Divine Mamahood

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!


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


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

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

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

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

* 7 times the Vitamin C content of oranges

* 4 times the calcium content of milk

* 4 times the vitamin content of carrots

* 3 times the potassium content of bananas

* 2 times the protein found in yogurt

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

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

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

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

 


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

 

 

 

 


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

 


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. 


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.