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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.

 


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]


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!


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.


There's Sugar, Then There's Sugar - Understanding the difference between sucrose and fruit sugar February 02, 2013 00:00

All sugar is not created equal. 

Understanding the difference between refined white and brown sugar and the natural sugars found in fresh, cooked, or dried fruits and vegetables is essential to making healthy food choices for you and your children.

How Refined Sugar Hurts Your Body

Refined sugar, scientifically known as sucrose, is composed of fructose and glucose molecules.  When you eat something containing this kind of sugar, like a candy bar or soda, you feel an instant rush.  Why?  Because of how the body metabolizes sucrose. 

When you consume sucrose, your body instantly releases insulin to combat the rapid rise in glucose levels.  Insulin's job is to help cells absorb the glucose and store it as fat for when your body needs energy later.  Because the sucrose  is introducing pure glucose into the body, the amount of insulin produced is overwhelming.  Your liver and muscles can store some of it, but much of it will get converted into fat, your body's energy storage facility.

While that burst of energy provided by refined sugar might be good for someone performing incredibly strenuous activity, like a firefighter running up several flights of stairs or an athlete preparing for a race, for most of us it just starts a vicious cycle of insulin resistance and sugar cravings.  Insulin resistance causes cells to say, “Whoa, no more glucose.”  Since the cells aren't opening their doors, the body actually produces more insulin to try to stabilize glucose levels. 

The bottom line is that high insulin levels build fat.  That's why refined carbohydrates and table sugar, as well as high fructose corn syrup, make you fat even when they are fat free.  Of course, this type of insulin regulation disorder can eventually cause Type 2 Diabetes and possibly affect heart function.

It doesn't stop there.  Insulin plays an important role in regulating brain function.  An inability to properly process insulin can potentially lead to psychological disorders like depression, anxiety, and memory loss.  Did you ever eat a pint of ice cream because you were depressed, only to have it make you feel even more depressed?  I'm not saying that the results are that instant, but the long-term correlation is there and being studied more thoroughly by mental health researchers.

Sucrose and Breastfeeding

While many nursing mothers crave sugar, it's better to grab an apple than a slice of cake.  When your blood sugar spikes as a result of eating something filled with sucrose, your nursing baby's blood sugar will spike, too.  Babies are not well-equipped to manage blood sugar spikes, and the unstable insulin production can interrupt the development of healthy physical and cognitive function.

The high levels of sugar in the breast milk can also cause early tooth decay, according to the Australian Breastfeeding Association.  This is especially true for babies nursed longer than twelve months.  Breast milk with high sugar content also increases the risk of thrush, a yeast infection caused by the high acid levels present in sugar.

Why is Natural Sugar Better?

The natural sugars found in fruits and vegetables have a different chemical makeup.  Fruit sugar is simply fructose, which must be broken down into sucrose and glucogen by the pancreas before it can be used as energy or stored in the fat cells.  This is why natural sugars rank lower on the glycemic index than sucrose.  It takes your body time to turn natural sugar into glucogen to be used by your cells, so  insulin doesn't have to rush in to balance suddenly high glucose levels.

When you consume healthy amounts of natural sugars from fruits, your body doesn't need to spike its insulin production.  Just as high levels of insulin are directly related to weight gain, low levels of insulin help keep you lean.

Furthermore, it's widely recognized among the medical community that eating lots of fruits and vegetables keeps your heart healthy, your blood pressure and cholesterol down, and your mind clear.  Not only is fructose a healthier form of sugar, the fruits and vegetables also provide essential vitamins, minerals, and fiber that a spoonful of sugar will definitely not give you.

Satisfying the Sweet Tooth

Even' the healthiest people want to indulge in a little something sweet once in a while, and in fact those cravings are your body's way of telling you it needs energy!  But don't fuel it with calories that aren't just empty, but potentially dangerous to your health.  Instead, appease your sugar craving with healthy alternatives like dates, dried cherries, dried apricots, coconut, nut butters, and a nearly unlimited variety of fresh fruits and vegetables. 

 

Once you switch to these healthier alternatives, you'll start to notice that sucrose-based desserts like ice cream, candy bars, and cookies taste sickly sweet.  Instead, you'll crave apples and almond butter, and your body will thank you for it.

