Recently I had two different moms who I attempted to help with adjusting to breastfeeding with a new baby. Both moms had had difficult labors and births, but both avoided cesareans. But both babies ended up spending a week in the NICU on antibiotics. Meconium aspiration was the culprit for both. They do not allow a baby to be roomed in with its mom if the baby has an IV. So separation, although not continuous, is a problem. It becomes increasingly problematic when trying to recover and also develop a milk supply and learn to breastfeed since the baby is also being given bottles along the way.

The first mom returned home and her baby was discharged after the week. The baby was nursing some and also being given formula. The mom was only nursing some of the time- some of the time she was pumping and some of the time the baby was being bottle fed. She was concerned about her supply- and rightly she should have been. It is important that a baby nurse from the mom at a minimum of 8 times a day and ideally more like 10 to 12 times a day. The baby had been on a 3-hour feeding schedule in the NICU.

I encouraged this mom to take a babymoon. Crawl in the bed shirtless with only a diapered baby- and nurse around the clock- doing nothing but being waited on by helpful friends and family- fed but doing nothing else but having skin to skin time with the baby and nursing as frequently as possible for 24 hours.

I encouraged this mom to do just that- and give me a call in 24 hours with the number of wet diapers, the number of poops and number of times she nursed.

24 hours later she texted me, “Hey! we didn’t do it today. I had too many people over today.” I replied, “prioritize.” I did not hear from her again. But I saw on social media pictures of the family giving the baby a bottle.

Hey, that works- the baby is being fed, right? Well, sure- but ideally the mom had wanted to breastfeed. I think visitors were fun, but they sabotaged her ability to get a good supply going. And not having a good supply, having nipple confusion with bottles and the mom being a hostess instead of resting is not the way to help her make breastfeeding work. The mom could not find her voice to tell her family what she really needed.

The second mom worked hard to be with her baby in the hospital and was also able to bring her baby home after a week in the NICU. She had great family support in every way except with breastfeeding. Neither of her moms had breastfed so when the first problem with latch began, rather than helping to pay for a lactation support person, they undermined her breastfeeding.

How? By stating how they had dried up their milk quickly with ice packs- only took a few days. By saying how formula and bottle feeding had worked fine for them. By holding the fussy baby and giving him a pacifier when he was showing signs to nurse, but they were attempting to “help” the new mom by doing so.

I wish the family would see that the best way to help is to find supportive solutions that are in alignment with what the ideals of the mom are instead. The second mom reached out to me. I was able to provide postpartum help. The mom realized quickly some things to improve the baby’s latch and also was reaffirmed on what a great job she was doing. And how normal her baby was acting. And she was given time to share emotions and feelings with acceptance.

So, what does a new mom need? REST: Rest. Encouragement. Support. Time. If you want to come and help, then help do the things that need to be done- meals, cleaning, errands, holding the baby while she showers- but otherwise- keep the baby with the mom! Encouragement means giving her courage to move toward her ideals. That means getting her help if you are not an expert in the area she is struggling. Gift her a postpartum doula, a lactation consult, a ride to a breastfeeding support meeting. Encourage her to call an expert rather than undermine her ideas. Support her emotionally by allowing her space to share her feelings without judgment and without dismissing her feelings as invalid.  Feed her- make sure she has her physical needs met as well. And remind her it takes a time to adjust to a new situation- to heal from the birth, to learn her baby’s cues and to figure out what works.

If you do not agree with what she is doing, keep your opinions to yourself unless you are concerned for her well being and her baby’s. Then reach out to an expert for advice and input.

The number one thing that is shown to make the biggest difference in success in breastfeeding. I encourage moms to also begin attending La Leche League groups as well. Today I received a sweet note from a mom who attended our breastfeeding class many years ago. She said I could share her sweet words with you! jennifer kunnard

Sooo, for the first time since December 2008 I’m not pregnant or nursing. Actually, the last time I nursed Gabe was October 22. He’d been telling me I was yucky for a few days and that was that, haha. He turns 3 in January. Madeline nursed for 22 months but weaned when I was about 3 months pregnant with Gabe.

Thanks for normalizing this. Breastfeeding past infancy and well into the toddler years. It’s not weird to nurse this long, but when I first got pregnant with Madeline I thought, “eh, I’ll nurse a year.” At the time when I started on the natural birth, breastfeeding kick, I was the only one I knew who did stuff like that! Now, I have a support network of mamas who don’t flinch when you talk about nursing an almost 3 year old.

