Common Concerns While Breastfeeding - What is That White (and painful!) Spot on My Nipple?

Welcome back to our blog series…. Common Concerns While Breastfeeding.  These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls we 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, we would like to share those tricks with you!

Many moms know the pain associated with a shallow latch during the early days, but have you ever had nipple pain suddenly begin after weeks or months of pain-free breastfeeding?  After checking nipples for signs of a poor latch, you notice a white spot on the nipple in question - you pick at it for a few seconds, but it still remains.  What is it?  What caused it?  What can you do to resolve it and get back to pain-free breastfeeding?  This is what’s called a “milk blister” or “milk bleb” and is not cause for great concern, but it can be an uncomfortable and unwelcome guest!

 

What is a milk blister?

A milk blister is a small white or yellow spot on your nipple - it is normally blocking a milk duct, hence sometimes the pain associated with it is felt both at the tip of the nipple as well as radiating out into the breast.  It can’t easily be wiped away or removed.  It may sometimes be associated with a plugged duct.  It is perfectly safe to continue to breastfeed while you have one.

What causes a milk blister?

There are two causes for what we call a milk blister.  One is that a bit of skin has grown over an open milk duct, blocking it and creating a blister.  The other is the build up of fatty milk at the site of the milk duct, and the calcification of this fatty milk, which then blocks milk from flowing from this duct. The things that can increase risk for a milk blister are:

• A recent plugged duct

• Nipple is pinched often while baby is breastfeeding

• Oversupply

• Unusual pressure from a bra or sleeping position

• Thrush

How can I get rid of the milk blister?

• Place some organic coconut oil on a cotton ball and place it on your nipple, inside your bra, in between feedings for a few days.  This will help break down the calcification at the tip of the nipple, as well as fight off any bacteria or yeast.

• Soak your nipple/breast in a saline bath of warm water several times a day.  According to Kellymom.com, add 2 tsp of epsom salt to 1 cup hot water.  Allow the salt to dissolve and soak your affected breasts prior to feeding. Then place a hot, wet facecloth over your breast right after the saline bath and right before breastfeeding/pumping.  This should help to soften the nipple and help the blister release while baby is feeding or while pumping.

• Apply moist heat to nipple prior to feeding

• Try to remove the skin prior to feeding - rub with a warm washcloth

• If all else fails, you can also ask your healthcare provider to use a sterile needle to open the blister.  After this procedure, follow up with organic coconut oil to keep the area moist and allow it to heal.

What if I keep getting milk blisters?

• Consider seeking help from a Lactation Consultant to try to resolve the underlying cause of the recurring blisters.

• Be sure your bras provide soft but strong support - avoid ones with underwire that may cause plugged ducts.

• Consider reducing the amount of saturated fat in your diet.

• Consider taking sunflower lecithin, 1200mg, 4 times a day, to keep milk ducts ‘slippery’ thereby preventing recurring plugged ducts and milk blisters.

What Every Mom Should Know About Breastfeeding During the Early Weeks

How much breast milk does my baby need per feeding?
What is common nursing behavior for a newborn?
How will I know that my baby is getting enough?

As a new mom, these are common questions that you may ask your pediatrician, midwife, postpartum nurse, family, and friends and GUESS WHAT..... they may all have a different answer!

How complicated is that?  

Sometimes you may feel like there are ‘too many cooks in the kitchen’ and that all of the advice you receive contradicts what you just heard from someone else 5 minutes ago. 

Talk about frustrating! 

Well, one of our goals at the San Diego Breastfeeding Center is to make breastfeeding as seamless and uncomplicated as possible.  We want to empower moms with knowledge and confidence to get breastfeeding off to a great start!

After listening to local moms express discontent about hearing contradictory breastfeeding information, we decided to do something about it.   First, we canvased our local breastfeeding mamas and asked, “What information do you wish you would have known about breastfeeding during those early weeks?”  Then we hired one of those awesome mamas, Elisa Suter, of Paper Doll Design Studios, to design a brochure that shares our top tips that every mom (and pediatrician) should know about breastfeeding during the early weeks.

