2012 Breastfeeding Conference: The Latest Research

September 24, 2012
breastfeeding houston

by: Renee Bowling, RN, CBFE

Breastfeeding ConferenceI was extremely lucky to be able to attend a breastfeeding conference recently in San Antonio, TX. The 3 presenters included Dr. Thomas Hale, Dr. Jack Newman and Barbara Wilson Clay. They are considered to be some of the leaders in breastfeeding research and clinical care.

Dr. Hale is a clinical pharmacologist with Texas Tech University and runs the Infant Risk Assessment Center in Amarillo, Texas. He is also the author of Medications in Mother’s Milk, along with many other lactation books. He is considered a world expert on medications during pregnancy and breastfeeding. He is currently doing research on many different drugs and breastfeeding including Domperidone, which is a drug used to increase milk supply. He has an excellent website with information on depression medications during pregnancy and breastfeeding, nausea during pregnancy and much more. Health care professionals and patients can both contact The Infant Risk Center to get answers on medication safety during pregnancy and breastfeeding.

His lectures at the conference included:
• Control and Production of Human Milk – Medications that Increase Milk Production
• Anesthetic and Epidural Medications in Breastfeeding Mothers
• Antidepressant Drugs in Pregnant and Breastfeeding Mothers
• Managing various Diseases in Breastfeeding Mothers

These are just a few of the things he talked about that I would like to share with you.
• Mothers with gestational diabetes have a higher risk of postpartum depression
• Mothers who breastfeed get more sleep than mothers who formula feed. (My thought is that this does not happen in the very beginning.)
• Breastfed babies need 400 IU/day of vitamin D. There is no vitamin D in breast milk.
• Epidurals are systemically absorbed, so the level in mom’s plasma is the same level in the baby’s plasma. If you get an epidural, wait till you are at least 5 cm. There are less side effects and fetal sedation.
• The more Pitocin drug used (used to induce labor or increase contractions) the less oxytocin (hormone that causes the milk to let down) released the first 3 days.
• The breasts produce the same amount of milk around the clock.
• A graph on his website can be found to determine the length of time it takes to eliminate alcohol from breast milk, based on mother’s weight.
• Every ounce of formula used is one ounce of breast milk you will not make.

Breastfeeding Conference Dr. Jack Newman is a pediatrician in Canada that runs the Newman Breastfeeding Clinic and Institute, which is part of the International Breastfeeding Center. He has a wonderful website with client handouts on numerous breastfeeding issues, including latching. There are many videos, including one on which shows how to tell the baby is drinking milk from the breast. He also has a protocol to follow for mom’s who want to breastfeed their adopted infant.

His talks included:
• When the Baby Does Not Latch On – How Birthing Practices Affect Breastfeeding
• Hypoglycemia and Jaundice
• Late Onset Decreased Milk Supply
• Numbers on Demand – How Feeding Babies by the Numbers Is a Disastrous Approach

Here is some information he shared:
• Babies should never leave the hospital with a nipple shield, because almost all babies will latch when mom’s milk comes in, or by 2-3 weeks
• The Montgomery glands on the areola secrete a smell that encourages the baby to latch
• Babies can pick out their own mom’s breast pads even when there is no milk on them
• Heel sticks for hypoglycemia (low blood sugar) are not accurate. If the baby is showing symptoms of low blood sugar, a plasma level should be drawn. If a baby is truly hypoglycemic the best thing to give them is:
1st: colostrum
2nd: Pumped milk or donor milk
3rd: An I.V.
4th: Formula
Healthy full term infants born after a normal pregnancy and delivery, and who are not showing clinical signs of hypoglycemia do not require routine monitoring of glucose levels.
• Breastfed babies who have jaundice are babies who are not nursing well, and should be called “Not enough breast milk jaundice”
• Sleepiness associated with jaundice is more likely to be related to a decrease in calorie intake than to the jaundice itself
• “Most exclusive breastfed, well gaining babies are slightly jaundiced and this is normal. What is not normal is the absence of jaundice in formula feed infants. The breastfed baby is the norm.”
• When babies spit up breast milk, it coats their digestive track and protects it.
• Babies respond to milk flow, not the amount of milk in the breast.
• “Breastfeeding poorly 12 times a day is no better than feeding poorly 8 times a day”
• “Nursing Strikes” may actually be caused by a reduced milk supply

Barbara Wilson Clay is a lactation consultant in private practice in Austin, Texas. She helped found the Mother’s Milk Bank in Austin, and is a researcher, and author of many lactation books and educational material, as well as an active lobbyist with the Texas Legislature promoting breastfeeding as a health policy issue.