 

 

 

 RESOURCES:

Turner, Joel.  Sugar's Negative Effect on Our Brains.  Kale University. 17 May 2012.http://kaleuniversity.org/6231-sugars-negative-effect-on-our-brains/

Griffin, Sharon.  The Effects of Sugar on Breastfed Babies.  Livestrong.  28 March 2011.http://www.livestrong.com/article/69073-effects-sugar-breastfed-babies/

Ketterer C, Tschritter O, Preissl H, Heni M, Häring HU, Fritsche A. Insulin sensitivity of the human brain. Diabetes Res Clin Pract. 2011 Aug;93 Suppl 1:S47-51. doi: 10.1016/S0168-8227(11)70013-4. Review. PubMed PMID: 21864751. http://www.ncbi.nlm.nih.gov/pubmed/21864751

National Institute of Mental Health:  Diabetes and Depression. PsychCentral.http://psychcentral.com/lib/2008/diabetes-and-depression/all/1/

Effect of Fruit and Vegetables on Insulin Resistance.  NIH Clinical Trial.http://clinicaltrialsfeeds.org/clinical-trials/show/NCT00874341

 

 


How Medications Affect Breastmilk January 20, 2013 21:26

At the pharmacy, I get a lot of questions about medications while breastfeeding.  While it is always safest to avoid medications while breastfeeding, sometimes mothers are left without a choice if their condition puts their own health at risk.  Although many medications are safe to use when you're breastfeeding, most drugs will get into your milk to some degree and may even affect your milk supply. To be safe, check with your child's doctor before taking any kind of medication, even over-the-counter drugs.  The mechanism of how drugs enter breast milk is described below in addition to some general guidelines that I follow when counseling my patients.

Transfer of drugs into breast milk is influenced by protein binding, lipid solubility and ionization

This sounds pretty scientific but basically this means that nearly all drugs transfer into breast milk to some extent.

Notable exceptions are heparin and insulin which are too large to cross biological membranes. The infant almost invariably receives no benefit from this form of exposure and is considered to be an 'innocent bystander'.

Drug transfer from maternal plasma to milk is, with rare exceptions, by passive diffusion across biological membranes. Transfer is greatest in the presence of low maternal plasma protein binding and high lipid solubility.

In addition, milk is slightly more acidic than plasma (pH of milk is approximately 7.2 and plasma is 7.4) allowing weakly basic drugs to transfer more readily into breast milk and become trapped secondary to ionization.

What you should know is that milk composition varies within and between feeds and this may also affect transfer of drugs into breast milk. For example, milk at the end of a feed (hindmilk) contains considerably more fat than foremilk and may concentrate fat-soluble drugs.

As a general rule, maternal use of topical preparations such as creams, nasal sprays or inhalers would be expected to carry less risk to a breastfed infant than systemically administered drugs.

This is due to lower maternal concentrations and therefore lower transfer into breast milk.

However, the risk to the infant must be considered in relation to the toxicity of the drug used, the dosage regimen and the area of application. For example, use of corticosteroids nasal sprays or inhalers in standard doses would be considered compatible with breastfeeding.

Infants have lower drug clearance (elimination) than adults

Drug clearance in the infant is a particularly important consideration and premature infants have a severely limited ability to clear drugs.

Within a few days of delivery, term infants have kidney filtration rates approximately one-third of adult values after adjusting for difference in body surface area, and premature infants have even more impaired clearance.

Generally, adult kidney filtration rates (adjusted for the difference in surface area) are attained by five to six months of age.

Minimize risk to the breastfed infant by reducing drug exposure

The overall risk of a drug to a breastfed infant depends on the concentration in the infant's blood and the effects of the drug in the infant. If, after assessment of the risks and benefits, the decision is made to breastfeed while the mother is using a drug, the infant should be monitored for adverse effects such as failure to thrive, irritability and sedation.

However, it is difficult to identify adverse reactions occurring in neonates. 

Feeding immediately prior to a dose may help to minimize infant exposure as concentrations in milk are likely to be lowest towards the end of a dosing interval.  Or,it may be reasonable to reduce infant exposure by alternating breast and bottle-feeding. For drugs that are not considered safe in breastfeeding, breast milk may be expressed and discarded for the treatment duration. Breastfeeding may be resumed after the drug has been eliminated from the maternal blood stream. A period of approximately four half-lives (the time it takes for half of the drug to clear the body) will reduce maternal concentrations to around 10% of steady-state (full) concentrations.