Here is the final product!  Isn’t it beautiful?  We hope that this brochure provides the clear, consistent, evidence-based breastfeeding information our mamas are looking for.  

If you live in San Diego and would like us to deliver these brochures to your pediatrician's office, please email us at robinkaplan@sdbfc.com. 

If you live outside of San Diego and would like to order the Adobe file to personalize this brochure for YOUR local pediatricians and clients, please email us at robinkaplan@sdbfc.com

Keeping Up Your Milk Supply During the Holiday Season

Since Winter Break has descended onto our homes, Ashley and I are taking the next few weeks off from blogging to spend some quality time with our families.  However, that doesn't mean that you'll be left without our breastfeeding support until the new year!  We have over 300 articles on the San Diego Breastfeeding Center blog, which means there is no reason for you to google 'sore nipples' at 3:30am.  Just check out our extensive article list and you will be well on your way!

Here are some of our favorite tips for keeping up your milk supply during the holidays

1. Holiday recipes often include herbs that can affect supply.  Don't eat too much sage or mint - these are herbs used to temper down or dry up a mom's milk supply.  One mint cookie won't do it, but be aware of the amounts you are consuming.
2. Continue to breastfeed or pump at regular intervals.  It's very easy to skip feedings and/or pumping sessions with all of the holiday festivities, which can lead to plugged ducts and mastitis.  Yuck! Try to stick to your regular breastfeeding/pumping schedule to prevent your breasts from getting overly full and uncomfortable.
3. Traveling during the holidays, expecially with a baby or toddler, can really wear your body down.  To keep up your milk supply, stay hydrated, bring tons of nourishing snacks for the trip, and do you best to get good sleep.  Plus, follow your child's lead and squeeze in a nap or two throughout the trip.  Your immune system will definitely thank you for it!
4. Find your comfort level with breastfeeding around family members.  Enlist your partner as your cheerleader and advocate so that you can feel comfortable breastfeeding your baby in all holiday situations. If you feel timid around certain family members and friends, invest in a breastfeeding cover, like this one from Bebe Au Lait, so you don't have to leave the room everytime your baby is hungry.  It's also a good idea to practice at home in front of a mirror, you'll see how very little of your breast is actually exposed and this may help you to feel more comfortable.
5. If you start feeling under the weather, stick with herbs and over-the-counter medications that don't dry up your mucus membranes, as they may dry up your milk supply as well.  Herbs that support your immune system, that are safe to take while breastfeeding, are echinacea and vitamin C.  If you feel like you are coming down with a cold, you can take homeopathic oscillococcinum and yin chiao to build your immune system and speed up your recovery.  For over the counter medications recommendations, listen to our Boob Group podcast with Dr. Frank Nice, Breastfeeding and Medication.  You can also contact your local lactation consultant and ask her to look up a particular medication to see if it is safe to take while breastfeeding.

Lastly, here are some of our most popular breastfeeding articles to help you through the holiday season:

Advice for the Newly Breastfeeding Mama's Partner

Help A Mama Out; Ways Partners Can Bond with Baby Besides the Bottle

Help A Mama Out: Overcoming Nursing in Public Anxiety

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

Common Concerns While Breastfeeding: Yikes!  Why are my Nipples Burning?

Common Concerns - Do I Have Mastitis?

We wish you a beautiful, peaceful holiday season and look forward to sharing more judgment-free breastfeeding resources with you in the new year!

Warmly,

Robin and Ashley 

Breastfeeding My Type 1 Diabetic Daughter

Almost 2 years ago, a dear friend of mine found out that her 19 month old daughter had type 1 diabetes and was fighting for her life.  Here's Theresa's triumphant story of how she was able to preserve her breastfeeding relationship while healing her daughter.  

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About a month ago a friend alerted me to a Facebook post that brought a wave of memories flooding over me from a day that changed my life forever as a parent.  A day that I will never forget, even though I wish I could.  It was literally the worst day of my life, but one that I will always be grateful for because it was the day my daughter’s life was saved.  

