Breastfeeding St. Louis | Ask Diana

Should Breastfeeding be shown on Sesame Street?

2012-02-10T09:07:00.000-08:00

Recently I saw this headline. “Should breastfeeding be shown on Sesame Street?” In other words, should children be exposed to one of the healthiest, most natural wonders of human nature? Personally and professionally, here’s what I have to say.

My two daughters grew up in an environment rich with images of pregnant mothers and breastfeeding babies. You see, I began my career as a Childbirth Educator. I taught classes out of my home. There were posters, model pelvises and visual aids everywhere! Our house was filled with the essence of reproduction. Even our family pets got into the swing of things by exemplifying procreation (dogs, guinea pigs, mice, finch… boy did we have finch!!). My daughters used to nurse their baby dolls, and even give birth to them!

Those little girls have grown into wonderful, accomplished young women, each breastfeeding their own sweet babies. They approached breastfeeding with a sense of confidence and normality. There was never a decision to breastfeed. It was just the way infants were fed!

When I saw the above mentioned headline, I took a fond walk down Sesame Street memory lane. (My favorite character was Snuffleupagus. I loved his name). Historically, breastfeeding had been portrayed in a discrete, gentle and sweet manor on Sesame Street. I actually recall seeing the 1977 episode where Big Bird learns about breastfeeding! (Here’s a link to the segment if you’re interested: www.youtube.com/watch?v=7-L-Fg7lWgQ ). Apparently, breastfeeding has not visited Sesame Street at all for a very long time. Indeed, disappointing.

Years of professional experience have shown me that breastfeeding is largely affected by our psyche. Women who were raised in environments where breastfeeding was practiced openly and without cynicism are undoubtedly more relaxed and confident about the process. So, my answer to the question…? ABSOLUTELY! Let’s set our children up for future breastfeeding success!

BTW, thank you www.bringbreastfeedingback.com (Bring Breastfeeding Back to Sesame Street) for letting me borrow your drawing. Its darling!

Healthy Holiday with Baby… How to Safeguard Your Baby without Being Rude.

2011-12-05T11:28:00.000-08:00

During the holidays, it can be a challenge to keep our babies safe from undue exposure to bacteria and viruses. After all, tis the season for colds and flu! But this is also the time to get out and enjoy the company of family and friends. Holiday parties… Air travel… Hoards of people in stores and malls… Great uncle Harry (with his weird wiry whiskers) who wants to kiss all over your baby!

The good thing is that if you are breastfeeding, you are providing a unique level of protection only you can give your baby. When you are exposed to pathogens in the environment, your body naturally produces antibodies and delivers them to your baby through your breast milk. Even though your breast milk is a powerful force, additional measures should be taken to minimize exposure. Here are just a few easy things you might consider:

· Encourage family members and friends who are ill to stay away. If someone in your household becomes ill, remind them to cough or sneeze into a tissue or toward their armpit (not into their hands). Did you know that droplets fly at about 100 miles per hour when someone sneezes without covering their nose?

· Wear your baby at parties. A baby wrap or sling discourages people from asking if they can hold your baby and prevents baby from being passed around. You can also keep a portion of the wrap hanging so that if you find yourself in close proximity to someone who appears to be ill (sniffling or sneezing), pretend you are shielding your baby from bright light or noise and cover his head (loosely) until you are far enough away.

· If others are permitted to hold your baby, ask that they wash their hands first. Blame your discourteous behavior on your healthcare provider! Explain that you are not trying to be rude, but that this is what your pediatrician has suggested you do. Carry a small container of hand sanitizer. It might be useful, even for yourself, if you’ve been shaking a lot of hands (goodness knows where those hands have been).

Gatherings are fun, and I would encourage you to socialize! Just know that by taking a few precautions, you can dramatically reduce the chances of your baby (and you!) becoming ill. While holidays are a great time for sharing… there are some things better left unshared!

Air Travel With Baby

2011-11-18T15:00:00.000-08:00

As we look forward to the up-coming holidays, some of you may be considering air travel with your baby. Fortunately, traveling by air with a breastfeeding baby can be very easy. Mothers who are comfortable with direct breastfeeding in public places will find traveling to be a breeze! Nothing extra to carry except, perhaps, a blanket or nursing cover-up! (See Hooter Hiders or Bebe au Lait for some ideas.) Mothers who prefer to bring bottled milk will be happy to hear that going through airport security has become much less of a challenge than in previous years. The Transportation Security Administration (TSA), U.S. Department of Homeland Security has modified its rules for bringing breast milk, formula and juice through the security checkpoints.

Basically, breast milk is now considered to be in the same category as liquid medication. (How very appropriate given its healing properties!!) It is exempt from the 3-1-1 rule. Carry-on is permitted in bottled quantities greater than three ounces as long as it is declared for inspection at the security checkpoints. The TSA screeners will inspect the milk, however, they will not ask mother or infant to test taste it. The passenger may be asked to open the bottle(s), and contents may be tested for explosives. I’m not sure how that is done, but I cannot imagine it would be harmful in any way. If you are traveling with a large amount of milk, it might be better checked in a suitcase and packed in Ice. For more information, here is the direct link to the TSA’s webpage on Traveling with Formula, Breast Milk, and Juice.

Some of you may wish to bring your breast pump along on your trip. Although breast pumps are permitted, the TSA gives the following notification: “Even if an item is generally permitted, it may be subject to additional screening or not allowed through the checkpoint if it triggers an alarm during the screening process, appears to have been tampered with, or poses other security concerns. The final decision rests with TSA on whether to allow any items on the plane.” I am not aware of anyone recently having had difficulty carrying on a breast pump, regardless of whether electric or battery operated. The TSA allows travel with dry cell batteries in carry-on or checked baggage. If you will not need to use your pump during your trip, consider packing it inside your checked or carry-on luggage. It will be better protected and less at risk for damage.

One final note. Flying with an infant poses the possibility of their experiencing ear pain associated with cabin pressure changes. Children and adults are encouraged to swallow in order to equalize ear pressure. An infant may be encouraged to swallow if fed (by breast or bottle) during the planes ascent and descent. The trick is not to offer the feeding too soon. Wait until you feel pressure changes. Your baby may signal you himself by becoming wiggly or irritable. A few swallows usually does the trick nicely.

Enjoy your flight!

Variations in Human Milk

2011-11-04T12:28:00.000-07:00

Like leaves in the fall, breast milk comes in an assortment of colors! During direct breast feedings we don’t see milk color because it travels unseen, directly from breast to baby. However, in those instances where we do see the milk (for example when baby spits-up or during milk expression), its color may be surprising (if not alarming)! Breast milk comes in a beautiful array of colors. It ranges from clear (not really a color), to light yellow, deep orange, pink, red, rust, and even hues of green, blue and purple!

Here are some explanations. In the beginning, colostrum is often seen as a deep yellow-orange color due to the large amount of beta-carotene. It may also be seen as a rusty color, possibly due to old blood that has collected in the milk ducts during pregnancy. If mother is experiencing trauma to the nipple, it is not unusual to see pink (strawberry) or red milk as a result of bleeding of the nipple itself. Maternal diets rich in seaweed and kelp, or where mom takes certain vitamins, may have green tinged milk. Gatorade, for one, has also been implemental in producing green milk. A bluish tinge to milk is very often seen, especially in mature milk. Rarely, there are reports of oral medication causing milk color variations (one in particular resulting in black milk). More commonly, gentian violet, applied topically as a treatment for yeast, lends itself to a colorful situation. Purple-tinged everything…baby spit-up, expressed milk, clothing…everything!

