Christian Doulas

Mamas and their Nurslings

 

What a tremendous blessing it is to feed your baby from the very source made by the hand of God, who has promised to give nursing mothers special care and succor:

 

"Like a shepherd He will tend His flock,

In His arm He will gather the lambs        

And carry them in His bosom;

He will gently lead the nursing ewes." (Isaiah 40:11, NASB))

The best resource site on the web for the answer to most breastfeeding problems is Dr. Jack Newman's.

The most knowledgeable group to turn to for breastfeeding advice is La Leche League; though LLL often meets in church buildings, they are not a Christian affiliation, so we at the Christian doula site encourage you to be wary of any parenting advice you might find there! Even so, you would do well to contact them if you find you need encouragement or help with nursing.

In Bloomington, LLL meets twice a month:

Morning meetings are held on the third Tuesday of each month at 10 a.m. at the Vineyard Community Church, 2375 South Walnut (behind T&T Pet Food & Supply).

Evening Meetings are held on the first Thursday of the month at 6:30 p.m., at St. Mark's United Methodist Church, 100 N State Rd 46 Bypass (just past Starbucks).

 

You've heard that breastfeeding your baby helps lower your chances for breast cancer. Here's a fabulous article to see why that is the case.

 

Colic in the Breastfed Baby


The breastfeeding baby with colic

Aside from the colic that any baby may have, there are three known situations in the breastfed baby that may result in fussiness or colic. Once again, it is assumed that the baby is gaining adequately and that the baby is healthy.

 

    1. Feeding both breasts at each feeding

Human milk changes during a feeding. One of the ways in which it changes is that the amount of fat increases as the baby drains more milk from the breast. If the mother automatically switches the baby from one breast to the other during the feed, before the baby has “finished” the first side, the baby may get a relatively low amount of fat during the feeding. This may result in the baby getting fewer calories, and thus feeding more frequently. If the baby takes in a lot of milk (to make up for the reduced concentration of calories), he may spit up. Because of the relatively low fat content of the milk, the stomach empties quickly, and a large load of milk sugar (lactose) arrives in the intestine all at once. The protein which digests the sugar (lactase) may not be able to handle so much milk sugar at one time and the baby will have the symptoms of lactose intolerance—crying, gas, explosive, watery, green bowel movements. This may occur even during the feeding. These babies are not lactose intolerant. They have problems with lactose because of the sort of information women get about breastfeeding. This is not a reason to switch to lactose free formula.

  • Do not time feedings. Mothers all over the world have breastfed babies successfully without being able to tell time. Breastfeeding problems are greatest in societies where everyone has a watch and least where no one has a watch.
  • The mother should feed the baby on one breast, as long as the baby actually gets milk from the breast (see videos at www.thebirthden.com/Newman.html) until the baby comes off himself, or is asleep at the breast. If the baby feeds for a short time only, the mother can compress the breast (handout #15 Breast Compression) to keep the baby feeding, not just sucking. Please note that a baby may be on the breast for two hours, but may actually feed for only a few minutes. In that case the milk taken by the baby may still be relatively low in fat. This is the rationale for compressing the breast. If, after "finishing" on the first side, the baby still wants to feed, offer the other side.    Do not prevent the baby from taking the other side if he is still hungry.
  • The next feeding, the mother should start the baby on the other breast in the same way.
  • The mother's body will adjust quickly to the new method, and she will not become engorged or lop sided.
  • Just as there should be no “rule” for feeding both breasts at each feeding, there should be no rule for one breast per feeding. Let the baby finish on one breast (use compression to keep him feeding longer) but if he wants more, then offer the other side.
  • In some cases, it may be helpful to feed the baby two or more feedings on one side before switching over to the other side for two or more feedings.
  • This problem is made worse if the baby is not well latched on to the breast. A good latch is the key to easy breastfeeding.
    2. Overactive letdown reflex

A baby who gets too much milk too quickly, may become very fussy, very irritable at the breast and may be considered “colicky”. Typically, the baby is gaining very well. Typically, also, the baby starts nursing, and after a few seconds or minutes, starts to cough, choke or struggle at the breast. He may come off, and often, the mother's milk will spray. After this, the baby frequently returns to the breast, but may be fussy and repeat the performance. He may be unhappy with the rapid flow, and impatient when the flow slows. This can be a very trying time for everyone. On rare occasions, a baby may even start refusing to take the breast after several weeks, typically around three months of age.

  • If you have not already done so, try feeding the baby one breast per feed. In some situations, feeding even two or three feedings on one breast before changing to the other breast may be helpful. If you experience engorgement on the unused breast, express just enough to feel comfortable.
  • Feed the baby before he is ravenous. Do not hold off the feeding by giving water (a breastfed baby does not need water even in very hot weather) or a pacifier. A ravenous baby will “attack” the breast and may cause a very active letdown reflex. Feed the baby as soon as he shows any sign of hunger. If he is still half asleep, all the better.
  • Feed the baby in a calm, relaxed atmosphere, if possible. Loud music, bright lights are not conducive to a good feeding.
  • Lying down to nurse sometimes works very well. If lying sideways to feed does not help, try lying flat, or almost flat, on your back with the baby lying on top of you to nurse. Gravity helps decrease the flow rate.
  • If you have time, express some milk (an ounce or so) before you feed the baby.   Not the first thing to try.
  • The baby may dislike the rapid flow, but also become fussy when the flow slows too much. If you think the baby is fussy because the flow is too slow, it will help to compress the breast to keep up the flow (handout #15 Breast Compression).
  • This problem is made worse if the baby is not well latched on to the breast. A good latch is the key to easy breastfeeding.
  • On occasion giving the baby commercial lactase (the enzyme that metabolizes lactose), 2-4 drops before each feeding, relieves the symptoms. It is available without prescription, but fairly expensive, and works only occasionally.
  • A nipple shield may help, but use this only if nothing else has helped and only if you have got good help without any relief.    This is a second last resort.
  • As a last resort, rather than switching to formula, give the baby your expressed milk by bottle.
    3. Foreign proteins in the mother's milk

Sometimes, proteins present in the mother's diet may appear in her milk and may affect the baby. The most common of these is cow's milk protein. Other proteins have also been shown to be excreted into some mothers' milk. The fact that these proteins and other substances appear in the mother's milk is not usually a bad thing. Indeed, it is usually good, helping to desensitize your baby to these proteins. Ask about this if you have any questions.

