Sheila's Breastfeeding Articles
Parenting on the Peninsula - Feburary 2010
A 2008 Bureau of Labor study shows that 60% of breastfeeding mothers return to work within the first nine months. Once back at work, 30% of new mothers give up breastfeeding after less than seven weeks. The American Academy of Pediatrics recommends exclusive breastfeeding for six months - it is our hope that this Q&A will allow more women to reach this important goal.
Q: Anne and baby Emily (3.5 months) ask, "When I return to work, how long should I pump during each pumping session?"
A: Typically moms are pumping between 10 and 15 minutes. Moms may pump longer if they have time and the milk is still flowing. Remember with younger babies, under six months old, most moms are pumping every three hours while they are seperated. It is a supply/demand equation, given that you will be away from your baby for one-third of the day-ideally you will pump to provide one-third of her needs. On average, most moms can express around 9 to 15 ounces in a workday. Remember, babies can make up the difference before and after work when you are home nursing.
To make pumping easier and to allow you to use your hands while pumping, we recommend a good hands-free bra. The new bra from Simple Wishes (www.simplewishes.com) is comfortable and provides secure breast pump attachment.
Q: Kelly asked, "After pumping, how should I store my milk?"
A: There are several choices for milk storage. You can choose to store in plastic bags designed for breast milk storage, glass bottles or BPA free plastic bottles. We recommend using whichever is easiest for you.
Use your oldest milk first and make sure the baby is also getting fresh milk during the day.
For the latest in milk storage guidelines, refer to La Leche League. www.llli.org/NB/NBstorage.html
Q: Madeline asks, "I'm going to work next week, what is the best day to start?"
A: Starting on a Wednesday or Thursday is our recommendation. This will give you a chance to get into a routine and before you know it, you are back at home for the weekend to recover. When Monday comes around, you will be rested and ready to go with a few days of experience.
Many women benefit from a back-to-work lactation consultation. Our Breastfeeding Center offers "Back-to-Work" consults that last 45 minutes that include a customized written plan to aid your transition back to the workforce.
Parenting on the Peninsula - April 2010
Many working mothers have trouble pumping or expressing as much as their baby is eating during the day.Occasionally this is a problem of truly insufficient supply, but often the problem can be remedied with more efficient pumping, smart scheduling, talking things over with your childcare provider, and using your freezer stash wisely. Even if your milk supply has decreased over the weeks or months you have been working, it can always be rebuilt. You really can provide as much breastmilk as you want for your baby!
Q: Aimee asks, "I have a couple of meetings that have begun running long so I missed my pumping sessions. Is this ok?"
A: If you get stuck in a meeting make sure to pump as soon as you are able for two reasons. One is to be comfortable and avoid a plugged duct and the second is to maintain your milk supply. Remember the supply/demand equation - the more you remove, the greater your supply. If you miss a pumping session, make up for it later in the day or once you get home with your baby. Also, make sure you keep a spare shirt and extra nursing pads at the office just in case you leak from being full.
Q: Carol asks, "My job requires me to travel to different job sites throughout the day. How can I pump if I do not have a set place or an office?"
A: There are so many options today for pumping on the go. Most quality electric pumps can run on a power source that does not involve having to use an electrical outlet. Most come with an external or an internal battery pack. This means you just have to find a private room or an empty office that can lock. Also, most breast pump companies sell vehicle lighter adapters that can be used with their pumps. This can allow you to use the pump in your car. Some moms will use a drape or cover the front window with a sun shield for additional privacy. The key is to be creative. We had one mom employed as a UPS driver; she would stop at local stores on her route and use their dressing rooms to express her milk.
Q: Beth asks, "Why is my milk supply always so low by the end of my work week? Is there anything I can do to help boost my supply?"
