Supporting Breastfeeding

La Leche League Canada

Traveling With a Breastfed Baby

Around this time last year, my husband and I were packing innumerable bags and loading the car for our first trip away from home as a family of three.  I toiled over the “to-pack” list and tried to supervise my husband as he stowed our luggage away, while our tiny baby nursed and slept at my breast.

Nursing pillow?  Check.  Nursing cover?  Check.  Breast pump?  Check. Pump parts, bottles, and milk storage bags?  Check, check, check.  Our baggage grew exponentially.

We planned for the four-hour drive to take five hours. Naturally, it took six.  Our baby was three months old, exclusively breastfed, and co-sleeping with us.  As we drove, she became increasingly less tolerant of being anywhere other than at my breast and in my arms, so we stopped often.

Once we arrived at our destination and again throughout our stay, I found myself frequently locked away in a bedroom, pumping breast milk.  At the time, it seemed like the least awkward of all of my baby’s feeding options.  After all, my baby girl’s grandmother wanted desperately to feed the baby a bottle and her grandfather was supportive but still uncomfortable with breastfeeding.  So, I hid and I pumped and I turned what should have been an enjoyable family visit into a week of sequestration and dirty dishes.

What I didn’t know back then was that traveling with your breastfed baby doesn’t have to be so hard.  My breast pump is a fabulous tool that allowed me to work full-time while also providing breast milk for my daughter, but on the road it became yet another complicated baby accessory.  If I really thought about my baby’s needs and my own needs, they were simple: feed the baby.  That didn’t change just because we were away from home.

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With hindsight being 20/20, here’s what I would change if I could take that first trip again:

I would leave the pump at home.  Maybe I’d pack a manual pump and one bottle just in case, but bringing my entire arsenal of pumping supplies – and washing them on the road – was a lot of work.  Nursing my baby is much, much simpler than pumping.  There is no time spent pumping, no storage, no toting bottles around, and no dishes to wash.  Nursing on the go is, dare I say, easy.

I would plan for more nursing breaks on the road.  It added undue stress to our trip when we had to stop unexpectedly because the baby was upset and needed to nurse.  We may need to stop more often when traveling with a baby, but we also should have planned for more nursing stops.  That would have helped relieve my anxiety that we were running behind and also would have given our baby the breaks she needed.

I would find other ways to let family share in caring for baby.  I know my daughter’s grandmother really, really wanted to give her a bottle, but instead she might be happy burping the baby after nursing and giving her a bath that evening.  There are so many ways family can bond with a new baby; it doesn’t have to be through a bottle.  And if I leave my pump at home, there really is no choice but to nurse her anyway (wink, wink).

I would put my baby’s need to nurse ahead of others’ comfort levels.  This is the hard one – for me – but I believe it’s also the most important.  Doing this might mean I choose to nurse my baby in a private room, but at least I’m not alone and hooked to a pump at the same time.  It might mean that I choose to nurse using a nursing cover, or it might mean that I choose not to be offended if someone leaves the room when I nurse uncovered. Ultimately, it means that I choose to put my baby’s needs first, even when we’re in someone else’s home.

Once we had that first trip under our belt, it became so much easier.  My confidence level rose knowing I could manage it all away from home.  I learned to lean on my nursing relationship with my baby instead of being inhibited by it, and suddenly things were so much simpler.  I was much less afraid to travel because it became less of an ordeal and more of an experience again.  And I am so happy I’ve been able to share those experiences with my nursing baby.

 

By Ashley Smith
Used with permission from LLL USA, New Beginnings http://www.lllusa.org/traveling-with-a-breastfed-baby/

 
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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Radiologic Procedures While Breastfeeding

Mothers often ask if they must wean before having a medical diagnostic scan or x-ray. In most situations, weaning is not necessary.

The first step is to gather information about the type of testing that is being recommended. Useful information to collect is the name of the test and the name of the radio-contrast compound or radio-opaque contrast media (i.e. the drug taken or injected to make parts of the body show up when x-rayed or scanned) being used.

