That First Week: Basic Answers to Common Questions

My friends, Joe and  Sam (short for Samantha)  just had their first baby,

 Benjamin.  So, of course, I've been "all over that", ya know, seeing them 

before hand and the morning after he was born, on their way home from the 

hospital and through texting/facebook as well.  

Like most new parents, they had concerns and questions which I am used to.   So I thought I would share our dialogs which contain useful information but 

most importantly reflect the process and progress.  I cannot 

emphasize enough how important on-going support is to the breastfeeding 

family.   And if this is done well and in a timely fashion, the result: less fear and anxiety, lots of milk and a happy, content baby.  

For you veteran - lactivists:   I am sure this dialog will trigger some mammaries, oops!... I mean memories of those very first days. 

Sam: I honestly have an amazing husband....The last two nights have been 

really long and hard for me because I just couldn't figure out what Benjamin wanted...Today joe kept telling me to nap and relax, which I did and it has made a WORLD of difference 

tonight. Thank you wonderful husband/awesome daddy!

Maria's reply: First of all props to Joe!  Second, It's simple - Ben just wants you. Think about it: he was wrapped inside the warmth, security and comfort of your body for 9 months. You're still his home -he's just on the 

outside now. And so your breasts have taken over where the placenta left off nourishing and growing his body - it's basic biology,.....we often forget that we are mammals.

Sam:  Ben spit up once yesterday and twice this morning....not a lot.    Should we burp him? He does get the hiccups.

Maria: Spit up: just means he ate more than he had room for. Maria-ism: " it's a 
laundry problem, not a medical one." the valve at the top of his stomach 
(esophageal) is very loose and floppy -which allows a baby to regulate his 
stomach contents by spitting up excess milk. Quite ingenious really. It helps 
not to force feed - he does not have to nurse on both sides - don't wake him up 
to feed him and don't lay him on his back right after he feeds etc. You will 
notice it happens more when your breasts are extra full...he will adjust your 
supply over the next 6-8 wks
Hiccups are a "space" issue. Their abdominal organs are all squished in a 
very small space right now. When they eat and their stomach is full- it presses 
up against their diaphragm ( which lies above the stomach) causing it to go into 
spasm. As their body gets longer and wider- their organs will drop lower 
allowing more room and thus the hiccups go away - basically they outgrow them. 
You don't need to do anything -remember in utero he drank about a quart of 
amniotic fluid a day and had the hiccups often without any problems.

Sam: my boobs still seem a little hard after Ben eats. Can I pump and save 
it for night time so Joe can do a feeding?

Maria:Yes it's fine to pump if nec-on mild to mod setting w/ good massage during -do one 
breast at a time -for only 15 min - more is not better . As far as 2 nite is 
concerned : your breasts will not allow u to sleep more than 2 maybe 3 hrs. Your 
prolactin levels are highest @ nite to accommodate the freq nite nursing in the 
beginning. So u will have to get up and pump - Joe will be stuck with a fussy 
baby fed or not, who wants his mommy and u will end up nursing anyway. Like I 
have said before: u need to learn how to lay down and nurse - this is the most 
effective tool to make your nites the best they can be /. I am happy to teach u 
how.  Also, if your breasts r very warm u can use some cool compresses in b/w feeds just wet 
two disposable diapers and place them in freezer tuck in bra until they reach body 
temp then refreeze reuse I 'd rather not use bottles just yet if Joe feeds him I'd rather him use the 
syringes - I show him how - you are doing so well ! I just don't want to screw 
anything up.

Sam: I tried to pump and it didnt work so I'll stick to feedings. As far as laying 
down to feed, I can't get myself up bc of my surgery. So eventually I will 

take u up on laying down feeding lessons.

Maria: You just need to roll onto your side and stay there all night -honestly, you can 
do everything from there. I fear if u don't soon -u will crash and burn, sweetie

Sam: I crashed and burned this morning-tears and crying. But then took a two hour 
nap. Much better. I'm going to nap after lunch.
Maria: Normal hormonal stuff -this should pass quickly. Yes, your best time to sleep will 
be 7am-12 noon for the next 3weeks -that's when the babies sleep the most. So no 
waking him up, no phone calls, txt, visitors or appointments -this is your 
sacred time!!! Take advantage of it - u will feel much better if u do. 

