Supporting Breastfeeding

La Leche League Canada

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.

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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.

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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 »

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.

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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.

 

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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

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Should You Mix Human Milk With Formula?

The Canadian and American Pediatric Associations recommend exclusive breastfeeding for the first six months of life and then the slow introduction of complementary foods while continuing to breastfeed for a year or longer. Exclusive breastfeeding means nothing but breastmilk: no water, no juice and no formula. Many mothers are happy to know that their breastmilk is all baby needs in the first six months but other mothers may consider supplementing with formula for a variety of reasons. Those mothers may have questions about whether it is okay to mix formula into their breastmilk.

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Here are some science based answers to this question:

It’s best not to mix breastmilk and formula in the same bottle because the storage guidelines for the two substances are very different. If you mix your milk with formula, and the baby doesn’t finish the bottle, then some of your milk goes down the drain. Formula has to be discarded after the feeding (Alberta Health) [1] whereas human milk left in the bottle can be refrigerated for another feed (LLLI Safe Handling and Storage of your milk [2]).

Mixing formula into the breastmilk will affect some of the protective components of human milk. The following quotes are from the Human Milk Banking Association of North America (HMBANA), [3] in their 2005 publication “Best Practice for Expressing, Storing and Handling Human Milk in Hospitals, Homes and Child Care Settings”: “Feed human milk, with or without fortifiers, separate from formula to maximize the benefits of human milk. If the mother is not producing sufficient milk for each feeding, collect as many pumpings as necessary to make one exclusive human milk feeding and use formula at the other feedings.”  The rationale: Quan et al [4] found that when bovine milk based formula is mixed with human milk prior to feeding, there is a significant (41-74%) decrease in lysozyme activity. Additionally, there is significant increase in the growth of E coli, resulting from the decrease in anti-infective properties in the milk. “Adding human milk fortifier causes a 19% decrease in lysozyme but no corresponding effect on the anti-infective properties or increased growth of E coli.”

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It makes sense that human milk, which is alive, would not be in its ideal state by adding a dead substance, possibly containing agents that might bind up some of the live constituents in the human milk, making them hard to absorb by the baby, or maybe not available at all.

The aim for most mothers is to exclusively human milk feed their babies. Therefore, if formula is used because the mother has not enough milk, but might in the future, it is best to treat the formula like a medicine, used temporarily and separately, to ‘top up’ her milk until such time as she has enough of her own.

Mothers with adequate milk supplies who may choose to use formula for some feedings rather than expressed breastmilk, will also want to ensure that their babies get the full benefits of the breastmilk by using the formula separately rather than mixing it with breastmilk.

If you have questions about how to increase your milk supply or any other
breastfeeding questions please contact a LLL Leader.
http://www.lllc.ca/thursdays-tip-should-you-mix-human-milk-formula

 

Links:

1 https://myhealth.alberta.ca/health/Pages/conditions.aspx?hwid=hw97537&

2 http://www.llli.org/faq/milkstorage.html

3 https://www.hmbana.org/

4 http://www.ncbi.nlm.nih.gov/pubmed/8200164

 
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!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

LLLC Spring Appeal Campaign [5] for the support of breastfed babies: Help LLLC Grow – If you, or someone you know, has benefitted from the support of LLLC, a donation is one way you can “pay it forward”.
Donate Today!
Over 385,000 babies are born in Canada each year and we want to ensure every mother has access to La Leche League Canada support whenever she needs it. We are working hard to grow and we need your support. Every donation helps us provide more support to more families!
Thanks to past donations, we have been working hard to grow our services:
Our volunteer Leaders are the cornerstone of LLLC and the support we provide. We have increased our Leaders by 10% in the past year and Leader Applicants by 40% over the past 2 years!
More than 13,000 mothers attend LLLC meetings and another 20,000 receive one-to-one phone support from Leaders.
We have doubled our community and health professional outreach in just one year!
5 new Information Sheets in various languages were made available free of charge to mothers and health professionals
A new Communication Skills program was developed to strengthen health professional and breastfeeding peer support skills and our Best for Babies pre-natal program continues to grow.
Our Leaders are a vital part of LLLC’s breastfeeding foundation. They freely devote their time to help other parents give their children the optimal start in life. You, the donor, make up the other part of the foundation on which the LLLC breastfeeding services rest. Your gifts mean that our Leaders can carry out the valuable help families need. Frankly, we would be unable to deliver services to families without you or our Leaders so please take a moment to consider how valuable your support is and make a donation, either online or by using our pledge form. If a one-time donation is not suitable for you, perhaps spreading your gift over a year would make sense. Our pledge form has the monthly donation option for your convenience.
We are proud of our growth – but we want to do so much more! We need your support to help us serve even more mothers. Please donate today so we can grow to serve the mothers and babies of tomorrow.
Thank you for taking the time to consider supporting La Leche League Canada and our continued efforts to support all breastfeeding families who need us.