A: There can be multiple reasons for a reduction in milk supply as the week progresses. Several include feeling tired, limited time or access to pump as often as you would like during the day, and/or not taking care of yourself during the busy work day. Try packing several simple healthy snacks that can help to keep your blood sugar level and your energy up. For example, a Ziplock bag full of raw almonds, some sliced cheese and crackers, a piece of fruit, or an energy bar and plenty of water can help give you that extra boost. Make sure you eat and drink something during your pumping time to help with your letdown; this can make a huge impact on milk production. Make sure you do not skip pumping sessions and nurse as often as you can when you are at home with the baby during the week and exclusively on weekends to help rebuild the milk supply. If these tricks do not work, herbs such as Fenugreek, Blessed Thistle, Goat's Rue, and Mother's Milk Tea are helpful with increasing milk supply in most cases.
Parenting on the Peninsula - August 2010
Nursing Your Baby: Traveling With and Without Your Baby
Q: Aimee W. asks, “I have to take a flight with my five month-old daughter Marie, who is breastfeeding. How does that work and should I take a bottle?”
A: Marie is the perfect age to travel with on a plane and breastfeeding will make the trip that much easier. She is portable, not yet mobile or wanting to crawl. Most breastfed babies, like Marie, are easily calmed and quieted during the flight if they have access to the breast for feeds and comfort. Some mothers find that bringing an inflatable pillow, like the My Brest Friend Travel Pillow, makes the journey easier. The pillow can act as a place to help you define your territory and ease the strain on your arms by supporting the baby’s weight during the flight (For product information visit www.mybrestfriend.com.). There is no need to bring bottles onto the plane, just make sure to nurse her if she is awake upon take-off and landing to help open up the Eustachian tubes in her ears and equalize the pressure. If she is sleeping, leave her alone. She will let you know if she needs some suckling to help with her ears. Many mothers do take a pump along to express milk for any absences from baby during their visit.
Q: Jillian S. asks, “My husband and I are going to be separated from our three-month-old baby Jack for several days to be in my sister’s wedding. Jack will bestaying w ith Grandma for the four days and three nights we are away. Can I continue breastfeeding when I return? Will I still have a good milk supply and will he still want to breastfeed?”
A: The good news is babies do better with separation than their parents and should adjust just fine. You will most
likely be able to continue with your breastfeeding upon your return. Prior to your departure, make sure Jack is willing to take a bottle so you will have peace of mind knowing that he can eat and be comforted while you are away. The recommended strategy is to start pumping and storing your milk several weeks before the trip. In order to do this, many moms will pump 20 minutes or so after the early morning feeds to collect milk. Alternatively, if Jack goes to sleep early, or sleeps long stretches, some moms find those times productive for collecting milk. Once collected, store the milk in the freezer. You will need to leave approximately 24 ounces for each 24 hours you are gone.
Grandma can easily defrost the milk by placing the bag or bottle in a bowl of very hot water or letting it defrost overnight in the refrigerator. You should nurse him right up until the time you leave and then as soon as you return. Remember to pack your pump. The most important thing you can do for your supply is to pump every two to three hours during the day and at least once or twice at night. If you are stressed for time, even a quick five-minute pumping session is helpful. Remember to keep up demand by pumping so your body will continue producing milk. During your travels, freeze all pumped milk, pack it in a Styrofoam cooler with dry ice or tightly packed with newspaper and check it with your luggage. Once home, put the frozen milk in the freezer immediately; any fresh milk that was recently expressed can be used within a week’s time. If Jack gives you a hard time nursing upon your return, go into a quite room, lay down with him, cuddle him, and try and get him sleepy, then try to nurse him again. If you feel like your supply is diminished, nurse often, and keep Jack skin-to-skin. Wearing him in a carrier like the Ergo www.ergobabycarrier.com is also helpful. Other tips include pumping after a few feedings once home, drinking Mother’s Milk Tea by Traditional Medicinals, taking Fenugreek capsules or drinking the tea, or trying the Nursing Tincture by HerbLore (www.herblore.com). For additional information on traveling with your nursing infant, visit the CDC’s Web site atwww.cdc.gov/breastfeeding/recommendations/travel_recommendations.htm.
