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.
Wednesday, July 6, 2011
Thursday, April 7, 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
Wednesday, April 6, 2011
The Concept of: Removal and Replacement
"Your baby owns the "feeding thing" - you just happen to have the milk." How many of you have heard me say that? Too many. So I thought I needed to explain the concept of milk removal and replacement and it's impact on your milk supply.
First of all, the breast is not a passive container of milk but an dynamically active organ. Milk production is infant driven rather than hormonal. It is the removal of milk from the breast that facilitates continued milk production. Your nutritional status, age, body composition have only secondary impact.
So what does that mean? Inadequate milk removal or stasis (milk sitting around) tends to limit milk production. Know that It is the quality and quantity of the infant's suckling or milk removal that governs your production. Milk production reflects each individual infant's appetite rather than your own ability to produce milk. Thus babies pick a feeding pattern that best suits them, not necessarily the sibling before them or you for that matter, but trust them they know what they are doing.
As long as milk is removed regularly from the breast it will be replaced, almost indefinitely. But what happens when we try to control our baby's feeding patterns by schedule feeding, convenience feeding, supplementing or sleep training? Our milk supply goes down! The baby is no longer in control of it's food supply. We have messed with the amazing phenomenon of the supply-demand response - the very feedback control that regulates our production of milk to match the intake of our baby. So if your milk supply is dropping, it's simply because less milk is being removed - this can be natural as with child-led weaning or unnatural as in parent-led weaning.
Since lactation is energy-intensive process there are natural safeguards against wasteful overproduction as well as mechanisms for a prompt response to your baby's needs. Some examples are if your milk supply is huge, the baby may nurse quickly leaving more milk in the breast to send signals to the brain to reduce the supply. If the milk supply is lower or the baby has a growth spurt, the feedings may be more frequent and longer.
As they say, "there is a method to their madness". So best to leave the "feeding thing" to the baby -as long as they have unlimited access to you, you will have enough milk for them....and then some!
Monday, February 14, 2011
The Day You Were Born
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| Maria"s baby pic |
So in saying that, I am feeling a bit reflective......glad to be alive: having survived breast cancer 6 years now, grateful for what I have: 3 wonderful children, amazing family and fabulous friends - more than I can count! But most of all, my mind is flooded with memories of my mom who passed away almost four years now. And oh boy, do I miss her! Tears are running down my face as I write this. (sweet tears)
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| My Mom as a young grandparent-look familiar? |
My mom had a great way of making you feel special. Since, I was born on Valentine's Day (I was almost called Valentina!) my mom baked me a heart-shaped cake every year without fail - the last one being two weeks before she died. I still have the cake pan which is 52 years old now (yikes!)
I often share with clients about a birthday tradition my mom started. On our birthday, she would come into our room and sit on your bed and tell the story of the day you were born. All the siblings would gather on the bed for the storytelling which as you might expect, was embellished more and more each year. Mine was a tall tale of blizzard-like conditions and treacherous travel to get to the hospital just in the nick of time. But my favorite part was that my mom said I was the first girl born that Valentine's Day! Which gave me celebrity status!
We all looked forward to the story, only our mother could tell, about the day we were born and she never failed to deliver it with drama, wit and love.
FYI- my mom was only "awake" for the birth of her last child #5 which my dad was present for as well.
For many years, I miss-interpreted the "first girl born that day" to mean that I was the first girl born in the whole world that Valentine Day! As a child, I used that assumed fact for bragging rights and leverage during heated neighborhood arguments about who's more special than who. Rightfully so, I was, hands down, the most special! Now you know where Maria gets her ego from!!
I continued the tradition with my kids and honor them and my mother in this way. To this day, my grown children (28, 26, 24) still get a big grin on their face when I tell them about the day they were born. Cherished memories worth repeating and embellishing!!
Happy Valentine's Day!!!
Tuesday, February 8, 2011
Taming Tiger Mom
Before I go on to speak about discipline let's clarify that I am referring to children over 2.5 years old. Discipline and babies should never be used in the same sentence! At that age it's more about distraction than discipline.
"The truth is, no matter how trying they become, babies two and under don't have the ability to make moral choices, so they can't be bad. That category only exists in the adult mind."
