Supporting Breastfeeding

La Leche League Canada

Breastfeeding is My Superpower

I recently saw a bumper sticker that said, “I make milk. What’s your superpower?” I chuckled out loud to myself in the car, because I have been breastfeeding almost continuously for nearly eight years, for three children, all with very different experiences. And it really can be a superpower with a little support and a lot of determination.

When my first child was born, I knew I wanted to breastfeed and even took a class at the hospital about it. I perused numerous books on the topic, and consulted with other breastfeeding mothers. I thought I was prepared and was even able to leave the hospital just four hours after my son was born. But shortly after I arrived home, the trouble began, and it continued for two miserable months.

I knew nursing wasn’t supposed to be painful, but it seemed that my son was latching on beautifully and he was gaining weight like a pro, so I figured I was just being wimpy. For all those weeks, I nursed roughly every three hours, literally crying through every feeding and biting a towel as stabbing pains shot through my chest. When I couldn’t take it anymore, I contacted a local La Leche League Group. I also saw a lactation consultant and my obstetrician. It turns out that while my son remained asymptomatic, I had mastitis and thrush—with no other typical symptoms—and was treated with two full rounds of strong antibiotics and three full rounds of an antifungal. Within a couple of weeks, I was free of pain!

 

1LeaderMother

 

My daughter, who has Down Syndrome, was born shortly after I weaned my son. The nurses discouraged me from nursing her, stating reasons ranging from aspiration to low muscle tone. Once again, I was quickly discharged from the hospital, fully intent on breastfeeding and realizing I would need to look elsewhere for support. I found a La Leche League pamphlet about breastfeeding a baby with Down syndrome (here) and began the process of helping my baby learn to nurse despite having many of the concerns described in the pamphlet—hypotonia (low muscle tone), a weak suck, slow weight gain, and swallowing issues.

At the recommendation of a general pediatrician and a developmental pediatrician, I even tried to supplement with bottle-feeding her with breast milk thickened with formula and melted butter, but my daughter just chewed on the plastic nipple despite support from a speech language pathologist and a lactation consultant who specialized in feeding issues in infants. We even endured numerous swallow studies prescribed by her pediatrician because of aspiration concerns, but those studies involved barium-infused liquids given by bottle, which my daughter would not take, so she choked and gagged and sputtered, with documented episodes of penetration into her airway and aspiration. The results, the doctors said, warranted that I discontinue breastfeeding and that she be fed through a nasogastric tube inserted into her nose and down to her stomach.

While I respect the opinion of physicians, I had strong instincts that breastfeeding remained the best option. So I politely declined the suggestion that she be fed via nasogastric tube and found different feeding positions that helped minimize her choking episodes. For example, I would sit her up on my lap and her head would remain vertical, so that the milk did not just automatically run down to the back of her throat. I used other strategies like starting the flowing of milk by massaging the breast tissue so that she would not have to expend calories sucking and waiting for let-down, and I also waited to latch her on until the initial let-down passed so that she didn’t have too much milk in her mouth at any given time. This made it more manageable for her to swallow on her own without aspirating. I learned to clap my hand on her back when I did notice some noisy breathing so that she could clear out the wayward milk quickly and easily.

download (75)

 

All that being said, I feel as though I breastfed my daughter against all odds, and I can tell you the benefits were unexpected and tremendous. She spent the first three years of her life in and out of hospitals for numerous diagnostic procedures, surgeries, and illnesses. During every hospitalization, she would go on a total “hunger strike”—refusing all food and drink—but she would always nurse. The benefits of nursing during these hospital visits went beyond simple nutrition and hydration. They were a source of great emotional comfort for her (I have photos of me lying beside her, my head and torso in the oxygen tent with her!). I believe this sense of comfort had physiological ramifications, as it likely reduced her own perception of her pain and discomfort, and accelerated the healing process. There was the added bonus that she was receiving my antibodies in the breast milk, providing her an immunity boost. I nursed her for about 3½ years, until the third trimester of my pregnancy with my third child.

When my second daughter was born, I really felt I had paid my dues and that nursing her should be second nature. But as luck would have it, I experienced pain from the very first latch-on and requested assistance right away from a lactation consultant. My daughter had difficulty latching on properly and was diagnosed with a tongue-tie. The pediatrician recommended clipping her tongue, but I asked to wait to see if we could breastfeed successfully without having the procedure. The doctor agreed to wait for two weeks. At the end of the two weeks, my daughter was breastfeeding well enough that we continued to nurse without clipping her tongue.

In my mind, these three very different breastfeeding experiences serve as a strong indication that lactation really is a super power! So, what’s yours?

By Cyndi Johnson.  Used with permission from LLL USA New Beginnings http://www.lllusa.org/breastfeeding-is-my-superpower/

 

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

 

More resources:

https://supportingbreastfeeding.wordpress.com/2015/05/25/babies-with-down-syndrome-can-breastfeed/

https://supportingbreastfeeding.wordpress.com/2016/10/31/overcoming-mastitis-and-tongue-tie/

https://supportingbreastfeeding.wordpress.com/2015/06/01/mastitis/

https://supportingbreastfeeding.wordpress.com/2016/08/22/breastfeeding-inflammation-infection/

https://supportingbreastfeeding.wordpress.com/2016/04/11/thrush-the-breastfeeding-family/

http://www.lllc.ca/Information-sheets

Leave a comment »

Breastfeeding Triplets

My breastfeeding journey began when I gave birth to my first daughter, Tayla. I was 21 years old and completely naive about breastfeeding. I had no role models, support or information, I just somehow knew I was going to do it. My nipples were inverted and I had no help or advice with latching so ended up with severely cracked nipples. I called La Leche League for help with latching, then expressed milk for a week or so until my nipples were healed and then carried on with breastfeeding. She selfweaned at 13 months, which I was sad about, but I was pregnant with number two and I thought I would breastfeed her forever. I had no problems at all with feeding the second time round but Dyani too self-weaned at 13 months.