 

MRI Scan (magnetic resonance imaging)

  • Best for looking at soft tissue (brain, muscle, cancers, blood vessels, etc.), and can be used for looking at bone.
  • Does not use radioactive material, but does use radio-contrast medium that under magnetic field shows up body parts.
  • Contrast is not always used but does enhance the image. Contrast substance used most commonly is gadopentetate and it is not radioactive
  • Less than 0.04% of the dose of gadopentetate will appear in a mother’s milk and only 0.8% of that is absorbed by the baby.
  • Those with claustrophobia are given conscious sedation.

 

CT Scan (computerized axial tomography) or CAT scan.

  • Gold standard for looking at bleeding (clots), tumours, inflammation, bone or tissue injury, guiding passage of a needle etc.
  • Person takes a compound that contains iodine. Multiple x-rays are taken encircling the body, and the iodine reveals bones or tissues.
  • Contrast medium used is not radioactive. Contrast is not always used. Like for MRIs it is used to enhance imaging.
  • The iodine in the contrast material is bound to a molecule forming the compound.  The compound does not enter the milk in any noticeable amount. The compound does not release enough iodine to alter the infant’s thyroid function.

 

IVP (intravenous pyleogram), or lymphangiogram

  • Uses contrast media similar to MRI (see above)
  • Contrast medium is delivered by intravenous to show under x-ray the kidney, lymph nodes or blood vessels.

 

Radioactive Scans

  • A radioactive form of gallium (Ga), technetium (Tc), or iodine (I) is sometimes given to a mother before a test or used as a treatment.
  • In order to protect the baby from ingestion of the radioactive compound in breastmilk, weaning for a period of time is recommended.
  • Appropriate times for being off the breast are listed in Hale
  • Mother will need to express her milk during this time to maintain her supply.

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Consider Other Options

If a mother has been told to wean her baby for one of the first three scans, she may be able to consider other options. Printed information can be shared with the doctor, such as pages from Medications and Mother’s Milk, Breastfeeding Answers Made Simple, or other references.
Has she asked her doctor if the test can be postponed or if another less invasive procedure is possible?  Has the doctor shown her evidence indicating that the baby must be weaned? Has she discussed with her doctor the risks of temporary weaning?

 

Support For Temporary Weaning

In the case where weaning is unavoidable, because the scan requires a radioactive contrast medium (the fourth scan above) which is not compatible with breastfeeding, a mother will require support as she decides how to cope with the situation. She may wish to prepare ahead by pumping and freezing breastmilk for use during the hours or days it takes the radioactive substance to leave her body. “Decay time” is the total time needed for the medium to leave her body. The term “half-life” refers to both the length of time it takes for ½ of the contrast medium to leave the body and the time it takes for the level of radioactivity to decrease by 50%. Decay time is usually 5-10 half-lives. You can prepare for pumping during the decay time and discarding breast milk safely should that be necessary.

In some cases, a mother may have to arrange for a caregiver for the baby during the “decay time”. Decay times and half-lives of many radioactive contrast agents are available from Hale or from the x-ray laboratory where the test is being done.

 
Note: This article was published in 2010. Updated resources may be available. For more detailed information and references, please refer to the article.

http://www.lllc.ca/sites/lllc.ca/files/Keeping-in-the-LLLoop-Fall-10.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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Breastfeeding With Diabetes

 

My first daughter, Katharine, was born four-and-a-half years ago. She literally kicked her way out of my womb, and my husband says when he saw her face for the first time, as she screamed at the top of her lungs, he felt a sense of fear: she was a force to be reckoned with. Katharine was demanding in every way, not the least of which was nursing. I was determined to nurse her exclusively for as long as possible. I have been an insulin-dependent diabetic for 15 years, and I knew that nursing her would reduce the risk of her getting diabetes but it was a challenge from the start.

Katharine wanted to be at my breast all the time. She rarely napped for more than half an hour. Like many needy babies I’ve learned about since then, she wanted to be held, comforted, and nursed most of the time. It seemed as if I never had enough milk for her. I remember one day when she was three weeks old, I had had her on my breast for five hours without more than a couple of 15 minute breaks all afternoon. At 5:30 PM, my husband, Lazaro, walked through the door and I burst into tears. I was exhausted, mentally, emotionally, and physically. We decided to give her a bottle of formula. After four ounces, she was finally contented and peaceful and she slept for the first time all day. I felt so inadequate as a mother. That day was truly a low point but, luckily, things became easier after that. I persevered, determined to nurse Katharine exclusively. Slowly but surely, my milk supply began to increase to the point where, at three months, she was satisfied and happy.

