When To Get Help

In the past, we lived in small villages raising our children as a collective so breastfeeding was a common public activity seen on a daily basis. In today’s society, many people often live far from their families, are having babies when they are older, or were born during a generation where breastfeeding was not widely practiced. For these reasons, breastfeeding typically occurs in the home and concealed from others. Due to the lack of exposure and knowledge, breastfeeding is still viewed as something that happens naturally for women. Unfortunately, for many women this is not the case and it may take practice as well as teaching from others to succeed. This is where an IBCLC can come to your aid because our knowledge and experience allows us to be equipped with helpful hints and tips to promote happy and healthy breastfeeding relationships.

As a lactation consultant I hear a range of reasons why women stop breastfeeding that include but aren’t limited to a low milk supply, breast pain, nipple pain, pressure from family members, going back to work, teething, and lack of support (listed below are some of the more common reasons for why moms stop breastfeeding). In addition, many women will simply struggle to continue breastfeeding but in the end stop because they simply find it to be too hard.

If you are experiencing any trouble with breastfeeding, please contact an IBCLC in your area so a full assessment may be taken. Often, a few simple changes can create a healthy breastfeeding experience!

Reasons to call in an IBCLC:

• Breast or nipple pain

• Low milk supply

• Fussy baby

• Changes in medication

• Mastitis

• Plugged ducts

• Oversupply

• Overactive letdown

• Going back to work

I would love to hear from you, feel free to drop me an email at hello@katiehowser.com!

Engorgement

Engorgement is a natural process that usually happens 2-6 days after birth and is your milk coming in. Engorgement is when a mother's breast size and fullness increases as her hormone levels change and her milk production increases. It is important to note, that mothers do have milk in the first days after birth, but it is generally colostrum which is rich in nutrients and very dense so that only small amounts are needed until her milk increases in volume and the baby needs to feed on larger amounts.

Engorgement can mean that breasts are a little tender and swollen. Engorgement does not always just happen around days 2-6, and simply refers to the swelling of the breast due to the increased volume from the mother milk supply. Swelling can occur at the breast up to the collarbone and underneath the arm, it may be in one breast or both breasts, it generally a large swollen area that is tender to touch. It is important as a mother to understand what engorgement is and to be prepared for it, as engorged breasts that do not reduce can cause other problems for both mother and baby that can be painful and stressful, but can easily be avoided. Most commonly a mother may become engorged, the breast will swell, but this swelling can flatten the nipple, which in turn makes feeding more difficult for the baby, who will in turn suck incorrectly, leading to nipple damage and a hungry baby. Other problems that occur due to unrelieved engorgement is pain due to the pressure from the swelling.

The good news is that there are a range of treatments available as well as precautionary measures that can help you avoid these problems all together. Before you become engorged teach your baby to latch – This is probably the most important thing that you can do to prevent problems associated with engorgement. In the first few days after birth, you will have a very dense milk called colostrum, it is important at this time to teach your baby how to latch-on correctly. At his time your breast are softer and your flow will not be as strong, so you will be able to train your baby much more easily. Room in with your baby, this will help your breast become attuned to your baby’s needs nurse often, do not let your breast become engorged, this includes night time. Make sure that you empty both breasts and do so for an adequate amount of time nurse using skin to skin contact wear a supportive bra (no underwire) use a hospital grade pump to empty your breasts if baby is having problems feeding. Do not over pump as this will make the problem worse.

When you are engorged you can hand express or pump, note it is important to not over stimulate the breast as this can lead to oversupply and make the problem worse. Hand express a little before your baby feeds, so that they can get a better latch on If you are using a pump use a hospital grade pump to prevent damage. Do not limit your feeding to 10-15 minutes as this is not enough time for your baby to empty your breasts. Get help from an IBCLC as a correct latch will help the fix your problem and avoid complications. If you are in pain, use a cold press between feedings to relieve the pain massage your breasts before,during and after. Here is a great video link on breast massage: https://vimeo.com/65196007.

If you'd like to get in contact with me, feel free to drop me an email at hello@katiehowser.com!

A little pain is OK, right?

