Divine Mamahood

When Breast Isn't Best: 6 Tips for Making Exclusively Pumping Work January 25, 2015 15:51

Many new mothers dream of breastfeeding their babies, but sometimes despite all of our good intentions and hard work, it doesn't work out. Whether it is due to illness, latch issues, or other problems, sometimes breastfeeding just isn't a possibility. In these cases, many women turn to formula, and while this is a perfectly acceptable alternative, others choose to exclusively pump. Exclusively pumping is a major commitment and is difficult to accomplish, but by following some important tips, you can make it work for you and your baby.

Don't Beat Yourself Up

Choosing to exclusively pump is not a decision that most women take lightly, and many mothers only decide to take this path after repeated attempts at breastfeeding have failed. Although this is not the path that you would have liked for you and your baby, it is important to remember that you are not a failure. By exclusively pumping, you are ensuring that your baby is still getting the best possible nutrition even though you are not able to breastfeed. Focus your energy on your baby and developing a strong bond, and don't allow guilt to affect how you feel about the process.

Get a Great Pump

The breast pump that you choose can make or break your ability to be successful at exclusively pumping. Research double-action electric breast pumps online to find the best one for you, and choose your accessories wisely. Since your pump will likely go everywhere with you, you'll want to find one that comes with a convenient carrying case and a small cooler, if possible.

Double (or Triple) Up on Pump Accessories

One of the major drawbacks of exclusively pumping is the amount of time that you will spend washing and sterilizing your pumping supplies. In order to make this process less labor intensive, consider an investment in duplicate pump parts. Contact your pump manufacturer or look online for extra tubing connectors, silicone diaphragms, valves, and horns. By having extra supplies, you won't have to wash your parts after every pumping session. 

Freeze Excess Milk

Exclusive pumpers know that you'll have good days and bad days in terms of your milk supply. Therefore, it is important to take advantage of your good days and to freeze any excess milk that you may retrieve. Invest in freezer bags and a permanent marker so that you can properly label them, and clear out some room in your freezer. By stocking up on extra milk, you will have backup available in the event that a drop in supply doesn't leave you with enough to feed your baby.

Find a Support System

While breast and formula feeding mothers usually have a support system of people who understand their feeding decision, exclusive pumpers are often left out. Therefore, it is important to find someone that you can talk to about your experiences and struggles with exclusively pumping. Ideally, your partner and family will be supportive of your decision, but if speaking to them isn't an option, go online to search out birth boards and support groups targeting women who exclusively pump. These mothers know exactly what you are going through and can provide you with tips on how to make your life as an exclusive pumper easier.

Take Pumping One Day at a Time

Exclusively pumping is hard work, and at the beginning, you may question your ability to maintain a consistent and rigorous pumping schedule. You may have a goal in your mind to try to pump for three months, six months, or even a year, and the thought of keeping up your routine for that length of time may seem overwhelming. In this situation, the best thing that you can do for yourself is to take pumping one day at a time. Focus on the present day and completing all of your pumping sessions. By putting the future and your ability to continue pumping out of your mind, you will feel less stress about your situation. 

 As an exclusive pumper, it is important to remind yourself about the sacrifice that you are making for your baby. While your dreams of breastfeeding may not have worked out, you are continuing to sacrifice your body and time in order to ensure that your child is getting the best nutrition possible. By focusing on your baby and using helpful techniques, you can make exclusively pumping a positive experience for your family.


Is Breastfeeding a Pain Reliever for Baby? October 16, 2014 20:27

Written By Michelle Roth, BA, LCCE, IBCLC 

 

Your newborn is fussy – you nurse him. Your older baby has an upset tummy – you nurse him. Your toddler falls and bumps his head – you nurse him. You instinctively know that breastfeeding makes him feel good. Our goal as mothers is to protect our babies, keep them from harm. We don’t ever want to see our babies in pain – in fact, a mom’s hormones change when she hears her baby cry, oxytocin and prolactin surge, she gets that tiger mother instinct. She wants to protect her baby.

 

But what happens in baby’s first year? If you follow the schedule recommended by the CDC and AAP, your baby may have as many as 25 immunizations during the first year of life, including the Hepatits B vaccination within the first 48 hours of life. In fact, in this first couple of days of arrival outside your womb, your baby is poked and prodded multiple times. It may even start before birth: a scalp electrode for internal fetal monitoring, the force of too-strong induced contractions, a change in body chemistry by altering mom’s hormones of birth and maybe even baby’s own hormones, forceps or vacuum extraction to pull baby out, shoulder dystocia due to positioning, and more. Then at birth we briskly handle baby with vigorous suctioning and drying. We lance baby’s heel to obtain a blood sample, we give a prophylactic vitamin K injection shortly after birth, eye ointment, bathing … do we ever stop to consider if these events are painful for baby, or how we can conveniently and safely manage that pain?

 

Strangely, there’s a history of denying babies feel pain. But what we know now is not only do babies feel pain, but the effects of untreated pain may be long-lasting (AAP 2006, Shah 2012). The AAP recommends “routinely assessing pain, minimizing the number of painful procedures performed, [and] effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures …” (AAP 2006). The use of sweetened water or a pacifier are probably the most researched means of non-pharmacological pain prevention for babies, but research about skin-to-skin contact and breastfeeding is also making its appearance and showing promising results (Agarwal 2011, Shah 2012).

 

In a 2002 study, Gray and colleagues studied whether babies being breastfed had better pain management during a standard newborn procedure than babies who were simply swaddled in a bassinet. These researchers looked at 30 infants randomly assigned to two groups – breastfeeding or standard care – for signs of distress during a heel lance to obtain a blood sample. These signs included crying, grimacing and heart rate changes. The results? Crying and grimacing were vastly reduced for babies who were actively breastfeeding: 91% and 84%, respectively, compared to the control group. The researchers add,

In fact, 11 of these 15 breastfeeding infants did not cry or grimace at all …. Only 1 of the 15 infants in the breastfeeding group cried at all during recovery. He did so for a total of 10 seconds. In contrast, the mean duration of crying during recovery for infants in the control group was 28 seconds (Gray 2002).  In addition, the heart rate readings were significantly different: babies being breastfed had a mean increase of 6 beats per minute, while in the control group that number was 29 beats per minute. Breastfed babies were more relaxed babies, even during a painful procedure.

 

Along the same lines, Uga et. al. found a significant difference between groups during heel lance. Two hundred babies were assigned to two conditions during standard metabolic screening – breastfeeding or standard care (caressing or pacifier use). Babies who were breastfeeding had significantly better pain management even when looking at individual segments of the pain scoring, such as limb movement, facial expression and vocalization. In fact, in the breastfeeding group “20 neonates obtained score 0 [out of 10], while no neonates in the control group got this score” (Uga 2008).

 

Another randomized controlled trial looked at the differences in pain management for babies in 4 categories: breastfeeding, being held by mother, sterile water administration, or glucose solution/pacifier use (Carbajal 2003). A sample of 180 babies was randomized to one of the 4 groups for a blood draw (venipuncture). Using two standardized pain scoring systems, 36% of the breastfeeding infants showed “no indication at all” that the test had happened. Pain scores for the infants in the breastfeeding group and the glucose/pacifier group were similar. In contrast, no infants being held by their mothers had pain reduction (both were clothed, and not skin-to-skin), and very few infants receiving sterile water had pain relief.

 

More recently, researchers wanted to tease apart whether the pain relief is from the substance (breastmilk versus glucose solution) or from the skin-to-skin contact between mom and baby (Gabriel 2013). What they found was that the babies with the best pain management were in a group where breastfeeding and skin-to-skin were combined. This unique study separated 136 babies into 4 categories: breastfeeding with skin-to-skin contact, sucrose (provided by syringe) with skin-to-skin, skin-to-skin only, and sucrose (by syringe) only. They found significantly lower pain scores for the babies in the breastfeeding and skin-to-skin group. Additionally, moderate-to-severe pain was also lower this group (11.4% compared to 31.4% in the sucrose plus skin-to-skin group, 51.5% in the skin-to-skin only group, and 51.5% in the sucrose only group).

 

Breastfeeding – such a multifaceted tool. It never ceases to amaze me that nature has created such a gift. In additional to all of its other benefits, breastfeeding is a free and simple way to help your baby deal with a painful world – emotionally and physically. Don’t be afraid to add this to your birth plan – you’d like to be holding your baby skin-to-skin and, more importantly, breastfeeding during any heel lances, injections or other procedures. Just because your birth facility hasn’t done it before doesn’t mean they can’t figure out how to do it now. When you visit the pediatric office, remind them that you’d like to nurse during immunizations. It won’t take any longer, and your baby will feel so much better. And don’t be afraid to make nursing your pain reliever of choice for the bumps and bruises of toddlerhood and beyond!

 

References:

Agarwal R. Breastfeeding or breast milk for procedural pain in neonates : RHL commentary (last revised: 1 June 2011).

The WHO Reproductive Health Library; Geneva: World Health Organization.

American Academy of Pediatrics, & Fetus and Newborn Committee. (2006). Prevention and management of pain in the

neonate: an update. Pediatrics, 118(5), 2231-2241. Reaffirmed May 2010.

Carbajal R, Veerapen S, Couderc S, Jugie M, & Ville Y. (2003). Analgesic effect of breast feeding in term neonates:

randomised controlled trial. BMJ: British Medical Journal, 326(7379), 13.

Gabriel MÁM, de Mendoza BDRH, Figueroa LJ, Medina V, Fernández BI, Rodríguez MV, Huedo VE, & Malagón L M.

(2013). Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick. Archives of Disease in

Childhood-Fetal and Neonatal Edition, 98(6), F499-F503.

Gray L, Miller LW, Philipp BL, & Blass EM. (2002). Breastfeeding is analgesic in healthy newborns. Pediatrics, 109(4),

590-593.

Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane

Database of Systematic Reviews 2012, Issue 12.

Uga E, Candriella M, Perino A, Alloni V, Angilella G, Trada M, Ziliotto AM, Rossi MB, Tozzini D, Tripaldi C, Vaglio M,

Grossi L, Allen M, & Provera S. (2008). Heel lance in newborn during breastfeeding: an evaluation of analgesic

effect of this procedure. Ital J Pediatr, 34(1), 3-7.

 


Low Milk Supply: Beyond the Basic Causes September 16, 2014 16:28

Written By Michelle Roth, BA, LCCE, IBCLC

 

Your milk supply is driven by how much milk is removed from the breast. The more often your baby nurses, the emptier your breasts get, the more milk you make. If the breast isn’t stimulated and emptied often, your hormones signal that it’s time to slow production.

 

Most often, low milk supply can be remedied by nursing your baby more frequently. Milk supply issues tend to be related to mistaken impressions of how often or how long a baby should nurse. It’s a product of our bottle feeding culture – we imagine a baby eating every 4 hours and taking a certain number of ounces. But nursing is much more fluid than this – and once moms start using babies’ cues and nursing more often, things improve. Sometimes you need to pump to increase the emptying of the breast in addition to feeding more often. If you have tried both of these methods – nursing more and adding pumping – and your supply is still faltering, here are five questions to consider:

  1. Could it be related to the birth? It may take longer than normal for your milk to “come-in” if you have had a cesarean birth. Colostrum – your first milk – is the perfect food for your baby during this time, and your baby does not necessarily need supplements. Continue nursing often to build the receptors necessary for a full supply when your milk does come in. While labor pain medications don’t necessarily directly impact your milk supply, they can make baby sleepy in the early days, meaning less frequent feedings. Waking these babies and getting them to the breast more often is the solution. If you’ve had IV fluids for the birth, you may be extra swollen for the first couple of days, which can make breastfeeding more challenging. Baby may have a shallower latch, and may not be able to remove much milk, laying the groundwork for the low supply spiral. If you experienced postpartum hemorrhage, especially if you have Sheehan’s syndrome, your milk supply may be adversely affected. If you have even a very small piece of placenta left in your uterus, it may be producing just enough pregnancy hormones that your body doesn’t realize it’s time to make milk instead.
  1. Is it a breastfeeding management issue? If you are giving your baby any supplements – expressed breastmilk or formula – by bottle, these are replacing breast stimulation and can decrease supply quickly. The same with scheduled feedings – your body isn’t getting enough stimulation to keep milk-making up. If your baby is using a pacifier, it’s possible that you are missing hunger cues, or that your baby is soothed when that suckling should in fact be at the breast. A baby who is missing feedings gets sleepier – not enough calories equals sleep to conserve energy. Also, if you are trying to get your baby to sleep through the night, or to take extended daytime naps, it’s likely that you’re both missing some feedings. Have you started solids and are you replacing breastfeeding with them? Early solids should be complementary to breastfeeding rather than in place of nursing. All of these breastfeeding management issues are easily resolved by nursing more often or stopping whatever it is you’re doing that is interrupting unrestricted feeding at the breast.
  1. Are you taking any medications or have you recently been ill? Cold medications – especially those containing pseudoephedrine – have the potential to dry up your milk supply. If you are ill and need medication, it’s always best to check with a Lactation Consultant (or checking for yourself on LactMed or the InfantRisk Center) before taking anything – whether prescription or over-the-counter. Another category of drug that could impact milk supply is hormonal birth control. Birth control methods containing estrogen are the most damaging to milk supply, even if you have a strong supply and you’ve been nursing for months. Progestin-only contraceptives, such as the ‘mini-pill’ or DepoProvera injection, may be a better choice for breastfeeding moms; but, they shouldn’t be started until 6-8 weeks after the birth. Before that time, they can wreak havoc with milk supply for some moms. If you have recently been ill, your supply may have decreased due to lack of appetite, dehydration, and infrequent nursing.
  1. Could it be hormonal? Is there a chance you are pregnant again? If so, the hormones to support pregnancy may cause a sharp decrease in supply. Sometimes a mother has an undiagnosed hormonal imbalance that impacts her ability to make milk. Such was the case with a retained placental fragment discussed above. If you had infertility issues before becoming pregnant with this baby, there is a chance that hormones played a part and will impact breastfeeding as well. Moms who have a history of polycystic ovary syndrome (PCOS) often report low milk supply – some of the hormones for milk making and breast growth are suppressed by other hormones in mom’s body. Low thyroid hormone levels can also cause low milk supply. This usually rebound to a normal supply once thyroid replacement therapy is started. These are only a few of the many hormonal imbalances that can affect milk production - so a thorough health history and wide-ranging laboratory tests can confirm deficiencies. 
  1. Could it be structural? Insufficient glandular tissue is rare, but can cause low supply – there just aren’t enough milk making glands to support lactation. If you have a history of breast surgery (whether augmentation, reduction or biopsy), there’s a chance that glands, nerves or ducts were disturbed. Working closely with a lactation consultant and your baby’s doctor will ensure you maximize your milk production and your baby gains weight adequately. A mom with inverted nipples may have problems with latch in the beginning, but keep in mind babies ‘breast’feed, not ‘nipple’feed. But improper latch due to inversion, or lack of milk transfer because baby can’t use the nipple normally, can lead to low milk supply. Structural problems for baby that can impact supply include tongue tie, cleft palate, low muscle tone, cardiac issues, and more. Anything that reduces the amount of milk baby actually transfers will work negatively on milk supply.

In addition to all of these potential factors that could affect your supply, lifestyle factors can inhibit your let-down reflex which will eventually limit your milk supply. Caffeine and alcohol have been known to inhibit “let-down,” making it likely that your baby isn’t able to transfer as much milk. The same with stress and fatigue. Mothers who smoke also report low supply more often, and these babies tend to have weight gain issues. Sudden maternal weight loss or extreme calorie restriction can also decrease supply.