Katharine weaned at eight months, earlier than I wanted but I was happy that it was her decision. Today, Katharine is an incredibly bright, healthy four-year-old who speaks fluent Spanish and English and is a joy to behold. She is (and always will be, I’m sure) demanding, energetic, and often difficult.

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My baby, Elizabeth, is just the opposite. She was born just over a year ago and her laid-back disposition was evident at birth, just as Katharine’s fiery personality was. Elizabeth has always been easy but when she was four days old I feared she was too easy. She was simply sleeping too much and not as alert as she should be. I knew something was wrong but I didn’t know what. My LLL Leader, Faith, was the one who noticed Elizabeth’s jaundiced appearance. Faith told me not to worry but to be sure and wake her frequently for feedings. I was worried and called my pediatrician, who was my husband’s cousin and godmother. When I described the jaundice, she said immediately, “Stop the breast. She has breast milk-induced jaundice. Give her formula. If you insist on breastfeeding, give her lots of bottles of water.” I knew from reading baby-care books that that type of jaundice was extremely rare and didn’t appear until two weeks and my baby was only five days old. My mothering instinct told me that what my baby needed was more of my milk, not less. I had read that giving her bottles of water would make her jaundice worse by starving her of the calories she needed. I decided to take my baby out into the sunlight and breastfeed her as much as possible. To my husband’s family’s horror, I decided to find a new pediatrician, one who would support my commitment to breastfeed my baby exclusively.

Elizabeth improved and within a few days was healthy and gaining weight like crazy. She did not have a drop of formula from the day she was born until she was ten months old. Even though I went back to work part-time when she was six months old, I had built up a supply of frozen milk from the early weeks by pumping every morning.  Elizabeth began to wean last month (at thirteen months) and is incredibly healthy.  I am so grateful that I had Faith’s support and counsel and that I had the determination to do what I knew was best for my baby – to give her my milk.

 

By Lauren Priegues

Used with permission from LLL USA http://www.llli.org/nb/nbmayjun00p84.html

Readers should remember that research and medical information change over time.

 

NOVEMBER IS DIABETES AWARENESS MONTH

 

 

 

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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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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Green breastmilk and Green Baby Poop

As a new mother, you may find yourself extraordinarily interested in the colour of things that you never imagined that you would spending any time considering: breastmilk and poop! In honour of St Patrick’s Day this week, let’s look at the colour that causes mothers the most concern.

Occasionally mothers who are pumping their milk are startled to discover it has a greenish tint. Generally breastmilk would be described as clear, white, bluish, tan or yellow. But at some point during the course of your breastmilk pumping experience, you may be surprised to find that your milk can be other colors as well.

Green milk can show up after the ingestion of green foods or foods containing green or blue dyes. Drinking green or blue coloured sports beverages can pass the dye into your breastmilk. Eating spinach, other deep green vegetables or seaweed may give your breastmilk a greenish cast. Some herbs and supplements can also turn breastmilk green. The Womanly Art of Breastfeeding (WAB 8th edition page 307) reminds us: “Don’t worry about the colour of your milk. It can change after you eat certain foods, but that doesn’t harm the milk at all. Just tell yourself, “If I were nursing, I wouldn’t be seeing this.” Most parents will change a diaper and find a greenish poop at least once during the diaper years.

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Eating green food

 

If the baby is within the first few days of life, the poop will be transitioning from black meconium to the yellow colour that is usual for a breastfed baby. During that transition phase there can be some poops that could be described as greenish. The colour should continue to change over the next few diaper changes and is nothing to be concerned about.

As baby gets older, an occasional greenish diaper is also nothing to be concerned about as long as baby is happy, eating and gaining well and there is no sign of blood in the diaper.