Parenting on the Peninsula - September 2010
"Is there any way to take a temporary break from nursing if needed?"
Q: Veronica asks, “I really want to breastfeed my baby when she is born, but I am afraid that if I get sick or need to take medication I will have to stop. Is there a way to take a temporary break from nursing if needed?”
A: The good news is that even if a nursing mother gets sick, we frequently encourage her to continue to breastfeed her baby. Her breastmilk will provide special protection against any illness to which she has been exposed. Continued nursing permits mothers to pass this protection directly to their infants through her precious breastmilk and keep her milk supply up. In cases when a medication is required, the vast majority of medications are safe to take while breastfeeding. Only a very few are not considered safe, such as chemotherapy agents or radioactive drugs that may be used for diagnostic tests. To determine if the medication you are taking is safe, check with your or your baby's healthcare provider, lactation consultant or a pharmacist who is familiar with medications and breastfeeding. Additionally, there is a new Web resource from Texas Tech University Health Science Center (www.infantrisk.org) that offers comprehensive information on drug safety during breastfeeding. In the rare case of a medication not being compatible with breastfeeding, we recommend pumping every three hours until the medication in question is out of your system.
Q: Sherry asks, “Why does my four-month-old baby girl Ellie take less milk compared to the babies in her
daycare that are getting formula? I just returned back to work and have been pumping my milk and leaving twelve ounces for her to drink during the day. She is growing well and very happy, but the daycare provider is making me feel like I am starving her.”
A: First of all Sherry, what a wonderful job you are doing by pumping for your baby while you are at work. Most moms bring home between nine and twelve ounces during an eight to ten hour workday. We consider pumping an ounce an hour to be a good number to aim for when away from your baby. Formula-fed babies require greater volume based on calorie/day calculations. Most formulas provide 20 calories per ounce; breastmilk ranges between 22-30 calories per ounce therefore requiring less volume per day. Breastmilk is also more easily digested and absorbed. This means that there is less waste and less need for larger amounts. On average breastfeed babies are taking 20% less volume than formula-fed babies and growing perfectly. Care providers without extensive experience with breastfed babies may not understand the vast differences between breastmilk and artificial baby formula and may be accustomed to overfeeding babies as a method of soothing, when the extra feeding may not be required. You may wish to also review breastmilk storage and heating procedures with your care provider to make sure excess breastmilk is not being discarded and heating is never done in a microwave oven. The CDC offers specific storage guidelines:www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm.
Parenting on the Peninsula - October 2010
Nursing the Premature
Q: Kim H. asks, "I have been on bed rest since I was 22 weeks pregnant and now at 32 weeks my OB feels I may be delivering soon. How can I make sure I have breastmilk for my baby if she is born premature and has to stay in the hospital nursery?"
A: If she is born early you can help to ensure that your milk supply will come in as fast as possible by starting to do hand expression or hand pumping right after birth. This Stanford Web site has video clips that nicely demonstrate these techniques very clearly, www.newborns.stanford.edu/Breastfeeding/HandExpression.html. It is recommended that you begin using a hospital grade electric pump within six hours after delivery. This will signal your breasts to start gearing up for making milk. When you send your breasts that there is a demand for milk, combined with the hormone surge that you experience after birth, the combination sets your body up to begin production right away. Also, when you are near your baby, this is always a good time to pump. Just being close to her will assist your body in this new endeavor. As soon as she is stable and you can hold her against the warmth of your bare chest, right next to your heart, do a technique called skin to skin or kangaroo care. This simple technique helps with the milk production and also helps to stabalize the baby, while helping to reduce the stress the both of you may feel from any seperation. A great Web site that demonstrates this technique is www.marchofdimes.com/prematurity/21295_6090.asp
Once you begin pumping, we recommend that you pump both breasts at the same time, for 10-15 minutes and use massage and hand pumping at the same time to help empty the breast.
