Breastfeeding and Exercise – What you need to know

Today I am sharing a post from a fellow momprenuer. Autumn Bonner is the co-owner and co-founder of My Tailored Fitness, an online video-based fitness program for moms.  Through her program, moms can build their own custom workouts based on how much time they have and the intensity they want.  It’s like having your own custom workout video!  The exercises are created specifically for moms and use limited equipment so you can squeeze in a workout at home during nap time. Autumn is passionate about helping moms be healthy so that they can be examples for their kids. She talks with each member monthly to give suggestions and provide support to reach their goals. You can try her program free for 30 days. Just visit www.MyTailoredFitness.com or like her Facebook page www.facebook.com/mytailoredfitness for helpful fitness tips and great healthy recipes.

Recently, I’ve received a bunch of questions from moms about exercising while breastfeeding, so I thought it would be a good topic for a blog post so we can cover everything you need to know!

After I had Sienna, I was really anxious to get back into my regular exercise routine so I could regain some sort of normalcy in my life.  I did wonder, however, what exercise would be like while nursing.  Would it be painful to run?  Would exercising affect how much milk I made? Do they make breastfeeding-friendly exercise tops? 

I decided to do a little research to find out.  Let’s cover the science stuff first and then we will take a look at the practical side. 

My resource for all things exercise and pregnancy related has been Dr. James Clapp’s Exercising Through Your Pregnancy. He has a chapter on breastfeeding and exercise that has a lot of great information.  Here are the highlights.

• Regular exercise, even at high intensity, does NOT alter wither the quality or quantity of breast milk produced, unless the mom isn’t consuming enough calories.

• Women who exercise and breastfeed should be sure to eat at least 1500 calories per day so that their breast milk production is not reduced.

When you exercise, you burn calories, and breastfeeding also burns calories (about 500 per day), so breastfeeding moms need to make sure they are consuming enough calories to cover the extra they are burning off during exercise and breastfeeding.  If the number of calories consumed drops below 1500, milk production can be affected. You will also need to increase your water intake, especially if you workout outdoors in warm weather.  The Boob Group has a great episode on this topic: Lose Weight While Maintaining Your Milk Supply.  The San Diego Breastfeeding Center blog also has an accompanying article: How to Lose Weight while Breastfeeding without Losing your Milk Supply

Ok, now on to some practical tips that will help make exercising while breastfeeding more comfortable

Buy a supportive sports bra

Prior to being pregnant, I never really had to worry about supportive sports bras because, well, I wasn’t too well endowed on top.  But that changed when I became pregnant and even more since Sienna arrived.  Luckily, the girls in my Stroller Strides class told me about Juno by Moving Comfort.  It’s a great, supportive bra that even has adjustable straps.  They also have a non-racerback version called Fiona.  Lululemon also sells a bra called the Tata Tamer.  Love the name!  It doesn’t have the adjustable straps, but works well too.  I wrote a blog post about supportive sports bras that you can read on my website: Support for your Girls - The best sports bra

 

Feed your baby right before you exercise

This will help a lot with comfort during your workout, especially for high impact activities like running or kickboxing.  Side note, did you know that there are laws that protect the right for women to breastfeed in public?  My lactation consultant, Robin, was actually just involved in resolving an incident here in San Diego where a woman was told she could not breastfeed her baby while she was waiting in traffic court.  Check out Robin’s article /blog/2013/2/7/a-resolution-to-the-chula-vista-courthouse-nursing-in-public.html here to read about it.  You can find your own state’s breastfeeding in public laws at www.breastfeedinglaw.com.  It’s always good to know your rights, just in case your little one decides she/he wants to breastfeed during your workout.

 

Try low impact exercise if you still have breast pain

If you still have any breast pain, try switching to lower impact exercise until your milk supply regulates and you are able to move around more comfortably.  You can still get a great workout without any jumping.  In all the Tailored Fitness videos, I give low impact options.  I also just filmed a series of Exercise with your Baby videos, which are all low impact and designed specifically for the newly postpartum mom.

