Breastfeeding Pain Diagnosis and Treatment: Yeast Infection and Thrush

I would love to tell you that breastfeeding is always easy, but unfortunately that is not always the case.  When you look up the word tenacious (te·na·cious) in the dictionary, I picture the nursing mother who has been tried by the challenges that sometimes come with breastfeeding.

Today, I am addressing a challenge that literally tries a mom by fire, yeast infections.  Yeast on nipples often exhibits itself as a burning sensation and sharp shooting pains in the breast even in-between feedings.   If you have pain only during the feeding, you need to address the latch.  Yeast naturally occurs in our bodies, but the overgrowth of yeast often as a result of oral or IV antibiotics can be a real challenge.  The good news is that it is fairly easy to diagnose and curing the overgrowth is manageable, especially if you know how to avoid a recurring incidence.

Lets start with the diagnosis.  As I said, the mother with yeast will normally have burning sensation on her nipples and sharp shooting pain in her breast during and in-between feedings.  Yeast is highly contagious so if you are experiencing these symptoms, check your baby for thrush in the mucosa lining of the mouth, not just white patched on the tongue which could be milk.  The baby might also have a bright red diaper rash.  NOTE:  Mom's nipples might not be red nor have a white spot and baby may have absolutely no symptoms and mom can still have a yeast infection if she has the burning, sharp shooting pain.  In either case if yeast is diagnosed, both mom AND baby must be treated simultaneously even if baby is asymptomatic otherwise the pair continue to pass the yeast infection back and forth and curing it becomes extremely difficult.

There are a few ways to diagnose yeast.  Initially the visual and pain cues I described before can lead you to suspect yeast.  Second, you can see your doctor: but if the thrush is not visible, he may have to test for the fungal bacteria which could delay your treatment.  The easiest way to check for a yeast infection on the nipples is to wash your hands and apply Gyne-lotrimin (clotrimazole) or Monistat (miconazole nitrate) to dry nipples after each feeding for 24 hours to see if your pain is starting to diminish.  You will find this with the vaginal yeast treatment in most drug store and heath and beauty section of grocery stores.  Make sure that the one you are purchasing is not just in suppositories, but has a tube that you can use like a breast cream.  If the pain is beginning to diminish (you are not yet cured) within 24-48 hours, it is most likely a yeast infection.

You have a yeast infection on your nipples.  What's next?

1.  After each feeding, air dry or sun dry nipples before applying the clotrimazole or miconazole with clean hands.  You can air-dry nipples by fanning them with your nursing pad, allowing them to dry naturally or use the sun or even a blow dryer on a cool setting if you are in a hurry.  These anti-fungals absorb in the skin within 15 minutes, so there is no need to wash them off before the next feeding.  It is not advisable to wash your nipples with a washrag when you are breastfeeding as you can actually remove the protective keratin layer on your nipples.

2.  Seek treatment for the baby.  Remember that mom and baby must be treated simultaneously even if one or the other does not have symptoms.  There are over the counter treatments for thrush in the baby such as gentian violet, but it quite messy so I recommend calling the pediatrician for oral Nystatin and following the directions.

3.  Change habits to promote healing.  Always use nursing pads to avoid contaminating your bras and only breathable disposable nursing pads.  We do not sell them, but we recommend Lansinoh and Ameda Nursing Pads as they do not harbor yeast.  Some pads have a plastic lining or are made with products that do not promote breath-ability, so stick to these brands to be safe.  You can find Lansinoh in most stores.  Wash hands frequently and sterilize breast pump parts, bottles, nipples, nipple shields, feeding syringes with each use.  Normally due to the anti-fungal properties of breast milk, you only have to sterilize breast pump parts once per day, but better safe than sorry!
In addition eating habits needs to be curved during a yeast infection.  Mom should eliminate wheat, refined sugar, alcohol and honey to promote a healthier intestinal flora instead of feeding the overgrowth of yeast.


