Tips for Mothers Who Exclusively Pump

Article written by guest blogger, Misti Ryan

Whether exclusive pumping is a decision or a necessity due to surrounding circumstances, there are several things you can do to make your efforts more successful.

Start early 

We know that the earlier after birth you begin expressing, milk production is set up for long-term success.  Hand expression of colostrum is often more effective than pumping in the early days and can increase your milk supply even when you begin using a pump.  You may not reach full production until around 10 days, so be patient as amounts in the early days may be very small. Here’s a fantastic video from Jane Morton at Stanford University, demonstrating Hand Expression

Pump often 

In the beginning, plan to pump about 8 times in 24 hours, for anywhere from 15-20 minutes per session.  Once you have reached full production, you can generally decrease your number of pumping sessions to 6 or 7 times a day.  You may also find you can express for 10-15 minutes and be done.

Plan to rent a multi-user hospital grade pump and later purchase a single user double-electric pump to establish and maintain your milk supply

Initially, a hospital grade pump is key to reaching full milk production.  Let’s put it this way…. The hospital-grade pump is like the Ferrari and the double-electric you can purchase is similar to a Toyota.  The motor is far superior in the hospital-grade pump, but it is too expensive to purchase, therefore we recommend renting one.  The double-electric is much more affordable, yet is best for maintaining a supply, rather than bringing one in.

Ensure a good flange fit and consider having more than one flange size available. 

A poor flange fit can cause breast and/or nipple damage and pain.  It can also decrease the amount of milk you are able to pump.  Check out this article about finding the correct pump flange size.

Pump hands-free

Purchase a hands-free bra or make one out of an old sports bra but cutting small slits where the flanges would fit.  Your hands will now be free to massage that ‘hard-to-get-out’ milk that pools in the periphery of the breast.

Use hands-on pumping

You can maximize your pump output by using breast massage as you pump hands free.

Learn some relaxation techniques to promote milk let-down

Take some deep breaths after you turn on your pump.  Put on some relaxing music.  Think about how amazing your body is as it provides warmth and nourishment to your baby.  If you need a mental break, dive into one of your favorite magazines.  This will help the time fly by!

Focus on your baby 

Whether you have your baby near or you have to be away, you can focus on your baby by thinking about him and listening to a recording of him cooing or making sweet baby noises.  Have an item nearby that smells like your baby and place a picture in your pump bag (or on your phone).

Prepare to store your milk 

There are a variety of bags and containers to safely store your milk in.  Bags made specifically for milk storage take up the least amount of room and will lay flat in your freezer.  Click here for current milk storage guidelines

Set up a pump station at home and/or at work

Have everything you need for pumping within arms’ reach.  Also have some water available to sip on, the TV remote or a book if that is how you choose to relax, a snack, and perhaps your headphones.

And finally, keep up the great work! 

Remember, whether you baby is going to the breast or not, every drop counts!  You are providing a life-long gift to your baby.  And every minute you spend providing breastmilk to your baby is worth it.

Misti Ryan, BSN, RN, CCE, IBCLC, RLC

Misti has been working with moms and babies for over 12 years as an L & D nurse, childbirth educator and LLL leader.  She is married and a mom of 5 breastfed children.  Misti certified as an IBCLC in 2011 and is co-owner of Bay Area Breastfeeding and Education, a private practice lactation consulting business in Houston, Texas and surrounding suburbs.  She can also be found on Facebook at: www.facebook.com/bayareabreastfeeding and blogging at: www.bayareabreastfeeding.wordpress.com

When It's Time to Find a New Lactation Consultant

Recently, I have noticed many conversations online where breastfeeding mothers have expressed feelings of despair and frustration that their needs were not met while working with a lactation consultant. In fact, this isn't just happening online, but also in my community as well. 

Last week, my appointment with a new mom started off with her explaining that she was feeling very fragile and insecure, as she had already met with a lactation consultant and it didn't go so well.  When I asked her what happened, she described a lactation consultation that had gone completely wrong.  In a nutshell, the IBCLC told the mom that if she followed her pediatrician's advice (which I actually thought was quite reasonable advice) that she would completely lose her already low milk supply (which was absolutely not the case) and that she should just consider bottle feeding her baby if her nipples hurt that badly.  At the end of the consultation, the mom felt completely defeated and that she was a horrible mom for wanting to follow her pediatrician's advice. 

This story absolutely infuriated me! 

How could this have happened?  How could this wonderful mom, who had been proactive about resolving some minimal breastfeeding challenges, suddenly feel inadequate and ill-equipped to take care of her new baby?  How could this lactation consultant have had such a negative impact on this woman's elf-esteem, especially during such a vulnerable time?

