Friday, February 28, 2014

Feeding Expressed Breast Milk: Fresh vs. Frozen

     Many moms are automatically freezing their breast milk each time they pump and retrieving frozen milk from their stockpile to feed the baby.  While this is ok for the mom who gives an occasional bottle, working moms should be giving freshly expressed milk whenever possible. 

     Before we list these factors, let us be clear than breast milk, fresh or frozen is immeasurably better for your infant nutritionally than formula; but to use the best at it's very best, we are explaining the changes that happen to frozen breast milk. 

     1.  Levels of pH are effected by freezing which in turn effects lipase which aids in digestion.  Lipase levels vary from woman to woman, so if you notice a soapy smell or metallic taste to your frozen breast milk, it may be especially relevant to you to give freshly expressed breast milk.

     2.  Bactericidal capacity of stored refrigerated human milk is at it's greatest within the first 48 to 72 hours of refrigeration.  (By the way, this is good to know so you can use fresh breast milk on your infants or toddlers hands instead of harmful alcohol based hand sanitizers.)

     3.  Breast milk is age appropriate.  Levels of nutrients, most of which we still do not fully understand change with your baby's age.  One example is magnesium which increases after 4-6 months.  Magnesium aids in bone development which is needed especially in infants as they begin to sit, crawl and pull-up.

     4.  White blood cells in breast milk are living leukocytes and are killed during the freezing process.  These white blood cells are prevalent in freshly expressed breast milk and help prevent infection and disease. 
living blood cells in breast milk before freezing

     5.  Antibodies are another reason freshly expressed milk is best.  If a mother has recently built immunity towards the latest illness going around, this is passed along to her nursling.  So it is especially important to give freshly expressed milk during the cold and flu season.

     6.  Energy density of breast milk varies with the age of the baby.  So giving a 6 month old breast milk expressed at 4 months, is not as beneficial to his energy needs as giving fresh breast milk.

     5.  Nutrients have been shown to decrease when breast milk is frozen over time.  One study showed a decrease in Vitamin C after breast milk had been frozen for 3 months.

     Now that you know some of the reasons that freshly expressed breast milk is best, how can you as a working mother or an exclusively pumping mother manage it. 
  • First know that all breast milk, fresh or frozen is superior to any formula.
  • If you are a M-F working mother, leave frozen milk for your baby on Monday but use the milk you pump Monday to give on Tuesday, Tuesday's milk is for Wednesday, etc.  Then when you come home on Friday, feel free to freeze that milk or save it in the refrigerator for Monday depending on how much stockpile you think you need in the freezer. 
  • Frozen milk is perfect for use as a back-up and if you see you have more than you need, please donate it!
  • If you are an exclusively pumping mom and need to dip into your frozen stockpile, don't beat yourself up about it.  You are doing so much good for your baby in giving breast milk.  To help you have more  fresh milk in the future, make sure to simulate growth spurts by pumping 11-12 times a day during the week your baby turns 3 weeks, 6 weeks and 3 months.  Also, make sure you use stopwatch on your phone or timer app to ensure you are double pumping for a full 10-15 minutes, whether milk is flowing the whole time or not.  This will help you get the stimulation you need to keep up a healthy milk supply.  Also don't forget to change valves, diaphragms or filters on your pump often to get the best performance out of your pump.
  • Many products are dedicated to freezing breast milk, but new products are helping moms label and organize their freshly expressed breast milk.  Breastmilk Bandit is an economical re-usable and fun way of helping moms with this task with their breast milk organizer.  These are day of the week bottle bands that say Mommy's Milk and the day of the week in fun colors.  Also helps identify your baby's bottles in the church nursery or day care.  Breastmilk Bandit Fresh Express Breast Milk Bands fit most 4-8oz breast milk storage and feeding bottles.

Remember, breast milk is best.  Frozen breast milk is great, and FRESH is EVEN BETTER!