4.  Complete treatment.  Give the Nystatin and Gyne-lotrimin or Monistat a full week to 10 days for treatment.  If both mom and baby are now symptom-free, treat for 3 additional days to know out any residual infection and remove any items that may be prone to harboring yeast.

What do I need to discard to avoid re-occurrence of yeast?

- breast cream 
Moms usually will put breast cream on the second nipple with the same finger they used to apply to the first nipple.  So it is essential to use a clean finger to apply the nipple cream.  Wash hands first and then use a different finger to apply to each nipple so you don't cross contaminate.
- washable nursing pads
You cannot kill yeast by washing or boiling.  The only thing that will kill yeast is an anti-fungal so pitch the washable nursing pads you used while you had symptoms!
- breast pump parts
Any breast pump parts that have come into contact with the breast milk must be scratch-free or non-porous.  If you used a bottle brush to clean your parts, pitch everything.  If you washed them carefully, get rid of valve membranes, duckbill valves, bottle nipples and replace any filters or back-flow protectors as well. Store breast pump parts in an air dry bag that promotes air flow and is machine washable.  Using a ziplock bag to store breast pump parts is an incubator for yeast growing on your breast pump parts.
-sterilize your parts frequently
Keep disposable microwave sterilization bags on hand to make it quick and easy to sterilize your breast pump parts frequently.

- feeding supplies
If you used a bottle brush to clean your bottles, pitch everything.  If they were washed with a soft cloth or in the dishwasher, you can just discard bottle nipples and some brands have rubbery sealing discs.  Even baby feeding syringes have a rubber plunger, so if you used one to feed breastmilk or give medicine, discard it and replace.
- breast milk
Any breast milk that you pumped during your yeast infection must be given to the baby during the first week of treatment.  During the three days that you are treating the yeast to avoid recurrence, only feed the baby directly from the breast, freshly expressed breast milk or milk frozen prior to the initiation of the yeast symptoms.

Here is to putting out the fire!
Tanya

Pumpin' Pal - Getting the Most out of an Angled Breast Pump Flange Size

Finding the right breast pump flange size is your first concern when starting to pump, but as you continue to pump exclusively or for working and breastfeeding, investing in a more comfortable flange can help not only your body, but your baby's milk supply.  Pumpin' Pal Super Shields offer a multitude of benefits including:

• Eliminating constriction of milk ducts that can be cause by traditional flanges 
• Promoting better milk flow
• Helping prevent plugged milk ducts and mastitis
• Reducing nipple irritation
• Saving mom from back aches caused by leading forward

While Pumpin' Pal Super Shields are effective in most cases, you will want to know if and how they fit with your breast pump before you invest in these breast flanges.  Pumpin' Pal M-XL work best with breast pump brands that have two piece breast shields such as Medela, Lansinoh and Hygeia.

Pumpin' Pal Small and X-Small include an adapter to work with two piece breast shields.

Again, start with finding your correct breast flange size.  Then work with making pumping the most comfortable experience possible because not only does flange size matter, but tension from pumping in an uncomfortable position can reduce oxytocin and therefore reduce milk supply.

On a coincidental note, getting a discount actually increases oxytocin in most people including nursing mothers, so you never pay MSRP at Lactation Connection!  And check out our breastfeeding coupon code or breastfeeding sale page for another boost of oxytocin...lol!

Here is to more comfortable pumping!
Tanya

UPDATE!  Connectors are now available so that you can easily use Pumpin' Pal with Ameda and Spectra Breast pumps.  The Pumpin' Pal Connector for Ameda and Pumpin' Pal Connector for Spectra can be purchased separately for use with your Pumpin' Pal breast shields.

