Sunday, December 29, 2013

Ringing in the New Year: Breastfeeding and Alcohol

     As the New Year and New Year's Eve parties are approaching, this is a question that Lactation Consultants get asked repeatedly.  While the advice has changed from a pump and dump approach to a you can have as much as you want mentality, the truth is really somewhere in the middle. 
     It is safe to have a New Year's toast after your baby has gone to bed.  It is also safe to have an occasional glass of wine.  The key is moderation and timing.  Alcohol does enter the blood stream and your breast milk.  It is also metabolized quickly.  So one glass of wine or beer or an alcoholic drink that contains one shot of liquor is metabolized in one hour.  If you baby nurses every 2-3 hours and you have one drink, there is no need to pump and dump.  If you have multiple drinks, you should pump and dump.  This is not to get rid of the alcohol as time will do that, but to keep you from getting plugged milk ducts if you do not pump or nurse.  Use the same rule of thumb you would for drinking and driving.  Wait one hour to drive or nurse your baby for each 1 oz of hard alcohol, 6 oz of wine or 12 oz of beer you drink.
     There are other reasons to practice moderation with alcohol consumption while breastfeeding.  Alcohol decreases milk production, as well as reflexes and good decision making.  This can be a detriment to your milk supply and your parenting skills.
     To help you ring in the new year with gusto, we are posting a recipe for a delicious mock champagne!

Happy New Year!
Tanya

Sunday, December 15, 2013

Breastmilk: It's just not that important!

     Although I have advocated for breastfeeding for over 20 years, breastmilk is not that important. I personally was not a breastfed baby. My mother had difficulty nursing her first child and was told she did not make enough milk. She was too discouraged to try to nurse her subsequent children so I did not get a drop of this precious substance.

      What my mother did give me was my upbringing. She raised me to know the truth about who I was. I am not an entitled human being who can do no wrong. Nor am I perfect in the eyes of my parents. I am flawed. I have a broken relationship with my creator and a deep need for healing. This I learned from my parents.

      My mother taught me to trust with every time she picked me up while I was crying.  My mother taught me about Jesus from the first time she sang to me. When she rocked me to sleep, she taught me of His love for me.

      It amazes me that God could have created us, knowing full well that we were going to destroy our relationship with Him and that He would have to sacrifice His only Son for us. It amazes me that Jesus, who is God incarnate, would put His life in the hands of a 15 year old girl to care for Him and raise Him to be a man. It amazes me that Jesus was fully God and fully man while he walked on Earth. It amazes me that Jesus followed God’s will and paid the ultimate price to bear our sins and put them to death on the cross. Knowing at that moment, that His relationship with God would be severed. And it amazes me that God raised Jesus from the dead showing us that when we believe in Jesus and his sacrifice, we can live eternally with Him. 

     So even though I have spent the last 20 years helping mothers learn to breastfeed and telling them of the importance of breastmilk, it is not that important. It is not that important because even though the benefits of breastmilk are immense and far-reaching, they are - as is life - temporary. Knowing Jesus is in a word - eternal.

      If you have a relationship with Jesus, take this time to celebrate His birth with your family and teach them about Him. If you don’t, you can right now. You have a need to have the debt of your sin paid. Jesus as God’s son, was the only one who could pay the price for you and He did. He willingly gave up His life on the cross for you. God raised Him from the dead and He is at the right hand of God on His throne. You can live eternally with Him, too. All you have to do is ask for salvation. The words don’t matter. Ask Him now. What is important is eternity for both you and your children.


 Merry Christmas,
Tanya Roberts




Wednesday, October 23, 2013

Breastfeeding Secrets Revealed: Position, Hold and Proper Latch

     New moms have told me that they wish they had been given more information on positioning and latch as well as the various holds associated with breastfeeding.  So I have decided to reveal these breastfeeding "secrets" here. 
1.  What is the secret to preparing for breastfeeding?
Holding the breast properly!  The c-hold is the proper way to support the breast when learning to breastfeed and should be practiced by expectant and new mothers because almost every new mom does it incorrectly.  How?  Moms tend to place the thumb on top (correct) but place the bottom fingers in the wrong place.  The bottom fingers need to be near the chest wall.  The index finger usually ends up on the bottom of the areola preventing baby from getting a deep latch.  Whether you are already breastfeeding or still expecting, check your c-hold in a mirror to make sure your fingers are out of the way. Also make sure the flap of your nursing bra is not in the way.  Remember, a new baby cannot support the weight of their own head, let alone your breast so support your breast properly and without hindering the latch.  If you are expectant mom, it is not proper to prepare for breastfeeding by toughening nipples, an antiquated practice that breaks down the keratin layer of the skin and is not helpful.  It is helpful to test nipples for inversion by placing the fingers 1" behind the nipple and gently pinching to see if the nipple inverts, goes flat or protrudes normally.  If it does not, consider using a breast pump to draw out nipples just prior to feeding.  A nipple shield is a last resort as it can cause a decrease in milk supply.
2.  What is the secret of a good latch? 
We will discuss proper body position in a few moments, but here are the basics of a good deep latch.
          1.  Support the breast in the c-hold discussed earlier.
          2.  Line the baby's nose up with your nipple.
          3.  Use your nipple to tickle the baby's lower lip in a downward motion to elicit the open mouth reflex.
          4.  Wait for a yawn or cry-wide mouth.
          5.  Swoop the baby's entire body towards you.
          6.  Bring the baby's bottom in closer to you.  This will dig in the chin and tilt the head slightly.
          7.  Support the breast for a newborn the entire feeding, but don't forget to relax your shoulders and make sure you have support for your arm as newborns can take 45 minutes to get in 20 minutes of swallowing.