Some babies have green, frothy poops. These can be a result of baby receiving more foremilk than hindmilk. “Foremilk” describes the breastmilk at the beginning of a feeding. It is lower in fat and higher in lactose than the milk at the end of a feeding which is known as “hindmilk”. The lactose, when it isn’t balanced with fat, moves through baby’s digestive system very quickly and can result in green poop. Sometimes this happens when mom has an especially forceful letdown or she has an overabundant supply of milk and baby isn’t getting the higher fat content hindmilk. If baby is otherwise healthy, happy, and gaining weight, nothing needs to be done. If baby is having trouble latching or staying latched, or isn’t gaining weight as expected then talking to a La Leche League Leader or other lactation specialist can help you find a solution to balance your supply and baby’s intake.

Green mucousy poop is a sign that baby’s intestines are irritated. If baby is still happy and eating and sleeping normally, then you can probably wait a day or two to see if things get better. If the poops return to their previous colour and frequency, probably baby had a mild virus or a reaction to something in mom’s diet. Teething may also be the culprit: When baby swallows a ton of drool, it can irritate the intestines and cause some mucus in the poop.

Green watery poops with a foul odor can be a sign of diarrhea, especially if they are much more frequent than usual. Baby diarrhea can be caused by a virus, infection, stress or food intolerance. Babies can get dehydrated quickly when they have diarrhea. In this scenario evaluation by a doctor is a good idea.

Link to: Some Common Concerns When Storing Human Milk  http://www.lalecheleague.org/nb/nbjulaug98p109.html

 

http://www.lllc.ca/thursday-tip-explaining-green-breastmilk-and-green-baby-poop

 

 

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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Jaundice and Breastfeeding

Infant jaundice is a yellow discolouration of a newborn’s skin and eyes.  It is a fairly common condition caused by an excess of bilirubin.  In utero, the baby has extra red blood cells to transport the oxygen he receives from his mother via the placenta.  Once baby is born and breathing on his own, these extra blood cells are no longer needed and they break down.  Bilirubin is a yellow pigment that is a by-product of the breakdown process.

In the early days, bilirubin is excreted by being bound to water-soluble proteins in the blood which are processed in the liver where bile takes them to the intestines and the bilirubin is excreted in the stools.  If it is not eliminated quickly, the baby starts to absorb bilirubin back into the blood stream.  As the bilirubin levels rise in the blood stream, it can enter the skin, muscles and mucous tissues causing the yellowing of the skin and eyes.

 

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Breastfeeding early and often encourages the rapid elimination of the meconium stools and decreases the opportunity for the bilirubin to be reabsorbed.  A study by Yamauchi & Yamanouchi (1990) showed a clear correlation between fewer breast feedings in the first 24 hours and rates of bilirubin levels over 14mg/dl on Day 6 (28.1% of the babies who fed two or fewer times compared with 0% of the babies who fed nine or more times).

Mild jaundice generally takes a few days to appear and the levels rise slowly usually peaking between day 3 and 5 at less the 12 mg/dl.  Jaundice that appears within the first 24 hours, rises quickly, and reaches higher than 17 mg/dl in a full term baby is indicative of a more serious problem.  Pre-term babies are at greater risk of brain injury from excess bilirubin.  Safe bilirubin levels are determined individually based on gestational age, weight and baby’s overall health.

Mild jaundice usually resolves without treatment.  Effective breastfeeding and adequate milk intake helps baby clear the bilirubin from the blood stream.  Some babies will have mildly elevated bilirubin levels for as long as 15 weeks.  In the past, there was a belief that prolonged jaundice was caused by breastfeeding and weaning was often recommended.  “The proven benefits of breastfeeding far outweigh any theoretical advantage of reducing mild to moderate levels of  jaundice” Gartner & Lee 1999.

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Because the majority of bilirubin (98%) is eliminated in the stools, supplementing the baby with water or glucose water does not prevent jaundice or bring down bilirubin levels and should be avoided.  Feeding the baby water with a bottle may compromise breastfeeding by causing the baby to feel full and by altering the sucking pattern.  Water or glucose water supplementation puts baby at an increased risk of absorbing excess bilirubin back into the blood stream.