How to Use a Baby Feeding Syringe for Breastfeeding

It is recommended that breastfed infants are fed exclusive of a bottle for at least 6-8 weeks while learning to breastfeed.  Bottle feeding greatly changes the way the infant sucks and their expectations for immediate gratification while feeding.  Feeding from a bottle provides immediate gratification because bottle drips even when sucking does not occur.  This causes the infant to thrust their tongue to the end of the nipple or to arch their tongue to collapse the nipple on the roof of their mouth to control the flow.There are several methods of supplementing a newborn with breast milk during the early days.  For short term feeding solution, we recommend finger feeding with a syringe.  This method is tried and true and can be learned by both parents and baby in a matter of minutes.

Instructions:

Wash your hands.

Sit with your feet on a stool or anywhere you can raise your knees.

Place the baby in your lap facing you so they are in a reclined with their head above their body.

Draw the breastmilk into the syringe from an open container.  This can be done with one hand once you learn to pull the plunger up with your thumb.

Allow the baby to suck on the index finger of your non-dominant hand.  Your finger should be in far enough that the infant's tongue is attempting to draw it in with a peristaltic wave motion.  If Dad is feeding and has large fingers, he may want to turn his hand and use his pinky finger.

Using your dominant hand, place the syringe full of breast milk in the corner of the baby's mouth.

Wait 30-60 seconds before tapping the plunger so that the baby understands that they need to suck before the milk lets down when they return to the breast.

Tap the plunger every 3 sucks, but not every suck so they establish a breastfeeding pattern of suck, suck swallow.

Remember that a newborn's stomach is the size of a cherry when they are born so during the first few days, the teaspoons of colostrum are all that is necessary.

If there is a reason to syringe feed beyond day 5, refer to the infant feeding chart for ounces needed.  A 10 cc or 10 ml baby feeding syringe is 1/3 of an ounce so it is easy to know that re-filling this syringe 3 times is 1 ounce.

Attempt burping after 1-3 times of re-filling the syringe.  If the baby is spitting up or taking the milk too quickly, burping is a good way to slow the feeding and eliminate excess air.

Syringes are an inexpensive way to supplement a newborn without interfering with breastfeeding.  This lactation aid may be a tool you will want to have in your arsenal in case your baby has latch or suck difficulties such as the ones that can arise from tongue tie.  A sleepy  baby can also become more lively if breast milk is supplemented correctly so they will have enough energy to stay awake at the breast.


Best wishes for a bottle-free start to breastfeeding!
Tanya

Troubleshooting: Breast Pump Replacement Parts for the Hygeia Breast Pump

If your Hygeia Breast Pump is not suctioning the way it used to, the culprit is usually one of two parts, the duckbill valve or the bacteriostatic filter.

The number one cause of low suction is a torn or worn out valve. The tip of the Hygeia duckbill valve must be able to close completely.  If it remains open, the amount of pressure your pump can provide is decreased.  As a rule, if you are pumping three times per day or more, replace duckbill valves every six to eight weeks at minimum.  If you are like most moms and you have multiple valves that you interchange and you notice a decrease in suction and want to determine which part needs to be discarded, switch to single pumping.  To do this, you will remove the tubing from one side and cover the opening with the port cover attached to the bacteriostatic filter.  Place the remaining breatshield still attached to the pump on one breast and test the suction.  If the nipple is being drawn in normally, remove the breast shield from your breast and remove the bottle from the breast shield.  Then remove and replace the duckbill valve to test the next one.  Continue to do this which each valve you have in your stash and discard any valves that are not performing well.  This way you don't use valves that may compromise your milk supply with inferior suction.

It is harder to visually determine when the Hygeia bacteriostatic filter needs to be replaced, but the rule of thumb is that whenever you replace a valve, replace the filter.  At the very least, if you are a working mother or an exclusively pumping mama, replace the filter every 2-3 months whichever comes first.  

