thinks it’s nursing time. If you have realistic expectations of what’s about to happen, then you may be better prepared to deal with it. Another way to fend off Mr. or Ms. Grabby Pants is to “relax” in a new or exciting (but safe) environment. Toddler areas at local museums or indoor play gyms tend to be enclosed – use that to your advantage. Your busy, curious, newly independent toddler will be much less likely to think of nursing when there’s other stuff to do and see.

The Scenario: You and Super Breastfed Baby are at an impasse and you’re not too sure you want to continue nursing.

You’re trying to set boundaries, but it seems nothing is working. It’s not so much that you want to wean Super Breastfed Baby (or maybe it is), but you would like for nursing to feel like it’s more on your terms than at his demand. First, there is absolutely NOTHING wrong with you feeling that way. Nursing is a mutual relationship – both you and your child have to want to continue. As I mentioned in Part II, if you’re feeling like you want to slow down the demands of nursing or even wean, first try to pinpoint which is the MOST difficult nursing time for you. For me, it wasn’t the morning, nap and night – those I could deal with. But it was all the in-betweens. However, I didn’t realize that I could deal with, and actually cherished, the morning, nap and night until I was able to really cut back on the in-betweens. It took lots of creativity and motion, but after a few weeks, he didn’t even realize the in-betweens were missing. As with any change to a child’s sense of normalcy, employing gentle techniques combined with lots of love and patience along with waiting (if you can) until the child is communicative enough to understand, even if he doesn’t agree, will yield the best results.

The Scenario: You and Super Breastfed Baby have found your groove, but sometimes, she acts like there isn’t enough milk.

Super Breastfed Baby is one smart cookie. Maybe it’s that x-ray vision or her supernatural senses, but something has alerted her that there is less milk. Did you read that sweet momma? LESS MILK. Less milk is different than “NOT ENOUGH” milk. A few months ago, when you started solids because your little one showed all the signs of being ready, the weaning process began. Your body naturally slowed down its milk production to meet your baby’s needs and has continued to be super efficient in adjusting to those continued needs. Yes, you do have less milk, but, in conjunction with the other foods he’s eating, he’s still getting exactly what he needs. In addition, Super Breastfed Baby knows what he’s doing when he seems to be kneading the breast or trying to “play” with the other nipple. He’s actually trying to elicit a faster flow of milk for himself. For most moms, the kneading is nowhere near as exasperating as the nipple twiddling. Toddlers need to learn manners, too, and where better to learn them then at the breast where they are happy and relaxed and met with love? If you’re trying to curb behaviors such as nipple twiddling, be consistent each time. Explain to your toddler that it hurts momma. Use words she can understand. And repeat each and every time. Sometimes, along with consistency, a little bargaining might help, too. “Instead of hurting mommy by touching my breast that way, you can [insert substitutive, less exasperating behavior here]”.

So many of my past New Year’s Eves were spent with a baby in arms, or in a sling, or on the breast, picking confetti (or food) out of their beautiful, thick brown hair. Some years, it seemed I would never have my body free at midnight – or ever. My Super Breastfed Babies are babies no more…I can’t even say they are in jest. This year, we weren’t nursing at midnight. I wasn’t holding them. Yet, there we were, all of us snuggled up and interlocked when the clock struck 12. Maybe not as it had been in years past, but then again, not much different either. Maybe it was because, as others would say, I “nursed them *forever*”. Or maybe it’s because, through the nursing process, I realized there’s nowhere else I’d rather be.

Happy New Year! 

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.

Do you have any additional questions for Andrea about nursing a toddler?  Share them in the comment section and we'll ask her to write another article!

Common Concerns - Do I Have Mastitis?

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!

Why is my breast so swollen???

Does your breast suddenly feel like it is going to explode, like a balloon, off of your chest?  Does it hurt to breastfeed, yet you know you have to remove your milk ASAP?  Are you starting to feel exhausted and lethargic... not something that can just be blamed on being a new mom?  Sounds like you may have mastitis!

What is mastitis?

Mastitis is inflammation of the breast, usually (although not always) from a bacterial infection.  Mastitis happens when milk gets stuck in the milk ducts and that milk stasis  causes engorgement and inflammation.  Not all mastitis is an infection of the breast and can often be treated with natural remedies.  Indications of an infection, and the need for antibiotics, are:

• Mastitis in both breasts

• Baby is less than 2 weeks old or you were just hospitalized

• Nipple has obvious infection

• Pus/blood in the milk

• Red streaking is present

• Temperature increases suddenly

• Symptoms are sudden and severe

(per Kellymom, Plugged Ducts and Mastitis)

How will I know if I have mastitis?