Thus, in the treatment of the colicky breastfed baby, one step would be for the mother to stop taking dairy products or other foods, but only one type of food at a time. Dairy products include milk, cheese, yoghurt, ice cream and anything else that may contain milk. When the milk protein has been changed (denatured), as in cooking for example, there should be no problem. Ask if you have any questions.  

If eliminating certain foods from the mother’s diet does not work, the mother can take pancreatic enzymes, starting with 1 capsule at each meal, to break down proteins in her intestines so that they cannot be absorbed into her body and appear in the milk.

Please note: Intolerance to milk protein has nothing to do with lactose intolerance, a completely different issue. Also, a mother who is lactose intolerant herself should also still breastfeed her baby.

Suggested method:

  • The mother should eliminate all milk products for 7-10 days.
  • If there has been no change, the mother can reintroduce milk products.
  • If there has been a change for the better, the mother can then slowly reintroduce milk products into her diet, if these are normally part of her diet. (There is no need to drink milk in order to make milk). Some babies tolerate absolutely no milk products in the mother's diet. Most tolerate some. The mother will learn what amount of dairy products she can take without the baby reacting.
  • If there is concern about your calcium intake, calcium can be obtained without taking dairy products. But, 7-10 days off milk products will not cause any nutritional problems. Actually, evidence suggests that breastfeeding may protect the woman against the development of osteoporosis even if she does not take extra calcium. The baby will get all he needs.
  • The mother should be careful about eliminating too many things from her diet. Everyone will know someone whose baby got better when the mother stopped broccoli, beef, bananas, bread, etc. The mother may find that she is eating white rice only. Our diets are too complex to be sure exactly what, if anything, is affecting the baby.

Be patient, the problem usually gets better no matter what. Formula is not the answer, but, because of the more regular flow, some babies do improve on it. But formula is not breastmilk. In fact, the baby would also improve on breastmilk from the bottle because of the regularity of the flow. Even if nothing works, time usually helps. The days and nights may seem eternal, but the weeks will fly by.

 

by Dr. Jack Newman

Video Demonstrating Compression Technique

...Especially good to use if your baby falls asleep mid-nursing. If video is not loading, see it here.

 

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and another one, with a just-in-case link as well...

 

 

 

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Breastfeeding Trouble Shooting: Sore Nipples and sore breasts

First, ask yourself, am I:

Allowing nipples to air after feeding?

Using pure lanolin ointment?

Positioning baby on nipple instead of on areola?

Checking for thrush if persistent, extreme soreness with sudden onset?

Rotating positions at successive nursings to change pressure points?

Beginning breastfeeding on least sore side?

Washing nipples with soap or antiseptic?

Using breast shields with plastic liners?

Using poor pump?

Wearing a too tight bra or one with under wires that are not positioned well?

Confusing baby with any rubber nipples?

(nipple shield, pacifier, bottle, etc.)

Pulling down bra flap when it has adhered to nipple? (See first item...)

Tickling baby’s mouth open WIDE and then pulling baby in close and parallel to mom’s tummy?

Then you can follow Dr. Newman's suggestions for treating sore nipples and sore breasts:

"1. “All purpose nipple ointment”
This combination of 3 ingredients seems to help for many causes of sore nipples, including poor latch, Candida (yeast), dermatologic conditions, infections of the nipple with bacteria and possibly other causes as well. It is always good, however, to try to assure the best latch possible, because improving the latch helps with any cause of pain.

