Thursday, February 27, 2014

Tongue tie and Low Weight Gain: Tatum's Story


Tatum, a healthy toddler who can stick out her tongue!
Today's guest post is about baby Tatum. She was thriving on breastfeeding until a tongue tie lead to a sudden weight loss. This amazing mom continued to breastfeed through a hospitalization and four months with a feeding tube. Tatum is now a happy,  healthy, breastfeeding toddler!




Tatum's Story


I can't believe that it's been one year (and 6 days) since she had her NG tube removed. That horrible, uncomfortable, unsightly tube that provided her little body the extra nutrients it so badly needed for 4 months. For 4 months, Dane and I mixed donated breastmilk with a fortifier for extra calories and used a syringe to fill her belly with the milk that I could not provide for her by nursing alone. 

When she was born, I noticed that her top lip didn't "flange" when she nursed. I was not incredibly familiar with lip ties or tongue ties, but I did recognize that the frenulum of her top lip was tight. At her 9 day checkup, I brought up the lip tie with her pediatrician. Tatum was already back up to within a couple ounces of her birth weight and nursing was not painful, so the doctor said that it wasn't a concern. I didn't think much of it afterwards. I had struggled to breastfeed both Vance and Harper, so I was more than thrilled that breastfeeding was actually "working" this time around! She continued to gain weight and her diaper count was always normal.

That was a busy summer to say the least. Dane was deployed to Afghanistan, so the kiddos and I were living in CA with my sister. In June, the kiddos and I drove back to Illinois to get ready for Dane's homecoming and get Vance ready to start Kindergarten.

Right before Dane was to come back, I started pumping so that I could have a bit of milk set aside in case we were able to have a date-night after his return (wishful thinking... I know! I know!). I was surprised that at 4.5 months postpartum I could still pump a couple ounces AFTER nursing Tate. I knew enough about supply regulation to know that if you don't pump regularly, your supply levels out and it's not terribly common to not be able to respond to the pump at all. I was able to get about 30oz saved over a couple week period and froze it in anticipation of Dane's return.

He came home at the end of September and it was amazing. The kiddos were so happy to see him again and Tatum found comfort in his arms from the get-go. It was like she had known him all her life. I weighed her on the home scale right around the time he got home and she was 12lbs 4oz. My chunky little 4 moth old was exclusively breastfed and I couldn't have been happier.

About a month later, I noticed that her cloth diapers were fitting looser. I weighed her and she had lost about 12 ounces! I was shocked! I called and made an appointment with her pediatrician here in IL on Tuesday. At the appointment, I expressed my concern about the lip tie. Her doctor was attentive to my concern and put in a referal to the ENT doctor affiliated with Milwaukee Children's Hospital. We were seen by ENT that Thursday. The ENT confirmed that Tatum had a significant lip tie and she also suspected a posterior tongue tie. She recomended getting them both clipped and because of Tatum's age and severity of the ties, she would need general anesthesia. I signed the consent forms and the surgery was scheduled for the folowing Monday, October 29, 2012.

The surgery was quick and Tatum was a trooper! Because of the amount of tissue that had to be clipped on her top lip, she had 2 stitches. When she came out of surgery, I tried to nurse her, but between the swelling and stitches, she couldn't get a good latch. We tried to get her to take a bottle with a little pedalite in it, but she did NOT want that! After realizing she couldn't latch, she nuzzled in against my chest and rested. She was released after a couple hours in recovery.

Over the next few days, she began to nurse more. Her lip flanged and it sounded like she was able to take nice, deep gulps of milk. Unfortunately, what she couldn't tell me, was that my milk supply had taken a dive over the last month. That, coupled with her weakened oral muscles, meant that she was not getting close to the minimum amount of milk she needed for her body to maintain, let alone grow and thrive. 2 weeks after her surgery, I noticed that she still looked very thin. I weighed her and was horrified to see that in the past 2 weeks she had lost a FULL POUND! I called her pediatrician that morning and took her in that afternoon. After an assessment, she called Milwaukee Children's Hospital and got Tatum a room. She was pre-admitted and we drove up there that night.
Late September everything is well, 6 weeks later she needs to be hospitalized.
Two days of tests showed nothing wrong genetically or metabolically  no parasites, no bacterial or viral infections. During that time, we began doing pre and post feed weights. It was then that it was discovered that she was getting less than an ounce each time she nursed, sometimes much less. I asked why she wouldn't be wanting to nurse even more. If she was starving and needed more, wouldn't she want to be latched all day long? I had always nursed on demand. I NEVER put limits on the time or frequency of her nursing sessions. It was explained that her body had gone into an anorexic state. She no longer had the drive to nurse more often.

