Krista Gray, IBCLC

Krista Gray, IBCLC – Lactation Services

Positioning and attachmentWhether you’re preparing to breastfeed or need support with your current situation, Krista Gray, IBCLC – Lactation Services is here to help.  I am a certified lactation consultant and offer face-to-face and online breastfeeding support (as well as prenatal breastfeeding classes) to assist you in meeting your breastfeeding goals.   I see clients throughout the Upstate of South Carolina and North East Georgia as well as via Skype and FaceTime worldwide.

Lactation Consultations

Initial Consultation – $135 for a 1 – 1 1/2 hour private consultation.  Sometimes you just need that bit of extra support to get breastfeeding off to a good start or to overcome challenges. I can help you reach your personal breastfeeding goals. This visit can take place in your home or my home office.  (Follow-up phone/text/emails for home or office consultations are always free!) Discount for clients who have a prenatal appointment with me.*

Follow Up Consultation – $75 For new concerns and follow up appointments*

Pump Consultation – $60 Heading back to work and want to make sure your pump is working properly? I can help get your pump set up, ensure the flanges are the right size, and share tips and information about maintaining your supply as you return to work.*

Virtual Consultation – $50 I offer virtual breastfeeding consultations worldwide via Skype or FaceTime. (Up to one hour consultation; Payment made via PayPal) 

Telephone/E-mail Consultation – $30 Do you have a specific breastfeeding question? I can discuss this with you on the telephone (up to 30 minute call) or through e-mail.

Monthly Retainer Option – $150 For those who would like me to be available for unlimited calls/texts/emails throughout the month.  There is no limit to how often you can contact me and, if I am not available at the time of a call/email/text I will always respond the same day.

*In home rate applies to homes within 15 miles of 29655 zip code.  Beyond that area, there will be a fuel surcharge and hourly travel fee, which will be quoted at time appointment is made.

*Payment can be made with cash, check, and PayPal.

*Payment is expected at the time services are rendered.  Nursing Nurture does not file insurance on your behalf, but will provide you with an itemized Super Bill for your health insurance provider.

What happens during a consultation? Find out more here.

Download the forms for your breastfeeding consultation.

Learn more about Krista Gray, IBCLC or contact Krista to schedule a lactation consultation. Continue reading »


Nursing while drinking coffee

Caffeine and Breastfeeding

Is it Safe to have Caffeine while Breastfeeding?

Breastfeeding and CaffeineYes, it is generally considered safe to consume caffeine while breastfeeding.  Though all babies are different and some may be more sensitive to the small amounts of caffeine that pass through breast milk, caffeine and breastfeeding are not contraindicated.

How Much Caffeine Passes into Breast Milk?

As a general rule, only about 1% of the maternal dose of any drug a nursing mother takes passes into her milk. But, most drugs are metabolized at a much slower rate in babies than in adults.  Caffeine is no exception.  Approximately 1% – 1.5% of the maternal dose is passed to a baby via breast milk.1 The half-life of caffeine is 97.5 hours in newborns, 14 hours in 3-5 month olds, 2.6 hours in 6+ month olds, and 5 hours in an adult.2  It takes 5 half lives to completely clear a drug from the system.  If you multiply the first-half life times five you will have an idea how long it takes to clear. So while very little caffeine that is ingested by a mother actually transfers to her baby, it can quickly accumulate.  It takes a newborn 487 hours (97.5 x 5) to completely clear caffeine from his system.  Though only a small amount may enter each day, it can quickly build up with such a long half-life. (Further information about drugs and breast milk can be found here.)

How is caffeine intake measured and what is too much?

Caffeine is measured in milligrams.  Peak levels of caffeine are found in breast milk between 1-2 hours after consumption.3  As caffeine leaves the maternal blood serum, it also decreases in breast milk.  Consumption of less than 300 mg/day is typically considered to be safe for a breastfeeding baby. 4 However, all babies are different and if you notice symptoms of sleep disturbance, decrease in your baby’s appetite, irritability, and/or hyperactivity it is possible your child is reacting to the caffeine in your breast milk.  Decreasing your caffeine intake, switching to decaffeinated drinks, and waiting for several hours to nurse after caffeine intake are all strategies than can reduce the amount of caffeine your baby is exposed to. Also, preterm or sick infants might be less able to metabolize caffeine and therefore impacted to a greater degree by small amounts of maternal consumption.