3.  What position is the best to learn to breastfeed? 
The cross-cradle hold gives you the most control, but depending on whether you had a c-section, the football hold may be best for you.  We will address the football hold a little later.  In a proper cross-cradle hold you will hold the baby at the nape of the neck with the hand opposite the breast you are using.  Use a proper c-hold on the breast.  Sit back in the chair, put your feet up on a stationary footrest.  This brings your knees above your hips helping to keep you from the temptation of bringing the breast to the baby.  Always bring the baby to the breast.  Otherwise you end up with a sore back from improperly leaning into the baby.  Latching on in the cross-cradle or any position should be done in a one (1) two (2) motion.  Practice the proper latch techniques previously discussed. 1. Swoop the baby in as soon as you see a yawn or cry-wide mouth.  2.  Pull your elbow towards your ribs bringing the baby's bottom with it.  This draws the baby's bottom close helping him dig in his chin and tilt his head back keeping you from the temptation of pushing the breast tissue away with your thumb.  You shouldn't push down with your thumb as it raises the nipple toward the roof of his mouth causing nipple irritation.  When using a pillow, remember that it is there to support you while supporting the baby.  It is not meant to support the baby without your help, but a nursing pillow is an effective tool to keep mom in the proper position and save her from backache. 


4.  What is the secret to a good football hold? 
Much like the cross cradle hold, mom holds the nape of the baby's neck with her hand, but this time, the same hand on the same side as the breast she is using. Use the c-hold and ensure that the bottom fingers are well below the areola.  Support the breast with your hand or a rolled up burp rag during the entire feeding for a newborn who cannot support the weight of his own head.  Remember that your hand should be on the nape of the neck and not higher on the head for several reasons. One being that baby's tend to arch their back when you touch the top of their head. Sit back in the chair, put your feet up and have a pillow on that side of your lap for support. Your baby should be tucked under your arm like a football. His legs should be in a fetal position or and older baby might have them raised up resting his bottom and legs on the back of the chair. done in a one (1) two (2) motion. Practice the proper latch techniques and the swoop and tuck motion previously discussed.   Nursing pillows are essential in this position unless you have a very wide soft armrest on your chair.


5.  What is the secret to when the cradle hold should be used?
It is best to use the cross-cradle hold instead of the cradle hold when you are first learning to breastfeed because you have more control over the position of the baby's head with your hand than you do in the crook of the elbow.  But many moms are very comfortable in this position so moving to this position after the initial latch on as long as you support the breast for the newborn with a rolled up burp cloth is easy to accomplish.  Or once the baby has more control over his head or you are a smaller busted mom, you can use the cradle hold comfortably.  Just remember the latch positioning discussed previously.  Baby's nose should be on target with the nipple.  He should be tummy to tummy with mom.  His ears, shoulders and hips should be in a straight line as it is hard to swallow with your head turned.  Also remember to bring baby to the breast and not the other way around and to relax your shoulders and use something to support your arm.
6.  Do I need to learn to nurse lying down?
Is it important to learn the side-lying position?  In a word, YES!  The side lying position can be the answer for a stressed sleep-deprived mom or a mom who wants to increase her milk supply!  The proper technique for the side lying position is to have a pillow or two under your head and a pillow between your knees to stabilize your hips.  Baby's nose is on target with the nipple and the baby is drawn close with moms arm that is under her.  The bicep of this arm is partially used to support the breast for a larger busted mom as well.  Remember in all holds baby is tummy to tummy with you and not lying on his back with his head turned trying to swallow.  The side-lying position is perfect for co-sleeping at night or catching a nap with baby.  Taking your baby to bed with you if you perceive a dip in milk supply is a great way to get a boost as well.  If you are uncomfortable keeping the baby in bed with you all night, you can still hear the early feeding cues and nurse lying down with a co-sleeper bassinet that keeps baby within arm's reach.
     Breastfeeding should not hurt!  If you have had previous trauma and are correcting an improper latch, there can be discomfort for the first 30-60 seconds, but then it should subside.  If it does not, break the suction by inserting a clean finger passed the gums and turning.  Then start the latch again from the beginning.  Don't let your toes curl and your teeth clench because you are a good mama.  The milk sinuses where the milk pools are located approximately one inch behind the nipple and not on the nipple for a reason.  The nerve ending are on the nipple.  Pain is telling you that your latch is incorrect.  Once the baby is in proper position with a deep latch, he will get more milk and you will have a more comfortable rewarding breastfeeding experience. 
     For more answers to breastfeeding questions visit our breastfeeding tips page or give us a call at 254-728-3627 9-5 M-F CST.


Thursday, September 26, 2013

Breast Milk Allergy: Breastfeeding Myth Busted!

     The breastmilk allergy myth was further perpetuated on the TODAY show's #bornTODAY series this morning causing me to have to speak out against irresponsible and incomplete journalism. 
The Myth: Some babies are allergic to their mother's milk.
The Facts: Human milk is the most natural physiological substance that baby can ingest which is why breast milk can be used as a "clear liquid" if a baby is ill with a stomach virus and it is also why breast milk does not sting when placed in the eye as a remedy for conjunctivitis.  
     If a baby shows sensitivities related to feeding, it is usually a foreign protein that has been consumed by the mother and entered into mother's milk, and not the breast milk. The remedy for this is to remove the offending food from mother's diet for 3-4 weeks.  One example is dairy.  Dairy is difficult to digest and can take 10 days to two weeks to leave the mother's system and another 10 days to two weeks to leave the nursing baby's system making the process take 3-4 weeks.  This lapse in time is no reason to wean because as any formula feeding mother can attest, it may take much longer than that to find a formula your baby can tolerate.

Here are some references to help bust the breastmilk allergy myth!

Hudson, I. et al. A low allergen diet is a significant intervention in infantile colic: results of a community-based study. J Allergy Clin Immunol 1995; 96:886-92.

Mohrbacher, N., Stock, J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois: LLLI, 1997; 97-99.