In the midst of all of these negative stories, I felt compelled to write an article listing some situations that indicate it is time to see a new lactation consultant.  I'd like to apologize upfront.  Some may find that the tone of this article is somewhat harsh, but I have to say that I am pretty fired up right now.  I am angry about how breastfeeding mothers are mistreated.

When it is time to find a new lactation consultant? 

The lactation consultant makes you feel like a bad mother

While the purpose for a lactation appointment with me is to improve breastfeeding challenges, my utmost goal is that I help the breastfeeding mom see what she is already doing well and to offer positive emotional support and guidance.  Being a new mother can be incredibly overwhelming and I remember second guessing everything I was doing, as this was completely unfamiliar territory.  No matter what the situation, there is always something that you are doing well and that is what the appointment should build upon.  If you are made to feel like you are doing everything wrong, then it's time to seek the help of a new practitioner. 

The lactation consultant doesn't provide you with  reasonable rationale for her recommendations

You are allowed to question any advice given to you by any practitioner... that is your right as a parent.  If something doesn't seem correct, ask the LC for her rationale.  If she can't provide you with a reason for her suggestions, or she seems upset or bothered that you would question her recommendations, the it's time to find a new LC.

The lactation consultant seems more concerned that you breastfeed than meeting your individual needs

Yes, breastfeeding can be great!  Yes, breastmilk is far superior to formula!  Yes, you clearly want breastfeeding to 'work'.... why else would you have called an LC for help in the first place???  Yet, while breastfeeding is optimal for your health and your baby's health, the first questions that an LC should ask is, "What do you want to work on today and what are your breastfeeding goals?"  The consultation should be all about YOU and YOUR needs, not what the LC thinks is most important.

You don't feel like there is a positive connection between the two of you

When you work with a lactation consultant, you should feel like this person truly cares about you and your child. Your needs and your baby's needs should come first.  Our mission is to help you meet those needs in the simplest way possible.  Sometimes the path to meet your goals is not easy...sometimes it is downright complicated (think twins with tongue-ties!),  but you should feel like the lactation consultant cares about you and your baby, both physically and emotionally.  She should support your wishes and help you to meet your goal.  And if your goal changes, she should stand behind you for those as well.

You just want a second opinion

Think about it, if you were dealing with a medical issue and you didn't totally like the doctor's recommendation, wouldn't you seek a second opinion?  When our son was having behavioral and developmental challenges, we not only spoke with our pediatrician, but also an osteopath, a chiropractor, and a nutritionist.  It was the osteopath that finally figured out that my son had a gluten intolerance, not a developmental delay, and we were so thankful that we had an opportunity to seek out additional opinions.  There have been times when I have recommended my clients to seek a second opinion from a physician, chiropractor, and even another local lactation consultant, if I felt that it would help her baby.  There's no shame is saying that you would like a second opinion.

As with all things related to breastfeeding and parenting, you should always feel supported, not judged, by your health care providers.  Breastfeeding CAN be wonderful and relaxing and joyous and fulfilling, especially if you surround yourself with supportive, caring, and nurturing family, friends, and practitioners!   There are many qualified International Board Certified Lactation Consultants (IBCLCs), around the world, who would love to provide you with the type of support you desire.  You deserve to be with the one who's the best fit for you!

*** As a side note, these scenarios could also indicate a reason to find ANY new health practitioner, as they are relatable to many different professions as well.

My Attempt to Trust My Milk Supply

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Krystyn Brintle'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, Krystyn, for sharing your story with us!  Your story is truly inspirational!

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A Brief History of My Breastfeeding Journey (So Far) in Numbers:

32 - Number of weeks along in pregnancy when a midwife suggested I meet with an IBCLC to discuss potential breastfeeding complications

75 - Percentage of tissue found in my breasts after examination by IBCLC, compared to average woman

50/50 - Odds given that I would need to supplement

27 - Number of herb capsules (goat's rue, alfalfa and malunggay) I began taking daily after my initial consultation with the IBCLC

7 - Number of days my daughter spent in the NICU following my unplanned c-section, further jeopardizing our planned breastfeeding relationship

3 - Number of weeks it took for my daughter to gain back to her birth weight, necessitating an extra weight check with her doctor and hours of agonizing over whether my breasts were failing us both

12 1/4 - Pounds my daughter weighs as of this afternoon (13 weeks), which averages to her gaining about half an ounce a day – perfectly reasonable for a breastfed baby

17,453,519 - Number of times I've doubted my supply, or number of hours spent searching the Internet for info re: IGT, hypoplastic breasts or signs your baby is getting enough milk