5 http://www.lllc.ca/fundraising-campaign

 

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Low Milk Supply and Breastfeeding

The most common questions La Leche League Leaders hear on phone calls, e-mails and at meetings are about milk supply and generally they are about the mother’s perception that she doesn’t have enough milk for her baby(ies). There are a lot of reasons that mothers may think they don’t have enough breastmilk which are not a low supply problem at all.

Here are some tips to help you sort out what is going on:

  • You don’t necessarily have a low milk supply if baby won’t go the X number of hours between feedings that your baby book, mother, friend or health care professional says they should. Normal babies sometimes feed every 2 hours but they can also want to feed again after 20 minutes or 45 minutes or… if they are having a growth spurt they may want to feed every hour for a few days. They may cluster feed and then sleep for a longer stretch (this often happens in the evening). All of these feeding spacings are normal and a baby might do all of them in one day or over the course of a week.
  • You don’t necessarily have a low milk supply if your breasts aren’t leaking anymore or if they feel softer than they used to. Around six to eight weeks after giving birth, your breasts will no longer have the excess of lymph and blood flow that they had in the early days and they will feel softer. Some mothers never experience leaking and for those who did have leaking, most find the leaking episodes decrease as their bodies get used to breastfeeding.
  • You don’t necessarily have low milk supply because you have small breasts. The size of your breasts has very little to do with the amount of milk making glandular tissue. If your breasts grew during your teen years and grew again during pregnancy then it is very unlikely that you don’t have sufficient glandular tissue to support breastfeeding.
  • You don’t necessarily have low milk supply because your baby won’t stay asleep if you put them down after a feeding. Babies often drift off to sleep at the breast and then wake up the minute you put them down. This happens because babies are happiest in their favourite environment (your chest). Many babies also like to take a short break, have a little nap, and then come back for the second breast. This is normal.
  • You don’t necessarily have low milk supply just because your baby will take milk out of a bottle right after you have breastfed. The sucking reflex is so strong that babies will take milk if a bottle nipple is put in their mouth even if their tummies are full.

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There are two things that may indicate that you that you have a problem with low milk supply:

  • Weight gain problems: Babies almost always go down from their birth weight. Most babies have regained birth weight by two weeks and then continue to put on 150-200 grams per week. There can be some variation so getting support from someone who has a thorough understanding of breastfed baby growth rates and breastfeeding technique is important if you have concerns.
  • Diapers: After the first week, we expect to see 6-8 wet diapers per 24 hours and several poops that are at least big enough to cover about 2.5 cms. If this is not what you are seeing when you change baby’s diapers then it is time to follow up with someone knowledgeable.

If you feel that you might have a low milk supply, or baby isn’t happily feeding, or for anything else about breastfeeding that concerns you, contact a La Leche League Canada Leader to help sort out how to deal with your breastfeeding/caring for a newborn challenge. Breastfeeding isn’t always easy, we’re here to help.
http://www.lllc.ca/thursdays-tip-breastfeeding-and-low-milk-supply

 

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/.