Not to worry if these variations are noticed. Breast milk is the best and safest milk for baby, regardless of its color. Furthermore, mothers’ milk almost never remains the same color. It varies from day to day, time of day, method of expression, how long it has been sitting (separation), maternal diet, etc. So enjoy the showy rainbow of color. It’s good, healthy entertainment!

Note: Unless milk is found to have a foul odor or is refused by baby, it may be used for feeding. A persistent change in milk color, odor or refusal of infant to take feedings from a particular breast should be evaluated by a physician.

Nursing Is Normal…Even in Public!

2011-10-28T14:51:00.000-07:00

When I was a new mother, I remember feeling shy about nursing my baby outside, in public places. Before leaving the house I would ask myself “What if she needs to eat while I’m in the supermarket?” My answer would be “Well, I’ll go to my car”. Or, “What if I’m in a department store? …Well, I’ll go to a dressing room”. I remember practicing in front of a full length mirror to see if I could latch my baby without anyone knowing what I was doing. I got really good at it! I am happy to report that these days' mothers have a lot more support and options for feeding in public than I did. In fact, legislation has been passed to allow for this! Still, we have a long way to go before we reach the level of comfort that many women enjoy in places around the world.
Just last evening I happened to see a YouTube video that was produced as a volunteer project in Quebec, Canada. As part of the “Nursing Is Normal” movement that began in the United States, this video is one of several that have been made in an effort to promote and protect breastfeeding outside the home. A photographic display of mothers feeding in public, it is based on the theory that the more we see mothers nursing out and about, the more we will accept it as a cultural norm. If you’d like to see it, click here. Also, if you have speakers, you may enjoy the toe-tapping, ragtime piano accompaniment to the slides. Kick up your heals and enjoy the fun. Remember…Nursing IS Normal!

Breast Milk Feeding Mothers Stand Up and Be Proud!!

2011-10-17T14:09:00.000-07:00

The other day, an expectant mother lowered her head in humiliation and told me that she “did not breastfeed” her first baby. As she continued to share her story, it became evident that she actually pumped and fed him her breast milk… exclusively, for more than 6 months!! Apparently, he was never able to latch. My heart sunk as I realized she took no pride in what she had accomplished.

If anyone deserves the recognition and pride that comes with human milk feeding, it should be this mother and all those like her (and I know there are many of you)! Anyone who has to exclusively pump and feed should be extremely proud given the fact that it requires twice the amount of time and energy. The bottom line is that baby is provided the very best. Regardless of how your baby is breast milk-fed, he is breastfed!! So, when someone is inquiring about how your baby is/was fed, pump dependant mothers please stand up and be proud! That’s right! Stand up and proudly report that your baby was breastfed. No one needs to know the how’s and why’s unless you want to share.

To pump and feed is to breastfeed. Mothers who have breastfed in this way should be given awards for what they have done. I, for one, thank them for the dedication in raising their children. After all, these babies are the future of our world!

Mastitis (Breast Infection)

2011-10-10T09:07:00.000-07:00

Mastitis is the inflammation of breast tissue. It may be the result of milk flow obstruction (blocked milk duct), bacterial infection (most often S. aureus) or non-infectious inflammation. Mastitis is most commonly seen within the first 2-12 weeks post-partum and can be a real bear!! If you are experiencing a low-grade fever with a painful reddened area of the breast, you might try very warm compresses (or a shower) with gentle massage of the affected area during and in-between frequent breastfeedings. Nurse your baby in different positions so that he uniformly empties the breast. Be sure to drink lots of fluids and get plenty of rest. You might also try an over-the-counter NSAID (like ibuprofen) to reduce inflammation and pain. Follow the old breastfeeding adage… “Heat, Rest, Empty Breast” and hopefully things will resolve.

If there is no improvement within about 24 hours or if you experience flu-like symptoms (body aches, chills, nausea) and a persistent or abrupt rise in body temperature, you should call your healthcare provider for further direction (usually a 10-14 day course of antibiotics). It is not uncommon to feel as though you’ve been run over by a truck! Although you may feel rotten, breastfeeding should be continued! Nurse baby on the affected breast first and use heat with gentle massage intermittently during the feed to encourage milk flow and ejection. If baby refuses to feed on the affected breast, you may have to empty it by manual expression or with a gentle breast pump. In any case, the breast must be emptied. Please remember that we (lactation consultants) are here to answer questions. If you find that you are having recurrent episodes of mastitis, please arrange for a thorough lactation evaluation.

Early Milk Supply and Prematurity

2011-09-26T14:04:00.000-07:00

A few weeks ago I had the extreme pleasure of spending an afternoon with Dr. Paula Meier, Director of Clinical Research and Lactation in the Neonatal Intensive Care Unit at Rush University Medical Center in Chicago. Dr. Meier’s landmark research contributed to the development of a breast pump product that assists pump-dependant mothers of prematurely born infants to produce volumes of breastmilk similar to those mothers of full-term, direct-breastfeeding infants. I sat across the table from Dr. Meier in a small group as she discussed her research. I was TOTALLY in awe!

Numerous studies have shown that mothers delivering prematurely often struggle to reach adequate milk supplies for their infants. Dr. Meier’s research coupled with uniquely engineered technology now provide a specific pattern of stimulation via mechanical support that assists these mothers in ”coming to volume” in ways they might never have otherwise. This new technology also has a “programming effect” on subsequent maternal milk volumes, decreasing the number of women who experience milk supply issues.

I am pleased to report that we (here at Missouri Baptist) are able to support our mothers and their prematurely born infants in this evidence-based, best practice through our recent purchase of this newest technology. So, mothers of pre-term babies, fear no more! We will help you get off to the best possible start in providing breastmilk for your baby. Thank you Dr. Meier!

Blood Sugar Levels in the Early Neonatal Period

2011-08-23T12:05:00.000-07:00

Maintenance of normal blood sugar (glucose) levels is a critical component of health, regardless of one’s age. For the newborn infant, it can be a very serious matter if blood sugar levels are too low. Almost all newborn infants experience a drop in blood sugar levels immediately after birth followed by a rise again within a few hours. This is a normal process of adaptation to life outside the uterus as the infant transitions from continuous trans-placental feeding (through the umbilical cord) to intermittent oral feeding after birth.

For some infants who are at higher risk, this transition may be complicated and result in persistent low blood sugar levels. Infants at risk include those who have gone beyond their due date, are small or large for gestational age, are delivered of diabetic mothers or had stress during or after their birth. Stress may occur due to a variety of conditions including having become too cold after birth.

There are several ways in which a mother can assist her newborn in stabilizing and maintaining normal blood sugar levels. First, if a mother knows her infant will be at higher risk of low blood sugar, she can try to collect any colostrum that might be available in the days before anticipated delivery. Even drops can make a significant difference! A needle-less 1 cc syringe may be used as an easy collection and storage device. The colostrum may be kept refrigerated or frozen, then fed to the infant (in addition to a direct breast feeding) right after birth. Colostrum is the best stabilizer of blood glucose, so baby should be given as much colostrum as is possible. Frequent effective breast feedings thereafter is the key. However, if levels remain low, a supplemental feeding of formula or IV therapy could become necessary.

