Induced Lactation: Protocols for Adoptive Breastfeeding Mothers

Motivation as in anything is extremely important in breastfeeding and even more important is tenacity when inducing lactation.  The success rate for the following protocols according to Nemba in the 1994 Journal of Trop Pediatrics was 89%.  In this study 33 of the 37 women nursed their babies for 9 months or longer.
These mothers began with a 100 mg single priming dose of medroxyprogesterone (Depo Provera).  After 7 days, they began 25 mg of chlorpromazine 4 times daily or 10 mg of metoclopramide (Reglan) 4 times daily until adequate lactation was established.  Frequent pumping before infant's arrival and/or frequent suckling afterward is encouraged.  A supplemental feeding device is necessary until adequate lactation is established.  Inducing lactation is a gift of time and love!
Breastfeeding an adoptive baby is more than about breastmilk.  It is about bonding.  Skin to skin contact is essential.  Use a lactation aide to feed donor milk or formula at each feeding.  This is essential for stimulation of the milk production, bonding and success.

Best wishes for nurturing and nourishing your baby,

Tanya Roberts, BSEd, IBCLC

www.lactationconnection.com 

Engorgement: Bowling Ball Breasts

If you are experiencing difficulty with breast pain or latch-on 3 to 5 days postpartum, it is probably due to engorgement. Your breasts can feel as hard as bowling balls making it difficult for your baby to get a good latch.  Most of the time severe engorgement can be prevented by nursing the baby immediately upon delivery and putting the baby to breast every 2-3 hours.  If your baby is sleepy or there is a delay in breastfeeding, engorment can set in heavily.  Advil is safe for breastfeeding and contains an anti-inflammatory that may reduce some swelling and discomfort. Your best friend during this time is a hot compress. Turn the tap water and let it run until hot. Take two disposable baby diaper and swipe it under the tap three or four times. Mold the diapers around your breast. Repeat this procedure before each feeding. Commercial hot packs are also available, but the diapers work just as well so you may want to save your money for a good breast pump. If the areola is still too hard for the baby to grasp, use a quality breast pump for three to five minutes before latching the baby on. If the baby goes to sleep before emptying the breast, finish pumping afterward. Take heart! Engorgement only lasts for 48-72 hours.

Milk Intake: Your Breastfed Baby at 12-36 months

As a Lactation Consultant, my main clients are mothers whose babies are under 12 months of age, so when looking for information for my daughter-in-law, I found it hard to find anything on milk intake for babies older than 12 months.  After doing some research, I have come to the following conclusion that I thought I would share with all moms.

Babies who are 12-24 months of age and weigh 20 lbs or more should take in 16-20 oz of milk; more if they are underweight. Normal weight gain during this period is 2 oz per week. A typical schedule would be nursing or feeding expressed milk 4 x daily, feeding solids 3 x daily with one or two healthy snacks in between. If you are weaning to cows milk, it should be whole milk unless advised otherwise by your pediatrician.  For toddlers 2-3 years or age, typical milk intake is 3 servings or nursings per day. After 24 months, most pediatricians recommend switching to 2% milk if you have weaned from breast milk. Toddlers 24-36 months should gain approximately 1 oz per week and eat 3 meals per day with one healthy snack.

Between the ages of 12-24 months, toddlers can still get about 15 oz per day from nursing. These 15 oz provide the following RDA: 29% of energy, 43% protein, 36% calcium, 75% vitamin A, 76% folate, 94% vitamin B12, and 60% of Vit C so if you are pressured to wean before you or your baby is ready, stand your ground, even if it is in the snow!