 

https://supportingbreastfeeding.wordpress.com/2014/09/22/establishing-your-milk-supply/

https://supportingbreastfeeding.wordpress.com/2015/03/09/how-to-know-your-breastfed-baby-is-getting-enough-milk/

https://supportingbreastfeeding.wordpress.com/2013/08/19/newborn-feeding-patterns/

https://supportingbreastfeeding.wordpress.com/2016/01/18/newborns-have-small-stomachs/

https://supportingbreastfeeding.wordpress.com/2015/06/08/why-does-my-baby-cry/

https://supportingbreastfeeding.wordpress.com/2014/03/31/crying-and-breastfeeding/

https://supportingbreastfeeding.wordpress.com/2015/03/16/tracking-newborn-weight-loss-in-breastfed-babies/

https://supportingbreastfeeding.wordpress.com/2014/08/04/tips-for-breastfeeding-success/

http://breastfeedingtoday-llli.org/what-your-baby-knows-about-breastfeeding/

 

 

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!

 

 

 

 

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Engorgement: Cabbage leaves and Other Treatments

Engorgement is the tender, full, larger feeling that many women get in their breasts between day 2 and day 6 after giving birth.  Some women describe it as feeling like they have Barbie Doll breasts.  The change in size and sensation is caused by increasing milk volume and increased blood and lymph flow to the breasts.  The increase blood and lymph flow supports milk production.

Women who have had intravenous fluids during labour are at an increased risk of having an extended period of engorgement while the body rids itself of the excess fluids.  If the baby is latching and nursing well the normal postpartum levels of extra fluid generally don’t cause any breastfeeding difficulties.  As the pregnancy and childbirth hormone levels decrease over
the next few weeks, mother’s breasts feel softer in-spite of the increased milk volume of established breastfeeding.

Several studies have shown that when babies feed more frequently in the early days mothers are less likely to experience engorgement.  An Australian study which compared mothers who were told to let their babies nurse as long as their wanted on one breast before offering the second breast found those mothers had less engorgement than the mothers who were told to be sure their babies took both breasts at a feeding.

BFnewBaby


Treatments for postpartum breast engorgement have not been well studied so mothers will get lots of opinions and advice.  The ideas we know work well are those that get the baby nursing effectively and emptying the breast:

-Breastfed as often as baby is willing (at least every 2-3 hours) and allow the baby to stay on the first breast until he comes off on his own.  The second breast can be offered if the baby is interested.  If baby isn’t interested in the second breast right away make sure to offer that side at the next feeding whether that is 10 minutes or two hours later.

– Get assistance sooner rather than later from La Leche League or another trained breastfeeding support person if baby is not latching well.

– Cold compresses between feedings can help reduce the swelling and the often feel good.  A soft gel Ice packs or a bag of small dice frozen vegetables works well to sooth an engorged breast.  Protect the skin with a layer of cloth between the ice pack and the skin.

– Pain medication may be helpful while waiting for the increased breastfeeding and cold compress to be effective if a mother is experiencing a lot of discomfort from engorgement. Discuss appropriate pain control medication with a health care provider.

– Express some milk if baby isn’t able to latch on well due to the swelling.  Some mothers worry that by expressing milk they will increase their milk production and create a bigger problem. Draining the breast helps to decrease the congestion of extra blood and lymph in the breast tissues.  Milk volume is unlikely to increase beyond baby’s needs with the amount of milk expression needed to regain comfort and make it easier for baby to latch on.

– Gentle breast massage before feeding or expressing may help to make the milk flow more easily.

-Cabbage leaves have long been recommended as a treatment for engorgement.  The small amount of research that has been done shows they don’t prevent engorgement.  Another study showed that they don’t appear to be any more effective than frozen gel packs but mothers preferred using cabbage leaves over the frozen gel packs.  If mothers want to try using cabbage leaves as a treatment for engorgement, choose green cabbage not the red/purple variety (it stains skin and clothing!).  Take a rinsed, room temperature or refrigerated, cabbage leaf and cut out the heavy vein out of the middle of the leaf.  The leaf or leaves are laid over the breast directly on the skin.  Putting on a bra or snug top over top of the leaves will keep them from falling off.  Remove the leaves when they are wilted and soft (usually within a few hours) or when the baby wants to feed again.  Fresh leaves can be applied after a feeding or when the first ones are wilted.