mupirocin 2% ointment (not cream): 15 grams betamethasone 0.1% ointment (not cream): 15 grams
To which is added miconazole powder so that the final concentration is 2% miconazole.
Sometimes it is helpful to add ibuprofen powder as well, so that the final concentration of ibuprofen is 2%.
This combination gives a total volume of approximately 30 grams. Clotrimazole powder to a final concentration of 2% may be substituted if miconazole powder is unavailable, but both exist (the pharmacist may have to order it in). I believe clotrimazole is not as good as miconazole, but I have no proof of that. Using powder gives a better concentration of antifungal agent (miconazole or clotrimazole) and the concentrations of the mupirocin and betamethasone remain higher.
The combination is applied sparingly after each feeding (except the feeding when the mother uses gentian violet). Do not wash or wipe it off, even if the pharmacist asks you to. In Canada, Kenacomb (easier to find) or Viaderm KC (less expensive) ointments (not cream) can be substituted for the above combination, but are distinctly inferior. I used to use nystatin ointment or miconazole cream (15 grams) as part of the mixture, and these work well, but I believe the use of powdered miconazole (or clotrimazole powder) gives better results.
2. Gentian violet for treating Candida is discussed here.
3. Grapefruit seed extract
Grapefruit seed extract can also be used for treating Candida as well. It can be used directly on the nipples and/or orally. If used directly on the nipples, it should be diluted (5 to 15 drops in 30 ml or 1 ounce of water), applied on the nipples with a Q-tip or cotton ball, allowed to dry, and then covered, sparingly, with the all purpose nipple ointment. By mouth, grapefruit seed extract can be taken as a pill, 250 mg three times a day.
4. Treatments for Raynaud’s phenomenon (blanching of the nipple)
Raynaud’s phenomenon is due to spasm of blood vessels preventing blood from getting to a particular area of the body. It occurs in response to a drop in temperature. Most commonly, Raynaud’s phenomenon will occur in the fingers, typically when someone goes outside from a warm house on a cool day. The fingers will turn white and the lack of blood getting to the tips of the fingers will cause pain. Raynaud’s phenomenon occurs more commonly in women than men, and is often associated with illnesses such as rheumatoid arthritis.
Raynaud’s phenomenon can also occur in nipples. In fact, it is much more common than generally believed. It can occur along with any cause of sore nipples, but it may also, on occasion, occur without any other kind of nipple pain at all.
Typically, Raynaud’s phenomenon occurs after the feeding is over, once the baby is already off
the breast. Presumably, the outside air is cooler than the inside of the baby’s mouth. When the baby comes off the breast, the nipple is its usual colour, but soon, within minutes or even seconds, the nipple will start to turn white. Mothers generally describe a burning pain when the nipple turns white. After turning white for a while, the nipple may actually turn back to its normal colour (as blood starts to flow back to the nipple), and the mother will notice a throbbing pain. The nipple may go back and forth between colours (and types of pain) for several minutes or even an hour or two.
The treatment for Raynaud’s phenomenon is to fix the original cause of the pain (poor latch, Candida etc). Almost always, as the nipple soreness from another cause is getting better, so will the pain from Raynaud’s phenomenon get better, but more slowly. Fixing the original cause of the pain (improving the latch, treating Candida etc) should be the focus of treatment. However, some mothers no longer have pain during the feeding, or never had it at all. Indeed, some start having Raynaud’s phenomenon during the pregnancy. If the pain is mild, there may be no reason to treat, and reassurance is all that is necessary. However, in some cases it is worth treating, especially if severe, and especially if the pain during the feeding does not improve, as severe restriction of blood supply to the nipple may delay healing.
The first choice for treatment is:
• Vitamin B6. This has shown to work by trial and error, but it does seem to work. There is no scientific evidence that it works, but it does nevertheless. It is safe and will do no harm. The dose is 150-200 mg/day once a day for four days, followed by 25 mg/day once a day. The mother continues it until she is pain free for a few weeks. It can be restarted if necessary. If the pain resolves with the larger dose but returns with the smaller dose, you can go back to the higher dose. If you have been pain free for a week or two, try going off the vitamin B6. If vitamin B6 does not work within a few days, it probably won’t. It is then useful to try:
• Nifedipine. This is a drug used for hypertension. One 30 mg tablet of the slow release formulation once a day often takes away the pain of Raynaud’s phenomenon. After two weeks, stop the medication. If pain returns (about 10% of mothers), start it again. After two weeks, stop the medication. If pain returns (a very small number of mothers), start it again. No mothers I am aware of took more than three, two week courses. Side effects are uncommon, but headache may occur.
• Nitroglycerin paste. We no longer recommend it, as severe headache associated with its use is fairly common. It also does not work more than about 50% of the time."

Breastfeeding Trouble Shooting: Fussy Baby


Aware that most babies normally have fussy periods?

Understands Infant’s need for closeness, contact, etc.?
Aware that breastfed babies nurse more often than bottle fed babies?

Observing for possible illness?

Mother over-working or under-resting?

Maintaining feeding schedule instead of demand feeding? (DANGEROUS to FORCE a schedule... Allow baby to establish the schedule in the beginning!!!!!)

Eliminating possible allergens from mother’s diet? (milk, gassy fruits/veggies, highly spiced foods)--see article above on Colic and the Breastfed baby
Mother experiencing emotional crisis?

Mother beginning menstrual cycle?


Infant’s need for stimulation being sufficiently met?


Drinking too much caffeine laced beverages?

Bathing baby during fussy time?

Burping baby properly?

Limiting breastfeeding to 5-10 minutes per breast? (try 5-10 on first, then as long as needed on second, can always switch back)

(with thanks to PAC for original trouble shooting lists,

 

Tips for Increasing Milk Supply

 

Take A Baby Holiday. The best advice I have heard for building milk supply was from a midwife.  She says it works 99% of the time (the one time it didn't work the mother did not follow her dirrections exactly).  Her recipe: Mom gets into bed with nothing on other than underwear.  Baby gets into bed with her with just diaper on baby.  They stay in bed for 24 hours and mom only leaves to use the bathroom.  Meals are brought to mom.  She nurses baby on demand and in 24 hours her milk supply will increase.
 

Take care of yourself.  Try to eat well, drink enough fluids, get sufficient rest.  You don’t need to force fluids – if you are drinking enough to keep your urine clear, and you aren’t constipated, then you’re probably getting enough.  Drink to thirst, usually 6-8 glasses a day.  Your diet doesn’t have to be perfect, but you do need to eat enough to keep yourself from being tired all the time.  It is easy to get so overwhelmed with baby care that you forget to eat and drink enough.  Don’t try to diet while you are nursing, especially in the beginning while you are establishing your supply.  You need a minimum of 1800 calories each day while you are lactating, and if you eat high quality foods and limit fats and sweets, you will usually lose weight more easily than a mother who is formula feeding, even without depriving yourself.

