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Friday, 05 September 2014 00:00

Don't Shove the Formula

Much to my surprise, I received a package from Similac in the mail the other day. It was an 8 ounce sample of formula, along with some informational packets, and $20 worth of coupons.

I was amused at the brightly colored box’s claims, “Similac with OptiGRO Nutrition is “closer than ever to breast milk*”! Notice the *. In fine print, it read, “Reformulated to better match the average caloric density of breast milk…” What a stark reminder that nothing beats the nutritional content of breastmilk and trying to advertise in a way that makes a formula comparable to it simply makes a company look downright foolish.

I am not trying to put down formula feeding parents. Sometimes formula is the best or only choice for a family, and I support their informed decision to formula feed. What I do not support is formula companies trying to shove samples and tempting coupons down the throats of expectant mothers, actually undermining their chances of success for a healthy breastfeeding relationship.  

According to the International Code for Marketing Breastmilk Substitutes, “the marketing of breast-milk substitutes, including infant formula, discourages mothers from initiating and/or exclusively breastfeeding their infants.”

The importance of avoiding the advertisement of breast-milk substitutes is so important that it is directly addressed in the global initiative of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) Baby Friendly Health Initiative.

One of the provisions of this initiative is that, “Hospitals and birthing centers wishing to attain Baby-Friendly designation must abide by the provisions of the International Code on Marketing Breast-milk Substitutes.”

The strict criteria for this code is listed below: 

  1. No advertising of breast milk substitutes to families
  2. No free samples or supplies in the healthcare system.
  3. No promotion of products through healthcare facilities, including no free or low-cost formula.
  4. No contact between marketing personnel and mothers.
  5. No gifts or personal samples to health workers.
  6. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels or product.
  7. Information to health workers should be scientific and factual only.
  8. All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding.
  9. Unsuitable products should not be promoted for babies.
  10. All products should be of high quality and take account of the climate and storage conditions of the country where they are used.

Many hospitals do abide by these rules, for which I am sincerely grateful, but an alarming number still do hand samples out--86% in 2007. Research has shown that free formula given to new moms tends to result in poorer breast-feeding outcomes.

It is because of this research (this known fact that having formula sitting around your house results in poorer breastfeeding outcomes) that I am upset by Similac sending me this package. I did not ask for it. I don’t know how they got my information. I don’t want the formula.

Let's imagine a new mother just home from the hospital. Say she chose a hospital that was certified baby friendly, so that she would have the support to initiate breastfeeding, and not send her home with formula samples. 

But, for whatever reason, this new mother is having trouble breastfeeding. It’s hard. It’s frustrating. Maybe it’s even painful. She feels like a failure as a mother because breastfeeding is not coming as easily or as naturally as she thought it would. She isn’t getting enough sleep. She is worried that her baby isn’t getting enough to eat. She is worn down by the stress of the situation.

She then remembers the samples that the formula companies so kindly mailed to her, in bright packages, full of tempting promises. In a moment of exhaustion and frustration, she uses some. She knows it isn’t what she wants, but in that moment it seems easier. Just. That. Once.

However from there, without the support she needs, she begins the downward cycle; as she resorts to formula feeding more and more often. Her supply begins to drop, and her baby, frustrated with the lack or speed of milk, no longer want to suckle at her breast. The mother, though saddened at this turn of events, doesn’t see any other choice and thus, the formula feeding relationship begins.

Allow me to reiterate that I fully support informed formula feeding! 

What makes my blood boil is how formula companies send out unsolicited samples. It would be one thing if they were available by request for parents that need to formula feed. It is quite another to distribute them to everyone before their baby is born.

Have you been sent formula samples? How did you feel about it? Share your story in the comments below!

Published in Feeding Baby
Saturday, 05 July 2014 04:43

Interview with Amy Wright Glenn

Last month, Jill Reiter from the Childbirth and Postpartum Professional Association (CAPPA) interviewed author, doula, chaplain, and mother Amy Wright Glenn.

In this 35 minute reflection, Amy reads from her book, "Birth, Breath, and Death" and reflects upon the role of a doula in supporting a mother's "hero journey" through birth. Amy also shares her insights regarding the significance of breastfeeding through the toddler years and how mothers can find "harmony" with the many demands on their time. 

Treat yourself to a wonderful, inspiring, and heart-warming interview with Amy Wright Glenn. 

To listen. 

 

It seems that everything in the parenting realm is up for debate, as differing opinions and standards may ultimately drive a wedge of fear between many mothers and mother’s intuition. “Recommendations” change with the season it seems, like the first introduction of solid food, and guidelines for car seat safety. The majority adapt to the changes and use them as a guide, even as a common ground among other mothers in social settings.

                                                                                                                                                                               Photo copyright: Jennifer Canvasser
Jennifer Canvasser breastfeeding son, Zachary. Why, then, when it comes to the health and well-being of the most fragile among us (babies born prematurely), does a lack of basic rights (especially for life-saving human milk) prevail? Statistically, it is clear that breastmilk is best. The American Academy of Pediatrics (AAP) advises that breast milk can help prevent or treat diseases such as necrotizing enterocolitis (almost 90% reduction, compared to formula1), gastrointestinal tract infections (64% reduction, and lasting two months post breastfeeding), and type 1 and 2 diabetes (30%; 40% reduction, respectively), to name a few, and that ”the potent benefits of human milk are such that all preterm infants should receive human milk”. Furthermore, per the AAP, “Lower rates of sepsis and NEC indicate that human milk contributes to the development of the preterm infant’s immature host defense.”2 Jane Morton, MD, FAAP states, “Unquestionably, breast milk is far superior to any formula designed for babies, and even more critical for the health of the premature baby.”3 Yet, the majority of hospitals (as much as 60%4) in the United States do not use donor milk, and many take it a step further by supplementing with conventional cow-based formula-fortifier, sometimes against the wishes of parents.