 

As you are working on milk supply issues, it’s good to have the support of someone knowledgeable about normal breastfeeding. Consider working with a board-certified lactation consultant (IBCLC) or a trained breastfeeding counselor (such as a CLC, La Leche League Leader, Breastfeeding USA counselor, or WIC peer counselor). The help of these professionals may be instrumental to your success. Most of all, keep an eye on your baby. As you are working on increasing your milk supply, make sure your baby is having plenty of wet and dirty diapers, and gaining weight well. You may need to supplement with expressed breastmilk (or formula), but working to increase your supply is well worth the effort.

 

References:

Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale Publishing, L.P.

Riordan, J., & Wambach, K. (2010). Breastfeeding and human lactation. Sudbury, Mass: Jones and Bartlett Publishers.

West, D., & Marasco, L. (2009). The breastfeeding mother's guide to making more milk. New York: McGraw-Hill.


Breastfeeding as Birth Control? September 01, 2014 14:21

 

Written By Michelle Roth, BA, LCCE, IBCLC

In teaching breastfeeding workshops, women (and men!) were always dubious when I taught that breastfeeding could be used as birth control. “Well, my friend’s sister’s roommate has babies 9 months apart, so breastfeeding must not be effective,” I heard. Of course, there are criteria to meet for it to be effective; but, in the early months after birth, the Lactational Amenorrhea Method (LAM) can be an effective means of preventing pregnancy.

LAM has a 99% effectiveness rate when used correctly and consistently. As it’s commonly used, LAM is 98% effective at preventing pregnancy. These rates are comparable to ‘the Pill’ and better than condoms! Check out this chart from the World Health Organization (WHO) to compare LAM to a variety of contraceptive methods.

For women who do not breastfeed, periods typically return six to eight weeks after birth. Women who do breastfeed, however, tend

to go much longer without regular periods. Some women’s menses don’t return until after baby is weaned – even if baby nurses a year or more! Research shows that the sooner after birth a baby breastfeeds, the longer the delay in the return of a woman’s periods. And it’s not just active feeding at the breast that counts – non-nutritive suckling also serves to prolong the time without menstrual cycles.

Lactational amenorrhea is a normal phase in a woman’s reproductive cycle. Levels of luteinizing hormone and estrogen, both necessary for ovulation, are low in breastfeeding moms, and researchers theorize that high prolactin levels are also at play. While these are the basic underlying hormonal mechanisms thought to control return of menses after birth, the research about lactational amenorrhea is ongoing.

So, how can you tell if this is the right method of postpartum contraceptive for you? If you can say ‘yes’ to all three of these criteria, then LAM is a good option:

  1. Your baby is younger than six months old.
  2. You have not started having menstrual periods again.
  3. Your baby is breastfeeding often (day and night) and gets no other food or drink.

In a review of data for 45 countries, however, Fabic and Choi found “nearly 75 percent of women who characterize themselves as current LAM users do not practice LAM correctly.” So it’s important to keep in mind that when you can answer ‘no’ to any one of the above, it’s time for a different method of birth control if you don’t want to get pregnant.

Another benefit of Lwww.divine-mama.comAM is that it doesn’t have side-effects. If you are breastfeeding, be cautious with hormonal methods of birth control, especially those containing estrogen. One concern has to do with the transfer of these hormones to baby through breastmilk. But, these contraceptives have the potential to impact your milk supply as well. While not every woman will have decreased supply after starting hormonal birth control, some do. So proceed with caution if you choose this method rather than LAM, and know how to boost your supply if it starts to falter.

Research about LAM is compelling, but lack of clear definitions can make it difficult to compare studies and the rates of pregnancy they report. According to a Cochrane Collaboration review, it was difficult to ascertain if LAM was more effective than just the natural period of infertility after birth. What made their review most difficult was lack of consistent definitions of amenorrhea as well as selection bias, lack of control groups, and inconsistent control for confounding variables.

On the other hand, some argue that LAM should be promoted more often than it is – regardless of these study inconsistencies. It is a no-cost, easy-to-explain method that any postpartum mom can use on her own without medical intervention. Panzetta and Shawe suggest that perhaps healthcare providers need to learn more – they are simply misinformed about LAM and its effectiveness. In their survey of women’s health practitioners in the UK, these authors found that attitudes about LAM ranged from “it’s too difficult to teach” to “women just want pills” to “we should be promoting the strongest, most reliable contraception available.” These beliefs show that persistent myths about LAM are limiting its use.

Labbok believes LAM promotion takes a ‘transdisciplinary approach’ – with governments, public health officials, healthcare providers, breastfeeding counselors, and more working together to promote innovative ideas that better women’s health (such as LAM).

LAM is free. You don’t need to remember to take it or worry about it ripping. It comes in convenient packaging. Trust your body, follow the guidelines, and consider breastfeeding as a valid birth control option.

 

References:

 

Fabic MS, Choi Y. (2013). Assessing the Quality of Data Regarding Use of the Lactational Amenorrhea Method. Studies in Family Planning, 44(2), 205-221.

Labbok, MH. (2008). Transdisciplinary breastfeeding support: Creating program and policy synergy across the reproductive continuum. International breastfeeding journal, 3(1), 16.

Panzetta S, Shawe J. (2013). Lactational amenorrhoea method: the evidence is there, why aren't we using it?. Journal of Family Planning and Reproductive Health Care, 39(2), 136-138.

Riordan J, Wambach K. (Eds.). (2010). Breastfeeding and human lactation. Jones & Bartlett.

Van derWijden C, Brown J, Kleijnen J. (2003). Lactational amenorrhea for family planning. Cochrane Database of Systematic Reviews, Issue 4.

 

 


The ‘Hormone Cocktail’ of Birth and Breastfeeding July 19, 2014 19:16

 Written By Michelle Roth, BA, LCCE, IBCLC

 

Mother Nature has endowed women with a system to handle growing, birthing and feeding a baby – a complex array of hormones that direct pregnancy, childbirth and breastfeeding. In fact, these hormones can make birth easier, safer, and maybe even ecstatic or orgasmic. And the release of hormones in breastfeeding not only aids milk production, but enhances relaxation. Pregnancy, birth, breastfeeding – all a part of the same continuum of sexuality and reproduction and all under the control of your hormones.

 

The hormonal roller coaster starts with pregnancy. A steady increase in hCG from the first week or so after conception until around weeks 8-10 of pregnancy signals that your body should produce more progesterone and estrogens. These hormones help the endometrium and embryo grow. Around week 10, the placenta takes over. Estrogen, progesterone, relaxin, prostaglandin, and more are produced to support the pregnancy. Progesterone relaxes the uterus and prepares the breasts for feeding. Estrogen increases blood flow to the pelvis. Relaxin loosens the ligaments for the expanding abdomen and impending birth. All of these hormones decline dramatically when the baby and placenta are delivered.

 

Researchers believe that the ‘nesting’ behaviors shortly before labor can be attributed a shift in hormones that means labor is imminent, though it’s not clear what the actual mechanism is that starts labor. The main ingredients of the ‘hormone cocktail’ during labor and birth include


Oxytocin

Sometimes called the ‘hormone of love’, oxytocin is released during sexual activity, orgasm, birth, and breastfeeding – it stimulates feelings of love and altruism. It is also at the root of uterine contractions during labor, and it mediates ejection reflexes (such as the sperm ejection reflex during intercourse, and the fetus ejection reflex during birth). This hormone increases throughout labor and is highest at the time of birth. It makes a woman feel euphoria and opens her to interaction with her newborn baby. Baby’s body is also producing oxytocin, creating a hormonally driven reciprocity with mom after birth. Oxytocin is also needed after the birth to aid in the release of the placenta, and to decrease postpartum bleeding. Pitocin and syntocinon are synthetic forms of oxytocin used for labor induction and augmentation, and sometimes after the birth. Be cautious, as these do not seem to act the same way (in mom or baby) as naturally occurring oxytocin does.

 

Endorphins

These are ‘nature’s narcotics’ – opiate-like hormones that act as pain killers. Beta endorphins also cause feelings of pleasure, euphoria, and dependency – which can be great for bonding with a newborn baby. But these traits also mean a mom needs to turn off her thinking brain, and depend on those around her for support and advocacy. Extreme levels of endorphins can slow contractions – nature’s way of helping a mom adapt to her labor over time. These hormones facilitate prolactin release, another essential birth hormone.

 

Prolactin

Prolactin is a necessary component for breastfeeding – it is the hormone that signals to the body to make more milk. But it’s also known as a hormone of submissiveness, anxiety and vigilance, thus giving it the name ‘the mothering hormone’. Thanks to prolactin, new mothers exhibit protective behaviors to keep their babies safe, especially when combined with oxytocin.

 

Fight-or-flight hormones

The release of adrenalin and noradrenaline in labor seems counterintuitive – why would a woman release hormones associated with either fighting or fleeing? If a mother feels especially fearful of birth, these hormones may even cause labor to stop or slow down, and can lead to interventions such as augmentation and cesarean birth. But these hormones are necessary for the actual birth of the baby. A release of these hormones close to the time of birth give mom a burst of energy to push her baby out once the cervix is fully dilated. Levels of these hormones drop sharply after birth, but still help a mother learn to care for and protect her newborn baby.

 

According to experts, such as Sarah Buckley and Michel Odent, any disruption of this ‘hormone cocktail’ can have profound effects – maybe some we don’t even know about yet. Odent suggests that the hormones of labor and birth prepare a baby for extra-uterine life, and disruption of this process can wreak havoc with baby’s adaptation.

 

In order to make the most of this hormone cocktail, women need to feel safe, and to labor undisturbed. This doesn’t mean to labor alone, but to minimize any interruptions that take her focus away from labor. She needs an environment of privacy where she won’t need to worry about intrusions. Dim lights and warmth help, too. Help her turn off her thinking, rational brain, and let her older, more primitive brain take over.

 

Once the baby is born, another hormonal shift takes place. The sharp dive in the pregnancy supporting hormones gives way to an increase in lactation supportive ones. Prolactin and oxytocin are the main players in this game. Oxytocin is the milk-ejection hormone – when the nerves in the areola are stimulated, the brain sends a signal to the milk making cells to contract and send milk to the baby. Prolactin is the milk-making hormone. But oxytocin is also the ‘hormone of love’ – released to enhance bonding. Prolactin receptors are increased in the early weeks of feeding – the more baby nurses, the more prolactin receptors there will be, and ultimately the more milk mom will make. Prolactin also makes a mom feel relaxed while the baby is nursing.

 

Another important hormone-like substance is the ‘feedback inhibitor of lactation’ (FIL). This is released when the breasts are too full to signal to the body to make less milk. This helps to even out your milk supply to meet baby’s needs, but can also lead to low milk supply if your baby isn’t nursing often enough or isn’t transferring milk well.

 

You can maximize these breastfeeding hormones by nursing early and nursing often. Put your baby to the breast within the first hour after birth, and expect your newborn to nurse eight to twelve times every 24 hours. Don’t schedule feedings or restrict how long your baby nurses. Know the signs of good milk transfer, and get help if you need it.

 

Want to learn more? Read anything by Sarah Buckley and Michel Odent, among others. Type Ecstatic Birth or Orgasmic Birth into your web browser’s search engine, and read more about maximizing your birth hormones. Read about how breastfeeding works before birth so you are better prepared when baby arrives. And trust that you were made to grow and nourish a baby – your body knows what to do as long as culture doesn’t get in the way of your enjoying this hormone cocktail.

 

References:

 

Buckley, SJ. (2010). Ecstatic Birth: Nature’s hormonal blueprint for labor. E-book. Available at www.sarahbuckley.com.

Nichols, F. H., & Zwelling, E. (1997). Maternal-newborn nursing: Theory and practice. WB Saunders.

Odent, M. (2007). Birth and breastfeeding. Clairview Books.

Odent, M. (1999). The scientification of love. Free Assn Books.

Riordan, J., & Wambach, K. (Eds.). (2010). Breastfeeding and human lactation. Jones & Bartlett Learning.


Could Chiropractic Care Help With Breastfeeding? June 21, 2014 13:55

Written By Michelle Roth, BA, LCCE, IBCLC

 

Imagine your baby’s position in utero – all folded and curled. Now think about the trip your baby makes during birth. In the most favorable situations – when baby’s head is down and anterior, and mom’s pelvis is mobile and open – baby still needs to make several twists and turns to be born. Add to this a modern hospital birth – with induction, lying flat in bed perhaps with your feet in stirrups, immobility due to pain medications, prolonged pushing with pelvic movement restricted, delivery assisted by forceps or vacuum, cesarean birth, and more. It’s no wonder some babies (and their moms!) seem to suffer from physical birth trauma.

 

Babies are designed for birth – the bony plates of the skull aren’t fused, allowing them to move and overlap in order for the head to move through the maternal pelvis. A baby’s skull is made up of 22 bones with 34 joints or sutures; and, the structures necessary for feeding are controlled by 60 muscles and 6 cranial nerves. 1  While babies are programmed for birth and breastfeeding, if the mechanics of the body aren’t working right, the expected behaviors can be impacted. 2, 3  With so many bones, muscles and nerves involved, the chance for problems is increased, especially when the natural course of labor is impacted by interventions. 1, 3, 4, 5  In addition, even a spontaneous vaginal birth without intervention may cause changes in the infant’s spine, and this misalignment can lead to discomfort and difficulties with all the baby’s systems. 3, 6  The solution? Gentle manipulation and realignment. Treating these misalignments, movement of bones and impingement of nerves – through chiropractic, osteopathy, cranial sacral therapy, etc. – has the potential to improve feeding at the breast. 3  But this type of treatment is not free of controversy.

 

At the July 2013 International Lactation Consultant Association (ILCA) conference, Dr. Howard Chilton, a neonatal pediatrician, answered an audience question about chiropractic care for infants, saying “this type of management is unproven, has no basis in science and potentially dangerous, both of itself and from the delay in the application of sound medical and nursing procedures …”, going on to call chiropractic care “pseudoscience.” ILCA printed his comments in their newsletter for members, but also printed a response from Dr. Joel Alcantara, from the International Chiropractic Pediatric Association, saying, “Chiropractic is a vitalistic, holistic and patient-centered approach to patient care” and citing research for application in pediatric settings. 7  So what are parents to make of all of this? Can chiropractic care be a beneficial adjunct to allopathic medicine for babies? Could chiropractic therapy help specifically with breastfeeding difficulties?

 

Two recent literature reviews suggest, while more research needs to be done, the few studies available showed improvement of breastfeeding issues and other problems (such as colic and asthma) with chiropractic intervention for the infant. 8, 9  In addition, Vallone discusses several case studies in which low milk supply was resolved with chiropractic care of the mother. She theorizes that the misaligned vertebrae can disrupt nerve and hormone function, and this can impact breast development (whether before, during or after pregnancy). The type of lactation difficulty will depend on the location of the subluxation; but in the cases she reviews, spinal manipulation showed results (such as, improved milk production and infant weight gain, in addition to maternal comfort) quickly. 10

 

In a larger case series, Miller and colleagues looked at 114 cases of breastfeeding difficulties where standard care for the infant was supplemented with chiropractic therapy. Infants younger than 12 weeks were referred for chiropractic care after being diagnosed with suboptimal breastfeeding. In this sample, 78% of the babies were exclusively breastfeeding after finishing the course of chiropractic care, which for most babies, was 3 visits. 4

 

Finally, Holleman, Nee and Knaap write about a case where breastfeeding aversion was resolved with chiropractic care. An 8-day-old baby was seen with the chief complaints being latch problems and a weak suck. Along with these infant issues, the mother suffered from painfully sore nipples. While breastfeeding had gone well for the first 4 days, the baby showed preference for one breast only on day 5, and then began refusing the breast on day 6. After 4 treatments consisting of gentle spinal manipulation and cranium treatments, the baby was nursing normally again. The authors suggest birth trauma may have been to blame (induced labor and shoulder dystocia, in this case). 5

 

While case studies cannot provide proof that the intervention indeed led to the improvement, what they do show is that this is an area ripe with possibilities for improving breastfeeding and infant health. More study can be done to provide the evidence base for body work in addition to standard care. All of the authors suggest a collaborative approach to breastfeeding difficulties. Pediatricians, family doctors, lactation consultants, chiropractors, massage therapists, etc. should work together with the parents to plan a holistic course of treatment for the infant having feeding difficulties.