Maria: It's annoying that I have an answer for everything, isn't it? Lol
Sam: Actually no....u r amazing. I'm sorry I have so many questions. 
Maria: Never apologize for asking questions ( I love playing stump the lactation 
consultant-lol) but honestly-most people do not know this information -it is my 
business to know it and share it 

Sam: We go to the Peditrican today :-)
Maria: Good -LMK how u do. Waiting on the slings-hopefully coming today

Sam: Sir Benjamin is now 6lbs 13 oz and grew a half of an inch!!!! Doctor said good 
job for ur breastfeeding instructions!!
Maria: Great job, people! That's 7 oz in 2 days! You should be so proud of yourselves 
-I know am!
Sam:  -) yay!!!   Instead of a peanut, he's a chestnut!

The "Corporate" Mindset - Are Women Thinking More Like Men?

Since Breastfeeding is not about control or perfectionism ( nor should it be) it

does not fit the "model" women have now become accustomed to.  Which I believe

is the corporate model set up by men. You know, constant micro-managing,

competition, over-evaluating, where A&B equal C,  more is better,  if it's free -how good could it be? and there is an agenda -always an agenda!   

Correct me if I'm wrong, but in order to effectively compete with men in the business world

-women have had to think like men.  This "corporate thinking" does not bode well

for breastfeeding and mothering in general.  But it works beautifully for the infant marketing industry!

In my practice demographic - mostly high socio-economic, two-income families,  control and
perfectionism runs long and deep.  This, of course, only sets one up for anxiety
and depression.   If one can't control it then it's too stressful and if it's not perfect immediately, it's deemed a waste of time-  Exhausted/ fearful/disillusioned/ disappointed and desperate -one reaches for anything that brings them back to their "comfort zone" of control.  In this case: bottle-feeding and/
or pumping.  And guess who's ready to swoop down when this happens?  We all know who those players are.

This pervasive mindset of control and perfectionism has set the stage for the most effective marketing strategy I believe history has ever seen - newborn product sales especially the infant feeding industry.

What can you do?  Put the "corporate" mindset aside (that's fine for work) and tap into the feminine/maternal side of you....it's in there somewhere!  Don't fall for the capitalism, commercialism and undermining marketing, that is stealing you from your child.  Money does not equal love.  Success in business does not equal success in parenting.  Embrace and celebrate what makes us different as women.  The tenderness, patience and fortitude to do what's right by your child comes from your heart, not your head.....or wallet.

Alcohol, Holidays & Breastfeeding

I get many calls this time of year re: alcohol intake and breastfeeding.
Even though it is fine to "partake", I think it helps to remind ourselves that too much alcohol can impair one's ability to respond and safely parent as baby needs -- no matter how baby is fed.

So it is not as much the amount of alcohol present in your milk ( its too unstable to stay there very long) but the level of impairment you experience.  Most of alcohol-related consequences are not breastfeeding issues, per se. but impairment ones.
So be smart and responsible: pay attention to how much you've had and your body's reaction to it - eat and drink lots of water.
If you get intoxicated:  do not drive, have someone else care for your baby, do not co-sleep or nurse until you are sober.  Only pump if you need to and discard that milk (until you are sober)

Please do not waste your money on alcohol test strips as they are not at all accurate or necessary.

For further info: This article from Thomas Hale's Infant Risk Center site can be helpful, whether breastmilk is direct from the source or expressed):
http://www.infantrisk.com/content/alcohol-and-breastfeeding.

Enjoy and be safe

Wean Me Gently

I know I look so big to you,

Maybe I seem too big for the needs I have.

But no matter how big we get,

We still have needs that are important to us.

I know that our relationship is growing and changing,

But I still need you. I need your warmth and closeness,

Especially at the end of the day

When we snuggle up in bed.

Please don't get too busy for us to nurse.

I know you think I can be patient,

Or find something to take the place of a nursing;

A book, a glass of something,

But nothing can take your place when I need you.

Sometimes just cuddling with you,

Having you near me is enough.

I guess I am growing and becoming independent,

But please be there.

This bond we have is so strong and so important to me,

Please don't break it abruptly.

Wean me gently,

Because I am your mother,

And my heart is tender.

by Cathy Cardall

Happy Holidays & Healthy New Year !

Hormonal Contraceptives & Breastfeeding

I receive many calls regarding low milk supply, a sudden drop in milk supply or a baby's poor weight gain or sudden drop or standstill in weight.  One of my first questions is : "Are you taking any birth control pills?"  Many times the answer is "Yes".   Since many doctors are prescribing without warnings or just ill-advised, here is the "skinny" on Hormonal Contraceptives and their impact on breastfeeding.  So you are able to make an informed choice yourself regarding what type of birth control method to use.