Barriers to human milk for those in NICU span beyond hospital regulation. Most insurance plans in the United States do not cover the costs associated with using donated breast milk (from a milk bank), which can be a hefty financial load to bare when already faced with medical expenses related to birth and the NICU. Few, if any, financial resources are available to parents in regards to donor milk.
A lack of resources, support, and education can also be a deterrent for anyone when it comes to providing breast milk to NICU babies in particular. For example, not knowing how or where to donate milk; how or where to obtain pasteurized donor milk, or not being informed of the benefits of breast milk (especially breastfeeding) for premature babies.

 A mother may experience a delay in lactation immediately following birth. Her supply may not easily increase (especially in an emergency situation, or a preterm birth) as it would if baby were directly breastfeeding on demand. New moms, especially in a critical situation, do not know how to breastfeed, nor how to pump. Providing resources, education, and assistance for mothers in a hospital setting will help both physically and emotionally for a mother to flourish in feeding her child. Hospital NICUs undeniably need to revamp lactation support policies, as well as provide a comfortable environment in which a mother can express milk or breastfeed.


Babies may be taken quickly from mother after birth (as in an emergency situation). It may be days before mom and baby are reunited, and possibly longer still before mom is able to touch or hold baby. During this time especially, support and education from the hospital itself is vital… for comforting mom, for preparing her and helping establish a milk supply, and for giving both mom and baby the freedom and ability to cuddle via skin-to-skin, bond, and thrive. Allowing as much skin-to-skin as possible leads to higher success of breastfeeding and/or pumping and provides numerous benefits to baby.5

Milk Banks typically provide monetary assistance for the shipment of milk from a donor to the bank. These organizations work with individuals to ensure that the process is stress and worry free. Donors are screened, and milk is pasteurized and cultured, to ensure the highest quality for fragile babies. The Human Milk Banking Association of North America provides a list of milk banks. Human Milk for Human Babies is an organization that provides informal breast milk donation, allowing mothers to connect personally. Milk donated exchanges hands directly between donor and recipient.

 

Jennifer Canvasser, founder of NEC Society, and mother of twins born prematurely, both of whom spent a length of time in the NICU at the University of Michigan Motts Hospital, knows firsthand the challenge of fighting for the right to human milk for babies. When faced with aversion, what can be done? With whatever energy a parent of a NICU infant has, Canvasser suggests, “Ask what are the policies around human milk for fragile babies? Do you have a program? Do you provide the infants with an exclusive human milk diet?”

Having an infant in a NICU is emotionally and physically demanding. Readily available resources for parents in regards to providing human milk for their baby (whether via mom or donor) could lessen some of the burden for parents. In addition, raising awareness of the need for human milk for fragile infants, sharing stories and experiences publicly, and working with healthcare professionals and administrations can be a start to ensuring the basic rights of those born prematurely: a safe environment, access to proper nutrition, and a fighting chance!

Organizations such as NEC Society and Best for Babes, along with recent documentary “The Milky Way” are actively doing just that. Says Canvasser of NEC Society’s current mission, “Our focus is on changing practices and reducing the incidence of necrotizing enterocolitis. We strive to empower NICU families and create real change in NICU practices that will better protect fragile babies. The first step is awareness and empowering families.”

How can an individual help to raise awareness? Simply put: talk. Discuss openly the benefits of breastmilk (especially for infants born prematurely) to friends and family, speak with the local hospital about policy, reach out to local media about possibly covering the story, meet with healthcare professionals to ensure accurate information is being spread and used, advocate on behalf of someone who’s experienced a loss as a result, or is currently in the midst of the battle. When emotionally ready, share with others. As the late Maya Angelou asserted, “There is no greater agony than bearing an untold story inside you.”

Human milk nourishes, protects, and heals. Every baby, regardless of circumstance, deserves the right to thrive.

 


Sources:

1
“Necrotizing Entercolitis Risk”. US National Library of Medicine National Institutes of Health. NCBI. April 2012. Web. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3357630/>
2
“Breastfeeding and the Use of Human Milk”. Pediatrics. Vol. 129. pp. e827-e841. Official Journal of the American Academy of Pediatrics. 27 Feb 2012/1 March 2012. Web. <http://pediatrics.aappublications.org/content/129/3/e827.full#content-block>
3
“AAP Policy on Breastfeeding and the Use of Human Milk”. Breastfeeding Initiatives. 28 May 2014. American Academy of Pediatrics. Web. <http://www2.aap.org/breastfeeding/policyonbreastfeedinganduseofhumanmilk.html>
4
“Fast Facts: Miracle Milk”. NEC Society. 06 May 2014. Web. <http://necsociety.org/>

“Holding your baby close: Kangaroo Care”. March of Dimes. Web. 2014. <http://www.marchofdimes.com/baby/holding-your-baby-close-kangaroo-care.aspx>

Published in Feeding Baby

     If you asked me while I was pregnant what my plans were for feeding my little one once she arrived, I adamantly responded with “we’re going to pump”. Period. End of discussion. My reasons were, and still are, justified: I wanted my husband to be able to bond with baby in that way, I didn’t want to be the one having to do all the night feedings while my husband lay snoring next to me, I didn’t even really want my husband to see me like that (how could he ever see me as a woman – and not just a mom – ever again?), and, after seeing the invisible tether between my friends’ boobs and their babies determining what they could do and when they could do it, it was decided that breastfeeding was just not for me. These reasons may seem stupid and selfish to some, but perhaps relateable to others. Little did I know, this was just the beginning to my - our - journey.
   

     My husband and I planned a home-water-hypno birth, and after learning how beneficial immediate breastfeeding is for baby and mama, we decided to have a little give in our plan and breastfeed following our birth. And this is where it all changed. That instinctual latch, those first gulps, the look in her big blue eyes, and those amazing “I’m really a mom” feelings.    