Parenting on the Peninsula - November 2010
Combining Breastfeeding and Solids
Q: Lynn D. asks, "My daughter is almost six months old. We are getting so excited to start solids but I don't want breastfeeding to end. How can I successfully comine the two?"
A: Introducing solids is an exciting time for both moms and babies. Please check in with your pediatrician before initiating solids.
According to the American Academy of Pediatrics (AAP) policy statement on "Breastfeeding and the Use of Human Milk," the reccommendations include exclusive breastfeeding for the first six months and support for breastfeeding for approximately the first year and beyond as long as mutually desired by mother and child. In general, the first foods should not be introduced until your baby is around six months old, can sit with support, has control of her head and neck muscles so she can turn to refuse food, can bring an object in her hand directly to her mouth, and shows interest in others eating around her. As you can see from the description above, the correct time to introduce solids is based strongly on what your baby can do vs. how old your baby is.
Traditionally, iron-fortified infant rice cereal mixed with breast milk has been a first food for many infants. Iron-fortified cereals can be constipating due to their highly processed nature. Other more nutrient-rich food choices are quickly becoming the first food choice. Current research is showing that it may be better to select a first food choice that is nutritionally dense, easy to thin to a watery consistency, and with low alergen potential. First food suggestions include ripe avocado, ripe banana, and cooked, pureed sweet potatoes. In order to prepare these foods for infants, fix the finely pureed food with enough breastmilk so it can pour off the spoon into your baby's mouth. First foods should only be slightly thicker than breast milk or formula. Continue for one food for seven days to rule out any allergies and thicken as your infant becomes able to coordinate swallowing. The first meal should be one tablespoon of solid food. The teaspoon can be increased over the next few weeks, very gradually, to a serving size of three to four tablespoons. Watch your baby's cues; some are eager to eat more, while others may show interest until after nine or more months. Both eager and hesitant babies are normal!
Breastmilk remains your baby's primary source of nutrition during the first several months after the introduction of solid foods. Ruth Yaron in Super Baby Food proposes a schedule to combine solids with breastmilk. We have adjusted her scheduling suggestions to include nighttime feedings and flexible times for solid meals. Overall, we reccommend you follow your baby's cues rather than any schedule.
Upon Wakening: Breast
Morning: Breast
Noon: Partial breastfeeding, followed by solid food, and then complete the breastfeeding
Afternoon: Breast (solids can be introduced here if infant is not interested or ready at noon)
Evening: Breast
Bedtime: Breast
Night-time: Breast
Once you think your baby is hungry enough for two meals a day, offer her a second meal later in the day. Here is Yaron's reccommendation for combining two meals a day with breastfeeding. Again, we have added nighttime feedings to reflect most infant schedules during the first year of life. Remember, this is not a hard and fast schedule. Many babies will be nursing up to eight or more times in a 24-hour day for months.
Upon Wakening: Breast
Morning: Partial feeding from breast and introduce a new food
Noon: Breast (solids can also be offered here if infant was not interested in the morning feeding)
Aftenoon: Partial feeding from breast and one food serving (same food as in morning or a previously introduced food)
Evening: Breast (Solids can be fed in the evening if the afternoon meal time was not of interest to the baby)
Bedtime: Breast
Nighttime: Breast
If your baby has a small allergic reaction to a particular food, such as a runny nose, your doctor will probably suggest that you try feeding your baby that same food again one month later. If he still shows sensitivity, wait to try again until he is at least one year old. If your baby has a serious reaction, you should not feed your baby that food culprit again.