I began pumping around the clock to increase my supply and took every supplement you could think of. When they tested the calorie content of the milk I was making, it was much higher than expected. Baby formula contains 20 calories per ounce and human milk averages about the same depending on the needs of the baby nursing. My milk was averaging 26-28 calories per ounce. I was trying to compensate for the lack of volume, but it still wasn't enough. To supplement we tried several bottles, a supplemental nursing system, and finger feeding, but she refused them all. The team of doctors and I realized that the last thing she needed was an aversion to eating, so it was decided to place an NG tube. All supplementation would be done through that.

Because it had been weeks since her stomach had more than an ounce or so of milk, supplementation had to be done slowly at first. In spite of the limited amount of nutrition she was getting, her sugar levels and liver function were within normal ranges. They feared that if they all of a sudden gave her 4ounces, her body would go into shock. We worked her up one ounce every 2 days (per feeding) until she was getting 3 ounces total per feeding. We did pre and post nursing weights to calculate how much she needed through the NG tube. After being admitted a week, she was released. The plan was to continue supplementing through the day (for 5 of her on demand feedings) and allow her to nurse on demand through the night.

Over the next several weeks she became stronger and more enthusiastic about nursing. Most mornings she was able to get her full 3 ounces (or more!) directly at the breast. My supply was on the upswing and she was tolerating supplementation well. Because ounce for ounce solid food provides fewer calories, we didn't start offering solids regularly until around Christmas time. She enjoyed dinnertime very much! We would give her a little of whatever we were eating and add a little extra organic butter or coconut oil to hers.

Tatum is going to become a big sister this Spring. I do not fear birth. I adore being pregnant. I am excited for the new baby smell. I am terrified of dealing with another lip and/or tongue tie. I am lucky that we have a pediatrician that understands the importance of getting any issue resolved as soon as possible. This was an experience that I wouldn't wish on any parent. 
This was the lip tie. The picture was taken on 10/24/2012, a few days before it was clipped.

This was the lip tie. The picture was taken on 10/24/2012, a few days before it was clipped.

I took this a couple weeks ago. The little nub on her upper lip is the scar from the surgery. That nub was attached to her gums down where her front teeth come in, hence the gap.
I took this a couple weeks ago. The little nub on her upper lip is the scar from the surgery. That nub was attached to her gums down where her front teeth come in, hence the gap.

Tongue Tie Resources:





Posterior Tongue Tie Information


Diagnosing Tongue-Tie in a Breastfed Baby: Tight frenulum can cause painful breastfeeding and poor weight gain


Dr. Kotlow Articles on lip/tongue tie 




Self Help for tongue tie and latch (photos and descriptions which may help you find tongue tie yourself, plus tips on improving latch)

Breastfeeding with an upper labial tie (lip tie)

Trouble Breastfeeding? Look in your baby's mouth. (Overcoming lip and tongue tie with an older baby)

To share with a reluctant provider: The American Academy of Pediatrics' newsletter on tongue tie and breastfeeding

The Myths About Painful Breastfeeding





Friday, December 14, 2012

What Causes Low Milk Production?

Many mothers worry that they may not produce enough milk for their babies. Well-meaning friends and relatives share their own experiences or stories they have heard from others in an effort to prepare expectant mothers for the worst. Even before their babies arrive, mothers may hear alarming reports:


  • "I tried to breastfeed, but I couldn't make enough milk."
  • “My milk never came in."
  • "My milk suddenly dried up!"
  • "Your mother had to supplement, so you will, too."