    To say our journey has always been this blissful and easy would be an outright lie. We definitely had our ups and downs. My milk took abnormally long to come in, our little one lost too much weight, then took to hour long feedings, and I continued to question whether or not every little thing I was doing was right. Many of the feelings behind my initial plan to abstain came flooding back: Sitting up in bed, half asleep, breastfeeding every 2 hours, having to seclude myself in another room for however long it took for baby to be satiated whenever company came over - how could they not? I even remember saying to my husband, in a stressed out state, “This is why I didn’t want to breastfeed!”

    And then something clicked. I took a deep breath, decided to stop stressing about how much she was getting, how long she was feeding for, how often she was feeding, why she was feeding, and just…let it happen! I was also fortunate enough to stumble upon some amazing articles online which helped me solidify my positive relationship with breastfeeding, and it was like the fog cleared:

“Easy, long term breastfeeding involves forgetting about the “breast” and the “feeding” (and the duration, and the interval, and the transmission of the right nutrients in the right amounts, and the difference between nutritive and non-nutritive suckling needs, all of which form the focus of artificial milk pamphlets) and focusing instead on the relationship. Let’s all tell mothers that we hope they won’t “breastfeed” – that the real joys and satisfaction of the experience begin when they stop “breastfeeding” and start mothering at the breast.”(1)

    The concept of “mothering at the breast”, along with understanding that this act is about more than an exchange of nutrients and calories, honestly changed my life. I began following such online campaigns as #milkmemo from Breastfeeding USA, which posts encouraging and uplifting photos and comments for moms who may be struggling with or questioning their breastfeeding experience. I began to feel confident, relaxed, and in love with this new relationship.
 
    We are now six and a half months into our breastfeeding journey, have begun to introduce food, and have no plans of ending our relationship with breastfeeding anytime soon. I am now the mama who sees breastfeeding as more than a meal. I am the mama who leans into the carseat to breastfeed while the hubby drives. I am the comfort breastfeeding mama. I am the co-sleeping, nurse-all-night-if-you-need-to mama. But more importantly, I am a mama who has learned that not everything works out how you planned, that feelings change, and then change again, and perhaps once more. That every woman and baby have the right to experience feedings (and any of the other myriad of things to do with parenting!) however they feel is appropriate for them and their family, and that these decisions should be respected, even if they change several times. That’s life. And that is most definitely parenthood. I’m sure this is just the first of many things my little one will teach me.

(1) Wiessinger, Diane. "Watch Your Language." Journal of Human Lactation 12.1 (1996) Web. 27 April 2014

Published in Feeding Baby
Friday, 07 March 2014 14:15

Your Breastfed Baby & Colic

Many mothers experience fussiness in their babies once in a while, and this is usually accepted as part of the trials of motherhood. However, some babies have “colic,” which is described as a healthy baby, who is gaining weight steadily, crying inconsolably for over 3 hours, for an incidence that happens more than 3 days a week, for over 3 weeks.  The crying usually starts at around the same time every time and is usually in the evenings. 

It doesn't matter whether you bottle feed or breast feed your baby--roughly one in every five babies experience colic. Colic starts at around 2 weeks and ends at around 4 months old. Some identifiers of colic are:

  • baby pulls up his legs while crying

  • baby's hands may be in a fist

  • baby is very gassy and his stomach is harder than normal.

The worst part about colic is that there is no proven treatment. 

I was one of the "lucky" moms with both of my babies having colic, and at first I blamed myself. I thought I did something wrong and that my children were suffering because of what I did.  I just did not understand how my children could be experiencing colic since I took care of myself during both pregnancies and during breastfeeding: I exercised, limited my caffeine intake, rarely consumed any dairy products (I have never liked cow’s milk), ate plenty of fruits, legumes and vegetables and ate organic as much as possible. Yet both of my babies experienced colic during their first four to five months of life, and even though my second daughter is having bouts less frequently, she still has periods of extreme fussiness. The change is that I now know how to treat and even sometimes prevent them. 

Although no one really knows what causes "colic", everyone has their own theory. It really annoyed me when people would tell me I needed to stop eating my kale, cabbage, onions and spicy foods (being from Southern California, spicy Mexican foods have become a part of my heritage!) and that the colic would go away on its own. While studies show that some babies might indeed have an allergic reaction to certain food proteins that resist digestion in the small intestine and find its way into breast milk (usually typical allergens such as dairy, nuts or soy), I didn’t stop eating my kale and onions without looking into other possible problems and how to fix them. Here are some things to consider based on my studies and research:

Incorrect Latch Issues

A good latch is the key to easy breastfeeding! A lot of parents don’t realize that proper latch on the breast is absolutely necessary for a successful feed. This problem happens usually to newborns in the first few days after their mother’s milk has come in. If your baby is not latched on correctly, he could be swallowing a lot of air, thus making him gassy. Moms are also likely to have very painful nipples and even mastitis due to the improper latch. Latch is the easiest problem to solve if it is what causes your baby to have colic. 

My Suggestions:

proper latch is when the baby’s chin is pressed against mom’s breast and their nose is well away from the breast. I like to call the shape baby’s lips make a “fish’s tail”. Baby should also not be making loud sucking noises when he feeds. Contact a lactation consultant, your midwife or doctor if you have any concerns or issues with your baby latching on. 

 

Overactive or Forceful Letdown (Milk Ejection Reflex)

With both of my daughters, I have had an overactive letdown; sometimes so much that I could feel the letdown coming quite painfully. With an overactive or forceful letdown, your milk comes down very forcefully, making it hard for your baby to swallow while breastfeeding. Baby may even gag and swallow a lot of air along with the milk. An overactive letdown can cause baby to be fussy at the breast. Baby may also become unhappy once the flow of milk starts to slow down. 