- Anne Cassidy
How many times have I heard?: "She's a bad sleeper." "He's a bad burper." "She's a bad nurser." "He's lazy." "She hates my right breast." "He hates my left." "She is using me as a human pacifier!" "He is killing me!" "She refuses the bottle." "He won't sleep on his own." "She is spoiled"
Honestly, people! Listen to the language we are using in reference to our little babies who come into this world pure, loving and trusting! Sounds silly now, doesn't it? Babies are not villains, out to manipulate, outsmart us and ruin our lives yet we tend to refer to them as such. (whose the baby here?)
Disciplining a child is a delicate process and is probably the thing that we feel most uncomfortable about, because why? it's about power imbalance! Not all of us are good at handling or managing power, probably because we didn't have the best role models ourselves. Discipline is woven into the fabric of who we are, it's a way of relating to the world, it is not a separate experience of parenting. It creeps into every aspect of the parent-child relationship and is reflected in every interaction.
When asked what the chief differences between the western style of parenting and the Chinese style of parenting Amy Chua Yale law professor and self-described "tiger mother," answered:
"I think the biggest difference is that I've noticed Western parents seem much more concerned about their children's psyches, their self-esteem, whereas tough immigrant parents assume strength rather than fragility in their children and therefore behave completely differently. … I think it goes without saying that love and understanding have to come first, without that it's nothing."
Frankly, it was difficult to find the "love and understanding" in most of her book which I felt was quite to the contrary -harsh.
Discipline is really about helping a child learn about the meaning of balance. When balance has not been integrated into a child's upbringing, disciplining methods are used to bring a situation gone awry back into a state of harmony. What we realize later is that poor discipline or introducing discipline too late in the day could send the situation into a serious mess. The root of all confusion is broken communication and lack of understanding.
Parents adopt different styles of discipline and punishment based on what they have learned in their childhood, or as a reaction to what they were exposed to. If one's parent was extremely authoritarian, inflexible and used physical punishment, then as a parent one might imitate that.
For instance, the "Little White Donkey" incident that pushed many readers over the edge. That was the name of the piano tune that Amy Chua, forced her 7-year-old daughter Lulu to practice for hours on end — "right through dinner into the night," with no breaks for water or even the bathroom, until at last Lulu learned to play the piece.01.20.11 Time Magazine
In contrast, parenting can rebound the other way to become extremely lenient. Either way, you are not responding in a productive way to creating balance in your child's upbringing, or your parenting style. The art of discipline is something you can learn only by being able to discipline yourself in a wholesome, healthy, and compassionate manner; every style of parenting is a reflection of one's own self-perception.
So is Amy Chua's style of parenting a reflection of her own self-perception? I'm sure it is.
"At its best I think it's not about achievement, but about trying to help your child be the best they can be and it's usually more than they think. It's saying “I believe in you so much that I know you can be excellent, and I'm going to sacrifice everything and be in the trenches with you and I don't care if you hate me while you're a kid and I'm just not going to let you give up.” That's, I think, a positive message. Amy Chua (Chew-Ah), Time Magazine interview 01.11.11
Most of us can agree that parents need to be firm and strict at times. Children actually need to feel that you are in charge, it gives them a sense of security. But discipline with love means to be caring, kind and considerate. In the same respect, parenting with love doesn't mean crippling, enabling or co-dependency.
The successful child is one who has learned how to overcome the inevitable losses and move on, not one who has been protected from all difficulties. Resilience is a much better measure of a child's ability to thrive than a lack of bumps in the road.
Just to "break it up a little" some comic relief from some famous people about parenting and kids.
The truth is that parents are not really interested in justice. They just want quiet.
- Bill Cosby
It would seem that something which means poverty, disorder and violence every single day should be avoided entirely, but the desire to beget children is a natural urge.
- Phyllis Diller
There comes a time when a woman needs to stop thinking about her looks and focus her energies on raising her children. This time comes at the moment of conception. A child needs a role model, not a supermodel.
- Astrid Alauda (author, Pippi Longstocking)
"When a child turns 13 you should put him in a barrel, nail the lid down and feed him through a knot hole. When he turns 16, plug the hole!"
- Mark Twain
"When my kids become wild and unruly, I use a nice, safe playpen. When they're finished, I climb out.
If you have never been hated by your child you have never been a parent.