Buying replacement parts is a small price to pay when the reward is a healthier milk supply.  Lactation Connection makes this easier with their subscription service.  With the Hygeia Replacement Parts Program, moms can choose to get parts delivered to you every 3 months for 2 shipments, 3 shipment or 4 shipments.  Each shipment arrives with free shipping and an option to add additional items that ship free along with your subscription in case you need more bottles, milk bags or any other breastfeeding supplies.  The subscription service takes the guesswork out of  replacing breast pump parts.  

During the month of March 2018 in honor of our 25th year in business, Lactation Connection has partnered with Hygeia to offer moms some exclusive deals.  We are really excited about the March Hygeia sale!  All Hygeia breast pumps and accessories products are 25% off, all month long with no coupon code needed.  Every order that includes Hygeia products during the month, will receive a free gift of a breastmilk storage guide magnet, samples of milk bags and nursing pads and a coupon for a future Hygeia order.  In addition, every mother who places any order at Lactation Connection during March 2018 has a chance to win a Hygeia Nursing Stool.  It is so simple!  If your order number ends in the number 25, you win and your stool will be shipped with your order.  That is a 1 in 100 chance of winning, so the odds are pretty great!

Best wishes for a healthy milk supply and good luck on winning a nursing stool!

Tanya

Milk Supply: How Do I Know if My Newborn Baby is Getting Enough Breast Milk?

Once your newborn is at least 6 days old, there are some guidelines to help you be sure of your milk supply.  Note that insufficient milk supply is rare.  What is more common are practices that can hinder your milk supply or baby's feeding which I will detail at the end of this post.

To assess good milk transfer, answer the following:

1. Is the baby wetting 6-8 diapers in 24 hours? (Disposable diapers are so absorbent, that it might be hard to tell.  If you are unsure, take a clean diaper in one hand and the removed diaper in the other and you should be able to tell by the slight weight difference.)
   Yes  |  No
2. Is the baby having 3-4 bowel movements in 24 hours that are mustard yellow with curds in them? (These shold be silver dollar size or larger, not just a stain.)
   Yes  |  No
3. Do the breasts feel full before feeding and softer after feeding? 
4. Yes  |  No
5. Do you hear swallowing when the baby is breastfeeding?
   Yes  |  No
6. Is the baby eating at least 8 times in 24 hours?
   Yes  |  No
7. Does the baby seem satisfied after a feeding?
   Yes  |  No
8. After the initial weight drop, has your baby started gaining 3/4 - 1 ounce per day?
   Yes  |  No                                                               
9. If tyou had some nipple soreness, is gone?                                                                                    Yes  |  No

Practices that hinder milk supply include "scheduling".  Making an infant wait for feedings, lowers milk supply and slows weight gain.  Infants may need to eat at 1-3 hours apart during the day, especially between day 10 and three weeks when the first grown spurt occurs.  The only scheduling that should occur is if the infant has not asked to be fed at the 3 hour mark from the beginning of the last feeding, it is time to nurse.  A mininum of eight times a day is normal for a newborn.  The longest stretch you could hope for is one 5 hour stretch.  It is common for newborns to feed up to 12 times per day during a grown spurt.  This practice ensure a healthy milk supply for a growing baby as milk supply follows a demand and supply principle.

Other practices that can hinder milk supply are the use of a nipple shield.  While they have a time and place to assist in latch.  They are not a cure for sore nipples and should not be used unless necessary and discontinued as soon as possible.  When using a nipple shield, a cut out ultra thin silicone nipple shield is best.  Place the cut out at the baby's chin so that the skin to skin can elevate your hormone response which increases milk supply.

Another practice than can reduce milk supply is unresolved engorment.  When the milk first comes in 3-5 days postpartum, softening the breasts with warm moist heat from a compress or disposable diaper doused with hot water and warmed in the microwave is essential before nursing or pumping so that milk is more effectively extracted.  Milk that is not extracted actually reduces milk supply as your body is being signaled that you do not need the milk.  That is why the practice of waiting for an insurance pump is not the best idea.  If your insurance company will not allow you to get a pump until after the birth, go with a private pay DME.  That way, you can order the breast pump on the day of the baby's birth and it will be at your doorstep between 3-5 days when you need it most.  You then have to file for reimbursement with your insurance company, but it beats waiting around for a company to bill your insurance and you may not have your pump when you need it most. 