The Facebook post was from a worried mom whose child was hospitalized after being diagnosed with type 1, “juvenile,” diabetes that very day.  The mama was breastfeeding and was terrified not only for her child's life, but that she would lose the best way she knew to feed and comfort her baby.  A little over a year and a half ago I was in her shoes.  At 19 months old, we were told that our daughter had type 1 diabetes, was in diabetic shock, and needed to be rushed to the emergency room.  She came very close to losing her life and was in critical care for a week at a children’s hospital. 

While she was at her sickest (almost admitted to the ICU), she was not allowed to nurse.  For as comforting as breastfeeding can be, not being able to do it during a time of crisis was torture.  My daughter was barely conscious, was in pain and terrified while she was awake, and I could not even hold her because she wanted to nurse.  I hope no other mama has to experience the excruciating helplessness you feel in a situation like that.  Our children's hospital has no lactation consultants and, by the time they could find a pump for me, we had already skipped about 7 or 8 feedings.  I was scared to death and in physical pain myself.

When we were finally given the okay for her to eat, I had to fight tooth and nail to be able to breastfeed her.  The doctors finally consented to her having breast milk, but because she was not a tiny baby, the doctors did not think it was important.  They told me that she absolutely had to drink from a cup or bottle.  (I had a manual pump at home and did not respond well to it at all.  I could not imagine how difficult it would be to have to exclusively pump.)  I begged them to let me nurse her.  It was my milk after all, whether it came from a pump and was poured directly into a cup or came straight from my breast.  No mother should ever have to beg to be able to feed their baby.  It took hearing our daughter scream and sob hysterically for the doctor to finally take pity on us and let me breast feed her.  As I held my tiny girl in my arms, it was the first time I began to feel like there was a possibility that she would be okay. Still, we were encouraged to not let her nurse after that.

Eventually, we were able to meet with the hospital's diabetes dietician who helped me calculate the average amount of milk I produced per feeding.  We looked at the amount of milk I was able to express with a pump then, by using the general amount of carbohydrates contained in breast milk, we were able to determine a rough estimate for carbohydrates per feeding.  Together we came up with a plan to space out her feedings as much as possible to keep her blood glucose stable (after each meal and to go to sleep).  The dietician was a lifesaver and a champion for us!  She spoke with our doctor on our behalf and convinced him that including breastfeeding as part of our daughter's nutrition was in her best interest.  The doctor has since become supportive.

Continuing breastfeeding brought my daughter so much comfort in the months of learning to live with daily multiple injections and painful finger prick blood tests.  It was something normal and peaceful for both of us during a stressful time of adjustment.  It supported her overall health.  It was a perfect source of nutrition for her combined with solids and was amazing for bringing her blood glucose back up to a safe level if she began to drop low at night (we do use a fast acting sugar, like juice, instead if she is below a safe threshold).  I am so thankful that we were able to continue our nursing relationship until she was 32 months old.

Type 1 diabetes (T1D) is a life-threatening, autoimmune disease in which a person’s body attacks their pancreas, causing it to stop producing insulin, a hormone needed to properly process carbohydrates in the food we eat.  People with type 1 diabetes check their blood glucose levels every few hours and must inject insulin several times every day or continuously infuse with insulin through a pump.  There is no known cause of type 1 diabetes and, at this time, no cure.  It will never go into remission and cannot be reversed.  As a mom, you can't help but wonder if you caused it somehow but, it just isn't possible that you did.  It is not connected to poor diet or lack of exercise.  Our daughter never has had a drop of formula, never had sugar other than that naturally occurring in fruit, never drank juice prior to needing it to treat hypoglycemia, and eats primarily homegrown, organic solid food.

Not many people think that a baby or toddler can develop type 1 diabetes, however it is definitely possible.  Not all doctors think of it either and it is commonly misdiagnosed as the flu, with deadly results.  It is very important to know the possible warning signs.  I would recommend all moms be aware of any major changes in nursing.  A sudden onset of increased nursing (past the length of time a growth spurt or teething would account for) along with much more frequent wet diapers can be a signal of diabetes.  Diaper rash (especially without a history of it) and yeast infections can be symptoms of high blood glucose.  Also, consider vitamin D supplements if a blood test returns low for vitamin D levels and investigate further if the test results are extremely low.  The researchers think there may be a link between low vitamin D and diabetes, however they don't know if it is a cause of diabetes or a symptom of it.  Our daughter had increased nursing and wet diapers, weight loss and developed labored breathing. Thankfully our pediatrician picked up on the problem and took action immediately.