Treatment of severe jaundice may involve separation of mother and baby so that the baby can spend time under phototherapy lights and/or supplementation if baby has not been getting enough breastmilk.  Both of these can be upsetting and discouraging to the mother.  Resolving the high bilirubin levels is the most important issue and generally only takes a few days.  Once the baby’s bilirubin levels are dropping resolving any ongoing breastfeeding issues can again be the focus.

Skin to skin contact between mother and baby, while baby is not under the phototherapy lights, can encourage the instinctive feeding behaviours.  Leaning back in a semi-reclined positon with baby resting tummy down on mum’s chest is comfortable and comforting even if baby is asleep.  As baby wakes, she may shift herself into a feeding position.

If baby is not emptying the breast effectively breast, compression may help her get more milk with less effort, which in turn will keep her more interested and actively nursing.

Mum may find pumping, while baby is having a phototherapy treatment, helps to stimulate her milk supply.  The pumped milk can be used for supplementation if needed.

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http://www.lllc.ca/thursday-tip-jaundice-and-breastfeeding 

 

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 Working Outside the Home

Many women wonder if they can continue to breastfeed once they return to jobs outside the home.  In Canada, most women are able to take a year away from their jobs so they have the opportunity to get breastfeeding well established in the early weeks and months.  As the time gets closer to their return to the workplace, they may wonder if baby needs to continue to breastfeed and how to organized life so that it is possible to breastfeed and work if they chose to continue.

There are as many ways to make breastfeeding and working work as there are mothers and babies who do it.  Much is dependent on the age of the baby at the time of returning to the workplace.  The older the baby is, the easier it is for day time nutrition and fluid intake to be managed with solids and liquids by cup.

Some mothers have child care situations that allow them to go to the baby during the day or to have the baby brought to them for feedings.  If mother and baby are missing some feedings then mum will most likely need to pump for comfort and to keep up her milk supply at least in the first months back at work.

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Night time breast feedings will often increase when mum and baby are separated during the day.  Baby needs both the calories from the milk and the closeness of the breastfeeding time with mum.  All little ones whose mothers are away at work need touch and snuggling time to reconnect at the end of the day and over weekends regardless of whether they are breastfeeding or not.  Breastfeeding is a nice way for both mum and baby to fill this need.

Continuing to breastfeed when your child is in a group care situation provides your little one with antibodies against the ever-present germs that get shared when lots of children spend time together.  Less sick time for baby means less time away from work for mum.

Here are some resources for mothers planning to work or attend school and continue to breastfeed:

La Leche League Canada: Frequently Asked Questions http://www.lllc.ca/faq-page

The Womanly Art of Breastfeeding: La Leche League International (available at Chapters/Indigo via the LLLC portal) http://www.lllc.ca/

Working and Breastfeeding Made Simple: Nancy Mohrbacher http://www.nancymohrbacher.com/books/

For the Caregiver of a Breastfed Baby: Nancy Mohrbacher  https://drive.google.com/a/lllc.ca/file/d/0B7j_VT34SKSDMkhrdEtuQ3lDZTY0eEJQLVplVy1EeE9yQ0h3/edit

Podcast interview with Nancy Mohrbacher (LLLC has no connection with the site hosting this interview) http://www.motherlove.com/blog/view/going-back-to-work-and-breastfeeding-listen-to-our-new-podcast

If you have questions about continuing to breastfeed while working or going to school or any other issues please contact a La Leche League Leader.

http://www.lllc.ca/thursday-time-breastfeeding-and-working-outside-home

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La Leche League Canada celebrates World Breastfeeding Week in Canada with this year’s theme BREASTFEEDING AND WORK:   LET’S MAKE IT WORK!

 

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/donate  so we can continue to help others breastfeed. Thank you!

 

 

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Breast Milk Feeding

One mother shares her parenting story of breast milk feeding her baby:  “I think that a lot if the time people forget that people like me are out there. Everyone assumes that a good mom has a baby at breast.  But there are some of us that try to move mountains to make sure our babies get breastmilk even though it is not possible to breastfeed them for medical reasons and despite everything that we can do to get them to breastfeed.