Avoid milk inhibiting medications (e.g. Oral contraceptives, antihistamines, diuretics)

Nurse frequently for as long as your baby will nurse.  Try to get in a minimum of 8 feedings in 24 hours, and more if possible.  If your baby is sleepy, try the technique in the videos above for waking him. Be patient if your baby is going through a growth spurt and needing to nurse more often than usual.  These spurts usually occur at 2 weeks, 6 weeks, 3 months and 5 months.  Keep nursing and your supply will eventually catch up with Baby's demand.

Offer both breasts at each feeding.  Try “switch nursing”.  Watch your baby as he nurses.  He will nurse vigorously for a few minutes, then start slowing down and swallowing less often.  He may continue this lazy sucking for a long time, then be too tired to take the other breast when you try to switch sides.  Try switching him to the other breast as soon as his sucking slows down, even if it has only been a couple of minutes.  Do the same thing on the other breast until you have offered each breast twice, then let him nurse as long as he wants to.  This switch nursing will ensure that he receives more of the higher calorie hindmilk, while also ensuring that both breasts receive adequate stimulation.

Massage the breast gently as you nurse.  This can help the rich, higher calorie hindmilk let down more efficiently.

Practice the Compression Technique (shown above), especially if your baby tends to fall asleep mid-nursing.

Use proper breastfeeding techniques.  Check your positioning to make sure that he is latching on properly.  If the areola is not far enough back in his mouth, he may not be able to compress the milk sinuses effectively in order to release the milk.

Avoid bottles and pacifiers.  You want your baby’s sucking needs to be met at the breast.  If your baby needs to be supplemented, try to use a cup, syringe, or tube feeding system, especially in the very beginning (babies under 2 weeks old). This is less of a concern with older babies who are well established with breastfeeding, as they are much less likely to have trouble switching back and forth between breast and bottle.

Rent a hospital-grade breast pump for a few days, unless you have a good quality double pump at home.  The best way to increase your supply is to double pump for 5-10  minutes after you nurse your baby, or a least 8 times in 24 hours.  Try to set the pump on maximum unless your nipples are very sore.  Most pumps work better on the higher suction settings.  Minimum is kind of like the baby sucking in his sleep toward the end of the feeding, and maximum is more like the vigorous sucking he does for the first few minutes of the feeding. Call Medela at 1-800-TELL-YOU to find a rental outlet in your area.

Eat Lactation Cookies

A yummy way to help boost your milk supply...

 Ingredients

1 C butter

1 C sugar

1 C brown sugar
4 T water
2 T flaxseed meal (no subs)
2 Lg eggs
1 t vanilla
2 C flour
1 t baking soda
1 t salt
3 C Thick cut oats
1 C Chocolate chips
2 T to 4T Brewers Yeast (no substitutions)

Preparation

Preheat oven at 375.

Mix 2 T of flaxseed meal and water, set aside 3-5 minutes.
Cream butter and sugar.
Add eggs or vegan substitutes.
Stir flaxseed mix into butter mix and add vanilla.
Beat until well blended.
Sift: dry ingredients, except oats and choc chips.
Add butter mix to dry ingredients.
Stir in the oats and then the choc chips.
Drop on parchment paper on baking sheet.
Bake 8-12 minutes

Use Herbal Encouragements, the most popular are Fennel,  Fenugreek, Blessed Thistle, and Red Raspberry.  Brewers Yeast (containing B vitamins) is another commonly recommended treatment for low milk supply.  (Note:  Fenugreek is rated GRAS (generally regarded as safe), but when taken in large doses may cause lowered blood sugar, so should be used with caution by diabetics.  It is in the same family with peanuts and chickpeas, and may cause an allergic reaction in moms who are allergic to them. It may cause a maple syrup odor in urine and sweat. For the majority of mothers, it causes no problems, and can be very effective.  It has not been known to cause any problems for the babies of the mothers who take it.)

Dr. Jack Newman suggests the following amounts of herbal supplements:

Fenugreek: 3 capsules 3 times a day
Blessed thistle: 3 capsules 3 times a day, or 20 drops of the tincture 3 times a day

Drink Lactation Tea

2 parts Fennel:  Supports lactation, digestion, gas, good urinary function.  (use seed)

1 part Fenugreek seeds: Supports lactation, rejuvenation, respiratory, & digestion. Said to able to help throw out placental fragments.

Boil water then add 1 tsp.of mix in 2 quarts water, keep 1/2 in thermos and warm the rest later in the day.  Make fresh daily.

Take Lecithin

Dr. Newman says,

"Lecithin is a food supplement that seems to help some mothers prevent blocked ducts. It may do this by decreasing the viscosity (stickiness) of the milk, by increasing the percentage of polyunsaturated fatty acids in the milk. It is safe, inexpensive, and seems to work in some cases. The dose is 1200 mg four times a day. There is more to preventing blocked ducts than taking lecithin."

(with thanks to Breastfeeding Basics for original list)

Breast Yeast a Problem?

Here's a midwife suggestion:

Recipe for Oregano Oil Treatment

by PJ Jacobsen
Midwifery Today #90
 
"Dilute 25 drops of Oregano Essential Oil by mixing with a 15ml bottle of a carrier oil (such as olive or almond oil).  Apply a few drops of this mixture to the nipples after every feeding.  There is no need to wash the nipples prior to the next feeding.  It can also be taken orally in capsules or by placing a few drops under the tongue several times a day."
 
Anita's summary: "This is a 2.5 page article I am condensing, but she mentions, "consistent therapeutic quality of the Young Living Brand (YL) of oregano oil to be the most effective."  Regarding the safety of oregano oil for baby, she states, "Since oils are always safe on the feet we treat baby with a foot massage with [this recipe] a few times a day."  Lastly, a product called "Inner Defense" is mentioned as being oregano plus "Thieves oil blend of clove, eucalyptus bark, cinnamon, rosemary and lemon."  And of course she mentions the usual elimination of white flour, sugar, starches, and colonization of the gut with probiotics."