Fast forward 21 years and I met my husband, Jason, who hadn’t ever had children but still hoped that he could, so I agreed (to just one!). We were understandably terrified when we found out I was pregnant with triplets, but again the idea of doing anything other than breastfeeding never crossed my mind. We found out that triplet mums can access a year’s free supply of formula but I still wasn’t interested.

After a problem free pregnancy I made it to 34 weeks. Two days before I was booked for a Caesarean, my body had other ideas and I went into labour that night. Our babies were born via Caesarean on the 22nd of November, 2011. Willow was 2kg, Connor 2.5kg and Summer 2kg. They all went straight into the NICU but were actually really healthy and big for triplets. I got to cuddle Connor the next day, Summer the day after that and Willow the day after that.

download (22)

 

I don’t think anyone at the hospital expected me to breastfeed because I had to ask someone 12 hours later, if they were able to get me a pump or show me how to get started expressing colostrum. A nurse then showed my husband and I how to express colostrum into tiny 1ml syringes. We got our first 1ml and I said “but there’s three of them, we can’t make them share 1ml!” So I expressed two more for that day, the next day I got 9ml, the next day 15 little syringes made their way into the NICU! Then I began pumping, every three hours day and night and within two days I was pumping about a litre a day, which became two litres within another week.

After a week I got to try breastfeeding Connor, who was the biggest and strongest. To breastfeed, a baby needs to co-ordinate sucking, swallowing and breathing all at the same time and this reflex doesn’t usually kick in until about 35-36 weeks gestation, but I wanted to at least be putting the babies to the breast, even if they weren’t latching at first.

My nipples seemed huge next to their tiny mouths and I wondered how they would ever get the hang of it but one by one, they all did. I would nurse them while they were getting a feed of expressed breastmilk through their NG tube, so they would learn the feeling of a full tummy and associate it with sucking. Gradually each of them started getting a full feed from me. After two weeks and four days, all the babies were taking a good feed from me and so we were allowed to graduate to the parent room. It’s like a motel room where you have your babies with you day and night and you do it totally on your own before going home…but with the nurses just down the hall.

The babies had to gain weight before we were allowed to go home and on just the second morning we had gains of 40g for each of the girls and 60g for Connor. So although it felt like a lifetime, after just three weeks we all went home.

My husband and I had no idea how we were going to do this – feed three babies all day and night – so we had to come up with a plan. For a start, I know that breastfeeding is all about supply and demand so we went against all the triplet parent advice and had no schedule for feeds. I refused to wake them for feeds if they slept longer than three hours and I refused to leave anyone to ‘self-soothe’ if they wanted feeding more often. Our first plan was that we would both get up to all of the babies all through the night, Jason would change and burp and I would feed.

After only four nights we realised that neither of us was getting any sleep so we switched to Plan B which was hubby took the 9pm to 2am shift and I did the 2am to 7am shift. I would pump so that he could have milk to feed them during his shift, and I would just breastfeed. Soon we realised that the 9pm to 2am was the ‘screaming’ shift and it wasn’t working again so we moved to Plan C. This was where I took Connor into our bedroom and co-slept with him and breastfed him all night (and pumped after every feed). Jason slept in the nursery with the girls (it was big enough to fit three cots and a queen bed), and would give them my expressed breastmilk.

This plan is still the one that we use now, the girls are better sleepers than Connor and wake much less frequently for feeds and I can do dream feeds with Connor so we are all getting as much sleep as possible. During the day all the babies are breastfed, and I get a break from feeding two of them between 9pm and when they wake at about 5am.

Fathers

 

Before I had the babies, I talked to another mother of triplets who breastfed for six weeks and she suggested either breastfeeding two and giving the third a bottle of formula, then rotating who got the formula each feed, or feeding one baby one side, the next baby the second side and by the time you get to the third baby the first side is full enough again. I decided I would try the second option. I have always had a great milk supply, and after reading about wet nurses in Victorian times who would feed up to six babies I figured I could definitely do three!

When the babies first came home they had no awake time, they woke for a feed and then went straight back to sleep. Each baby would take around 20-30 minutes for a full feed, so by the time I got to the third baby, the first breast was full again. Then as they got older, their feed times got shorter but my body was already in the swing of how much milk was needed so I’ve never had problems with supply. In the evenings they often cluster feed and I could do 12-15 feeds in three hours! An average day of feeding would be 24 feeds, add in cluster feeds AND growth spurts and some days I was doing upwards of 33 breastfeeds!

I can and have done tandem feeds but I find that it’s nice to have at least SOME one-on-one time with each baby, and also a tandem feed with another feed straight away gives me no time to get full again. Because they are all demand fed it’s not very often that all three are hungry at the same time anyway so it’s actually easier than what you might think.

In the beginning there were eight bottles in the fridge that I had to fill each day for that nights feeding and now the girls may only need one or two feeds each, so I only have to pump once a day to get the 500- 600mls needed for that which also saves me time.