When baby fills up on the watery foremilk, he may get a stomach ache from the combination of filling his stomach too fast, swallowing air to keep up with the let-down, and the laxative effect of a large quantity of lactose (milk sugar). The enzyme lactase, which digests the sugar, may not be able to handle so much milk sugar at one time and the baby will show symptoms of lactose intolerance—crying, gassiness, and explosive, watery, green poop. While people might that that having “too much” milk is a good thing, it can be very frustrating for both baby and mom.  

My suggestions: 

Keep baby on one breast per feed. If your other breast is too uncomfortably full, pump just enough between feeds to relieve the fullness, but not so much that you overproduce milk (Remember that milk production is a supply-and-demand issue). Make sure that your baby drains that breast completely to get all of the fatty hind milk, even if you have more than one let down. With a forceful letdown, it is usually the first let down that is the most painful.

Find a position that keeps baby’s head above your breast, such as propping baby up in a “sitting” position with your arm supporting him, to prevent choking during the letdown. You can also try feeding your baby while lying down in a side-lying position. 

My last suggestion is to take your baby off the breast when you feel a strong letdown coming. Catch the overflow of milk in a clean cloth, then place baby back on your breast once the letdown slows. This may or may not upset your baby more, so make sure you follow baby's signs cues. 

 

Sensitivity to cow’s milk proteins

This is NOT lactose intolerance. Lactose intolerance is the inability to digest the sugar lactose found in milk, while Cow’s Milk Protein Intolerance (CMPI) is an immunological reaction. Babies who are sensitive to dairy in mom’s diet are sensitive to specific cow’s milk antibodies in the form of proteins (not lactose) which pass into the mother’s milk. Cow’s milk (either in the mother’s diet or added into formula) is a common source of food sensitivity in babies. If your baby is sensitive to dairy in your diet, it will not help to switch to lactose-free dairy products. The problem is the cow’s milk proteins, not the lactose. 

CMPI can cause colic-like symptoms, eczema, wheezing, vomiting, diarrhea, bloody filaments found in stool, constipation, hives, and/or a stuffy, itchy nose1

My suggestions: 

If your baby is only a little sensitive to dairy proteins, you may be able to relieve baby’s symptoms by eliminating only the obvious sources of dairy: milk, cream, yogurt, butter, cheese, sour cream, ice cream, cottage cheese. You may even be able to eat small amounts of dairy without it affecting baby.

If your baby is highly allergic, it will be necessary to eliminate all sources of dairy proteins, which requires a careful reading of food labels. Also, a large amount of babies allergic to cow’s milk proteins are also allergic to soy1,2 and some may even react to goat’s milk, sheep’s milk, and even beef. 

 

Sources of Cow’s Milk Protein:

Beef, butter, butter fat, buttermilk, casein, cheese, cottage cheese, cream, ghee, half & half, kefir, lactoglobulin, lactose, all forms of milk (condensed, sweetened, whole fat, non fat, evaporated, skim, malted), nougat, pudding, sour cream, whey, whey proteins, yogurt. 

**Also make sure to avoid deli meats since many of them do contain dairy products or may have been contaminated with dairy during the process. 

Sources of Soy: 

Edamame, soybeans, soy proteins, soy milk, soy bean oil, tofu, tempeh, soy sauce, tamari, soy flour, miso, soy lecithin, and soy isoflavones.

 

It can take up to 2-3 weeks for the proteins to completely exit the mother’s system1, but sometimes baby can show improvement within as little as a week2

Once the trigger foods have been eliminated from your diet for some time, you can try slowly reintroducing dairy products. If baby still reacts, it is best to wait until baby is around 6 months old and his digestive system is stronger before reintroducing dairy into your diet3.  

The main concern with a CMRI elimination diet is the fact that dairy is a major source of calcium for many breastfeeding mothers, and without dairy it may be difficult for them to maintain the 100 mg daily recommended dose.

However, it is possible to consume enough calcium without dairy. Here are some sources of non-dairy calcium: 

Collards- 1 cup boiled and drained – 357 mg calcium

Rhubarb – 1 cup cooked– 348 mg calcium

Sardines – 3 oz / 85 grams – 325 mg calcium

Spinach – 1 cup boiled and drained – 291 mg calcium

Turnip Greens – 1 cup boiled and drained – 249 mg calcium

Blackeye peas – 1 cup cooked – 211 mg calcium

Kale – 1 cup boiled and drained – 179 mg calcium

Bok choy – 1 cup boiled and drained – 158 mg calcium

Beans, baked– 1 cup – 142 mg calcium

Okra – 1 cup boiled and drained – 136 mg calcium

Shrimp – 3 oz / 85 grams canned – 123 mg calcium

Crab – 1 cup canned – 123 mg calcium

If you are not sure that you are getting enough calcium through diet alone, consider a calcium supplement. If you do this, make sure that the supplement you choose is combined with magnesium in a 2:1 ratio so that your body will readily absorb it. 

**Before starting any elimination diet, please consult a nutritionist or your doctor to ensure you will be getting enough nutrients and to make sure you will not be deficient. 

 

Sources:

"Dairy and Other Food Sensitivities in Breastfed Babies." Kelly Mom. 26 July, 2011. Web. Mar 2014. 

"Cow's milk protein allergy through human milk." National Center for Biotechnology Information. March 19, 2012. Web. Mar 2014.

"Eating Like a Cow: Breastfeeding & Cow's Milk Protein Intolerance." Childhood 101. n.p. Web. Mar 2014.

Published in Feeding Baby
Monday, 25 November 2013 10:49

A Day to Live Again

Oh little boy. If I could just pick one day in my life to live over and over again, it may well be today. Why not? It was just a perfect day with you. We played in the ocean. You “swam” back and forth between Carol and me. You laughed with me playing tag around the chair in the front room. We biked together. You chased the cat clicking your tongue as you hear me do that when I call her. She always runs from you, but that doesn’t mean you don’t love to try to get her. We played in the back of the pick up truck. I drummed out a song on the steel and you spun around and around a few times dancing. I just love the beyond this world tenderness when you cuddle into my arms and nurse yourself to sleep.