Most mothers have heard at least one of these reports before their own babies arrive. The good news is that the majority of women can produce all the milk their babies need for healthy growth and development. More often than not, concerns about milk production are simple misunderstandings of normal newborn behavior or breastfeeding management issues that can be fixed. Rarely, a woman may have a physical or hormonal condition that makes it difficult to build or maintain milk production. One study suggests these conditions occur in about 5% of the population of women (Neifert, 2001). The following sections outline some of the medical causes of low milk production:

Maternal Conditions Related to Low Milk Production

Insufficient Glandular Tissue: During puberty, progesterone and estrogen signal the growth and development of the mammary (breast) glands. Active growth of ductal tissue takes place during each menstrual cycle. In rare instances, the glands do not grow or develop fully during puberty, and insufficient glandular tissue, known as breast hypoplasia, may result (Neifert, Seacat, & Jobe, 1985). Some women with insufficient glandular tissue may have breasts that are unusually shaped or appear not to be developed at all. Some women may have breasts that seem to be fully developed but have a limited capacity to produce milk because fatty tissue is present, but glandular tissue is not sufficient. During a normal pregnancy, glandular tissue continues to develop, and there is usually (but not always) a noticeable change in breast size, increased sensitivity or tenderness, visible veining on the breast, and darkening of the areolas. Some signs of breast hypoplasia are:
  • “oblong”, tubular shaped breasts
  • “flat,” underdeveloped breasts
  • widely spaced breasts (more than 1.5” apart)
  • breast asymmetry (one breast noticeably larger than the other)
  • very large or “puffy” areolas
  • absence of noticeable breast changes during pregnancy or after birth
Any or all of these signs do not always indicate that a woman is unable to produce milk, but they should prompt women and their health-care providers to be aware of potential problems and have a plan of action to overcome them. Women with signs of insufficient glandular tissue are encouraged to develop a breastfeeding management plan with an International Board Certified Lactation Consultant (IBCLC) before they give birth.

Breast Surgery: Milk ducts may be cut, and nerves can be damaged as a result of surgery. The milk ducts may "re-grow" (recanalize) during pregnancy as the breast changes rapidly in preparation for lactation. Mothers who are unable to produce enough milk to meet the needs of a first baby may have better milk production with the next child as a result of breast development that occurs with each pregnancy. Sometimes, chest surgery or injury may result in nerve damage that affects the milk ejection reflex, or rarely, it may cause damage to the glandular tissue of the breast and result in a decreased capacity to produce milk. Mothers who have had breast, nipple, or chest surgery or injury may find the evidence-based website, Breastfeeding After Breast and Nipple Surgeries, to be helpful and encouraging.


Hormones: Many mothers with a hormonal imbalance such as Polycystic Ovary Syndrome (PCOS) have reported trouble producing enough milk for their babies. To date, PCOS, other hormonal disorders, and related conditions such as insulin resistance and infertility are not well-understood in terms of how they may affect milk-production. Some women may produce excess milk, while others struggle to meet their babies' needs. There are medical treatments which may help maintain balance and an adequate milk supply. A woman who thinks she may suffer from a hormonal imbalance should discuss her concerns with a health-care provider and develop a breastfeeding management plan with an IBCLC before she gives birth.


Impaired Thyroid Function: Hypothyroidism is common in women and may affect “4-10% of women” in the postpartum period (Ogunyemi, 2011). Both Hyperthyroidism and hypothyroidism result in irregular production of the hormones T3 and T4 which act on the metabolism of the body. Women who are experiencing low milk production may benefit from having their thyroid hormone levels tested so that problems may be treated. Many mothers with these conditions will have improved milk production when their symptoms begin to resolve.


Hormonal Birth Control:  The use of combined estrogen/progesterone hormonal birth control is associated with low milk production. Many breastfeeding mothers are prescribed progestin-only hormonal birth control because it does not typically decrease milk production. However, it can be associated with a decrease in milk production in some women especially if started before 6 weeks postpartum. Women who are planning to breastfeed should discuss alternative forms of birth control with their health-care providers.


Retained Placenta: The detachment of the placenta signals a cascade of hormones that cause the milk to "come in" after the baby is born. Even a tiny piece of placenta left attached to the wall of the uterus may cause the mother’s body to “think” it is still pregnant. When the placenta does not completely detach as it should, progesterone levels stay too high to allow copious milk production. When the placenta is shed or removed, the mother's milk production is likely to increase (Neville & Morton, 2001). Retained placenta can be very serious. Health-care providers will explain warning signs to watch for, such as very heavy postpartum bleeding. 


Excessive Blood Loss: When an abnormal amount of blood is lost during childbirth or through postpartum hemorrhaging, the system that triggers the release of prolactin (the “milk making” hormone) in the pituitary gland may be interrupted, and inhibit milk production. 