Salmon, M. Breast Milk: Nature's Perfect Formula. Demarest, New Jersey: Techkits, 1994; 32-3.


Newman, Jack: Pitman, Teresa, The Ultimate Breastfeeding Book of Answers, 2003; 150

Tanya Roberts
Lactation Connection

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Monday, September 9, 2013

Why Fenugreek Isn't Working for Breastfeeding

     The truth is fenugreek is a great tool to boost milk supply in most moms.  However, in the two decades that I have been helping nursing moms, I get this comment a lot, "Fenugreek didn't work for me."  How can it be that an herb with such great success stories doesn't work for a large number of mothers.  In most cases, the answer is in the quality, dosage or delivery method.
     Many moms buy Fenugreek at a local health food or grocery store in brands that are not stored or bottled in the best way to keep them at full potency.  Also, shelf life factors into this so buying from a store that doesn't cater to the largest market for Fenugreek, nursing mothers, will not have the best turn-around.  It is always a good practice to check the expiration date on any herb before using.  Fenugreek capsules work best when taken in a quality brand like Nature's Herbs or Nature's Way Fenugreek and in the appropriate dosage or combination.   The correct dosage is essential.  If you are under 150 lbs, start with three capsules, three times daily.  Yes, that is nine capsules per day.  Possible side effects of fenugreek for mom are loose stools and you may smell like maple, but who cares if you are taking this short term for a boost and the result is more milk!  If you stools are not loose or you are over 150 lbs, you can take up to 5 capsules three times daily.  This dosage is for Nature's Herbs as it is 620 mg per capsule.  Some brands only contain 500 mg.  You should see more milk in 48-72 hours.  Always finish the bottle which is about a 10 day supply.  Don't save it for later as once you open the bottle, it begins to loose freshness.  If you are still not getting a result, combine Fenugreek with Blessed Thistle.  Take 3 Fenugreek + 2 Blessed Thistle three times daily.  You can also use Alfalfa instead of Blessed Thistle.
     What about Fenugreek drinks?  Fenugreek Tea such as Mother's Milk Tea, Earth Mama Angel Baby Milkmaid Tea tea bags should be steeped for about 15 minutes to get the full amount of herb available.  It is more difficult to tell how much you taking so I only recommend using tea bags as a supplement to the capsules or for long-term intermittent use and not for a quick three day boost.
    The best way to get the correct herbal dosage is either a capsule with a single herb such as fenugeek or a single serve kcup lactation tea that serves the same amount of herbs every time.  Anna Naturals Nursing Mama Tea comes in single serve cup for  kcup compatible brewers and is the best-tasting of all the herbal lactation teas we have found! This lactation tea cup works in Keurig and other k cup style brewers.  Drink 3 cups daily for best results or use as a supplement in taking with Fenugreek or Blessed Thistle capsules if drinking sporadically.  (Paragraph added 3/2/16)
     Remember, milk supply is usually a supply and demand issue.  Baby is not nursing frequently enough or emptying the breast well enough or you are not pumping for a full 15 minutes or every 3 hours while at work.  Another reason for low supply could be missing out on growth spurts.  If you miss a growth spurt,  add 3 extra nursing or pumping sessions with a quality double breast pump in each day for five days in a row to make up for the missed stimulation.

Best wishes for a healthy milk supply!
Tanya






Thursday, August 1, 2013

7 Stages of Breastfeeding: A Baby's Perspective


Just for fun in honor of World Breastfeeding Week 2013, I thought I would write something from baby's perspective as a breastfeeding tip for mom.  Here is one tip for every day of this week!
1.  Birth-day Initiation:  My stomach is the size of a marble.  I am loving being skin to skin with Mama and the reward of a swallow of golden colostrum!
2.  10-Day-itis:  After 10 days, I start my first growth spurt.  I want to eat every hour or two and can't get enough of this liquid gold.
3.  6 weeks:  Breastfeeding is easier for me, but pooping is harder.  I am going through another feeding frenzy and things seem to be changing!  I was pooping all the time, but now only once in a while!
4.  3 months:  Another growth spurt.  Love it!  I get to eat as often as I like and no one complains, but I do get a little distracted 'cause there is so much to see while I'm eating.
5.  6 months:  I'm learning to sit up and trying solid foods just for fun.  My mom always lets me nurse first so I don't get too full for my milk, but I think it's so I don't get green beans on her breast!
6.  The Groove:  My mom and I are in a groove, we are nursing whenever and wherever I am hungry.  I may not be nursing as often as I was the first six months, but I can down a meal in 20 minutes if I am not too busy learning new things!
7.  Weaning:  Mom is letting me wean myself.  I haven't decided when yet, but we are in no hurry.  I heard her tell dad that if she does decide to wean me by a certain time that she is only going to drop one feeding no closer than 3 to 5 days apart.  This way, her breasts and my brain have time to get used to the change.   I love my mommy!

Happy World Breastfeeding Week, Mamas!
Tanya Roberts, BSEd, LC
Lactation Connection
{The Nursing Mother's Milk Supply}

Friday, July 26, 2013

Free Breastpump! How to Get your Breastpump Covered by Insurance

     When the Affordable Care Act was enacted, insurance companies were required to cover breast pumps for new moms at 100%.  There are a few grandfathered policies that are exceptions, but this is a very small percentage so it would benefit any new mom to use this information to pay for her breast pump. 
     This coverage is under preventative care so you should not need a prescription from your doctor.  There may be some stipulations mandated by your particular insurance company so you will want to get that information from them.  For example, some insurance companies are stipulating that only one breast pump will be covered every three years.  In that case, you will want to purchase a pump like the Hygeia EnJoye Breast Pump that has a three year warranty over a Medela Pump In Style that only has a one year warranty.