La Leche League Leaders can help you work through engorgement and other breastfeeding challenges.

http://www.lllc.ca/thursday-tip-cabbage-leaves-and-other-treatments-engorgement

More information about engorgement can be found by clicking here.

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!

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Breastfeeding on One Side Only

Most people assume that you need to have two functional breasts to breastfeed a baby but there are women who, for a variety of reasons, nurse their babies, on one side only. The first concern people bring up is whether the baby will get enough milk. When you consider that mothers of twins (and more) can successfully breastfeed, it is clear that each breast will produce the amount of milk needed given the right stimulation.

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The most common reason for mothers to find themselves breastfeeding from one side only is past surgery for cancer or to remove a benign lump. If the ductal tissue of the breast has been removed or severely damaged, the breast may not produce milk or the milk may not reach the nipple. Other mothers have found themselves nursing on one side because of physical issues of their own or the baby’s, or they have a baby whose adamant refusal to feed from one breast can’t be overcome.

Producing an adequate milk supply when breastfeeding on one side only requires the same things as stimulating a milk supply in both breasts: putting baby to the breast early and often and ensuring that baby has a good latch. The breast that is not stimulated will, over time, stop producing milk.

DSC_4408

If you are surprised that breastfeeding is possible with only one functional breast you may be even more surprised to know that mothers have breastfed twins or tandem nursed a newborn and a toddler with only one breast. With knowledge, support and determination breastfeeding mothers can do amazing things!

http://www.lllc.ca/thursday-tip-breastfeeding-one-side-only

 

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!

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Breastfeeding and Juice Cleansing

New mothers can feel incredible pressure to get back to their pre-pregnancy weight and shape.  The natural inclination to wish you could fit into your favourite clothes is exacerbated by all of the magazine photos showing celebrities who have recently had babies wearing lovely, form fitting clothing.  As you stand in the grocery store checkout line up with a squawking baby in your arms, baby spit on your shoulder, your clothing wrinkled and without your make-up on, seeing them beautifully made-up and looking polished and shiny can make you feel like you should be “doing better”.
Along with all the other dietary ideas that abound, those same magazines often talk about the juice cleanses these celebrity new mothers have done to get themselves back into front cover photo worthy shape.  Many mums wonder if doing a juice cleanse is safe and compatible with breastfeeding.
The first thing to understand about juice cleanses is there are no good scientific studies to back their claims that they clear toxins from your body or promote healthy weight loss. Your liver, kidneys and colon are designed by nature to remove toxins from the body and for most people who are eating a healthy fiber-rich diet, they do an excellent job.
Juice cleanses are low in calories, fats and protein all of which are needed to fuel breastmilk production.  If you are not providing these nutrients to your body through your diet, it will take them from your own stores in order to continue to make high quality breastmilk for your baby.  Juice cleansing will likely cause you to lose some weight but it will be at the expense of your own energy levels.  As much of the weight lost will be water weight, it is also likely to come right back when the cleanse is over.  Juice cleanses are also low in the dietary fiber which is required by our bodies for the colon to do its job of clearing toxins.

 

