Preventing Breastfeeding Roadblocks: Finding a Pro Breastfeeding Pediatrician

 

There are some roadblocks to breastfeeding than come up often when moms are in the hospital or at their first pediatrician visits.  Depending on a mom's personality some are good advocates for themselves, but a lot of moms just go along with what they are told without questioning.  Often even if the pediatrician is pro-breastfeeding, a staff member will give you a biased opinion of what needs to be done in a certain situation.  While there are times supplementing with formula is helpful, often it is not necessary and depending on how the supplementation is done can hinder breastfeeding success.  

Common scenarios that present barriers to breastfeeding are listed here including science-based evidence for this information in case you need to pass it along to any health professionals who may disagree so that you be your baby’s advocate. 

1. The baby has low blood sugar.

The high protein content of colostrum helps with glucose stabilization and promotion of ketogenesis which is as effective as formula supplementation.

https://www.jognn.org/article/S0884-2175(15)31316-2/fulltext

2. The baby has jaundice.

There is a difference between breastfeeding jaundice and physiological jaundice.  Physiological jaundice appears within the first few days and can be a normal result of an immature liver which is not removing bilirubin quickly enough.  Colostrum is an effective treatment because it helps the baby pass meconium, the first stool, which removes excess bilirubin from their body.

The cause of breastfeeding jaundice is unknown, but it is most likely related to infrequent feedings. It does not usually present itself until after the first week of life.

https://www.ncbi.nlm.nih.gov/books/NBK537334/ 

Phototherapy is common protocol to treat jaundice.

3. The baby is big and “needs” supplemental formula.

Birth weight can increase the stomach capacity,  but supplementation, especially without expression hinders the mature milk from coming in on time.

The defense is a good offense.  Initiate the first feeding within 30 minutes of birth because after the first 1-2 hours baby goes into rest mode and is difficult to feed well for the next 8-12 hours, but any attempts at suckling will help stimulate milk production.  Approximately 5ml to 10ml is the typical colostrum feeding in the first 24 hours of life so if the baby is larger, it is important to feed more frequently than 2-3 hours as normally recommended.  Studies show that babies can metabolize up to 20ml per hour and since colostrum comes in approximately 5ml teaspoons, feeding every hour is beneficial. Mature milk normally comes in between the 3-5 day postpartum so frequent feedings can help the mature milk to come in on the earlier end of this range and help offset the big baby syndrome.

https://pubmed.ncbi.nlm.nih.gov/23662739/

4. The baby has lost too much weight and “needs” supplementation.

Typically, the baby’s first pediatrician’s appointment is on day 5-6.  It is normal for breastfed babies to lose 7-10% of their birthweight as the mature milk does not come in until day 3-5 and moms and babies are learning how to breastfeed.  Formula babies only typically lose 3-5% of weight since larger amounts than are necessary are often fed and bottle nipples drip formula into the baby’s mouth without effort. Not putting formula standards on breastfed babies can prevent unnecessary supplementation which can interfere with breastfeeding success.

https://www.ncbi.nlm.nih.gov/books/NBK536449/

  

It is beneficial when interviewing a pediatrician to tactfully get a feel for how quickly they recommend supplementation. 

Here are some sample questions:

 

I understand some jaundice is common, do you recommend pumping and feeding the baby colostrum or formula?

 

Is low blood sugar a reason I would have to supplement formula instead of colostrum?

 

When is the follow up visit scheduled after birth?

 

How much weight is ok for my baby to lose the first week while I am breastfeeding?

 

How the pediatrician answers these questions may help you determine how pro-breastfeeding they are.  It is more difficult to determine how pro-breastfeeding their staff is without being a patience, but if at any time you get advice from a doctor’s staff that seems contradictory to the doctor’s values, don’t hesitate to ask for a phone call from the pediatrician in person.

 

That being said, sometimes supplementation is necessary but sometimes moms are bullied into supplementing even when not necessary.  If either is the case, it is important to stand firm on not using a bottle nipple to supplement.  A 10cc slip tip syringe can be used to finger feed the baby easily and this method keeps the baby’s tongue in a good position for breastfeeding.  In addition, it is easier to slow the pace of the feeding with a syringe which keeps baby on track with moms increasing milk production instead of exceeding her production where she is always playing catch-up.