Atkinson HC, Begg EJ, Darlow BA. Drugs in human milk. Clinical pharmacokinetic considerations. Clinical Pharmacokinetics 1988;14:217-40.

Bennett PN and the WHO Working Group, editors. Drugs and human lactation. 2nd edition. Amsterdam: Elsevier, 1997.

Infantrisk.com

 


Returning to Work or School while Breastfeeding Your Baby - Some tips for Success December 28, 2012 21:23

Congratulations on your decision to provide the best possible nutrition and protection for your baby after returning to work or school! Here are some tips to help you succeed.

Combining breastfeeding with work or school is challenging, but well worth it. The health and immunity benefits your little one gets from your breast milk cannot be matched by formula. And sitting down to cuddle and nurse after a busy day is a wonderful way to de-stress and reconnect with your baby.

Two keys to success are planning and being organized. Below are tips that other mothers have found helpful, as well as information about the federal law to support breastfeeding mothers at work.

What should you do before you deliver?

Before you begin maternity leave:

 

  • Find out how much time you will be able to take off from work or school after you deliver. 
  • Take as much family leave as you can to have more time with your baby.  Research your options for returning to work or school.  Can you work/study part-time for a while?  Can you telecommute or use distance learning? Is there a more flexible work or school schedule you can try? 
  • Talk with your supervisor. Will he/she be supportive? You may want to point out the company advantages of having breastfeeding employees: 
    • »  Less time lost from work because breastfed babies tend to stay healthier than their formula fed counterparts.
    • »  Fewer health expenses for the baby and lower overall health care 
         costs. 
    • »  Higher employee satisfaction, morale and productivity and lower staff 
          turnover. 
    • »  Major recruitment incentive for new employees. 
    • »  Reputation as a company concerned for the welfare of working 
          mothers and children. 
  • When making arrangements for childcare, choose a provider that supports your wishes to provide pumped breast milk to the baby while you are away and allows you to nurse your baby as soon as you return. 
  • Be aware of the laws regarding employees who are breastfeeding. On March 23, 2010, as part of the Patient Protection and Affordable Care Act, a federal law amending Section 7 of the Fair Labor Standards Act (FLSA) (29 U.S.C. 207) was passed. This law mandates break times for breastfeeding mothers to express milk.
  • Find out where you will be expressing milk for your baby. Does the room have an electrical outlet? Is there a refrigerator nearby? If not, you may want to purchase a pump with rechargeable battery back-up and an insulated cooler with ice packs (blue ice). Is there a sink available to wash breast pump parts between pumping sessions?
  • If not, is there a microwave handy to steam clean the parts? If not, you may want to purchase wipes you can use to clean the parts.

What should you do before you return to work or school? 

  • Learn how to manually express breast milk, even if you plan to use a breast pump.
  • Become familiar with your breast pump. Practice setting up your pump and putting the parts together. Try it out. Adjust the settings so that the speed and suction are as close as possible to how your baby nurses.
  • About two or three weeks before returning to work or school, begin pumping once each morning about an hour after you have nursed your baby. (Prolactin levels are highest in the morning.) You may not get any milk during the first couple days, but you are sending a message to your body to begin increasing your milk supply.
  • Gradually add two or three more pumping sessions between feedings. Once you start to get milk, store it in the freezer for emergencies. Store expressed or pumped milk in small amounts, two to four ounces. 
  • Introduce the bottle to your baby two or three weeks before you go back to work or school. It may be easier to have someone else offer the bottle, since your baby links you with breastfeeding. Try to use the newborn-sized nipple for as long as you breastfeed, but you may have to experiment to find one your baby likes. 
  • Consider buying a “hands-free” nursing bra that allows you to use your hands while you are pumping milk.
  • It may be helpful to schedule a practice day. Set your alarm for the time you will be getting up when you’re working or attending class. Take your baby to childcare for at least part of the day. Breastfeed and pump at the times you expect to during work or school. At the end of the day, see if your baby drank as much as you pumped.
  • The evening before your first day back, pack the diaper bag and your pump bag. (See packing lists below.) Include an extra blouse or sweater that you can leave at work in case of a milk leak that soaks through breast pads.

What should you do when you return to work or school?