Mastitis often starts as a plugged duct.  This pesky blockage starts to get harder and more painful over a few hours as the milk stays 'stuck' in the milk duct.  As with a plugged duct, mastitis typically affects one breast, rather than both.  Plugged ducts often resolve within a few hours to a few days, and while uncomfortable and tender, they are relieved with a few comfort measures over time. 

Mastitis, on the other hand, has a few additional symptoms:

• Painful, hot area on the breast

• Breast may have a red streak over the hardened area

• Breast looks swollen and the affected area is tight and uncomfortable

• Mom feels like she has the flu - extreme exhaustion, achy, chills

How can I treat mastitis?

Once you start feeling like your plugged duct is exacerbating into mastitis, you want to start treating it as quickly as possible.  Mastitis can often be treated with many natural remedies, rather than needing antibiotics.  The reason we want to leave antibiotics as a last resort is that they kill off both the bad bacteria, as well as the good bacteria, leaving your body wide open for increasing your risk for thrush... Huge bummer!

Here is a list of my personal favorite natural remedies for treating mastitis:

• Bed rest! This is your body's way of telling you it's time to rest and take care of yourself. Think of yourself as having the flu. While mastitis is not contagious, you definitely need to remove your milk and feed your baby. The best way to do this is to spend the rest of your day in bed.

• Fluids and nourishment. Drink lots of fluids (like water, coconut water, and green smoothies) and eat warm nourishing meals (like soup.) The laundry can wait, I promise!

• Remove milk every 2-3 hours. If it hurts too much to breastfeed on the side with mastitis, you will need to pump instead.

• Castor oil compresses - Castor oil used topically helps to move things under the skin. Pour castor oil on a face cloth (it stains, so not on a nice one) and place the face cloth on your sore breast. Place a heating pad over the face cloth, as the heat will help the body absorb the castor oil and move the blockage. Check every 20 minutes and use as long as it takes to soften your breast.

• Dandelion tincture. Dandelion is a natural antibiotic and a great way to battle any infection. Two droppers full, 3-4 times a day, can often do the trick. The flavor is definitely intense, but well worth it!

• Vitamin C and Echinacea. Mastitis is your body's way of telling you it's time to slow down. Both vitamin C and Echinacea boost your body's immune system. A safe dose to take is 3000-5000mg/day (mega dose to be used acutely during mastitis) of Vitamin C and 900mg of Echinacea per day (acutely).

• Homeopathic belladonna. These tiny little pellets can make a world of difference to reduce your temperature while battling mastitis. Plus, you cannot overdose on homeopathy... if it isn't working, then you just stop taking it. 2-3 pellets, under the tongue, every 30 minutes for up to 6 hours.

How can I prevent mastitis?

Once you get mastitis, you definitely never want to get it again, so how can you prevent it from happening even in the first place?

Ways to prevent mastitis:

• Effective and frequent removal of milk. Engorgement or ineffective removal of milk can cause your milk to get backed up in the ductal system, causing inflammation and mastitis. Tongue-ties, latching problems, oversupply, limiting baby's time at breast, nipple shields, sleepy baby, and skipped feedings can all decrease the baby's effectiveness at breast, thereby allowing the breast to fill up too much.

• Make sure certain areas of your breast are not being constricted. Tight, under wire bras and restrictive clothing can put undo pressure on a particular area of your breast, which may cause a plugged duct.

• Seek help ASAP when you have cracked or bleeding nipples, as these wounds increase your risk for infection.

• Support your immune system. Having a new baby can be draining on your body and immune system, especially if you are recovering from an exhausting birth, cesarean, or just too many visitors in your space. In many cultures, new moms don't leave their homes for 6 weeks and their family and friends cook all of her meals and help her take care of her new baby. Unfortunately, in the United States, that is simply not the norm. When our immune system is run down, we are much more susceptible to illness and inflammation. Limit visitors in the first few weeks to only HELPFUL visitors, and ask them to bring food. Relax and rest during and in between breastfeeding sessions to let your body heal after the birth. Eat warm, nourishing foods to keep your blood flowing and your body healthy. Take an Omega 3 supplement (from a reputable company, like Nordic Naturals) to reduce inflammation.

Disclaimer: Most herbal treatments have not been thoroughly researched, particularly in regard to lactation. Herbs are drugs, and some caution is necessary. I am presenting this data as is, without any warranty of any kind, express or implied, and am not liable for its accuracy nor for any loss or damage caused by a user’s reliance on this information.

Toddler Nursing Part II – Toddler vs. Breastfeeding

Written by guest blogger, Andrea J. Blanco, IBCLC

Have you ever read Dinosaur vs. Bedtime by Bob Shea?

“ROAR!! I’m a dinosaur! ROAR! NOTHING CAN STOP ME!”

It’s a cute little book about this dinosaur who faces many challenges, and wins all but one. The dinosaur is FOR SURE a toddler. I just know it.