A little pain is ok, right? The amount of times that I have heard a mother ask me this question is frightening. All breastfeeding should feel like it is gentle tugging only. Pain is not ok; it is our bodies indicating that something is wrong. Often in breastfeeding, something being wrong is not a dreadful or awful thing, but merely a slight adjustment, that can be made easily and quickly, that not only will alleviate pain but also makes breastfeeding easier for both the nursing mother and her infant. While it is always advisable to seek professional help for pain or discomfort, I have compiled a list below of some of the reasons that a mother may experience pain when breastfeeding and what your IBCLC may do in order to help you. In many of the cases below it is imperative to seek help as soon as possible because even slight pain or irritation will quickly  become incredibly painful simply due to the frequent use.

There are two tiers of breast feeding help: Tier one is a private appointment with a Lactation Consultant, IBCLC where you will receive an individualized clinical plan of care.

Tier two includes peer support with expert facilitation such as breastfeeding support groups or new parent groups.

If you are experiencing any issues such as: pain, infant weight concerns, or low milk supply they would be best addressed by tier one support. This may look like an in-home visit where a lactation consultant  address all of your breastfeeding concerns, brings a scale to monitor baby’s weight and works closely with your pedi and OB/midwife. If you don’t have any specific concerns but you would like to get out of the house and connect with other breastfeeding parents tier two is the best option.  

If you'd like to get in contact with me, feel free to drop me an email at hello@katiehowser.com!

Teething

Teething starts between 4 and 14 months, but for most infants teeth will start coming in around 5 to 8 months. Many moms are worried about what to expect when their babies first start to teethe and one main concern is that once there are teeth, there will be biting. The two bottom middle teeth are the first teeth that come in and are where the baby’s tongue lies when they are sucking. Since babies will not bite down on their own tongue, so you are protected.

One thing that will make teething more bearable is to have on hand a variety of teething toys, including toys that can be frozen or refrigerated and toys that have raised surfaces or bumps. These textures feel good on their tender and swollen gums.

What to do if your baby bites during a feeding session:

• Pay attention to when your baby bites you. Is it near the end of the feeding? Often babies bite because they are bored and are just playing with the nipple.

• Infants cannot suck and bite simultaneously, so end the feeding when your baby stops actively sucking.

• I believe that if your baby does bite you, you should tell them, “No, that hurt. Please do not do that again.” Then wait a few minutes before you start feeding again or end the feeding.

• Sometimes offering your infant a cool teething ring or chew toy before the feeding can help soothe their sore gums.

If you'd like to get in contact with me, feel free to drop me an email at hello@katiehowser.com!

Tongue Tie Overview

Tongue tie or ankyloglossia, refers to one’s tongue movement being restricted by a short or thick band of tissue that is connected to the lower jaw and called the frenum or frenulum. Although everyone has a frenum, not all are tongue tied. Tongue tie is often hereditary and can easily be fixed, but is often left undiagnosed so many adults are tongue tied but unaware. A tongue tied child may have no noticeable problems, however many times the children will have trouble breastfeeding, sticking their tongue out, speaking, swallowing, and orthodontic problems.  

The correction of tongue tie has increased in the last several years. This is not because more people are tongue tied, but due to the increasing trend toward breastfeeding. For many years, parents were advised to bottle feed their children, but we have seen a trend back to breastfeeding. Breastfeeding is not only more natural but also provides many benefits to mother and baby. Furthermore as our society has changed so have medical practices, and back in the day midwives had one long nail that they used to clip a tongue tied child. You may have been horrified that midwives used to snip a tongue tie with their fingernails, but the procedure is a very quick and the snipping, is not done through muscle but rather through a skin like webbing, hence the reasons nurses were able to use their nails. This is not to say it doesn’t hurt, but it should serve to reassure you that your child will feel minor pain and they may cry. Most children will not need any help in the way of pain relief, but if they do ask the provider what they recommend.