After having breast fed three babies after breast surgery and making it through challenges with each, my last baby has presented the greatest challenge.  Ben had trouble feeding since birth due to a bad start presented by a metabolic problem (hypercalcemia that made him very sleepy) as well as reflux.  His feeding refusal has only become worse with time and he is now G-tube fed.  Throughout all of his eleven months of struggle, I have kept pumping, despite pressure from healthcare professionals to switch to formula, the challenges of rural life with a sick baby, multiple hospital admissions, and other children in tow.  We are also introducing blended foods via tube the best we can to avoid transitioning to formula and to provide our baby with better nutrition.  Despite all that I, no longer get to be a breast feeding mom, which breaks my heart.

What is my identity as a mom now?  I know I am not able to breast feed this time but there are other moms like me that try to walk bravely thru these types of struggles so at least our babies can benefit from our milk.”

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Every parent’s breastfeeding journey is unique.  For some, this mother’s challenges will seem familiar.  For others, the experiences they face will be very different.  Breastfeeding, as an act, is not the definition of good parenting.  It can be one part of being the kind of parent you envision yourself to be.

Breastmilk however definitely equals the gold standard in nutrition.  In some families, the baby will get breastmilk at the breast all of the time.  For others, baby will get breastmilk at the breast and via a cup or bottle and the frequency and timing between those feeding methods will vary. For others, mum will pump all of her milk and the baby will get breastmilk via a cup or a bottle or a tube 100% of the time. Still others will provide as much breastmilk as they can and use artificial baby milk to provide the rest of their child’s nutrients.

Every one of us has to define for ourselves what it means to breastfeed or breastmilk feed our baby and look within ourselves to decide if we have met our own goals.  As people who are friends, sisters and community members interacting with others, we need to remember that our definition of what makes us a breastfeeding mother or a breastmilk feeding individual is unique and cannot and should not be applied to others.

Celebrate every drop of breastmilk that a baby gets and celebrate the efforts every mother makes to provide that milk whether you are thinking of yourself or someone else.   If you meet someone who is not a breastfeeding mother or breastmilk feeding parent, respect that this decision was based on factors you will never know or understand.

Celebrate with all parents the joy we get from being mothers and fathers.

Adapted from “Am I Really a Breastfeeding Mother?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/ so we can continue to help others breastfeed. Thank you!

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The Power of Hand Expression

By Diana West from La Leche League International’s Breastfeeding Today.

I was a new mother struggling with low milk production and a baby who wouldn’t nurse when the first effective “consumer grade” breast pumps were invented. I’d been renting a hospital-grade pump to remove my milk, but the idea of owning a good quality pump that was more portable enticed me to buy a double-sided electrical model. It looked so cool! It was in a black bag designed to look like a briefcase so it could be carried to work discreetly. I wasn’t working, but I loved the way it made me feel efficient and smart. I was in the first wave of breastfeeding mothers to flock to this type of pump, and millions have been sold over the years.

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Knowing what I’ve learned since those days, my heart sinks to think I put such stock in a cool looking pump when my own two hands could have done a better job. But expressing my milk by hand never crossed my mind then. My impression of hand expression in those days was as a last resort when a good pump wasn’t available. My mind has changed quite a bit since then.

I now see hand expression as far more powerful than pumping in many ways. Research has shown that it can be more effective at removing milk in the first days after birth when the colostrum is thick and the breasts are swollen. Pumping colostrum leaves only sprays on the side of the bottle that are hard to give to the baby, but hand expression into a spoon saves every drop. Hand expression can also be used as a technique during and after pumping to increase caloric content and remove more milk.  It can be more reliable than a pump when electricity is scarce. It’s quieter than a pump when privacy is needed. It’s certainly less expensive than a pump. But I think the most powerful aspect of hand expression is the way it affects our perception of our breasts and what they can do.

Many young women have an uncomfortable relationship with their breasts before they become mothers. They’re usually aware of the sexual aspects of their breasts before they think about their ability to make milk.  As an erogenous zone, women often feel it’s more appropriate for their partners to handle their breasts than to touch them themselves. There can be a delicate balance between breasts as sexual power and targets of sexual vulnerability.