Another practice known for its benefit in blood glucose stabilization is skin-to-skin contact immediately after birth for at least one hour. This keeps baby toasty warm, (protecting him from cold stress) and facilitates effective breastfeeding right from the start.

Remember that your body is so very capable of taking care of your baby’s needs. Assist your baby as he transitions to life outside your uterus. After all, you are his world!

Premature Mothers Milk - Colostrum for Premature Babies

2011-07-29T15:02:00.000-07:00

We have known for a very long time the importance of colostrum to all newborn infants. However, studies published in the recent past suggest that colostrum produced by mothers of premature infants contains considerably HIGHER concentrations of immune-globulins and other protective elements than colostrum of mothers having delivered full-term infants. In fact, they suggest that the earlier a baby is born prematurely, the greater the concentration of protective elements found in its mothers colostrum. Not surprising. It is yet another testament to how our bodies naturally protect our babies, regardless of gestational age!

More important than ever is the need to express colostrum for our prematurely born infants, even if we do not plan on breastfeeding! While it is important to note that manual (hand) expression remains advisable, technology in mechanical expression (electric breast pumps) has risen to a new level of precision in facilitating the production and collection of colostral milk. Here at Missouri Baptist, in accordance with the World Health Organization, we recommend that all babies receive their mother’s milk as soon as possible in the days following birth. So much so, in fact, that we’ve just purchased 20 new State-of-the-Art, hospital-grade electric breast pumps (Medela Symphonies) to add to our already sizeable fleet! Due to the newest technology, mothers of premature and full-term babies alike will have pumping regimes designed specifically to their pumping needs. Our lactation consultants, post-partum and NICU staffs are pleased to be at your service. Our goal is to help you and your baby get off to the best possible start!

When Breastfeeding Baby Refuses to Take Bottles

2011-07-20T08:59:00.000-07:00

Planning for a return to work can be anxiety producing to say the least. Fortunately, things often go better than expected, especially if you are able to plan carefully in advance. However, on occasion, our sweet little friends decide to complicate the process by refusing to take a bottle! Have no fear…eventually things work out if you hang in there.

Here is a list of some things to consider if you are being challenged:

Bottle Giver – If your baby will not take a bottle from you (which is often the case), see if your partner or other caregiver has some success. Baby may sense your presence in the room, so you might want to disappear for a while.

Nipple Types – These days there are so many different choices! Buy only one of two or three types of bottles with slow flowing nipples. If your breastfeeding baby is introduced to a bottle with a fast flow nipple, he may choke and release the nipple quickly with overwhelm. Conversely, if he is older or if you have a rapid and forceful milk ejection reflex, he may prefer a fast flow nipple. So you might enlarge the nipple hole just a bit if he takes the bottle initially but seems frustrated with a slow flow.

Degree of Hunger – Try offering the bottle before your baby exhibits signs of hunger. If that doesn’t work, try waiting until hunger signs are becoming evident (fussing and rooting).

Taste – I recommend teaching a breastfed infant how to take a bottle using fresh breast milk in the bottle. If you are using previously frozen milk, and your baby is persistently refusing the bottle, I would suggest you perform a taste test: defrosted vs. freshly expressed milk. In about 1 out of every 500 cases, previously frozen breast milk takes on a different (often soapy) flavor. This has to do with changes in the lipid fraction of the milk during the freezing process (more on that later, but call the lactation office if you find this is in fact the case).

Temperature - Is the nipple and milk warm (body temperature)? While most babies enjoy their milk at room temperature or even cold, some have a “gourmet” palate that demands perfection. A warm nipple is the expectation of your breastfed baby as milk is delivered directly from your soft and warm breast. Something cold and firm may not be acceptable to your baby.

Sense of Smell – Babies are very sensitive and acutely aware of their own mothers scent. Try rubbing the bottle nipple on the skin of your breast so that it smells more like you. You might also have your caregiver place something that you have worn (yes, I mean your well worn, smelly tee shirt!) near baby’s face while the bottle is being offered.

Motion - Rocking, swaying, or riding in a car seat might mesmerize your baby enough to accept a bottle.

Trickery - Try slipping the bottle into baby’s mouth while she is sleeping in care giver’s arms (not flat on her back in bed). She may awaken to discover that drinking her mama's warm, sweet milk from a different container isn’t so bad after all!

In any case, please don’t give up. If all else fails, there are alternate ways to feed your baby (including by cup if necessary). Some babies may opt for smaller indirect (bottle or cup) feedings during your work hours followed by frequent requests to feed directly from your breasts when you are at home. As long as he gets an adequate 24 hour intake, he'll be fine. You’ll see. Things eventually work out and you will be proud of yourself for hanging in there!

FDA Recall of SimplyThick

2011-06-24T09:21:00.000-07:00

Thickening of breast milk or formula is sometimes recommended in the treatment of gastroesophageal reflux in infancy. Earlier this month, the FDA issued a recall of Simply Thick, a thickening agent manufactured by Thermo Pac, LLC. They are investigating a possible link between the product and several cases of necrotizing enterocolitis (NEC), a life-threatening intestinal condition seen most often in premature infants.

The FDA is aware of 15 cases of NEC, including two deaths, involving the use of Simply Thick mixed in the breast milk or formula of premature infants. Until the investigation is concluded, the agency is recommending that parents stop using the product in infants born at or before 37 weeks gestation.

Here’s a link to the FDA consumer update: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm256250.htm

The Milk Bar is….Open

2011-06-16T13:51:00.000-07:00

Hi there! My name is Molly and I’m filling in for Diana this week. I am an Internationally Board Certified Lactation Consultant here at Missouri Baptist. I work with moms and newborns on the postpartum floor, and I also facilitate our breastfeeding support group that meets on Thursday mornings at 10.

One issue that came up this week in our meeting is how newborns need to nurse often, and at different intervals. Imagine this: You have just nursed your baby and he has fallen asleep at your breast. You are congratulating yourself on a job well done, another feeding accomplished. Now you’re looking forward to closing the “milk bar” and putting your breasts away for a couple of hours. But wait! Just 20 minutes later, your baby is stirring and seems like he wants to nurse AGAIN. Could he really be hungry so soon after finishing his last session? This scenario is a familiar one for many new moms, and it can be frustrating and confusing.

Here is one explanation for what’s happening. When your baby sucks, either at the breast or on a pacifier, his sucking activates his parasympathetic nervous system, which triggers his GI tract to release hormones. The purpose of this is to aid in digestion. One of these hormones is cholecystokinin, or CCK. When CCK levels rise, they induce the baby to feel full and sleepy. When CCK levels fall, your baby becomes alert and hungry. So as your baby nurses, or sucks on a pacifier, his CCK rises and he starts to feel very drowsy…after 20 minutes or so, he succumbs and drifts into dreamland. If he has been breastfeeding, he has had a nice little meal; but with a pacifier, he has missed out on any calories.

At the breast, this whole process works magically by enabling your baby to nurse for a period of time, drink some milk, and digest it. By putting him to sleep, it prevents your newborn baby from working too hard and too long. Hey, sucking is a lot of work when you only weigh 7 pounds! Afterward, your baby will take a cat nap, and while he isn’t sucking, his CCK starts to drop. Like an alarm clock, it awakens him a short time later and he demands to nurse again. It’s time for seconds! This gives him a chance to top off his meal, in case he didn’t get enough the first time. Also, it keeps the “milk bar” open and busy, which provides plenty of stimulation to build a generous milk supply. However, beware of the pacifier, because in these instances, sucking on a pacifier may satisfy your baby, but without the benefit of the meal for him, and the stimulation for you.