Infant Conditions Related to Low Milk Production

Latch: A baby who is not attached well and positioned comfortably at the breast may be unable to transfer milk efficiently. An ineffective latch may result in:


  • damaged nipples
  • disorganized sucking
  • fussiness at the breast(Genna, 2008)

A common solution for pain during breastfeeding is to ensure baby is positioned comfortably, stabilized, and given assistance to latch deeply. Sometimes, however, a change in position and a deeper latch do not resolve pain, and there may be a structural problem such as tongue tie, lip tie, or high palate. When breastfeeding discomfort continues despite position and attachment changes, an IBCLC can help with assessment, recommendations for feeding, or referral, if necessary, to other professionals that can assist with treatment.

Suck Dysfunction: If baby is not able to suck effectively and remove milk from the breast, the result may be low milk production. Suck dysfunction is associated with some medical conditions, early birth, low muscle tone, and other problems which should be addressed by a IBCLC or other health-care provider. Some of these babies may tire at the breast while feeding, while others may use their tongues ineffectively or have trouble coordinating the behaviors associated with feeding (Genna, 2008). Sometimes, position changes that increase “positional stability” for the infant (Colson et al, 2008) may be helpful. Some babies improve dramatically with age, but in many cases, close attention from a IBCLC or other health-care provider is also necessary.


Non-Medical Causes

Infrequent Nursing: In many cases of low milk production or slow weight-gain, the baby simply needs to nurse more often. Healthy newborns breastfeed an average of at least 10-14 times in 24 hours, and most babies must feed frequently in order to take in enough milk. Many babies who are not gaining weight well simply need more time at the breast, and some babies need encouragement in order to feed more often. A mother may help this process by offering the breast every 1-2 hours and paying close attention to signs that the baby is hungry or satisfied. When the breast is drained, the body responds by making more milk. Placing the baby directly onto the bare skin of the mother's chest facilitates intimate contact between the two of them and is associated with more frequent breastfeeding and greater milk production. All babies need unrestricted access to the breast in the first three weeks, when the body is “primed” to learn to make enough milk (De Carvalho, 1983). 

Many factors can lead to babies spending too little time at the breast:

  • Early formula supplements can lead to less breastfeeding and lower milk production.
  • Frequent visitors, traveling, or entertaining can reduce the time a mother spends alone with her baby, skin-to-skin, and breastfeeding. Early feeding cues can be missed if mother and baby are not together or the baby is sleepy or overwhelmed from being passed from person to person.
  • Scheduling, delaying, or limiting breastfeeding restricts the amount of milk a baby is able to remove and how much a mother can produce.

By responding to the needs of her baby when he indicates a desire to nurse, a mother eliminates the hazards of restricting access to the breast. A new family may benefit by limiting distractions and visits from well-meaning family and friends for a few weeks after birth. If people are eager to help with the new baby, the mother can suggest they provide some meals, run errands, or help with some housework. Nursing at the first sign of a hunger cue in the early weeks, can help protect milk production in the long term.


Lack of support: Many mothers experience a lack of support for breastfeeding from their communities. Well-meaning friends, family members, and even health-care providers may undermine breastfeeding by inadvertently giving inappropriate advice.  Some health-care providers have little or no training in human lactation and may not be providing the most accurate information about breastfeeding. Family members may want a turn to bottle-feed the new baby. Friends might not be familiar with breastfeeding and question how frequently the baby is at the breast. These situations may result in less breastfeeding and lower milk production.


Misunderstanding normal infant behavior: A fussy or unhappy baby is not always a hungry baby. Mothers and those around them may be concerned that a baby who is fussy or needs to nurse frequently is not getting enough milk. It is not uncommon for a newborn to nurse for 20 minutes and then be ready to nurse again 10 minutes later. The mother is often told, “He can’t be hungry; he just ate,” or “You’ll spoil him.” This kind of advice can lead to giving supplements when they are not needed. Instead, a mother may need to be reassured that her baby is getting enough milk at the breast.

When Supplementation is Necessary: Sometimes babies do not gain weight at the minimal expected rate for health and development and need temporary additional nutrition. Ideally, a supplement should be the mother's own milk or donor human milk. In the early days, if a supplement is necessary, mothers should be encouraged to hand express and supplement with their own colostrum as demonstrated in this video from Stanford School of Medicine: Hand Expression of Milk. Sometimes, a mother is not yet producing enough milk to feed as a supplement and uses formula. Whether a mother supplements with donor human milk or formula, she should be encouraged to express her milk in order to maintain (or increase) her milk production. Because formula takes longer to digest, many babies who are taking supplemental feedings exhibit less-frequent hunger cues. Over time, a baby receiving this kind of supplement may feed less frequently, and if the mother is not also removing milk as frequently as her baby would normally demand, decreased milk production may result. 