Here's to all the pro-breastfeeding pediatricians and nurses out there!  They do exist!

Tanya

Getting the Most Out of Your Spectra Breast Pump: Massage Mode vs Expression Mode:

Spectra is an industry leader in breast pumps and if you have the option to getting a Spectra breast pump, whether it is through insurance or private pay, it is a great investment.  These pumps are high quality, offer high output, exceptional warranty service and offer a wide variety of accessories to make your pumping life easier.

One of the best things you can do when you get your breast pump is to familliarize yourself with the control panel.  The one pictured below is for the Spectra S1, but the only difference between the control panel on the blue  Spectra S1 and the pink Spectra S2 is that on the S2 you will not see the battery life indicator in the top right section of the LED display since the S1 offers a rechargeable battery whereas the S2 is powered only by electricity. The green S3 Pro intented for hospitals, clinics or corporate lactation offers the same control panel as well.

 

 Of course, you will want to start with the on button located in the middle bottom of the panel.  After that, I will take you from left to right explaining the function and features of each button.  On the far left is your cycle control with plus and minus buttons to go up or down in speed.  The speed in the breast pump industry is often referred to as CPM (cycles per minute).  The Spectra S1 and S2 have 5 speed levels.  Level one will be 38pm and level 5 will be 54 cpm.  The average baby does about 48 sucks per minute when they are in an effective nursing rhythm.  In addition, babies nurse at a faster speed of about 70 sucks per minute when they are initiating a let-down which bring us to the top middle button that looks like it is a wave or as I like to refer to it as a white river.  This is the massage mode which automatically sets your pump to 70 cpm to help initiate let-down.  This button should be turned on after you are sure your flanges are centered on the nipples at the beginning of the pumping and used again anytime the milk slows and you would like to initiate another let-down.  Press the button again to go back to expression mode.  This is the best course of use rather than using the massage mode all the time.  You will want to simulate a typical nursing experience with your breast pump as a baby will not sustain 70 cpm the entire nursing and you want the massage mode to be effective when you choose to use it.

To the right of the massage buttom, you will find the plus and minus buttons to use for vacuum.  The strength of vacuum is measure in millimeters of mercury which you will see written as mmHg. There are 12 levels of vacuum pressure for the Spectra S1 and S2 breast pump in expression mode ranging from 50 mmHg to 270 mmHg.  In massage or let-down mode, there are 5 ranging from 50 mmHg to 200mmHg.

As an additional feature, there is a light button on the control panel for night pumping.  This button has two settings which when pushed once is on high and when pushed a second time, it is a lower light setting.

As a side note, the front of the pump has two ports where the tubing is to be attached, but if you would like to empty on breast, the Spectra air cap port cover which is also connected there can be used to close off one port for single pumping.

Get ready for pumping success by getting to know your Spectra breast pump! Make sure to sterilize your breast shields, valves, and bottles; the tubing and backflow protectors are for air and backflow protection so do not come into contact with the breastmilk and do not need to be sterilized.

Plan for your breast pump maintenance by having in stock replacement valves and backflow protectors.  These two parts affect your breast pump suction so if you want to get accurate vacuum and effective milk extraction, take care of your breast pump parts.  

Pro Pumping Tip:  Don't use bristle bottle brushes as these can scratch, damage and harbor yeast.  Instead use a silicone bottle brush when cleaning these parts.   

Expressly yours,

Tanya

Lactation Consultant: Tips on Locating, Hiring and Getting the Most from your Breastfeeding Consultation

One of the questions we are often asked is how do I find a lactation consultant near me?  And does insurance cover the consultation?

Those are two great questions and we have answers for you as well as tips on how to hire your IBCLC and what questions you should ask in the process.

1.  Use an up-to-date lactation consultant locator.  The ones on the international board of lactation consultant examiners is often outdated as many lactation consultants aren't in private practice and don't do home visits.  Lactation Connection hosts a free locator on their website and it is up to date for 2024 with lactation consulants who have personally provided their current contact information and service areas.