Warning signs of type 1 diabetes can include:

 • Extreme thirst

 • Frequent urination

 • Drowsiness, lethargy

 • Sudden vision changes

 • Increased appetite

 • Sudden weight loss

 • Fruity, sweet, or wine-like odor on breath

 • Nausea or vomiting

 • Heavy, labored breathing

 • Stupor, unconsciousness

 • Sugar in urine

Most importantly, if you feel that something is wrong, go with your gut and keep asking until you find answers!  A quick finger prick test to check the blood glucose level can rule out diabetes.  For this test, a small drop of blood from the tip of the finger is sampled.  Results are often immediate.  A simple urine test can also check for abnormalities.  Undiagnosed and untreated T1D can become deadly very quickly.

If you have a little one diagnosed with diabetes, ask to speak to the nutritionist about continuing to incorporate breastfeeding into their nutritional plan.  By pumping once and measuring the amount expressed or by weighing the baby before and after feeding they can help you determine the general amount of milk and therefore carbohydrates they receive at the breast with each feed.  (Because it is an estimated number and not exact, they can often account for the difference in the allotted carbohydrate plan.)

Also, there are amazing support resources available for small children with T1D!  Facebook groups like “Diapers & Diabetes” and organizations like JDRF offer support for families, education, a place for children to feel encouraged and like any other child, and help navigate the uncertain and ever-changing waters that are type 1 diabetes.  Additionally, JDRF funds research and is constantly striving to improve life for type 1 diabetics.  Most importantly, they are fighting for a cure for type 1 diabetes.

*** Please note that these are just our experiences.  I'm not giving medical advice and don't claim to be an expert on diabetes--I'm just a breastfeeding mom doing everything she can to keep her daughter healthy!  Seeing her grow and thrive, and watching her play momma and nurse her baby dolls, I think I might be doing an okay job.

If you want to learn more about type 1 diabetes, www.jdrf.org is a wonderful resource.  For a glimpse into our life with it or to help fund a cure, please visit:

 http://www2.jdrf.org/site/TR/Walk-CA/Chapter-SanDiego4053?px=2922459&pg=personal&fr_id=2382

or watch our story at: https://www.youtube.com/watch?v=2Fc6r8HEnn0

My Village of Breastfeeding Support

 Over the next few weeks we will be sharing stories of triumphant breastfeeding mamas and their biggest supporters who helped them reach their personal breastfeeding goals.  If you would like to share your breastfeeding story and thank your biggest breastfeeding cheerleaders, check out the details in our recent blog article.

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Here is Stephanie's story.

It has truly taken a village to help me be successful in nursing both of my babies!  I knew I wanted to breastfeed, but, after the birth of my first son, my passion and commitment to it were a surprise to even me.  I was also caught extremely off-guard by the difficulties both of my boys encountered as we began our breastfeeding journeys together.  Tongue ties, lip ties, low weight gain, low supply, poor latch, pain/cracking/bleeding, overactive letdown, and more were all hurdles we had to cross.  There is absolutely NO way I could have made it to 13 months formula-free with my first son and still going strong and formula-free at 6 months with my second without these amazing people.

My husband!  My passion and commitment to breastfeed my babies surprised him also, but he never questioned it and stood by me no matter what decisions I made!  He became just as committed and passionate about it, knowing it was the best thing we could do for our boys.  He came to appointments, helped get the baby latched on time after time, stood up for me when others questioned why I didn’t just quit, and let me cry when it all just became too much!  He has truly been my rock through all of this, and I can sense his gratitude for the sacrifices I have made to give our boys this amazing gift!

My Lactation Consultants! Four different lactation consultants have come alongside my babies and me in our journey together.  Every single one of them encouraged me that I could do it when the hurdles seemed insurmountable.  They provided a listening, sympathetic ear when I just needed to vent or cry or talk it out.  They provided help, advice, referrals, and life-changing solutions that kept us going!