So now you may be wondering how can you tell if your child has a tongue tie. With babies, one indicator of a tongue tie may be problems breastfeeding. These problems may include a baby having trouble latching, not latching at all, or they may simply come on and off the breast multiple times. You may also hear a clicking sound, they may have trouble gaining weight, or mom could have nipple pain. Since tongue tie may present itself in a range of different ways, it is important to work with an IBCLC if you have any problems related to breastfeeding. Often, the evidence may not lie with the baby. A tongue tied baby will overcompensate by increasing their suction which can lead to a mom having very sore and often damaged nipples. Many of these symptoms of a tongue tie can be attribute to other causes, so often babies are not diagnosed straight away. Furthermore, as we as a society moved away from diagnosing tongue ties, we have lost the knowledge necessary that allows many practitioners to be comfortable diagnosing tongue ties that are not extreme, or immediately obvious. For these reasons, it is important that you not only seek an experienced Lactation Consultant, but also that they recommend you to a pediatric ENT who has experience dealing with children who are tongue tied. Now that we know what tongue tie is, let us have a quick look at the different types of tongue ties and go over some of the myths and facts associated with tongue ties.

If you think that your child may have a tongue-tie, make sure that you have your baby checked by someone, who is familiar and has worked with them before. You should book an appointment with a pediatric ENT, and once they have determined your baby has tongue tie, they  will release it. To release a tongue tie, the ENT or pediatric dentist will use scissors or a laser. The procedure will be over in a few seconds and there will be minimal bleeding. Once the procedure is complete, most babies will be able to nurse immediately, some may be a little fussy and sore. Some babies may not feed immediately, but don’t worry, this will not last long and does not happen in the majority of cases. Once your baby’s tongue tie has been released it is imperative to see your IBCLC for another consultation, because while some mothers will immediately see a difference in the way their baby nurses, many mothers will not. For the mothers who do not see an immediate difference, your baby may need a helping hand while learning to adjust to the new way of nursing. After the release of your baby’s tongue tie your IBCLC will work with you to gently encourage tongue movement. These are very simple and gentle exercise to ensure that the tongue tie does not reattach. Please do not worry if you think your baby has a tongue tie, your IBCLC should be familiar with tongue ties, they will be able to answer your questions, and know that this is something that is easily revised.

If you'd like to get in contact with me, feel free to drop me an email at hello@katiehowser.com!

Resources:

http://tonguetie.net/

https://breastfeedingusa.org/content/article/tell-me-about-tongue-ties

Pumping When Returning to Work

As many people know, the breast pump allows a mother to get back to work and other responsibilities while still allowing you to use breastmilk as the main source of sustenance for baby. Most of the products on the market use the same technique to promote the release of milk. Flanges are attached to the breast and a tube runs from there to a bottle at the other end. Air travels through the tube simulating sucking, promoting the release of milk, which then travels into the storage container.

There are a range of reasons that mothers can be a little nervous about using a pump, so I'd like to walk through the common questions. The first thing you might not expect is that your milk supply can potentially drop a little bit when using a pump. Breast pumps are great and convenient, but they cannot replicate the special relationship that babies have with their mothers. Never fear however, being aware of this you can prepare for the effects. You will need to pump regularly at work, and I would advise that you work out a schedule before you return so that you do not feel stressed when you need to go and pump. It is a great idea to put in at least one extra session a day so that you can have a little bit of leeway when you are implementing your own personal plan. Stress can also lead to a dip in milk supply, so having a plan can help you manage any anxiety you might have. You should also be aware that there are herbal supplements that help if your milk supply dips, though I don't recommend using these until they become necessary.

Another standalone tip is to make sure you are drinking water and eating at regular intervals. Staying hydrated and snacking helps breastfeeding in general, as milk is 90% water and you burn hundreds of calories each day making milk. In addition, you should also keep your pumping frequency regular. It is important that your boss/coworkers know that you will be pumping at regular intervals and it is your right to inform them about how you plan to pump. If people understand your plans up front about pumping are much more likely to understand and honor your commitment.

When you return home and see baby at the end of the day, it is a great idea to do at least one breastfeeding session without the bottle. If you communicate with your caregiver to stop feeding 2 hours or so before you come home, this can allow you to come home a feed right away, which will establish a bond with your baby, and bring comfort to both of you. This is a simple way to promote milk supply and avoid issues like plugged ducts naturally.