2.  Speaking of information, that should be your first question when you speak to a lactation consultant. Below are some examples of what to ask.

    What are your credentials?  There is a vast difference between an IBCLC (International Board Certified Lactation Consultant) who is board certified and required to have 90 hours of lactation education and 1000 hours of clinical experience with mothers and babies and a CLE (certified lactation educator) which is a breastfeeding specialist with a 20 hour training course. And most often the cost of your visit will vary by credentials and experience of the consultant or educator.

    How long have you been practicing? This question can be followed by a specific concern you may have if it is a unique issue such as a baby with downs syndrome, etc.  I would not ask if your consultant can help you with latch or other common issues because if she could not, she would not be in the profession.

    Do you take insurance?  Be specific with your insurance company when asking this question.  And if the answer is no, follow up with how much the home or office visit is per hour and if there is a minimum hourly requirement for their services.

3.  Other things you will want to confirm are listed below:

    Home or office visit? Some lactation consultants come to your home, while other prefer an office visit.  Office visits are usually less expensive but home visits can be more beneficial especially if the issue is one of latch as you want to get positioned correctly on your own furniture.  The height of the arm rests of your chair or footstool can be a factor in being comfortable while breastfeeding which reduces stress and can fascility a calm environment while acheiving a proper latch.

    What about a virtual visit? If you are in an area that does not have a lactation consultant near you, this can be somewhat helpful but you will want to make sure that your consultant has visual tools that can help you during your video call such as breast and baby anotomically correct models.  It is also helpful to let her know in advance if you have a specific breast pump or specific nursing pillow.

    Language barriers? Many consultants who offer virtual visits will state that they ofter them nationwide or even worldwide.  The worldwide statement is a red flag because they need to be multi-lingual to be able to offer worldwide service.  If your first language is Spanish for example, you may want to hire an IBCLC who is truly bilingual in Spanish to get the most out of your visit. 

4.  What should you expect during a consult? You should expect a very professional visit.  A board certified lactation consultant is there to help you get the most out of your breastfeeding journey.  She will wear gloves and ask permission before touching you or your baby.  If you can, the tips below will help you get the most out of your visit:

    Ask questions! No question you might have is unimportant.

    Include a person you trust at the visit.  Your partner, mother or friend can be instrumental in helping you take notes or offering a helping hand with things they also learned at the visit.

    Get instruction on nursing and pumping. A quality breast pump can be a very effective tool with drawing out inverted nipples, increasing milk supply and reliveing engorgement when used properly.

Here's to hoping for the best start to a long and healthy breastfeeding journey,

Tanya

Pack Your Hospital Bag

 

 

Packing your hospital back should be quick and easy with this list.  

We have curated most of what you need in just one place!  Shop for your dual purpose hospital bag, nursing bras, nursing covers, nursing pad and breast cream here. 

Another thing you might want to do is to put your breast pump in your vehicle in case you need it!

Best wishes for a safe and healthy birth!

Tanya

Spectra Bottles: Spectra Pink & Gold Bottles + New Ivory Design

Big news: Spectra is making changes to their bottles!  

As inventory rolls over, all Spectra products will begin featuring a new bottle to replace the pink and gold ones.  The new bottle features an easier to grip and easier to read design as well as a gender neutral ivory colored collar, sealing disc and cap.  So if you have a boy, and you are using the bottles for feeding, going from pink to ivory is a bonus!  

The wider base is very helpful to prevent tipping and crying over spilled milk, but they will not fit in the bottle holder; if you were unsure, that is what the round hole on the S1 and S2 was for.  Since it only held a single bottle, most moms weren't using it anyway.  Lactation Connection offers a Dual Dock Double Bottle Holder that is specifically designed to hold all Spectra bottles including the new ivory design!

The new ivory bottle design is compatible with all Spectra breast shield flanges!

The bad news is that if you love the Spectra gold logo bottles with the white collar, they are being discontinued which means if you want those, you need to buy them up fast.  You can always see what bottles are currently available for breast milk storage and feeding here.