My tribe of other breastfeeding Mamas! Friends I have known since childhood, friends I’ve made in recent years, and people I met through the breastfeeding process made it all possible - others who had or were experiencing some of the same challenges, some who didn’t have trouble but believed just as passionately in the benefits of breastfeeding, some who visited, some who called, and one who even created an on-line community to connect us all!  There were many people in my life who didn’t understand why I didn’t give up when they saw the emotional and physical toll it was taking on me, but these other Mamas got it!  They knew why I couldn’t quit, why no challenge was too big!  

My virtual breastfeeding community!  Although I will never meet most of these women in person, the support, advice, commiseration, and encouragement they have provided have truly been critical!  To be able to jump online in the middle of the night when it just seemed like I couldn’t do it and have others on there to tell me that, yes, I could do it got me through many rough moments!  They have calmed nerves, answered questions, given virtual hugs, and just been an amazing support system!

My babies! Even from the very start and even in the face of all of our challenges, my babies have always loved nursing!  They didn’t quit so there was no way I could!

Breastfeeding in the Operating Room

Over the next few weeks we will be sharing stories of triumphant breastfeeding mamas and their biggest supporters who helped them reach their personal breastfeeding goals. 

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This story is from Dawn.

I have to thank my hospital TEAM for my breastfeeding success! 

When I gave birth to my son 5+ years ago, it wasn’t what any first time mom would like to experience. I was having problems with maintaining my blood pressure and when my little boys’ heart rate dropped too low, I was rushed into an emergency c-section. It was an extremely frightening process that didn’t even enter my mind as a possibility. The months that followed were hard. We struggled at finding a proper latch and feeding became such a difficult task, I dreaded it.

It never occurred to me that our difficulties at latching could have been because of the birth experience.

In early 2012 we received good news, we were expecting! I did my best to set everything up for a different birthing experience. I searched out a CDC accredited Baby Friendly Hospital in my area, researched VBAC’s and educated myself on the benefits of skin-to-skin.  It wasn’t until closer to my due date that I was informed I couldn’t have a VBAC.  No hospital would even consider me as a potential VBAC candidate because of my small heart issue as well as my age.  After fighting and pleading, I had to acknowledge that I had no other option, but another C-section.

I may have lost that battle, but I was going to do everything in my power to have skin-to-skin with my little girl. I was aware of the evidence-based research on the benefits of skin-to-skin and its success rate with c-section births. I talked to my pediatrician about this and he agreed.  (I since found out that it is the pediatrician who is in charge in the OR!)  I wrote my birth plan with the intentions of doing skin-to-skin immediately after the c-section unless there was a medical reason not to. 

Alas, I wasn’t able to make it all the way to my scheduled c-section date. This time I was low on amino fluids and baby’s lack of movement put me into the hospital at 36 weeks. With concern, my OB and the pediatrician, agreed, that under supervision, they would monitor me and try to get us to the 37th week and do the c-section. 

Now, prior to this, we made sure to talk with all the right people about our wishes for skin-to-skin.  Everyone was on board: our OB, the hospital’s labor and delivery nurses, and staff.  In fact, the hospital staff has been championing the change in procedures to allow skin-to-skin in the OR without success. 

The day of my C-section, my regular pediatrician was out of town and his standing replacement wasn’t comfortable at all.  I had to conveince the standing pediatrician that this was in my and my baby's best interest.  The hospital's Head Labor & Delivery nurse helped us get to a compromise!  She is my angel!  She proposed that if everything looked good my little girl would be immediately placed on my chest, without ANY other intrusion.... meaning the vernix would be wiped off her while she was on my chest and she would be weighted and measured later. 

When the hour came for us to have the c-section more drama around skin-to-skin unfolded, this time all the way up to the director of the Family Birth Center.  The director of the Family Birth Center was completely opposed to it and tried talking my OB out of it.  We were lucky we had enough support and commitment from the labor and delivery nurses and my OB to move forward. We finally got our wish!

I have to admit, because she was coming 3 weeks early, I wasn’t sure we would even get the option of skin-to-skin, but our little girl emerged perfectly!  She was screaming and quickly confirmed in perfect health! 