  • Be prepared. Your first day back at work or school may be very emotional. Try to start on a Wednesday or Thursday. Easing back into the work or academic world by starting with a shortened week will be less stressful. 
  • Breastfeed your baby when you wake up, then give him/her a “top-off” when you get to childcare.
  • Your baby will need at least two to three bottles while you are away, so you will need to pump at least two to three times during the eight or nine hours you are at work or school. (If you have a longer work day or longer commute, you will need to pump more milk.) This is the milk that will be given to your baby the next day at childcare. 
  • You may have an easier time having a let-down reflex if you look at a picture of your baby or have a piece of clothing handy that smells like your baby. Pack these in your pump bag. 
  • Clean pump parts that come into contact with you or your milk. Read the instructions that came with your breast pump. Between pumping sessions you may: 
    • »  rinse with cool water, then wash with warm soapy water and leave out to air dry, 
    • »  wipe with a sanitizing wipe sold by pump manufacturers, 
    • »  rinse parts well and store in the fridge or your cooler, and 
    • »  alternate options above throughout the day. For example, rinse and store in fridge after the morning pump session and wash in warm soapy water after the lunchtime pumping session. 
  • Some women prefer to purchase several extra sets of pump parts so they do not need to clean parts while at work or school and just put everything in the dishwasher at night. 
  • Breastfeed again as soon as you and your baby are back together. You can discuss your baby’s day with your childcare provider during this time. Let the mothering hormones that are released during breastfeeding help you relax and bond. 

1 Bridges CB, Frank DI, Curtin J. Employer attitudes toward breastfeeding in the workplace. J Hum Lact. 1997;13(3):215-219 

Resources 

Books

  • Working without Weaning: A Working Mother’s Guide to Breastfeeding (2006) by Kirsten Berggren 
  • Milk Memos: How Real Moms Learned to Mix Business with Babies-and How You Can Too (2007) by Cate Colburn-Smith and Andrea Serrette 

Websites 

  • www.workandpump.com
    Has many helpful tips for managing the transition back to work 
  • www.usbreastfeeding.org
    Has information on new legislation that relates to breastfeeding 

The information presented here is not intended to diagnose health problems or to take the place of professional medical care. If you have persistent medical problems, or if you have further questions, please consult your doctor or member of your health care team. 

 


Over-the-Counter Medication Use While Breastfeeding December 20, 2012 22:20

Working as a pharmacist, it is not uncommon for me to get several questions throughout the day from breastfeeding women about the use of over-the-counter medications.  Most medications can be detected in breast milk in small amounts (about 1% to 2% of maternal intake), but  very few are contraindicated while breastfeeding.  Adverse reactions from drug passage into breast milk is more likely in nursing infants <2 months old. 

In general, the safest thing to do when an over-the-counter medication may be needed is to try nonpharmacologic symptom management first. If all else fails, then medications can definitely be considered to use, it’s just important to know which ones are safest while breastfeeding. As always, nursing mothers should consult a health care professional before starting any medication.

A drug’s characteristics determine how much of it will be transferred into the breast milk. These include the molecular weight of the drug, the proportion of drug that is bound to plasma and milk proteins, the solubility of the drug in lipids and in water, the proportion of the drug that is ionized or nonionized, the pH of the drug, and the half-life of the drug. The lower the molecular weight, the easier the drug passes into the milk. Low protein binding drugs will more readily pass through to breast milk. Lipid soluble drugs rapidly accumulate in the breast milk. Drugs that are weak bases would be more likely to cross the membranes from plasma into breast milk. The longer the half-life of the drug, the greater the accumulation will be in the mother, in the breast milk, and in the infant.  Aside from potential adverse effects in the infant, some drugs may decrease milk production.

According to the American Academy of Pediatrics Committee on Drugs, to minimize a nursing infant’s exposure to maternal drug, breastfeeding women take oral medications immediately after nursing or just before the infant’s longest sleep period.  As a pharmacist, I recommend single ingredient products at the lowest dose possible. Try to avoid using extra strength, maximum strength, or long-acting formulations. In addition, avoid alcohol-containing formulations when possible or avoid frequent or high doses of alcohol-containing formulations. Breastfeeding women should also be sure to watch for any possible side effects that may occur.  As a last resort, breastfeeding may be withheld during the period of drug therapy if the drug is contraindicated.

 

Analgesics

Many OTC options for analgesics are available. Acetaminophen is routinely used for fever and pain in infants, and levels excreted into breast milk are expected to be less than the dose given to infants.