If a mother does not breastfeed and/or express her milk frequently or fully enough, an unproductive cycle can develop quickly; baby fills up on formula and spends less time at the breast. Baby spends less time at the breast, so the mother produces less milk. Mother produces less milk, so she gives more non-human milk, and so it continues until she is no longer making enough milk for her baby. This cycle can often be reversed if the mother instead makes sure to increase time at the breast, remove milk frequently, and use breast compressions while nursing.


If a baby needs supplemental feedings it is important to explore all of the possible maternal or infant causes of low milk production in order to help restore full breastfeeding. Supplemental feedings, while sometimes necessary, do not address the underlying cause of low milk production. Identifying the cause of the problem, if possible, may help determine the best solution. While supplemental feedings may be part of the plan of action, steps should be taken to ensure that the goal is that exclusive breastfeeding resume. 


If you need help making more milk, or if you are worried if your baby is not getting enough milk, an International Board Certified Lactation Consultant or community breastfeeding support worker may be able to help. Finding the support you need can help you reach your breastfeeding goals.



Related Articles

Losing Your Milk: What seems like dwindling milk can actually be normal changes in baby and you

Resources

Breastfeeding After Breast and Nipple Surgeries
Hidden Hinderances to a Healthy Milk Supply
Lowmilksupply.org
Making More Milk
MOBI Motherhood International


References

Akre J. E., Gribble, K. D., & Minchin, M. (2011). Milk sharing: from private practice to public pursuit.  International Breastfeeding Journal,  6(8). Retrieve December 12th, 2012 from International Breastfeeding Journal Website: http://www.internationalbreastfeedingjournal.com/content/6/1/8


Colson, S. D., Meek, J. H., & Hawdon, J. M. (2008). Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development,  84(7), 441-449.


De Carvalho M, Robertson S, Friedman A, & Klaus M. (1983) Effect of frequent breast-feeding on early milk production and infant weight gain. Pediatrics, 72(3)


Genna, C. W (2008). Supporting Sucking Skills in Breastfeeding Infants. Sudbury: Jones and Bartlett Publishers.


Kent, J., Mitoulas, L., Cregan, M., Ramsay, D., Doherty, D., & Hartman, P. (2006). Volume and frequency of breastfeedings and fat content of breastmilk throughout the day. Pediatrics, e117(3).

Lieberman ,T. (2011). Booby Traps Series: Postpartum hemorrhage and retained placenta – Two birth-related causes of low milk production. Best For Babes. Retrieved December 12th, 2012 from Best for Babes Web Site: http://www.bestforbabes.org/booby-traps-series-postpartum-hemorrhage-and-retained-placenta-two-birth-related-causes-of-low-milk-pr


Marasco, L., PCOS and Breastfeeding. Retrieved Decemeber 12th, 2012 from Hcp.obgyn.net website: http://www.obgyn.net/displayarticle.asp?page=/pcos/articles/childers-chats Neifert, M.R., (2001). Prevention of Breastfeeding Tragedies, Pediatr Clin North Am., 48, 273-297.


Neifert, M.R., Seacat ,J.M., Jobe, W.E., (1985). Lactation failure due to insufficient glandular development of the breast, Pediatrics, 76(5), 823-8.


Neville, M.C., Morton, J. (2001). Physiology and endocrine changes underlying human lactogenesis II. J Nutr., 131(11), 3005S-8S.


Ogunyemi, D. A. (2011). Overview. In Autoimmune Thyroid Disease and Pregnancy.

Retrieved April 8, 2012, from Webmed LLC Web Site: http://emedicine.medscape.com/article/261913-overview


Pennington, S. S., Abrams, A. C., & Lammon, C. B. (2009). Physiology of the Endocrine System. In Clinical Drug Therapy (9th ed., p. 341). Philadelphia: Lippincott, Williams and Wilkins. (Original work published 2001)


The Academy of Breastfeeding Medicine Protocol Committee (2005). ABM Clinical Protocol #13: Contraception During Breastfeeding


West, D., & Marasco, L. (2009). The Breastfeeding Mother’s Guide to Making More Milk. McGraw-Hill.