Hopefully understanding this system can help you, as a new mom, feel confident in offering the breast as many times as your newborn requests it. The result will be a nice weight gain for your baby, and plenty of milk at the bar!

MoBap Moms Breastfeeding Get-Together

2011-05-13T13:06:00.000-07:00

Hello St. Louis Breastfeeding Moms,
We are starting a new MoBap Moms Breastfeeding Group.
This group of breastfeeding mothers and their babies meets in a comfortable and supportive environment while they discuss various aspects of breastfeeding. Led by an International Board Certified Lactation Consultant, these get-togethers are designed to boost confidence, develop skills and lend support to mothers who are breastfeeding one or more babies.

Breastfeeding Get-Together Meetings are held weekly and at no charge! So, jump in at any time!

When: Every Thursday morning, 10:00-11:30 a.m.
Where: 3rd floor Childbirth Center Classroom (located on the mother-baby area).
Parking: FREE Valet parking at the front door of the North Entry (Building D) or in the North Entry (Building D) parking garage.

For more information, please call: 314-996-5751 (Registration is not required)

Hope to see you there!

Maternal Benefits of Breastfeeding

2011-04-25T13:44:00.000-07:00

Did you know that women who breastfeed their children for more than six months reap a variety of long-term benefits? First of all, exclusive breastfeeding reduces the incidence of some forms of breast and ovarian cancers. It is also known to improve bone density over time by decreasing then increasing with each successive breastfeeding cycle. The hormones relaxin and oxytocin, known as the “mothering hormones”, are released during feedings. These “mothering hormones” allow us an easier adaptation to the challenges of early post-partum infant care, thus reducing the chances of severe post-partum blues. Finally, on a lighter note, the act of producing breast milk alone burns more than 500 calories per day! You can’t beat that as a great method of losing our baby weight!

More on the Value of Skin-To-Skin

2011-03-10T12:53:00.000-08:00

Now, more than ever, researchers are convinced that frequent and prolonged skin-to-skin contact results in better breastfeeding outcomes. Studies are showing that skin-to-skin improves the rate of exclusive breastfeeding. In one study, babies who spent more than one hour skin-to-skin with their mothers during the first 3 hours after birth were most likely to exclusively breastfeed during their first few days. Furthermore, there seems to be a dose-response relationship between skin-to-skin and breastfeeding. The longer mother and baby spend in skin-to-skin contact, the longer breastfeeding remains exclusive. This, of course, translates to longer durations of breastfeeding (months and years), healthier outcomes, financial savings to the family, etc. Known to be a “best practice” for both mom and baby, skin-to-skin begins at birth and can be continued for several weeks.

News Release from The United States Congress, Feb 10, 2011 It is about time!!!!

2011-02-11T14:29:00.001-08:00

Breastfeeding Equipment to be Allowed as Medical Tax Deduction and Reimbursed by Flexible Health Spending Accounts

Washington, D.C. – In response to a request from Senators Jeff Merkley (D-OR), Tom Harkin (D-IA), and Representatives Sander Levin (D-MI) and Carolyn B. Maloney (D-NY), the Internal Revenue Service (IRS) announced they will reverse a ruling that denies equipment used to help women breast feed from being covered as a health care expense. The previous ruling excluded breast pumps from coverage under flexible health spending accounts and made them non-deductible on tax returns.

Merkley, Harkin, Levin, and Maloney wrote to IRS Commissioner Douglas Shulman in November to call for the decision to be reversed. Senators Merkley and Harkin were joined by 9 other Senators; 32 other House members joined Reps. Levin and Maloney.

In response to today’s decision, Senators Merkley and Harkin and Reps. Levin and Maloney released the following statement:

“Today’s decision is a huge victory for nursing mothers everywhere. Modern medicine has documented numerous health benefits linked to breastfeeding, including a reduced risk of illness in infants and a reduced risk of cancer in mothers. And because breastfeeding is so effective in preventing disease, it also happens to save billions in health care costs. We thank the IRS for their careful consideration and quick response.”

Breastfeeding with Anxiety and Depression

2011-02-10T12:19:00.001-08:00

This discussion comes up all the time. Women who suffer with anxiety and depression often worry that pharmacological treatment for their symptoms would contraindicate breastfeeding. NOT true! There are many medications that have been studied in depth and believed to be safe for use during lactation. As well, there are a number of non-pharmacological therapies that have been shown to be effective. Depressed mothers are physically and psychologically in pain. They may not be able to sleep. They often feel lonely, isolated and sad for no apparent reason. Depressed mothers may experience frequent bouts of crying and feelings of being out of control or terribly anxious. So, please, if you are struggling with symptoms of anxiety or depression, don’t hesitate to reach out. Speak to your doctor, a family member or friend. If you’d like, there is a wonderful local resource for telephone support called the Mother-to-Mother Postpartum Support network. They can be reached at 314-644-7001 (or toll free at 1-877-644-7001). There is nothing to feel shy or embarrassed about. In the long run, it will be better for both you and your baby if you are treated. Remember, you have to take care of yourself in order to take care of your baby. Don’t be shy. Get help! Additional Note: If you are having thoughts of harming yourself or your baby, please call 911 or The Life Crisis Hotline at 314-647-4357 immediately.

In The News… Breastfeeding Can Boost Academic Test Scores…Especially in Boys!

2011-01-21T11:19:00.000-08:00

A new study published in the January issue of Pediatrics found that, at ten years of age, children who were breastfed for at least six months achieved higher scores in math, reading and writing than those breastfed less than six months. The most interesting result was that it was especially important in boys! Here’s the link to an article in MSN Today Enjoy!

Storage and Handling of Breast Milk

2010-11-29T11:24:00.001-08:00

One of the best things about breast milk feeding is its flexibility in handling and storage. Breast milk can be collected, refrigerated or frozen and used later as desired! This allows us so much freedom… to share lunch with a friend, to have a relaxing massage, to spend a few hours shopping, etc., etc.!

All mothers should have information about the storage and handling of breast milk. This is most easily described in a table format, so here it is:

Breast Milk	Room Temperature	Refrigerator at ≤ 39 degrees	Refrigerator Freezer	Deep Freezer
Fresh	Use within 4-6 hours	Use within 3-7 days	Use within 6 months	Use within 12 months
Frozen then thawed in refrigerator	Use within 4 hours	Use within 24 hours	Do not refreeze	Do not refreeze
Frozen then thawed in a warm water bath	Use right away	Use within 4 hours	Do not refreeze	Do not refreeze

Although the immunological composition of cold-stored milk will have been altered, it is still the next best thing to fresh breast milk for your baby. In preparing bottles for feeding, many of us assume that milk must be warmed. However, many babies actually enjoy chilled milk straight from the fridge! Some prefer room temperature. Others seem to like it slightly warmed. To warm chilled milk, place the unopened container in a warm water bath (cup or bowl) for a few minutes. Warning: Because babies can be badly injured, please remember never to use a microwave to heat baby’s milk.

