New Year, New Thoughts

Well, we made it. 2017 is finally here. Over the last year I moved, bought a house, and took several trainings in maternal mental health. It became apparent to me that mothers need a lot more support than they are getting. What does this have to do with breastfeeding? A lot. I often tell mothers, "Healthy mom for a healthy baby", while encouraging them to rest, seek outside support, and even take carefully prescribed medication if needed. A mother who is breastfeeding often feels unable to do any of these things. How can I rest when the baby is cluster feeding? How can I go to an appointment if I can't leave the baby with anyone? Am I harming my baby if I take medication while nursing? These are all questions that may not get answered (at least correctly) for the mother. The OB may say, "You'll feel much better in six weeks" and the pediatrician may say, "The baby gained weight - good job!" A lactation consultant is in the unique position to see both mother and baby and assess their needs, while working to preserve the breastfeeding relationship. She can say, "Let's think of some ways to simplify feedings so you can get the most rest right now" or” Why don't we make up a pumping plan for the next week so it feels a little more manageable?"

Working and Breastfeeding – Getting it Right

Mothers are entering or continuing in the workforce more than ever and, sooner than ever after childbirth. Can you breastfeed and work? YES, and pumping is a valuable part of this balance. There are three things that can help to insure a positive breastfeeding and working relationship.

The Right Pump

·         The right pump is: double, electric, and NOT your friend’s pump she only used twice! If you are working more than one or two days a week, I would suggest using a double electric pump. A double pump is more efficient and effective, as well as easy to use. One caveat: Do not borrow your cousin’s pump or buy one on ebay!! You can buy a new pump (shower gift?), ask for one from your insurance company, or, if you are a WIC client, ask for a rental from your local office (*I can help with the last two options – email me). Think about where you will be pumping, as some pumps come with a car charger and/or battery pack.

The Right Plan

·         The right plan: I recommend starting to pump and store milk at least two weeks before you return to work.  Try pumping in the morning, when milk supply is usually high, and start accumulating a reserve in the refrigerator or freezer*. Look at your work schedule and map out a preliminary schedule, with break times for pumping (see an example below). If possible, return to work on a Thursday or Friday. This enables you to see how things go while having a few days to tweak your plan before starting a full work week.

The Right Support

·         The right support:  Try to get supports in place ahead of time. Ask your boss about break times, places to pump, and flexibility in your hours. Ideally, you will have a private space (not a bathroom) to pump and access to a refrigerator or cooler for storage (don’t forget to label!). Talk to your child care providers (have a back-up!) and make sure they understand how to store and use expressed breast milk. Finally, know your rights. Recent legislation requires companies of 50 employees or more to provide breaks and a place to pump for nursing moms. See the full provision here.

You can do this! Babies who are breastfed are healthier and that means fewer missed work days for you, as well as continued health and happiness for both you and your baby.

Maternal Depression and Breastfeeding

   I recently wrote a piece for HealthComU about postpartum depression. I did a topical overview, but wished I had said more about breastfeeding and maternal depression. I have found that women who are being treated for depression and other mood disorders often stop taking their medications during pregnancy or in the postpartum period, when breastfeeding. Mothers are understandably concerned about their baby's health and don't want to do anything to cause harm, but may need these medications in order to function well, especially with the stressors of a new baby. Many medications are compatible with breastfeeding, but physicians and/or pharmacists are not always informed with the latest research. I often use Lactmed or Dr.Hale's Infant Risk site or latest book. It is also possible that breastfeeding can prevent or forestall postpartum depression, as the mother's hormones are not undergoing such a big shift from pregnancy to the postpartum period. The hormone Prolactin, secreted during nursing, can have a calming effect, both on mom and baby.

              Finally, there are those times when maternal medication is incompatible with breastfeeding (Lithium, e.g) but the benefit to mom is greater than the risk of not breastfeeding. One of my catch-phrases is: "Happy Mom, Happy Baby". Mothers who deny themselves needed medication may be putting both themselves and their baby at risk. Every situation is different and must be evaluated carefully, often with the coordination of a lactation consultant, psychiatrist, and pediatrician. A team approach can be a good way to ensure a positive outcome and there are many options for treatment. Ask for help - you and your baby deserve it!