Of the NSAIDs, ibuprofen is considered the drug of choice for breast-feeding women and is used routinely in infants. While ibuprofen is excreted into breast milk, the concentration and subsequent transfer to the infant are very low.Naproxen should be used cautiously in breast-feeding women due to its long half-life. Alternative therapeutic options are recommended; if aspirin is taken, the mother should avoid breast-feeding for one to two hours after the dose.

 Allergy, Cold, and Cough Preparations

Antihistamines: All OTC antihistamines are known to be excreted in breast milk, and their sedating effects may also be seen in infants. While it is known that diphenhydramine is excreted into breast milk, the concentration and infant transfer are unknown. Clemastine is a long-acting antihistamine that should be used cautiously due to its association with significant effects on infants, including irritability, refusal to feed, and neck stiffness. All of the sedating antihistamines have the possibility of causing sedation in the infant and/or decreasing milk supply, especially when taken in conjunction with a decongestant, and should be used with caution.

Currently, the only nonsedating OTC antihistamine that is available is loratadine, which is excreted in breast milk. However, concentrations in the infant are low and considered safe. Due to its nonsedating effect, loratadine is the preferred antihistamine.

Decongestants: The two OTC oral decongestants available are pseudoephedrine and phenylephrine. Due to new regulations regarding the sale of pseudoephedrine, many cough and cold preparations have reformulated their products to contain phenylephrine. 

Phenylephrine, an ingredient in pediatric cough and cold preparations, is considered safe. While excretion into breast milk is unknown, it is unlikely to be excreted into breast milk in large quantities due to its poor bioavailability. The effect of phenyl­ ephrine on milk production and supply is also unknown; therefore, this medication should be used with caution in women with limited milk production.  Pseudoephedrine is excreted in breast milk and has been shown to decrease milk production and possibly cause irritability in infants. Nasal decongestants are an alternative to systemic decongestants. Most OTC products contain either oxymetazoline or phenylephrine. Excretion in breast milk of oxymetazoline is unknown. However, due to their local activity and minimal systemic absorption, nasal decongestants may have a low concentration in breast milk and are preferred over systemic oral decongestants.

Cough Medications:Dextromethorphan is a common cough suppressant used in cough and cold preparations. Although dextromethorphan has not been studied in breast-feeding, expected concentrations in breast milk would be low. Guaifenesin is used as an expectorant in many formulations of cough and cold products. Cough preparations may also contain alcohol. While alcohol is considered compatible with breastfeeding by the AAP, lactating mothers should choose alcohol-free or low-content alcohol products. 



Gastrointestinal Medications

Gastrointestinal medications include agents used for the treatment of diarrhea, constipation, and flatulence. Loperamide, which is used for the treatment of diarrhea, is generally considered compatible with breast-feeding due to minimal oral absorption.Docusate is a common OTC stool softener. It is minimally absorbed orally, and minimal transfer to breast milk would be expected. As a precaution, mothers who take docusate should watch for loose stools in the infant. Other OTC medications for the treatment of constipation are the stimulant laxatives bisacodyl and senna and the bulk-forming laxative psyllium. Bisacodyl has not been studied in breast-feeding; however, due to its minimal systemic absorption, it would not be expected to cause adverse effects in the breast-fed infant and is considered compatible. Senna, a strong laxative, is compatible with breast-feeding. Although older reports indicated an increased incidence of loose stools in infants who were exposed to senna, newer reports have not shown this adverse effect with current senna products.  Psyllium is not absorbed systemically and, therefore, does not enter breast milk. It is considered compatible with breast-feeding. Simethicone, used for the treatment of intestinal gas, is commonly used in infants. The drug is not absorbed systemically and thus would not pass into breast milk. Simethicone is considered compatible with breast-feeding.

Below are some great online resources regarding medications and breast milk and from where the information above is referenced. 

Online Resources:

Motherisk. http://www.motherisk.org/index.jsp. Offers consumers answers to questions about morning sickness and the risk or safety of medications, disease, chemical exposure, and more. Provides teratogen information for healthcare professionals and updates on Motherisk’s continuing reproductive research.

Perinatology.com. http://www.perinatology.com/. Provides teratogen information for healthcare professionals, links to clinical guidelines, and more.

Organization of Teratology Information Specialists (OTIS). http://www.otispregnancy.org/. Provides medical consultation on prenatal exposures for consumers and healthcare professionals.