Many women have discovered that learning how to hand express during pregnancy helps them feel more comfortable touching and handling their breasts. I jokingly call this “making friends with the girls” when I suggest the idea to a client. That usually makes her laugh and lightens the mood, but there’s some real truth to it. One study found that learning hand expression during pregnancy increased mothers’ confidence and readiness for breastfeeding. Another study found that it increased not only breastfeeding confidence, but also how long they breastfed. Experimenting slowly with hand expression to figure out what it takes to get drops of milk can be empowering, especially during pregnancy before there’s any pressure to express milk for the baby.

In my experience, there’s no one right way to hand express. When I was nursing my first baby almost 20 years ago, I remember being taught the Marmet Method of Milk Expression, which was developed by Chele Marmet, one of the pioneers of the lactation consultation field. Over the years, there have been several other official methods, many of which are now demonstrated on YouTube. But I think hand expression methods are best used as a starting point to figuring out what works best on your own individual breasts. We’re all different, and what works for you might be different than what works for me. The one movement that I find helps no matter what else you do is to move the skin over the breast tissue instead of sliding your fingers over the skin. You’ll also almost always get milk to spray by compressing just behind the areola where there’s a sort of “sweet spot.”

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Getting to know the landscape of your breasts and the way they work can help you start to think of them as your breasts. You may feel a slowly growing pride as you see that they can feed and soothe your baby. You’ll start to appreciate their superpower. After a few days of nursing, you may realize that your breasts are your connection to this baby with whom you are falling so deeply in love. That’s the power of hand expression.

From Breastfeeding Today, used with permission. http://viewer.zmags.com/publication/46f5a2ad#/46f5a2ad/1

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/ so we can continue to help others breastfeed. 

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Breastfeeding or Expressing Milk in the Work Place

La Leche League Leaders regularly receive calls from mothers regarding breastfeeding and returning to work.  Mothers sometimes report that employers act negatively toward their requests for time or a place to breastfeed or express milk.  Many mothers have been able to educate their employers about the human rights policies that cover pregnancy and breastfeeding.  In the Ontario Canada human rights code under “Employment and Duty to Accommodate“, it states that employers can provide a supportive environment for a breastfeeding employee by “providing a comfortable, dignified and appropriate area so that a woman can breastfeed, or express and store breast milk at work.”

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Breastfeeding is healthy for both mother and baby, providing optimal nutrition, immune factors and mother infant interaction which help to protect the developing child both in the short and long term. Lack of breastfeeding is a risk factor in various diseases and evidence gathered by the Canadian Pediatric Society, the World Health Organization and the Public Health Agency of Canada continues to show that breastfeeding should be protected and supported.

Healthy breastfeeding families save employers money because lactation support in the workplace reduces absenteeism, sick leave and the need for training of replacement workers.  Breastfeeding mothers save provincial and Canadian funds in terms of health care spending during their child’s early years and over their own lifetimes.

The question of acceptable places to breastfeed a baby or express milk is complex because mothers themselves may have varying needs for privacy and also because the essence of human milk itself makes it resistant to bacterial growth and spoilage in various environments.  A private place where the woman feels safe and physically comfortable is needed for effective milk expression.  Of course she will need a chair.  At a minimum ,the most important things needed are a place for the woman to wash her hands properly and a clean surface on which to place her containers and pump.  This can be accommodated with either sanitary wipes or paper towels.  It is reasonable to expect the space to obtain at least the same cleaning routine as other workspaces or lunchroom spaces at the workplace.  If the employee will be breastfeeding her child at the workplace, the space needs to be arranged so that dangerous objects are not in reach of the nursing child.  Often very small changes to routines can create a space that meets the employee’s needs.

Breastfeeding the baby directly is more efficient and effective than expressing milk so an on-site or a nearby child care site would enable employees to breastfeed while on breaks or during lunch and is an advantageous option.

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La Leche League Canada has information on pumping, expressing and storing breastmilk.  Leaders are happy to provide information and support on managing milk supply to mothers anticipating separation from baby.

http://www.lllc.ca/thursday-tip-breastfeeding-or-expressing-milk-work-place

 

If you need more information or have a breastfeeding problem or concern, you are 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 blog helpful, La Leche League Canada would appreciate your support in the form of a donation at http://www.lllc.ca/ so we can continue to help others breastfeed. 

 

 

 

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