Use these steps to get started:
1.  Call your insurance company and ask the following questions:
     A.  Is a breast pump covered under my policy?  What type?  Is there a three year limit?
     B.  Do I have to buy from an "in network provider"?  If so, where do I get the list?
     C.  If not, can I buy from a DME and then submit my receipt for reimbursement?  If so, how soon will I see reimbursement?

2.  If you must go through a network provider, call the ones on the list and ask for the breast pump of your choice.  If they do not have the breast pump in stock or the time frame to receive one is too long, call the insurance company back and ask them about GAP coverage.  GAP coverage allows you to buy out of network and then file for reimbursement if the providers do not have what you need.

3.  If the insurance company allows you to buy out of network, give us a call at 800-216-8151.  We will provide you with our DME information and the breast pump insurance codes needed.  Giving this info to your insurance company before they receive your receipt for reimbursement speeds up the reimbursement process.  Once the insurance company has this information, you can buy your pump directly from us on the phone or online at http://www.lactationconnection.com.  Your package will arrive within 3-10 days.  Once you receive your package, you will use the enclosed receipt to file for reimbursement.  The receipt will contain the insurance codes needed for reimbursement of a breast pump and breastfeeding supplies such as additional parts, storage bottles and bags, etc.

For more information of the Affordable Care Act and Breast Pump Insurance Coverage, follow this link:  http://www.lactationconnection.com/Breast_Pump_Insurance_Coverage_s/1916.htm

If you need advice on which breast pump is right for you, please give us a call at 800-216-8151.

Happy Pumping!
Tanya Roberts, Owner
Lactation Connection

Tuesday, July 23, 2013

Supplementing the Breastfed Baby: Lactation Aid Feeding Tubes vs Supplemental Nursing System & Lact-Aid Nursing Trainer

     In my practice as a board certified lactation consultant, there were times when it was medically necessary to supplement.  Whether it was due to a poor suck or mismanaged milk supply, we need options when recovering from these issues and getting back to breastfeeding.  Many times, I would recommend finger-feeding with a syringe to keep moms from using a bottle nipple.  I would have rather recommended a Supplemental Nursing System which has a container with tubes that runs to the breast; but I didn't want to see mom spending the extra money when her budget was so tight.  At that time, the only options were the Supplemental Nursing System (SNS) by Medela and the Lact-Aid Nursing Trainer.   These cost mom $50 or more and had small tubes to be cleaned which were cumbersome.   Now, with more options available, Moms can use a short-term feeding tube which accomplishes the same thing and can be cleaned for a few days before disposing of it.  It is a small investment in comparison to the commercial systems.  While moms who are adopting babies and inducing lactation, rather than just building milk supply may still want a commercial unit; the Lactation Aid Feeding Tubes are the best course for the short term situation.  Thanks to IBCLC, physician and lactivist, Dr Jack Newman videos and instructions are available for using these feeding tubes.  You simply cut a slightly larger hole into a bottle nipple.  Insert the adapter end into the bottle and feed the tube into the babies mouth while he is latched on.  You may also use medical tape if you prefer to have the tube in place prior to latch.  These can be purchased from the International Breastfeeding Center in Canada, but due to the long ship time of up to three weeks, we have added them to our selections at Lactation Connection.  Sold in a two pack for under $10, these will last up to two weeks while mom is re-establishing milk supply or training a baby with a weak suck.  Each tube is in an individual sterile pack ready to use.  Instructions are included with the feeding tubes when purchased here:  http://www.lactationconnection.com/Jack_Newman_s_Lactation_Aid_Feeding_Tube_p/54-5036-2.htm
     Dr. Jack Newman also has a helpful instructional video on YouTube.  I encourage you to view it and encourage lactation consultants and breastfeeding counselors to recommend and use these feeding tubes for short term situations of supplementation. 
http://www.youtube.com/watch?v=ezGIkIkhC_o&feature
     It is also important to recognize the appropriate amount of supplementation.  Always assess milk supply first, then only give the difference of what mom is producing and the actual need of the baby.  This is to say that you supplement not how much the baby will drink, but the need of a baby of that weight.  Here is a link to a chart for appropriate milk intake to show how much to feed per pound of body weight:  http://www.lactationconnection.com/Feeding_s/1907.htm  For example, a 7lb baby who is older than 6 days needs 2.25oz eight times per day.  If mom is making 1.25, then the appropriate amount of supplementation is 1 oz. per feeding.  Contact you local lactation consultant for further instructions on supplementation or give us a call at 254-728-3627 9-5 M-F CST. 


Lactation Aid Images: 





Thursday, May 30, 2013

Breastfeeding Decreases Chances of ADHD

     I know the title is a bold statement, but there is reseach to back this up which I will provide below.  The reason I state that breastfeeding decreases ADHD (attention defecit hyperactivity disorder) so emphatically is that I saw this in my own children who are now 24, 20 and 18.  Twenty-four years ago, professional grade personal breast pumps were not on the market and my doctor gave me very little information about breastfeeding.   When I told him that I had to go back to teaching and coaching when my firstborn was only 4 1/2 weeks old and asked him if I could breastfeed for just that duration, he said yes.  Period.  No further explanation.  There were hospital grade breast pumps that I could have rented.  I didn't know.  I also didn't know that I would be going back to work with bowling balls instead of breasts because I tried to wean over a weekend.  When my second and third were born, I sought out more information and nursed for 15 months and 18 months repectively.  Unfortunately, my firstborn suffered the consequences of ADHD and severe allergies that never affected my subsequent children with the same genes.  Therefore, I am convinced that breastfeeding protects against ADHD. 
     As for the research, A team led by Drs. Aviva Mimouni-Bloch and Anna Kachevanskaya conducted a retrospective matched study of children diagnosed with ADHD at 6-12 years of age, comparing them to healthy siblings without ADHD and non-related peers. The team found that, in children later diagnosed with ADHD, 43% were breastfed at 3 months of age, compared with 60% of healthy siblings and 73% of non-related peers.  At 6 months of age, 29% of children with ADHD were breastfed, compared with 50% of siblings and 57% of non-related children. 
http://online.liebertpub.com/doi/full/10.1089/bfm.2012.0145  