Anyway, I’m proud of my journey. So, so proud. Madeline never got a bottle, Gabe only got bottles in the NICU. This was all me. I should take pride in what I’ve been able to do for my kids but,  I know this would be seen as formula-shaming or pump-shaming if I posted on my own status. It’s really not, it’s just taking pride in being able to TRUST my body enough to provide solely for my kiddos. I ignored the world, people who told me what I produced wasn’t enough, who told me my milk made my kids spit up, etc. I also had it rough for a long time with Madeline due to chronic plugged ducts (I had a cyst removed in my left breast and it really did cause issues). It wasn’t always easy, but it has been so, so worth it.

Keep doing what you’re doing.

Jennifer
p.s. and yes, Craig and I took the couple’s breastfeeding class

Come join us- we do normalize breastfeeding. But we also give you tons of information for you to determine what works for you. But we will work with you on helping you find a successful relationship for you and your baby!

 

Growth spurts with breastfed babies tend to follow these numbers- 3 weeks, 6 weeks, 9 weeks, 3 months, 6 months and 9 months.

You will see the baby all of a sudden not be sleeping well in the early weeks and months. wanting to nurse all the time for about 48 hours- to build up your supply of milk! Ironically when they get older- toddlers and beyond, during a growth spurt you will find they will all of  sudden take longer naps. This is all normal.

Babies do not usually sleep through the night until 3 months or 15 pounds- and by sleeping through the night, that means five hours at a stretch.

measured head of infant seca-212-baby-and-toddler-head-measuring-tape-7

Keep in mind the growth a baby grows a lot in the short time of being a newborn! Amy Spangler reminded us that  the baby’s head growth in the first year is 3 inches. The child will not have another 3 inch growth until they reach the age of 16! So feeding the baby often is a great way to help that baby in that growth!

The reason most babies begin to eat and need solid food during the first year around 6 to 9 months is partly due to this growth spurt times. So, don’t be worried that you do not have enough milk- you will, just nurse for a few days around the clock as the baby increases your milk supply. It is a short time and works itself out in no time at all.

Oh let me count a few of the ways….

Only allowing the baby to nurse for a limited time. If the baby has a good latch, it does not hurt the baby to nurse for longer times.

Full-WhiteKitchenTimer

Watching the clock instead of the baby and her signals that she is hungry, You eat snacks and sip drinks besides eating meals- so does your baby. Scheduling early on will interfere with milk production. Nurse more and you will have more milk. Nursing more in the first days when colostrum is present helps the baby get rid of the early meconium stools and have less jaundice issues as well.

girl-watching-the-clock-at-work

Being given a bag full of formula from the hospital, undermining your confidence. These gifts are not gifts at all! Hospitals and pediatrician offices who offer this are not baby friendly places. Avoid them!

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Swaddling the baby and keeping them in the box at the hospital- they need to be skin to skin on the mom as much as possible and not sleeping so soundly that they do not nurse regularly.

swaddled up baby in box

Don’t send your baby to the nursery. Out of sight means the nurses may offer bottles to your baby unknowingly. The studies show moms actually sleep more with the baby in the room- it is a mammal thing- they worry when the baby is away from them.

LD S2 NEWS PATTERSON BOYS HUL.1

Nurses giving lousy advice, like your baby is starving, you do not have enough to satisfy such a big baby, some women just can’t breastfeed! Ask for a lactation consultant.

nurse-manager-wagging-finge

Dad’s wanting to be helpful and give the baby a bottle. That is fine once breastfeeding is well established and if you are going to be pumping when he is doing it so your supply and demand is not thrown off. Get him to help in other ways- rocking the baby, changing diapers, putting on a load of laundry!

dad giving a bottle

Grandmothers and others who mean well but give you awful advice. They should be coming to support you by helping you with all the things not related to the baby. Put the baby back in the mom’s arms please and go fix her a nice dinner!

grandmother with baby

Too many visitors while you are in the hospital trying to learn how to nurse your baby. Every time someone comes in you have to cover up and stop nursing your baby.

visitors at hospital

Too many visitors once you get home. Ten minutes is a visit- more than that you have worn out your welcome unless you are vacuuming, folding laundry or cooking! Leave a meal and say hello- don’t even sit down to visit. Let the mom rest please.

leave food door mat

Undiagnosed tongue ties. The pediatrician who says let’s wait to see if it causes speech development is the wrong pediatrician for breastfeeding support.

tongue tie

A poor latch leading to sore nipples. If in doubt read this article on LATCH.

 sore breasts

Not realizing ahead of time you could have done something about a flat or inverted nipple. Ask your midwife to look at your nipples and evaluate them before you give birth. Read about this here. Avoid the nipple shields that seem to be handed out like candy- they too can cause huge issues.