 

Chiropractic care for breastfeeding babies may be useful in the following situations: 1, 11

  • latching difficulties, especially when accompanied by nipple pain or damage
  • uncoordinated sucking, or difficulty with suck-swallow-breathe
  • preference for only one feeding position or one breast, fussiness in other positions
  • needing to nurse “all the time” or cannot transfer milk even though they seem to be nursing
  • just as much trouble with the bottle as with the breast
  • a fussy, uncomfortable, colicky baby

Openness to new modalities can often be the solution when a mom is about to give up on breastfeeding. Chiropractic care has the potential to alleviate discomfort for baby and mom, and to preserve the nursing relationship.

 

References:

1Smith LJ & Kroeger M. (2009). Impact of Birthing Practices on Breastfeeding. 2nd ed. Sudbury, MA: Jones & Bartlett.

2 Frymann VM, Carney R, & Springall P. (1992). Effect of osteopathic medical management on neurologic development in children. J Am Osteopath Assoc, 92(6), 729-744.

3 Tow J  & Vallone SA. (2009). Development of an integrative relationship in the care of the breastfeeding newborn: Lactation consultant and chiropractor. J Clin Chiropr Pediatr, 10(1), 626-632.

4Miller JE, Miller L, Sulesund AK, & Yevtushenko A. (2009). Contribution of chiropractic therapy to resolving suboptimal breastfeeding: a case series of 114 infants. Journal of manipulative and physiological therapeutics, 32(8), 670-674.

5Holleman AC, Nee J, & Knaap SF. (2011). Chiropractic management of breast-feeding difficulties: a case report. Journal of chiropractic medicine, 10(3), 199-203.

6 Towbin, A. (1969). Latent spinal cord and brain stem injury in newborn infants. Developmental Medicine & Child Neurology, 11(1), 54-68.

7 Lactation Matters. (2013). A Response from the International Chiropractic Pediatric Association.Retrieved from http://lactationmatters.org/2013/11/01/a-response-from-the-international-chiropractic-pediatric-association/

8 Fry, LM. (2014). Chiropractic and breastfeeding dysfunction: A literature review. Journal of Clinical Chiropractic Pediatrics 14(2), 1151-1155.

9 Gleberzon BJ, Arts J, Mei A, & McManus EL. (2012). The use of spinal manipulative therapy for pediatric health conditions: a systematic review of the literature. The Journal of the Canadian Chiropractic Association, 56(2), 128-141.

10Vallone S. (2007). Role of subluxation and chiropractic care in hypolactation. Journal ofClinical Chiropractic Pediatrics, 8(1&2), 518-524.  

11 Ohm, J. (2006). Breastfeeding difficulties and chiropractic. Pathways To Family Wellness(11), 24-25.


What Can I Do About My Low Milk Supply? May 09, 2014 13:07

Written By Michelle Roth, BA, LCCE, IBCLC

One of the top reasons women wean their babies before intending is thinking that their milk supplies are low (McCarter‐Spaulding & Kearney 2001; Gatti 2008; Kent, Prime & Garbin 2012; Kent, et. al. 2013; Neifert & Bunik 2013). While there are cases where women cannot produce enough milk for their babies, more often the problem is in expectations about breastfeeding patterns and what’s normal for a breastfed baby.

Sometimes around 10 days and then again around the 4-6 week mark, women think they have “lost their milk” because their breasts don’t feel as full or their milk is no longer leaking copiously. Changes around these times, however, are normal fluctuations in the way your body makes milk. They are likely signs that your initial engorgement has subsided and your milk supply has evened out to perfectly match your baby’s needs (Mohrbacher 2010; Kent, et. al. 2013).

Women who feel their milk supply is insufficient often base this perception on infant behavior – a baby who seems unsatisfied, who wants to nurse often, who is fussy or unsettled, etc. Though these behaviors can have many causes, women tend to blame their own bodies for not producing enough milk (Mohrbacher 2010). In addition, use of formula before hospital discharge is often wrongly instituted for “insufficient milk supply” at a time when moms aren’t yet making much milk (as nature intended!). While their bodies are, in fact, working right, they are led to believe something is wrong. And this perception sticks with them causing them to wean early (Gatti 2008). In addition, McCarter-Spaulding and Kearney (2001) found “mothers who perceive that they have the skills and competence to parent a young infant also perceive that they have an adequate breast milk supply” and vice versa. If a mom isn’t confident in her abilities, she may think her milk supply is low whether that’s truly the case or not.

So, milk supply issues – whether real or perceived - can impact how long a baby is breastfed. The solution is to help these moms feel confident in their milk supply. Working to increase milk supply will help those who are truly experiencing a dip in output, and may aid those who perceive a low supply feel more self-assured in their ability to breastfeed. Consider these tips for increasing milk supply:

  • Nurse more! The more stimulation your breasts get, the more milk you will make. And the baby is better at prompting this than any pump on the market. You need to be sure, however, that your baby is transferring milk well. Do you hear your baby swallowing after every one or two sucks early in the feeding and less frequently as the feeding progresses? This may sound like a soft “kah” sound, or may look like a pause in the middle of a suck. Do your breasts feel full before a feeding and softer when your baby has finished? These are good signs that your baby is transferring milk. Is your baby falling asleep at the breast soon after starting a feeding? These babies need to be encouraged to keep going.

Newborns will nurse every 1-2 hours, but even older babies may nurse often. Has your baby stopped nursing so often? Is he skipping feedings? Are you getting busy during the day or using a pacifier and missing some feeding cues? Has your baby started “sleeping through the night”? These can all lead to a decrease in supply. Try a “nursing vacation” – spend the weekend tucked in bed with your baby and nurse as often as possible.

  • Pump: Using a quality electric breast pump can help to stimulate supply. Keep in mind that pumps and pumping supplies can wear over time, so be sure yours is in top shape for the best results. Also, some brands are better than others at removing milk, so do some research before purchasing a pump.

Some women choose a few times a day, and consistently pump at those times. Other moms pump on one side while baby nurses on the other. Or you can try pumping for 5-10 minutes after every nursing session. The key to getting a good yield of milk when pumping is the ability to elicit milk ejections. If you have difficulty letting-down to a pump, you will get less milk. Two let-downs are sufficient, and three or four are even better. (Mohrbacher 2010). Use all of your best relaxation techniques: relax your muscles, breathe deeply, think about your baby, listen to a recording of your baby crying, smell something baby has slept in, do whatever it takes to condition yourself to let-down to the pump.

Also, doing breast massage before and during a pumping session (sometimes called “hands-on pumping”) can increase the amount of milk you are able to remove, and may give your nerves more stimulation resulting in an increase in production (Mohrbacher 2012).

  • Consider herbal galactagogues: A galactagogue is a substance that can increase production of breastmilk. Different substances have different mechanisms, but they should all be used in conjunction with increased nursing or pumping, or reserved for use until after other methods have failed to produce the desired results (Mohrbacher 2010).

Fenugreek (Trigonella foenum-graecum L.) is an herb used in many cultures to increase milk supply. The recommended dosage is 1800mg three times a day. Supply generally increases 24-72 hours of beginning the supplement; but for some women, it can take as long as one to two weeks. Use caution with this supplement if you have a history of allergies, asthma, hypoglycemia, or diabetes, and do not use if you are taking blood-thinning medications.

The effects of fenugreek are improved when combined with the herb blessed thistle (Cnicus benedictus). Adding 3 capsules of blessed thistle 3 times per day along with fenugreek improve output.

Both fenugreek and blessed thistle seem to be the most effective if used in the first few weeks after birth. Other herbs (including marshmallow root, goat’s rue, alfalfa, fennel, spirulina, raspberry leaf, brewer’s yeast, and shatavari) and some foods (for instance, oatmeal) have milk-enhancing properties, so adding them to your diet may boost your milk production. Keep in mind, though, these substances won’t do much if you aren’t nursing or pumping often.

  • Discuss medications with your healthcare provider: Prescription medications that act as galactagogues are sometimes warranted when all else has failed. Domperidone is the medication most likely to be effective in increasing milk supply, and the least likely to cause untoward effects for mom or baby. It has been used successfully in many parts of the world; however, use in the US is restricted. Reglan (metoclopramide) is another drug that helps to increase milk production. This drug should not be used by anyone with a history of depression or anxiety as it can increase the severity of these symptoms, and can even cause these symptoms in someone without a prior history. Use of Reglan should be considered with caution (Mohrbacher 2010; Zuppa 2010).


Any time you are dealing with a dip in supply, you should consider working with someone knowledgeable about breastfeeding, such as a board certified lactation consultant (IBCLC) or trained peer counselor. Sometimes just having that support is all you need to persevere through difficulties with supply. Any amount of breastmilk your baby gets is a gift – but maximizing your production so you can continue to nurse is well worth the effort, for you and for your baby.

 

References:

Gatti, L. (2008). Maternal perceptions of insufficient milk supply in breastfeeding. Journal of Nursing Scholarship, 40(4), 355-363.

Kent JC, Hepworth AR, Sherriff JL, Cox DB, Mitoulas LR, Hartmann PE. (2013). Longitudinal Changes in Breastfeeding Patterns from 1 to 6 Months of Lactation. Breastfeeding Medicine 8(4), 401-7

Kent, J. C., Prime, D. K., & Garbin, C. P. (2012). Principles for maintaining or increasing breast milk production. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 41(1), 114-121.

McCarter‐Spaulding, D. E., & Kearney, M. H. (2001). Parenting Self‐Efficacy and Perception of Insufficient Breast Milk. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 30(5), 515-522.

Mohrbacher, N. (2012). To Pump More Milk, Use Hands-On Pumping. http://www.nancymohrbacher.com/blog/2012/6/27/to-pump-more-milk-use-hands-on-pumping.html [Accessed March 30, 2014].

Mohrbacher, N. (2010). Breastfeeding Answers Made Simple. Amarillo, TX: Hale.

Neifert M & Bunik M. (2013). Overcoming clinical barriers to exclusive breastfeeding. Pediatric Clinics of North America, 60(1), 115-145.

 

Zuppa, A. A., Sindico, P., Orchi, C., Carducci, C., Cardiello, V., Catenazzi, P., ... & Catenazzi, P. (2010). Safety and efficacy of galactogogues: substances that induce, maintain and increase breast milk production. Journal of Pharmacy & Pharmaceutical Sciences, 13(2), 162-174.


The Power of Skin to Skin April 13, 2014 18:30



Written By Michelle Roth, BA, LCCE, IBCLC

 

What if there were an intervention that could improve how many moms breastfeed their babies, and could help those babies nurse more months than other babies? And what if this intervention was completely FREE? It wouldn’t take any additional investment of money, time or energy on the part of the parents or the birth facility, but it can be started as soon as the baby is delivered. Would you try it?

In reading a recent journal article, I was reminded that we already have tons of research to support just such an intervention – uninterrupted mother-baby skin-to-skin contact. In their survey of 413 mothers, Augustin and colleagues found 59% of mother baby pairs were still breastfeeding at 6 months. Of these dyads, 62% had spent time skin to skin and 49% breastfed in the first hour after birth. Earlier contact means breastfeeding sooner, which may mean a stronger milk supply and a longer overall duration of breastfeeding.

Nils Bergman, one of the world’s foremost experts on skin-to-skin contact and kangaroo mother care, says that for newborns, birth is a habitat transition. I heard him speak at the 2007 La Leche League International Conference in Chicago, and his comment that “the mother is the baby’s habitat” has stuck with me ever since. On a practical level, if we can help mothers and babies stay together – in their natural habitat – we can improve the postpartum adaptation, including breastfeeding success.

Amazingly, babies come into this world hardwired to expect to stay with mom after birth, and if left undisturbed and in contact with mom, they will find the breast and begin feeding, usually within that first hour after birth. Researchers have described a distinct “behavioral sequence that begins immediately after birth and terminates with grasping the nipple, suckling and then falling asleep” if baby is placed skin to skin with mom and left undisturbed. In their study, Widström et. al. found that babies have a brief “birth cry,” then progress slowly through relaxation, awakening and active phases, each with distinct characteristics. They will then make crawling motions interspersed with rest periods, and when they reach the breast they will familiarize with it then begin suckling and finally will sleep when a feeding is completed. They key to these behaviors? Being left skin to skin with mom, without interruption for hospital routines. The authors conclude that these innate behaviors are adaptive. They help baby to self-regulate from birth, which in turn leads to better developmental outcomes.

Some birth interventions do get in the way of this natural sequence. For instance, the Augustin et. al. survey mentioned above found that 71% of women who had a cesarean birth did not have a chance to spend time skin to skin in the hour after birth, and had a longer span of time before the first breastfeeding was able to take place. On a physiologic level, pain medications for labor and delivery interfere with the baby’s innate reflexes and behaviors after the birth. Righard and Alade found that when mothers use certain pain medications in labor, their baby’s just don’t show the same behaviors at the breast. The babies who fared the worst in their study? The ones whose mothers had narcotic pain medication and who were NOT placed skin to skin with their mothers. The babies placed skin to skin and not exposed to pain medication were all able to suckle successfully within the first two hours after birth.

Another researcher, Suzanne Colson, writes that human infants, like other mammals, are abdominal feeders. Colson and colleagues describe 20 feeding-related newborn reflexes, and, more significantly describe how maternal and infant positioning can impact the expression of these reflexes. When mothers assumed full “Biological Nurturing” positions, babies were more likely to use their reflexes to feed effectively. What components make up this optimal positioning? A semi-reclining position for mom, with baby prone on her body. Colson’s book and website illustrate how laid-back nurturing - a non-structured approach to feeding and latch - can facilitate better breastfeeding. While Colson’s work doesn’t rely on skin to skin contact necessarily, it does inform how moms and babies can best work together to use baby’s inborn traits to facilitate breastfeeding success.

Anytime you are able to spend time skin-to-skin with your baby – from birth onwards - is a good thing. Bergman and Bergman recommend at least 2 hours of uninterrupted skin to skin time after birth, and then remaining skin to skin for the first 24 hours. This challenges the model we have created for hospital birth, with a swaddled baby, frequent separation for routine newborn care, and the inevitable barrage of visitors most moms receive in those first couple of days after baby’s birth.

It’s never too late for skin to skin time, especially if you missed it in the first few hours after birth. Skin to skin can be used to continue your baby’s adaptation to the outside world even after you get home from the hospital. Imagine the baby’s first three months as the 4th trimester, and continue to create a womb-like environment. Carry your baby, sleep with your baby, respond immediately to your infant’s needs, and breastfeed often.