Solid foods represent much more than nutrition; they are a social experience for humans. Feeding solids should be a joyful and not a stressful time for families. If your baby is not ready for solids, it is perfectly fine to wait several months to begin introducing solids. Your infant will learn to communicate her preferences with each new food introduced. It can take 20 unique attempts to encourage a baby to accept a new food. Watch her cues; communicate by responding to her likes and dislikes and take the whole process slowly. Complete nutrition is coming from breastmilk so the introduction of solids can be a relaxing, fun, and growth experience for your entire family.
An example of this type of bra is one made bywww.simplewishes.com. It is also recommended that you attempt to pump at least eight or more times in 24 hours. Some of these sessions can be close together, while others may be every three hours. The goal is the overall number of minutes spent pumping, coupled with frequency. This also includes pumping at night, when your milk producing hormones are peaking. This combined with baby contact is your best bet to being able to make all the milk your baby will need as early as possible. Do not be suprised if at the beginning of this process your body may start out producing very small amounts of milk; maybe even drops. Know that every drop counts and this first milk, called colostrum, is very important for any baby, but especially for a baby born early. It is a gift if this can be the first type of milk your baby recieves. This will help her prepare her digestive system and protect her from possible infections, while helping get her immune system off to a wonderful start. When collecting your milk, make sure you save everything, label and date it for use when your baby is able to take your milk. Some of your milk may be frozen for later use, so this step is very important. When your baby is ready, the nurses and the lactation consultants will help you and your baby begin to practice breastfeeding. It may be short attempts in the beginning, but eventually your baby will be transitioned to the breastfeeding, without the use of a feeding tube or bottle.
Parenting on the Peninsula - December 2010
Q: .Aimee W. asks, “I have to take a flight with my fivemonth- old daughter Marie, who is breastfeeding. How does that work and should I take a bottle?”
A: Marie is the perfect age to travel with on a plane and breastfeeding will make the trip that much easier. She is portable, not yet mobile or wanting to crawl. Most breastfed babies, like Marie, are easily calmed and quieted
during the flight if they have access to the breast for feeds and comfort. Some mothers find that bringing an inflatable pillow, like the My Brest Friend Travel Pillow, makes the journey easier. The pillow can act as a place to
help you define your territory and ease the strain on your arms by supporting the baby’s weight during the flight. (For product information visit www.mybrestfriend.com.) There is no need to bring bottles onto the plane, just make sure to nurse her if she is awake upon take-off and landing to help open up the Eustachian tubes in her ears and equalize the pressure. If she is sleeping, leave her alone. She will let you know if she needs some suckling to help with her ears. Many mothers do take a pump along to express milk for any absences from baby during their visit
Q: Jillian S. asks, “My husband and I are going to be separated from our three-month-old baby Jack for
several days to be in my sister’s wedding. Jack will be staying with Grandma for the four days and three
nights we are away. Can I continue breastfeeding when I return? Will I still have a good milk supply and will he still want to breastfeed?”
A: The good news is babies do better with separation than their parents and should adjust just fine. You will most
likely be able to continue with your breastfeeding upon your return. Prior to your departure, make sure Jack is
willing to take a bottle so you will have peace of mind knowing that he can eat and be comforted while you are
away. The recommended strategy is to start pumping and storing your milk several weeks before the trip. In order
to do this, many moms will pump 20 minutes or so after the early morning feeds to collect milk. Alternatively,
if Jack goes to sleep early, or sleeps long stretches, some moms find those times productive for collecting milk.