Her lectures included:
• Tricks of the Trade – Rousing the Sleepy Newborn
• Breastfeeding Management of the Late Preterm and Small for Gestational Age Infant
• Nipple Shields: What is the Evidence Basis?
• Lactation Case Studies: Breastfeeding Management of Infants with Special Feeding Issues

Here are some of the things she shared:
• “There is no sale by date on breastfeeding”
• Keep the baby skin to skin to increase breast focus
• When doing paced bottle feeds, give 3 swallows and then stop and allow for a breathing break. If milk is dripping out their mouth, then the flow is to fast.
• Medicaid covers donor milk and no one is turned away from the milk bank due to lack of ability to pay.
• A baby who has lost greater than 7-8 percent of birth weight will conserve energy by sleeping and is a red flag for failure of milk production. They need to be evaluated on the breast and improvements with nursing need to be made at this time.
• The most common reason for lactation consultants to use nipple shields was to help the less than 35 week baby latch and breastfeed
• Promotion of fast growth in small for gestational age infants by nutrient-enriched formula increases the risk of high blood pressure and obesity in later life. There are no advantages of using nutrient-enriched formula with regard to intellectual development.

I hope you enjoyed me sharing with you just some of the great information I received!

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The Importance of Breastfeeding Support

April 5, 2012
breastfeeding houston

By: Stephanie Duhon

The American Academy of Pediatrics and the World Health Organization recommend that moms exclusively breastfeed their babies for at least the first six months, but preferably longer. And according to the Centers for Disease Control and Prevention, more moms are achieving that goal in the United States. In 2011, 14.8 percent of 6-month-old babies were exclusively breastfed in the U.S. That’s an increase of 4 percentage points since 2007.

But despite growing evidence of the benefits of breast milk for babies and increased efforts to offer support to moms, that’s still a small number and a recent study out of Scotland suggests increasing that percentage is not as easy as it sounds. According to the report, published in the journal BMJ Open, researchers interviewed 36 pregnant women and a significant other about what it would take to breastfeed exclusively and why the ones who stopped choose to do so. The report says some of the women said breastfeeding wasn’t the bonding experience they were expecting and was much harder than expected, while others said they lacked a support system.

I can definitely relate to women who planned to exclusively breastfeed and yet still struggled. While breastfeeding is indeed natural, it is far from easy for most women. Breastfeeding takes a lot of time, practice, commitment and support. I learned that I could be doing everything “right” and still encounter problems.

My daughter was born in September 2010 and I fully intended to exclusively breastfeed her for at least 6 months. I know the benefits of breastfeeding and was excited to be able to offer my daughter the very best. I took a class, I read up on nursing and what to expect and had access to an amazing lactation consultant. I knew going in that it may be a bit difficult at first, but I was terribly disappointed when breastfeeding turned out to be much harder than I expected. My daughter didn’t latch well and it took her a long time to nurse. Despite nursing for what seemed like forever sometimes, she was not gaining sufficient weight. Per doctor’s orders, I had to supplement her with formula because her weight was too low. I pumped, I took supplements such as fenugreek to increase my supply and I dealt with painful clogged ducts because my daughter wasn’t properly draining my milk supply. I was devastated and thought I was doing something wrong. Renee, the amazing lactation consultant at The Motherhood Center, was extremely supportive and showed me different nursing positions and helped me figure out how to effectively use the breast pump. Unfortunately, I was never able to get my supply up completely, so I had to supplement breastfeeding with formula, but with the amazing support of Renee, as well as my husband and friends, I am proud to say that I overcame some of the other early obstacles and was able to successfully feed my baby girl at least some breast milk for the first six months of her life.