Beware, because unlike Lactation Connection, most companies do not update their product images like we do.  When you buy from us, we pride ourselves on keeping our images up to date.  And if we have a change that we could not predict, we contact you before we ship! Breastmilk Bandit's Dual Dock Bottle Holder acommodates two Spectra bottles and tames your tubing as well!  Unique design will securely hold the new ivory bottles as well as the pink and white gold bottles. The new double bottle holder is available in blue and white. Pink is coming soon!

So far, the Spectra pink bottles can still purchased separately for breastmilk storage and feeding separately.  But again, if you are purchasing a premium accessory kit from anyone other than Lactation Connection, you may not receive the bottles you think you are getting in the kit or even if you are purchasing a new Spectra breast pump.  View our selection of breast pumps for up to date images.

If you have questions about any of our products, there is a link to click on each product detail page like the one pictured here: 

Just go the product on our website that you have a question about, and you will find the option to ask a question on the product page!  We are happy to help!

Here's to storing your breast milk your way!

Tanya

Manual Expression of Breast Milk: Marmet Technique

 

The Marmet technique for hand expression has long since been the gold standard for teaching moms how to hand express breast milk.  Having the ability to hand express breast milk comes in handy if you want to harvest colostrum, alleviate a clogged milk duct or just need to get the breast milk flowing for the baby who needs extra encouragement to latch.  

Before you begin, prepare both your body and your mind, by using massage or warm compresses as well making the environment comfortable and conducive to relaxation which will help with let-down.  

If you need a faster method for expression, a quality manual breast pump like the Spectra Manual Pump is great for occasional use and very affordable.  If you are working and breastfeeding, choose a double electric breast pump instead.  

Here's to keeping it flowing,

Tanya

How to Treat Mastitis

When a plugged duct turns into mastitis, it is not something that is not to be taken lightly.  How do you know if you have mastitis?  Usual symptoms are an area of your breast that is red and painful along with flu like symptoms such as chills or fever.  

If you experience these symptoms, use this tactic:  Heat, Rest, Empty the Breast

Heat:  Apply hot compresses.  If you don't have a hot compress on hand, use a disposable baby diaper with hot water in it.  This can be re-warmed in the microwave, but test on wrist before applying to breast.

Rest:  Sleep when the baby sleeps and get off your feet as much as possible.

Empty the Breast:  Point the baby's chin towards the affected area.  For example if the clog is more towards your arm, use the football hold.  Pump after every feeding for 5-10 minutes to finish emptying anything the baby leaves behind. You may see some information that says to avoid breast pumps, but this is only if you are using them before softening the breast with the hot compresses.  Use your pump on a fast speed and only the highest suction level that is comfortable.  Do not turn up the suction to an uncomfortable level.

Take ibuprofen such as Advil to relieve pain and reduce swelling.  In addition, Sunflower Lecithin capsules are very helpful.  This supplement help the fat slide off the sinuses of the breast which can help relieve mastitis sooner.  The dosage indicated on thee bottle is one capsule daily.  This dosage is only appropriate for maintenance in moms who have a tendency to get clogged milk ducts.   During a clogged duct or as a mastitis supplement, it is recommended to take 3-4 of these 1200mg capsules daily such as at breakfast, lunch, dinner and bedtime.

Do not wear an underwire or tight bra.  This can complicate your symptoms. 

If symptoms continue for more than 24 hours, see a physician as mastitis can turn to abscess.

If you are reading this and have a tendency for clogged ducts, you may want to keep Sunflower Lecithin and a good hot compress on hand. If you are still pregnant, you may want a hot compress that does both hot and cold applications for postnatal engorgement as well.  In this case, we recommend the Legendairy Milk Breast-Ease Gel Packs. You can also use these compresses to relive pain but only after feeding or pumping.  Cold can restrict the let-down if you use them before feeding or pumping.