Hope these tips help you to be able to breastfeed and exercise comfortably! 

Help a Mama Out: Tips for Breastfeeding the Distracted Baby

Over the past few months I have been posting readers' questions on our Facebook page and have been blown away by the fantastic advice and support you have shared.  The downfall with Facebook, though, is that eventually the terrific advice will work its way down the wall and succumb into Facebook oblivion, never to be found again.  

Well, that's just a travesty!

So, here is what we're going to do....

Each week I will post a topic and question (or maybe a few!) on the San Diego Breastfeeding Center and The Boob Group Facebook pages.  At the end of the week, I will collect all of YOUR fabulous breastfeeding mama advice and tips and place them into a blog post, which I will share the following Tuesday!  Now your breastfeeding expertise and support will be documented and saved for moms to cherish and learn from, even years from now!

So, let's get started.....

'Help a Mama Out' Topic of the Week:

 Tips for Breastfeeding the Distracted Baby

What's Your Best Advice for Nursing a Distracted 8-10 month old Baby?

Gina: Strap toys to bra, like the kind with a loop for a play gym or use a nursing necklace.

Kat: Different things worked for my daughter at that age. Sometimes I would nurse with a cover so she wouldn't get distracted by the environment. A nursing necklace sometimes helped. Sometimes I would sing a song so she would only look at my face.

Yolanda: I sing, hmmm never thought to clip toys to me lol. 

Melissa: Nursing/teething necklace. TONS of patience :-)

Christine: My daughter (who's now 10 months, not a lot has changed since then) loved to hit, pinch, and slap me so I would simply take her hand and hold it and talk to her. Talking to her seems to help her focus because she has one thing to focus on, my voice. I also will position her upright straddling my knee to nurse so she can somewhat look around while she's nursing and then she feels like she's not missing out on all of the way cooler things than eating lunch. Or simply latching her and standing up to walk around with her so she can nurse and still look around at all of the would-be distractions. I find it's better for her to nurse in busy areas where she has lots of things to look at in those ways than nursing in a quiet, dimly lit room because then she'll just do the "fake sucks" and try really hard to listen to noises outside.

Michelle: Dark room and soothing music

Kara: A quiet, out of the way - darker room! From about 7-10 months my first nursling required no distractions whatsoever!

Jennie: Go in a dark room:)

Ria: Read them a book and hold it up so they can see the pictures. Or keep a pile of toys just for that time, toys with different textures and and colors. Works for us.

Katie: In a room away from others/TV...use a nursing necklace. 

Kathy: I always started playing with my son's hands. I would rub them, fold them into a fist, etc. Now he plays with my hair the whole time! :-)

Jessica: I tap on my daughter's leg or arm gently and that helps keep her focused.

Tammy: Tapping the bottom of her feet. All of mine went through periods (just days) where they were not as interested.

Jeni: I found hanging a toy off a necklace helped focus him back towards me and then he played while he ate.

Jona: Patience; reducing distraction by nursing in a quiet, dark room; breastfeeding when baby is sleepy.

Amy:  Babywearing! I'm relearning it 1st hand with my super distractible 9 month old. 
I put him up in a front carry and it helps immensely. Otherwise even in a calm environment he's too busy checking it all out. Wearing him is my saving grace every day and some days the only reason he gets a good milky feed in the daylight hours. I'll stand by it now and forevermore as the 2nd best parenting tool!

Creating a Sense of Community When Using Donor Milk

In an effort to demystify milk sharing, for the next few weeks we will be sharing stories from breastfeeding moms who either donated their excess breastmilk or supplemented their baby with someone else’s milk.  For more information about milk sharing, both informal and through milk banks, please visit our article: Supplement Options: Donor Milk, Milk Banks, and Formula, as well as our Boob Group podcast episode, Low Milk Supply: Donor Milk, Milk Banks, and Formula.