1BabyCarrier
So what can you do to improve your diet, increase your energy levels and perhaps encourage a few of the pregnancy pounds to go away without jeopardizing breastfeeding? Breastfeeding is the best way to lose the extra weight you may be carrying post-pregnancy.  New mothers often weigh about 10 pounds more than they did when they got pregnant and that weight was put there by nature to fuel breastfeeding.  For most mothers, those 10 pounds disappear without any extra efforts over the first six months to a year as you breastfeed your baby.  Eating a nutrient-dense diet of whole grains, protein, healthy fats, fruits and vegetables is best for your body at any stage of life and especially when breastfeeding.  Juices aren’t off-limits to new mothers.  They can be healthy if they are low-sugar (primarily vegetable based with only enough fruit for sweetness) and part of a well-rounded diet.  Juices can be tempting as a quick pick-me-up when you are really busy and juggling life with a small baby.  Some mothers find a smoothie made with greens, fruit or fruit juice, low-fat milk or milk substitutes and a fiber source is quick to make and easy to consume while breastfeeding the baby or walking circles with a fussing little one.  Many high fiber smoothies can be made ahead of time which is extra helpful when you are busy.
Here are a few links to smoothie recipes to get you started (click on the name):
Oatmeal Cookie Smoothie
Smoothies for Breastfeeding Moms
Disclaimer: La Leche League Canada has no personal or commercial connection with these sites and makes no claims about their information other than that the smoothies look tasty and healthy.
Lastly, remember that those celebrity mothers on the magazine covers generally have help of all kinds from baby care to cooks and fitness coaches.  The amount of time and effort required to look like they do is considerable and it is time away from their children. Also, photo editing can make anyone look 10 pounds lighter, smoother, or less exhausted. Don’t believe that everything you see in the magazines is the way things really are when the cameras aren’t looking.

http://www.lllc.ca/thursdays-tip-breastfeeding-and-juice-cleansing

 

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!

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Easier Breastfeeding the Second Time Around

There are many women who will tell you their early breastfeeding experience was easier with the second baby. In particular, they will say that they had better milk production. Some of this ease of breastfeeding the second time around is undoubtedly due to mother being more relaxed, already having experience recognizing baby feeding cues and knowing how to get baby to latch on well. New research indicates that these anecdotal stories may also have a scientific basis to back them up.

Camila dos Santos of Cold Spring Harbor Laboratory in New York and her colleagues looked at the mammary tissues of mice prior to pregnancy, during and after first pregnancies, and again during and after subsequent pregnancies. In their research, they confirmed that pregnancy is the key change agent for the mammary gland.

During the first pregnancy, as any pregnant woman can tell you, there is a tremendous expansion of cells within the breast tissue. The pregnant and lactating breast has alveoli (hollow cavities, a few millimeters large) lined with milk-secreting cells and surrounded by epithelial (surface) cells. The alveoli join to form groups known as lobules. Each lobule has a duct that drains into openings in the nipple. The results of the dos Santos study showed that many of these cellular changes to the alveoli and epithelial cells created during the first pregnancy are maintained after the first period of lactation has ended.

When the test mice became pregnant for the second time the mammary tissues responded to the pregnancy hormones more quickly than during the first pregnancy. The mice were also seen to create additional alveolar structures and additional epithelial cells during the second pregnancy. This increase in cellular structure enhances the body’s ability to produce mature milk and produce it more quickly. The researchers suggest that the cellular “memory” from the first pregnancy primes the body for mammary function in the future.
family and newborn


Looking at this “lactation cellular memory” from a human evolutionary
perspective, it has a clear advantage. The mother with her first baby has more time available to spend feeding the baby. When baby #2 (or more) comes along the mother needs to be able to feed the baby and keep up with the needs of older children. Those mothers who had the ability to produce a greater milk supply for subsequent babies had the greatest likelihood of their genes being passed on to the next generation.

This study gives hope to mothers who struggled with milk supply with their first babies and provides another layer to the explanation why there was more breastmilk the second time around for mothers who have already had a second baby.

Even though your breasts will be primed for increased milk supply with baby #2, there is always value in getting encouragement and information from a knowledgeable breastfeeding supporter if you are currently struggling with breastfeeding or if you are expecting a second baby and struggled the first time around.

http://www.lllc.ca/thursday-tip-factors-may-make-breastfeeding-easier-second-time-around

 

 

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!