© Jolie Black Bear, IBCLC, Serena Meyer, IBCLC, Teglene Ryan, and Adrienne Uphoff, IBCLC--All Rights Reserved

Saturday, September 15, 2012

Breastfeeding a Baby with Lip and Posterior Tongue Ties

Today I have a guest post from a mom, Diane Coombs of New Foundland, Canada, who shares her story on breastfeeding a baby with lip and tongue tie.

My baby girl is nine months old today! Our breastfeeding relationship got off to a rough start because of an undiagnosed posterior tongue tie and lip tie. The pediatrician in the hospital did not diagnose her, neither did our LC nor family doctor. I was told over and over it was 'poor latch' or thrush or 'lazy feeder.' All were incorrect.

Scarlett was gagging, coughing, extremely gassy, and she 'clicked' with each suck, my poor nipples were being crushed and so badly abraded my daughter would spit up blood after feeding. Nursing was making her so tired, she was sleeping through feeds to conserve calories, and was losing weight in a vicious cycle.

I researched what could be causing our issues, trusting my gut that there was something more wrong besides the diagnosis given. I went to a LLL meeting and met a mom whose story matched mine. She was unable to get her son treated locally so she went to see Dr. Kotlow, a pediatric dentist in Albany, NY - the leading expert in the field of tongue and lip tie. Immediately I got in touch with Dr. Kotlow. He diagnosed the problem via pictures I sent him, and I quickly booked our flight: 1500 miles from Eastern Canada to Albany. She was treated (laser revision) and immediately, she latched PERFECTLY!

I am not saying each baby with latch issues is tongue or lip tied, (and not every baby with a lip and/or tongue tie has trouble breastfeeding) but if you are having problems, and seem to have no answers - research it and see if tongue tie (especially POSTERIOR tongue tie) and/or lip tie is the issue. Here are some places to start:

The Hidden Causes of Feeding Problems?

Posterior Tongue Tie Information





Self Help for tongue tie and latch (photos and descriptions which may help you find tongue tie yourself, plus tips on improving latch)

Breastfeeding with an upper labial tie (lip tie)

Trouble Breastfeeding? Look in your baby's mouth. (Overcoming lip and tongue tie with an older baby)

To share with a reluctant provider: The American Academy of Pediatrics' newsletter on tongue tie and breastfeeding

The Myths About Painful Breastfeeding

I hope you don't have to jump through as many hoops as we did, and I hope you have someone closer to you who is an expert in the field. See the list of frenotomy surgeons here to find one near you: http://www.lowmilksupply.org/frenotomy.shtml

Cheers, and happy breastfeeding!

She's about 7.5 months here.


WARNING ON NEXT PIC: Post revision scar of the lip tie - might make some squeamish! Before's on the left, after's on the right. The whole look of her face changed! The before pics were takes two weeks before the after.


Her posterior tongue tie - very hard to diagnose unless you know what to look for.


Here is a video on finding a posterior tongue tie:



This is an excellent video on post-frenectomy exercises: Frenectomy Exercises with Melissa Cole of Luna Lactation

If you need help with breastfeeding, or suspect your baby has a tongue or lip tie, a Breastfeeding Counselor La Leche League LeaderNursing Mother’s Counsel or International Board Certified Lactation Consultant may be able to help.

Have you breastfed a baby with tongue and/or lip tie? Did you find the help you needed in your area?

Thursday, September 6, 2012

Good for the Whole Family

I’ve often heard moms say that they don’t have time to breastfeed because they have older children to take care of. They don’t have time to “sit around nursing all day”. So what if you do stop breastfeeding so that you can have more time to spend with your older children? What does that teach the older children? That baby’s needs don’t matter? That if something is inconvenient then you just switch to something easier, even if the inconvenient thing was better? The truth is kids are really inconvenient (not to mention loud, messy, and demanding). Why is breastfeeding so often at the top of the list of things to be tossed? I love how this mom points out, “Some portion of ‘The Family Schedule’ belongs to you (the nursing baby).”

I was there once. I was surprised when I heard myself think it. I considered not breastfeeding because it would take too much of my time and energy to do it. How could I, of all people, consider that as an option? My situation was a little different than most because my baby was a bit of a surprise and came to us through adoption, so I had no milk. I was needing to induce lactation.