I have discussed how to collect breast milk (by hand and by pump) in a previous blog, so please select keywords “milk expression” or “collection” for more information. BTW, I will be chatting very soon about introducing bottles to babies. I hope this discussion on milk storage was helpful. Please feel free to post any questions your may have by clicking on the comment link. Happy milk storage!

Collection of Breast Milk for Storage

2010-11-19T14:46:00.000-08:00

This topic came up at our Moms MoBap Morning meeting the other day. Michelle and Crystal were wondering how and when to begin this process in preparation for their return to work.

First of all, you can start collecting anytime after breast milk production is well established. Many mothers begin around the third week after birth depending upon when they plan to return to work. Expression of milk for storage should be done in the morning hours when we typically have more milk. Always feed baby first so he gets what he needs. It is important that you choose a time when things are quiet and you can relax.

1) Always wash your hands before you begin.

2) Expression may be done manually (by hand) or with a breast pump.

A. If you are expressing manually, choose a clean collection container with a wide opening (like a bowl or wide mouth jar). Place your thumb on top and index finger below your breast. Keeping your fingers apart, move them into place over your areola (the brown area surrounding your nipple) to about ½ inch behind where the nipple and areola meet. Step 1, keeping your fingers in place and apart, push into your breast (toward your ribs). Step 2, gently squeeze your fingers together as you roll them toward your nipple. Do not slide your fingers over your skin. Step 3, release the squeeze but keep your fingers in place. Repeat these 3 steps over and over at a comfortably rapid pace. Practice aiming your milk as it begins to stream into the collection container (you can see why a wide opening is helpful!).

B. If you are using a pump, be sure to adjust the suction control to its lowest setting. Then, as you pump, turn it up gradually to the highest level that is comfortable. If you are using a double electric pump, wrap your hands around the flanges as you hold them to your breasts. This will help to maintain a good seal and allow you to massage your breasts with your thumbs. This will increase your output. Do not be concerned if only small amounts of milk are obtained at first. Over time, your output will increase.

C. Helpful Hint: For a mother whose baby often takes only one breast per feeding, expression may be done on one breast while baby feeds on the other. This takes advantage of the natural milk ejection reflex where milk flows freely toward the nipple and can be easily collected.

Remember that expressing your milk should never hurt!

3) Milk may be stored in various types of containers including polypropylene BPA-free bottles, polyethylene bags or glass. There are containers available for purchase specifically designed for breast milk storage. Here are some guidelines for storage:

A. Freshly expressed milk can be kept at room temperature if it will be used within 4-6 hours.

B. It can be stored in the refrigerator and used within 7 days.

C. If it will be frozen, store it in portions of 1, 2 and 3 ounces. Until you get an idea of how much baby will take in a feeding, you won’t have to waste milk left in the bottle.

D. Because milk expands when frozen, leave an air space between the milk and the top of the container. We wouldn’t want it to burst and be spoiled!

E. Milk should be stored in the bottom and back of the freezer, never on the door.

Michelle and Crystal, I hope this helps. Next week I will chat about handling of stored breast milk, so keep an eye out!

On the Issue of sleep

2010-11-11T13:59:00.001-08:00

Published recently in the journal Pediatrics, researchers report that they found no difference in the amount of sleep a mother receives whether she is breastfeeding or formula feeding her baby. In their study, 80 new mothers were monitored electronically over a ten-week period beginning at 2 weeks post-partum. Additionally, the mothers completed daily diaries. Researchers measured total sleep and time awake, sleep quality, fatigue and daytime sleepiness. In addition to finding no difference in the amount of sleep, the researchers found no difference in fatigue or daytime sleepiness.

The fact is many of us have long believed that breastfeeding mothers get as much sleep (if not a little more) and perhaps a better quality of sleep than their formula feeding counterparts. One reason may be that when we breastfeed, the hormone relaxin is stimulated and released from our brain. Relaxin helps us to feel more relaxed. So, we tend to fall asleep very easily after feedings, nature’s way of encouraging rest for a new mom. Furthermore, little effort is required to bring baby to breast when he awakens for a feeding. And the milk is already warm and waiting! No formula mixing, warming, etc. is necessary. More time to sleep! Finally, breastfed babies tend not to over-feed or take in large amounts of air during feedings, so they are not prone to the discomforts of stomach distention and aerophagia commonly seen in formula / bottle-fed infants. In the event you’d like to read more, I have added a couple of links to more information about the study. However, please don’t lose valuable sleep over this. Remember the old adage “sleep when your baby sleeps” and you should be fine!

Happy Sleeping!

http://bit.ly/b7y2Up

http://reut.rs/bFj4eX

Duration of Early Feedings

2010-10-15T11:55:00.000-07:00

In previous blogs, I have addressed recommendations regarding breastfeeding frequency in the early hours and days after birth. However, mothers may wonder how long feedings should last. So, here are a few words on early, in-hospital feeding duration.
During the first few days after delivery and before the transitional milk comes in, it is important that mothers allow their babies to feed at breast for as long as baby indicates a desire to do so. This is, of course, providing that mom is physically and emotionally comfortable. In the distant past, it was thought that limiting an infant’s feeding time at breast would prevent nipple soreness. This is NOT the case!!! As long as an infant is attached correctly and there is little or no discomfort for mom, unlimited feedings may take place without the risk of soreness.
Frequent, unlimited feeding at breast is advantageous to both mother and baby. For mother, frequent, unlimited feeding promotes milk production, rest and relaxation as she progresses through early post-partum. Unlimited feeding may also prevent painful breast engorgement as her transitional milk comes in. For baby, this allows plenty of practice in transferring milk BEFORE he has to handle the larger volumes. Furthermore, baby receives more colostrum (lots more swallowing), gains weight faster, stabilizes body temperature and blood sugar levels, expels more meconium, develops less jaundice, etc, etc.
In summary, if breastfeeding is comfortable for mom, and baby is swallowing at the breast, length of feedings need not be a concern.

Your Baby has a Fuel Gauge!

2010-10-05T15:36:00.001-07:00

In a previous blog we talked about BABY watching VS CLOCK watching to determine baby’s readiness to feed. A full-term newborn will exhibit hunger cues by flexing her arms, tightening her little hands into fists, turning her head and pulling her fists to her mouth. Her whole body becomes tense and she produces sweet short vocal “yaps” to alert us to the fact that she is ready to feed. These are early signs of hunger and would be the best time to put her to breast. Late signs of hunger include a scowled forehead, facial tension and crying or screaming in “alarm” of the fact that she is hungry.

So, how do we know when baby has had enough milk? As baby continues to feed at the breast and her tummy begins to fill, her body should become increasingly more relaxed. Arms lose their flexion and release to extension. Fists open. Scowled forehead disappears and baby’s face and mouth become more relaxed. She may, in fact, “fall” off the breast. Now, here’s the trick. If, when you raise then release her arm, she tenses it and wiggles or roots, she probably needs to feed a little more. However, if her arm flops down to her body (as if she were a rag doll), and this is repeated two or three times, chances are good that her tank is full! Now it’s time to rest. I’ll bet you didn’t know your baby came with a fuel gauge!

In the News...Again!

2010-09-30T06:54:00.001-07:00

Monday, in the online addition of the journal Archives of Disease in Childhood, a team of researchers from the University of Crete in Heraklion, Greece, reported finding significantly fewer incidences of infections and hospitalizations in children exclusively human milk-fed for the first 6 months of life. Many other studies have had similar findings. However, it is important for us to hear it again and again and again.