If you’ve never seen a baby crawl to the breast, several resources can be eye-opening. The video Delivery Self-Attachment is short and sweet. Health Education Associates has developed two DVDs – one for parents and one for professionals – to illustrate the newborn breastfeeding reflexes described above. The website www.breastcrawl.org has a wonderful video and extensive resources to learn more about this important aspect of early care. (I have no financial interest in any of these resources, just a passion for helping moms and babies make the most of their nature through a nurturing approach to birth and parenting.)

 

References:

Albright L. (2001). Kangaroo Mother Care: Restoring the original paradigm for infant care and breastfeeding. Leaven 37(5), 106-107.

Augustin AL, Donovan K, Lozano EA, Massucci DJ, Wohlgemuth F. (2014). Still nursing at 6 months: a survey of breastfeeding mothers. MCN AM J Matern Child Nurs 39(1), 50-5.

Bergman J, Bergman N. (2013). Whose choice? Advocating birthing practices according to baby’s biological needs. J Perinatal Edu, 22(1), 8.

Colson SD, Meek JH, Hawdon JM. (2008). Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Human Development, 84(7), 441-449.

Moore ER, Anderson GC, Bergman N, Dowswell T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 5.

Righard L, Alade MO. (1990). Effect of delivery room routines on success of first breast-feed. The Lancet, 336(8723), 1105-1107.

Widström AM, Lilja G, Aaltomaa‐Michalias P, Dahllöf A, Lintula M, Nissen E. (2011). Newborn behaviour to locate the breast when skin‐to‐skin: a possible method for enabling early self‐regulation. Acta paediatrica, 100(1), 79-85.

 


Can a birth doula improve breastfeeding success? March 29, 2014 15:26

Written By Michelle Roth, BA, LCCE, IBCLC

Continuous labor support during childbirth has many advantages, including a decreased risk of interventions (including cesarean birth), less use of pain medication, and more positive birth memories (Hodnett 2013). But did you know a doula may also increase breastfeeding success?

From the Greek word for slave, doula has evolved to mean a woman who supports another woman during the birth process. During childbirth, she supports the laboring woman and her partner physically - helping mom change positions, providing massage or counterpressure, and giving the birth partner suggestions on how to help – as well as emotionally and intellectually. She is typically with the couple from the start of labor to the time of birth. Because of her presence and her trusted position with the new parents, she may be the ideal member of the birth team to help a mom initiate breastfeeding.


In an early study of the effect of doula care on breastfeeding success, researchers found that women in the intervention group (doula care) were more likely to be exclusively breastfeeding at one month after the birth (Langer et al, 1998). These women were also less likely to wean or supplement for perceived low milk supply. In closing, the researchers write, “These results provide grounds to consider that psychosocial support during labour and the immediate postpartum period should be part of comprehensive strategies to promote breastfeeding “ (1062).

In another study, Nommsen-Rivers and colleagues (2009) assessed the timing of the onset of lactation and the proportion of breastfeeding moms at 6 weeks postpartum for two groups – those with and without doula care for the birth. Compared to the standard care group, women in the doula care group were more likely to have their milk come in by day 3, were less likely to use a pacifier in hospital, were less likely to report concerns about milk supply, and were more likely to be breastfeeding at 6 weeks. After looking at relationships between confounding factors, the authors conclude, “Among mothers with a prenatal stressor, doula care was particularly effective in increasing the odds of continued breastfeeding” (172).

When studying the effectiveness of a hospital-based doula program, Mottl-Santiago and colleagues found that women with doula care were more likely to express an intention to breastfeeding, and were significantly more likely to breastfeed within the first hour after birth. The authors caution, however, that their results may not be a direct effect of a doula at the birth, since the doulas also provided prenatal breastfeeding education to the expectant mothers.

A recent study showed even more promising results. Of the women who had doula care during birth, nearly all initiated breastfeeding (97.9% compared to 80.8% in the general low-income population studied). When looking at a subgroup of women who are less likely to initiate breastfeeding, the researchers found 92.7% of African American women with doula support initiated breastfeeding, significantly higher than in the general population studied (Kozhimannil 2013). The authors suggest that “access to culturally appropriate doula care may facilitate higher rates of breastfeeding initiation,” with the key being suitable matching of doulas to the client population.

What more evidence do we need? Having doula support for your labor and birth may increase the chances of your breastfeeding. Choose a doula who shares your same values and birth philosophy so you feel comfortable and confident in her care. Ask friends, family, your care provider, or your childbirth educator for referrals or check the DONA International website for a doula in your community. Be sure to interview the doula you choose – even asking about her background in breastfeeding education and support. Let her know you plan to nurse your baby, and ask if she will help you get started. Her support may be essential.

 

References:

Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. (2013). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews, 7.

Kozhimannil KB, Attanasio LB, Hardeman RR, O'Brien M. (2013). Doula care supports near-universal breastfeeding initiation among diverse, low-income women. Journal of Midwifery & Women’s Health. E-pub ahead of print 9 JUL 2013.

Langer A, Campero L, Garcia C, Reynoso S. (1998). Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers’ wellbeing in a Mexican public hospital: a randomised clinical trial. British Journal of Obstetrics and Gynaecology (105), 1056-1063.

Mottl-Santiago J, Walker C, Ewan J, Vragovic O, Winder S, Stubblefield P. (2008). A hospital-based doula program and childbirth outcomes in an urban, multicultural setting. Matern Child Health J 12, 372–377.

Nommsen-Rivers LA, Mastergeorge AM, Hansen RL, Cullum AS, Dewey KG. (2009). Doula care, early breastfeeding outcomes, and breastfeeding status at 6 weeks postpartum among low-income primiparae. JOGNN 38, 157-173.

 


Divine Mama Spring Giveaway! March 23, 2014 20:20

Happy Spring! Who wants some free bars?

Prizes include:

1 Combination box of 30 (Retail Value $64)

1 Flavor of Choice box of 12 (Retail Value $32)

1 Flavor of Choice box of 12 (Retail Value $32)

Giveaway starts March 24 at midnight and ends March 30!

Enter below to get started and GOOD LUCK, Mamas!

 

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The Reality of Infant Sleep March 09, 2014 20:55

Written By Michelle Roth, BA, LCCE, IBCLC

 

It’s 3am. You’re awake for the second time so far tonight, and your baby cries every time you set her back in the cradle. The same happened last night. When will she start to sleep more at night? Is there something you’re doing wrong – isn’t everyone else’s baby is already sleeping through the night? How are you going to manage if you don’t get some rest? Who would ever want to “sleep like a baby” if this is what it’s like? This isn’t at all the glowing picture you imagined before the baby was born …. Isn’t sleep deprivation a form of torture?

We’ve all been there. Parents-to-be hear about sleep deprivation during pregnancy. Everyone tells you to be prepared for it. But the reality of fragmented sleep is still a shock to the system. We may intellectually understand that babies will wake often, but we cannot grasp the impact of that until we are living through it. Is there a better way – before baby’s birth -  to align parental expectations about infant sleep with the actuality of it?    

As a new parent, you can start by considering how you typically slept before baby was born. Did you wake every now and then to look at the clock or adjust your blankets? Did you need to get up to use the bathroom or get a sip of water? Our babies are waking for those same reasons – comfort and companionship. And it’s a normal part of sleep – for the baby and for you. James McKenna, the lead researcher at the University of Notre Dame Mother-Baby Behavioral Sleep Laboratory, says humans are meant to be “biphasic sleepers” and it’s only within the last century that Western culture has consolidated sleep into a single block. In the past – as well as in other cultures today – people sleep for a short period, then spend a couple of hours awake, and finally finish their sleeping for a longer stretch, usually with a nap added during the day.

 

Next, parents need to keep in mind that human babies are born with only a fraction of their adult brain volume making them the most immature mammals neurologically, and they have a slow rate of maturation. So an infant’s caregivers need to act as regulators of all functions from elimination to eating to sleeping. A baby sleeping alone and for extended stretch
es, however, is a cultural phenomenon that came about in the last 100 years and is specific to Western culture. Biology doesn’t change that fast – and it may be that our cultural proscriptions are completely out of tune with what babies need biologically to survive and thrive. Babies are not programmed to sleep for extended periods, but we want them to fit into our ideal, thus the rise of “infant sleep problems.” The real problem may be our expectations, not the baby’s behaviors.

Let’s take a look at what we know about infant sleep. Newborn babies sleep 12 to 20 hours a day on average. They wake often, day and night, and rarely sleep longer than 3 hours at a time. Some babies have their days and nights confused. Helen Ball, of the Parent Infant Sleep Lab at Durham University in the UK, says this is to be expected. She writes that “infants are not born with functional circadian rhythms. Their sleep patterns begin to consolidate into a diurnal pattern only from around 3 months of age, with the body clock maturing between 6 and 12 months.” Galland and collegues agree, concluding that sleep-wake regulation and sleep states evolve rapidly during the first year of life with continued maturation across childhood. Because newborns do not have an established circadian rhythm, their sleep is distributed throughout the day and night with each period of sleep short because of feeding frequency. At around 10-12 weeks of age, the circadian rhythm begins to emerge, and infant sleep becomes increasingly nocturnal.

So, around 3 or 4 months, we can expect babies to begin to sleep more regularly, with most of that sleep at night when we’d like to sleep, as well.

Waking at night is also the product of sleep cycles – at the end of a cycle, we might arouse briefly before another starts. For infants, they may need their regulators (parents) to help them return to sleep. But there’s a huge disconnect between adult and infant sleep cycles. Adults move through five stages of sleep, beginning with deep sleep and ending with light, or REM, sleep after a 90-minute cycle. Over the course of a sleep, adults have more REM and less deep sleep. Infants, on the other hand, start their sleep in the lightest stage, REM sleep, which researchers think is necessary for brain development. After 20 minutes or so, they move into deep sleep, but start to arouse after a 60-minute sleep cycle. This difference in the length of the sleep cycles may mean that your baby is waking you before you get through your entire sleep cycle, making you feel more pronounced effects of sleep fragmentation. Interestingly, when breastfeeding mother-baby pairs cosleep, the start to have synchronous sleep cycles, which may mean a better quality of sleep for mom despite waking often to tend baby.

In their systematic review of literature pertaining to normal infant sleep patterns, Galland and colleagues admit that a major problem with the research is a lack of distinction between breast- or bottle-fed babies. We do, however, have a robust body of research about co-sleeping infants and breastfeeding thanks to researchers like McKenna and Ball who have created sleep labs to study the effects of shared sleep.

Their studies have provided huge insight into the safety of mother-infant co-sleeping, as well as the beneficial effect of nighttime breastfeeding.

Much of their work focuses on SIDS prevention, showing that co-sleeping, breastfeeding, and night waking might be protective for infants. In an early study, Mosko, Richard & McKenna looked at mother-infant pairs in a sleep laboratory. These dyads were recorded sharing sleep and sleeping apart, and comparisons were made. What they found was that, on the bedsharing night, infants had longer total sleep, more light sleep, and more arousals during deep sleep. Moms also had more light sleep, but no change in total sleep. The most interesting finding? Moms and babies had overlaps in arousal on the bedsharing night – so moms weren’t getting interrupted sleep, they were awakening briefly at the same time as baby and then returning to sleep. The researchers think this may serve as “practice” for baby in navigating sleep – again, the necessity of the caregiver to help baby regulate his or her system until the baby is neurologically ready to assume self-regulation.

An additional reason babies wake at night relates to hunger. Nils Bergman in a review of the literature found that newborns typically have a 20ml stomach capacity, and it takes about one hour for that 20ml of breastmilk to be digested. This gastric emptying time fits nicely with the length of an infant sleep cycle, leading one to believe that hourly waking and feeding is biologically appropriate for human babies.

What itall comes down to is that night waking is NORMAL for the human infant. The main problem is that our culture makes sleeping through the night seem like the norm. Researchers say caregivers’ expectations and behaviors that are at the source of infant sleep problems, so we need to help parents better understand normal sleep. Helen Ball agrees, saying we need to realign parental expectations with reality of newborn sleep. Night waking is not pathological, and extended periods of sleep are a developmental milestone – we should be helping parents “anticipate and cope” with this pattern.A recent article in Breastfeeding Review supports this assertion, concluding that

“New parents should be aware that infants' sleep is unlike that of adults and that meeting their infant's needs is likely to disrupt their own sleep. They will need to adjust their routine to manage their own sleep needs. “

So instead of leaning toward sleep training for infants, it’s more important to adapt your own behavior to better meet your baby’s biological potential. Researchers Douglas and Hill conclude that  “we’re telling parents to do with their young babies exactly what we tell them not to do if they are adults experiencing insomnia themselves!” Tactics such as tracking how long or often the baby sleeps, and when the baby wakes, cause parents to resent infant intrusion on their own sleep.

So how can you as a parent learn a better method for dealing with sleep fragmentation and infant waking? First, educate yourself about normal infant sleep. Some great books include:

Helping Baby Sleep by Anni Gethin and Beth Macgregor

The No-Cry Sleep Solution by Elizabeth Pantley

Sleeping with your Baby by James McKenna

Good Nights by Jay Gordon

Sweet Dreams by Paul M. Fleiss

Nighttime Parenting and The Baby Sleep Book by William Sears

Then go with your instincts. If it seems like your baby is content and thriving, her sleep schedule is just right for her. Be aware of your own sleep deficit, and find ways to combat it. Sleep when your baby sleeps – or at least get horizontal and rest, even if you don’t actually sleep. Go to bed earlier yourself, so that you get a few extra minutes per day. Eat well, stay hydrated, and get exercise and fresh air every day. Most of all, remind yourself that this is temporary – your baby will grow and start to sleep more, and you will catch up on your sleep deficit without even realizing you’re doing it.

 

References:

Ball H. (2013). Supporting parents who are worried about their newborn’s sleep. BMJ 346: f2344.

Bergman NJ. (2013). Neonatal stomach volume and physiology suggest feeding at 1-h intervals. Acta Paediatr 102(8):773-7.

Douglas PS & Hill PS. (2013). Behavioral Sleep Interventions in the First Six Months of Life do not Improve Outcomes for Mothers or Infants: A SystematicReview.  J Dev Behav Pediatr 34: 497–507.

Galland BC, Taylor BJ, Elder DE, Herbison P. (2012). Normal sleep patterns in infants and children: A systematic review of observational studies. Sleep Medicine Reviews, 16(3): 213-222.

McGuire E. (2013). Maternal and infant sleep postpartum. Breastfeed Rev. 21(2):38-41.

McKenna JJ. (2001). Part I: Why we never ask “Is it safe for infants to sleep alone?”: Historical origins of scientific bias in the besharing SIDS/SUDI ‘debate.’ ABM News and Views, 7(4):32,38.

Mosko S, Richard C, and McKenna JJ. (1997). Infant Arousals During Mother-Infant Bed Sharing: Implications for Infant Sleep and SIDS Research. Pediatrics 100(2): 841-849.

Sadeh A, Tikotzky L, Scher A. (2010). Parenting and infant sleep. Sleep Medicine Reviews 14(2): 89-96 

Small, M. (1998). Our Babies, Ourselves. New York: Anchor Books.

Tsai SY, Hu WY, Lee YL, Wu CY. (2013). Infant sleep problems: A qualitative analysis of first-time mothers' coping experience. Midwifery. 2013 Aug 14. [ePub ahead of print]


“Can I still eat broccoli?” – Nutrition for nursing moms March 02, 2014 19:27

Written By Michelle Roth, BA, LCCE, IBCLC

As a lactation consultant, I am frequently asked whether moms can eat certain foods when breastfeeding. I am often astounded by the number and kinds of foods moms are avoiding to keep their nursing baby from being fussy or colicky or due to food allergy potential. But is this necessary? Here are some of the most common concerns parents share with me, as well as the facts to counter the myths.