Lastly, do not underestimate the importance of the environment in which you are doing your pumping. By California law, workplaces are required to give you a room you can pump in. However, this may not be the best or most inviting room to be in and I recommend you visit before you start pumping to see what you will need to be comfortable.

All in all, pumping is an amazing tool for returning to work and getting back to your commitments. It lets you return to a manageable schedule while still letting your baby have the best source of nutrition available. Good luck getting started!

If you'd like to get in contact with me, feel free to drop me an email at hello@katiehowser.com!

Domperidone

Last time, we talked about Fenugreek to help increase milk supply. Another prescribed alternative is a drug called Domperidone. It is sometimes referred to by the brand name Motilium, which is a drug you will find prescribed for gastrointestinal tract disorders or nausea. Its also been used to treat spit up and weight loss in infants. The "side effect" that we can take advantage of as breastfeeding moms is that it helps the creation of the hormone prolactin which stimulates cells in the breast to produce milk.

It should be noted that Domperidone is not FDA approved for breastfeeding mothers and you should check with your general practitioner if you want to try any medication. All medication should be considered potentially dangerous - not just in general, but specifically in terms of you and your health history. In 2004, the FDA warned that domperidone can have cardiac side effects, however this warning was based on studies of seriously ill elderly patients taking the drug intravenously. That being said, if you have any underlying cardiac issues, you should not take Domperidone.

The alternatives that are FDA approved such as Metoclopramide (Maxeran and Reglan) include side effects such as fatigue, depression, involuntary body movement, and irritability and anecdotally I have had mother's report the side effects of Domperidone to be much more mild. The American Academy of Pediatrics has rated Domperidone as “usually compatible with breastfeeding” and pharmacist Tom Hale has given it the best (safest) possible rating breastfeeding mothers. Prescriptions of Domperidone usually range from 3 to 8 weeks. It usually takes at least 2 to 3 weeks to have an effect. Some mothers report an increase milk supply within 24 hours, though this is rare.

Before you turn to Domperidone, you may want to investigate some other alternatives. I have had mothers use herbal supplement, change their pumping frequency, or a combination of both and have had success. Lactation consultants specialize in creating a plan to help you with your milk supply issues and make sure you are using optimal technique with baby to make sure milks transfer is high.

References:

• http://www.breastfeedinginc.ca/content.php?pagename=doc-DGS
• http://www.lowmilksupply.org/domperidone.shtml
• http://www.breastfeedingonline.com/domperidone.shtml#sthash.ZWWZW3Fg.ueFjZqJE.dpbs
• https://www.breastfeeding.org/uploaded_files/bf_meds/Domperidone_Patient_Handout.pdf

Fenugreek

Every year in the United States, around 3 million mothers start their breastfeeding journey. Despite best intentions, many end up stopping for one reason or another. One of the leading causes is what health care professionals sometimes term “insufficient milk supply.” It has been estimated that as many as 10% of all mothers experience this, and it It can leave you feeling anxious, frustrated and upset. However, depending on the cause, this can often times be a manageable condition.

One of the less complex remedies that has shown positive results for some mothers is Fenugreek. This is a an herb that can be used for everything from cooking to brewing tea (though I’ve been told this is can be bitter!). It’s used in many Indian dishes, and is has been common in Egyptian, Persian and Turkish cuisine for generations. These days, it can also be found in the form of a pill marketed to increase milk supply.

While studies have been done, none have been completely conclusive on the positive effects of Fenugreek. Indeed, the underlying reason that Fenugreek could increase milk supply is not known. There are theories that it contains hormone precursors or that it somehow stimulates sweat production (breasts are modified sweat glands!).

Many mothers worry about taking any kind of herbal supplement. It’s always important to understand the risks associated with what we put in our bodies. Fenugreek is generally considered safe for nursing mothers in moderation by the FDA. However, there are absolutely a few exceptions: Fenugreek should never be taken by pregnant mothers as it can cause uterine contractions. Diabetics should also avoid Fenugreek as it can lower glucose levels. You should always consult your doctor/healthcare professional when considering any kind of supplement.