0 - Number of times I will ever judge a mom who gives her baby formula, because I know now that there are extenuating circumstances beyond our control that can make the dream of EBF impossible

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With my borderline PCOS diagnosis and lifelong struggle with weight, my biggest concern in pregnancy was eating healthy and exercising enough to prevent gestational diabetes. Breastfeeding complications
were simply not on my radar - my older sister is still nursing my three-and-a-half-year-old nephew - until my 32-week appointment. I mentioned that I thought I was leaking a little colostrum; the midwife did a brief examination and suggested that, considering the PCOS issue, I meet with an IBCLC to discuss any potential hurdles. I made the appointment, not entirely clear about what these hurdles might be. Sure, my breasts hadn't changed during pregnancy - but I convinced myself that was because milk comes in after birth. After a physical examination, Ellen (the IBCLC) explained that there was a term for what I had always considered my unsightly breasts - I had breast hypoplasia. She went on to estimate I had about 75% of the expected breast tissue and that the "plumbing" involved in making my milk did not extend fully through my breasts and into my chest. She gave me 50/50 odds that I'd need to supplement. We went through a list of various foods and supplements to help increase supply; she explained no research had shown that prenatal use of galactagogues affects milk, but that it couldn't hurt to try. At least it felt like I was trying to help my girl, buying all the expensive herbs and choking them down three times a day.

After an unplanned c-section, my daughter was taken to the NICU for meconium aspiration. She was placed under an oxygen hood and was unable to nurse for the first 24 hours. I had read about the difficulties a c-section could pose in terms of breastfeeding; adding to that the intense stress of her condition, in addition to my IGT, I feared breastfeeding was not in the cards for us.

We worked hard to establish our nursing relationship while she was in the NICU, requesting help from the IBCLCs on staff for nearly every feeding. We supplemented with donor milk while waiting for my milk to come in, were introduced to the stressful world of pre- and post-feeding weighs - but by time she was discharged, she was relying solely on me and my breasts for her nourishment.

I scheduled LC appointments weekly. We did pre- and post-feeding weighs and determined she was getting two ounces when she nursed on both sides. When she hadn't gained her birth weight back by two weeks, I began to fear the worst: the odds weren't in my favor, and I'd have to figure out the SNS I'd requested in the hospital "just in case." My daughter's pediatrician requested we return the following week for a weight check, and she also requested I nurse the baby every two hours (instead of letting her sleep for longer stretches like I had been).

The stress of the situation really took its toll. I couldn't keep food down, I wouldn't allow myself to go to sleep for fear of missing a feeding. My midwife diagnosed PPD and told me I needed to allow myself to be okay with my husband handling a feeding so that I could get four continuous hours of sleep each day. When pumping wasn't netting enough, and when I felt my sanity slipping away due to the stress, I caved and bought a can of formula. Over the course of a weekend, my daughter had four formula bottles. And I felt like a failure.

But I also really slept for the first time since she was born. I relaxed a little, knowing she was eating even if my body wasn't producing her food. I started accepting the idea that breastfeeding didn’t have to be an all-or-nothing proposition.

When we went back to her doctor for the weight check, she had gained back to her birth weight plus an extra ounce. Knowing that all but four feedings of that weight gain came from me was the proudest moment in my young motherhood. We had our third - and final - LC appointment the following day, where the scale showed she took 78 mL of milk (and promptly refluxed 18 mL back). Ellen told me I could start weaning off the herbs and that, somehow, I was the exception to the IGT rule.

My lovely Liv has not had another formula bottle. Despite her extreme refluxing, she's gaining appropriately and is in the 50th percentile for weight - right where she should be. After everything I've been through, I've found that I am a lot less judgmental when I see mothers feeding their babies formula.  There are plenty of reasons why a mom might have to supplement, or maybe the stress of trying to breastfeed was too much - now that I've been there myself, I've come to understand that moms are just trying to do the best they can.

I'm only 13 weeks in, and my IGT story has a happier ending than most, but I can honestly say I'm incredibly proud of how I've handled what was an obstacle-laden path to breastfeeding and am so proud of the other mamas out there who are doing the same!

Krystyn Brintle

A Farewell to Na-Na: When It's Time to Wean

Written by guest blogger, Jessica Lang Kosa

My youngest is weaning. Most people assume she has long since stopped nursing, since she goes to preschool, eats everything, and has sleepovers with the grandparents.   She still usually nurses at bedtime, but sometimes forgets to ask.  Occasionally she'll drift off, and then bolt up, announcing "bedtime nana!"  She seems to be on roughly the same timetable as her older brother and sister, so I suspect she'll forget more and more often, and be weaned altogether in a few months.