OBfocus. http://www.obfocus.com/. Provides information for healthcare professionals and consumers on pregnancy and lactation related issues, including drug exposure. Provides a list of resources on high-risk pregnancy.

LactMed. http://toxnet.nlm.nih.gov/. Drug and Lactation Database by U.S. Library of Medicine. Provides information on drugs and other chemicals that breastfeeding mothers may be exposed to. 

                                                     

 

 

 

 

 

       




The Top Thirteen Health Benefits of Breastfeeding Your Baby December 07, 2012 22:44

Breastfeeding is not an option for all mothers, but there is now an impressive body of evidence suggesting that those women who can breastfeed will reap substantial health benefits. Some of these apply to the development of the baby, while others influence the health of the mother. Read on to discover thirteen fascinating and profoundly important reasons why breastfeeding is a smart choice.

 

1) It reduces your risk of developing certain cancers:

Cancer research has shown that mothers who do not breastfeed or who only breastfeed for a short period of time (i.e. less than three months) are a shocking 11% more likely to suffer from breast cancer at some stage in their lives. Further studies have also connected breastfeeding to a reduced risk of developing ovarian and endometrial cancers.

 


2) It is linked to higher intelligence:

Recent studies have revealed that children who were breastfed as babies are, on average, more likely to score higher on IQ tests and more likely to get better grades in school.

 

3) It can help you become slimmer:

There are a couple of reasons why breastfeeding can help you to get in shape. Firstly, it burns around 500 extra calories each day, and this will help you to lose weight. Secondly, when you lactate this causes your uterus to shrink more rapidly, and the quicker your uterus returns to its normal size then the easier it is to cultivate a slimmer figure.

 

4) It makes your baby less likely to suffer from digestive difficulties:

Breastfeeding your baby reduces its risk of developing a range of intestinal problems, including Crohn’s disease, ulcerative colitis and diarrhea. It is not entirely clear why this correlation exists, but a large body of research has established that there is a significant connection.

 

5) It reduces your risk of developing osteoporosis:

As a result of an overwhelming number of studies, it is now almost universally agreed that women who do not breastfeed their babies are around four times more likely to develop osteoporosis (i.e. brittle bones) in older age.

 

6) It boosts your baby’s immune system:

Breast milk helps to promote a strong and healthy immune system in your body, and this means that your baby is less likely to contract serious illnesses. This is because breast milk is a source of lymphocytes and macrophages, which produce antibodies that protect us from bacteria and viruses.

 

7) It reduces your baby’s chance of developing breast cancer:

A study conducted in the mid-nineties proved that female children who were not breastfed were as much as 25% more likely to develop some form of breast cancer during their adult lives.

 

8) It makes your child less likely to develop arthritis at a young age:

According to studies aimed at discovering how we might prevent arthritis, children who are breastfed appear to be around 60% less likely to develop arthritis during their childhood or teenage years.

 

9) It reduces your baby’s risk of suffering from diabetes:

Research conducted in Finland has found that drinking dairy products (instead of breast milk) at a young age raises the risk of ending up with type one diabetes. This is because cow’s milk antibodies are linked to a greater chance of developing diabetes.

 

10) It can help with insomnia:

The chemicals in breast milk can help to encourage your baby to fall asleep. This, in turn, can also help you to feel more relaxed and able to sleep.

 

11) It makes your child less likely to develop asthma:

Studies on respiratory health show that children who were breastfed as babies are much less likely to suffer from the wheezing and chest discomfort that are experienced by sufferers of asthma.

 

12) It promotes your child’s dental health:

When babies suckle in order to breastfeed, this tones and strengthens their facial muscles. Orthodontic studies show that this toning and strengthening improves jaw alignment, which in turns makes those children less likely to need braces or other orthodontic work in later life.

 

13) It helps to create and maintain a body between you and your baby:

When you breastfeed your baby, your endocrine system responds by releasing a hormone called oxytocin. This is the same hormone that is often called the ‘cuddle hormone’ because of its ability to increase emotional intimacy between romantic partners. In the context of breastfeeding, it improves milk ejection and promotes happy and relaxed feelings during the feeding process. In addition, babies it comforting to be cuddled, and being cradled in your arms during breastfeeding helps to soothe them.

 

As is obvious from these impressive health benefits, breastfeeding can boost the health of both you and your baby. However, note that you should never breastfeed if you have a serious bacterial or viral infection, and you should always speak to your doctor to make sure whether you are taking any medications that could harm your baby if they are transferred via breast milk.