Baby came home to us in July 2009 at 18 days old. My older kids, two boys, "Scootch", 7, and "Curly", 9, were on summer break from school. However, we had decided that when school began again in August they would not be going back. From now on we would be homeschooling. Several people asked me when we got the baby, “You’re not still going to try to homeschool are you?” The truth is the thought never crossed my mind not to. We had taken a long time to make this decision to homeschool. We had decided that this was what was best for our two boys. Now that we had a new baby girl the needs of my boys did not suddenly change. It was still best for them to stay home. The reverse was true as well. This baby needed to be breastfed, regardless of the schedules and needs of other family members.

Baby sister meets big brother 
When my boys were babies I took all of the time I needed to make breastfeeding work. Why should it be any different for this baby?

I had about 6 weeks of summer left and I started the process of relactating. It was so frustrating to have this baby and no milk! It took a lot of time. A few weeks into the school year and I was beginning to doubt that I could do it all. To make things even harder she was premature weighing 3 lbs 2.8 ounces at birth, and only 4 lbs 0 ounces when she came home. She had a weak suck and she could not draw milk through an at breast supplementer meaning I needed to spend even more time pumping and bottle feeding while practicing at the breast.

I confided in my good friend, “I don’t know if I can do it. I don’t have the time. How can I do a good job homeschooling the boys when I’m spending so much time with her trying to bring in a milk supply? All the time at the breast, pumping, mixing formula and preparing the bags for the Lact-Aid. Maybe I should just give up on the whole breastfeeding thing.”

My friend could see the bigger picture when I could not. “It is important to the boys too. Their sister is important to them. Let some of the school work and other things go.” That was over 3 years ago and I still remember her words. She is important to them.


Scootch and Baby sister

She was right. This tiny baby girl meant everything to the boys. They loved their little sister. This was just as good for them as it was for her. I couldn’t see it then, but three years later I can see it.

Curly and Baby sister
What did they learn by watching me work so hard to breastfeed her? First, they learned an awful lot about inducing lactation! They would watch me pump. When I first started to get drops of milk Scootch (7) walked up and saw the little bit of milk in the bottle. He started jumping up and down and called for his brother to come see, “She’s getting milk, she’s getting milk!” I had no idea they’d be so excited.

They watched me spend countless hours nursing their little sister. They watched as the bottles were replaced by the Lact-Aid, and then the formula supplements gradually went away altogether.




They learned that their little sister was important. That babies are important and that they deserve to have their needs met. They learned that nursing was important, even if you don’t make enough milk. They learned that everyone in the family is important, and that we do what we need to do to take care of each other. They’ve learned that family is more than just DNA.

We did school work while I wore baby sister in the Moby wrap. When she got bigger, they wanted to wear her in the back pack. They were learning how to love and care for a baby.



They wanted her to have the best, just like I did.


The fact that she was important to them was reason enough to spend the time and work hard for breastfeeding to work, even if it meant I had less time to spend doing certain things with them.



Letting her play with their Legos is proof of how much they love her!

One homeschool project was building a sled for little sister.


Now that she is three, she knows how to pester her big brothers, and she does! She can be the annoying little sister, but these boys love this little girl. They would do anything for her. Taking the time to bring in a milk supply and breastfeed her did not take away from them, instead it gave them, and all of us so much!

Then there is always this argument:



Tuesday, September 4, 2012

Increasing milk production and weaning from supplements

Before working to increase milk supply, make sure there is a true supply issue first! Take a look at these articles to first see if you have low milk production:


The golden rule of milk production: The more frequently and completely the breasts are drained, the more milk will be produced: How Mother’s Milk  is Made

Increasing milk production:

  • offer both breasts two times at every feeding
  • use breast compressions
  • nurse frequently (at least 12-14 times in 24 hours)
  • increase skin to skin contact
  • rest, and stay hydrated

What this process looks like:

Offer baby the first breast and allow him to nurse as long as he likes. When he starts to slow down on his sucking/swallowing start doing some breast compressionsWhen you squeeze your breast you should see baby respond with an increased sucking/swallowing. Baby has “finished” the first breast when breast compressions no longer get baby nursing more, baby falls asleep or lets go of the breast. When baby has finished the first breast offer the second breast. Repeat the above steps with breast two, (offer breast, use breast compressions and allow baby to finish the breast) then repeat the whole process again with both breasts. If baby is still hungry after taking both breasts two times, then you can continue the process, nursing on one side and then the other, until he is full and/or falls asleep.