Mostly, I'll be glad. My milk supply is now very low, so nursing can feel annoying sometimes. And in our household, weaning is a right of passage marked by a family celebration…. with balloons and favorite foods.  It's kind of her first graduation party.

Like all my kids' milestones, it will also be bittersweet.  I will miss the potent mothering tool that toddler nursing has been, and I will miss this part of her life.

I'll miss the magic ability to calm an overtired kiddo and stop a tantrum; from meltdown to melting-in-my-lap with the flip of a breast.

I’ll miss the intense physicality of the nursing connection, and the way it relaxes both of us.  Coming home from work used to trigger a demand of “nana on couch!” I’d sit right down on the sofa to nurse her, reconnecting first thing, rather than getting swept into the flurry of household activity.

I’ll miss nana-as-medicine.  'Tis the season for colds and bugs.  Preschool germs have been so much more manageable since I could nurse her through them when she didn't feel like eating or drinking.

I won't particularly miss some of the boundary negotiations, but I'm glad we had them. Learning as a toddler that it’s not OK to strip-search mommy is a great introduction to personal space.  It's been a opportunity to teach that critical concept: other people, even mommy, have feelings.  Someday, when she's a young woman in a relationship, I hope her subconscious will remember my gentle limit-setting and guide her towards taking care of herself while loving someone else.

Since she's my third, I know how fast they grow up.  At preschool, she has friends her own age and a cubby and art projects with her name on them.  She helps make her own lunch, and proudly packs it in her backpack. As she discovers the outside world, with all its glory and its hazards, I will cheer her on, but miss the simplicity of her time as a baby.  She’s a long way from the tiny infant I used to tote around with me, but nursing allowed me to see and feed the baby inside her.  Watching her outgrow nursing in her own time has been a privilege.  Weaning has been a microcosm of holding on while letting go.

Jessica Lang Kosa is an IBCLC, providing in-home lactation consulting for families in Greater Boston, and breastfeeding education for professionals around New England.  

Connect with her at:

http://motherfeeding.com

http://www.facebook.com/motherfeeding

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.

Breastfeeding and Going Back to Work: Roundup

With so many of my friends and breastfeeding support group mamas going back to work by the end of the year, I thought I would do a round-up of my favorite Going Back to Workarticles (written by me, as well as some of my colleagues.)

Here's what you'll find on the San Diego Breastfeeding Center website:

Hi ho, Hi ho, It's Off to Work We Go: Part 1 - Starting the pumping and bottle feeding routine.

Hi ho, Hi ho, It's Off to Work We Go: Part 2 - Making plans with your employer and your rights as a breastfeeding/pumping/working mom.

How Long Does my Breast Milk Stay Fresh? - Take the guesswork out of how long your pumped milk stays fresh.  Here are all of the answers you'll need.

Help!  I am Going Back to Work and My Baby Won't Take a Bottle! - Top 10 tricks to get your little one to take a bottle before you return to work.

So, You’re Going Back to Work - one of my favorite memoirs from a local breastfeeding, working mom!

Now that you've perused all of our articles (and I can guarantee there are more waiting to be written over the upcoming months), here are a few of my favorite resources beyond our web site:

United States Breastfeeding Committee - FAQ's: Break Time for Nursing Mothers

Kellymom - Links: Working and Pumping Tips

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! 

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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!

Reminiscing About My Son's Birth

As I rested with my son, Ryan, tonight, I told him the story of the day he was born, exactly 6 years ago.  How he entered this world so peacefully and beautifully and how grateful I am that he is my son.  My eyes filled up with tears as I hugged his sweet little body, my heart feeling like it would explode right out of my chest.  There are no words to fully describe the way I love this little guy and his birth was just the beginning.

6 years and 9 months ago, I found out that I was pregnant with my soon-to-be Ryan.  Ben was 7 months old and I had just returned to work full time.  Let’s just say that SHOCKED cannot even begin to describe how I felt when that little stick had two lines.  We knew we wanted to have at least 2 children, but never thought it would happen this soon!  Feelings of guilt filled my heart as I thought about how I had robbed Ben of months where he would be an only child.  Panic set in when I counted how many months apart my kids would be (15!!!)  How would I tell my boss?  How would I tell my parents?  Most importantly, how would it be possible for me to love another human being as much as I loved my 7-month-old Ben?  I just wasn’t ready!

As the months flew by, I slowly became connected to my growing baby.  I felt his movements much more quickly than I had with Ben and I loved how my stomach would contort and expand during the staff meetings at work.  I wasn’t quite as sick while pregnant this second time around, which was a blessing since I had Ben to contend with as well.  I still wondered how it would be humanly possible for me to connect with this new baby as I had with Ben.