The key aspect I learned from my experience is not to be afraid to ask for help. Women go through many emotions after having a baby and when you combine the hormonal changes, lack of sleep and commitment of breastfeeding, it can become overwhelming very quickly. The Motherhood Center has wonderful resources to help moms reach their breastfeeding goals. In addition to lactation consultants, TMC offers hospital grade breast pumps to rent and has a large variety of breastfeeding supplies, such as nursing tanks and bras, nipple cream, My Brest Friend nursing pillows, nursing covers and more. Experienced staff members can help you determine what you need and can also help you figure out the proper size of nursing tank or bra, which as many moms know can be difficult to figure out!

One thing that some people may not know is that The Motherhood Center also helps local businesses offer support to moms! You may have heard of some offices having a pumping room for moms. These rooms are invaluable for moms who need to pump at work. It gives them the opportunity to pump in private and not have to spend the 15-20 minutes pumping at their desk, in the bathroom or closet or in their car. Breastfeeding experts say to successfully pump, you have to be relaxed so your milk can let down. That’s hard to do if you are worried about someone entering the room mid-pump!

TMC founder Gabriela Gerhart says moms who have support from their employers not only have an easier time exclusively breastfeeding, which can cut down on medical costs because of the health benefits of breast milk, but they are also more productive because they don’t have to worry about finding time and space to pump during the day to feed their baby.

Are you an employer who wants to learn more about creating a pumping room? Call us at 713-963-8880 and ask us about our corporate membership and how we can help you help nursing moms at your office.

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No Need to Panic Part III: Plugged Ducts

April 2, 2012
breastfeeding houston

by: Kimberly Bowman

If you notice a hard lump in your breast while breastfeeding do not burst into tears and call the oncologist. Instead, let your baby finish his calm nursing session and check for the lump’s perimeter. Have you noticed feeling run-down or any flu-like symptoms? If the answer is yes, take your temperature. If you have an elevated one, you may have mastitis and you will need to see your doctor for an antibiotic prescription. Do this without delay and read my previous post Anti-Antibiotics? Let it Go When Facing Mastitis.

Another possibility is that your answer to those questions is no and you are experiencing plugged ducts. By finding the edges of the lump you will be able to sufficiently massage it while nursing and apply warm compresses to help relieve any discomfort. It is safe for your baby to nurse while you cope with plugged ducts and will also help. Also gently massage the area while in the shower as the warmth and pressure can help clear the duct. Watch your symptoms for any increase in severity. Plugged ducts, and your susceptibility to them, are often pre-cursors to mastitis. They are a clear sign that you are overwrought.

When mom is overwrought, everyone in the family loses. Make sure your partner is aware of your situation. Extra rest and vigilance will keep you out of the doctor’s office but we ultimately have to take responsibility for trying to be in more than one place at a time. Knights in shining armor are super rare these days. If you want to be saved, you must rescue yourself. You only have two hands and one head. Use them in coordinated ways that enable you to get reasonable things accomplished while staying healthy. Putting yourself first ensures that everyone else gets a place in line for their dose of mommy.

Previous Posts:

No Need to Panic Part I: Breastfeeding Issues

No Need to Panic Part II: Blebs

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No Need to Panic: Breastfeeding Issues Part 1

March 12, 2012
breastfeeding problems

by: Kimberly Bowman

There you are, breast-pumping away while reading People. Ok, so it was The Economist but you were wishing it was People. When you glance down to revel in the collection of your one woman milk factory, you notice that the milk is a bit orange and there is bright red blood at your nipple. Bright red blood is generally not a welcome sight outside the body. Orange breastmilk, for that matter, isn’t in the realm of welcome sights either. In this situation however, it is likely that there is nothing to worry about.

There are many reasons why blood can present in breastmilk. The most common is ruptured capillaries close to the surface in the nipple. Vascular engorgement will cause the “rusty-pipe” look to milk as mentioned above. The changes that breasts go through during pregnancy and the increased blood flow can cause this phenomenon. First time mothers are the most common sufferers and generally they experience this in both breasts. Nipples that have become cracked can also be a source of blood. Latch is always the key to successful breastfeeding and getting your nipple far enough back in your baby’s mouth will prevent it being compressed against the hard palate instead of the soft one. Remember, it is breastfeeding, not nipplefeeding.

Another reason, though less common, for blood in breastmilk can be intraductal papillomas, caused by fibrocystic breast disease. These benign lumps are located in the milk ducts and cannot be felt. This generally occurs in only one breast and resolves on its own.