 

 

 

 

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Breastfeeding Twins After a Difficult Pregnancy and Birth

I am a mother of 1 year old twins. They were born 7 weeks early and delivered by Cesarean Section and I am proud to say that I was able to provide them both with breast milk, nearly exclusively for the first 6 months, and as required for the next 6 months. I began by pumping every 2 hours in the day and every 4 hours at night. My daytime pumping would start at 6 am and end at 10 pm. I woke every night at 2 am to pump. I was pumping 20 minute sessions, 10 times a day. My breasts were usually empty after the first 10 minutes or so but I kept pumping to continue stimulating the glands. Often times after the 16 minute mark, more milk would come out. I was recovering from preeclampsia and taking medication four times a day which slows breast milk production. It took about 2 weeks until I was producing enough milk for them to both have breast milk exclusively. Being preemie though, that was not a large amount: about 16 oz a day between them. I took galactagogues to help bring in my milk. I was so proud of myself when I was finally able to provide for them. Having had limited contact with them in the NICU, it was one of the only things that was exclusively mine and made me feel like a mother. Everything else was determined by the doctors and nurses: when I could hold them, bathe them, feed them, but not this. I and I alone could provide my babies the nourishment they needed to grow strong and healthy to come home.

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I tried to put my twins to breast once they were old enough and found it to be too time consuming to breastfeed, then top them up with a bottle, then pump. By the time I finished it was time to start again. They were still too small to have the strength and stamina they needed to empty the breast and meet all of their nutritional requirements. They were just barely 5 lbs when they came home after only 31 days in the hospital. They needed to eat every 2 – 2.5 hours and often not at the same time. I was only averaging about 2 hours of broken sleep a day when I was trying to put them to breast. I was just too exhausted to be the only one that could feed them. I needed help. Pumping on my schedule allowed me to sleep and have other people feed them. They got all of the benefits of breast milk and I got to sleep. I tried again to put them to breast when they were about 10 lbs thinking that they were more than big enough to empty the breast now but by then they were use to the bottle and I was use to pumping. I was still exhausted and did not feel up to the challenge of exclusive breastfeeding and no bottle. It was a difficult decision for me to make to exclusively pump. I really wanted the bonding aspect of breastfeeding but was too overwhelmed with exhaustion and recovering from the preeclampsia to do it all on my own. Pumping was a good compromise and my husband and family got to share in the feeding/bonding experience.
I maintained my rigid pumping schedule for the first 8 months. When they started sleeping through the night, I was still getting up to pump. At my most, I was producing 60 oz of breast milk a day with no medications or herbal supplements . I did need to supplement with formula right before they started solids. They were each getting only 3 or 4 bottles a week of formula for about 2 months. The rest was all breast milk.
I began to tire of all of the pumping and really wanted to sleep through the night. I decided to start taking a medication so I could maintain my supply and pump less. I was able to drop to 8 pumps per day, sleep through the night finally, and have the same volume. When they were about 10 months old, I again was able to drop 2 pumps per day and was now at only 6 pumps per day, every 3 hours instead of every 2, producing about 40 oz a day. I stuck with 6 pumps a day until they turned 1 and am now in the weaning off process which in itself opens up a whole new bag of emotions.

Dad and Babe

 
As I said, I really wanted to breastfeed but more importantly, I really wanted them to be breast milk fed. Breast milk was the best thing I could offer their tiny bodies and I was determined to do it. I attribute my success to a supportive family and an amazing breast pump. My family and friends were extremely supportive and together we made sure that pumping came before all else. At family and friends homes, I did not excuse myself and leave to go pump. I pumped right there amongst the conversations. At first of course, I did excuse myself but felt as though I was missing out. I hated being secluded from the action and started to resent pumping because it was so time consuming and I was stuck there sitting by myself. I decided that if I was actually breastfeeding, I would have fed the babies right there in front of my family and friends anyhow, so pumping was really no different. Everyone just accepted it as they would have if I was breastfeeding.
I used a Breast Pump that was tiny and portable, yet powerful. I could walk around the house while pumping, use the computer, sit and play with my kids, and managed to bottle feed them and burp them all while pumping. I took it everywhere. I’ve pumped in my car in countless parking lots, while being the passenger in a car numerous times, several doctors offices, other people’s houses, hair salons, friends weddings, anywhere I was when it was time to pump. I just brought a cooler bag with an ice pack. Everywhere I went, people were so supportive when I needed a place to pump. Never once did I encounter a doctor’s office or any other place where I could not pump. In my mind, I was breastfeeding and if I was out with a baby whom was put to breast, I would have had to put them to breast in all of those places. It didn’t matter to me where I was or who I was with. My kids needed to eat and deserved the best I could offer.
I got so many compliments and congratulations on sticking with it. I was so proud of myself. Other than the extra dishes, to me, it did not seem like that much more work than breastfeeding and actually allowed me more freedom from the babies than breastfeeding. Yes it was inconvenient at times and I wanted to take the easy rout and switch to formula but then I would think about if I were actually breastfeeding would I be quitting? The answer was always no. I wanted to breastfeed for a year and for all intents and purposes, I was breastfeeding, just not the traditional way.
My twins are now a year old and have never been sick a day in their lives. They are strong and developmentally caught up to term babies. I am so happy to share my breastfeeding story with others. Successful breastfeeding of twins is possible, even if it has to be done with a pump. It was not my ideal dream situation but we made it work with relatively little disruption to our everyday lives. The payoff was well worth any inconvenience, two healthy babies and not to mention the amount of money saved not buying formula.