Today on the San Diego Breastfeeding Center blog, I am honored to share Cara's story, which demonstrates how a sense of community can blossom through supplementing with and donating breast milk.  If  you would like to submit your story to be shared with our readers, please email me at robinkaplan@sdbfc.com.  Thank you so much, Cara, for sharing your inspiring story with us!  Your daughter is so lucky to have you as her mother!

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I feed my daughter a mix of my breast milk, formula and donated breast milk from 5 different women. Not only has donated breast milk benefitted my daughter's digestion and overall health, it has introduced me to other moms that I'm now proud to consider part of my community.

We were only two days postpartum, after a beautiful unmedicated birth, when the first hospital-based lactation consultant looked at my breasts and her face fell a little bit. She informed me with a matter of fact tone that I might have breast hypoplasia/Insufficient Glandular Tissue (IGT).  She said not to try too hard or be too hard on myself, as physiologically I might never make enough milk for my daughter.  It turns out, she was right. When my milk finally came in, my daughter only transferred 10ml per feeding - less than half an ounce.  However, through herbal supplements, medication, and pumping after each feeding I've managed nearly 4 months later to increase that amount to 20-30ml per feeding, but that's another story for another time.  Bottom line: I've only ever made 8-10 ounces of breastmilk a day, max. Not nearly enough for my daughter.  So at 4 days postpartum, after my daughter's weight dropped too far and my milk supply was not increasing: my husband helped me begin supplementing with formula using a syringe and feeding tube at the breast.  I was just relieved to have a plan, and as my daughter thrived I was grateful for formula and the nourishment it was offering my baby.

At 6 days postpartum we met with a local IBCLC.  She guided us on how to continue trying to increase my milk supply, and in the meantime how much to supplement.  And she also mentioned donor milk.  

I originally brushed off the idea of donor milk.  While it made sense since human breast milk is the best food for babies, it seemed like it would be awkwardly intimate to use another mother's milk, and I was also afraid of disease. My husband and I were not in a place to pay the high price for formal milk bank donor milk, and informal channels made me nervous.  I was also clinging to the hope that all the work I was putting into making my own breast milk would pay off and I might someday be able to exclusively breastfeed.  A few weeks later, however, I had to come to the painful realization that would never happen.  I cried as I realized I would be supplementing my daughter’s diet with either formula or donor milk for the long-term.  

So I began looking into donor breast milk.  I checked out the Human Milk for Human Babies Facebook pages, but was too uncomfortable with the idea of taking milk from strangers, so I sent an exploratory email to the moms I know in the area, asking if they or anyone they knew had extra milk they could donate.  Somehow breast milk from friends or friends of friends made me a lot more comfortable.  I only sent that email to 6 other mamas, but one friend responded that her friend had some extra milk due to an oversupply.  Another friend/co-worker responded that she herself was weaning her toddler, and had just stopped pumping at work.  She offered to resume pumping once a day and donate that milk to us.  I was blown away with gratitude - what a gift… but, also nervous.  Do we trust other milk enough to feed it to our daughter?  My husband and I made a decision together: to trust.  We decided these moms were feeding this milk to their own babies, so we would choose to feed it to our baby as well.  

I first accepted donated breast milk from my friend and co-worker.  I supplied her with breast milk storage bags which she filled and labeled.  For her it was very little milk, just 4 ounces or so a day, but for us and my young baby that was a significant amount.  I was so grateful, and felt humbled.  This was a gift I could never repay.  I would normally be uncomfortable with this imbalance - accepting a gift I couldn't repay - but was willing to do anything for my baby.  And my friend's attitude helped tremendously - she was so kind and sweet and seemed honored to give this gift to my baby.  A few days later, this friend texted me asking if my daughter liked her milk.  I laughed as she explained that it felt like she'd made a casserole for someone -- and wanted to know if she liked it!  My daughter certainly liked her milk, and I texted her a picture of my daughter in a post-meal milk-drunk stupor with a happily full tummy.  After all - that happily full tummy was the reason we were doing all of this.