- Bette Davis
Like all parents, my husband and I just do the best we can, and hold our breath, and hope we've set aside enough money to pay for our kids' therapy."
- Michelle Pfeiffer
In all fairness to Amy Chua, I commend her honesty and integrity in explaining why she wrote her book: Tiger Mom.
“I didn't write this book to tell people how to parent. In fact, I wrote this book in a moment of crisis. I was raised by extremely strict but extremely loving Chinese immigrant parents. To this day I adore them and I feel I owe them everything. I tried to raise my children the same way. My daughter rebelled against this kind of parenting and I felt like my family was falling apart. So the book is about many of the strengths I see in that kind of parenting but it's also about the mistakes.”
Amy Chua (Chew-Ah), Time Magazine interview 01.11.11
We are all far from perfect and everyone has the right to voice their opinion and raise their family as they see fit. I think we all learned something from the discussions that have taken place since her book came out. It helped to raise our awareness. Keeping us ever vigilant to pause and "check ourselves" from time to time.
What did I come away with ? Looking at discipline as simply instruction instead of punishment. We are the teachers, they are the students.
"It is not your job to make your child happy; it is your job to teach your child appropriate behavior that will potentially foster his happiness." - Susan Merkel, MD
Friday, February 4, 2011
How to Have a Good Fight - 10 Rules of Engagement
This past Sunday in church, Pastor Clay Porr's message was on How to Have a Good Fight. 10 Rules of Engagement.
This is important stuff. Pastor Clay said almost every fight a couple engages in has to do with: money, children or the having of children. Sound familiar? The important thing is not whether you fight or not because it is inevitable. Disagreements are going to happen especially now that your lives have been turned upside down!
So, I trust this will help and remember both parties need to follow the rules in order for it to work. All is NOT fair in love and war!
!0 Rules of Engagement
1. Don’t sweat the small stuff.
You don’t have to fight every battle. In fact, if you want to have harmony in your family, you need to overlook minor offenses whenever possible.
2. Don’t sweep it under the rug.
On the other hand, if you can’t overlook the problem, you have to deal with it. Don’t just sweep it under the rug. Otherwise, the pile will build up and become much more difficult to handle.
3. Look in the mirror.
Before you begin arguing, ask yourself, “How have I contributed to this problem?” In the hundreds of times I’ve helped people with relationship issues, never once have I seen a situation in which only one person was at fault.
4. Hold hands.
Even if you don’t physically hold hands, remember that you’re part of the same family. The person you’re arguing with is someone you love. Act like it!
5. Identify the issue.
If you can both agree how to describe the issue you’re dealing with, half of the battle is over. Agreeing on the problem doesn’t solve it, but you can’t solve it if you don’t agree what it is.
6. Seek to understand.
Seek first to understand, then to be understood. A great way to do this is to restate what the other person said and ask if your understanding is accurate. We’re so quick to want to make our own points. But, if we’re willing to make the effort to make sure the other person knows we’ve understood them, the problem will get solved much more quickly.
7. Keep it current.
If you keep bringing up the past, you’ll never be able to move forward in your relationships. We can’t change the past, and we can’t expect our loved ones to change it either.
8. Avoid absolutes.
Never say “never” again! Don’t say “you always.” Don’t exaggerate what the other person has said or done; and don’t minimize your own shortcomings.
9. Apologize sincerely.
Do you want to know the quickest way to end a fight? Surrender! Apologize sincerely.
Don’t just say “I’m sorry if you were offended.” Or, “I’m sorry, but I wouldn’t have done that if you hadn’t done this.” Don’t minimize your offense. Don’t shift the blame. Be specific. Own your junk.
10. Forgive fully.
Forgive and don’t bring it up again.
Forgiveness means accepting the consequences for the other person’s actions. If you lend me $1000 and I don’t pay it back and you forgive that debt, you’re out $1000. You’re bearing the consequences of my failure to pay that debt. It costs you something. The same is true when we forgive one another when we hurt each other.
We talk about forgiving and forgetting. The problem is that we usually can’t forget, and so we’re tempted to bring up the offense again. But true forgiveness doesn’t mean forgetting, it means not bringing up the offense again even when we can’t forget it. That’s pretty difficult to do. But necessary.
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