Certainly, Greek mothers need to hear it. In 2000, while visiting Greece, I felt privileged to have been invited to attend a La Leche League meeting held in the suburbs of Athens. The leaders of the group explained to me that breastfeeding rates were very low in Greece at the time and that it was a challenge to educate the public. So, I am very glad to hear that this research has come out of a Greek university.

On the subject of the La Leche League meeting, it was really wonderful to see all those Greek mothers and babies gathered in support of what was best for their babies. The meeting was conducted in Greek. However, much to my surprise, I was able to understand most of what was being discussed!! I guess breastfeeding is a universal “language”. It certainly was not all Greek to me!!!

Check out this link to WebMD for the story http://bit.ly/agRVmU

Protection Against Overweight and Obesity

2010-09-20T14:41:00.000-07:00

Last week, Michelle Obama spoke about the importance of human milk feeding of infants in reducing the incidence of obesity. Several people have asked me exactly how breastfeeding confers this protective effect.

Researchers have found that there is a difference in intestinal flora (bacteria) and pH between breastfed and formula-fed infants. The breastfed infant gut has a lower pH with a higher level of healthy bacteria and fewer disease-causing organisms. The formula-fed infant gut has a higher pH which inhibits the growth of healthy bacteria and enables disease-causing bacteria to grow. Therefore, formula feeding predisposes the infant intestine to the development of long-term, low-grade inflammation, a condition associated with a number of health challenges including overweight and obesity. Because breast milk controls inflammation, it helps to protect infants and children from the development of childhood and adult obesity.

Breastfeeding in the News Again!

2010-09-13T13:38:00.000-07:00

Everyone knows that breastfeeding is best for human babies. However, the fact that breastfeeding is best for human mother’s receives far less attention. A study published in the September 9th issue of The American Journal of Medicine finds that women who breastfed exclusively for at least one month were at a much lower risk of developing type II diabetes than those who gave birth but did not breastfeed. Type II diabetes is a major public health concern here in the US. If breastfeeding for at least one month could decrease the incidence of type II diabetes, then legislation and public health policy needs to reflect it. If you have a familial history of type II diabetes, this research will be particularly interesting to you. Here’s the link to information about this new study: http://www.reuters.com/article/idUSTRE6893Z320100910

Calling All Babies – Expressing the Need for Colostrum

2010-09-10T12:33:00.000-07:00

As some of you know, I am a strong advocate of the veterinary model of healthcare management when it comes to birth and early infant feeding, regardless of one’s species! Anyone who breeds cows, horses or other mammals will tell you how important it is for a newborn to receive colostrum, a mother’s very first milk. Loaded with antibodies, colostrum protects an infant from harmful environmental bacteria and viruses. To this end, farmers who raise cattle will immediately coax a newborn calf to its mother, skin-to-skin with her udder. Knowing the serious health consequences of not receiving species-specific colostrum as soon as possible after birth, veterinarians and zoologists will take extraordinary measures (like milk expression and alternative feeding methods) to ensure that a newborn receives its mother’s first milk. In the animal world, it is well-recognized that health, and even survival, is greatly influenced by receipt of this amazing liquid. Although artificial baby milks may be formulated for some species, illness and healthcare costs are significantly higher for those that must be “hand raised” (formula fed).

Human infants are no different. Infants not having received colostrum are four times more likely to become ill and require hospitalization during the first year of life than their human-milk-fed counterparts. Often called baby’s “first immunization,” colostrum provides passive immunity to a newborn because it is so rich in antibodies. In addition to immune factors, colostrum has an amazing ability to stabilize blood sugar levels, far better than formula. This is extremely important to a newborn infant, especially those who may have had a stressful birth, been born prematurely or delivered by a diabetic mother.

Like farmers and veterinarians, We too can ensure that our babies receive colostrum as soon as possible after birth. In cases where baby can be placed directly at the breast, skin-to-skin after birth, we certainly should do so. If not, let’s hand express and spoon- or syringe-feed this liquid gold to our newborns (see blog on hand expression). Our babies deserve the very best, so let’s let advocate for them by behaving like a bunch of animals!

Skin-to-Skin Kangaroo Care – Yet Another Amazing Story!

2010-09-03T08:45:00.000-07:00

You all HAVE to see this video clip featured on the TODAY show this morning. An amazing story you cannot miss! Here’s the link
Parenting on Today Show - Premature infant stirs to life after two hours of kangaroo care
It is yet another testament to the value of skin to skin contact for all babies!

Hand Expression of Milk

2010-09-01T09:21:00.000-07:00

Over the course of my career I have been privileged to observe hundreds of mothers happily breastfeeding their infants AFTER having had early and/or significant challenges with breastfeeding. In other words, breastfeeding doesn’t always get off to an easy start. However, with expert clinical assistance, time, patience and determination, most breastfeeding issues can be resolved. In the interim, expression of mother’s milk may be necessary to ensure a baby’s receipt of breast milk. When a baby is unable to or has trouble with attachment (or latching), it’s highly recommended that the mother begin pumping with a hospital-grade electric pump as soon as possible after birth. Pumping technology has advanced to the point that mothers can maintain a milk supply for months and even years. However, manual (hand) expression is still considered to be the most effective means of expressing colostrum, mother’s very important first milk. Hand expression of milk may also be helpful later when managing breast engorgement (another discussion for another day). Using the thumb and index finger in a systematic method of breast compression, we are often able to collect significant amounts of this thick, rich colostral milk for our babies. Spoons, syringes, feeding tubes or even tiny cups may be used for feeding this liquid gold to our little ones. I have included this link for step-by-step instruction of hand expression of colostrum, which you may find extremely helpful:

Hand Expression Video - Stanford University

Whether or not hand expression becomes necessary in the early days of breastfeeding, I recommend that all breastfeeding mothers develop the propensity to perform this handy maneuver. You never know when your breasts will express their need for some relief! Happy expressing!

“Cah, Cah”…Evaluating for Transfer of Mother’s Milk

2010-08-20T11:35:00.000-07:00

One of the best ways to evaluate an infant’s feeding at the breast is to observe for swallowing. During the first few minutes at breast (after your transitional milk has come in), your baby should exhibit a suck/swallow ratio of about one-to-two sucks per swallow. This means that you should see one or two jaw excursions (sucks) followed by a deep draw (chin drops and mouth pauses in an open position) then the sound of a swallow may be heard (a quick, gentle “cah” sound). Swallowing may also be felt by resting a finger gently on baby’s throat while he is feeding. Remember, a good attachment to the breast is important. There should be a wide gape of baby’s mouth around your breast. His lips should be flanged outward with a good seal between your breast tissue and his lips. No air spaces should be seen and milk should not run out from the corners of his mouth. So listen and count those “cah’s.” They eventually turn into coo’s! Relax and enjoy your baby’s feeding!

Tick, Toc, Tick, Toc: Must we always watch the clock?