Enough Said

A recent article from The New York Times

 "A Free Miracle Food"

If at First

   Many, many times a pregnant mom will come to me and say, “I want to breastfeed, but don’t know if I can – it didn’t work the first time”. I can think of a lot of success stories, but I feel really blessed when a mom that I have worked with has been able to nurse when she couldn’t before. Every baby is different and every birth is a new chance to breastfeed.

   What happened last time? It’s important to think about why breastfeeding was unsuccessful and see if those issues can be avoided this time. Often, early supplementation with formula is the culprit and it often happens in the hospital. This is such a set-up for problems! I tell moms to nurse early and often and to resist offers of formula (“so mom can rest”, e.g.). Babies don’t need to eat so much in the first 24-48 hours, nor do they automatically require supplementation if they have greater than 7-10% weight loss. An immediate assessment of breastfeeding, by an IBCLC, can help to turn things around.What about anatomical issues like tongue tie (baby) or inverted nipples (mom)? Inverted nipples can be easier to evert with later pregnancies and, a sibling of tongue-tie means that the baby should definitely be evaluated, both for tongue tie and labial or lip ties as well.Some situations cannot be resolved, such as glandular insufficiency or galactosemia, but these are not very common. Most important is to support the mother to have a new and better experience and hopefully, to successfully breastfeed.

Pay Me Now

       I haven't blogged for awhile, but recent events have led me to write again.

At the end of November our church was burned to the ground by an arsonist and, of course, the massacre in Newtown has been shocking and unbelievably sad. I was reminded this week of something I heard in a La Leche League meeting years ago: "Pay me now or pay me later". What does this have to do with tragedy? Breastfeeding? Kids? I think of the phrase as meaning, "Meet your kid’s needs now or they will go looking to meet them in other (potentially unhealthy) ways." I have to clarify that I am in no way suggesting that all mental illness stems from poor parenting or that people who do bad things must have been neglected as children. However, why not invest heavily in your most precious "product" - your kids?! 

        Ok - back to breastfeeding. Nursing your child gives them not only the healthiest start in life, but also the experience of being skin-to-skin with mom, being fed both emotionally and nutritionally. Breastfed babies tend to be fed more frequently (breastmilk is digested much faster than formula), are put to breast for both nourishment and non-nutritive sucking, and often spend more time with their moms. In fact, it is said that breastfed babies can smell the difference between their mother and another nursing mom in the first few days of life. Finally, human milk is for human babies (and ideally, breasts are for nursing). The first few years of life involve incredible brain development and doesn't your child deserve the best brain food? I can't guarantee that every breastfed baby will grow up to be a nice, kind, law abiding citizen, but I am willing to bet that there is a better chance for a good outcome if you begin with the best (or the breast!).

        

The "Frankenstorm"

 

    Here on the east coast, we are familiar with high winds, flooding, and power outages. The local stores have displays filled with flashlights, batteries, and bottled water; locals are out in their yards, putting away deck furniture and potential projectiles. However, as a lactation consultant, my thoughts go to those moms who are pumping and storing breast milk. This article, from the Florida Keys, has great tips on safely using and storing breastmilk during a power outage. If your baby is hospitalized, ask the hospital staff for their preferred guidelines.

      Now, a story: In 2005, I was pumping exclusively for my preemie who was in a hospital NICU two hours away. A high wind came through the area (the "Rogue Storm of 2005") without warning and winds gusted up to 100 miles an hour. We lost power for a few days and I was desperate to find a way to use my hospital grade electric pump. I asked around, and found a neighbor who had a generator. I went over to her house and found many neighbors (male and female) sitting around her kitchen table enjoying coffee. They pointed to the one outlet in the middle of the kitchen and said - "There you go!". I put aside modesty, and started to set up. I don't think they really realized what I was going to do because as soon as those flanges came out the husband jumped up and said, "I think there's another outlet in the garage". I would have pumped in the kitchen, but the garage was fine and most importantly, I was able to save that "liquid gold" (in a cooler) for my baby.