types of nipples

Attend a breastfeeding support class prior to having your baby. A couples’ class is best to get your partner on board. If you can not attend prior to having the baby, attend soon after having the baby. Attend La Leche League meetings to get that mother to mother help as well.

breastfeeding prenatal classFinalWICBreastfeedingc_4604

Dont’ be shamed into isolating yourself to a bathroom to feed your baby. The more normalized you can begin to see breastfeeding, the easier it is to get out and about.

breastfeeding in bathroom

Avoid unnecessary inductions. Baby’s who are not quite ready to be born have more difficulty nursing and end up with more NICU stays separating moms and babies.

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Avoid interventions that could lead to a cesarean birth. It is harder to recover from a surgical birth, takes longer to have your milk come in and a longer stay at the hospital creates more issues with getting good advice.

 cesarean

Avoid IV fluids during your labor. Fluids cause edema which flattens out your nipples and can cause a baby to have difficulty latching on properly. Having IV fluids for two hours or more can inflate your baby’s weight. Weight loss should be determined based on what the baby’s weight was at 24 hours instead. Read the study here.

iv fluids

Nurse the baby before the baby is weighed. A small baby or a big baby can lead to blood sugar stabs that should not be done without having the baby have an opportunity to nurse first. And the baby’s stomach is the size of a marble- regardless of his size. Colostrum is all the baby needs.

baby on scale

The hearing test must be done while the baby is not crying. So if the baby is hungry and wants to nurse, they will offer a bottle instead. Always send your partner with the baby when the baby leaves the room. And tell them you do not give them consent to give your baby a bottle.

newborn-hearing-screen

Circumcision is painful- during the procedure and afterwards. They offer sugared pacifiers for comfort. But the real problem is afterwards the baby retreats due to the pain and does not nurse well for up to 12 hours sometimes. Consider leaving your son intact- 60% of the US is doing so now. And the higher the education and higher the income, the less likely the boys will be circumcised. Do you research. And if you decide it must be done, consider waiting until the baby is a week or so old and breastfeeding and bonding is more established

.circumcision

When you register at the big box baby stores, your name is sold to the formula companies. All of  a sudden you will get gifts to sabotage your nursing relationship. Beware of FREE gifts.

free-gifts-from-similac

If you are returning to work, don’t be in a rush to begin offering bottles. Bottle nipples can often cause confusion to a new baby. There is a proper way to feed a bottle to a breastfed baby- note this.

formula-baby-bottles

And offering a pacifer can also cause nipple confusion early on. Think about it- the baby has a desire to suck Sucking on a fake nipple does not help your breast supply and causes the baby to get a lot of air- causing stomach pain. The baby needs to be at the breasts- helping your supply and protecting your latch.

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Crying babies have more gas. You are missing the signs of early nursing desires- sucking on their hands- smacking their mouth. Try to catch the baby early on.  Baby’s cries are alarms not to be ignored for their best development.

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Putting the baby in the bed or next to the bed with you allows for easier night time needs being met and more sleep. Night time nursing is needed until the baby reaches 15 pounds or three months expect to nurse frequently. Babies begin to start sleeping for a 5 hour stretch often at this point.

Co-sleeping

 

Sleep scheduling can be to the detriment of your milk supply. Be careful. Meeting your baby’s needs, especially during that fourth trimester- the first three months after birth, are essential to the well being of your baby. Read about newborn sleep and soothing techniques on the blog and by our favorite authors listed in the store site for book recommendations.

getting-baby-to-sleep2

 

Remember breastfeeding is not a medical advice issue usually, so your pediatrician may not be a good resource. In fact the Academy of Pediatrics agrees with me here!  Listen to your own intuitive heart, it is a good guide.

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So in summary,here are a few of the things you want to do to insure breastfeeding success are:

  • Take a breastfeeding couple’s class prior to birth. And if you can not do so, consider attending afterwards or meeting with a lactation educator or consultant for some guidance. 
  • Get the latch right early on- and if it hurts that means the latch is not correct.
  • Attend La Leche League meetings prior to the birth and get to see new mom’s nursing their nurslings. Talk to other moms about what worked well for them.
  • Buy a good breastfeeding book or two. We have suggestions on our site.
  • Have a gentle, non interventive birth if possible- set yourself up to win in this way by taking good classes and assembling a great support team. An alert baby and non medicated mom has less problems with breastfeeding from the start.
  • Leave the hospital as soon as possible- the studies indicate the longer you stay the more sabotage occurs.
  • Have your support team in place when you get home- hire a postpartum doula to help. Get in touch with a breastfeeding consultant to help if you are having issues as soon as possible to figure out what the problem is and resolve it quickly.
  • Nurse often and with a good latch- for the length that meets your baby’s needs.
  • Don’t look at the clock- look at your baby. And realize sleeping for longer stretches come in time. Rest when the baby is resting so you are not sleep deprived.
  • Interview your pediatrician about their level of support to expect but get your support mostly from other breastfeeding moms and knowledgeable professionals.
  • Avoid advice that is unwanted and ill advised. 
  • Resist using formula, bottles and pacifiers until breastfeeding is going smoothly.
  • Do your research and stay away from elective procedures that can interfere with mom and baby being bonded from the start.
  • Wear your baby and have the baby skin to skin often.
  • Involve your partner in other ways that are fun ways to meet the baby’s needs besides feeding.

 

 

Published September, 2012 in PEDIATRICS Volume 130

Kwok, Leung, Lam and Schooling

 This is a very limited study- but it appears that breastfed children reach puberty later than children who were not breastfed and instead were fed cow’s milk formula. The concern regarding this study is that there may be some socioeconomic issues that were factors as well.

You may ask why this is important. But “early puberty is associated with hormone related cancers and cardiovascular diseases.” So delaying puberty is certainly of interest to us now!

Cow’s milk formula is suggested as causing early puberty due to the specific nutrients in milk such as animal protein, animal fat, and calcium. It goes back to human milk for human babies. Is it no wonder that giving a different animal’s milk to a human would have proteins and fats and different calcium that we cannot absorb properly?

This study could not be replicated in different places around the world.  The US showed more of a larger quantity of early onset of puberty based on quantity of milk consumed. The study showed different results based on quantity vs. frequency of milk consumption. They were concerned that there were many other factors that could be different in different populations. So they felt it was a bit inconclusive.

The other issue that arose with the study was the type of formula given. Some people were using soy based formula although it should not be substituted over cow’s milk without a medical reason for doing so.  (This made me wonder how many families make decisions regarding formula use without getting advice from their pediatrician. And the concerns about soy are rampant regarding the estrogen issues in soy. )

This study was conducted beyond infancy- they looked at milk consumption at 6 months, 3 years and 5 years.  The fallacy in the study was regarding infants on exclusive breastfeeding vs. some supplementation vs. formula feeding.  In Hong Kong where the study was conducted, has a short breastfeeding duration thought to be due to moms returning to work quickly.  Three months was the duration they were seeking for the study but many moms had quit exclusively breastfeeding within two months.

The study was also conducted looking at two factors- frequency of milk consumption and when consumption started. They did a lousy job of collecting the data since exclusive vs. part time breastfeeding was confusing to the stats.

They also seemed to have a hard time determining what constituted the onset of puberty. For girls it was a bit simpler- they looked at breasts development. But for boys it was conflicting if it was the genital stage or the testicular volume for boys. They decided to use the genital stage II to be the factor- and my guess is the testicular volume results were not looked at once they decided to use the genital status. But you can see this is not a precise situation.

They classified the children in a few ways: gender, the families- education, occupation and income and then infant maternal issues that included second hand smoke exposure, mother’s age at the birth and the place of the birth.

I think this study is too flawed to be a conclusive one. Relying on the mother’s recall on consumption and the various conflicting issues seem to corrupt the results.

I think we can hold that human consumption of human milk can cause less problems- but the onset of puberty based on frequency and quantity of consumption can just be considered a possible factor not a conclusive one.

 

Published December, 2011 in PEDIATRICS Volume 128

Jones, Kogan, Singh, Dee, Grummer-Strawn

This study was trying to determine what factors were causing the duration of breastfeeding to remain low in the US. It was sad to see that in the 75% of the children breastfed only a little more than 16% were breastfed exclusively for six months. Race showed little difference in the exclusivity of breastmilk in the first six months but race did have a difference in the non Hispanic black children who were breastfed less. Government agencies and medical organizations promote breastfeeding- and it does seem to have made a difference.  Since the value of breastfeeding exclusively is thought to make a difference in reduction of medical cost of 2.2 million dollars per year, it is in the government’s interest to promote it. They hope to change the percentage that was found in 2006 of just over 14% exclusively fed for six months to a little over 25% and hope to increase breastfeeding being initiated to over 80%.

The factors that were considered associated with breastfeeding being exclusive for six months included: race, income, density of residence, mom’s age, education, marital status and BMI.  They knew of no study that took into consideration the mom’s emotional or mental health, whether she was native or immigrant, if there was a smoker in the home or the family structure. They interviewed over 91 thousand families targeting only one child and the children being between 6 months and five years of age.