When she was placed on my chest and covered with a warming blanket, I was in awe.  This little 6 pound bundle was just perfect.  After a little while, she actually scooted and rooted for my breasts and eventually latched and nursed!   I just didn’t think I would get that experience since she was early.  The remembrance still makes me cry.  It was such an amazing experience.  I was so happy I had the team in my corner and the hospital went forward with my wishes.  

When I was first told I would have to have another cesarean, I felt completely out of control and very disappointed.   Creating a birth plan around my c-section allowed me to take a bit of control back and talking with all parties that come with a c-section allowed me the skin-to-skin connection that was deeply important to me.  

It has been over a year since Beth was born.  We are still nursing strong and have a connection that I attribute to the wonderful team that helped me get skin-to-skin in the OR! 

Side note:  I have since heard that they have allowed other moms the same experience!  The hospital team not only helped me, but also have persevered in getting policy “changed” at the hospital!  

Dawn Alva

Rumina Nursingwear

Comebacks for ‘Why Are You Still Breastfeeding?’

Any woman who has ever had a breastfeeding challenge or has breastfed longer than than someone else deems ‘normal’ has been asked this question at one time or another.

“Why are you still breastfeeding?”  

Sometimes this question is passive aggressive with undertones of “I can’t believe you have breastfed your baby for THIS long.”  Other times it comes from a place of love meaning “You seem like you are in pain... are you sure you still want to try this?”

Regardless, if you are anything like me, the snappy comeback or educated response that I SO desired to say only comes after the situation is long gone and I am kicking myself for not defending myself and my choice to breastfeed the way I wanted to.

Well, ladies... look no further!

Here are some handy, snappy (evidence-based) comebacks that you can tuck away in your back pocket, only to whip out at the most appropriate times, pun intended! (P.S. These comebacks also work if someone asks why you are STILL exclusively pumping!)

Top 10 Comebacks to Answer the Question: Why Are You Still Breastfeeding?

 

1. “It’s the perfect food for my child. 24 hours a day, 7 days a week!”

• Babies can digest human milk more easily than the milk of other animals, probably because human milk contains an enzyme that aids in this process. 
• Breast milk forms softer curds in the infant's stomach than cow's milk (the basis for most formulas) and is more quickly assimilated into the body system. 
• While it contains less protein than does cow's milk, virtually all the protein in breast milk is available to the baby. By contrast, about half the protein in cow's milk passes through the baby's body as a waste product. 
• Similarly, iron and zinc are absorbed better by breastfed babies.

2. “Breastmilk doesn’t lose it’s nutritional value.  Can you say that about the food YOU eat?”

• Even at a year, breastmilk continues to pack a powerful punch for nutritional value.
• In the second year (12-23 months), 448 mL of breastmilk provides:29% of energy requirements

• • 43% of protein requirements
  • 36% of calcium requirements
  • 75% of vitamin A requirements
  • 76% of folate requirements
  • 94% of vitamin B12 requirements
  • 60% of vitamin C requirements

Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1), from Kellymom.com Breastfeeding Past Infancy Fact Sheet

3. “Breastmilk protects against disease for my baby.  Don’t you want my (our) baby to be healthy?”

• Because the mother makes antibodies only to pathogens in her environment, the baby receives the protection it most needs-against the infectious agents it is most likely to encounter in the first weeks of life. 
• Here are a few ways that breastmilk helps make a healthy baby:
  • Breastfed babies also have less diarrhea and fewer gastrointestinal infections than babies who are artificially fed.
  • Six months or more of exclusive breastfeeding reduces risk of food allergies. 
  • Breastmilk decreases a child’s risk of Crohn's disease and ulcerative colitis in adulthood.
  • Breastfed babies have lower risk for developing recurrent wheezing when they are older (age 6 or more) – asthma
  • They have less reflux
  • They have less eczema 
  • Breastfeeding protects baby against respiratory infections
  • Women who were formula-fed as infants have higher rates of breast cancer as adults. For both premenopausal and postmenopausal breast cancer, women who were breastfed as children, even if only for a short time, had a 25% lower risk of developing breast cancer than women who were exclusively formula-fed as infants.