The friend-of-the-friend was also incredibly kind, and we set up a time to pick up the milk from her.  She made me comfortable by asking if we were OK with the two cups of coffee she has in the morning.  Just her awareness of this issue made me feel she was a conscientious Mama aware of how her breast milk could affect her baby, and my baby.  She did request that we not tell her husband - as he would be weirded out by it all.  This honestly made me a little uncomfortable as I was so recently myself overcoming the 'weirdness' factor.  But she also seemed honored to help out and with an oversupply was happy her milk was going to good use.

I then met a woman with oversupply at a breastfeeding support group.  She was exclusively pumping and had repeated bouts with mastitis so was pumping far more than her daughter needed in a day.  I picked up some donated breast milk from her - feeling comfortable because we'd met a couple times at group, and I knew she'd struggled to do her best for her baby.  We laughed a bit sadly as we realized we were in similar conundrums.  Both pumping all the time - me in an effort to build supply and her in an effort to stave off mastitis.  She seemed happy to help my daughter, and I promised to provide her with replacement breast milk storage bags.  Somehow - buying donor moms breast milk storage bags feels like I'm repaying them just a bit - or at least making it a bit easier for them. 

By 8 weeks of age my daughter was thriving with about a quarter to a third of her diet coming from my breast milk, and the rest a mix of formula and donor milk.  I was first afraid to tell my daughter's pediatrician that we were using donated milk.  At my daughter's two month appointment I tentatively brought up donor milk - then quickly mentioned I was aware of the risks of contracting diseases and the like.  Our pediatrician didn't seem fazed at all that I was using donated breast milk - and she even encouraged it.  She brought up the fact that women with new babies have been tested for infectious disease during their prenatal care - so the risks are very low.  She was very comfortable with us feeding my daughter donated breast milk, which made me even more comfortable myself!  

I was also so grateful for the donated breast milk as it also seemed to help my daughter’s tummy, as she began struggling with constipation from the iron in formula.  We switched formulas to a brand we thought was better and cheaper - double bonus.  However, my daughter started straining to pass hard little pellets, and stopped eating as much. We were very concerned.  We began to consider giving her apricot nectar to help her bowels and with the hope she would start eating enough again.  However, before the fruit juice, I wanted to try one more thing - my friend/co-worker had just given us about 12 ounces of breast milk so instead of spreading that amount out over a couple of days, I decided to try feeding it to her all in one day to see if it helped her tummy.  It did!  It made me sad to realize formula was affecting her so negatively, but so happy to have a tool on hand - donated breast milk - to help my daughter gently.  We switched back to a brand of formula we knew worked better for my daughter, but she still had sluggish bowels.    

Having seen the benefit of breast milk on my baby's tummy I decided to give Human Milk for Human Babies a try - milk from strangers.  This decision was also encouraged by an internet community I had found of other mamas with low milk supply - some of whom were exclusively feeding their babies with donated breast milk from many different mamas. I posted a request on the Human Milk for Human Babies Southern California page on Facebook.  Immediately after posting I panicked realizing the post might go up on other people’s news feeds.  While my husband and I had become comfortable with donated breast milk, and I was open about my low milk supply struggles with friends and family, I was NOT open about using donated breast milk.  I just didn't want to have to defend our decision, when we had been a bit conflicted about it ourselves.  I'm still not sure if it went up publicly or not, but I decided to only deal with it if someone brought it up. They didn't.  