 

How do you REALLY feel about nursing?

Take this on-line quiz to find out what influences your attitudes about breastfeeding your baby.  Take a moment to check out the commentary on each question as well.  

 

Learn more about the history of breastfeeding, and our cultural expectations about it.

 

 JcjKeDyTZP8

Avoiding 10 Nursing Pitfalls

Subject: How to Avoid the Top 10 Nursing Pitfalls

How to Avoid the Top 10 Nursing Pitfalls
BY DIANA WEST, IBCLC, and LISA MARASCO, MA, IBCLC

As a pregnant or new mother, you might be concerned about making enough milk for your babe. The following 10 nursing pitfalls are among the most common reasons for milk supply difficulties. Knowing what they are and how to avoid them will help you lay a strong foundation for a successful breastfeeding experience.

Pitfall #1: Latch Problems
One of the most common causes of low milk production in the early weeks is poor attachment to the breast. When baby latches too shallowly, he doesn't have enough breast in his mouth to effectively draw out milk. Less milk is removed, and the breast responds by cutting back on production. The good news is that correcting the problem is often relatively easy. If you aren't able to fix it on your own, the problem could be related to baby's ability to suck effectively and may require the help of a lactation consultant.

Pitfall #2: Hormonal Birth Control
"Combination" birth control pills containing forms of both estrogen and progesterone can significantly decrease milk production. Newer "minipills" are estrogen-free and better for nursing mothers, but a small number of women still experience a drop in supply. Similar problems have happened with patch and subdermal implant birth control, and a case of low supply related to a hormonal intrauterine device (IUD) has been reported. Depo-Provera, a long-acting injectable hormonal birth control, poses more serious problems because it lasts for three months and cannot be reversed; the best option is to try milk-increasing herbs to counter the effect. Waiting three months or longer after birth to use hormonal birth control will reduce the risk of problems.

Pitfall #3: Herbs
Just as there are herbs that may help increase milk production, others seem to decrease it. Parsley is considered to have lactation-suppressing properties in large amounts, such as in a dish like tabbouleh. Peppermint and sage are reputed to decrease production when consumed in large or concentrated amounts. Frequent brushing with toothpaste containing real mint oil or even eating potent mint candies has caused trouble for some mothers. Fortunately, most of these herbs don't cause problems unless they are consumed regularly or in large amounts.

Pitfall #4: Alcohol
Alcohol inhibits both the milk ejection reflex and milk production, especially when taken in large amounts. Even a single beer or glass of wine can disrupt the balance of lactation hormones. While the immediate effects of alcohol on milk production and delivery last only as long as the alcohol is in your system, chronic alcohol use has the potential to lower your milk supply overall.

Pitfall #5: Outside Interferences
Some mothers facing a medical procedure, drugs, or hospitalization are told that they can't nurse for a period of time. To make matters worse, little or no guidance is provided on how to maintain production, and by the time breastfeeding is "allowed" again, milk supply is damaged. Educating yourself on the facts is your best defense, and regular pumping is your backup. Dr. Thomas Hale's book, Medications and Mothers' Milk (updated biannually), is an excellent safety reference.

Pitfall #6: The Sleepy Newborn
Excessive sleepiness has several possible causes. A newborn may be drowsy after delivery because of medications given to you during labor. The effects may be brief, or they can linger for several days. During this time, lots of skin-to-skin contact can help stimulate your baby and trigger his nursing instincts.

Simply not getting enough milk can also cause a baby to sleep too much. He may eventually rouse and show signs of hunger but fall asleep again within minutes at the breast. This in turn leads to needing longer periods of sleep to conserve precious energy. This can happen as a result of low milk supply, a problem with baby's suck, or baby's medical complications. Supplementation may be needed until milk production can be increased or baby is able to take more milk.

Another cause of infant drowsiness is jaundice, a temporary yellowing of the skin that often looks like a suntan and can make babies lethargic. Wake baby at least every two to three hours until he begins to rouse more on his own. Gentle methods such as holding him upright, massaging his body, talking to him, undressing him, or changing his diaper are most likely to result in willingness to feed.

Pitfall #7: Unnecessary Supplementation
There are certainly times when baby isn't getting enough milk and must be supplemented. But there are also times when unnecessary supplements sabotage milk production by reducing milk removal and stretching out feeding intervals. Problems usually start with "just one bottle a day" or "just a few bottles a week," but the more supplements given, the more are needed because milk isn't made when it isn't removed. It becomes a slippery slope where bottle-feeding eventually seems more convenient or baby appears to like it better.

Pitfall #8: Pacifiers
Pacifiers can mask the hunger cues of babies who are easily soothed by them. They are often given in the belief that baby is supposed to be full after so many minutes at breast. An assertive baby will spit it out and insist on more milk, but an easygoing baby may not be as persistent. This can disrupt the baby-driven milk-making process by forcing inappropriately long feeding intervals that ultimately reduce milk supply.

Pitfall #9: Busyness
Juggling a baby and the conflicting demands of a busy household is challenging. Feedings can be unconsciously postponed when you're preoccupied by other tasks, trying to get "just one more thing" done. It's especially difficult if you have older children and are always on the run driving them around, and the temptation to put off feedings instead of taking time to nurse right now may be strong. Though this may sound difficult, it is crucial to slow down and remember that this baby will only be young once, and his needs are immediate and important. Keeping him close in a soft baby carrier can help you respond to early feeding cues while on the go.