If I could live any day in my life over again, it would certainly be a day when you breastfed. I love the tenderness and the kindness that comes from the way you suckle milk from my body. It nourishes your every cell. It’s completeness incarnate. Joy incarnate. I just love you little one. My sweet boy. My courageous, funny, go down the slide yourself over and over little guy.

May you always know how precious you are to me. May you always trust that I’ve got your back. May you know how much your mother loved you, all the way through the marrow of her bones. I do. No matter what happens in this world. No matter what happens at all. These days are holy and precious beyond money, beyond gold, beyond anything. That is why I’m doing everything I can to keep them happening. To keep them flowing. I will defend your right to breastfeed. I will make the money needed to keep your father relatively calm so that you and I can have these days together. It’s the best for your early development. I know that through and through. It’s perfection. 

If I could live one day again in my life, this precious, fleeting mysterious, challenging, and holy life--- it would be a day like today with you.

Sleep well angel.

Mom

 

 

 

 

The term lactation consultant or LC has become the title for someone with expert knowledge in breastfeeding; an allied health professional who specializes in the clinical management of breastfeeding. They may be employed in hospitals, public health programs, and private practice. They work with moms and babies to address breastfeeding issues and concerns. They may also teach classes, assist with establishing breastfeeding, and promote and protect breastfeeding.

Origin of the term “Lactation Consultant”

The term “LC” originated as a short form of “IBCLC” or International Board Certified Lactation Consultant because, as you can see, that term is a mouthful.

“LC” is not trademarked and does not hold a professional standard like “IBCLC” does, so one will occasionally find a practicing LC who is not an IBCLC. Consumers (mothers and families) and other professionals (doulas and doctors) need to be aware of this.

As well, not all those who work as “lactation consultants” in health centers or breastfeeding support centers are IBCLCs. Some employers encourage employees to pursue the credential but don’t mandate it for employment.  Many times, nurses with some breastfeeding education fill these jobs.

Why is this IBC part so important?

The International Board of Lactation Consultant Examiners (IBCLE) awards the title of International Board Certified Lactation Consultant to only the candidates who meet the comprehensive pathway and pass an international exam. This allows IBLCE to establish the highest standards in lactation and breastfeeding care worldwide and to certify only the individuals who meet these standards.


BIRTH

ROLE/RESPONBILITY

BREASTFEEDING

Childbirth Educator

EDUCATION

Lactation Educator

Doula

SUPPORT

La Leche League Leader

Midwife

CLINICIAN/MANAGEMENT

IBCLC

 

All the roles are important, but they provide their own distinct scope, responsibilities, and abilities. They can all work together to provide comprehensive support. One does not replace the other.

Primary roles of caregivers

As you can see, I’ve broken this down into three primary roles.

1.      Education

2.      Support

3.      Clinical management

Education

Educators teach you about the normal and expected processes of childbirth and breastfeeding. They typically call themselves childbirth educators and lactation educators

They teach the normal process of birth & breastfeeding and what you can expect when having a baby and breastfeeding, as well as encourage and promote breastfeeding to others.

This information helps you make decisions, helps you know if you are on track, gives you references for getting the birth and breastfeeding relationships you want, and helps answer your questions.

Educators typically teach community classes in group settings.

Support

Support people are those who have additional training in supporting mother, baby, and family during crucial times: birth and breastfeeding.

They’re typically doulas and La Leche League (LLL) leaders. Doulas are usually paid professionals, and LLL is a mother-to-mother volunteer peer support group. These roles offer the encouragement and motivation you need to get through the processes of birth and breastfeeding.

They’re well versed in normal and expected outcomes. They know to watch for red flags to ensure they can guide you to further resources and caregivers if you have come outside the normal, expected process.

Their job is to provide physical and emotional support, encouraging you to ask questions of your caregivers to make sure you’re well informed about what occurs. They have resources and guidelines to reassure you that you’re indeed in the realm of normal, and if things deviate from normal, they can point you in the direction of more resources. They are not health care professionals and do not perform medical tasks.

Clinical management

Lastly, we have the clinical management professionals.

These are the folks responsible for the clinical and medical bits of the scenario. They look at the facts and figures, histories, and red flags to determine if the scenario is within the normal and expected category and making a plan from there if it not. They are the big picture thinkers. They have the clinical experience of birth &breastfeeding that fall outside normal expectations and how to manage them.

Closing Remarks

All of these people have a place in the realm of support and care giving; what is important is that people know their role and responsibly and respect the others. Where it becomes problematic is when the client/consumer is expecting one thing and gets another because they have the various people confused for another and their expectations are not met and they think it is because “that” person did not do their job. In the case of this article, we are really looking at how an IBCLC stands out.

 

Let’s say a mom thinks that a Lactation Educator is an IBCLC, and her breastfeeding issue does not resolve after a consultation.  She looks for more help and calls a La Leche League leader who determines that the issue is outside their scope and needs a recommendation to an IBCLC.  When the LLL Leader suggests this, the moms says, “I already saw one and they did not help.” This hurts all of the support people. The educator gets a bad rep because she did not help, but it is the IBCLC profession that gets the bad rep because of the misunderstanding of the different roles and expectations. And LLL could not help because the needs were not within their scope. Moms need to know with some clarity what their expectations are and who the best person is to meet their expectations based on role, scope and experience. 

Published in Feeding Baby
Wednesday, 13 November 2013 00:00

Breastfeeding: How to Soothe Sore Breasts

It happens to the breast of us

Sore breasts caused by a sudden increase in milk flow and/or barriers to breastfeeding are absolutely normal and dreadfully unavoidable. There are, however, ways to ease the pain and assist mom in enjoying the art of breastfeeding.