It’s wonderful to be able to do this for my babies and I get a lot of supportive comments from people but it is hard to find support with other triplet mums doing the same thing because no-one is breastfeeding. I have asked around in our triplet circles and none of them breastfed past six weeks (if at all), and they were all supplementing with formula from the beginning. So I get my support for multiples from the Multiple Birth Club, and breastfeeding support from various breastfeeding pages/ groups on Facebook. I do get out quite a bit with the babies but only for short walks, it is nearly impossible to meet up with other people face to face so online support is awesome. Also, as there is always another baby to feed/change/entertain, anything that is online is easy to stop and restart, as opposed to a phone call.

My babies are now ten and a half months old, they have two or three meals of solids a day and are still having six to eight breastfeeds as well. At nine months they all weighed in around 8kg so they have grown exceptionally well. Given that we started out with a fair amount of disbelief, little support, a c-section, separation from my babies, unable to actually breastfeed for two weeks, and of course the fact that there are three of them…it’s amazing how far we have come!

It’s now my mission to let other mums know that it is possible to exclusively breastfeed triplets, and while it is a full-time job, it is very rewarding!

By Davina Wright
Used with permission from LLL New Zealand, Aroha: Three Babies, Two Breasts http://www.lalecheleague.org.nz/Websites/laleche/images/PDF_Downloads/Aroha_articles/Aroha_vol_14_iss_5_Three_babies,_two_breasts.pdf

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

 

PLEASE REMEMBER LA LECHE LEAGUE CANADA ON GIVING TUESDAY NOVEMBER 29, 2016

2 Comments »

Be Determined, Be Informed, and Trust Your Instincts!

When I had my first baby, I was very determined to breastfeed even though I had barely seen anyone breastfeeding while growing up in France. None of my family members (mother, aunties, cousins) had breastfed their babies nor did any of my friends with the exception of my sister-in-law. She breastfed her three boys until they were almost two (but people looked at her like she was an alien). But from what I had gathered through my antenatal classes and the information I had researched online, I was convinced that breastfeeding was the best for my baby.

 

Finn was born naturally weighing almost 4.5 kgs (10 lbs) and had lost less than 10 percent of his weight when we came home on day three. But he then took about six weeks to get back to his birth weight, some weeks only gaining 20 or 30 gm a week. We also discovered during this time that he had a tongue tie so this got snipped by a specialized GP when he was six weeks old. It helped his latch but my milk supply didn’t improve significantly and his weight gain still wasn’t very good. He was being weighed every single week, tested by the GP for infection while I was expressing after each feed, day and night only to get about 10 ml after thirty minutes with a hospital grade pump. I was a total mess. I was barely getting any sleep, had no family around to help and my partner went back to work four days after Finn was born.

download (80)

 

Around week two, I saw a lactation consultant from the maternity centre who I didn’t connect well with during our thirty minutes together and left feeling even more guilty.  I ended up worrying all the time about his weight and followed advice from Plunket, my family and friends and started supplementing breastfeeding with formula when Finn was about three months old.  At the time I was on holiday in France visiting my family.  This was during a heat wave and every single person was telling me to give him water and/or formula on top of my own milk to prevent dehydration.  Even though it felt wrong to me (and was factually wrong), I ended up listening to everyone and doing it.  I also had to go back to work four days a week when he was six months old so only managed to maintain partial breastfeeding until he was nine months old.

 

Looking back, there were many things that contributed to this first frustrating and stressful experience: no family support around us, my partner going back to work really quickly, the weekly weighing of Finn which was probably over the top and didn’t help, the message from midwives that I was to breastfeed on a schedule and not on demand, a lactation consultant who made me feel like a failure instead of offering real support, people around me promoting formula as the only solution to my problems, me going back to work too early…

 

The second time around, when my daughter Mina was born, I had learned from some of my mistakes.  She was breastfed on demand from day one (and until I weaned her at 30 months). I didn’t wait to ask for help – I called a great lactation consultant on day four after three days of screaming because Mina couldn’t latch properly and this was fixed after a thirty minute session. This lactation consultant was amazing.

 

I ignored the comments and the pleas from my friends and family to give it up (because between the on demand feeding and the expressing day and night for the first eight weeks, I was a zombie), and I had the support of my partner who understood why it was so important for me and for our baby to succeed at this and who became informed on the subject.

download (84)

 

I had changed my GP to one who was knowledgeable about and was a strong advocate of breastfeeding and I got in touch with a lactation specialist from Canada, Dr Jack Newman, who has a great website and who advised me to take domperidone.  I was against it at first but it enabled me to exclusively breastfeed my daughter which I’m forever grateful for.  I took it for the first 10 months until my supply was not such an issue as she was well onto eating solids.  It was a challenge to get someone to give me a prescription though.

 

My second experience was a lot more positive but still very challenging which makes me a bit sad sometimes.  Because I breastfed Mina until she was two and a half, I got a lot of nasty looks and comments from people after she turned one (she’s walking/talking/a big girl/on solids, she should not be breastfed anymore, you’re spoiling her, etc…) which I always replied to with the same answer:  the World Health Organisation recommends breastfeeding children until they’re at least two!

 

But I feel lucky that I was able to breastfeed Mina for the first 30 months of her life.  She’s now three and a half, has never been sick apart from chicken pox last year so has never taken any drugs and we have a very close physical and emotional bond which has been undoubtedly enhanced by breastfeeding.  When she’s upset she still wants to cuddle my “boobs” to get comfort which is a lovely thing to be able to offer her.

 

A few months ago when my son returned from a birthday party where a lady was bottle feeding a tiny baby, he said to me: “Mum, why doesn’t this baby’s mum have breasts?”  I loved the fact that he found it very odd to see a baby being bottle fed (growing up, I would have found someone breastfeeding a baby equally as puzzling!).