Pitfall #10: Clock-Driven Feeding Durations and Feeding Schedules
Mothers are often urged to get baby on a schedule as quickly as possible to instill early discipline, fit him conveniently into family life, make life more predictable, or for "sleep training." Whatever a parent's fear or motivation, schedules are often regarded as an important parenting goal.

Schedules may seem helpful to parents, but they don't always meet the needs of breastfeeding mothers and babies. Rather than allowing milk production to be driven by baby as nature designed, schedules artificially determine when feedings will take place. Mothers with abundant production and vigorously nursing babies may do well, but mothers with marginal supplies or babies with difficulties often do not. Even if all looks well in the beginning, a sudden drop-off in production can happen after a few months if an insufficient number of hormone receptors were established in the early weeks. Bottom line: advice that supersedes your instincts on when to feed your baby can undermine your milk supply.

Dish with Mindful Mama! Share your tips for breastfeeding success with other moms, and maybe even pick up a few new ones.

Diana West, IBCLC and LIsa Marasco, M.A., IBCLC are the authors of The Breastfeeding Mother’s Guide to Making More Milk (Mc-Graw Hill, 2009), and board certified lactation consultants in private practice.


Engorgement

Cabbage leaves for engorgement:


Severe engorgement about the third or fourth day after the baby is born can usually be prevented by getting the baby latched on well and drinking well from the very beginning. If you do become engorged, please understand that engorgement diminishes within 1 or 2 days even without any treatment. Continue to breastfeed the baby, making sure he gets on well and nurses well. However, if you should get engorged to the point of severe discomfort, cabbage leaves seem to help decrease the engorgement more rapidly than ice packs or other treatments. If you are unable to get the baby latched on, start cabbage leaves, start expressing your milk and give the expressed milk to the baby by spoon, cup, finger feeding or eyedropper and get help quickly.
1. Use green cabbage.
2. Crush the cabbage leaves with a rolling pin if the leaves do not accommodate to the shape of your breast.
3. Wrap the cabbage leaves around the breast and leave on for about 20 minutes. Twice daily is enough. It is usual to use the cabbage leaf treatment two or three times or less. Some will say to use the cabbage leaves after each feeding and leave them on until they wilt. Some are concerned that such frequent use will decrease the milk supply.
4. Stop using as soon as engorgement is beginning to diminish and you are becoming more comfortable.
5. You can use acetaminophen (Tylenol™, others) with or without codeine, ibuprofen, or other medication for pain relief. As with almost all medications, there is no reason to stop breastfeeding when taking analgesics.
6. Ice packs also can be helpful.
7. If you are one of the women who gets a large lump in the armpit about 3 or 4 days after the baby’s birth, you can use cabbage leaves in that area as well.

 

with thanks to Dr. Jack Newman

Nursing Modesty

Our babies need to eat when they are hungry, but God calls His handmaidens to be modest.  What's a mama to do?  Try out this beautiful nursing covering, handmade by one of Barbara's clients.  

What's in breast milk? How does it vary with Mama's nutrition?

k1RzlEVkVhgHere's an excerpt from "Human Nutrition in The Developing World":

"There is a widely held belief that the composition of breastmilk varies enormously. This is not so. Human breastmilk has a fairly constant composition, and is only selectively affected by the diet of the mother. One litre of milk provides about 750 calories and contains approximately the following:
• 70 g carbohydrate,
• 46 g fat,
• 13 g protein,
• 300 mg calcium,
• 2 mg iron,
• 480 µg vitamin A,
• 0.2 mg thiamine,
• 0.4 mg riboflavin,
• 2 mg niacin,
• 40 mg vitamin C.
The fat content of breastmilk varies somewhat. The carbohydrate, protein, fat, calcium and iron contents do not change much even if the mother is short of these in her diet. A mother whose diet is deficient in thiamine and vitamins A and C, however, produces less of these in her milk. Thiamine deficiency in the lactating mother can lead to infantile beriberi in the baby (see Chapter 16). In general the effect of very poor nutrition on a lactating woman is to reduce the quantity rather than the quality of breastmilk." (emphasis added)

Breastfeeding and Bacteria

The Art of Midwifery: Breastfeeding and Bacteria
Wednesday, June 10, 2009 at 7:41am
— Jeff D. Leach
Excerpted from "C-sections, Breastfeeding and Bugs for Your Baby: What the doctor probably won't tell you," Midwifery Today, Issue 79

Breastfeeding newborns, like the evolutionary process of vaginal birth, is about bacteria. The breast milk of a human mother, like other mammalian mothers, is species-specific, having been adapted over eons to deliver specific and sufficient nutrition to guarantee proper growth, health, and immunity development. Researchers have long known that breastfed babies possess an intestinal flora that is measurably different than formula-fed infants. Of specific interest is a group of bacteria known as bifidobacterium. Some of you may immediately recognize the name, as they are often added to dairy-based foods such as yogurt, often advertised as "live cultures" on the packaging. These are probiotics.

Studies have shown that at one month of age, both breastfed and formula-fed infants possess bifidobacterium, but population densities in bottle-fed infants is one-tenth that of breastfed infants. The presence of a healthy and robust population of bifidobacterium throughout the first year or two of life contributes significantly to the child's resistance to infection and overall development of defense systems—not to mention the physical development of the intestinal system in general. Aside from the substances secreted by these specific bacteria that are known to inhibit the growth of pathogenic bacteria, they also work to make the intestinal environment of the infant more acidic, creating an additional barrier against invading pathogens. In short, breastfed babies are sick less, are less fussy, have fewer and shorter duration of bouts of diarrhea, and have more frequent—and softer—bowel movements.

