Birth and Breastfeeding: Choosing to Use a Doula

     In honor of World Doula Week, we wanted to give you some information to help you if you choose to use a Doula.  DONA international is the official certification organization for a professional doula.  According to DONA, the word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.
   Here are some tips for questions to ask a potential doula:
1.  Are you certified by DONA?  This is the official organization certifying doulas.
2.  What are your professional credentials?  They should be CD or PCD
3.  Are you affiliated with a hospital?  This is a red flag as you want the doula on your side and not siding with the hospital or birth facility if  your birth plan comes into question.
4.  Do you help with the postpartum period such as learning to breastfeed?  If your doula is PCD, she is certified to work with you in the postpartum period.  She may also have credentials such as CLE, certified lactation educator or IBCLC, international board certified lactation consultant which offers the highest degree of education in breastfeeding.
5.  What are your gifts?  A good doula needs to be an encourager  and have a servant heart so this question may reveal a lot about her personality.
    Studies have shown that when doulas attend birth, labors are shorter with fewer complications, babies are healthier and they breastfeed more easily.  Use your instincts and these questions to help you find the doula that is right for your family.

To locate a doula in your area, visit the DONA website.

May you have a Blessed Childbirth!
Tanya

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.

      7.  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 breast milk 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.
• Unless you are keeping you milk at room temperature and using it within the next 6-8 hours, you will need to plan to keep your milk cold to transport it.  Use only hard ice packs as they stay cold longer than soft ice packs do.  Invest in a breast milk cooler tote that holds six bottles.  If you have six bottles, you are pumping into new containers each time and can chill the milk before combining it which is the safest method. 

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

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!

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

http://www.lactationconnection.com 

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. 

      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. 

      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

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, but much better than using a bottle.

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.  

     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.

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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