 

My advice to new mums would be to become informed instead of listening to “well wishing” people, and to make sure your partner and close family are informed about breastfeeding (the immense and long lasting benefits of it, how supply and demand works, what issues you might encounter and how to overcome them).  Surround yourself with “breastfeeding friendly people” (friends, coffee group people, GP) so they don’t undermine your efforts, don’t wait to ask for help (from La Leche League or a good lactation consultant) and know that all of your efforts, as hard as it can be some days, will pay off tenfold and for many, many years to come

By Maureen Talpi

Used with permission from LLL New Zealand http://www.lalecheleague.org.nz/Websites/laleche/images/PDF_Downloads/Aroha_articles/Aroha_vol_14_iss_3_Be_determined,_be_informed.pdf

 

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.
 

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

Leave a comment »

Overcoming Mastitis and Tongue-tie

My daughter was born after a beautiful, unmedicated vaginal delivery. My entire birth plan had gone exactly as I had hoped. She latched on within a few minutes of birth. Her latch was weak and my daughter was sleepy, but she was perfect. After giving birth to my son a few years earlier and seeing him whisked away to the neonatal intensive care unit (NICU), I cherished every wonderful second with my daughter in my arms, the way it was meant to be. When the lactation consultant visited, we discussed different positions and what to expect over the next few days and weeks. The nurses offered support and guidance with each visit. Everything was going well when we left the hospital.

When we were home, I started to notice some discomfort while nursing. I could never seem to get the latch deep enough, and after five or six tries I would give up and grit my teeth through the feeding. I woke up on the fifth day and before getting out of bed, I knew that my milk had come in. My breasts felt like melons and were very tender, which I was expecting, but they were very red. I felt pain deep in my chest, all the way to my back. After sitting up, I realized that things didn’t feel right. The force of gravity caused more pain than I could tolerate, so I had to lie back down and call my husband to bring my daughter into the room. I could barely get her to latch, and the pain was excruciating when she did latch. As the day progressed, I could feel a fever coming on, along with a raging headache, and nausea and vomiting whenever I tried to sit up. My entire body hurt and my breasts were so engorged that I could barely lift my arms. By evening, I couldn’t sit up or get comfortable enough to nurse my daughter or do anything else. My husband had to feed our daughter formula and care for both of our children completely because it was all I could do to lie flat on my back in bed.

On the next day, I felt worse. We found a thermometer that showed I had a temperature of 40 degrees celcius (104.5°F). I knew I needed to see a doctor, but it was Sunday and I didn’t think my condition warranted a trip to the emergency room. With regular doses of over the counter analgesics and fever reducers, I was able to keep my fever around 101.3°F during the day, but by evening I was breaking down. I finally called the hospital and talked to the on-call physician who diagnosed double mastitis. He immediately prescribed an antibiotic and scheduled my appointment for Tuesday. If only I had called sooner! Lesson learned.

I took the antibiotics for 48 hours before I started to feel well enough to sit up and hold my daughter. At this point, I hadn’t been able to hold her—let alone nurse her—for over four days. I was so relieved to be with her that the last thing I wanted to do was spend the time pumping and building up my milk supply. I decided that I would just enjoy my daughter, continue to heal, and feed her formula.

After completing the 14-day course of antibiotics, the guilt hit me hard. I had pumped exclusively for my son for a full year due to unresolved latch issues. I felt that I had to at least offer my daughter the same start to life, even if I couldn’t get her back to the breast. So I began to pump. I pumped every two hours. I pumped less than an ounce total during that very first day. My goal was to pump for two weeks. If I didn’t see any progress then I would be content to bottle feed and know that I had tried my best.

Five days into my relactation journey, I had mastitis again. This time I knew all of the warning signs and was able to start antibiotics right away. I started to feel better within 48 hours of the initial symptoms, and within 24 hours of beginning the antibiotics. To my surprise, two weeks into pumping I was pumping over ten ounces per day! One month later I was pumping 25 ounces per day. I finally felt ready to try breastfeeding again.
My daughter was almost two months old and still very willing to take the breast. She would eagerly latch on, but the latch was very shallow. During this time, I had mastitis again. The doctor concluded that the infection was being transferred through my damaged nipples. During this round of treatment for mastitis in my left breast, I actually got mastitis on the right side. This led to a trip to the emergency room where I was given antibiotics intravenously and sent home.

This is when I decided that it was more important for my daughter to get breast milk than it was for me to be able to breastfeed. I decided to exclusively pump for my daughter as I had done with my son. I decided that I would stop pumping entirely and begin hand expressing in order to minimize the risk of bacteria entering my body through my nipples.

 

1leaderandmotherwm
In the world of exclusive pumping or hand expressing, an oversupply is a bonus. The more milk produced, the less stress there is about feeding the baby. Freezing the excess milk is a goal for many mothers. It serves as peace of mind during those growth spurts or when the baby is extra hungry. While exclusively hand expressing, my milk supply increased to more than double her daily needs. This meant that I was feeding her and putting a full day’s worth of milk in the freezer. By the time she was three months old, I had over 1,000 ounces in the freezer that was quickly running out of space.

At a Fourth of July party, a fellow attendee asked why I didn’t feed my daughter directly from the breast. I explained my choice but began to question myself. Maybe her mouth had grown enough to compensate for her weak latch? Maybe her latch was the result of a tongue-tie? Can that be fixed? Will it get better with time? Would a nipple shield help? Why was I struggling when so many other women didn’t have these problems? So I made myself another goal. I told myself I would give it one last try. If it didn’t work, then I would know I had given it all of my effort. I scheduled an appointment with an ear, nose, and throat specialist (ENT), a lactation consultant, and a pediatric dentist. I bought a nipple shield. I began to offer the breast with a nipple shield once a day when she was in a happy mood. My goal was to encourage her to take the breast and to enjoy being at the breast. After more than three months of bottle-feeding, I knew it might be a challenge. I wasn’t concerned yet whether or not she was able to get a feeding in, so I continued the regular hand expression cycle and gave her a bottle of breast milk when she was hungry.