Thursday, May 16, 2013

Breastfeeding, Co-Sleeping and The Family Bed: Safe Sleep

     There is much controversy associated with co-sleeping.  My opinion may be less biased than others because although my husband and I slept with our babies, we started them out in their crib and then when they awoke to feed brought them into bed with us for the rest of the night.  This gave us time alone before the baby came to bed with us and also alowed them to sleep though the night without feeding when they were ready. 
     What I am passionate about is the myth that co-sleeping is more dangerous than crib sleeping. 
The Chicago Infant Mortality Study reveals that Breastfeeding Infants have 1/5th the Rate of SIDS. They report a nearly doubled SIDS rate for cosleeping, but this study does not remove the powerful effect of smoking parents from their statistic. When other studies remove this behavior, they find the remaining infants enjoy a greatly lower rate of SIDS for cosleeping versus isolated crib sleeping.There are two kinds of cosleeping, that conscious decision made by highly attentive parents, and that coming from factors such as fatigue from partying or drinking. When sofa sleeping and wedging dangers are also removed, the family bed shines as safest.
Below is a summary of the statistics:
Number of U.S. births per year 2000: 4,058,814
Total infant deaths per year 2000: 28,411
Age birth to 1 year. (6.9 per thousand)
Number SIDS deaths per year 2000: 2,523  (SIDS is defined as death with unexplained cause, birth to 1 year.)
Total suffocation deaths per year 2000: 1,000
Number of crib-related "accidents" per year : 50
Number of playpen-related deaths per year : 16
Number deaths per year attributed to overlying: 19 Most are only "suspected" and may have drug or alcohol involvement.
Number of babies (0-2) dying in night fires per year: 230 Many of which may have been retrievable if next to parent, not in another room of home. This is true for abductions and other night dangers as well.
Number of deaths per year in adult beds reported as entrapment or suffocation between bed and wall, headboard, or other furniture, on waterbed, in headboard railings, or tangled in bedding: 18 With side-rail: 1
Number of deaths per year reported as suffocation of unknown cause in adult bed: 13 (These would be SIDS if in a crib. Remember, these do not necessarily involve cosleeping.)
Number of deaths per year in adult beds from sleeping on stomach: 5  (These are considered SIDS in cribs, and they are preventable in adult beds, as in cribs.)  4 per year died not from falling out of adult bed, but from suffocating (pile of clothes, plastic bag) or other danger (such as drowning) after falling out.
     According to National Institute of Child Health and Human Development 2000 Survey, 13% of U.S. infants are routinely cosleeping with nearly 50% sharing bed for part of the nights.   The number of U.S. infant lives that could be saved per year by exclusive and extended breastfeeding is 9,000 because exclusinve and extended breastfeeding cuts SIDS risk and cuts overall infant death risk in half.  Bed-sharing increases number of night feeding and protects your milk supply and therefore your long-term breastfeeding rate increases. 
     There is no 100% way to protect your baby, but I hope this arms you with the facts so that you can make the best decision for you and your family.  You are a good parent or you wouldn't be doing the research.  Trust your instincts. 

Tuesday, May 14, 2013

Breastfeeding Essentials: Budget for Breastfeeding

     We all know that all you really need for breastfeeding is a boob and a baby, but I often get the question, "What do I need for breastfeeding?".   The answer is that it really depends on your situation and your budget.  Are you going to be working outside the home?  If you are mostly working in the home, do you have times that you need to be away from your baby for conferences, etc? 
     Formula costs about $150 per month so you budget for breastfeeding could be over $1000 and still be ahead, but most most do not spend that much.  If you work inside the home and are not separated from the baby, you can spend very little.
     The following is a checklist and depending on whether you are work at home mom or a mom who works outside the home, you will want to pick and choose the type of breast milk collection product you will need based on your situation.   I have been in the business of breastfeeding for 20 years and am very familiar with the major brands and products associated with breastfeeding so the product list below is one given with experience and based on what products I would buy for myself, my daughter or my daughter-in-law:
Nursing Pads
__2-3 packs of washable nursing pads
Breast Cream
__1 large tube of breast cream
Nursing Bras and Gowns
__2-3 quality nursing sleep bras
__2-3 daytime nursing bras with good support (non-underwire)
__2-3 nursing gowns
Breast Milk Collection and Storage
__1 quality double electric breast pump
__2-3 packs of breast milk bags
__3 packs of breast milk bottles for storage
     The best time to be fitted for a nursing bra is 3 weeks prior to delivery.  This is a great time to finalize your list and make sure your hospital bag is packed and ready.  Happy nurturing!

Tuesday, March 26, 2013

Nursing In Public: To Cover or Not to Cover

     There is an ongoing debate in the breastfeeding community about covering up while breastfeeding.  Many lactivists insist on nursing without a cover.  Others may even be rude to a nursing mother who is nursing in public.  A cover is a personal choice.  Nursing in public may be more comfortable to you while you are learning to latch on discreetly with a nursing cover.  Once you and your baby learn to latch well, a nursing top or other discreet top may work for you.  If you are in a group of women, it is actually helpful to nurse without a cover so that other women can learn from you.  One of the reasons our culture has a difficult time with the early days of breastfeeding is that we have never seen it done.  Although Spanish is my second language, in my 20 years of counseling nursing mothers I have had less Hispanic clients who needed help with latch due to the culture of women helping women. 
      If you choose to cover, the Bebe au Lait or Hooter Hider is an excellent nursing cover because they have a patented stay to keep the cover lifted out just enough for you and your baby to have eye to eye contact.  The LatchOn Nursing Strap is a great go-to item because it turns any blanket into a nursing cover making it very easy to carry with you even if you are only toting a purse, one diaper and wipe.
   So cover, don't cover.  It is up to you.  Do whatever makes you, not just others feel comfortable.  The more comfortable you are, the longer you will breastfeed!