First a woman in Anaheim asked if I would make the 3-4 hour round trip drive up there to get breast milk from her. I decided I wouldn't.  I wanted donated breast milk for my baby, but formula was working OK and I decided the time in the car in Southern California highway traffic was not worth it for me and my daughter.  Then another woman private messaged me saying she was in the area, had never donated before, didn't have any diseases, only had small amounts of alcohol after her infant daughter goes to bed for the longest stretch between feedings, and had some frozen breast milk that was about to expire and needed to be used.  Her message made me feel comfortable, and I messaged her back thanking her for her openness and explaining I had never accepted milk from a connection with a stranger on a website before.  We decided to meet for the first time at a mall near me, as she was going to the Hollister nurse-in.  

It felt kind of like a Craigslist sale, meeting this stranger to exchange goods, except without the financial component.  I texted her telling her to look for a woman wearing a sleeping baby in a baby carrier (me)- then she walked up wearing her daughter in a baby carrier as well - and with a large cooler full of frozen breast milk.  Her husband and older son were with her, but as we started talking breastfeeding and postpartum struggles they wandered away.  She sort of smiled and said her husband had wanted to come with her to meet this stranger from the internet.  We laughed and then I wondered: why the heck was I so willing to just go meet a stranger from the internet without anyone with me?!  Minutes after meeting her I'd felt comfortable.  She was a mama with plenty of breast milk who stored some up when her daughter was much younger - and as the frozen milk neared its expiration date, she didn't want it going to waste.  We are both moms who knew breast milk was best for our babies, and both moms doing our best to provide what we can.  We've stayed in touch, as she might have some more milk for us in the future as she easily pumps above and beyond her daughter's needs. Even if she doesn't, we are grateful for the gift she has given us.

Since then, I met another mom in a breastfeeding support group, also exclusively pumping and with more milk than her daughter needs.  After meeting her a few times and running into her in my neighborhood, she insisted she could begin providing us with fresh breast milk every couple of days.  I accepted. Once again, I felt comfortable as I knew she was doing the best she could for her baby and attending support groups for support.  Since then I've enjoyed meeting up with her for walks as we compared the struggles of new mama-hood.

I still sometimes have fears of my daughter contracting a communicable disease - or imagine the horror of a donor realizing she has something she didn't know she had - but have decided that the benefits outweigh the risks.  I'm not yet open with family about the fact that we're using donor milk.  Perhaps that's an indicator that I'm still not 100% OK with it, but mostly I think it's because I just don't want to have to defend our decision.  The heartbreak of low milk supply is something I've learned to speak rather matter of factly about -- but how we choose to feed our daughter is nobody’s business, but our own.  Who we choose to involve in that decision (for example: our pediatrician, our lactation consultant) is just that - our choice. Perhaps over time I'll be more open about the donor milk that is helping to nourish my daughter -- writing up our experience like this is a start!

Thanks to my breast milk, donated breast milk, and formula my daughter is thriving.  Thanks to donated breast milk I've gotten to know other moms in a new way and we've built a community I never even dreamed we'd have.  I am just so grateful for this gift other moms have given my daughter!

Mustering Courage to Accept Breastmilk From a Friend

In an effort to demystify milk sharing, for the next few weeks we will be sharing stories from breastfeeding moms who either donated their excess breastmilk or supplemented their baby with someone else’s milk.  For more information about milk sharing, both informal and through milk banks, please visit our article: Supplement Options: Donor Milk, Milk Banks, and Formula, as well as our Boob Group podcast episode, Low Milk Supply: Donor Milk, Milk Banks, and Formula.

Today on the San Diego Breastfeeding Center blog, I am honored to share Christine McCarty's story about how she mustered up the courage to ask a friend for extra breastmilk for her baby.  If  you would like to submit your story to be shared with our readers, please email me at robinkaplan@sdbfc.com.  Thank you so much, Christine, for sharing your inspiring story with us!