Within a week, she nursed without a fuss for a full feeding, when I offered each breast once a day. It was excruciatingly painful, but with the nipple shield I only had slight bruising and blistering on the tip of each nipple. By the end of the second week, she took two full feedings a day at the breast, and the pain began to fade. My toes still curled at the initial latch, but after 30-60 seconds I was able to relax, and it was slightly uncomfortable. During the third week, I met with an ENT specialist. He told me that there was nothing anatomically wrong with her mouth and that some babies just couldn’t nurse. I refused to believe this, so I decided it was all or nothing. I started offering the breast at every feeding. If I was feeling tense or dreading the next feeding, I would give her a bottle and not stress about it. The hardest part was reminding myself that there was no pressure and that I needed to cut myself some slack. This was all new territory for both of us.

By the end of the fourth week, we were exclusively breastfeeding using a nipple shield. Then I was railroaded by mastitis for the fifth time in a little over three months. Fortunately, this time I was able to nurse through it. The mastitis cleared up faster than the other times. I found that the more I nursed her the less it actually hurt.

olderbaby

 

Around this time, I had my appointment with a pediatric dentist. She confirmed my suspicions that my daughter had a posterior tongue-tie. She offered to release the tongue-tie with a laser. I decided that since we had made progress on our own over the last week or so, I would not put her through that procedure. It seemed that the larger her mouth grew and the more practice we had, the more comfortable nursing became without any intervention. If I had known about her tongue-tie and been able to get an appointment soon after birth, I would have done so without hesitation.

We went home and I felt so relieved. I felt like all of my struggles had been justified by her diagnoses. Looking at the symptoms of a posterior tongue-tie, I couldn’t believe it hadn’t been diagnosed earlier. Together, we had nearly every symptom in the book from frequent mastitis, to an unexplainably painful latch. If only I had known sooner!

I stopped using the nipple shield when my daughter was just over four months old, which was about a week after we were exclusively breastfeeding. It was slightly uncomfortable at first but no longer toe curling! I am so thankful that weaning from the nipple shield was not a struggle. Every day became less and less painful. Within a couple weeks it was almost entirely painless: a word I never thought I would use to describe breastfeeding.

I have never been one to take the easy way out, and in this case I am so glad that I was able to keep trying to breastfeed. I am so thankful for the support of the local La Leche League Leaders and the mothers in the local LLL Group. The women in this group understood how important breastfeeding was to me and knew how far a mother is willing to go for her children. My daughter is almost five months old now, and this is not the end of our breastfeeding journey. I wanted to share the beginning of our story because I hope it can inspire others to keep going, find support, and know that they are not alone in their struggles.

 

by Katelyn Lacsamana
Used with permission from LLLUSA New Beginnings http://www.lllusa.org/katelyns-story-overcoming-mastitis-and-tongue-tie/

 

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

1 Comment »

Second Time Around

As I sit here breastfeeding my second daughter, Niamh, I am so thankful that I became a part of my local La Leche League group. Without the support, information and contacts of the group, my second breastfeeding experience may not have been so positive.

Like my first, my second pregnancy was hard won, though took less time to achieve than my first (two years to conceive as opposed to five for my first). As my older daughter was born prematurely at 30 weeks, we were thinking this time would be similar; the reason for the premature birth was due to my uterine anomaly (Uterus Didelphys) and reduced kidney function, as I only have one kidney and less room in my uterus for the baby to grow. So as soon as I found out I was pregnant again, I started taking low dose Aspirin pills and calcium pills daily. I found an independent midwife who had experience with high risk pregnancies, and was referred to the Obstetric team at Waikato Hospital, who wanted to see me when I got to 20 weeks gestation. From 24 weeks gestation, I was injecting myself daily with blood thinners (Clexane); my impaired kidney function (resulting in protein in my urine) and my age made me higher risk for blood clots in pregnancy. I had to continue this until six weeks after Niamh was born. It wasn’t something I’ve done before, and not being that fond of needles, I certainly didn’t enjoy it, but I tried to shut my brain off and “aim and stab”.

When the pregnancy got to, and past 30 weeks, I was almost just waiting for something to happen. I was having fortnightly blood and urine tests to monitor my kidney function. The levels were worsening, but so far manageable. I noticed on the weekend when I was 33 weeks pregnant, that my face/neck looked a bit swollen and puffy. It became more noticeable the following day. So I contacted my midwife and she got me in for a blood pressure check. My blood pressure was fine, but she wanted me to have a blood test done along with my fortnightly kidney function tests which were due that day. My midwife phoned that evening and said my kidney function results had deteriorated in the past two weeks, so I needed to go to Women’s Assessment Unit to be admitted for observation.
I was admitted to hospital on the Monday night. On the Tuesday my Obstetrician came to see me and said she wasn’t happy with the test results, and that she would rather deliver my baby now to preserve the kidney function I had. The Renal specialist wasn’t quite so concerned, but after much consultation between the two specialists, it was decided that my baby would be delivered by elective Caesarean section first thing Wednesday morning.