Once collected, store the milk in the freezer. You will need to leave approximately 24 ounces for each 24 hours
you are gone. Grandma can easily defrost the milk by placing the bag or bottle in a bowl of very hot water or
letting it defrost overnight in the refrigerator. You should nurse him right up until the time you leave and then as
soon as you return. Remember to pack your pump. The most important thing you can do for your supply is to
pump every two to three hours during the day and at least once or twice at night. If you are stressed for time, even a
quick five-minute pumping session is helpful. Remember to keep up demand by pumping so your body will
continue producing milk. During your travels, freeze all pumped milk, pack it in a Styrofoam cooler with dry ice
or tightly packed with newspaper and check it with your luggage. Once home, put the frozen milk in the freezer
immediately; any fresh milk that was recently expressed can be used within a week’s time. If Jack gives you a
hard time nursing upon your return, go into a quite room, lay down with him, cuddle him, and try and get him sleepy, then try to nurse him again. If you feel like your supply is diminished, nurse often, and keep Jack skin-to-skin. Wearing him in a carrier like the Ergo (www.ergobabycarrier.com) is also helpful. Other tips include pumping after a few feedings once home, drinking Mother’s Milk Tea by Traditional Medicinals, taking Fenugreek capsules or drinking the tea, or trying the Nursing Tincture by HerbLore (www.herblore.com). For additional information on traveling with your nursing infant, visit the CDC’s Web site atwww.cdc.gov/breastfeeding/recommendations/travel_recommendations.htm.
Parenting on the Peninsula - January 2011
Q: Carly B. asks, “I am five months pregnant and not sure which hospital I should choose when I have my baby. I am planning to breastfeed and have heard the term “Baby Friendly.” What does that mean? If a hospital is not “Baby Friendly” could it impact the breastfeeding help I get when I am there? And what can I do to make sure I am able to breastfeed successfully?”
A: The designation of Baby Friendly is given by UNICEF and World Health Organization (WHO) and promotes, protects, and supports breastfeeding through The Ten Steps to Successful Breastfeeding for Hospitals. Nationwide, there are only about 100 hospitals that have received this certification. For more information visit the UNICEF Web site at www.babyfriendlyusa.org.
Luckily, many of our local hospitals already practice Baby Friendly policies, but have not applied for the certification. Cost is the biggest barrier to a hospital achieving the Baby Friendly certification. Hospitals are reluctant to give up ties to the formula industry because they receive free formula, pacifiers, and bottles.
Additionally, staff must undergo many hours of specific training about breastfeeding, which can be costly. When looking for a facility, ask what the hospital policies are related to breastfeeding. For example, does the hospital limit the use of unnecessary formula, water, and pacifiers? Check to see if you will be provided with daily visits from a Board Certified Lactation Consultant. Also ask if the hospital encourages early and frequent breastfeeding attempts and lots of skin-to-skin contact between you and your baby, both of which aid in milk coming in quickly and encourages the baby to practice breastfeeding skills and behaviors. Find out if the hospital practices “rooming in” which means a healthy baby and mom stay together during their hospital stay. All of these practices will help you and your baby get off to a healthy breastfeeding start.
I would encourage you to register for a prenatal breastfeeding class so that you can learn as much as possible about breastfeeding. You might also think about attending a local support group for new breastfeeding mothers so that you can see what really happens during the first few weeks. Gather as much information as you can about breastfeeding. There are several good Web sites including: www.drjacknewman.com,http://newborns.stanford.edu/Breastfeeding/ and www.kellymom.com. These Web sites offer a wealth of information and video clips that cover everything from how to latch your baby to the proper way to use a breast pump.
Once you’re in the hospital and have had your baby, place him on your chest, skin-to-skin, as soon as possible. Allow your baby to have free access to the breast as often as needed. Know that practice makes perfect and babies learn to breastfeed by breastfeeding. It is a myth that you can spoil a newborn, so listen to your baby’s needs and respond accordingly. While in the womb, your baby was used to being fed 24 hours a day and asking him to go several hours between feeds takes some getting use to. His tummy is also tiny so it’s normal for him to feed frequently. While in the hospital, ask for help with latching your baby as it can take many attempts to get it right.
Once you and your baby get home, should questions or issues arise, contact your local Board Certified Lactation Consultant or if you’re a WIC participant, your local WIC (Women, Infant and Children) office for a one-on-one visit so that you can have personalized hands-on help to make your breastfeeding experience work for you and your baby.