Whatever you decide, remember the number one rule: Feed the Baby! Regardless any issues you face, your baby needs to get an adequate amount of sustenance to support a healthy weight gain. Lactation Consultants use a very precise scale before and after feedings to make sure your baby is getting enough milk and help you set up a plan to make sure both mother and baby are healthy and happy!

Tips for Weaning

In the United States, we tend to stop breastfeeding around 3 months. This is extremely low compared to the worldwide average of 4.2 years (though it’s hard to know the true figures). Regardless of the average, there are a ton of benefits to be had for allowing breastfeeding to go on as long as you’re finding it mutually beneficial for mom and baby. Just one example (according to the American Academy of Pediatrics) is baby’s that were exclusively breastfed for the first 4 months of life were significantly less likely to be hospitalized for a lower respiratory tract infection. Mom’s antibodies are shared through breastmilk and are a huge source of protection against everything from ear infections to certain kinds of spinal meningitis.

However, there comes a time where you will want to slowly wean your baby, and there are a few handy ways to make this a natural and simple process.

1. Do it gradually. Drop 1 feeding every 5 - 7 days and replace that with formula, solid foods. Whole cow’s milk can also be a tool if baby is older than one year. Prior to that, baby’s immature kidneys have trouble with the high concentrations of protein and minerals.
2. Drop the feeding just before bedtime last, as this feeding has a lot to do with comfort and not just nutrition.
3. If you’re finding it uncomfortable because of breast fullness, you can hand express or pump for 1 - 3 minutes just enough to relieve any discomfort. The idea is not to fully drain the breast, just make things more comfortable.
4. Some mom’s opt to start the combined birth control pill (estrogen/progesterone) to reduce milk supply. If you still desire to do some breastfeeding, this is not advised as it can have a dramatic effect on supply.

As a side note, drugs containing pseudoephedrine (lots of over the counter cold meds) are also known to decrease milk supply - as much as 24% after a single dose. It has reported that this can cause some agitation and irritability in baby, so I don’t usually recommend this as a tool. If you’re finding the process of weaning scary or nerve racking, don’t hesitate to reach out to a Lactation Consultant for help.

References:

• New Mother's Guide to Breastfeeding, 2nd Edition (© 2011 AAP)
• http://nacd.org/health/protocol.php
• http://www.lalecheleague.org/faq/weanhowto.html
• http://www.ncbi.nlm.nih.gov/pubmed/17664905

Guidelines on Latching

As a breastfeeding mother or partner of a breastfeeding mother, you have probably heard a great deal about latching. The latch refers to how the baby’s mouth and tongue are positioned around the mother’s nipple. Something to realize right away is that there is no “right” way to latch. Just because a latch looks good doesn’t mean it is pain-free or that milk is transferring properly. When I consult, I want to know how the latch feels, because often a lot of pain and trouble can be pre-empted by some adjustments early on. No one is 100% the same in this regard. It’s my job to figure out and ensure that both mom and baby are safe, comfortable, and baby is receiving an adequate amount of breastmilk.

I recently read an article written by a mom that resonated with me. As a society we place so much emphasis on everything being perfect and following what we know is the “correct” position. Many times a mother’s latch will work for her and her baby, even though it might not fit with what we envisioned as a “good latch.” I always say that if the baby is healthy and receiving an adequate amount of breastmilk, and the mother is not having any pain then they have found their “perfect latch.” On the flip side, if a mother is in pain or stressed out, or if the infant is not transferring adequately, we need to adjust things — even if that latch looks textbook.

The number one rule is “feed the baby.” No matter what other issues come up, you need to make sure that the baby is getting an adequate amount of milk (even if that means you are supplementing while you are working out the kinks). Other health issues to be on the lookout for are a drop in weight, dark yellow urine, less stools, or an unsettled baby constantly wanting to eat. If baby is experiencing any of these issues, its time to get a Lactation Consultant on board.

If you'd like to get in contact with me, feel free to drop me an email at hello@katiehowser.com!