MYTH: Nursing moms need to eat a lot more calories.

FACT: During pregnancy, the body puts on extra fat stores to provide for milk production. After birth, a breastfeeding mom needs about 500 extra calories per day for, though this depends her weight, activity levels and individual metabolism. Even this number is disputed, with new research showing that nursing moms can take in far fewer calories without impacting the quality or quantity of milk. 

How often and how long the baby nurses also makes a difference – an older nursling who isn’t feeding as often and is taking many solid foods doesn’t need as much breastmilk; thus mom doesn’t need as many calories to keep up production.

Rather than counting calories, nursing moms should eat when they are hungry. Focus on the quality of foods at every meal or snack – avoiding empty calories and junk food, and opting instead for more nutritious choices. Avoiding overeating and empty calories may even help you lose weight while nursing.

 



MYTH: I don’t like milk, and I’ve heard you need to drink milk to make milk.

 

 

FACT: Do cows drink human milk in order to have enough to feed their babies? Some moms find they need to keep water nearby because they are exceptionally thirsty when they are nursing. There’s no need, though, to push extra fluids – whether milk or water – when breastfeeding. Simply drink to thirst. Drinking more than you’re thirsty for can actually have negative consequences: researchers found decreased milk production was linked to excess fluid intake. Aim for eight, eight-ounce glasses per day, with water being the best choice. 

 

MYTH: You need to avoid broccoli, cabbage, Brussels sprouts, oranges, tomatoes, etc. so that baby doesn’t get gassy or fussy.

 

FACT: Your body just doesn’t work that way. Yes, these foods may give mom gas or heartburn as they are digested. But breastmilk is made from the components of mom’s diet that pass into her bloodstream – and the gas and acid are limited to mom’s gastrointestinal tract. Occasionally a baby may be sensitive to something mom eats – but this more often has to do with a protein in the food passing into mom’s bloodstream and her breastmilk, than with the food producing gas in mom’s stomach or intestines.

MYTH: Nursing moms need to avoid fish.

FACT: It’s true that nursing (and pregnant) moms should avoid certain fish due to high mercury content. These include shark, swordfish, tile fish and mackerel, among others. But fish are a good source for fatty acids that improve the types of fats available to your baby through your breastmilk. Good choices for this include salmon, albacore tuna, lake trout, Alaskan halibut, sardines, and herring. Choose cold-water varieties of fish and know where your fish came from, if you can.

MYTH: If you don’t eat the perfect diet, your milk won’t be any good.

FACT: Even if you were to live on a diet of fast food and soda, your breastmilk would still be perfect for your baby. You would likely feel the effects of poor nutrition (decreased energy being the biggest one), but your baby would still thrive. In countries where malnutrition is common, breastfed babies are chubby and flourishing until they begin weaning to solid foods. You’ll have more energy and a greater sense of well-being if you are eating a nutritious diet, but that diet will do little to impact your nursling. He or she will get the perfect nutrition despite what you consume.

MYTH: You need to avoid all caffeine when you are breastfeeding.

FACT: Some moms decide to wean because they miss their morning cup of coffee, or they want to enjoy a chocolate bar every now and then. While it’s true that caffeine does pass into your breastmilk, it’s only a very small portion of your dose. Some babies are more sensitive to caffeine than others, so approach caffeine consumption with moderation. Consider all sources of caffeine in your diet, and if your baby is fussy, sleepless or seems over-stimulated, cut back on your intake.

MYTH: Alcohol is a no-no when nursing.

FACT: The American Academy of Pediatrics says that an occasional alcoholic beverage has not been found to be harmful to the nursing baby. Alcohol passes easily into breastmilk from the maternal bloodstream, but also easily out of milk as the concentration in mom’s bloodstream decreases. Any effects on your baby are directly proportional to effects on you – if you feel fine, then it’s likely that baby is getting little to no alcohol in his system. Keep your metabolism in mind: it can take 2-3 hours to eliminate one serving of beer or wine depending on your body type. Side effects to watch for include a sleepy baby who is hard to rouse, or (strangely) a baby who is sleeping less overall. Alcohol can also possibly inhibit let-down, and change the smell of your milk.

Basically, the best diet for a nursing mom is one of wholesome foods as close to their natural state as possible (not processed or refined). Try to make all of your food choices count – get the most nutrients for the smallest number of calories. Meals and snacks that are composed of a carbohydrate, a protein and a fat will be the most satisfying. Vitamins and minerals are best from natural sources – so eat plenty of fresh fruits and vegetables. Choose low-fat and whole-grain options whenever possible. Eating well when breastfeeding doesn’t need to be complicated or difficult.

An interesting added bonus to eating what you like is that your breastmilk takes on strong flavors from your diet; so, breastfed babies are exposed to a wider variety than their formula fed counterparts. Some researchers think this may lead to fewer aversions as the baby moves into toddlerhood and is introduced to novel foods. Just another reason to continue enjoying all of your favorite family foods while breastfeeding your baby with confidence.

 

Resources: 

American Academy of Pediatrics Section on Breastfeeding. (2012). Breastfeeding and the use of human milk. Pediatrics 129(3): e827 -e841.

Lawrence RA & Lawrence RM. (1999). Breastfeeding: A guide for the medical profession. 5th ed. St. Louis, MO: Mosby.

National Research Council. (1991). Nutrition During Lactation. Washington, DC: The National Academies Press.

Riordan J & Wambach K. (2010). Breastfeeding and Human Lactation (4th Edition ed.). Sudbury, MA: Jones & Bartlett.

Sears M & Sears W. (2000). The Breastfeeding Book. Boston: Little Brown.

Sears W & Sears M. (1999). The Family Nutrition Book.Boston: Little Brown.

 

 

 

XX

The Power of Prolactin: Reverse Cycling and Your Milk Supply February 13, 2014 15:16

Written By Michelle Roth, BA, LCCE, IBCLC

Prolactin is a hormone produced by the pituitary gland in both males and females throughout the life cycle. It’s a protein important for immune function, cell growth, and more. In females, prolactin takes a starring role in the reproductive cycle, and is especially important as the main hormone of milk production.

 

 

Often called “the mothering hormone,” prolactin creates protective behavior in a woman during the birth process, as well as throughout breastfeeding. One of the
most interesting aspects of this substance is that it has a circadian rhythm – higher levels are present at night in both males and females. This diurnal pattern may be the reason women who practice unrestricted breastfeeding – both day and night – tend to see a delay in the resumption of their menstrual cycle as well as a stronger milk supply.

Building a robust milk supply depends on frequent nursing from the start. In fact, nursing often establishes more prolactin receptors in the breast, increasing a mom’s ability to make milk over the entire cycle of lactation. And the more often you nurse, the better your supply – thanks to an intricate hormonal dance that includes prolactin, among others. A full breast will release a feedback hormone that says, “hey, stop making milk.” But a breast that is emptied often keeps filling. Prolactin levels rise whenever a baby suckles - they spike during nursing - and more prolactin equals more milk production.

For moms struggling with milk supply issues, nursing more frequently is often all that’s needed for improvement. But this increase in nursing needs to happen at night, too, in order to take full advantage of the higher nighttime prolactin levels. Sometimes babies naturally get into a pattern of more frequent night nursing, often called reverse cycling. These babies nurse more in the evening and at night, and less during the day for a variety of reasons. While moms may be losing some sleep, reverse cycling is actually a boost for their milk supplies.

Reverse cycling is most likely to happen in situations where mom and baby are apart during the day, but together at night (for instance, when a mom works outside the home). Sometimes a working mom will find that her baby drinks only enough during the day to take the edge off his hunger, but then spends the evening nursing non-stop and wakes several times throughout the night to nurse. This pattern shows a strong mother-baby attachment. Rather than a behavior in need of correction, it is, in fact, the key to keeping up a strong milk supply after returning to work. 

But reverse cycling can happen for other reasons, as well. If you are taking care of other children, or have simply had a busy day for whatever reason, it may be that you miss some of the daytime cues for breastfeeding. Your baby may try to catch up – on calories and on closeness - by reverse cycling. Or maybe your baby is at that distractible stage – every time he nurses, he starts and stops multiple times to look at the cat, listen to the noises outside, smile at his sibling, etc. Or maybe he’s busy learning to crawl or walk, and doesn’t want to slow down to nurse. These babies may use the quiet of night to get the majority of their calories.

You might think that all that night waking is a disadvantage, and others may encourage you to get your baby onto a “sleep schedule.” But, research shows moms whose babies nurse often at night actually get the rest they need. This is especially true if you choose to co-sleep with your baby. Moms and babies who sleep in close proximity – especially when sharing a bed – tend to have entrained sleep cycles. When your baby wakes, you’re in the same stage of sleep, and the waking doesn’t provide the same level of disruption to your system that sleeping apart in separate rooms would. When a mom sleeps near her baby, she often notices small sounds and movements before either she or her baby are fully awake, and can often doze as baby nurses. If you choose to share a bed with your baby, be sure that you take precautions to make your sleep space safe. Learn more here [Add hyperlink - http://cosleeping.nd.edu/safe-co-sleeping-guidelines/]. If your baby is reverse cycling and you’re feeling a little sleep deprived, try going to bed earlier or napping during the day.

Another benefit of reverse cycling for working moms is that they may not need to pump during their workday. If your caregiver tells you repeatedly that your baby isn’t taking much from his bottles, but he nurses like crazy when you’re together, you may be able to cut back on how often you pump (or maybe not even pump at all depending on your baby’s pattern). Many women find this eliminates much of the stress surrounding working and breastfeeding. You can read more about other working moms’ experiences with reverse cycling and nighttime nursing in La Leche League International’s magazine for mothers, New Beginnings here  [http://www.llli.org/nb/nbmayjun00p98.html] and here [http://www.llli.org/nb/nbiss3-09p32.html].

The biggest benefit of reverse cycling, though, is that the baby consumes more breastmilk, thus keeping your milk supply strong and your baby healthy and happy. The key is to practice unrestricted breastfeeding when you are with your baby – whether that feeding takes place day or night - to take advantage of your hormones for keeping up your supply.

 

About the author

Michelle Roth, BA, LCCE, IBCLC is a board-certified lactation consultant working in a private pediatric practice. She has been a La Leche League Leader for the past 12 years, and currently serves on the Area Council for LLL of Western PA. As a freelance writer and editor, her favorite jobs are proofreading and blog writing. With 4 active children, she doesn’t get much time to herself; when she does, she enjoys reading, crocheting and cross-stitch.

 

Resources:

Ayden, KK. (2001). Employed Mothers: Supporting Breastfeeding and Mother-Baby Attachment. Leaven 37(5), 101.

Bonyata, K. (2011) Reverse cycling. Accessed at http://kellymom.com/bf/normal/reverse-cycling/.

Buckley, S. (2010) Ecstatic Birth – Nature’s hormonal blueprint for labor. E-book. Available at www.sarahbuckley.com.

Lawrence RA & Lawrence RM. (1999). Breastfeeding: A guide for the medical professional. 5th ed. St. Louis, MO: Mosby.

Riordan J & Wambach K. (2010). Breastfeeding and Human Lactation. 4th ed. Sudbury, MA: Jones & Bartlett.

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

Tips for Tearless Weaning January 11, 2014 21:24

Whether you have been nursing your newborn for a few days or your toddler for a couple of years, the nagging question may have crossed your mind; “Will he/she ever want to stop?” Although no one has ever heard of a kid who is still nursing in high school, it may seem like you are in the nursing game for the long haul unless you are going to wean. While many mothers and children enjoy a long-term nursing relationship, there may be practical considerations to consider when weaning. The process does not have to be traumatic if you inform yourself and introduce the new routine to your child gradually. 

When Weaning begins

Officially, the weaning process begins when the child is given solids for the first time, around the age of 5 or 6 months, and, if the child is left to his or her own devices, the process may continue until the child is 2 ½ to 4 years of age. The answer to the question “Will my child ever want to stop?” is, “Yes, eventually.” Even in non-Westernized societies in which children are allowed to wean themselves, there are rarely children who choose to nurse past the age of 4 ½ of 5. Of course, in Industrialized countries, the weaning process usually begins much earlier; less than 20% of babies are still nursing past six months of age. This is perhaps because of the number of women who return to work when their children are around 3 months old. Although the American Medical Association recommends that women nurse their babies up until they reach 6 months of age, nursing up to three months still provides a young infant with a good supply of vitamins, protein, and germ-fighting antibodies, as well as the emotional connection that is so essential for optimal development. Whether you begin your weaning process after a few days of nursing or after a year, you can be confident that your baby’s nursing experience was beneficial.

Reasons to Wean

One of the most common reasons for weaning is that the mother needs to return to work. Although there are breast pumps on the market to suit every need, a mother might find pumping milk at work to be an irritating intrusion in her work day, or she might not have a job that provides adequate breaks needed for pumping. If a woman is in a high pressure environment, she might find that her milk supply might suddenly decrease. As one woman reports, “When I was at work, all I could think about was when I was going to get a chance to go and pump. I couldn’t concentrate. And then, when I finally had a chance to get to a bathroom and pump, there was no milk, because I was so stressed out!” Although it is best to give pumping a try before weaning altogether (breast milk, unlike formula, has antibodies that protect your baby certain illnesses), pumping is definitely not for everyone. It is best to invest in a low cost pump to see if it works out before buying a state of the art model.

Some women find that babies go off the breast themselves. This is the easiest of all weaning scenarios, because the baby doesn’t need to be coaxed into accepting alternatives. However, there isn’t always mutual agreement; many mothers are quite disappointed when their babies go off their milk suddenly. If this is the case, your baby might be going on “strike” for some reason, and will resume their desire to nurse in a few days. You may want to express milk to maintain your milk flow. If you were thinking of weaning, consider yourself lucky, but don’t be surprised if the baby changes his or her mind later. Use gentle words and give your child a lot of love an attention in addition to a bottle of their favorite (or second favorite) beverage.

There are many medications that are considered harmful to babies if it is absorbed into the breast milk. This may lead a mother to conclude that she must wean suddenly. Since gradual, rather than sudden, weaning has been proven more beneficial to a child, make sure that there really is no other alternative. Some doctors choose to play it safe by telling women to wean their babies when they prescribe certain medicines; confirm with the doctor that there truly is a risk. Ask your doctor if there are other medications that are not harmful, or try alternative remedies (but you also need to check that herbs support nursing).

It was believed for many years that women were required to wean as soon as they became pregnant. It has now been proven that as long as a pregnancy is healthy, the mother does not have a high risk of delivering pre-term and she is not carrying multiples, a pregnant woman can usually continue nursing up to and after delivery (many women nurse more than one child at a time. This is called “tandem nursing”). The taste of the milk changes at around 12 weeks, and many babies will self wean if they don’t like the new flavor.

Many women nurse because it just “feels like the right time”. When a mother starts to feel a bit irritated with her child’s breastfeeding demands (which usually become more vociferous with toddlers), or she feels that it is no longer comfortable or convenient, this is usually an indication that it is a good time to wean. Since this is a matter of preference rather than immediate necessity, the weaning can be done gradually in a way that is mutually beneficial for the mother and the child.

Weaning Your Baby

It is especially important to try to wean a small baby gradually, since it is impossible to explain to them what is going on. Replace one feeding a day with formula or solids and let your milk supply diminish slowly. If the baby seems agitated, it is alright to backtrack and resume a feeding you had previously given up, but get back on schedule the next day. The last feedings to go are usually the late night feeding followed by the early morning feeding.