In my previous post, we talked about some of the reasons why nursing a toddler can be a helpful transition for you and your little one. Dealing with a little person who has so many changes going on all at once can feel a lot like those battles in Dinosaur vs. Bedtime. Here are some suggestions for turning the tables on your little dinosaur or dinosaurette.

I want to keep nursing, but am being pressured to quit.

In this society, if you happen to be nursing your 3 month old, you are in the minority. Six months? You are an anomaly. If you’ve gotten to the point where you’re thinking of nursing your toddler, then it is safe to assume that not everyone around you will understand or agree that you are doing a very important, *normal* thing. However, dealing with that lack of support is crucial to your wellbeing and to the likely continuation of your breastfeeding relationship. So what can you do if the people closest to you don’t necessarily share your same enthusiasm?

First, have a conversation about their concerns. Be a good listener and find out why continued nursing is bothersome for them. It’s rarely about YOU nursing YOUR toddler that is offensive to them and has to do with other concerns, like spending time with you (in the case of a partner) or spending time with the baby (in the case of extended family) or concerns (real or perceived) over your work duties (in the case of an employer). If you’re able to get to the real issue for which breastfeeding is taking the hit, making small changes to show you are conscientious of their concerns will get the attention off the nursing and you and your toddler can continue your breastfeeding relationship.

There are times when despite your best efforts, it will feel like a lonely journey. However, in this day and age, that needn’t be the case. A lot of communities offer breastfeeding support groups and even breastfeeding toddler groups. Check with your local hospital or La Leche League chapter to see if there are any in your area. When my first was approaching toddlerhood, I found my support through online forums where I met some great, like-minded mommas whose virtual support was key to our continued breastfeeding success. If you’re on Facebook, become a member of one of the many groups there are offering mother-to-mother support. Are you on Twitter? Search #breastfeeding and for the most part, you’ll be met with tons of virtual kindness. What about downloading some great podcasts from The Boob Group? You don’t need an army of people cheering your name – sometimes one person who gets what you are going through is enough. Toddler Nursing vs. the World? Toddler Nursing WINS!

My toddler is very demanding about wanting to nurse, even when I don’t want to.

As you’ve probably realized, toddlers are VERY demanding about EVERYTHING. Nursing will definitely not be excluded. It’s easy to continue to fall into this routine of “on-demand” nursing when you’ve been at it for so long, but with your child’s developing language comes the understanding that we live in a world where patience and manners are necessary and there are boundaries. While breastfeeding does still serve a nutritional purpose in that second year of life, it probably isn’t what your toddler is surviving on alone. In the same way that you are curbing the throwing of sippy cups on the floor so hard that the top comes off and the water (if you’re lucky, it’s just water!) spills everywhere, you can begin to curb the octopus arms toddlers suddenly develop when trying to get to the breast. Model the behavior you wish to see and be gentle, but firm about it (laughing or smiling and cooing at how cute it is that your little one grabs at your shirt and pulls so hard while yelling for some milkies when you’re trying to say no isn’t very effective). Octopus Hands vs. Nursing Manners? Nursing Manners WIN!

But, what if I’m out and my toddler still wants to nurse?

Maybe nursing a baby in public has been a challenge for you. If so, then the idea of nursing a toddler in public is really intimidating. Because toddlers are all about exploring the world around them, they are [generally] easy to distract when you’re out. There was, however, that one time at mass when my little angel decided that the crayons and snacks I’d brought along weren’t going to cut it. Nothing like hearing “BOOOOOBIEEEEEE” being yelled out in a quiet room built to echo. As mortified as I may have been at the moment, it’s also one of my most cherished memories. If distraction isn’t working, with a little quick thinking, there’s always a quiet place you and your little one can go for that needed pit stop, breastfeeding under the choir robes included. Also, while you are aware you’re nursing a toddler, most people wouldn’t even think of it, so just as in the case of a baby, to a passerby, it can look like your child is sleeping on your lap, and nothing else (this, of course, doesn’t apply if your son has already announced his plans to the entire congregation). Boobie vs. Echo? Boobie WINS!

When all else fails, don’t forget – you can set boundaries. It doesn’t have to be all or nothing. I’ve dealt with countless clients who, by the time their child gets to a certain age, are having a hard time continuing the nursing relationship because of these demanding moments. If you are at your wit’s end and feel like you want to keep nursing but…, try to find a middle ground. If you are able to target the most stressful times and/or nursing behaviors, you can then find ways to work around them. Maybe that means finding gentle ways to say no by way of distraction more often than you are used to, but if it goes hand in hand with keeping your sanity and in turn, continuing your nursing relationship, then, whether your toddler agrees with you at the particular moment or not, it’s still a win/win situation. Demanding Toddler vs. Boundaries? Boundaries WIN!