About 3 days before Ryan was born, I woke up around 6am with this very weird feeling, like something was wrong.  I pushed on my belly to stir the little one, but didn’t feel any movement.  For 30 minutes I rolled from side to side in my bed, walked around from room to room (praying I didn’t wake up 15-month-old Ben), and drank a glass of water.  I still didn’t feel any movement.  I decided to wake up my husband, Jason, and instantaneously broke out in hysterical tears. I hadn’t felt Ryan move in over 45 minutes and I wanted to go to the hospital immediately!  I cried the whole way there, trying to talk myself out of thinking the worse, but I just couldn’t.  We ran into the hospital and begged them to hook me up to see if anything was wrong.  Within minutes, we were in triage, strapped to a monitor and saw to our relief that our baby boy was just sleeping soundly.  I drank some orange juice and he started to stir.  It was one of the scariest moments in my life and as we drove home, I hugged my belly and told him I would be waiting patiently for him, whenever he was ready to arrive.

Three days later, after a gorgeous evening walk, pizza dinner, and a little vino, I was awoken from my semi-deep sleep to some mild abdominal cramping.  I checked my clock and started to feel some excitement as the cramping continued to surge every 10 minutes.  After an hour, I woke up my husband to tell him that I was having contractions and that they were starting to get pretty regular.  Now, this was the first time I had felt contractions like this, as I was induced with Ben and never felt the growing, consistent surging I was feeling now.  As I rolled out of bed, the contractions started to become even stronger and jumped to about every 6 minutes.  We immediately called my step-mom, as she was going to watch Ben, and left for the hospital as soon as she arrived.

The drive to the hospital was pretty horrible, as I was bent over with my head between my legs, trying to breathe… I am not one who can handle pain very well!  The check-in at the hospital was a blur, as all I wanted to do was get into my room and the walk down that hospital corridor seemed like a 10K, as I paused every few steps to grab my pulsating belly.  By now it was 3am.  My mom and mother-in-law joined us in the labor/delivery room.  My mom began to massage my legs as I breathed through the contractions.  Had I known what I know now, I would have gotten out of that bed and walked around as much as I could to just keep things going.  Instead, I sat in bed, breathing through every contraction, gripping my mom and husband’s hands until each one dissipated.  Then, the shaking set in….I was so frustrated because mentally I felt like I could power through this a bit more, yet I felt like my body was showing me that it couldn’t handle this anymore.  I waited until about 4:30 before calling for the anesthesiologist.

After the epidural was administered, we all relaxed a little, just watching the contractions ebb and flow on the computer screen.  By 7am, I was fully dilated and the doctor was paged.  I had no idea what to expect from here.  With Ben, I was in labor for over 18 hours and pushed for 2.5 hours.  I wondered if I was in for a marathon again.  The doctor arrived and asked if I wanted a mirror to watch the birth.  While I was petrified to do this during Ben’s birth, I felt much more confident this time around and agreed to roll in the mirror.  Well, 2 pushes in, Ryan’s little head slipped out and the third push delivered his beautiful body.  And I was able to watch the whole thing!

My doctor brought Ryan to me and laid him on my chest as his umbilical cord finished pulsating.  My stomach immediately grew warm as he peed all over me and we laughed that at least his ‘parts’ were in working order!  Within 20 minutes, my sweet one had latched on beautifully and we laid there for over an hour just gazing into one another’s eyes, memorizing each other’s face and scent. 

And as I held my brand new son, this overwhelming sense of love enveloped me.  It was as if I knew how much joy this incredible being was going to bring to our lives.  That fear that I had felt for the past 9 months… the one where I would be incapable of loving another child as much as I loved Ben… it just disappeared within minutes.  That guilt that I initially felt about depriving Ben of more time with just me and Jason flew out the window as I began to envision the two of them as brothers, sharing things only brothers get to share.

Six years later, I remember Ryan’s birth like it was yesterday.  I still love to hold him and memorize his face and scent, as I know his face will continue to change and get older.  My heart still melts when I watch Ryan and Ben act like loving brothers, for I know that a sibling is the greatest gift a parent can ever bestow on a child.  And, while I may not have consciously chosen to have my kids 15 months apart, I know deep down in my soul that we were meant to have our Ryan.

Happy birthday, beautiful boy!  We all love you so very much!

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

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

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

Weathering a Storm with a Freezer Stash of Breastmilk

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

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

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

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

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

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

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

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

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

Take a look at this:

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

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

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

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

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

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

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

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

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

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

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

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

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