In NeoReviews, the official journal of the AAP, Thomas Hale, PhD states in his article Pharmacology Review: Drug Therapy and Breastfeeding (2005;6;e233-e240)

"Birth control products probably produce more complications than any other medication used by breastfeeding mothers.  Estrogen-containing birth control products have been found to reduce human milk synthesis significantly in some mothers.  Therefore, progestin-only products are greatly preferred in this population.  However, even progestin-only products may reduce milk synthesis in some mothers, and great cautions should be used following their initial use.  All mothers should be advised that these hormonal products may reduce milk synthesis, and they should discontinue their use immediately if they note a decrease in milk production.  The use of medroxyprogesterone (Depo injection) early postpartum should be avoided until milk production has been established.  Some mothers anecdotally report complete shutdown of milk production following its use."

The Drugs and Lactation Database (LactMed) HYPERLINK "http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT"  states that "nonhormonal (contraceptive) methods are preferred during breastfeeding".  The hormonal contraceptive choices in question are progestin-only oral contraceptives,
Depo Medroxyprogesterone (DMPA) injection, Mirena IUD, and Implanon/Norplant implant.
Estrogen-containing contracrptives continue to be contraindicated for breatfeeding mothers.

Progestin-only oral contraceptives (Micronor, Camila, Errin, Jolivette, Nora-BE, Nor-OD)
Although touted as the preferred oral contraceptive for breastfeeding mothers, in the 2010 edition of Medications and Mothers' Milk, Thomas Hale states that "recent reports claim that Micronor can be assocoiated with decreased milk production".  Also these drugs "may reduce lactose content and reduce overall milk volume and nitrogen/protein content, resulting in lower infant weight gain"  Milk levels increase for most of these women when this contraceptive is stopped.

Depo Medroxyprogesterone (DMPA)
Common injection given to clinic moms in the hospital during their postpartum stay.  Hales rates this as an L4 or Possibly Hazardous if given within 3 days of birth.  LacMed states that "Administration sooner than 3 days postpartum could inhibit lactogenesis and interfere with the establishmnet of lactation."
If if this injection is given later, it can be a problem for women sensitive to progestin since it cannot be removed or stopped.

Mirena IUD
Even though, Mirena produces the lowest plasma levels of progestin thus becoming more popular, it is not without concern.  Hale does note that "some caution is recommended as I've received three accounts of milk suppression following insertion of Mirena IUDs"

Implanon/Norplant implant
This involves placing six match-size, flexible capsules under the skin of a woman's upper arm.  These release a low dose of synthetic progestin continuously for up to five years. I recently saw a client who experienced a decrease in milk supply after receiving this contraceptive - which again is difficult to remove.

Seasonale
This is an extended-cycle oral contraceptive  but due to it's estrogen content , caution is recommended in breastfeeing mothers due to potential reduced milk supply.

Plan B, Levonelle or NorLevo
This is a post-coital emergency contraception.   The mother should not breastfeed for the first 8 hrs, or at the most 24 hrs to reduce the estimated dose to the infant via breastmilk.


So am not advocating no birth control but there are enough "red flags" to use them with great caution.
Milk supply and infant weight gain needs to be carefully monitored.  It is difficult to sit with a mother who is suddenly struggling with her milk supply and suspecting that her birth control method prescribed by her doctor may be responsible.  It has high-emotional, physical and economic consequences for the mother and baby that should not be ignored or placated.

The Great Cloth Diaper Change 2011

NaturallyBorn.net - A Website I like!

Most of you know, I am not big on promoting websites. Simply because I feel people spend too much time on the internet looking for answers instead of with their baby (who has all the answers!).

But, I have to admit,  I am excited about this new one called, naturallyborn.net.  No hidden agenda just a mission to bring natural parenting out of the "alternative" and into the mainstream.  (you know, I am all for the natural)

Looking for a midwife, birthing center, doula or breastfeeding expert ?- it's all there!  A great resource for anyone looking to formulate a natural childbirth plan and breastfeed as well.

Not only is It is an informative site but interactive as well, with experts (such as myself!) answering simple questions.

So check it out....like it, tweet it,  post comments if u like and pass it on to friends and family.

www.naturallyborn.net