Whether pain and discomfort is from engorgement, cracking and drying, or mechanical issues (i.e. improper latching), mom does not have to suffer in silence. Breastfeeding is an amazing achievement and experience, and should not be discontinued or dreaded because of soreness!

Awful, unbearable pain is not exactly normal. Yes, it does happen, and there are reasons for it, but pain should not last more than 24-36 hours. Consult a physician, doula, or lactation consultant in the case of extreme pain, fever, or excessive cracking or bleeding, as there is a possibility of an infection or underlying issue.

Soreness due to engorgement

When milk is being produced in abundance without a release, breasts can become hard, swollen, and tender. Here are a few ways to help make it easier to tolerate:

  1. Use a hot pack on the top of the breasts shortly before feeding.
  2. Use cold packs on the top of the breasts shortly after feeding.
    - One AWESOME trick (image seen above) is to fill 2 diapers with water and place them in the freezer. Once frozen, remove from the freezer and break up the ice a bit. The diapers turn into wonderful ice packs that fit the breasts well; they cup the breast better than the average ice pack.
  3. Wear a sturdy, supportive bra that is not too snug. Avoid underwire.
  4. A warm shower. Letting warm water run on the breasts works wonders.
  5. Gently massage the tops of the breasts - from right above the nipple up towards the chest, and from the side of nipple towards the armpit.
  6. Pump. This is not ideal during the first few weeks of breastfeeding as the baby is going through such tremendous growth spurts that it may confuse the body's natural response to produce (more) milk. However, if needed, pump a little from both breasts prior to breastfeeding, or pump one breast while the baby feeds from the other. Doing the second is less likely to trigger the body to produce more milk than necessary, and will help to ensure even flow. Pump on a low setting (if doing so electronically) and only for a few minutes, unless pumping one side while feeding with the other. 

Soreness due to cracking, drying, and/or mechanical issues

Having cracked and dried nipples can make breastfeeding extremely painful. Allowing them to heal is vital for the success of breastfeeding. Below are a few suggestions for how to soothe sore nipples due to cracking, drying, and more:

  1. Allow the nipples to "breathe". Let the nipples relax and air out for about ten minutes after feeding, and after applying any sort of moisturizer, as moisture can increase the likelihood of cracking and other issues. Additonally, sticking to fabrics may be an issue if nipples are moist.
  2. Use cold/ice packs between feedings for comfort.
  3. Make sure that the baby is properly latching onto the nipple. Consult a lactation specialist or your doctor if questioning the latch.
  4. Use colostrum/breast milk. Rub a bit onto and around the nipple after feeding.
  5. Rub a bit of coconut oil (cold pressed and organic) onto the nipple after each feeding.
  6. Feed evenly. Start with the least sore breast. Try not to feed for more than 20-25 minutes on one side at one time (when baby is young). Switch as needed. [Note: Do not take the baby off of one breast to switch after only a few minutes. This can cause gas, as the first bits that come out of the breast are less caloric and higher in sugar content, and that can build up in the baby's system.]
  7. Change positions. Think of the nipple as a clock. Have the baby's mouth stretch across 12 & 6, and then across 3 & 9. This can be done by alternating between a cradle and a football position (or other positions).
  8. Relax. Do not tense up when the baby is latching on. Try to breathe, and focus on dropping your shoulder blades towards your rear.
  9. Use breast pads when not feeding. Make sure that pads are changed often and remain dry (do not allow the pad to become soaked with milk). Organic cotton washable pads work well, and are less harsh as far as friction.
  10. Soothies are gel pads made by Lansinoh that last for a few days and are disposable, Soothies help soothe the nipples with a cooling effect and protect against friction. They are reusable (usually for a few days) and absorbent. This brand also makes a hot/cold pack for breasts.
  11. Speak with a lactation consultant about trying a nipple shield. Consult them with any questions and for a proper fitting. Nipple shields are also helpful for moms with inverted or small nipples, for a baby with a shallow latch, and for hurt or sore nipples. They are not, however, meant to be used long term, and can end up being a barrier to breastfeeding later on if not used appropriately. Wean baby from the nipple shield once the breasts have healed.
  12. Natural cream, such as Nipple Butter from Earth Mama Angel Baby, Organic Nipple Balm from the Honest Company, or Nipple Cream from Mababa. These products have ingredients to help not only soothe but heal the area, and can be purchased from the local health food store, or online.
  13. Olive Oil. Dab just a bit on the nipple. There's no need to remove prior to nursing, but you certainly can if you would prefer to.
  14. Clean, cold, organic cabbage leaves. They, like the diaper ice packs, cup the breast.
  15. If all else fails, consult your doctor to see if medication may ease the discomfort and help with swelling.
     

Do not suffer in silence

If symptoms persist for more than a few days (after beginning treatment), a clogged duct or infection is suspected, or there is a noticeable amount of blood excreting from the nipple, contact your physician, doula, or lactation consultant.

Lactation consultants and doulas are well-educated and very resourceful. Contact one at a local hospital, try La Leche League, or ask around. There are many forums and websites devoted to helping make mom and baby's lives easier, breast feeding included. Speak with someone about any questions or concerns, and meet in person to review positions, latching, and more, as this will help significantly improve the quality of feedings.

Make sure to stay hydrated, of course, when breast feeding. Adding natural anti-inflammatory and pain relieving ingredients - such as garlic, turmeric, and ginger - to the diet may help as well.

Breastfeeding is a beautiful thing, and so beneficial for both mom and baby! This is just a tiny pebble in the road to bonding, nutrition, and pure blissful love. Do not suffer in silence, mama!