http://www.lllc.ca/breastfeeding-information

 
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!

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Newborns Have Small Stomachs!

It should be self-evident that very small people will have very small stomachs.  However, many adults are surprised when they learn about the limited capacity of a newborn’s stomach.

Here are some facts that may help you (or those around you) better visualize what baby’s tummy can hold:

Before birth baby never feels hunger as he is fed constantly via the placenta. After birth small frequent feedings help baby transition to an intermittent feeding pattern. To make this transition easier for baby mother’s breasts provide small amounts of milk (colostrum) on day 1.

Newborn stomachs don’t stretch. Zangenet al (2001) found that on day 1 a newborn’s stomach wall is firm and doesn’t stretch. By day 3 the stomach starts to expand more easily to hold more milk. Interestingly, day 3-5 is when the milk volume starts to increase for most mothers.

When breastfeeding is going as expected, each day baby feeds more effectively. In response, mother’s milk production increases and baby gets more milk, which encourages her to feed more effectively. Supply follows demand.

Birthnewborn

 

Day 1:  baby’s stomach holds 5-7 ml (1 – 1.4 teaspoons) at a time. The mother will produce about 37 ml (one ounce) of milk/colostrum in the first 24 hours. The capacity of a newborn’s stomach is influenced by birth weight however the differences are not substantial.

1st week:  with frequent feedings milk production increases to about 280 -576 ml (10-19 ounces) per day by day 7. Baby’s stomach can now hold 30-59 ml ( 1 -2 ounces) at a feeding by the end of the week.

2nd & 3rd week:  with frequent feedings mother’s milk supply continues to build. Now baby’s stomach can hold 59 – 89 ml (2-3 ounces) at a feeding and baby is taking in 591-750 ml (20-25 ounces) per day.

4th & 5th weeks:  babies will now be taking an average of 89-118 ml (3 -4 ounces) per feeding and daily milk intake will be in the range of 750 – 1035 ml (25 – 35 ounces) per day.

At one month most mothers will be producing nearly as much milk as their baby will ever need. Because the rate of growth slows as babies get older, they continue to need about the same amount of breastmilk per day from one month to six months of age. The nursing pattern will change during that time even though the volume of intake over the day remains much the same.

Some people have trouble visualizing stomach capacity so using common objects can help make the capacity clearer:

Day 1:  5-7 ml is about the size of a large marble or a cherry

Day 3:  22-27 ml is about the size of a ping pong ball or a walnut

One week:  45-60 ml is the size of an apricot or plum

One month:  80-150 ml is about the size of an large chicken egg

 

Adult stomach size is equivalent to a soft ball or the size of your own fist clenched at rest and has a capacity of 1-4 liters.

When someone asks you why your newborn is nursing at least 10-12 times in 24 hours and suggests that your milk might not be filling up her tummy, you now have some information to help them understand that frequent feedings, on baby’s own schedule, is exactly what her tummy and your milk supply need.

 

http://www.lllc.ca/thursday-tip-newborns-have-small-stomachs

 

 

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!

 

 

 

 

 

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