Newborn2

Fortunately this time I was awake for the delivery (my older daughter was born by emergency c-section with me under general anaesthetic), so it was quite a surreal experience having open abdominal surgery while still awake. It was all very leisurely and relaxed, even though I felt on edge. I got to see my baby briefly as she was taken across to the resuscitation table, then again as she was taken out to the Neonatal Intensive Care Unit (NICU). I got to see her properly for the first time two hours later, when I’d been given the all clear from recovery. I was wheeled on my bed down to NICU and Niamh was taken out of her incubator to have a skin-to-skin cuddle with me. She was on Continuous Positive Airway Pressure (CPAP) to help her breathe. Even though I had been given steroid injections a week before to help mature her lungs for a potential premature arrival, because it wasn’t her that initiated labour, her lungs hadn’t had time to start adapting to life outside.

As I had been through the premature baby experience before, I knew I needed to start hand expressing colostrum for Niamh to be fed through her feeding tube. My midwife helped with the hand expressing on day one, I think the first syringe was only 0.1 ml of colostrum. Most of the rest of that day was a blur as I was dosed on pain medication. By day two, my hand expressing was getting a bit more volume. On day three I started using the electric pump.

Niamh was being given small amounts of my milk as it was available. She was also on a glucose drip to keep her blood sugar up. As she tolerated the milk, her volumes were increased, and the glucose reduced until she was only on breastmilk by nasal gastric tube.
She was able to come off CPAP on day five, and was put onto high flow oxygen to give a little bit of assistance. Day six was a milestone day, I was discharged from hospital, (which is one of the hardest things I’ve now had to experience twice, with each of my children, leaving my baby in the hospital), Niamh went off any breathing support and was maintaining her body temperature, so could come out of the incubator and into a cot (and into clothes!).

With my first daughter, pumping every three hours in the day and once overnight didn’t result in enough volume, so this time I was pumping every three hours in the day and twice overnight, setting an alarm to wake me to pump. The amount I was expressing wasn’t great, but was slowly increasing every day. While Niamh was in NICU I was only just keeping up with her scheduled feed demands, which put stress onto the expressing, and needing to get enough to feed her. I was also getting incredibly painful nipples from expressing; the breast pump fittings didn’t seem to fit me properly. A Lactation Consultant let me have a different type of fitting, and we bought another one the same so I could double pump, which helped immensely. I also hired a hospital grade double pump for using at home, to try and maximize the output and speed up the pumping sessions.
I knew from my time expressing with my older daughter, that I got a larger volume of milk after I’d had skin-to-skin cuddles with her. After reading up on the topic during my second pregnancy, and having a midwife who was very pro active in getting her clients to do skin-to-skin, I made sure that every day I spent at least an hour with Niamh skin-toskin. I only had to justify it once to a NICU Nurse, who suggested that Niamh would be “better off back in her cot”. I explained to her that I needed to have skin-to-skin cuddles with my baby, as it helped build my supply.

download (22)

 
When she was a week old, I tried our first breastfeed (she was 34 weeks gestation corrected age). She didn’t latch at all, and fell asleep at my breast, which wasn’t a surprise but I continued to try each day during our time spent skin-to-skin. One of the nurses gave me a nipple shield to try; they said that she was probably struggling to latch on because her mouth was so small. This made no sense to me, as my older daughter, who was more premature, had launched herself at my nipple when she was 32 weeks gestation corrected age, and started sucking. So I knew if a smaller baby could do it, then it was definitely possible. But I tried it, and it did seem to allow Niamh to have a deeper latch so we started using the nipple shield for every breastfeed attempt. I did notice that she had a dip in the end of her tongue, that made it kind of heart shaped, and remembered that being mentioned in a book one of my group leaders had lent me, called Making More Milk*, in relation to tongue ties, but I thought nothing more of it. I guess I assumed the NICU nurses would identify if there were any reasons why feeding wasn’t happening as it could be.

To be discharged from NICU, Niamh needed to be fully suckle feeding (breast or bottle), and gaining weight. So that became my goal. At just over two weeks old, I asked the charge nurse if I could try demand feeding Niamh when I was at the hospital, at my breast only without giving any expressed milk through her nasal gastric tube (NGT), and then see how long she went before waking for her next feed. We’d give her a top-up after the last feed I was able to be there for, to try and ensure she would last the three hours till her next scheduled feed (which the nurse would do).

She agreed that we could try this for two days, and if she had gained weight in that time, then we could room in. So I would feed her at the breast when she woke, which would be around every three hours, then pump, and then be back beside her for when she next woke. I was able to be there for four of her scheduled feeds on both of those two days, and she had gained weight during that time, so on the Saturday we were allowed to room in. Rooming in is where you stay in the hospital (they have dedicated rooms for mothers of NICU babies) and have your baby with you 24/7, and you do all the feeds and cares. If the baby gains weight during that time, you are discharged.

Our first day of rooming in, Niamh kept pretty much to three hourly feeding, at the breast with no top-ups. She was weighed the next morning, and had only gained 9 grams. My midwife said they like them to be gaining a minimum of 20 grams a day before they allow discharge. The second night we roomed in was pretty hectic. Niamh wanted to feed constantly, would scream if not feeding, screamed when trying to feed, and we both hardly slept. In desperation, I went to the nursery and got one of the NICU nurses to make up a 20 ml bottle of my expressed milk for her. I wanted to solely breastfeed, so was very upset at having to resort to a bottle at this point.

The weigh in after the second night was exactly what we needed; she had gained 22 grams so we were allowed to take her home. She was two weeks and five days old (36 weeks gestation corrected age) weighing 2,041 grams.

That should have been the end of the challenges, if my older daughter was anything to go by. I was expecting to come home, and just have her needing to feed and grow. But it wasn’t to be that straight forward.