It is important to find the right formula for your baby. Cow’s milk is not recommended for babies under one year of age. The baby will want to satisfy his or her sucking instinct, so give your child a pacifier or teething ring. If thumb sucking begins, don’t discourage it until the weaning process is over; the child might prefer the sensation of skin to a that of a rubber pacifier. Make sure to give your child some extra cuddling, although if cuddling is closely associated with nursing, this might be difficult for a few days. In this case, give your spouse or a close relative a chance to help out. Most families are full of eager volunteers when it comes to cuddling a baby.

Weaning Your Toddler

Toddlers can be more difficult to wean because they are known to be more vocal about their demands and less tractable than babies, but weaning a toddler doesn’t have to be an ordeal. Give it several weeks or months rather than several days; the more a toddler enjoys nursing, the harder it is for him or her to stop.

The best strategy for weaning toddlers is the “Don’t Offer and Don’t Refuse” method. This means that a mother shouldn’t offer the child an opportunity to nurse, but if the toddler demands, time for nursing should be provided. This gives the toddler a sense of independence to make his or her own decisions. Give your toddler regular meals including snacks and drinks. It is possible to bribe him or her away from the breast with a special treat, but this might create a problem if the food is candy something you wouldn’t want your toddler to eat every day. Healthy “bribes” such as Ovaltine or fruit might be possibilities, but make sure you consistently have them on hand. Give your child some structure to his or her day so you toddler isn’t tempted to nurse out of boredom. If you are accustomed to nursing your toddler to sleep, find alternative methods of inducing sleep, such as putting the toddler in a stroller, reading a story, or singing a lullaby. Since a toddler usually nurses for comfort rather than hunger, you can feel confident about limiting the time at the breast. Saying “That’s enough for now” firmly and lovingly is often accepted favorably by a toddler. Don’t worry if your toddler turns into a thumb-sucking and blanket-clutching Linus; a good motto for parenting is “One issue at a time!”


Stopping the Milk Flow

Make sure you wear a supportive bra and nursing pads so the wet spots don’t show through your clothes. Pumping to relieve engorgement is a good idea. Cutting down on fluids does not reduce milk flow, so drink 8 glasses a day as recommended for every healthy adult. Cutting down on salt seems to help many people, since salt tends to cause fluid retention. It is a good idea to take 200 mg of vitamin B6 every day to relieve engorgement.

Cabbage leave compresses are a tried and true method for relieving breast engorgement. Simply remove the leaves from the cabbage, wash them and remove the spine in the center so each leaf lies flat like a piece of paper. Put them in the refrigerator and place a leaf on each breast, leaving the areole exposed. The coldness of the leaves is soothing, but the leaves wither fast and should be changed every 30 minutes.

Another effective “granny” cure is sage tea. Sage contains an estrogen-like compound and helps to dry up milk. Take one teaspoon of rubbed sage and put it in one cup of hot water. Let it steep for 15 minutes and drink it with sugar or honey, since it is quite bitter. Sage is slightly more effective when used as a tincture and can be found in most health food stores.

Weaning can be an emotional time for both mom and baby.  Give yourself infinite love and patience during the transition.  Kathleen Huggins, author of the The Nursing Mother's Guide to Weaning, reminds us:

“Independence grows out of a child's faith that her source of security will always be there when she needs it.” 

 


ACUPUNCTURE: An Ancient Practice for Breastfeeding Health November 13, 2013 20:10

You may know someone who has treated their migraines or muscle pain with acupuncture, but did you also know that this ancient Traditional Chinese Medical practice is also effective in treating common breastfeeding complications and increasing milk supply?

WHAT IS ACUPUNCTURE, EXACTLY?

Acupuncture is a five thousand year old practice that, combined with herbal treatments, massage, nutrition, and other various practices, forms the wider umbrella of Traditional Chinese Medicine (TCM).  TCM approaches the body as a vessel full of vital energy.  This energy flows throughout the body on a system of meridians.  This energy is called chi (qi).  The premise is that when your chi is off balance or blocked, your body can experience all kinds of pain and illness. Through acupuncture, these maladies are alleviated or eliminated by manipulating (or stimulating) specific meridian points associated with the flow or balance of energy.

When you undergo acupuncture, an experienced practitioner will place very fine needles into meridian points directly connected to the energy blockage.  You might feel a slight twinge of pain as the needle goes in, or you could feel nothing at all.  Once the needles are placed and wiggled a bit, you’ll get to rest quietly for fifteen minutes to an hour.  You may even fall asleep!  (The nap alone sounds good, right?)  The needles are then painlessly removed and you’re on your way to wellness!  Many women experience increased milk production and a decrease of symptoms of mastitis after just one visit, but it may take more depending on your particular condition.

From a western medicine mindset, this can be a little bit hard to stomach.  It may help to know that in 1997, the National Institute of Health (NIH) gave their nod of approval for the use of acupuncture for the treatment of various conditions, with promise of future widespread approval.  According to NIH’s National Center for Complementary and Alternative Medicine (NCCAM), the number of adults using acupuncture in the U.S. has increased by over a million since then.

WHY DOES ACUPUNTURE HELP WITH BREASTFEEDING?

According to Monica Legatt M.Ac., Dipl., NCCA, of Downtown Seattle Acupuncture, typical problems with lactation are a result of either insufficient energy or stagnant energy. 

When you don’t have enough energy, you will often experience low milk production. It is fairly common for a new mother to be exhausted post-partum.  Combine that with blood loss during delivery, and the levels of energy and blood flow necessary to produce sufficient milk are just not there.  Acupuncture treatment actually increases the hormones necessary to produce and move breast milk.  In TCM, your practitioner will combine diet recommendations with herbal treatments and acupuncture to achieve a healthy milk supply for your nursing infant.

When your energy isn’t flowing properly around the breasts, you may experience engorgement, pain and pressure, distention, and even mastitis (which also involves infection).  This energy blockage generally stems from emotional stress such as anxiety, depression, resentment, anger, frustration, or any of the other day-to-day stresses you may feel as a new mother.  These stresses cause a blockage in the flow of energy within the liver channel, which is related to nipple function in women and thus breast milk production and nursing.  Aside from avoiding all stress (yeah, right), acupuncture can open up the energy blockages causes the painful symptoms.

When you receive acupuncture to treat these symptoms, you can rest assured that there will be no needles inserted into your breast!  The practitioner will be treating the liver channel, which has points near the rib cage and on the torso, legs, and feet.

The best way to treat mastitis is by combining western medicine (antibiotics) to get rid of the infection, and acupuncture along with other TCM therapies to relieve the blockage.

 

 

 

 

 


HOW DO I FIND A GOOD ACUPUNCTURIST?

 

 

The first thing to do is to ask your best resource… your friends!  A first-hand recommendation for a good acupuncturist who has worked well with lactation issues beats any search engine you can put your curser on.  Ask at your mom’s group.  Ask your lactation consultant, doula, or midwife.  Ask your doctor.  Once you get a small list of recommended practitioners, do your homework.

Check the acupuncturist’s credentials.  There are several certifying bodies that train TCM practitioners in proper technique, and you’ll want a string of letters behind their name to ensure that you’re getting the highest quality treatment. 

MD or DO:  Your practitioner is a certified medical doctor, but ask if he or she has their Medical Acupuncture Certification through the American Board of Medical Acupuncture.

MAc, or M.A.O.M.:  Masters in Acupuncture and Oriental Medicine.  Your practitioner has completed a rigorous program through the Accreditation Commission for Acupuncture and Oriental Medicine.

NCAA, or NCAAOM:  A certificate from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is required to obtain a state license to practice acupuncture.

Finally, you may want to check with your insurance company to see if acupuncture is covered.  If it is, ask your provider if any practitioners on your list are within your network and if their services are covered.

As you embark on this new path to nursing health, please remember that unless an acupuncturist is also a certified doctor, they are not in a position to diagnose medical conditions.  It’s best to always get a diagnosis from your doctor or midwife and then ask him or her if acupuncture would be beneficial to a holistic treatment plan. 

RESOURCES:

http://blog.seattleacupuncture.com/acupuncture-for-lactation-milk-supply

http://motherloveblog.com/tag/acupuncture-and-breastfeeding/

http://umm.edu/health/medical/altmed/treatment/acupuncture

http://www.acupuncture.com/education/points/liver/liver_index.htm

http://www.nih.gov/news/pr/nov97/od-05.htm

http://nccam.nih.gov/health/acupuncture/introduction.htm

http://acupuncturists.healthprofs.com/cam/content/acupuncture_credentials.html

 

 


The Official Divine Mama Breastfeeding Diet October 01, 2013 14:32

At last!  I finally had some time to put together what I think is a great dietary guideline to follow while you are breastfeeding since each day I receive so many questions about food choices - what's good, what's bad, etc. for breast milk. 

While lactogenic foods are important, they are just one part of a more comprehensive diet and lifestyle plan that will help you and your baby reach optimal health while breastfeeding. 


I have studied over fifty different dietary theories as a pharmacist and nutrition counselor. Unfortunately, I have found that most mainstream theories contradict themselves, making it difficult to sift through all of the information and make the best decisions for you and your baby. 

From my knowledge of lactogenic foods and from my personal experiences, I’ve created an official Divine Mama Breastfeeding Diet with the intention of providing you with simple guidelines that will help take the guesswork out of your quest for wellness.  

Learn more about the diet here!


Conscious Eating: Why Grass Fed Meats Are Important For You and Your Family July 07, 2013 16:25

You want the best for your family, and that includes the food that you eat. You shop for organic produce and dairy products produced without growth hormones, but what about meats? Grass fed meats represent one of the best possible choices for your family where food is concerned. Choosing grass fed meats not only enhances the nutritional value of the meals you place on your family’s table, but also provides an ethical and socially responsible example for your children.

 

What Are Grass fed Meats?

Back in the day, nearly all meats were grass fed. Ranchers and farmers fed their chickens, cattle and pigs by allowing them to range on the prairies surrounding their farms or homesteads. Today’s high-tech feed was not available. In the twenty-first century, grass fed meats borrow from that tradition by skipping commercial feed and even corn in favor of allowing animals to graze and feed on grass.

The process is not as simple as turning the animals loose, however. Ranchers and farmers who cultivate grass fed meats follow a strict protocol of feeding  and grazing that is designed to enhance the quality of the meat as well as ensure that animal welfare standards are followed in the raising of the animals.

Nutritional Advantages of Grass Fed Meats

Grain fed animals are raised to fatten up for market as quickly as possible. In the case of grain fed beef, this means that cattle are slaughtered after fourteen to eighteen months.   Many grain fed cattle are penned in close quarters for much of their lives. By contrast, grass fed cattle are allowed to graze much as they did during the nineteenth century, and are not slaughtered until they are more than two years old. As a result, grass fed cattle are leaner and have more nutritional value than grain fed cattle.

Environmental Advantages of Grass Fed Meats

Grain fed meats represent a major drain on environmental resources. Commercial feed, corn and other crops must be cultivated, which requires using land and water resources. Growing grains for grain fed meats also encourages monoculture – the cultivation of single crops that can exhaust the soil. By contrast, grass fed meats do not require the diversion of crops such as corn that could be used for human consumption. Instead, the animals graze on grass and other naturally growing plant life.

Ethical Advantages of Grass Fed Meats

 Besides avoiding the diversion of grains from human consumption, grass fed meats also represent an ethical method of animal husbandry. By definition, grass fed meats are not enhanced with growth hormones or genetically altered crops to boost their growth. Animal welfare standards are also an essential element in maintaining grass fed cattle, pigs and chickens.  By contrast, many grain fed animals are raised in appalling conditions, along with being fed a steady diet of growth enhancing substances.

Health Advantages of Grass Fed Meats

Bovine spongiform encephalopathy, abbreviated as BSE, is commonly known as “mad cow disease.” Mad cow disease gets its name from the fact that cattle that are infected with BSE often behave erratically. This incurable condition, although extremely rare in humans, can be contracted by consuming infected beef products, primarily from the spine or brain of an infected cow. In humans, BSE is known as variant Creutzfeldt-Jakob disease (vCJD), which is fatal and incurable.

The practice of including parts of slaughtered animals in animal feed to be fed in other animals has been identified as a major factor in spreading BSE. Since grass fed beef is never fed renderings from other cattle, the odds are virtually zero of grass fed cattle being infected with BSE. Likewise, chickens and pigs that are grass fed are also not fed renderings from other animals, minimizing the chances that similar health hazards would ever occur in grass fed pork or poultry.

For Further Reading

  • The New York Times: Where Corn Is King, a New Regard for Grass Fed Beef
    nytimes.com/2013/06/18/us/for-ranchers-an-uncommon-quest-for-grass-fed-beef.html?pagewanted=all&_r=0
  • Teens Health from Nemours: Mad Cow Disease
    kidshealth.org/teen/infections/bacterial_viral/mad_cow_disease.html#
  • WebMD: Mad Cow Disease
    webmd.com/a-to-z-guides/mad-cow-disease-overview
  • Whole Story: Raised to Taste Better
    wholefoodsmarket.com/blog/raised-taste-better
  • Whole Story:  The Scoop on Grass Fed Beef
    wholefoodsmarket.com/blog/whole-story/scoop-grass-fed-beef

Heard of Moringa? It's an herb that helps milk supply. June 09, 2013 00:00


For any new mother who wants to do the best for her baby, breastfeeding can easily provide many benefits. However, some women have problems producing enough milk throughout the breastfeeding years. There can be causes for low milk supply such as being under stress or having some types of hormonal imbalances. Other causes can be having duct milk damage from previous surgeries, smoking, or even getting pregnant again while nursing.  When these possible causes can be ruled out, Moringa can be an option to help increase breast milk flow.

The Moringa tree was first referenced around 2000 B.C. when it was used by people in Northern India. It was believed the tree had medicinal benefits and was able to prevent over 300 diseases. This tree was also used for various reason by the Greeks, Romans, and Egyptians as both protection from the hot sun and as a lotion. Maurian warriors of India ate the leaves believing they had the power to increase their strength and stamina. 

Although the Moringa tree is native to the Northern part of India, it is now found in many areas of the world including Central and South America, Africa and Asia in tropical and sub-tropical climates. This tree can grow up to 12 meters high and has drooping branches on which there are small leaves that contain an incredible powerhouse of vitamins and minerals. It grows best in sandy or dry soil with bright sunshine, but cannot tolerate excessive flooding or soil with little drainage. The tree needs little water, making it a valuable commodity in drier climates.    

The Moringa tree has many uses including: food for humans and forage for livestock, medicine, dye, water purification, and can also help to increase flow of breast milk in lactating women, as has been proven in studies. The leaves of the tree are full of vitamins and minerals which contain:

* 7 times the Vitamin C content of oranges

* 4 times the calcium content of milk

* 4 times the vitamin content of carrots

* 3 times the potassium content of bananas

* 2 times the protein found in yogurt

The Academy of Breastfeeding Medicine Protocol Committee did a study to find out how Moringa effects the rate of milk flow in lactating mothers. Two groups of mothers were given breast pumps and asked to pump every four hours. One group was given the supplement and the other was not. The mothers in the study were asked to write down how much milk was produced each time they pumped over a three day period. The results came back showing that the mothers who had used the Moringa supplement produced more milk overall than those mothers who didn’t use the supplement.

In another such study, the same results were found. Mothers were asked to measure their breast milk production on the third, seventh, and fourteenth day of production. Although all mothers had about the same results on the third day, the mothers taking a Moringa supplement had increased production on the seventh and fourteenth days when compared to those who didn’t take a supplement. These promising results will most likely lead to even more studies showing the efficacy of the supplement on lactating women.