Will Breastfeeding Cause Your Child to have Cavities?

by Dr. Linda Folden Palmer

REVISED OCTOBER 1, 2007

Breastfed children have far fewer dental cavities than those who are bottle-fed.(1-3) This includes nursing caries as well as other cavities. The unfortunate term “nursing caries” refers to a typical pattern of dental decay seen when juice, formula, or breastmilk sits in the mouth frequently for extended periods. Nighttime snacks are highly cavity causing because saliva is not very mobile during sleep, leaving baby without this rinsing and antibacterial protection. Juice bottles by far promote the greatest number of nursing caries.(4) Both breastfed and bottle-fed infants have a need for comfort nursing. The only way bottle-fed infants can find this comfort is to “nurse” their bottles very slowly when allowed to lie and hold their own bottle, causing formula to sit against their teeth for long periods. Nursing caries are more common in bottle-fed infants, especially in those who have nighttime bottles at older ages. Among breastfed infants who develop nursing caries, most are those who comfort nurse for long periods during the night after teeth have developed.(5) And among these, most are those who have frequent snacking and sugary foods or juices in their diets.(6,7)

The making of a cavity

A cavity is a small infection in the tooth that destroys the tooth material. Fresh mother's milk has many antimicrobial activities but both human and cow's milk have lactose sugar, which feeds cavity-causing bacteria when allowed to sit in the mouth. Mother’s milk has immune factors that reduce the presence of unfriendly bacteria, and laboratory tests show human milk does not encourage cavities,(8) but this doesn’t mean that caries can’t develop on breastmilk alone. On the other hand, formula is definitely cavity promoting.(9) Formulas with sugars other than lactose are the worst.(10) Although Streptococcus mutans bacteria are generally thought to be the chief cause of dental decay, living on sugars, the candida yeast that builds up on pacifiers has been found to promote cavity formation to a great degree.(11) Because of this candida and the occasional incidence of nursing caries from bottles or nighttime breastfeeding, dentists and pediatricians commonly recommend throwing out bottles and pacifiers at 12 months of age and weaning breastfed infants prematurely. Of course, the common suggestion that one must switch from human milk to bovine milk, i.e. “wean,” makes no sense at all.

Consider the whole child

Babies naturally experience hunger and need comforting during the night. Withholding response to these needs can possibly be more harmful to a child than any risk of damage to temporary teeth, although your dentist may feel that teeth are the primary concern. Certainly, the known health benefits of extended breastfeeding outweigh any potential challenges to temporary teeth. While dental treatments on infants are traumatic, warranting preventive measures, the mere possibility of infant caries (about a 14% chance) is not enough of a worry that I would withhold or withdraw important feeding and comforting from any infant, especially before any such symptoms have occurred. Feeding and comforting practices can be modified when needed to protect teeth, without blunt, drastic weaning measures.

Mother too

Nursing mothers may be prone to cavities related to nursing (maybe these are the true "nursing caries"). Especially during the first months of breastfeeding, nursing mothers often find a need for midnight snacks. This food sitting against the teeth in a sleeping mom may cause some cavities in her teeth, which have mildly reduced calcium content (no matter how much calcium is supplemented) until after the end of lactation. Preventive measures should be taken in a cavity-prone mom.

If cavities are found

There are times when a parent chooses “watchful waiting” over immediate repair of small dental insults in a very young child who appears quite traumatized by dental procedures; hoping the repair will be simpler and less harrowing when the child is some months older or that the parent can get the problem under control with diligent efforts.

Like all other bones of the body, teeth have a potential to heal, when attacks are very small, but this will only occur with conscientious efforts and even then, only occasionally. A small brown spot may be left even after the bacterial assault in a tooth has stopped, because the enamel coating does not heal. One must remember that the decay can “spread” however, creating a larger problem. Below are some efforts that can be tried during “watchful waiting,” and even better, before cavities are ever present.

Cavity prevention and care

In cavity-prone families, or when any evidence of decay has been detected in an infant, night nursing and bottle practices can be gently reduced (not necessarily eliminated) once several teeth are present. A squirt of water into the mouth or stirring the child enough to cause some extra swallowing after nursing will help to clear the mouth of milk. Juice bottles should never be given at night. Good dental hygiene in the parents’ mouths will reduce baby’s risk of developing cavities. Still, genetic tendencies and other unknown factors make some children susceptible to bacterial presence and destruction in their mouths no matter what measures are taken.(12) Although damage to baby teeth does not affect adult teeth, a strong tendency for decay will likely carry over to adult teeth. Caries in baby teeth can serve as a warning that good preventive measures must be taken with permanent teeth.

Xylitol is a natural fruit ingredient that promotes dental healing and can be found in special chewing gums for those who are old enough. Avocado, carrots, raspberry, strawberry, and yellow plum have all been found to contain anti-cavity ingredients. Likely many other dark-colored fruits and vegetables will be discovered to have the same qualities. There are many herbs that fight caries, such as cloves, mint, thyme and savory. In cheese, the lactose sugar is pre-digested. The milk protein left in cheese has been shown to be anti-cavity. Once the baby is eating solids regularly, it would be a great practice to end a meal with any of these foods or to choose them as snacks.

Tea tree oil is strongly antimicrobial against cavity-causing bacteria.(13) It can be found in toothpastes in healthfood stores and some parents concoct a mouthwash with it. Like fluoride, ingestion of any significant quantities can be harmful. Twice/daily acidophilus drops help to maintain a less aggressive flora in the mouth. Good brushing (not just wiping with a cloth), twice-daily flossing if the decay is between teeth, and some occasional scraping with a dental tool at home are valuable efforts. Do not allow food or drink (besides water) to sit in the mouth at night. Again, when needed, during night breastfeeding one can encourage some swallowing after nursing by disturbing the child a bit before they fall back to sleep or by providing a sip of water.