Published in Feeding Baby
Monday, 11 November 2013 20:31

How to Increase Breast Milk Supply

As if society does not place enough pressure on breastfeeding mothers, add in that nagging “good mother’s voice” and times of low milk supply with a demanding infant ready to nurse, and one has the ultimate recipe for a milk supply strike. First and foremost, women have been breastfeeding for thousands of years. The body is perfectly engineered to give baby what baby needs, when baby needs it. Demanding the breast and constantly wanting to nurse is a sign of a healthy eater who wants to breastfeed. It may mean less restful sleep for mom, or possibly sore breasts, but it is important to stick with it, and know that baby will help the body produce more milk. A woman’s body is designed and destined to work with the baby. As the baby demands more milk, the body produces it. Sometimes, it may feel as though the body is not keeping up with baby, and then - as if with a snap of fingers, the white gold flows.

Babies go through an average of five to seven growth spurts within the first year of life.1Growth spurts are directly correlated to the sleep and eating patterns of babies. One of the most common reasons for ending nursing early, supplementing with formula, and causes for stress for a breastfeeding mother is what is thought to be a low milk supply. Often, during growth spurts, the body takes a bit of time to catch up to the always-changing demand of the baby. It is vital that the baby be allowed to continue to attempt to nurse, especially during times of growth spurts, in order to solidify the longevity of breast feeding. Supplementing takes away from time at the breast, which is a contributing factor to low milk supply in the first place.

 

There are many reasons one may have a low milk supply; stress, baby not nursing due to lip tie, hormones, recent surgery, lack of time at the breast/pumping, poor nutrition, etc. Regardless of the reason, there are plenty of ways to help pick that milk supply back up in order to nurse on! After determining (the best one can) the cause of the drop in production, consider some of the following to aid in getting back on track.

Nutrition

Staying hydrated is important for anyone and everyone, but especially so for breastfeeding mothers. Skip the caffeine whenever possible. Too much caffeine can deplete the body of vital nutrients and cause dehydration. Drink plenty of water throughout the day. For those who easily bore with basic water, add in some almond milk, coconut water, or a juice of a variety of fruits and vegetables. It is natural and normal for mothers to feel dehydrated when nursing. Keep a water bottle handy and within reach, and sip the day away.

Just as there are natural remedies for ridding the carpet of that pesky stain, and for lessening the duration of the seemingly ever-lasting cold, increasing milk production has its own herbal best friends. Fenugreek and blessed thistle are classified as galactogogues, or milk makers.2 Other beneficial natural herbs include fennel, brewer’s yeast (used most often in “lactation cookies”), raspberry leaf, alfalfa, hops, stinging nettle, motherwort, milk thistle, basil, chamomile, and goat’s rue. These herbal ingredients can be consumed as a tea, mixed in with water, used in foods, or taken as a supplement. Do some further research on each to determine if it is the right choice, and become familiar with the galactogogue of choice. Mother’s milk tea, from Earth Mama Angel Baby, is widely recommended, as it encompasses a few galactagogues in one, easy to drink tea.

Along with staying hydrated and adding herbs to the diet, eating proper and healthy meals throughout the day is also important; not just for maintaining and producing breast milk, but for the baby, too. Anti-inflammatory foods may help; like garlic, ginger, and turmeric. Eating plenty of fruits and vegetables, along with an adequate amount of protein, will produce great results, and help mom and baby to feel fantastic all day long.

Boob, Boob, and More Boob

One of the easiest, yet tedious and tiring, ways to produce more milk is to trick the glands into thinking that it is growth spurt time. Offer the breast at every given possibility, even if baby only nurses for a short time. Pump or express milk, too. Massage the breasts in between nursings and/or pumping/expressions. This will help to reduce the likelihood of clogged ducts (another reason for a dip in supply). Think happy baby thoughts while pumping and/or nursing to help with the let down and stimulation of milk ducts. Look at pictures of the lovely little one, or read a magazine or article about babies or breast feeding.

Stress Less

Being stressed is bad all-around, not just for breast feeding. The higher the stress level, the less milk is produced. How, though, with such little time in the day, do moms find time to unwind? Taking a few moments to meditate can be as calming as taking a long run, just as doing yoga with or without baby is a stress reliever all the same. Other things to reduce stress are to journal, talk with a friend, go for a quick walk, take a bath or shower, drink some tea, read a book, take a class, do a craft, do an at-home facial, sit in silence for five minutes, cuddle, cook a favorite meal, paint nails, look at old pictures, plan a vacation, do some pushups or a quick ab workout, color or paint a picture, write a letter to baby or a friend, or do something else that requires some “me time”.

If absolutely necessary, there are natural herbs and foods that can help alleviate stress, like L-Theanine, Inositol, St. John’s Wort, lavender, and magnesium. Of course, as always, do personal research, as other medications being taken may interact. The main point in taking such herbs is to lower stress levels. Long-term use of such herbs may not be best for everyone. Therefore, finding stress relieving avenues that do not involve herbs and medications, and fits well with one’s lifestyle and schedule, is recommended.

Other Ways to Increase Milk Production

Skin to skin contact with baby may help make baby want to nurse more, and may help to stimulate milk production in mom. Some mothers opt for acupuncture as a means to stepping up the breast milk game. If back issues and pain are contributing to a decrease in milk supply, seeing a chiropractor may help. Antibiotics and other medications can contribute to a dip in production, too. Taking probiotics daily can help the body to combat the effects of such medications.

Decreasing the use of nipple shields, bottles, and pacifiers may aid as well, as sometimes cause barriers to nursing at the breast. If there is an issue in regards to nipple confusion or baby pacifying, try limiting the use of such products. "Babywearing" helps to keep baby near the breast, which - like skin to skin contact - helps both mom and baby with wanting to nurse.

An old Irish wives tale is to drink half (about six ounces) of a craft beer daily. It is thought that not only will it help mom to relax, but the barley and hops (typically higher in content in craft and specialty beers) helps with milk production as well.3 Doing so is at the discretion of the mother, and should be done with proper timing, as to avoid possibly (although unlikely) contaminating the breast milk. As TBS can not condone drinking while nursing, please do thorough research and always be responsible, as TBS knows moms are with every decision.