2010-08-13T07:24:00.000-07:00

We talk about how human infants should feed every two to three hours in the early weeks and months, and certainly that is true. However, once effective breastfeeding is well-established and baby is gaining weight nicely without intervention, it may be time to kick back and relax. What’s wrong with letting baby dictate how often he wants to eat as long as he is thriving? A baby who begins to get hungry will exhibit early hunger “cues.” Examples of early hunger cues include upper body movement, hand-to-mouth behaviors, rapid eye movement during sleep, etc. Late signs of hunger include fussing and crying. So, sit back, put your feet up and let your baby do the talking. Tick, Toc, Tick, Toc…perhaps we shouldn’t watch the clock!

The Value of Skin-to-Skin Contact

2010-08-06T10:25:00.001-07:00

Did you know that placing your baby skin-to-skin on your chest, especially while you are resting, is more than just a sweet snuggle time? Skin-to-skin positioning (also known as kangaroo care) not only facilitates milk production and the release of the maternal hormone oxytocin (the mothering hormone), but also has an effect on your baby’s physiology. Holding your baby skin-to-skin (no fabric between you) actually regulates his body temperature, respirations and heart rate. Research in this area is absolutely fascinating! For example, a mother’s breast temperature actually rises in order to warm and lowers in order to cool her baby when he has direct skin-to-skin contact with his mother. His breathing becomes relaxed, and his heart rate becomes regular. Talk about a mother’s ability to provide for her baby! Here’s another fascinating example: in two separate case studies, pre-term twins were placed simultaneously skin-to-skin with their mother, each against one of her breasts. Remarkably, each breast (in all four cases) responded individually to the thermal needs of the infant on that particular breast by raising and lowering its temperature independently of the other. So, let’s not underestimate the power of our breasts. Food, warmth and security… all in a soft, beautiful package! What more could our babies want?

Night Time Feedings

2010-07-30T11:15:00.000-07:00

New mothers usually want to know if they should wake their baby for night time feedings. The answer is dependent upon several things. First of all, if your baby is under two weeks of age, you will want to remove milk from your breasts every two to three hours. This will assist in establishing a good milk supply and keep you comfortable. Most full-term babies wake to feed at this frequency anyway, so it works out well for both. Babies who were born a little earlier than expected, may need to be aroused for their feedings in order to gain weight. A two- to three-hour interval works well. Once your baby is nursing effectively, stooling and voiding within normal limits, and gaining weight, it’s acceptable to allow for longer intervals between feedings, especially at night. So, if your breasts can tolerate a wee bit of fullness, I say go for it, and let baby sleep. Enjoy your ZZZ’s.

Fussing and Crying

2010-07-23T11:09:00.000-07:00

Recently, I attended a professional conference addressing gastro-esophageal reflux in infants. I must say that the discussion brought back the passion (and empathy) I feel for the issue of excessive fussing and crying in infants. During the late 1990’s and early 2000’s, I was privileged to work with Dr Anthony Kulczycki of The Washington University School of Medicine, Division of Allergy and Immunology. Together, we explored the role of a certain cow milk protein in the incidence of infantile colic. We studied breast-fed and formula-fed infants alike. I became fairly skilled at assessing and managing excessive fussing and crying in the breast-fed infant.

I bring this topic to the table, because when a breastfeeding baby is ‘colicky,’ the practice of continued breastfeeding is placed at great risk. Most mothers jump to the conclusion that their baby is either hungry or ‘allergic’ to something they are eating. Some mothers discontinue their efforts to breastfeed in favor of formula feeding, which usually doesn’t help. In fact, formula feeding may worsen the symptoms. Other mothers starve themselves in an effort to avoid every food that has ever been implicated in producing gas or fussiness in babies. This usually doesn’t work either.

A baby’s excessive and sustained fussing and crying cannot be taken lightly. This can cause serious upheaval in any household. Breastfeeding may not seem to work. Parents are exhausted. Babies are at risk of being shaken (yes, even the best of parents can snap under these conditions). And, a mother’s gift for nurturing and protecting her baby is crushed by feelings of worthlessness and frustration.

If you have a baby that is fussing and crying to the point of concern, please don’t try to treat this yourself. Get help. Pick up the phone and call us. Here at MoBap, our team of lactation specialists is fully equipped to assist you in a systematic evaluation of the situation. We are genuinely happy to help, and you can always call me on the phone for another opinion! Whatever you do…don’t stop breastfeeding without first seeking help!!!

One-Breast vs Two-Breast Feedings

2010-07-16T11:15:00.000-07:00

I am often asked whether one breast or two breasts should be offered per feeding. This is a tricky question, and every mother/infant couplet should be considered individually. However, in the first couple of weeks after birth, a mother’s breasts may be somewhat engorged (normal fullness) as they begin to regulate milk production. Offering both breasts per feeding allows each breast some relief of pressure, and therefore comfort for mother. Later, after the initial couple of weeks, one-breast feedings may serve to balance the intake of fore-milk and hind-milk (a discussion all in its own).

Indicators of Adequate Infant Intake

2010-07-09T11:16:00.000-07:00

New mothers often wonder how they can tell if their baby is getting enough milk. Fortunately there are several indicators that can be used to determine the adequacy of baby’s milk intake.

First and foremost is weight gain. Most babies lose some weight in the days following birth. However, once a mother’s transitional milk comes in, her baby should begin to gain. By two weeks of age, she should expect to see a return to birth weight. Breastfed infants typically gain between four and eight ounces per week thereafter.

Stool output and urination is another important means of gauging adequate intake. An infant who is receiving adequate amounts of milk (and therefore enough calories for growth) will stool at least three times in every 24-hour period by the time he is five or so days of age. Often the stool is yellow in color and has a pasty or watery consistency. Tiny white seeds or curds may often be seen. Wet diapers are important as well, but are only an indicator of hydration, not caloric intake. So, while at least five wet diapers in every 24-hour period is expected (and certainly encouraging), stool output is the most reassuring indicator of adequate intake by an infant under six weeks of age.

Your Breasts (and you) Need to Arrive Alive!

2010-07-02T11:03:00.000-07:00

Please don’t pump and drive!!! Yes, we’ve all been warned about texting, talking on the phone, applying make-up, etc. while driving. Well, here’s another one for you!

Now that we have hands-free pumping options, it doesn’t mean we shouldn’t use good sense. Sure, those of us who are in a hurry to get to work would have loved to nurse before we left the house. But, unfortunately no one may have told the baby. Or perhaps you slept through the alarm. At any rate, imagine the look on the police officer’s face when you try to explain that the milk was overflowing the bottle and you let go of the wheel to turn off your breast pump. Or worse yet, that you aren’t drunk. Instead, the release of the hormone relaxin made you feel so relaxed and sleepy that you began swerving from lane to lane! Your breasts (and you) need to arrive alive.For your safety and the safety of others on the road, please don’t pump and drive! Pumping really can wait a few minutes until you reach your destination! :-)

Inverted Nipples

2010-06-25T11:16:00.000-07:00

Today, an expectant mother asked me what she could do to prepare her breasts for breastfeeding. This is a common question, so I thought I might address it here with our group.

The most important thing a mother can do is to check to be sure she doesn’t have inverted nipples. Inverted nipples are those that retract (telescope in to the breast tissue) when the areola (brown area behind the nipple) is gently pinched together. The condition makes it difficult for a baby to latch correctly. If identified during pregnancy, treatment can be very effective in reducing the degree of retraction and facilitating an early attachment of infant to breast. So, if a mother thinks her nipples might be inverted, she can ask her doctor to check or call our lactation office for a recommendation.