While it can be downright frightening to see blood in your breastmilk, think of the simplest explanation first. The small amount of blood will not harm your baby and you are encouraged to continue pumping and breastfeeding. Should this condition last for more that two weeks after birth, consult your doctor and a lactation specialist about the next step.

When you embark on any journey in life, one of the most important things you must take along is your sense of humor. While we discussed blood in breastmilk here, the fact is that we’re still talking about boobs and that is funny. There are plenty of things in life to cry about. Make sure you are really dealing with one of those things before you start shedding the tears. First, laugh out loud at your rusty pipes. Then pay attention, give it some time and proceed with caution.

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What is a Hooter Hider??

May 19, 2011
hooter hider

by: Rachel McKenny

If you plan to breastfeed, you’ll want to know the answer to that question. Hooter Hiders are made by Bebe au Lait and they are my absolute favorite nursing covers on the market! When you need to breastfeed discreetly (and even stylishly), this is your product! Bebe au Lait actually has two lines of nursing covers- the Bebe au Lait line and the Hooter Hiders line. Both styles have the feature that makes these nursing covers unique: a rigid neckline that allows for ventilation and gives you the ability to make direct eye contact with your baby.

Your mom or grandma may tell you to just throw a blanket over yourself. I disagree. Bebe au Lait nursing covers allow you the privacy you desire, without cutting you off from bonding with your baby (or cutting off your baby’s air!) Each cover is generously sized to keep you completely covered and is made of 100% cotton. The covers have adjustable D-ring neck straps, and side pockets to store breast pads or pacifiers. Bebe au Lait and Hooter Hiders are machine washable and come in a variety of super cute prints to satisfy every mama’s personal style.

The differences between Hooters Hiders and Bebe au Lait covers are minimal. It basically comes down to which print you like best. (Each line has its own set of fabrics to choose from).Hooter Hiders have visible pockets on the front with a ruffle detail, versus Bebe au Lait’s hidden pockets (on the inside of the cover) that are made of terrycloth.

As an added bonus, Bebe au Lait and Hooter Hiders retail for only $35! I think it’s a great price- especially since the covers are nicely made and are multi-functional. I’ve seen moms using them as blankets and as sunshades to protect their baby’s skin.

Here at The Motherhood Center we just received a new arrival of adorable prints for summer! Check out this week’s video on Bebe au Lait- and don’t worry, I don’t try to demonstrate breastfeeding. :-)

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Bringing the Baby Home

April 11, 2011
houston breastfeeding

by: Kimberly Bowman

There is a great cartoon showing a mother in the hospital bed with the baby and the father, dutifully standing next to her. All three have thought balloons above their heads reading “Now what?”

During your pregnancy you likely went on tours of where you would give birth, took classes on infant care, CPR and breastfeeding. You prepared and purchased, installed and assembled. The baby has seventeen different places to sit and more blankets than he’ll ever need along with books, toys, stuffed animals, a DVD titled How to Speak a Foreign Language When You’re Under 3 Months Old and a college fund. Now the baby is here and he is small, not that cute and doesn’t seem to play with the twelve different rattles in his room. He hasn’t even seen his room. You remember nothing prior to the birth, including everything from all those classes.

The first six weeks of a baby’s life are an exhaustive time, and yes, beautiful, magical, incredible, absolutely fantastic. Anyway, during this time the important thing to remember, aside from the massive amounts of information swimming about in your brain that you likely won’t need to recall for another six months, is that you and the baby are meant to do this: sleep, eat, heal, adjust. That’s it. Even if you are returning to work at the end of six weeks, allow yourself the true measure of that time to accomplish those four things. Sleep when baby sleeps, eat well, heal your body by following doctor’s orders and take one moment at a time.

The baby will nurse between 10-12 times in 24 hours and will often seem sleepy. He will be wrinkly and will contort his face in unimaginable ways. He may utter sounds like that of a grizzly bear. His poop will astound you. Enjoy his funny little body while you give him a bath. Pump if you need to make yourself more comfortable and nurse as much as you would like and he will accept. Wake a sleepy baby by changing the diaper, gently blowing on his head, removing his socks or burping.