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My story starts several months ago, when my daughter was about 5 months. I have a friend who has Raynaud's disease and pumps constantly to continue to give her son the best nutrition she can. We were having a conversation about breastfeeding (as most of our conversations are about, lol) and she mentioned she produced 80-120oz PER DAY! A few weeks later I was off to see my favorite IBCLC frantic and in tears because for 2 days I had only pumped 1.5oz (from both breasts total, not individually) per pumping session at work. I remember hugging my lactation consultant, crying in her shoulder, telling her "I'm losing it, I'm losing my daughter's lifeline, I'm such a poor mom, I just can't keep up." After much reassurance, we got back on the right track, but I still had the issue that my production hadn't gotten back up to speed for the next day I had to go to work.

I was in the grocery store about to buy some formula when I thought of my friend and how she was complaining she was running out of freezer space.  I immediately put the formula back on the shelf. I knew I had to do something, but nothing about giving my daughter formula felt comfortable, and I wanted to exhaust the only other option I thought I had… my friend! I had to think about how to approach her to ask her about using her milk because I wasn't sure how comfortable she would be with it, since there's such a huge stigma attached. I mustered up the courage and called her to ask her to discuss milk sharing with her husband and see if they were mutually comfortable with it.  

My friend started crying and I was in shock! Had I offended her? Was she sorry for me and my low production rate? Was this the end of our friendship? No way! She said she was so honored that I would come to her to ask for help and this meant so much to her to be able to help our family and help my daughter! She talked it over with her husband that night and it was settled.  They brought 180oz to my house the next day along with her medical testing she had gotten done throughout her pregnancy and all she had afterwards, along with her son's paperwork.

The funny thing is, after I had gotten her milk, I became a total milk maid! My production boosted SO much! I'm sure it was because I knew I had her milk to rely on and that took off all the pressure I had put on myself.  I didn't even need to use her milk until I had to go out of town for a week for work when my daughter was 8 months old. This time she donated 300oz. My daughter drank and lived happily off of her milk while I was across the country and when I came back she latched right back onto me and we've been nursing beautifully ever since.  Now at 9 1/2 months she's still sucking strong and we'll continue to support breastfeeding and milk sharing :)

Also, my friend now feeds two other families who's children are exclusively drinking her milk (no solids yet), as well as her own six month old son, WHAT A ROCKSTAR!!!

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

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!

I Never Knew I Had Insufficient Glandular Tissue

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

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

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

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

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

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

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

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

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

Jennifer Thomson

How Can CranioSacral Therapy Improve Breastfeeding?

Dear SDBFC,

My little guy is 7 weeks old and suddenly won’t latch right.  It feels like his tongue is flicking my nipple instead of being underneath covering his gums.  He also won’t open his mouth very wide to get the whole nipple in.  It’s causing me a lot of pain.  What can I do to encourage proper latch?

Sincerely,

Christina S.

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Dear Christina,

While I am not sure why at 7 weeks your little one’s latch started to become uncomfortable, the symptoms you are describing sound like your son's jaw and tongue could use a little unwinding. This is when I often refer the baby to a CranioSacral Therapist.  Since breastfeeding requires that a baby has full range of motion with his tongue, jaw and neck, some babies may require a little extra assistance to relax these areas and their central nervous system. One technique is CranioSacral Therapy (CST).

What is CranioSacral Therapy?

Jennifer McIsaac, a Holistic Health Practitioner and CranioSacral Therapist describes CranioSacral Therapy (CST) as a system of techniques and diagnostic tools that focus on the soft tissue structures that surround the brain and the spinal cord, as well as the nerves.  This light-touch massage, using pressure up to the weight of a nickel, can relax the brain and the body immensely!  This soft pressure works well in infants, as their connective tissue is so soft and malleable.  (The Boob Group, Episode 13)

What typically takes place during a CranioSacral Therapy session?

Most sessions include an evaluation of the baby (head to toe) and soft-tissue manipulation in the baby’s mouth (if necessary) and on the head, spine, and pelvis.  There is very little movement during the manipulations, so it may look like the therapist is not actually doing much of anything.  This is because the therapist doesn’t have to use a lot of force to manipulate and relax the soft tissue. 