Breasts: Small Versus Large

2010-06-18T11:09:00.000-07:00

Breasts come in all shapes and sizes. Many women are led to believe that the size of one’s breasts will determine their ability to produce milk. Not true. Most of us are blessed with an ample amount of mammary (glandular) tissue that is responsible for making milk. Our mammary glands make up only a portion of our breast tissue. The rest is adipose (fat) tissue and is the greatest contributor to breast size. Women with large breasts will not necessarily make any more milk than those with small breasts. So, don’t let your breast size be your guide. Remember, breasts may be small…but they will be mighty!!!

Getting Started: The First Few Days

2010-06-11T15:57:00.000-07:00

In many cases, the first few days of breastfeeding a newborn are quite different from what most of us have read or learned about breastfeeding. For example, we are told that a full-term baby will want to nurse about every two to three hours in the first few weeks. This is true. However, the first few days may throw us for a loop! Day one:Baby is often sleepy and may not awaken easily for feedings. This can be related to his tummy being filled with amniotic fluid (especially if born by cesarean) or by the store of fluids and nutrients transferred to baby in the days and hours just before birth. Day two:Baby is more awake and alert. His store of nutrients may now be depleting, and now he wants to nurse every hour! These are called “cluster feedings” and are baby’s way of letting mom’s breasts know that he will soon be ready for larger volumes. These frequent feedings not only help mom’s uterus to stay nicely contracted, but also allow baby to practice suckling before the voluminous transitional milk comes in. Days three to five: Mom’s transitional milk is coming in. Her breasts may change (blood and milk engorgement) and baby must re-learn how to latch to these “new” breasts. He must refine the way he suckles in order to handle the increased flow of milk. It is usually at this point that feedings begin to occur more consistently at two- to three-hour intervals. After the first few days, things begin to settle into more of a routine. Still there will be many more changes to adapt to. Life with a new baby can be challenging, yet wonderful. Just remember to eat, drink and sleep when baby sleeps, and let everything else go to pot!

I Think I Can, I Think I Can

2010-06-04T07:14:00.000-07:00

Have you ever read the children’s book about the little engine that could? It is an inspiring story about the value of positive thinking and self-empowerment. When we are expecting our first baby, many of us feel worried about breastfeeding. This is completely normal, especially if we are going to be working mothers. In our culture of communication technology and information overload, expectant mothers often hear only about problems associated with breastfeeding. Unfortunately, that’s what people talk and write about. They may not hear the scores of wonderful, successful breastfeeding stories (yes, even for working mothers)! In most cases, especially when there are expert clinical resources, women and their babies do quite well with breastfeeding. One thing to remember is that, as women, our bodies are built for growing, birthing and breastfeeding babies. So let’s not forget that! Yes, indeed, I think you can, I think YOU can!

Hospital Breastfeeding Practices

2010-04-29T11:02:00.000-07:00

April 2010, The Joint Commission (an organization that accredits more than 17,000 top notch hospitals and health care facilities in the United States) established a new set of evidence-based core measures for quality in perinatal care. Included in these core measures is a requirement that hospitals strive to increase exclusive breast milk feeding of infants from birth to discharge. This means that in order to be accredited, hospitals will have to be more cautious about their use of formula in breastfeeding babies. Here at MoBap, we take breastfeeding very seriously (and yes, we are accredited by The Joint Commission).

If any breastfeeding baby may need supplementation, their mothers are encouraged to pump or hand-express their own milk for use as a supplement. We have state-of-the-art, hospital-grade breast pumps for use by any mother that may need one while she is here. Our goal is that every breastfeeding infant receives as much of his own mother’s milk as possible before anything else is given. A Lactation Consultant visits every breastfeeding mother everyday that she is here, providing support and encouragement and addressing any questions or concerns that these mothers may have. We are very proud of our more than 85 percent breastfeeding rate and will continue to provide the very best for our breastfeeding families. We believe The Joint Commission will be quite pleased with our breastfeeding practices and other core measures of quality in perinatal care!

Health Care Reform

2010-04-14T15:45:00.000-07:00

As we all know, Health Care Reform is under way. Regardless of how we feel about it in general, there are some specifics that you, as breastfeeding mothers and advocates, might be interested in discussing. President Obama’s signing of the Patient Protection and Affordable Care Act (also known as Health Care Reform) will positively impact those of us who are employed and breastfeeding. The Act states that employers must provide “reasonable break time” and a private place (not a bathroom) for employees to express breast milk for their children up to one year of age. This is great news! The law became effective immediately upon signing, and the Department of Labor is working quickly to establish rules for enforcement. Unfortunately, employers are not required to pay employees for the time spent expressing milk. Nor are employers with fewer than 50 employees required to provide breaks for this purpose if it would cause “undue hardship” for their business. Nevertheless, this gives us legal rights with regards to breastfeeding and returning to work. So, ladies, let’s gear up (great pumps are available for working moms) and discuss options with our employers!

Economic Benefits of Breastfeeding

2010-04-08T11:04:00.000-07:00

Breastfeeding is in the news again! A new study published this week in the journal, Pediatrics, deserves some discussion. Researchers from the Cambridge Health Alliance and Harvard Medical School did a pediatric cost analysis comparing current costs to projected costs if families were able to exclusively breastfeed their babies for at least six months. They found that if 90 percent of U.S. families complied with the medical recommendations to breastfeed exclusively for six months, the U.S.would save $13 billion per year and prevent more than 911 deaths (mostly infants). This comes as no surprise to those of us in breastfeeding circles. We’ve known the economic benefits of breastfeeding for a long time as similar studies have indicated in the past. Still, we are thrilled to see public acknowledgment of such magnitude. The authors of this new study conclude that current U.S. breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. So, ladies and gents, let’s keep up the good work in providing the very best for our babies (and pocket books)!

Baby Slings

2010-03-18T11:10:00.000-07:00

In the news, throughout the last few days, there has been a lot of discussion about the safety of infant carrier slings. Since many breastfeeding mothers choose to wear their babies, I thought this might be a good topic of discussion.

Baby wearing is customary in many cultures around the world. Wraps, ties, slings and front packs are just a few examples of baby-wearing attire. These allow for comfortable, hands-free infant or baby carrying. Carriers are often worn therapeutically as well. I wore my colicky (refluxing) baby upright for the first three months of her life. It was the only way I could keep her comfortable and get anything done around the house!

So, wraps and slings may be helpful, but are they safe? The key to safety is proper positioning. Very young infants and those born days or weeks earlier than their due date, are at a significantly greater risk of suffocation when their bodies are slumped over excessively, with their chins pressed against their chests. The issue here is airway constriction. This can occur in car seats as well as infant carriers. That’s why our pre-term babies receive car seat checks before they are discharged.

Regardless of carrier type, an infant should have freedom to extend his neck and head. Bag-like slings do not allow for easy head extension. Upright carriers can be both easy and safe, but often need to be removed for breastfeeding. Oblong fabric wraps are designed for multiple positions, allowing most babies to ride safely (when positioned properly) and are great for discrete breastfeeding in public. Babies have been worn for thousands of years. It would be unfortunate if parents altogether stopped wearing their babies. So let’s learn to do it safely! I am thankful that the government and media have called attention to this problem. In fact, KMOV-TV did an interview with one of our pediatricians, Dr. Kelly Ross, who happens to be a good friend. In the interview, she explains more about the issue. Here’s the link if you are interested.