Cute babies who are sitting up, smiling and are able to let go when they grab a fistful of their own hair are not newborns. Newborns are funny, amazing little creatures and will let you know, in no uncertain terms that they have arrived and will change all the rules. Letting them do this for a couple of weeks is OK. They won’t remember the thrill of the power but you will remember the letting go of the books and the classes and the learning of listening to your baby.

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The Mother and Baby Who Nurse Together, Drink Together

March 27, 2011

by: Kimberly C. Bowman

At one time mothers were encouraged to drink beer when nursing to relax and increase milk supply. While there may have been a connection to the Brewer’s Yeast content and that ingredient’s galactagogue (milk increasing) effect, it was likely a weak one. More likely is that the doctor’s opinion was that mothers who drank the occasional beer made better patients.

Alcohol is considered a compatible drug during breastfeeding. This means that it is possible to drink alcohol and safely breastfeed, but there are recommendations to ensure this. Alcohol leaves breastmilk as it leaves blood. The alcohol content of your breastmilk will peak between 30-60 minutes after consumption depending on your body weight and whether or not you have eaten. While pumping and dumping is unnecessary, as it will not speed the elimination of alcohol from breastmilk, it is wise to wait approximately three hours before nursing. Obviously, the more alcohol you consume, the longer it will take for your body and therefore your breastmilk, to metabolize it efficiently. Mothers who abuse alcohol can ultimately decrease their milk-ejection reflex and the babies of these mothers will nurse more frequently but ingest less milk. Over time, this could lead to slow weight gain or even failure-to-thrive. Alcohol abuse by a nursing mother is categorized by the consumption of two or more drinks, daily.

Babies who consume alcohol via breastmilk will often fall asleep quickly. How lovely, you think. The celebration will be short lived however, as it has been shown that baby’s sleep cycles going forward are interrupted. Not so lovely. Much the same way our sleep’s quality is lessened by too much drink, baby will experience wakefulness as a result and this will be all the more difficult to deal with if you have been imbibing.

By treating alcohol the way we do chocolate we can avoid the potential downfalls. Relax with a glass of wine after baby goes to bed so you can enjoy the benefits while keeping your breastmilk alcohol-free by the time you need to nurse again.

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Anti-Antibiotics? Let it Go When Facing Mastitis

March 9, 2011

by: Kimberly C. Bowman

When facing breast infection issues, it is important to know the differences between a plugged duct and a bacterial infection. A plugged duct comes on gradually, may shift in location with little or no warmth in the area. Pain is mild and localized with a temperature lower than 101F. A breast infection comes on suddenly, is localized, with redness and swelling, pain is intense and flu-like symptoms are accompanied by a temperature of 101F or higher.

The mastitis mantra is rest, rest, rest but this begins beforehand. Plugged ducts are often the first sign that you are doing too much. It is difficult to relax and slow down but a plugged duct is a message from the universe or God, or whomever you wish to hear it from, that the time is now. An untreated infection steals time away from life’s responsibilities quicker than rest during the day. Sleep when baby sleeps. Lie down in an older child’s room where they can play, lock the door and let them quietly play while mommy has a time-out. Feeling guilty, like you’re not doing enough and need to keep at it? Burning 500 calories a day just lactating is doing enough, sister.

Though rare and only occurring in a small percentage of women with infectious mastitis, breast abscess is a potential effect of untreated mastitis. It is serious and painful and requires immediate medical attention as it must be aspirated or surgically drained. Then it is followed by a course of antibiotics. A simple course of antibiotics to begin with is a better choice.

Antibiotics are often the only option when dealing with an infection and thank goodness they are available to us. Most antibiotics are safe to take while nursing. This information can be verified with your doctor, your pharmacist, a non-emergency call to Poison Control and/or by calling upon your local La Leche League International Leader to look up any medication in Dr. Hale’s Medications and Mother’s Milk. To combat intestinal tract upset, eat yogurt or add your favorite probiotics product to your daily regimen. Continue rebuilding your gut’s healthy bacteria after your antibiotics course is finished to keep your immune system armed and ready.

Mamas with plugged ducts and mastitis need to tap their inner vigilante with one eye on the worst case scenario. It is not worth waiting it out and having to deal with something worse down the road.

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