What are some examples of how CranioSacral Therapy can improve breastfeeding? 

• Helps to bring the baby’s tongue out over the gum line (assuming that there is not a tongue-tie or another anatomical restriction)
• Relaxes the baby’s jaw so that he/she can open his/her mouth more widely and comfortably
• Reduces tension in the baby's neck, which may have been cuased by how he/she was resting in utero or as a result of something that took place during his/her birth (breech position, vacuum, long-stage pushing, etc.)
• Relieves tightness in the baby’s neck and jaw, which may cause him/her to feed less comfortably, and even pinch the nipple, on one side only
• Relieves tension inside the baby’s mouth, which may cause suction that is too strong, painful, or off-center or a suck that is too weak to be efficient
• Increases the baby range of motion with his/her tongue and jaw after a frenotomy (tongue-clipping due to a tongue-tie) and relieves bunching of the tongue
• Relaxes a baby’s sensitive gag reflex

Besides breastfeeding, how can CranioSacral Therapy help an infant?

• All rights reserved by hollyloo (Flickr)Reduces and resolves plagiocephaly (misshapen head)
• Relieves torticollis (muscle tissue that is tight on one side of the neck, causing a shortness in those neck muscles)
• If used early on, it can reduce the baby’s need for a helmet, due to plagiocephaly and torticollis

Will CranioSacral Therapy hurt my baby?

Actually, it is quite the exact opposite.  Most parents describe watching their babies ‘melt like butter’ on the massage table while receiving a treatment and that their babies look completely relaxed.  Often times, babies who have tight jaws and necks may not be sleeping well at home, so after a CST treatment they may take a wonderfully long nap.  Many babies will actually sleep through the treatment.

How often should I expect to take my baby to CranioSacral Therapy?

This definitely depends on the baby and the issues he/she is presenting.  Most babies respond quickly to this treatment, as their bodies are so malleable and receptive to bodywork.  These babies may only need to be seen for 2-3 treatments and then their issues are resolved.  Others might need ongoing treatment and may be seen once or twice a month for several months.

How can parents find a CranioSacral Therapist?

The Upledger Institute has a search function where you can find a therapist in your area.  Most Doctors of Osteopathy are also trained in CranioSacral Therapy and may actually be covered under your insurance.  Before considering treatment from any practitioner, it would be wise for the parent to ask the practitioner about his/her experience working with infants and what type of training he/she received.

I hope that this helps answer your question, Christina!  

Warmly,

SDBFC

Additional resources:

La Leche League International: Considering CranioSacral Therapy in Difficult Situations

CranioSacral Therapy: When Can It Help, by Dee Kassing, BS, MLS, IBCLC 

JM Therapeutics: What is CranioSacral Therapy

Kellymom: CranioSacral Therapy and other gentle body work for breastfeeding problems

Entertaining a Toddler While Breastfeeding a Newborn

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

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

Here is our question of the week:

Dear SDBFC,

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

Alicia
 

Dear Alicia,

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

Tips for Entertaining a Toddler While Breastfeeding a Newborn

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thanks so much for your question, Alicia!

Warmly,

SDBFC

How to Prepare for Breastfeeding Before Your Baby is Born

Dear SDBFC,

What should a first-time expectant mother who wants to breastfeed expect at the (big, traditional) hospital in the way of breastfeeding support? It would be nice to know what we're allowed to expect/ ask for. Should the hospital lactation consultants be sufficient or should we plan on working with an independent LC right away? Is there anything we can do before birth to help ensure smoother breastfeeding?

Sincerely,

Jenny

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Dear Jenny,

That is an excellent question, and to be honest very difficult to answer.  The type of breastfeeding support you will find at a hospital will vary greatly depending on which part of the United States you live in, whether the hospital is Baby-Friendly, its yearly breastfeeding rates, if they have certified lactation consultants (IBCLCs) on staff, and if their postpartum nurses have had recent breastfeeding training.  One hopes that the hospital lactation consultants will be fabulous, but that may not always be the case.  Also, a new mom typically won’t even see a lactation consultant in the hospital unless she is high-risk for breastfeeding challenges or she asks for one directly.