Best wishes for health breasts,

Tanya

Harvesting Colostrum: Antenatal and Postnatal Colostrum Collection

    Harvesting colostrum both antenatally (before birth) and postnatally (after delivery) is a great way to prepare for the unexpected.  Sometimes birth plans do not go to plan and having this liquid gold at your disposal in case of emergency is always a plus especially since colostrum is essential as baby's first immunization, highly concentrated in antibodies and nutrition to boost your baby's immune system.  In addition, if feedings are slow to start, colostrum can maintain your baby's blood sugar levels.  

A colostrum collection kit makes it easy to have the things you need on hand.  While using a breast pump can sometimes cause contractions, a more gentle hand expression is not only safer but more effective in saving every drop. While there are several methods of hand expression found online, research shows that the Marmet Technique is still the most effective so we have included the full instruction sheet below. 

Once you have begun hand expression, start by using the smaller 3ml syringe in the colostrum collection kit to draw up the colostrum direction off the nipple and areola.  If you use a breast pump, it is harder to get the sticky colostrum off the pump parts and valves.  After you have harvested the colostrum, place the syringe(s) into a freezer bag or breast milk storage bag so that you can safely keep them in the freezer.  Babies only need a teaspoon of colostrum per feeding initially so the 5ml syringes included are perfect for feeding. Postnatally, more volume of colostrum may be collected so you may want to express into the 50ml container included in the kit as you can also use the syringes to draw from the container for feeding. 

The Liquid Gold Colostrum Collection Kit includes:

(6) individually wrapped sterile 3ml syringes with caps

(6) individually wrapped sterile 5ml syringes with caps

(1) 50ml/2oz colostrum container with lid (non-sterile - sterilize before use)

If you have additional transitional milk which is a higher volume of colostrum as the mature milk is coming in, there are 10ml syringes, 50ml minifil bottles and 60ml colostrum containers with lids also available to purchase.

Happy Harvesting!

Tanya

Can I Supplement with Formula and Still Breastfeed?

Just like a birth plan, sometimes, breastfeeding does not go to plan and some moms may need to supplement.  This does not have to mean the beginning of the end of breastfeeding if caution is used in how you supplement.

Supplementing Baby at the Breast

Often supplementation is only necessary for a short term while mom is regaining her milk supply or baby is having a frenotomy to release a tethered tongue to facilitate milk transfer. And the best method for supplementing formula is doing so while keeping the baby at the breast.  However, Supplemental Nutrition Systems are often expensive and difficult to clean so short-term feeding tubes are the preferred method in these cases.  In the case of supplementing a newborn, the best option is a 5FR feeding tube that is 36" long.  Don't opt for a shorter tube such as 15" because the shorter the tube, the faster the flow of milk and babies need to latch and use their tongue and jaw just as they would when exclusively breastfeeding. The act of the baby sucking at the breast while being supplemented also increased mom's milk supply.  

Lactation Aid Feeding Tube

You can use the feeding tube by placing the large end in a container and taping the other end of the tubing to the breast with the tube slightly past the nipple since the nipple will elongate during the feeding. You can use a 50ml cap as shown above or just a bottle and nipple by enlarging the hole in the nipple for this use only.  

Positioning Tubing on Nipple

Use medical grade tape such as transpore tape or micropore tape. Micropore tape has been found to be slightly more gentle on dry skin.  Image above shows tape on the areola, but you may prefer to start the tape the an inch behind the nipple to keep it secure and out of the infant's mouth. Either way it is best to run the tape in the same direction as the feeding tube 

Micropore Medical Tape

Lactation Aid Feeding Tube Sets can be purchased with tubing, containers, caps and syringes for flushing the tube as well. As I mentioned earlier, this is a short term feeding system so discontinue using the tube if it becomes rigid on the end or after two weeks of use, whichever comes first.

Lactation Aid Feeding Tube Set

Remember that your goal in short-term supplementing formula is to provide any shortage of nutrition to your baby.  So don't supplement the full amount of a feed if your body is making milk.  Only supplement the difference in formula.  This amount should be decreasing as your body begins to increase in milk supply.  In addition to keeping the baby at the breast to further hinder your supply, you will want to take a galactagogue lactation supplement to help you increase supply more quickly.  This way the time necessary for supplement is shortened.  

Best wishes for short-term supplementation and long-term breastfeeding!

Tanya