4. “There are incredible health benefits for my breastfed baby.  Do you really think it’s wise to limit my baby’s intellectual and physical potential?”

• Breastfed children have higher IQ
• Breastfeeding reduces a baby’s risk of SIDS by 50%
• Breastfeeding protects baby against vision defects.  Breast milk is generally the main, if not the only source, of vitamin A during a child's first 24 months of life (or for the duration of breastfeeding).
• Suckling at the breast is good for a baby's tooth and jaw development, as the constant pulling at the jaw muscles promotes a well-formed jaw and healthy teeth.

5. “Breastfeeding improves my overall health.  Who’s going to cook all of the meals and take care of the home if I’m not healthy? (I know...super snarky!)”

• Breastfeeding decreases mom’s risk of postpartum hemorrhaging as it stimulates contractions to shrink he uterus back to pre-pregnancy size.
• Breastfeeding reduces mom’s risk of osteoporosis
• Breastfeeding reduces mom’s risk of anemia, as breastfeeding postpones the return of menstruation for many women. 
• Breastfeeding reduces mom’s risk of breast cancer. Women who breastfeed reduce their risk of developing breast cancer by as much as 25 percent. The reduction in cancer risk comes in proportion to the cumulative lifetime duration of breastfeeding. That is, the more months or years a mother breastfeeds, the lower her risk of breast cancer.
• Breastfeeding reduces the risk of uterine and ovarian cancer.

6. “Breastfeeding promotes mother/infant bonding and emotional well-being.”  

• Babies feed for about 45 minutes per time in the first few months.  This is nature’s way of making moms sit down and relax and promote her postpartum healing.
• Breast milk actually contains chemicals that suppress pain (endorphins). This is the perfect remedy for a child who accidentally hurts himself and is in need of some pain relief and comfort.  It's like having a boo-boo-healing superpower!
• Babies can also feel the warmth of mom's skin, take in her scent and hear her heart beating. This helps to neurologically center thebaby after birth and help him/her adjust to the outside world.  
• Breastfeeding also decreases a mother’s risk for postpartum depression.

7. “Breastfeeding can promote a positive relationship between mom and a supportive partner.”

• Partner support is crucial during breastfeeding, especially when there are challenges along the way.
• In the beginning, when baby is pretty much just eating and sleeping, mom and her partner can spend this time together, hanging out while the baby is feeding, getting to know one another as parents, not just partners.
• This is a great time to reconnect with your partner as the both of you get to know your baby, as this is a new time for your family.
• You are also a team during this time.  Partners can make sure that all visitors offer positive breastfeeding comments, especially when breastfeeding is a challenge.  No sabotaging comments allowed!

8. “Breastfeeding is definitely more convenient and less expensive than formula.  I thought we were on a tight budget!”

• Breast milk, in any supply, is free. Ready-made formulas can cost families $800 to $1800 per child, annually.
• Nipples, bottles, bottle brushes and bottle bag inserts are additional costs, as well.
• Breastfed babies are ill less often, meaning that their parents miss fewer days at work and spend less on prescriptions, doctor's visits, and hospital stays.

9. “Breastfeeding, just like parenting, has bumps along the road and I won’t quit on my worst day.”

• As all thing that have to do with parenting, what works some days, doesn’t work on others and most things don’t go smoothly as planned.  
• Your baby is born with a personality and a style that requires becoming familiar with and understanding.  
• What works for some babies and children may not work for yours, so seek support anywhere you can find it: friends, family, lactation consultants, websites, Facebook groups, physicians, etc.  
• Don’t quit on your worst day.  Let 24 hours pass to gain some perspective and reach out  for help during that time.  
• Have an IBCLC evaluate your situation and provide a plan for overcoming your challenge.

10. “I promise you that my child won’t breastfeed until his high school graduation, but if he did, he’d probably be the smartest, healthiest graduate there!”

• Ok, maybe that’s a little too sassy, but you get the point.  It is your choice to breastfeed for as long as mutually beneficial for you and your child.  Every drop of breastmilk your child gets is liquid gold and you are a superstar for producing that for him/her!  So stay strong, mama, and know that your ‘breast friends’ have your back!  Happy nursing!

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.