For any mother who struggles with not producing enough milk, the Moringa supplement may be just what she and her baby needs. There are no ill side effects and a good variety of vitamins and minerals come from it. According to both studies done, it may be beneficial for a mother to begin taking the supplement as soon as she gives birth, enabling her milk flow to increase by the third day after birth.

  1. http://www.treesforlife.org/our-work/our-initiatives/moringa
  2. http://itsmoringa.com/1/about/history
  3. http://www.drugs.com/breastfeeding/moringa.html
  4. http://miracletrees.org/growing_moringa.html

 


Lactogenic Foods as described by Hilary Jacobson CH.HU.SI, author of Mother Food May 11, 2013 00:00

 

 

 

 

 

 

 

 

 

 

 

 

With permission from Hilary Jacobson, here's a great comprehensive lactogenic list of foods from her book,  Mother Food for Breastfeeding Mothers...

Lactogenic foods support lactation for many reasons. Eating sufficient calories and getting an abundant supply of nutrients is helpful in itself for lactation, but these foods also contain substances that interact with and support the chemistry of lactation. These substances include phytoestrogen, natural plant sedatives, plant sterols and saponins, and tryptophan, among others. In addition, a rich supply of minerals and a good balance of fats ensure that the mother’s cells and nerves are functioning at an optimal level.

Vegetables

Fennel

Fennel can be eaten raw or cooked, for instance, steamed, or sautéed in butter and then simmered in a bit of water. Fennel seed is well-known as an herb to increase milk production. The vegetable, containing the same pharmacologically active volatile oils, acts as a gentler support.

Carrot, Beet, Yam

These reddish vegetables are full of beta-carotene, needed in extra amounts during lactation. Carrot seed has been used as a galactagogue, and the vegetable, also containing the volatile oils and phytoestrogen, acts as a gentler support. The beet is a wonderful source of minerals and iron. Taking raw beet can help alleviate iron deficiency. These vegetables are naturally sweet, and they support the liver.

Dark Green Leafy Vegetables

Dark green vegetables are a potent source of minerals, vitamins and enzymes, as well as phytoestrogen that support lactation. Dandelion and stinging nettle leaves are diuretic, and can help reduce edema during pregnancy and after birth. They can be plucked from your garden in early spring and eaten whole, chopped into salad, or used to make tea. Stinging nettle can be harvested for salad or cooked as spinach. In your market, you'll find arugula, beet leaves, kale, Swiss chard, spinach, chicory, collard greens and others.

Grains and Legumes

Grains and legumes have a long history as galactagogues. The most commonly used grains include oats, millet, barley and rice. Oats are the most widely used lactogenic food in the US. Legumes to include in your diet are chickpea, mung beans and lentils.

Nuts

Nuts that support milk supply include almonds, cashews, and macadamia nuts. As much as possible, eat raw nuts, not roasted or salted. The taste of raw nuts will grow on you.

Oils and fats

Healthy fats play a vital role in cellular and neural metabolism. The kinds of fats a mother eats will influence the composition of fats in her milk. Please see the article “Dietary Tips for Pregnancy and the Postpartum” for more information.

The renowned expert in fats, Mary G. Enig, suggests that mothers get regular and substantial dosages of butter and coconut oil. In addition, use cold-pressed virgin olive oil, and take equal amounts of cold-pressed sesame oil and flaxseed oil in salads.

One way to balance the fats is to dribble a quarter teaspoon of olive oil, flaxseed oil, sesame oil, and a thin slab of butter over meals. Be sure to eliminate unhealthy fats such as partially hydrogenated vegetable oils and transfatty acids from your diet, as these will also enter your milk.

In addition, be sure to have a source for essential fatty acids. For more information, see “Dietary Tips.”

Beverages

Lactogenic beverages include getting enough plain water to hydrate the body, drinking commercial lactation teas, non-alcoholic beer, ginger ale, Rivella, and natural herbal root-beers from your health food store. Check out coffee substitutes based on the lactogenic grain barley, such as CARO, Roma, Caffix, Pero or Dandy Blend. These imitation coffees usually also contain chicory or dandelion, plus malt—ingredients that are all lactogenic. A recipe for "Barley Water," a potent lactogenic beverage, is at the bottom of this article.

Condiments

Garlic

Garlic is famous for its medical benefits, and has a long history as a galactagogue.

In one study, babies were seen to latch on better, suckle more actively, and drink more milk when the mother had garlic prior to nursing(2). If you do not wish to eat garlic, try adding a capsule of garlic extract to a meal eaten about an hour before breastfeeding.

If you would like to introduce garlic to your diet, and are not used to eating garlic, introduce it very slowly and observe your baby’s reaction. Take only 1 – 2 cloves per day. These can be chopped or pressed through a garlic press into any food after it has finished cooking. Try it in vegetables, rice, grains, pulses, salad sauce, spaghetti sauce, or other sauce.

Our culture does not encourage eating garlic, and many people do not tolerate garlic well (or onions, another food which is traditionally lactogenic). For this reason, garlic is not recommended by the American Herbal Product’s Association while breastfeeding except under the guidance of a qualified herbalist. However, if you do tolerate garlic there is no reason that you should not benefit from it. Take garlic in moderation as do mothers all over the world.

Caution: Do not combine with anticoagulants, as garlic has blood-thinning actions.

Danger: Babies and small children should never be given garlic in any form, whether fresh, dry, powdered or in capsules, to chew, swallow, eat or suck on. Garlic is highly caustic to delicate body tissues, and rubbing it in one’s nose or eyes could be painful and dangerous. Babies will benefit from the garlic a mother eats, and that reaches him through her milk.

Ginger

Ginger is helpful for the letdown and milk flow. Some mothers benefit from drinking ginger ale. Even commercial ginger ale is flavored with “natural flavoring” that is real ginger.

Warning: Do not use ginger or ginger ale in the early postpartum if there was significant blood loss during birth. Do not take ginger immediately after birth due to danger of hemorrhaging.

Caution: Ginger tends to compound and increase the effects of medication being taken. Talk to your doctor if you are taking medication, especially diabetic, blood-thinning, or heart medicine.

Sources: You can find ginger at your local grocery store. Check out stores that sell Asian foods, health food stores, and on line.

Spices

Spices in your kitchen can be used to support milk production. Try adding marjoram and basil to your meals, and anise, dill or caraway. Black pepper, taken in moderation, is helpful.

Turmeric

This powdered yellow root gives curry its yellow color and basic flavor. A potent anti-inflammatory and antioxidant, turmeric is being studied in connection with the prevention of Alzheimer’s disease, rheumatism, and cancer. Turmeric has lactogenic properties and can also be taken to help prevent inflammatory conditions. One half teaspoon of turmeric a day may help prevent inflammation in the breasts. 
Caution: Some herbalists warn that pregnant women should not use turmeric if they are at risk for miscarriage.

SPECIAL FOODS

Oats (Avena Sativa)

The humble oat is one of our most nutritious foods, and contains proteins, vitamins, minerals and trace elements that nourish the nerves, support the metabolism of fats, and uplift the spirit. In traditional medicine, both the seed and the leaf—called oat-straw—are taken. Oats are prescribed as a nervine tonic in the treatment of nervous exhaustion. In Europe, women traditionally take oats after birth. Oats are taken today in the US to increase milk production, both as food and as a supplement. Like other galactagogues, oats are antidepressant, antispasmodic, and they increase perspiration.

Allergy: Occasional. Persons sensitive to gluten in wheat are frequently able to tolerate oats.

Dosage and Preparation:

Taking large dosages of oats is helpful in kick-starting milk production.

Oatmeal can be taken for breakfast or an afternoon snack.

Oat-straw is especially rich in minerals. It is available as capsules or as an ingredient in so-called “green-drinks.” Take as indicated on the package.

Fluid extract: 3 – 5 ml (15 – 35 drops), three times a day.

Nutritional and Brewer's Yeast

Nutritional or brewer’s yeast frequently leads to a significant boosts in a mothers’ milk supply. Mothers sometimes say that they feel much more energetic and emotionally balanced while taking yeast. This may signal a lack of essential nutrients in their diet, in particular, chromium, vitamin B complex, and especially vitamin B12, found in some brands of fortified nutritional yeast. Brewer’s and nutritional yeast also contain protein and good levels of phytoestrogen.

Allergy: Persons who are allergic to yeast should avoid these products.

Side-effects: Occasionally, mothers or babies become gassy, more so with brewer’s yeast than nutritional yeast. To be on the safe side, start with a small dosage and slowly increase.

Sources: Vegetarian stores and health food stores.

Green Drinks

Green foods are reputed to increase the fat content of breastmilk. Some mothers supplement with chlorophyll. So-called "green drinks" can be very helpful. Their ingredients include barley-grass, alfalfa leaf, spirulina, corellas, kelp, oat-straw and other herbs with lactogenic and medicinal properties.

Caution: Chlorella, a common ingredient in commercial green-drinks, is used by medical specialists to chelate (remove) heavy metals from the body, especially mercury. If not taken at the correct dosage, chlorella can lead to an increase of mercury in the bloodstream and probably in a mother’s milk as well. It is wise to choose green-drinks that only contain a low percent of chlorella.

Sources: Super markets, health food stores, online.

Green Papaya

Green papaya is taken as a galactagogue across Asia. It is a superb source of enzymes, vitamins, and minerals, including vitamins C, A, B, and E. Green papaya is the unripe fruit, and it needs to be simmered until soft. Green papaya can also be taken in supplement form.

Allergy: Persons allergic to latex may be allergic to papaya and other fruit.

Caution: Persons taking Warfarin should consult with their doctor before taking papaya supplements.

Sesame Seed

Large, black sesame seeds are used to increase milk production across Asia. Husked, light-colored sesame seeds are also effective and easier to digest. Sesame seed "butter" known as Tahini can be found in health food stores. Sesame is our most potent vegetable source of calcium!

Allergy: Allergy to sesame is becoming more common.

Spirulina

Spirulina is a non-toxic variety of blue-green algae. It has been farmed in lakes and ponds as a food source for thousands of years. It is valued for its proteins, enzymes, minerals, vitamins, chlorophyll, and essential fatty acids. Spirulina's nutrients are easily absorbed, even when a person’s digestion is not up to par.

It is important that spirulina be cultivated on a farm that is not located in waters that are contaminated, in particular with heavy metals. It is also advisable not to use spirulina that has been genetically ‘improved.’ Spirulina and other “green foods” may increase the fat-content of breastmilk.

Note: It is not wise to rely on spirulina as a source of B12.

Barley Water

Barley-water is used medicinally to treat colds, intestinal problems (both constipation and diarrhea) and liver disorders. It was recorded in Greek medicine two thousand years ago as a galactagogue. Taken for a week or two, it often helps mothers with chronic low milk supply. Make a pot in the morning and drink it throughout the day, warming each cup and sweetening it with a natural sweetener as desired.

Barley-water can be made with whole grain or pearl barley. Barley flakes can also be used, though these have been processed and are possibly less potent than the whole or pearled grain.

 


Prenatal Yoga: How to Get Started April 28, 2013 00:00


It might be difficult to find the time and energy to exercise while pregnant, but the benefits of doing so are numerous. Properly done, it can actually increase the amount of energy you have. It can reduce back pain, constipation, and bloating, and could even make labor a lot easier.

Prenatal yoga is a great way to stay in shape while you are expecting. Prenatal yoga will make you and your baby stronger. It does not matter whether you’re a first-timer or an experienced yogi – prenatal yoga is available to everyone, regardless of experience. There are a few considerations to be made depending on what trimester you’re in, but there are a few things that apply no matter what.

First Timers

Many women around the world have only thought about trying yoga. Now that they’re expecting mothers, it’s the perfect time to try. It is important to only seek classes that are specifically for expecting mothers. Yoga looks relaxing, but it is actually an incredibly stressful exercise, one that can cause trouble if not approached appropriately.

Your regular class may still do if your instructor knows how to teach prenatal yoga. In either event, it is best to inform him or her of your condition as soon as you know so the proper adjustments can be made.

Long-time Devotees

Experienced and expecting practitioners need not stop just because they’re now carrying a child. Some positions will be uncomfortable if not downright dangerous as your pregnancy progresses, so feel free to back out of more intense sessions. Do not feel obligated to do more than you feel your body and baby can take. If necessary, temporarily switch out of your current class to go to a prenatal yoga class so you can stay away from questionable poses.

Dedicated Home Yogis

Home practitioners may either continue practicing at home or sign-up with an experienced prenatal yoga class to make sure that you’re doing it right. If you’re confident in your skills, simply add “Prenatal Sun Salutations” to your routine. “Prenatal Sun Salutations” start in Tadasana, with your feet set as wide as the mat. While inhaling, bring your arms up through the center, up towards the ceiling until you are into the Urdva Hastasana position.

Other positions great for Prenatal Yoga include:

  • Cat-Cow Stretch: Being on all fours helps get the baby in position. To make it even more effective, you can have the relevant movements start in the pelvis.
  • Utthita Trikonasana: This is an excellent pose that opens up the hamstrings, hips, and chest.
  • Parighasana: Your stomach or middle can get exceptionally low on space as the pregnancy progresses, making side stretches extremely satisfying to perform.
  • Pelvic Tilts: Lower back pain is common in most pregnancies. Stretching it out will offer some relief.

There are more positions. It is best to consult with an experienced prenatal yoga instructor to learn more.

Yoga after the Pregnancy

The wonderful day has come and past, but that’s no reason to stop practicing yoga. Yoga has a number of physical and mental benefits that new mothers may want to experience. Doctors, however, strongly recommend waiting for a month and a half after delivery before practicing yoga again if you gave birth vaginally. The recovery period may be significantly longer if you had a cesarean operation. Regardless of which method was used, you will have the opportunity to practice yoga again.

 

 


Protein: Essential Building Blocks for You and Your Baby April 20, 2013 00:00

Most people don’t know as much about protein as they think they do.  When you were in school, or perhaps in your own kitchen as a child, you learned that protein was one of the rainbow colored sections that comprised the all-powerful Food Pyramid.  The protein section of the poster was filled with pictures of beans and chicken legs, nuts and eggs.  Your mother complained that the only protein she could get down you was peanut butter.  Now, as an adult and a mother, you know that protein is important to growing bodies.  But what, exactly, is t protein-rich food comprised of and why is it necessary for a healthy body and mind?

Proteins are the building blocks of life

Simply stated, proteins are compounds formed from various combinations of amino acids, of which there are twenty, arranged in countless combinations.

Every single chemical reaction and every body function relies on the presence of amino acids.   So you can see that proteins really are a requirement for a healthy body. They build cells, regulate fluids, rebuild tissues, and are vital to hormone, antibody, and enzyme production.  In the absence of carbohydrates and fat, proteins also supply the body with energy.

Eight of those twenty amino acids that form the proteins are not produced or stored inside the body, so they absolutely must be consumed throughout the day.  They are phenylalanine, tryptophan, valine, isoleucine, leucine, lysine, methionine, and threonine.  These eight are called essential amino acids, as in, “It’s essential that you eat them!”

Essential amino acids are found in a variety of protein sources like fresh water fish, eggs, nuts, and some nut oils. But it’s also important that you eat a balance of various types of proteins, essential and non-essential, as your body often cannot produce enough of the non-essential amino acids to meet your needs.   Let’s see if we can make it easy for you to figure out just how much and what types of proteins to include in your diet.