Here is to a Healthy Milk Supply, Mamas!
Tanya

Breast Shield Size - Do You Need a Small 15 mm or 19 mm Breast Flange?

Recently, we have been researching the effectiveness of small breast flanges for moms who are trying aftermarket brands in 15mm.  Most manufacturer's do not offer flanges that small.  This mom in particular was having difficulty because even a 15mm was too large.  A smaller flange can often be too large if too much of the areola is being pulled in and the milk sinuses are not being compressed properly at the breast shield.
This problem can ofte be solved with a silicone insert or silicone breast shield.  So where a 15mm plastic flange may be too large, a 15-19 mm silicone breast shield such as the x-small and small super shields by Pumpin' Pal will work very well.  The reason is the material.  Silicone helps hold the breast tissue in place whereas the hard plastic flange will allo the tissue to be draw in too far.
If you have tried a silicone shield, and still need to the areola to be held in place more efficiently, rolling the silicone so that it suctions to the breast is often the answer.  See the image below which is from Pumpin' Pal's 2018 Quick Start Instruction Guide.

Not only are the SuperShields angled for a more comfortable pumping position, they are available in x-small 15-19 mm breast shields and small 20-23 mm breast shields in silicone for better adhesion to your breast.

These are now also available for use with popular Spectra breast pump when using the Spectra flange adapter.

Here is to better pumping!

Tanya

Troubleshooting: When to Replace Breast Pump Parts & Accessories

If your breast pump is not suctioning the way it used to, the problem often lies in one of two breast pump parts.  Most breast pumps have a valve plus a diaphragm, filter or backflow protector.  The number one cause of low suction is a dirty, torn or worn out valve.  If you valve is the type that has a valve head and membrane shown here, it is imperative that you remove these parts when cleaning.  The valve membrane will retain a build up that decreases the suction.  Taking the membrane apart from the head is essential to remove this build-up.  If you see that the membrane will no longer close completely with the head or if it has a tear, replace it as soon as possible.

If your breast pump has a duckbill valve (shown below) which in most cases is a clear or white valve, the tip of the duckbill must be able to close completely.  If it remains open, the amount of pressure your pump can provide is decreased.  As a rule, if you are pumping three times per day or more, replace duckbill valves every six to eight weeks at minimum.  This is a small maintenance expense that will reward you in the dividend of a healthier milk supply.

One example of essential breast pump parts that need replacement are the Spectra S2 parts that include the white duckbill valve and the backflow protector.  These two parts are the most commonly replaced parts for Spectra breast pumps and if either of these parts is used for longer that eight weeks, the amount of pressure your breast pump has can be decreased.  The longer you use a breast pump with parts that are not functioning at capacity, the greater the chance of decreasing milk supply.

The most commonly replaced parts for each brand are listed below:

Spectra - duckbill valve, backflow protector
Ameda - duckbill valve, diaphragms

Motif - duckbill valve, diaphragms 
Hygiea - duckbill valve, bacteriostatic filter
ARDO - duckbill valve, membrane pot
PJ's Limerick - micron filter, silicone gasket
Bailey Nurture III - filter

Breast pumps that do not have closed systems such as Medela do not need parts replaced as often, but open system can lead to exposure of bacteria to breast milk so we do not recommend these pumps.

Lactation Connection offers subscription services for replacement parts on our most popular brands so that you don't forget to replace them on a regular basis.  We only sell authentic manufacturers parts for Spectra, Ameda, Hygeia, ARDO, Limerick, Bailey, Rumble Tuff and BelleMa to ensure quality of performance in your breast pump.

Salud! Here is to a healthy milk supply!
Tanya