Introducing a Bottle to the Breastfed Baby

     Waiting to offer a bottle is essential for initation of lactation.  Experts tell us that we should wait at least 3-4 weeks.  I believe it should be at least four weeks because even a bottle of breastmilk can interfere with stimulation during the three week growth spurt period. It can undermine moms confidence when baby gulps a bottle down during the hunger games of growth spurts.  When you offer a bottle of expressed milk, it is essential to pump to replace that feeding or it can interfere with milk supply or cause plugged milk ducts. 
     Most moms begin a bottle because they want the freedom of allowing someone else to feed or out of necessity because they are going back to work.  If you choose to nap and let Dad feed make sure to fully empty the breasts by nursing first.  If a bottle has been given while you were asleep or running errands, pump when you return even if you have nursed immediately when you came through the door.  Anytime a bottle was given, baby will not be as hungry and therefore not empty the breast as well and residual milk can cause clogs especially in the early weeks of breastfeeding.
     If you are not going back to work or want someone else to feed, a bottle is not an absolute.  You may wait longer if you wish, but some moms who wait longer than 8 weeks find it difficult to coax their baby into taking a bottle.  So if you are going back to work, the best window may be 4-8 weeks.  If you are not going back to work, but find yourself in an emergency situation that you have to be away from your baby, the baby will normally take a bottle from another person if you are gone very long.  If you are not gone more than 3-4 hours, the baby may also wait for you.  In any case, it is important to have stored up at least 24-48 hours worth of breastmilk in the freezer.   Here is a breast milk intake chart to help you determine how much you need based weight.

Store milk in 2-4 oz increments.  This makes it easy to defrost and access just the right amount without waste.  You may store breast milk in sealed bottles or breast milk bags.  Bags have been the preferred method for most moms due to the quicker defrost time and space saving size.  They are more costlly in the long run so bottles may be more cost effective and better for the environment, but today inexpensive biodegradable breast milk storage bags are available.

Sunday, March 24, 2013

Breasfeeding: When and How to Supplement a Breastfed Baby

     Although breastfeeding is natural and a full milk supply is available in almost all women, there are times that milk supply is down for reasons that we can usually trace to supply and demand issues.  These issues include mother baby separation, scheduling, good baby syndrome, and birth control prescriptions. 
     Many times, however supplementation occurs because of perceived low milk supply.  Just because a baby gulps down a bottle of formula when offered doesn't mean moms milk supply is low.  If you feel your milk supply is low, stop and calculate.  First, check your baby's wet and dirty diapers.  Your baby should have at least 8 diapers.  The number of dirty diapers is age dependent.  If your baby is 6 days to six weeks, he should be having 3-4 silver dollar sized stools per day or more.  If your baby is over six weeks as little as one stool every 3-5 days can be normal.  Your baby's stool schedule changes at about six weeks so if additional changes occur, check weight.
     If your baby is not wetting an pooping properly, the next step is a weight check.  Your baby at ages 6 days to 6 months, should be gaining an average of 3/4 oz per day.  You can go by your doctor's office and use their scale or buy a baby scale or rent a baby scale.  Calculate how many weeks it has been since the last weight check and subtract from the new weight.  Divide the difference by the number of weeks.  Your baby should have gained at least 5 oz per week.  (Remember, there are 16 oz per lb.)
     If your baby has really not gained appropriately and you must supplement, do it wisely.  If your baby is under six weeks, use a 10 cc slip tip syringe for finger feeding, medicine cup or feeding tube.  If using a syringe, please note that 30cc is equal to one ounce.  Feeding tubes can be used for finger feeding or for supplementing while at the breast.  If you have an older baby, someone other than mom may supplement with a wide-mouth slow flow silicone nipple in a tummy to tummy position with the baby held tightly.

     Before you begin supplementing, check your milk supply.  Do this with a professional grade or hospital grade double breast pump.  The best time of day to check milk supply is the second feeding of the morning.  Nurse during the first feeding as usual, wait three hours and then double pump for 15 minutes.   Use the breast milk supply chart on this page to determine if your milk supply is normal.        
     Once you determine your output, subtract that amount from the average output and supplement only that amount.  For example, and 8 lb baby extracts an average of 2.5 ounces per feeding.   If your output is 1.5 ounces, then supplement no more than 1 ounce after feeding for no more than two days.  Pump after each and every feeding that you supplement.  Use breast milk to supplement whenever possible.  On the third day, check your supply again.  If your supply is now 2 ounces, only supplement the difference of 1/2 ounce and check again on the third day.  This consistent stimulation of pumping and limited supplemental schedule should keep the supplementation from spiraling into a vicious cycle. 
     Do not supplement additional amounts unless your baby has signs of dehydration such as no wet diapers or diapers that have a red brick powder-like substance in them.  If your baby is fussy after the allotted amount, put them back to the breast.  This will help you baby stimulate breast milk production as well as soothe them with suckling.
     Call a doctor or lactation consultant if your supply does not increase with the above method.  You can use lactation bars or cookies than contain galactagogues or take herbs like Fenugreek and Blessed Thistle to increase milk supply.  You can take 3-5 capsules of Fenugreek three times daily or a combination of three Fenugreek and two Blessed Thistle capsules three times daily for a minimum total of 15 capsules per day.  In general, herbs in glass bottles are more potent than those in plastic bottles due to freshness and quality.
     Is summary, supplementation should not be taken lightly.  If done improperly, it can be the beginning of the end of breastfeeding.  If necessary supplement wisely, minimally and with a plan for increasing milk supply in hand.

