by: Renee Bowling, RN, CBFE
I 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.
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:
2nd: Pumped milk or donor milk
3rd: An I.V.
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!