Exclusive breastfeeding was determined to be done for 180 days with nothing else- no other food or liquid offered including water. The study wanted to look at these factors: mother’s age at time of birth, education level, immigrant/nativity status, mental/emotional health, race, birth weight of the baby, family structure, poverty status, and tobacco use in the household and density of residence. (more…)

My review of “Breastfeeding and the Use of Human Milk”

Published March, 2012 in PEDIATRICS Volume 129

Policy Statement by AAP

This is the policy statement from the American Academy of Pediatrics. It was six years ago since they made a public policy statement on breastfeeding. I love that they feel breastfeeding is a public health issue not just a life style or parenting choice. They make an affirmation on exclusive breastfeeding for six months. And they encourage it to continue after other foods have been added up to a year or as long as it is a relationship that the dyad of mother and baby desire.

The national average for women who begin by breastfeeding their infant is at 75%. Hispanic population is higher and the black population is much lower. The government supplemental programs like WIC show a low rate of initiation of breastfeeding if the mom’s income was lower. And the very poor black population was the lowest. The studies also show women under 20 are lower at initiating breastfeeding and moms over 30 are the higher at initiating.

In ten years this initiative to try to promote breastfeeding has had little change in the moms who begin to breastfeed. I can’t help but wonder if the PSA ads that are not ever shown during daytime or primetime hours on television are considered a promotion of sorts by the government. If this is truly a public health issue, it is certainly not being covered by the media. I think the concerns of making women feel bad if they are not breastfeeding and making the formula companies angry seem to be of more concern. So the targets to get more women nursing seems to have had a little effect but the cessation of breastfeeding early on seems to be the norm in the US regardless.

One quarter of all women’s maternity services provide formula to moms in those crucial first two days after birth. Until the government steps in and really treats this as a public health issue, nothing much will change. The formula companies will continue to promote their artificial breast milk and moms will continue to get mixed messages from the maternity centers. The AAP notes that until the practices of hospitals change, the targets will not be met. (more…)

There is a lot of misinformation about co-sleeping out there. For most breastfeeding moms, co-sleeping is a fabulous way for everyone to get their must needed sleep and also not interrupt the breastfeeding dyad! So here are some wonderful links for great information to help you be successful and SAFE!Co-sleeping

How Babies Sleep

USC Co-sleeping Pamphlet

Safe Sleeping

Dr William Sears:

Dr Jay Gordon:

Mercola on the Family Bed

Benefits of Co-sleeping Past Infancy

Family cuddling.

Needs vs Habits, Tine Thevenin

Rediscovering the Family Bed, Tine Thevenin

Transitioning Out of the Family Bed

 

This is a great article that tells it like it is. http://commonhealth.wbur.org/2011/08/hospitals-bad-job-breast-feeding/ and this is the study link http://www.cdc.gov/vitalsigns/breastfeeding/

Yesterday I got a call from a mom who had had a baby less than 18 hours earlier. Her daughter had been born unmedicated and gently. She was a VBAC baby who weighed 9 pound even. Beautiful baby that within the first hour after birth had nursed beautifully. She then began to have her heel lanced and her blood sugar checked before feeding each time. This is not a little prick- it is a full lance of her foot- making it quite sore I am sure. Her blood sugar was fantastic. But this baby girl cried after nursing often times. She had 12 bowel movements- so obviously it was not because she was not getting enough colostrum to make her bowels move great- and we all know her stomach is the size of a marble irregardless of how big she was! But guess what? Instead of teaching the mom to swaddle or soothe her baby, the nurses convinced her that her baby was hungry and crying because the mom was not producing enough!!! AUGH! It makes me want to SCREAM!!!! So, this article shares what the CDC studies prove- the hospitals sabotage the nursing relationship-

“– (And this one is astounding to me, hence the bold) In nearly 80 percent of hospitals, healthy breastfeeding infants are given formula when it is not medically necessary, a practice that makes it much harder for mothers and babies to learn how to breastfeed and continue breastfeeding at home.”

Baby Bottles

I wonder how much formula she was sent home with! Why can’t we educate those who could really make a difference for moms and babies? I honestly tell people there is not one hospital in our area that I think does an excellent job after the baby is born. There is either some stupid policy about bathing the baby or having to pay for an isolete like a recent hospital I doula’d at… or stupid stuff like this mom went through. ENOUGH! We need to stand up and SCREAM NO! STOP IT! ENOUGH!