    

Tuesday, March 5, 2013

Breastmilk: The Perfect Food

Breastmilk varies in composition from colostum to transitional milk to mature milk and each stage is perfect for your baby's stage of development. 

Colostrum can begin leaking during the last trimester of pregnancy and is produced during the first few days (1-7 days) after birth.  It contains a higher amount of protein and less fat than transitional or mature milk. It is thick and sticky and coats and protects the infant's stomach.  It is high in antibodies and acts as the first immunization for your baby. Colostrum has a laxative effect on the newborn, helping your baby pass the meconium stool.  It also comes in teaspoons and not ounces, making it the perfect amount for a newborn whose stomach is the size of a walnut.

Transitional milk is the breast milk that transitions from colostrum to mature milk.  Transitional milk is produced from approximately day 8 through the second or third week in most women.  However, when moms deliver a baby prematurely, transitional milk can last much longer as it is the perfect milk to help the baby grow in that stage of development.  Transitional milk includes high levels of fat, lactose, water-soluble vitamins, and contains more calories than colostrum.

Mature milk is usually present at about 21 days after birth and going forward. It can vary in fat content, as the fat of the milk received by the infant increases as the feed progresses.  This progression is also called hindmilk.  Mature human breast milk is 80% water and contains whey proteins, carbohydrates, fats, minerals, vitamins, enzymes, hormones, anti-infective and anti-allergenic agents. These enzymes, hormones, anti-infective and anti-allergenic agents cannot be reproduced in an artificial milk. Human milk has a combination of amino acids that is unique to human milk. The type of protein and the finely balanced combination of different amino acids such as glutamic acid and taurine enable the baby to digest and absorb fats in their intestines in the first few weeks of life. The combination of ingredients in breast milk actually changes and matures as the baby grows older, to specifically suit your baby's changing needs. 

Each stage of breasmilk is perfectly formulated for your baby's needs as they grow and develop,  You are enough for your baby.  It is the main source of nutrition thoughout the first year.  After six months when your baby is stitting completely alone, if you wish to being solid foods, know that this is a complement to breastmilk and not to take the place of their superior food.  Nurse first and give a small amount of solids immediately afterward.  This way your baby doesn't fill up on anything other than breastmilk.

Saturday, March 2, 2013

Sleep Training and Breastfeeding

     Sleep training is understandably a popular subject among sleep deprived new mothers.  Unfortunately popular methods like BabyWise and the Ferber method can decrease milk supply dramatically.  I recently had a mother contact me who was using the Ferber method.  Her 5 month old baby who was previously gaining weight well had only gained 3 ounces in six weeks after starting the Ferber method*.  This can occur because a baby is not feeding frequently enough during the day and then is not being fed when he wakes in the night.  Please know that sleep should take a back seat to weight gain.  And waking at night is not only healthy for milk supply, but there may be other benefits as well.  Breastfed babies have a lower incident of SIDS.  We do not know whether that is due to the superior nutrition in breast milk or whether it is because they wake more frequently at night.  Breast milk is more easily digested than formula so it is normal for the breastfed baby to feed more frequently than a formula fed baby. 
     Having stated the case for night nursing, I do not want for you to loose all hope that you will ever sleep all night again.  Here are some things you can do to gently guide your baby into a longer nights sleep:
1.  Make sure that your baby feeds frequently during the day.  A baby under 6 months of age should feed at least 8 times per 24 hour period.  The baby 6-12 months normally feeds 5 times per day.  Getting more feeding in during the daytime hours, will help with less feedings at night.
2.  Unless you want to practice attachment parenting and the family bed, you can start with the baby in his or her crib at the beginning of the night.  If after nursing the baby at bedtime, you put the baby in a crib, when he learns to sleep through the night, he is already in his own bed.  This prevents the baby from waking just because he smells your milk.  (Note:  If your baby is not gaining weight properly or you are trying to increase milk supply, you should certainly take the baby to bed with you for unlimited feeding.)
3.  Try to keep your baby on task when feeding during the day.  If your baby is distracted, try nursing in a quiet darkened room or use distractions for the older children to be less of a distraction for your baby.  One of my favorite tricks is to devide toys into bins and bring down a fresh bin of toys right before nursing.  Another is to have a drink or helthy snack ready for your toddler so his needs are met before you start.

Additional Tips for Moms:
1.  Don't let sleep training "experts" fool you.  It is not normal or even healthy if you look at the SIDS studies for a baby to be alone in his crib for 12 hours.  Count it a blessing if your baby sleeps for 5 hours so you can get some REM sleep and jump for joy if he sleeps for eight hours at any given point in time.  This is the norm for breastfed babies. 
2.  Sleep when your baby sleeps.  It may be necessary for you to get a nap during the day or even go to bed a little earlier if your baby goes to sleep early for you to get your much needed sleep.
3.  Know that normal "schedules" go out the window when your baby goes through growth spurts.  Even if your baby was sleeping for 5-8 hours, during the 3 week, 6 week, 3 month or 6 month growth spurts, feeding will be more frequent.  This is normal and usually only lasts 5 days if you do not delay the feedings.

     Breast milk supply is all about supply and demand.  Weight gain is based on total calories consumed in a 24 hour period.  If your baby is distracted during the day and not feeding well, it is important that he or she gets her calories at night.   You are a good mother, if you were not you would not be reading articles to learn more about parenting your baby.  Every child is different and norms do not hold true with every child.  All I can do is give you information based on training as an International Board Certified Lactation Consultant and 20 years of experience.  I hope this article helps you to protect your milk supply and meet your breastfeeding goals.

*Note:  The average baby from 6 days to 6 months of age gains 5-7 ounces per week.