Nursing a toddler, like having a toddler, isn’t always easy, but if you so happen to embark on the journey, you may find it is always worth it. It gives you another mothering tool to help navigate those battlefield moments and is a sure fire way to connect with your child amidst this busy life we lead. One day my little one got his finger caught in the door and came wobbling over to me, tears of pain streaming down his soft, round toddler cheeks. Instinctively, I lowered my shirt and offered the breast. The older one, worried about his brother, came over and said to him “You see, B? There is love in there so you’ll be ok.” I realized the only reason he felt that way was because of what he experienced at the breast by way of watching and doing. I couldn’t have asked for a bigger reward from my nursing relationships. Toddler vs. Breastfeeding? Love always wins. 

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.

Breastfeeding with Hypoplasia

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Fakiha Khan'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, Fakiha, for sharing your story with us!  It's stories like yours that make me want to be the best mom I can be! 

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

When my son was born 2 and 1/2 years ago, I wanted nothing more than to be able to breastfeed him.  He was in the NICU for a week after he was born, and I really did not get to nurse him until he was a week old.  By that point, he had trouble latching on, and my milk just was not coming in.  For the next five weeks, I did what I could.  I tried to nurse him every hour and a half, I pumped, I took herbs, and I finally went to see a lactation consultant. 

I will never forget how shocked she was that my son transferred only 1/2 an ounce at the age of five weeks.  Other than telling me to continue pumping with a hospital grade pump, the consultant had no other ideas of why I was not producing milk.  She kept saying to me - it is the most natural thing to produce milk.  It's all about demand and supply.  If you keep putting him on your breast, the milk will come. Well, I kept trying, and after weeks of emotional torture and physical discomfort, I finally gave up.  I was producing an ounce of milk from both breasts at that point.  And, giving up was not easy.  I felt like a complete failure, like I could not do the thing that is supposed to be so natural. 

I got a second chance when my daughter was born two months ago.  I figured that, with my son, I just didn't get started on nursing quickly enough.  This time, I decided to be proactive even before the baby was born.  I talked to people and a lactation consultant prior to giving birth.  This consultant suggested that I might have a physiological problem such as hypoplasia, but I would not know until I got checked out.  I didn't get a chance to do so before I gave birth, but I went into the birth with hope of doing better this time. 

When the baby was born, I immediately put her on my chest and I nursed her within a half hour of birth; I kept her with me nonstop, nursing her whenever I could.  But, within the first two days, it was clear that I was not even making enough colostrum.  I had to give her some formula.  My fuller colostrum finally came in at day 3 and the milk first came in on day 5.  But, despite nursing every hour and a half, the baby was still fussing and clearly unsatisfied. 

Those old feelings of frustration and failure came rushing back to me.  I kept thinking, this is supposed to be so natural.  Every mammal mother makes milk for her child, yet, I can't feed my baby who is trying so hard to get out a few drops of milk from me.  All of the instructions from the breastfeeding class kept repeating in my head.  I kept thinking, maybe today I will suddenly make the milk my baby needs, maybe today.   

Before giving up, I went to see my doctor to find out if I had hypoplasia.  The doctor told me that hypoplasia was not possible, as I did not have the physical signs (tubular breasts that are set far apart) and because I was making some milk even if it was only an ounce at a time.  So, I thought, ok, there has to be something I can do.  So, I did some research and found out about fenugreek.  I began taking that, and immediately I got a boost in my milk supply.  But, then within a week, it started going back down again.  At this point, I was ready to scream, but before giving up, I decided to consult another lactation consultant.

As it happened to be, this consultant specialized in low milk supply.  She finally told me what I had been suspecting - I have insufficient glandular tissue.  The consultant suggested a number of herbs and medication, all of which I tried.  Again, my milk supply went up very quickly, but now after 3 weeks, I see it going back down again.  I still don't know if any of the medications or herbs (which I understand work by increasing hormone levels) really work with insufficient glandular tissue.  Can they create tissue where none exists?  No one can seem to answer this question for me. 

Now, I continue pumping during the day, saving the little bit of milk I made (about an ounce and half), and mixing it with formula.  I nurse when I can and regularly throughout the night.  But, I have resolved myself to the fact that I will not be able to exclusively rely on breast milk.  It's a very sad realization, and I wish I had a solution, something to fix this problem, or even a bit more information.  Alas, I do the only thing I can and, in the process, laugh at myself when I am proudly toting home the four-ounces of breast milk I take home after pumping 3 to 4 times at work.  To a regular breastfeeding mom, four ounces is probably how much she produces in one feeding.  For me, it's a day-long effort, and at the end of the day, I carry it home with the same pride as if I had just discovered gold!