Consuming the placenta has been known to help increase milk supply as well as many other fascinating benefits. The placenta can be dehydrated and encapsulated, initially eaten raw as part of a smoothie, or consumed more long-term as a tincture. 

If all else fails, yes, there are medications that have been known to help increase breast milk supply. Speak with a physician or lactation consultant, and research further about medication. There are many known side effects, and medication is not personally recommended, but it is an option. Physicians can determine if low levels of prolactin or other hormone imbalances are a part of the problem. Some medications that are commonly prescribed for low milk supply are Metoclopramide (Reglan), Sulpiride (Dolmatil, Eglonyl, Sulpitil, Equemote, Sulparex), and Domperidone (Motilium). Empowering and educating oneself is the first step in determining whether or not medication is the right path to take.

Chin Up and Feed On

Breastfeeding moms with a dip in supply can most definitely bounce back to nursing bliss. Surrounding oneself with support and positivity can work wonders, along with the help of nature, exercise, baby, and sometimes, doctors. Do not suffer in silence, or stress over “not producing enough for baby”. There are already so many factors working against breastfeeding mothers, that mothers’ thoughts need not be one.

Nurse away, and do so with the confidence that breastfeeding and baby’s health are absolutely worth it. Seek help if needed, confide in others, and rest assured that more mothers suffer from low milk supply than one would think. Again, there are many factors that are attributed to a decrease in milk production, but the majority of them can be resolved easily and painlessly.

With these suggestions, next stop: How to Manage an Oversupply

Sources:

1Life Stages Feeding. Brittney Kirton. Everything you need to know about infant growth spurts. <http://www.lifestagesfeeding.com/blog/everything-you-need-to-know-about-infant-growth-spurts/>

2 Ask Dr. Sears. 2013. Herbs to Increase Milk Supply <http://www.askdrsears.com/topics/feeding-eating/breastfeeding/while-taking-medication/herbs-increase-milk-supply>

3 Mother Food - A Lactogenic Diet. Hillary Jacobson. 13 Oct. 2011. Beer as a Galactagogue - A Brief History. <http://lactogenicdiet.blogspot.com/2011/10/beer-as-galactagogue-brief-history.html>

Published in Feeding Baby
Thursday, 28 November 2013 09:07

Why Public Breastfeeding Is Necessary

Countless ingredients, some yet to be discovered, perfect nourishment and comfort for the child, and life saving processes for the mother; No one can question the benefits derived from, not just breast milk, but the act of breastfeeding. Yet it seems every day there is a new story about a mother being harassed and humiliated trying to do so. So often, these people claim to be 100% pro-breastfeeding but say that the act should only be done in one's home, that their teenagers or husbands should not be exposed to it, or question how they could possibly find a way to explain what the mother and baby are doing to their children. Some even reduce it to the equivalent of using the bathroom! In their opinion, breastfeeding should be covered, hidden, and/or secluded. They claim to be 100% for breastfeeding but fail to estimate the damages society incurs by NOT seeing a mother feed her baby as nature intended. How will other women, very possibly including their daughters and granddaughters, learn to breastfeed if they aren’t exposed to it? How will their sons best learn to support the breastfeeding women in their life if they have never encountered it before?

Years ago formula was either too expensive or too dangerous to risk. Breast pumps were scarce and not known about like they are today. These women still had to leave their homes at some point and their babies still had to be fed. Back then mothers would have been exposed to their mothers, aunts, sisters, friends, and other relatives, even their grandmothers, breastfeeding. No one would have questioned what the best action to take would be. Simply feed your baby, relieve your breasts, and move on with life. However, we can’t do that anymore, not these days; now that formula is widely considered a superior way to feed a child and breast pumps abound. Now mothers feel the need to be cautious. They become anxious, almost paranoid, waiting for someone to give them that “look” or worse, confront them. Lots of mothers are prepared for such nowadays but there are just as many who aren’t.

There are some who are more comfortable with a cover regardless of what others might think, myself included, but my 13 month old will not tolerate one. Plus, the last time I used a cover, I put my head under it and the air was so thick it was almost hard to breathe, my baby was covered in sweat and we were in a car with the AC on blast! Since then my cover has found its way to the bottom of the diaper bag, I haven’t used it since. Fortunately for myself, my 13 month old doesn’t need to eat as much. Unfortunately, when he does need to eat, he will not allow this cover; He’ll either pull it up or off or play peek-a-boo with everyone else in the room with it. If my car is parked some distance away or whatever reasons permitting, I refuse to reduce my son to getting his nourishment and comfort within the confines of a bathroom. A lot of times when we go out, I do not plan on it and when we do plan on going out, I usually cannot find the time to pump my milk. Some women do not respond to a pump whatsoever, I do, but it takes me about 45 awkward and somewhat painful minutes to pump 1 5oz. bottle which defeats the purpose since my son will not take a bottle, even when he was younger, and he will not drink my milk from a sippy cup although he does drink other beverages from a sippy cup now. Even at this stage, my breasts become uncomfortably full going just a few hours without feeding him.

Most women breastfeed their babies discreetly, from a glance you wouldn’t be able to tell that they were doing anything more than holding their child, and when something does end up getting exposed, it is temporary and usually minimal, doubtfully the result of her trying to catch some attention. Even if a person is more comfortable using a cover or going somewhere more private, let’s make them feel welcomed if it isn’t working out for them and instead of insulting the mother, regardless of of the age of the child, how about we praise what an amazingly awesome job she is doing? This way, children will grow up acknowledging breastfeeding as the normal way to feed a baby. It will then impact others to believe likewise and ensure mother and baby's health and create a supportive society which will then encourage other mothers to feel comfortable to at least try breastfeeding and that alone would produce healthier generations.

Published in Jessica's Blog
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