My midwife came to see us on our first day home, she weighed Niamh, and while it was a “gain” in numbers, when she factored in Niamh’s vest and nappy and different scales to the NICU ones, the “gain” was actually very minimal. She then checked in Niamh’s mouth and said that she was fairly certain there was a tongue tie and that we should consider whether or not to have it snipped. I took her to the hospital the following week, where the Lactation Consultant confirmed a type 3 tongue tie, and she snipped it.
My midwife came to see us at home over the next few days. Niamh continued to gain, but incredibly slowly, with barely 10 grams a day, which my midwife was concerned about. So she suggested that we start supplementing with my expressed milk, and that I pump after as many feeds as possible to build up supply. The hope was that once her tongue tie was snipped, feeding would improve, and supply would improve.

So I started pumping after every feed, I was already taking several different herbal supplements, taking the medication Domperidone, and doing breast compression while pumping. We re-hired the double pump for a month, and I would double pump, then single pump each side while doing compressions, after every breastfeed. Yet the amount I was expressing didn’t seem to be increasing.

Since I wasn’t producing enough extra milk to meet the amount suggested by my midwife, I had to make a decision on what to do; Niamh wasn’t gaining weight well, though she wasn’t quite deemed “failing to thrive”. Our options were to use either donor breastmilk or formula to make up the shortfall for top-ups, until my supply increased and Niamh got stronger at feeding. I wanted to avoid using formula this time, as I had used it for one bottle a day with my older daughter, and wanted to trust that my body would do it this time. I discussed milk donation with my husband, and we decided we’d try. Through some contacts we found two mothers who were happy to donate milk to Niamh. I didn’t need much as the potential shortfall was only around 20-50 ml a day but it was a massive relief to have the donor milk available. I could now focus on trying to build my supply, knowing I had a back-up option ready and waiting if needed. In the end, I only needed to use 100ml of it; with a frequent pumping schedule I managed to just keep my expressing (and Niamh’s weight gain) on track.

 

download (75)

 

During all of this, I was still pumping after every feed. We decided to do the night feeds solely by bottle to try and maximize sleep. My husband would feed Niamh, and I would pump. We had to set an alarm to wake us up so we could feed her, as she wasn’t waking on her own, and with minimal weight gain, she couldn’t afford to go too long without feeding. I was getting increasingly concerned about my supply, as I was struggling to get 50 ml in total during these night time pumping sessions. When I was doing the same for my older daughter, I was getting 100 ml. I continued on with the galactogogues, Domperidone, and herbs, which had helped before, but nothing seemed to be working this time. It was then that my group Leader asked me what medication I was on, so I said only the blood pressure medication, Enalapril. That was our Eureka moment. My group Leader had consulted with Alison Barrett (IBCLC, Obstetrician), who found information which stated that when post-partum women were put on Enalapril (an ACE inhibitor) in the first 12 weeks, their breastmilk production could be impacted, with prolactin levels being reduced by 20%. The studies she looked at suggested this would happen at a dose of 20 mg/day, which is what I was on. So I then swapped my medication back to the pregnancy safe Labetalol, and the change was incredible. The day after I stopped taking Enalapril, I got 80 ml during my night time pumping sessions, then the next night I got 100 ml, then 120 ml. The blood pressure medication was the cause of my shocking supply. It also explained why I could pump the most volume in the late afternoon, but very little overnight, as I was taking the pill at night before bed, and by the afternoon it had worn off.

That wasn’t the only challenge we faced. Two weeks after Niamh came home, she started showing signs of Gastroesophageal reflux. My older daughter had had reflux, and was on medication for it until she outgrew the need so I recognised the symptoms immediately. We were checked at the hospital to make sure there were no physical issues at play, and were given the all clear.  So in addition to pumping after every feed, I now had a baby with reflux who would scream in pain after every feed, didn’t like to lie down flat, and had to be held upright after every feed for 20-30 minutes to try to keep the milk down.

I knew that in many instances reflux could be a result of physical issues, so I had my Osteopath treat her. She helped with realigning her body, though it didn’t appear to help the reflux. The Osteopath did however improve her breastfeeding. Even after her tongue tie was snipped Niamh still couldn’t poke her tongue out. But once the Osteopath treated her tongue, she instantly poked it right out, and could latch without a shield.

I then wondered if the reflux may be caused by food sensitivities as I had discovered while pregnant that I had sensitivities to certain foods. After keeping a food diary for a week, and noting what foods I’d eaten, and any symptoms I experienced, then what symptoms Niamh had, I was fairly sure that wheat and dairy were issues. When she was two months old I took her to my Naturopath, who tested her, and identified all the foods she is sensitive to, which along with my suspicions of wheat and dairy, were; gluten, soy, beef, pork, peanuts, cashew nuts and yeast. So I then cut them out of my diet, and within a few days, she was no longer screaming in pain after every feed, and we stopped medicating her for reflux.

Her growth has continued to be in the realms of “slow and steady”, with a predictable 20 grams a day. She is happy and healthy in all other respects, and developing in line with her corrected age.

I later discovered that she had an upper-lip tie, and that some of her tongue-tie had either come forward or reattached, as she regained the dip in her tongue. Breastfeeding was becoming uncomfortable as she was not able to latch properly and couldn’t flare her lip out. We subsequently had it revised by laser and her latching and feeding is greatly improved.

It has been an interesting and stressful learning curve, and while some of the aspects of our journey together are similar to the experience I had with her older sister, there are many more that are different. My husband was a wonderful support, and he took over a lot of things like doing the pre-school run with our older daughter on the two days she went, and keeping the house running.

