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.)
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.
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.
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.”
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.