How to Evaluate the Early Signs of Postpartum Depression November 26, 2012 13:09

 

The room is dark. The clock says 3am. You relish this brief moment of rest. And then, the baby cries again. You cringe, desperately hoping she’ll stop. But the crying gets louder. Your man merely grunts and rolls away from the sound. Suddenly, a wave of emotion hits you in the gut, and your whole body begins to spasm with impending tears. Postpartum depression is real, overwhelming, and terrifying. Here is a brief guide on how to cope with the initial onset of postpartum depression.

When does postpartum depression start, and how long does it last?

Immediately after pregnancy, all women experience hormonal fluctuations. Some women (but not all) experience mood changes as a result of these hormonal shifts, and the mood changes can vary from minor “baby blues” to full postpartum depression. The onset of these symptoms can start within the week after delivery, or they could emerge any time within six weeks. For some, the symptoms might last for a few days. For others, it can last weeks or months.

So it’s important to know that every woman experiences hormonal changes. You are not alone. It’s also important to recognize that the “baby blues” are common for many women (estimates say 50-90% of women experience these minor mood changes), and they will fade away when your hormones stabilize.

It’s also important to be aware of more severe symptoms of postpartum depression, which affects 20-25% of women. Be honest with your doctor and pediatrician about the symptoms you are experiencing, and be open and willing to get help, if needed.

The Early Signs of Postpartum Depression

Women experience a wide variety of mood changes during the postpartum hormonal-adjustment period. Many women feel unhappy, weepy, anxious, and have sudden shifts from happy to sad. More often than not, these feelings come without clear or adequate reasons. Often, the smallest thing can initiate a mood swing. However, some symptoms should be viewed as red-flags, and you should get help immediately.




 How to Know if You’re in Danger

It is important to regularly do a self-check on yourself. Here are some questions to ask:

1. How long has your depression lasted? (Concern: Your depression lasts longer than a week.) 

2. How are you sleeping? (Concern: You have trouble sl

eeping when baby is sleeping.)

3. How is your appetite? (Concern: You have very little interest in food.)

4. How are your interests? (Concern: You have lost interest in yourself and your family.)

5. How is your hope? (Concern: You have very little hope; you only see a bleak future.)

6. How is your confidence? (Concern: You feel helpless, without any control.)

7. How is your desire to press on? (Concern: You have suicidal thoughts or urges.)

8. How do you see your baby? (Concern: You wish the baby had never come.)

9. How am I caring for my baby? (Concern: You are not taking care of the baby; you have thoughts of harming the baby.)

10. How is my mental state? (Concern: You are experiencing weird thoughts, extreme fears, hallucinations, etc.)

If you are experiencing any of these “concern” symptoms, call your doctor and get help immediately. Don’t hesitate. Even if you feel you might be over-exaggerating, it doesn’t hurt to talk to someone. If anything, talking out your symptoms will put your fears to rest. And the good news is that help is just around the corner. There are well trained counselors and doctors who will quickly come to your side and support you through this experience. And often, you might be encouraged to join a mother’s group with women facing the same feelings as you. This kind of support (even if it’s the last thing you thought you’d need) can drastically soothe your feelings of panic and give you the tools and encouragement needed to get through this postpartum period. Help is close at hand. You just have to ask.

 Tips and Tricks to Cope With the Initial Onset

Step One: First recognize and accept your problem. In this case, you are experiencing a form of postpartum depression. As discussed above, you first need to accept that mood changes are normal and common during the postpartum period, and it is due to hormonal changes. Do a self-evaluation (perhaps regularly) to see where you are at in the depression spectrum. If in the danger zone, the first step is to get immediate help.

Step Two: During the postpartum period, you will often think negatively. Unfortunately, negative thoughts fuel negative behaviors and moods. So when you are feeling overwhelmed, take a moment to step back and evaluate your thoughts. Write them down if you can. “I feel like I’m doing everything wrong.” This is a thought. It’s a negative thought. Take a moment to step outside yourself and evaluate this thought. Is it accurate? In most cases, negative thoughts are extreme and overly-critical. If you can, try to come up with a positive thought as a rebuttal. “I may feel like I’m doing everything wrong …BUT, I am showered and dressed, and the baby has a clean diaper. That counts for something.” It may be simple. It may seem ridiculous. It may take time to really believe the statement. But these positive thoughts can and do dampen the fire of your negative emotions.

In Conclusion

All women experience hormonal changes after pregnancy. And 50-90% of women experience a mild case of “baby blues” that can last for a few days or so after delivery. In 20-25% of cases, women experience a more intense hormonal reaction called postpartum depression, which can vary from mild to extreme. It’s important that you regularly do a self-check to see if your symptoms are warning that professional help is needed. If you see these red flags, be quick to ask for assistance. Otherwise, for the day-to-day coping of postpartum depression, you can practice evaluating your thoughts. Positive thoughts can dampen your negative thoughts. And practicing positive “rebuttal” thoughts can pave the way for a greater sense of control and self-validation as you navigate through this (sometimes brutal) postpartum period.


Living Mindfully Through Breastfeeding November 21, 2012 00:00


 

 

 

 

 

 

 

 

 

 

 

 

 

As many concepts related to parenting, green living is an ideal that often gets tossed out the window once the baby arrives. Staying sane on only an hour of sleep while taking care of a demanding infant and remembering basics like getting your teeth brushed on a daily basis can be hard enough, much less living mindfully and in an environmentally friendly manner. However, incorporating green living into your daily life as a parent can start with something as simple as how you feed your infant.

One of the most ways a new mother can live mindfully and be green at the same time is to breastfeed her baby. While of course this is not possible for all mothers, nursing can be an incredible way to foster emotional bonding between a mother and child and may offer important health benefits such as increased immunity. Breast milk is also free, which can substantially lower overall costs compared to purchasing baby bottles and formula. According to the website KidSource.com, the yearly cost of baby formula can range between $1275.00 and over $3000.00, compared to the potential cost of a yearly breastpump rental, which costs less than $500.00 a year.

The creation of baby bottles, nipples, and formula containers has an environmental cost as well as a financial one, since natural and energy resources must be used to manufacture and distribute these items. Such objects are also less likely to be recycled and may take up to 400 years to disintegrate once left in a landfill. Moreover, there may be an environmental risk to using bottles and nipples, as plastic baby bottles and some nipples may contain biphenyl-A (BPA), which a chemical commonly used in the production of plastic items. BPA is also found in the metal lining of several types of infant formula cans, including Enfamil and Similac. The U.S. Environmental Working Group (EWG) has shown that exposure to BPA, even in low doses, may result in early puberty, cancer, behavior and brain disorders. According to MomsandPOPsProject.org, infants who are bottle-fed are the highest population group to face high levels of BPA exposure, which can be reduced through the simple act of breastfeeding.

Many parents think that using filtered water to mix their baby formula is a healthier choice than tap water and in many instances that may be true. However, water is also used to manufacture the bottles, formula and nipples used to feed these babies and this water may not be filtered. This increases the potential risk for contamination of cadmium, aluminum, lead, pesticide and other hazardous chemicals. Dangers with the water used to mix baby formula often continue at home as well. The hot water that parents frequently use to make baby formula in order to warm the formula before feeding it to their baby can also dissolve potential contaminants into the water faster than cold water, which only increases the overall risk of the infant’s exposure to potential chemical contamination.

For all the environmental, health and financial reasons to breastfeed your baby, there is no denying that there is an environmental risk in breastmilk as well. Pollutants that the mother is exposed to or ingests through what she eats or drinks can pass into the breastmilk, including heavy metals, pesticides and persistent organic pollutants (POPs). POPs can include a variety of chemicals, including DDT and other bioactive substances that can pose a health risk to humans. While this may make parents despair that nothing is safe for babies, not even human milk, the U.S. National Institutes of Health concludes that there is little evidence that the chemical agents in breastmilk are strongly linked to morbidity in infants and any potential health risk is lower than any potential health benefit to breastfeeding.

Not all mothers can breastfeed and if this is true for you, consult with your pediatrician about the best type of baby formula to use. If you do use baby formula, look for baby bottles, nipples and formula marked “BPA Free” and remember to clean and recycle the items when you are done with them. Moms who can nurse should consider doing so, due in no small part to the emotional, physical and environmental benefits. But don’t forget that nursing comes with a responsibility as well and carries a risk that may be reduced by eating organic foods whenever possible, choosing meat and dairy items marked “Hormone Free” and consuming a healthy diet. Doing so is a good choice for your mind and body, not to mention your baby and the environment.