Since much of this may feel like it is not under your control, there are many steps YOU CAN make to ensure that breastfeeding gets off to a great start, regardless of the breastfeeding savviness of your hospital.

Here are my top 10 tips to prepare for breastfeeding before your baby is born:

1. Have a long chat with your partner.  Take turns discussing each person’s goals for breastfeeding and what type of support you may need from one another as a new parent.  Our article Partner Support: Can it make or break your breastfeeding experience shares different ways a partner can support a breastfeeding mom.

2. Take a fantastic breastfeeding class!  Don’t settle for the status quo.  Search for a class that not only covers the basics (latching, common concerns, how to know that your baby is getting enough), but also discusses local resources and is taught by a dynamic teacher with a background in lactation.  My favorite comment I saw on an evaluation of a breastfeeding class was, “the teacher even made my husband wish he could breastfeed!”  Now that’s a great class to attend!

3. Do some research about which hospital/newborn procedures are necessary during and after a birth.  Some hospital procedures are protocol, yet are not medically necessary for every baby, and can often negatively impact breastfeeding. 

4. Read an informative and fun breastfeeding book, such as Latch: A Handbook for Breastfeeding with Confidence at Every Stage. (Written by our very own, Robin Kaplan!)

5. Attend a breastfeeding support group, prenatally!  First, you can see the lay of the land (where to park your car, where the group is located, and if the women seem like the type of ladies you would want to hang out with.)  Secondly, you can see women breastfeeding in their ‘natural habitat’….meaning, baby on boob, minus the cover, without feeling the need to cover up.  Thirdly, you can sit next to a woman who has a newborn and ask her all of those questions about being a new mom that you have been dying to ask someone.  Last, but not least, you will feel an abundance of support for your desire to breastfeed and know that this is a safe and fun place to return to after your baby is born.

6. Come up with a ‘Visitor Policy’.  Those first few days after your baby is born are critical in establishing your milk supply and helping your baby become a successful breastfeeder.   When the entire family and neighborhood are camping out in your hospital room, it might be difficult to feel entirely comfortable taking your top off and letting your baby find his/her way to your breast.  This is YOUR time to figure out breastfeeding, not to practice breastfeeding in front of an audience.  So, decide on a policy with your partner and stick to it.  Remember, your friends should understand that this is your time to get to know your baby and that they can all come and see you once you get home.

7. Choose a breastfeeding-friendly pediatrician.  The is most likely a physician you will see more in these next few year than any other you have ever seen before.  Make sure that the pediatrician is supportive and knowledgeable about breastfeeding.   Ask to interview him/her BEFORE your baby is born so that you can make an informed decision.

8. Create a hospital-plan that will optimize your breastfeeding success.  Items to include are: rooming in, no pacifier or bottles, no formula unless medically necessary, limiting visitors, delaying your baby’s bath, and keeping your baby skin to skin as much as possible.

9. Ask for assistance from a certified lactation consultant, or a well-trained postpartum nurse, while at the hospital.  Have her check positioning and your baby’s latch.  You are paying for these services, so  take advantage of them!

10. Look for a local lactation consultant while you are still pregnant.  Spend time perusing the Internet to find a local IBCLC that seems like a good fit for you.  Attach her name and contact information to your fridge, so you can find it quickly if you need it.  This way you aren’t calling the first person you find, out of desperation, after the baby is born.

*** I know I said Top 10, but I couldn't forget to include this tip.... Hire a birth doula.  The easier your birth is and the fewer birth interventions you encounter can definitely get breastfeeding off to a great start.  Doulas can make this happen:)

Thanks for your question, Jenny!  Hope this helps!

Warmly,

SDBFC