Wednesday, February 27, 2013

Breast Pump Insurance Coverage & Reimbursement

   As the Affordable Care Act is enacted and more and more moms are becoming aware of the benefits of it, we are learning more and more about getting insurance to cover your breast pump.
 First, don't take "no" for an answer.  Call your insurance company.  If the representative tells you that a breast pump is not covered ask why.  Some insurance companies are still classifying breast pumps as "personal comfort" items.  According to the US Government Department of Health & Human Services, " Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012."
     The Affordable Care Act covers Breastfeeding support, supplies, and counseling.  Some insurance companies are covering hospital grade breast pump rentals, but others are covering quality personal use pumps sold by DME supplies like Lactation Connection.  We found the United Health Care policies buried in a table entitled Expanded Women's Preventative Health and it states that these items are required coverage for plans beginning after 8/1/12.
     Make sure to get prior approval from your insurance company before purchasing from an out of network supplier, especially if you are on an HMO.  But it is always a good idea to call your insurance company first for information on how to get reimbursement.  Take down the name of the person you spoke to.   If the answer is "we don't cover that"  ask why and if the answer is not that you have to buy "in network" or that your plan is grandfathered.  Call back and speak to someone else until you get a knowledgeable helpful representative.  Finally, ask what paperwork you need to submit for reimbursement.  Lactation Connection provides you a receipt with the appropriate insurance codes attached for your convenience when you purchase at http://www.lactationconnection.com


http://www.hrsa.gov/womensguidelines/
http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Preventive_Care_Services_CD.pdf

Saturday, February 16, 2013

Breastfeeding Herbs: Is it all Fenugreek to You?

Herbs can be confusing because not all herbs are created equal. Cheaper herbs can loose their efficacy quickly.  For increasing milk supply you want a high quality brand Fenugreek in a trusted brand  like Nature's Way Fenugreek for maximum freshness and potency if taking in capsule form. You also need to take the appropriate dosage for your weight.  If you are an average weight and taking  610-626 mg capsules, you should take three capsules three times daily which is a total of 9 capsules per day.  If you are a plus sized mom, you should take 5 capsules three times daily for a total of 15 capsules per day.  Below is a height and weight chart for the average women 18-34 for the purposes of dosage:
4'10"-5' 90-128 lbs
5'1"-5'3" 101-141 lbs
5'4"-5'6" 111-155 lbs
5'7"-5'9" 111-169 lbs
5'10"-6'   132-184 lbs
Fenugreek can also be taken in the form of tea.   Traditional Medicinals Organic Mother's Milk Tea company recommends drinking three cups per day.  There is no recomendation for plus size moms.   Some moms like to use capsules when they are on the go and coffee or tea when they are relaxing with a beverage.  You can also use the tea as a cold beverage once steeped.  It is easier to get the appropriate dosage from capsules.  Fenugreek capsules also work well when combined with another herb such as combining 3 capsules of Fenugreek and two capsules of Blessed Thistle three times daily.  When taking the appropriate dosage in a quality herb, you should see results in just 48-72 hours.
May your cups run over!
Tanya

Sunday, February 10, 2013

Comparing Hygeia Breast Pump Models

     The Hygeia EnJoye Breast Pump has become our most requested pump of 2013, but the different models can be confusing.  First, all EnJoye pumps have the same motor with the same three year warranty. All three are "green" pump so they are approved by the FDA for multi-person uses so can be resold.  If you are purchasing a used Hygeia EnJoye you will need your own sanitary double pumping kit which includes the tubing, filters bottles and valves. And all three have the CARE function witch is an audio recording device to record your baby's coos or cries and play them back to assist with let down while pumping.  The distinctions are below:
Hygeia EnJoye EPS Breast Pump has an external power supply (AC adapter) only and can be purchased on our site with or without a tote.
Hygeia EnJoye EXT Breast Pump has both the AC adapter and an external AA battery pack.  You can purchase these with a brown or black tote which makes a very nice diaper bag as well.
Hygeia EnJoye LBI Breast Pump has both the AC adapter and includes an internal lithium ion rechargeable battery for moms who don't have access to an outlet and reply on a battery to pump.

The Hygeia EnJoye Breast Pump is an excellent purchase and is covered under your insurance plan if purchased from either a network provider or a DME supplier like Lactation Connection in most cases.  Always check with your insurance company for details on breast pump insurance coverage, but know that in 2013 a breast pump is covered as preventative care under the Affordable Care Act so don't take no for an answer.  Breastpumps and breastfeeding supplies are covered. 
     If your insurance company pays for breast pump rental, the Hygeia EnDeare is an excellent choice.



Thursday, February 7, 2013

The Breastfeeding Baby and Smoking



I recently had a grandmother ask this question, "Unfortunately my daughter has smoked during her entire pregnancy. She wants to breastfeed and continue smoking. She will not quit spite the potential problems. How can you smoke and breastfeed safely?" 
This is a difficult issue and I thought it best to arm her with the facts.  There are many studies on nicotine in breast milk, but I am referring below two helpful articles.  The first shows that while nicotine is harmful, it may be less harmful to breastfeed and smoke than to bottle-feed and smoke since the baby will most likely be getting the passive second hand smoke.  The second shows the effects of sleep patterns on infants due to nicotine intake.  These babies have difficult sleep patterns and increase risk of respiratory infection.  The Nicotine patches are a much reduced risk to the baby, so I would encourage the mother in that direction.  Also, when dealing with someone who is self-involved, make it more about her benefit than the babies.  For example, tell the mother that she will get more sleep when her baby sleeps better.  Tell her that she will spend less money and time at the doctor when her baby does not have a respiratory infection.  Tell her that she will not have to buy or mix formula when her milk supply is not decreased by nicotine. 
If the mother continues to refuse to stop smoking, make her aware that the nicotine peaks at 60-90 minutes so avoiding nursing during that peak, will help somewhat.  As I said, this is a difficult issue when you care so much, but it is ultimately the mother who will have to come to terms with her decisions.
Best Wishes,
Tanya

References


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277470/