Happy Nurturing,
Tanya
www.amamante.com

Weaning: Gradual & Partial

There are many considerations when deciding to wean your baby. The American Academy of Pediatrics recommends breastfeeding for at least one year. If you choose to wean before one year, first make sure your baby tolerates other foods well. Next absolutely, positively, do not wean cold turkey. Before you wean, consider your alternatives such as pumping at work or partial weaning. Partial weaning works well when a baby is older than 4 months. Moms can choose to use formula during the day while at work and still nurse in the morning and at night. This only works after milk supply is well established which is why you should wait until at least 4 months of age before employing this method and always follow the same schedule seven days per week. You cannot put the baby to the breast in the middle of the day, if you have weaned that feeding. Whether you choose to partially wean of fully wean, drop one feeding every three to five days. For example, if you are nursing 8 times per day, drop one feeding in the middle of the day, substitute formula, and continue that schedule for at least three days. At the end of the three days, if your breast have no plugged ducts or pain, you can drop a second feeding. If you feel discomfort, wait until the 5th day to drop another feeding. You continue dropping on feeding every 3-5 days until all feeding are dropped. After the last feeding is stopped, you may need to nurse or pump one or both breast a final time within the next week to make yourself comfortable. One pumping or nursing in a 24 hour period will not increase your milk supply and helps to alleviate any discomfort. This method is slow, but pain free. Sudden weaning can lead to clogged milk ducts, breast infections and even breast abscess. Both you and baby will be happy with gradual weaning.

Don't be misled by advice that tell you to bind yourself.  If you need to expedite weaning, cold cabbage leaves in your bra replaced every hour can help, but make sure you listen to your body and if it is talking to you by means of pain, you are weaning too quickly and you will need to nurse or express milk if you are feeling lumps.  If you have chills, fever or flu-like symptoms, call your doctor right away.

Best wishes for painless weaning,
Tanya

Cup Size Confusion: DD, E, DDD, F

One of the most common questions I get as a professional bra fitter is where do I find a DDD?  There are several reasons moms are having such a hard time finding their bra, even after they have been measured.
1.  They don't understand the cup size equivalents.
2.  They haven't been properly measured.
Let me address the measurements first.  If your bra fitter did not take three measurements, she has been trained to fit you into certain brands of bras.  Many companies do not offer cup sizes larger than a DD so they use two measurements and add 4 or 5 inches to make up the difference.  Another problem with fitting is when moms measure themselves, the assume the size under the bust is equal to the band size. 
Here is the scoop on bra fittings:
1) Make sure you get three measurements.
2) Understand whether you are buying a full figure bra or a standard bra.
Not all bra companies use standard equivalents.  Most brands like Bravado Nursing Bras, QT Intimates, La Leche League Intimates and Amamante Nursingwear are as follows:  6" difference between under the bust and the fullest part of the bust = DD, 7" = DDD/F, etc.  That is where the confusion comes in so let me make it clear.  A DD cup = E for full figure bras, DDD = F, but if you are used to buying a standard bra that comes in cup sizes B-DD and no higher, there will be about a half cup size increase between the DD in a standard style and a DD/E in a full figure style.  To clarify, full figure styles start at D cup size; they do not make the B or C cup.  That's how you know if a DD will equal an E.  
Some manufacturers like Bravado Designs Nursing Bras advocate a 2 measurement method, but do offer larger sizes.  You should still use the 3 measurement method to get your Bravado Bra size, as their size charts still correspond since they use a multi-cup system. For example, they offer a 36FG which fits both and F and a G cup.  Some of their styles fit an even wider range of cup sizes.  For example, the Bravado BodySilk Nursing Bra comes in 4 sizes, but also Consider Amamante Caress and Contour Nursing Bra which has two sizes making it very versatile and affordable option for the new mom whose shape is constantly changing in the early weeks of breastfeeding.
To make things even easier, go to our fitting room for full measuring instructions and a sizing chart.
Shop by nursing bra size here.
When you order bras online, make sure to order at least two different brands in the size you are measuring.  You would not take just one swimsuit into a dressing room and expect it to fit.  The more nursing bra styles you try, the better the fit.  You may also want to order more than one cup or band size if your are measuring an in-between size.  When you receive your bra, hook it in front of you and then turn it around to make sure you know which hooks you are using for the band size.  Then turn it around to put the straps on.  Then either lift the bust into the cups or lean into them to ensure that all of the busts are in the cups before determining if it is the right size.  DD and DDD are by no means the largest cup sizes as we offer nursing bras that come in cup sizes G, H, I, J and K!

Here is to clearing up the cup size confusion!

Tanya