With the difficulties that we’ve experienced, if Niamh had been my first child, I do wonder if I’d have been able to overcome them or find the support to work through them. I only discovered my local La Leche League group when my older daughter was 13 months old. Through the information I’ve gained (from the group meetings and group library books) and the support of the Leaders and other group members, I am pleased to have overcome our difficult start, and gone on to have another rewarding, loving breastfeeding relationship with my child.

* The Breastfeeding Mother’s Guide to Making More Milk, by Diana West, may be in your local LLL group’s library, and is also available through lllc.ca on Chapters Indigo.

 

by Alison Stacey
Used with permission from LLL New Zealand http://www.lalecheleague.org.nz/Websites/laleche/images/PDF_Downloads/Aroha_articles/Aroha_vol_15_iss_4_Second_Time_Around.pdf

 

 
If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support. Your donation is essential and very much appreciated to help LLLC cover the cost of producing breastfeeding resources: https://www.lllc.ca/donate or become a LLLC Friend http://www.lllc.ca/join-lllc-friends

Leave a comment »

Breastfeeding Success after Cesarean Section

Alert and active participation by the mother in childbirth is a help in getting breastfeeding off to a good start.

This statement from La Leche League philosophy encompasses all births, whether medicated or unmedicated, vaginal or cesarean section. Due to the surgical procedure, mothers who have a cesarean birth may face challenges unlike those who have a vaginal birth.

The Womanly Art of Breastfeeding (8th edition) states on page 57:
The effects of medications and IV fluids, and the difficulty in finding comfortable positions for breastfeeding when your abdomen is tender from surgery, can make breastfeeding more difficult. And it’s challenging to recover from major surgery and look after a new baby at the same time. This doesn’t mean that you can’t breastfeed after a C-section—many, many women do…

download (18)
Here are a few tips for getting breastfeeding off to a good start after having a cesarean birth:

Breastfeed as soon as possible after delivery. Because of the nature of Cesarean delivery, it may not be possible to breastfeed immediately following delivery, but as soon as you feel comfortable doing so, try to nurse. Nursing soon after delivery stimulates the release of hormones, which will help your body first produce colostrum followed by your breast milk. Whether a mother went through labor or had a cesarean birth, her milk supply may take longer to come in and vary if she received medications or other circumstances at the time of delivery. Your milk will come in anywhere from two to six days (usually two to three days) after delivery, and colostrum will provide exactly what your baby needs until then.

Take advantage of an extended hospital stay. Room in with your baby if possible so that you can bond and offer the breast as frequently as every two hours. Concentrate on nursing and bonding with your new baby. Encourage your partner to snuggle and bond with the baby when visiting. This gives you time to rest.

Try different breastfeeding positions to avoid discomfort at the incision site. If holding your baby across your belly is uncomfortable, try the football hold, where baby is tucked under your arm on the feeding side. Another position to try is side-lying. With the baby parallel to your body, lie on your side with pillows to support your back and incision.

Stay well rested. Eat nutritious, protein-rich meals and stay hydrated by drinking plenty of water. When you were pregnant, you likely heard, “If I can do anything for you, just let me know,” from friends, family, and neighbors. Take them up on their offers. Allow people to bring over food, walk the dog, do the laundry, or help clean the house.

Ask for help. Don’t assume that just because the act of breastfeeding is a natural function of your body that it comes naturally. If you are having an issue, reach out to a La Leche League Leader, lactation consultant, or your health care provider. They may be able to answer questions and provide insights to help you overcome many breastfeeding struggles.

Gather the things you will need while feeding your baby in one place or put them all in a basket that you can carry with you. Having your supplies together will minimize the number of times you have to get up and allow you to focus on nursing. Have a water bottle, some reading material (or the television remote), your phone or tablet, baby wipes, snacks, and burp cloths handy at your nursing station.

Try to relax. Establishing your breastfeeding relationship while learning how to be a mother and recover from surgery may be stressful for you. Take a few minutes here and there for a hot shower (or a bath once your doctor gives the go-ahead), go for a walk, or have someone rub your back and shoulders. Snuggle time and skin-to-skin time with your baby can relax you.

Rule out other issues. If you are having problems getting started, don’t be too quick to associate them with the surgery. Contact a La Leche League Leader, lactation consultant, or your health care provider to discuss concerns that may be related to latch, inverted nipples, or other issues.

Newborn2
For more information about getting breastfeeding off to a good start and breastfeeding after a cesarean birth, please click on the following links:

How to Get Your Milk Supply Off to a Good Start  www.llli.org/nb/nbjulaug05p142.html

Is it possible to breastfeed after a cesarean birth?  www.llli.org/faq/cesarean.html

Establishing Your Milk Supply http://www.lllc.ca/Information-sheets

Can I breastfeed after having a Cesarean (C-section) birth? http://www.lllc.ca/faq-page

Breastfeeding After a Cesarean Birth https://supportingbreastfeeding.wordpress.com/2014/06/23/breastfeeding-after-a-cesarean-birth/

 

By Kendra Atkins-Boyce
Used with permission from New Beginnings
http://www.lllusa.org/set-yourself-up-for-breastfeeding-success-after-cesarean-section/

 

If you need more information or have a breastfeeding problem or concern, you are strongly encouraged to talk directly to an accredited La Leche League Leader. In Canada, Leaders can be located by clicking http://www.lllc.ca/find-group or Internationally http://www.llli.org/.

If you have found this article helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/join-lllc-friends so we can continue to help others breastfeed. Thank you!

Leave a comment »

%d bloggers like this: