Divine Mamahood

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

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

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

 

What Are Grass fed Meats?

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

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

Nutritional Advantages of Grass Fed Meats

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

Environmental Advantages of Grass Fed Meats

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

Ethical Advantages of Grass Fed Meats

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

Health Advantages of Grass Fed Meats

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

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

For Further Reading

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

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

 


Breastfeeding Aids: Herbs and Milk Supply January 05, 2013 00:10

Mothers who are nursing for the first time are often concerned about the amount of milk they produce. Some mothers worry that they don’t produce enough to satisfy their baby while others wonder what to do with all their extra milk.  In addition to including lactogenic (milk-producing foods) in a well-balanced diet, sometimes the use of herbs can also help to boost and maintain an abundant milk supply.  A lot of mothers worry about taking supplements that might harm their infant. Simple remedies available at home or at most health food stores can help put these worries to rest.

 

Mothers need only look as far as the kitchen sink to help keep their milk flowing.  It is easy to become dehydrated when breastfeeding a hungry newborn. A nursing mother needs to be aware of her thirst and consciously drink water throughout the day to replace the liquid the baby draws from her. Simply staying hydrated will help milk production.

Nursing mothers have used herbs for centuries and they are usually considered safe alternatives that can help nursing mothers keep up their milk production. As always, consult a health care professional before taking any new supplement. Using the wrong herbs or using herbs in the wrong way can cause undesirable side effects.

Galactagogues are herbs that are used to increase the milk supply. These herbal remedies may come in a liquid tincture, tea or pill form. Mothers may need to take these natural aids for up to two weeks to see an affect.

Relaxing with a cup of warm tea can be soothing and help ease milk letdown. Chamomile tea is said to have a calming affect while red raspberry tea can stimulate milk production. Fenugreek is perhaps the most well known galactagogue. It is taken alone or in combination with other herbs to increase milk supply. Taking Fenugreek can result in a slight maple odor in the urine. Caraway, Blessed Thistle, and Brewer’s yeast can also be used to boost milk supply. Aniseed can aid in milk production and promote healthy digestion.

If herbs don’t seem to increase milk production, try using a breast pump for 5-10 minutes after the baby is finished feeding. This additional stimulation will help mothers produce more milk. Mothers can save the pumped milk, store it in the freezer, and have plenty of milk for their baby when return to work.

Mothers who have an overabundance of milk or choose to stop breastfeeding may also seek an herbal aid. Sage is the herb of choice for mothers who wish to decrease or stop their milk supply. Taking sage is reported to help dry up a mother’s milk. Sage can be drunk in tea form or consumed in a liquid tincture available from health food stores.

Most nursing mothers will find they have sufficient milk to feed their new babies. For those who feel they need a little help, natural remedies can provide safe, attainable answers.