Happy Nurturing,
Tanya




References:
Lawrence R. A., and Lawrence R. Breastfeeding: A Guide for the Medical Profession. 6th ed. Philadelphia, Pennsylvania: Mosby, 2005: pp. 106-129
Per Gaskin, Ina May. “Soapy-, Metallic- or Rancid-tasting Milk that You Have Thawed.” Ina May’s Guide to Breastfeeding. New York: Bantam, 2009. p.165.
A few studies have found a significant decrease in vitamin C levels in frozen milk after 3 months Buss et al., 2001; Bank et al., 1985
Martínez-Costa et al., 2007
EFSA Journal 2013;11(7):3331
Goldman AS. The immune system of human milk: antimicrobial, anti-inflammatory and immunomodulating properties. Pediatr Infect Dis J 1993 Aug;12(8):664-71

Note:  Breastmilk Bandit breastmilk storage organizer systems for retail and resale wholesale accounts can be purchased through Amamante.

Wednesday, February 5, 2014

Breast Pumps: Pumping Mama Tips

     Many of you are "pumping mamas" that is to say you pump when you are away from your baby for work or you exclusively pump and give breast milk in a bottle.  If so, there is some planning involved to maintain your breast pump and milk supply.  Here are some valuable tips to keep the milk flowing: 
     1.  Use a quality double electric breast pump.
The Hygeia EnJoye Breast Pump , the Spectra S2 or Ameda Purely Yours Breast Pump are professional double breast pumps that offer a closed system with the proper suction and speed settings to maintain your milk supply.
     2.   Make sure your breast flanges are the right size.
The easiest way to get started finding the right fit is to look down at your nipple and your fingers at the same time.  If your nipple shaft (not including the areola) is the size of your ring finger, start with the standard size flange which is usually 24-27 mm depending on the brand of pump.  If it is smaller like your pinky finger, use an insert like the Flexishield in the standard flange.  If you nipple is wider like your thumb, go up to a custom-sized flange.
     3.   Pump every 3 hours that you are away from your baby.
If you miss or delay a pumping, make sure to put the next ones closer together so that you don't end up skipping a session.
     4.  Double pump for a full 10-15 minutes. 
Double pumping increases prolactin levels for a healthier milk supply than does single pumping.  You need to pump longer than the milk is flowing so if milk stops, don't stop your pumping session until you have pumped for 15 minutes.  Breast pumps like the Ameda Platinum are available for rental and offer a timer to ensure you are pumping for the optimal time period.  You can also use your phone timer to help you stick to the plan.
     5.  If you miss a pumping session, make it up!
If there was an emergency and you had to miss a pumping, make it up with two more pump sessions at home.  One after your baby's evening nursing and one right before you go to bed.
     6.  Maintain your breast pump by replacing valves once a month.
White duckbill valves like the ones used with Ameda and Hygeia pumps should be replaced frequently to maintain optimum suction.  Examine the end for tears or warping if you find suction to be lessening.  
     7.  If your pump has a filter or diaphragm, replace once every 2 months.
Hygeia filters should be replaced every 2 months and Ameda diaphragms every 2-4 depending on how they are cleaned.  Diaphragms should not be sterilized.  Use soap and water only on this Ameda part.
     8.  Simulate growth spurts by pumping every 2 hours.
Babies typically go through growth spurts at 3 weeks, 6  weeks, 3 months and 6 months.
Add three pumping sessions per day for five days in a row to effectively simulate growth spurts.  If you were a stay-at-home mom, your baby would be nursing more frequently so you need to do the same with your pump.  Note that the first growth spurt can show up as early as 10 days of age.
    9.  Use freshly expressed milk whenever possible.
Use the milk you pumped the day before for the next day instead of freezing it.  Fresh milk has the most antibodies.  Frozen milk is second best, but still far superior to any infant formula.  A rule of thumb to use the most fresh milk is to freeze Friday's milk, but use the fresh milk Monday through Thursday.  Your frozen stockpile can be used for low milk supply times like when your period returns, emergencies, and for mixing with solids after your baby is sitting alone and developmentally ready for them.  If you need help organizing your milk in the fridge, Breastmilk Bandit is a great labeling solution.
     10.  Your baby is the best motivation.
Sight, smell and sound can help trigger the milk ejection reflex aka let-down.  Look at a picture of your baby.  Drape a nursing scarf or receiving blanket around your neck that smells like your little nursling.  Play back a recording of your baby's coos or cries.  After all, you are doing this for your baby! 

Best wishes for a healthy milk supply and a happy baby!