Mom resting with baby after nursing with a starter SNS
When working to increase milk production, increase milk intake, or work to eliminate supplements, spending as much time as possible resting with baby skin-to-skin on your bare chest, encouraging frequent nursing, can make a big difference in a short amount of time. This can also be a chance for mom to rest, with baby napping on her bare chest. It can be a great time to have a movie marathon. If you have older children they can be movies to entertain them while you and baby rest and nurse.

Weaning from supplements:

Consider using an at breast supplementer instead of bottles for the supplemental milk. This will provide extra stimulation to your breasts and prevent a preference for bottles.

Lact-Aid at breast supplementer


If you are using bottles make sure you are giving them in a way that supports breastfeeding and minimizes flow preference. Bottle feeding in a way that supports breastfeeding includes:
  • Using a slow-flow soft bottle nipple that has a wide base and a shorter, round nipple (not the flatter, orthodontic kind).
  • Starting by resting the tip of the nipple on the baby's upper lip and allowing him to take it into his mouth himself, as if he were nursing.
  • Keeping the bottle only slightly tilted, with the baby in a more upright position, so he has to work to get the milk out. If you hold the bottle straight down, the milk will come out too fast, and he may feel overwhelmed by the flow (Kassing, 2002).
More information on bottle feeding in a way that supports breastfeeding: 

If you are currently supplementing with a bottle at every feeding, baby may expect that the time at the breast is always followed by a bottle. If you are using an at breast supplementer at every feeding, baby may expect the constant flow of milk from the tubing whenever he is at the breast. The first step towards eliminating supplements is to get baby comfortable with nursing without supplements at every feeding. Begin by encouraging comfort nursing between feedings, for at least a few days, before you begin to eliminate supplements. If baby is using a pacifier between feedings begin to replace the pacifier with your breast as much as possible.

Nursing without supplementing

If baby is gaining weight on target and is showing signs of getting enough milk then you can safely begin to wean off of supplemental milk.

One way to do this is to start by eliminating the first supplemental feeding of the day. Follow the steps above to nurse multiple times on each breast and use breast compressions. If baby is still having enough wet diapers (5 per day, plus at least 3 poops if baby is under 4-6 weeks old) then after a few days you can eliminate the next supplement of the day. Eventually you will get to where you are only giving one supplement in the evening and that will be the last one to drop.

Common Questions and Concerns:

I’m afraid to cut back on supplements, I ‘m worried my baby will starve!
Taking away one supplemental feeding will not cause your baby to starve or get dehydrated. You need for baby to be hungry enough to want to nurse more as that will increase your milk production. You can always go back to more supplemental milk if you realize you cut back too much too soon.

I tried eliminating the first time I usually supplement, but baby was screaming and refusing to nurse any more before it was time for the next supplement.
Go ahead and give the next supplement. You can simply delay the time of the first supplement instead of just eliminating it. If you were to delay that first supplement by one hour every day, by 24 days you would no longer be supplementing.

My baby seems hungry 10 minutes after taking both breasts. Does that mean it is time to give a supplement?
No. If baby is hungry again soon after nursing on both sides, offer both sides again. And again. Your breasts are never “empty”. As you continue to nurse, your body continues to produce milk.

How can I nurse so frequently? My breasts don’t have time to “fill up”.
Your breasts are never empty and don’t need time to “ill up”. The emptier the breast is, the faster it tries to refill - similar to an automatic icemaker. Emptier breasts make milk faster than fuller ones (How Mother’s Milk is Made).”

If I eat better and drink more water, will I make more milk?
“Research shows that the mother's diet, her fluid intake, and other factors have little influence on milk production. If the "milk removal" piece of the puzzle is in place, mothers make plenty of good milk regardless of dietary practices. If the "milk removal" part isn't there, nothing else can make up the difference (Smith, 2001).”
The more milk is removed the more milk you will produce. Pumping will remove more milk and help to increase your milk production. However, if you are nursing at least 12-14 times in 24 hours it will be hard to fit in pumping. Some thnigs to ask yourself include: Is it worth the additional stress? Would it be better to spend that time resting with your baby skin-to-skin? If you do pump, you can use it to replace any other milk you have been using to supplement.

Resources
Book: The Breastfeeding Mother's Guide to Making More Milk By West and Marasco

Bottles and At Breast Supplementers