Healthy Protein Consumption

You may have heard proteins referred to as complete or incomplete, high-quality or lower-quality.  These terms simply refer to whether or not a protein source provides you with all of your essential amino acids in the necessary proportions.  Sources such as meat, dairy, poultry, eggs/egg whites, and fish provide you with the correct balance of all of your amino acids.  However, you can still get all of your amino acids by combining several incomplete proteins such as nuts and oats, or beans and brown rice.

Eating large amounts of red meat and dairy can actually add too much fat to your diet, without the necessary fiber for a healthy digestive system.  Instead, you should balance your protein intake by combining lean meats and fish, low-fat dairy and eggs, with combinations of nuts, legumes, and whole grains. 

How much is enough?

The Food and Drug Association recommends a daily protein intake of about 50 grams, based on a 2,000 calorie diet.   This might look like two poached eggs for breakfast, a yogurt cup for a snack with granola, a cup of beans and brown rice as part of your lunch, a pork chop with dinner, and a handful of almonds and seeds somewhere in between. 

Contrary to what you may think, the necessary intake of protein does not changed based on physical activity.  Instead, protein needs are based on your weight, and should be right around .8 – 1 gram of protein per kilogram of body weight.

Protein for Breastfeeding and Pregnancy

However, if you are a nursing or pregnant mother, you will need to increase your protein intake by about thirty additional grams per day.  While still in the womb, this protein is crucial to the healthy   development of his or her body and brain.  Also, the amino acids that you take in will help regulate your sleep and your emotions, two very important things for your own personal well-being. 

 

 

Infants use a third of their dietary protein to build new muscles and connective tissues.  Since their primary, and best, source of nutrition is their mother’s breastmilk, you will need to make sure yours has all the protein necessary for your baby’s healthy body.

You can add extra protein into your diet easily by snacking on unsalted nuts, egg whites, lean meat slices and hard cheeses, or by sprinkling your cereals and yogurt with flax seeds.  Skip the chips and opt for edamame or raw trail mix, and add a slice of turkey bacon to your morning omelet.  Carry some prepackaged protein bars in your purse to avoid grabbing a bagel when you’re out running errands. 

With just a few simple changes, you’ll be able to add the right kinds of protein to your diet… for your body and your baby’s.

 

Resources:

  1. U.S. Food and Drug Administrationhttp://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/FoodLabelingGuide/ucm064928.htm
  2. Nutrition and Well-being A to Z    

http://www.faqs.org/nutrition/Pre-Sma/Protein.html

  1. The Nutrition Source, Harvard School of Public Health http://www.hsph.harvard.edu/nutritionsource/protein/
  2. USDA Dietary Guidelines for Americans 2010 

http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.ht

 

 

 

 


5 Reasons to Co-Sleep While Breastfeeding April 13, 2013 00:00


 

 

 

 

 

 

 

 

 

 

 

 

The conventional wisdom for a couple expecting their first child is to equip a room with a crib and other furnishings, to buy baby formula, bottle, and diapers, and to prepare to lose sleep. Parents often secretly expect their lives to be changed for the worse. They may cover up these fears with false cheer. Truthfully, these fears are well-founded. This conventional approach to welcoming a new child into the home is in fact artificial and needlessly painful -- it is plainly difficult. There is a much easier approach, in which parents share their bed with the baby, and the baby nurses at will throughout the night. Parents may find this way not only easier, but simpler and more life-giving. Here are five benefits of co-sleeping with your newborn while breastfeeding.

One of the greatest discomforts parents face when they relocate the infant into her own room and crib is a lack of sleep for themselves. A child separated like this may wake at any hour of the night, and cry for food or comfort. Parents are then left with a dilemma: to climb out of bed yet again and feed or hold the child, or to remain in bed and let the child "cry it out". Arguments may occur about who arises to tend to the infant. These difficulties can also occur for parents whose infant sleeps in their bedroom, but in her own bed.

This is barely a problem at all for co-sleeping families. A co-sleeping child, next to her mother and able to nurse at will, is able to rest much more easily. The child need not cry loudly to wake the parents and to draw them near; the parents are already there. All the child need do is grunt and touch the mother, and the breast is there. The mother need not even be fully awake to nurse the child. They can both fall back asleep, naturally. And there will be no arguments between parents over who will rise and feed the baby next

There are many psychologists today who argue that the conventional removal of a newborn to its own room and bed is traumatic to the infant. The argument is that the infant physically and psychologically needs the physical warmth and touch of the mother's skin. Having just come from the total comfort of the womb, she requires a far more gradual separation from the mother, taking years, rather than hours. Moving the infant into its own room so early is traumatic, and shakes her trust in her parents -- and in the world -- deeply and irreparably. Her suffering is multiplied when she is required to "cry it out". Parents may feel guilt over this separation and the suffering of the child.

When co-sleeping while breastfeeding, all this potential trauma simply does not occur. The infant goes straight from the comfort of the womb to the comfort of the parents' embrace. Needless suffering is avoided. The parents don't sever the bond of comfort and trust, so they carry no guilt. They experience greater freedom to love and help the child, and less need to "make up" for their failings.

A mother's milk is the ideal food for an infant. The best formula cannot approach its nutritive benefits. The small body of a newborn results in a fast metabolic cycle. Because an infant gets hungry frequently, often even at night, she needs to nurse frequently -- sometimes several times an hour.

When parents nurse an infant while co-sleeping, that food is always there. Since an infant does most of its growing at night, the necessary nutrients for growth will be readily available in the easily-digestible mother's milk. And the infant need not get to the point of crying or screaming before nursing, when her growing hunger is already unbearable; when nursing while co-sleeping, she can eat as soon as she is hungry. Her nutritional needs are met as soon as they occur.

One fear of expectant parents is the financial strain a new baby will bring. Many of the usual costs don't exist when nursing and co-sleeping. Since all the food comes straight from the mother, the greatest expense there is her own food. There is no need to buy formula. No crib is necessary, either, though parents might invest in a sleeping pad to avoid urine stains in their bed. Freed of the compulsion to buy new things for the home -- things often made of unattractive plastic -- the material simplicity of co-sleeping while breastfeeding contributes to a certain peace of mind. There is less clutter from "baby stuff" in a co-sleeping home -- and more happiness.

A family does not require a new room for the baby when she simply sleeps in bed with the parents. The notion of a nursery is in fact foreign to a co-sleeping family. A co-sleeping family doesn't feel the need to expand their living space. This acceptance of things as they are invites contentment and a lack of stress. With any extra space not "swallowed up" by the baby, the family can use an existing extra room for another purpose -- perhaps for a recreational, family-building purpose. Perhaps the space can be used to develop a personal hobby, or for activities toward fulfilling one's lifelong dreams. All this adds joy and vitality to a young family, rather than the nervous oppression that infects so many young parents.

Co-sleeping while nursing provides significant benefits over the conventional approach to raising an infant. Parents get more sleep, and form a deeper bond with the child. The infant receives better nutrition. Parents save money, and don't need to scramble for more space. All of these benefits, significant in themselves, lead to the greater benefit of more peace and joy in the home. 


The Benefits of Coconut Oil Before, During and After Pregnancy March 16, 2013 00:00

Nothing is more important than your health – unless, of course, it’s the health of your baby. Coconut oil has recently gained wide-spread attention for its health-boosting properties. A variety of studies have shown that it can help increase metabolism, balance hormones and improve immune system functioning.

Here are some simple ways that coconut oil can support health for both Mom and baby:

Before pregnancy

  • Regular coconut oil consumption can help balance hormones. Properly-balanced hormone levels make it much more likely for a woman to ovulate and to conceive.

During pregnancy


  • Coconut oil is rich in lauric acid, a rare medium-chain fatty acid that is also present in breast milk. Lauric acid is antiviral, antifungal and antibacterial. Increasing your coconut oil consumption during pregnancy might help support both your and your developing baby’s immune systems.
  • There is evidence that coconut oil – by helping to balance blood sugar – might help women avoid or control gestational diabetes.
  • Coconut oil can help settle your stomach if you’re coping with morning sickness. While taking the oil “straight up” might be too much for some women, it’s easy to stir some coconut oil into soup, hot cereal or a warm drink.
  • Rubbing coconut oil on your skin can help prevent or relieve the itching and discomfort often connected to pregnancy. Coconut oil’s moisturizing properties can also help prevent stretch marks.
  • Coconut oil is an excellent personal lubricant. It can help to alleviate the discomfort of vaginal dryness, a symptom sometimes present during pregnancy.

After pregnancy 

  • You can use coconut oil to treat your new baby’s diaper rash and cradle cap. It is non-toxic and very gentle on baby’s skin. And as an added bonus, it smells lovely!
  • If you’re breastfeeding, you might suffer from irritated or sore nipples. Applying coconut oil can help prevent and treat cracking and soreness.
  • The medium-chain fatty acids in coconut oil are reported to help increase milk flow. Your body needs adequate fat in order to produce enough breast milk to support your baby’s needs.
  • The antibacterial, antiviral and antifungal properties of coconut oil – mentioned earlier – continue to be of benefit after your baby is born. The lauric acid that you consume in coconut oil will be directly passed on to your child through your breast milk.
  • Coconut oil is perfect for massaging your new baby. Infant massages can help calm and relax babies, and has been shown to improve sleep. Improved sleep for baby means better sleep for Mom!

Your baby is the most precious, important thing that you will ever hold in your arms. Of course you want to do whatever you can to ensure that he or she will be healthy, happy and strong. Coconut oil is one tool that can help you support both your own and your baby’s optimal health.


The Good, The Bad, and the Ugly: Here's the Skinny on Dietary Fat March 07, 2013 00:00

BAD FAT 

While a fat-free or even low-fat diet is not the healthiest choice, there are certainly some types of fat that you'll want to do your best to avoid or limit.  These are the fats that are detrimental to your health, especially when consumed in large quantities.

Saturated fat comes from animal sources.  When you eat a burger with bacon and cheese, the saturated fats from the meat and dairy raise your total and LDL blood cholesterol levels. This is not good. High LDL cholesterol dramatically increases your risk of cardiovascular disease and type 2 diabetes.

Trans fats are naturally occurring in some animal products, but most trans fats are the product of partial hydrogenation.   The process of hydrogenation takes healthy unsaturated fats and turns them into fats that are more shelf-stable and easier to cook with.  These fats are usually solid at room temperature, .like lard, butter, margarine, and shortening.  They are often referred to as synthetic fats, and are found in a lot of the processed and prepacked food that fills most American grocery stores.

Many restaurants and food manufacturers now advertise the fact that their products are trans fat free.  Be careful of tricky labeling... just because a doughnut is trans fat free doesn't mean it is good for you.  It's likely to be high in sodium, sucrose (the bad sugar), or heavy in saturated fats.  Your best bet is to read the label, including the little box that tells you all the vitamins and minerals (or lack thereof). 

Remember, food is fuel.  If you are filling up with empty calories (that's food that is basically void of any nutritional value), you won't be able to run very long before you crash.

GOOD FAT

The term “good fat” is not an oxymoron.  Fats are the building blocks of the brain and are absolutely essential for proper body function, but you must be able to differentiate between the good, the bad, and the ugly... or at least the good and the bad.

Monounsaturated fat is found primarily in oils (like olive oil), nuts, sunflower seeds, and avocados.  This type of good fat reduces the risk of cardiac disease and stroke, because it helps regulate LDL cholesterol in the bloodstream.

That's not all, though. A diet rich in monounsaturated fats verses one that is comprised of “bad fats” and carbohydrates often results in weight loss, decreased symptoms of rheumatoid arthritis, prevention of type 2 diabetes, and reduced belly fat.

Polyunsaturated fat is found in plant-based foods, oils, and some types of fatty fish.  One especially beneficial type of polyunsaturated fat is Omega-3 fatty acid, found in some types of fatty fish, nut oils, and flax seeds.  According to the University of Maryland Medical Center,  Omega-3 fatty acids are a necessary component of a healthy brain, including memory and behavioral function.  In fact, infants who have not received enough of this polyunsaturated fat in utero can suffer from vision and nerve problems.

Balanced consumption of Omega-3's is also associated with reduced risk of inflammatory diseases like cancer, heart attack, stroke, and arthritis. 

WHAT CAN GOOD FAT DO FOR ME?

According to information published by the Franklin Institute for Science Learning, fat literally builds your brain.  Fatty acids from the food you consume are the substance your body uses to build the specialized cells which allow you to think and feel.

Good Fats Build Neuron Membranes

Neurons are the specialized cells that the brain uses to communicate with the rest of the body.  The membranes of these cells are comprised of the same fatty acids that you consume in your foods.  The process of digestion breaks the dietary fat into molecules of different lengths.  These molecules become the building blocks of the fats used in the formation of brain cell membranes.

Good Fats Protect Your Brain

Myelin is the sheath that protects the neurons of your brain.  It's composed of 30% protein and 70% fatty acid.  Oleic acid, the most abundant acid in human breast milk, is one of the most common fatty acids found in the brain's myelin.  Excellent dietary sources of monounsaturated oleic acid are avocados, olive oil, and oils from peanuts, macadamias, almonds and pecans.

Good Fats Aid Digestion

Believe it or not, that slippery looking margarine is hard to digest.  Why?  The shape of a trans fat molecule is not barbed, which means lots of those molecules can clump together nice and tight.  On the other hand, a mono or poly unsaturated fat molecule is barbed, which means they are loosely packed and can be picked apart by the body and put to good use.  These fats are more readily absorbed and distributed to the cells that need them.  Whereas the bad fats, in essence, plug you up. 

WHAT CAN GOOD FAT DO FOR MY BABY?

A pregnant mama supplies two specific types of fatty acids, DHA (docosahexaenoic acid) and AA (arachidonic acid), to her growing baby.  These fatty acids are crucial to the baby's brain and vision health. Studies have shown that a deficiency in DHA and AA can lead to impairment of the baby's central nervous system and cognitive development. 

After the baby is born, the mother will continue to provide these necessary building blocks through her breast milk.  Since Omega-3 and Omega-6 fatty acids are essential nutrients, they can not be manufactured by the body.  They must be built from the foods that we consume.  A diet high in nuts and cold pressed oils will help ensure that a nursing mother produces the most nutritious breast milk for her baby's growing brain and body.

HOW MUCH GOOD FAT DO I NEED?

The United States Department of Agriculture's Dietary guidelines are based on a 2,000 calorie per day diet.  Within that framework, you should consume about 44 to 78 grams of fat per day, most of which should be unsaturated fatty acids. 

Remember, even good fats are high in calories.  For a nursing mom who needs to consume a few more calories, this is no problem.  But it's best not to go overboard.  Start by replacing a couple of beef dinners a week with fresh water fish.  Snack on nuts, or non-hydrogenated nut butters on celery, instead of chips and crackers.  Whip up a free-range egg white omelet for breakfast.  Go for a snack bar that is full of flax, almonds, or macadamia nuts instead one that is really a glorified candy bar.


By making these simple dietary changes, you can provide your beautiful baby with the most nutrient rich breast milk possible.  Not to mention that your own mental and physical health will benefit right alongside your baby's.  Healthy mama.  Healthy family.  It's a no-brainer.

RESOURCES:

Mayo Clinic.  Nutrition and Healthy Eating.  Dietary Fats:  Know Which Types to Choose.

http://www.mayoclinic.com/health/fat/nu00262/nsectiongroup=2

The Franklin Institute:  Resources for Scientific Learning.  Nourish- Fats.

http://www.fi.edu/learn/brain/fats.html

University of Maryland Medical Center, Omega-3 Fatty Acids.

http://www.umm.edu/altmed/articles/omega-3-000316.htm

United States Department of Agriculture:  Dietary Guidelines.  2010.

http://www.cnpp.usda.gov/DietaryGuidelines.htm