1. A.A. al-Dashti et al., “Breast feeding, bottle feeding and dental caries in Kuwait, a country with low-fluoride levels in the water supply,” Community Dent Health (England) 12, no. 1 (Mar 1995): 42–7.
2. R.O. Mattos-Graner et al., “Association between caries prevalence and clinical, microbiological and dietary variables in 1.0 to 2.5-year-old Brazilian children,” Caries Res 32, no. 5 (1998): 319–23.
3. N. Kanou et al., “[Investigation into the actual condition of outpatients. II. Correlation between the daily habits of eating and toothbrushing and the prevalence of dental caries incidence],” Shoni Shikagaku Zasshi (Japan) 27, no. 2 (1989): 467–74.
4. A. Mohan et al., “The relationship between bottle usage/content, age, and number of teeth with mutans streptococci colonization in 6–24-month-old children,” Comm Dent Oral Epidemiol 26, no. 1 (Feb 1998): 12–20.
5. K.L. Weerheijm et al., “Prolonged demand breast-feeding and nursing caries,” Caries Res (Holland) 21, no. 1 (1998): 46–50.
6. L. Lopez Del Valle et al., “Early childhood caries and risk factors in rural Puerto Rican children,” ASDC J Dent Child 65, no. 2 (Mar–Apr 1998): 132–5.
7. A.L. Hallonsten et al., “Dental caries and prolonged breast-feeding in 18-month-old Swedish children,” Int JPaediatr Dent (Sweden) 5, no. 3 (Sep 1995): 149–55.
8. P.R. Erickson and E. Mazhari, “Investigation of the role of human breast milk in caries development,” Pediatr Dent 21, no. 2 (Mar–Apr 1999): 86–90.
9. C. Sheikh and P.R. Erickson, “Evaluation of plaque pH changes following oral rinse with eight infant formulas,”vPediatr Dent 18, no. 3 (May–Jun 1996): 200–4.
10. D. Birkhed et al., “pH changes in human dental plaque from lactose and milk before and after adaptation,”vCaries Res 27, no. 1 (1993): 43–50.
11. P. Ollila et al., “Prolonged pacifier-sucking and use of a nursing bottle at night: possible risk factors for dentalvcaries in children,” Acta Odontol Scand 56, no. 4 (Aug 1998): 233–7.
12. M.I. Matee et al., “Mutans streptococci and lactobacilli in breast-fed children with rampant caries,” Caries Res (Tanzania) 26, no. 3 (1992): 183–7.
13. K.A. Hammer et al., “Summary of full report: Antimicrobial activity of tea tree oil against oral microorganisms,” http://www.rirdc.gov.au/reports/TTO/03-019sum.html, Rural Industries R&D Corp., (May 2003).

Bottle feeding and childhood obesity

Why bottle-fed babies grow faster

London, Apr 26 : Breast milk has less protein than formula, a new study has claimed.


It has been believed that formula-fed babies, who tend to be bigger, are "programmed" to store fat and so have a higher risk of childhood obesity.

Now, an international study of 1,000 babies, published in the American Journal of Clinical Nutrition, has suggested that protein levels in formula should fall.

The study, which was carried out in Belgium, Italy, Germany, Poland and Spain, included babies born between 2002 and 2004.

Parents were recruited to take part in the first few weeks of their babies' lives, reports The BBC.

To reach the conclusion, a third were given a low protein content formula milk, a third had a formula with a higher level of protein, while the rest were breast-fed during their first year.

In order to qualify as breast-fed, kids had to be either exclusively given breast milk, or have a maximum of three bottles per week.

Then the infants were followed up to the age of two with regular weight, height and body mass index measurements taken.

At the age of two, there was no difference in height between the groups, but the high protein group were the heaviest.

The researchers suggest lower protein intakes in infancy might protect against later obesity.

The children are being followed up further to see whether those given the lower protein formulas have a reduced risk of obesity later on.

Professor Berthold Koletzko, from the University of Munich, Germany, and who led the study, said: "These results from the EU Childhood Obesity Programme underline the importance of promoting and supporting breastfeeding because of the long-term benefits it brings.

"They also highlight the importance of the continual development and improvement in the composition of infant formula. Limiting the protein content of infant and follow-on formula can normalise early growth and might contribute greatly to reducing the long-term risk of childhood overweight and obesity."

200 Hospitals in America have swapped out their take-home formula bags for breast feeding bags!

Contact your hospital to see if they, too, can make this change that will encourage Mamas to give their babies the very best food of all.

Nipple Shields

Sometimes can be a saving grace with breastfeeding difficulties, but they are not without their consequences. Read this LLL article about Nipple Shields: Friend of Foe.

That AMAZING stuff called breastmilk!

I am always a bit amused when I read yet another scientific article extolling yet another newly discovered beneficial property of breastmilk.  The obligatory tone of scientific self-congratulation in these articles always prompts me to say, "It's as if they are taking credit for CREATING the stuff!"  Anyway, the CREATOR of the Universe has indeed designed human milk to be pretty amazing.  And every time I learn something new about it, I have new reason to praise Him and His creative prowess.

Did you know, for instance, that the nutritious constitution of breastmilk changes according the the time of day it is produced?  For that reason, pumped breastmilk ought to be fed to babies at the same time of day that it was originally produced.

 

Or, did you know that simply hanging around women who are lactating could actually increase YOUR sex drive

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