How Much Caffeine is in My Favorite Drink?

Caffeine Content of Various Drinks and Foods
CoffeeTea
DrinkServing SizeCaffeine (mg)DrinkServing SizeCaffeine (mg)
Starbucks Filter Coffee, Short8 oz160 mg Starbucks Hot Brewed Tea, ShortAllvaries
Starbucks Filter Coffee, Tall12 oz240 mgStarbucks Chai Tea Latte, Short8 oz50 mg
Starbucks Filter Coffee, Grande16 oz320 mgStarbucks Chai Tea Latte, Tall12 oz75 mg
Starbucks Caffe Latte, Short8 oz75 mgStarbucks Chai Tea Latte, Grande16 oz100 mg
Starbucks Caffe Latte, Tall12 oz150 mg
Starbucks Caffe Mocha, Short8 oz85 mg
Starbucks Caffe Mocha, Tall12 oz95 mg
Starbucks Americano, Short8 oz 75 mg
Starbucks Americano, Tall12 oz150 mg
Starbucks Cappucino, Short8 oz75 mg
Starbucks Cappucino, Tall12 oz75 mg
Starbucks Espresso, Solo75 mg
Starbucks Espresso, Doppio150 mg
Starbucks Macchiato, Solo75 mg
Starbucks Macchiato, Doppio150 mg
Starbucks Caffe Americano, Short8 oz75 mg
Starbucks Caffe Americano, Tall12 oz150 mg
Starbucks Caffe Americano, Grande16 oz225 mg
Starbucks Cappuccino, Short8 oz75 mg
Starbucks Cappuccino, Tall12 oz150 mg
Starbucks Cappuccino, Grande16 oz150 mg
Starbucks Caffe Misto, Short8 oz75 mg
Starbucks Caffe Misto, Tall12 oz115 mg
Starbucks Caffe Misto, Grande16 oz150 mg
Hot Drinks
Starbucks Hot Chocolate, Short8 oz10 mg
Starbucks Hot Chocolate,Tall12 oz15 mg
Starbucks Hot Chocolate,Grande16 oz20 mg
Starbucks Frappuccino, Tall12 oz 70 mg
TeasServing SizeCaffeine (mg)
Starbucks Chai Tea LatteShort (8 oz) / Tall (12 oz)50 mg / 70 mg
Starbucks Green Tea LatteShort (8 oz) / Tall (12 oz)25 mg / 55mg
Soft Drinks
DrinkServing SizeCaffeine (mg)
Coca-Cola12 oz30-35 mg
Coke Zero12 oz35 mg
Diet Coke12 oz38-47 mg
Pepsi12 oz32-39 mg
Diet Pepsi12 oz27-37 mg
Dr. Pepper12 oz36 mg
Mountain Dew12 oz46-55 mg
Barq's Root Beer12 oz18 mg
Energy DrinksServing SizeCaffeine (mg)
Red Bull8 oz76 mg
Full Throttle8 oz70-72 mg
Monster8 oz80 mg

Does Chocolate Contain Caffeine?

Yes, chocolate does contain caffeine but it depends on the type of cocoa beans and the degree of fermentation as to how much caffeine is present.  Typically, chocolate has caffeine levels typical to decaffeinated teas and coffees. 5 Caffeine is not typically listed as an ingredient in chocolate because it is a part of the cocoa itself and not an added ingredient, much the same way as water would not need to be listed as an ingredient in a whole watermelon.

Chocolate also as theobromines which have a similar impact on the body’s nervous system as caffeine. 6   But, as with caffeine, the levels in chocolate are quite low.  One oz of milk chocolate has 6 mg and 1 oz. of dark chocolate has 20 mg. 7 Chocolate does not usually cause problems in breastfeeding babies.


What To Do When Baby Won’t Latch

Cindy and Jana

Cindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families.  You can download their app NuuNest – Newborn Nurse Answers and Baby Tracking for expert guidance through the first crucial weeks after childbirth or visit their website, Cindy & Jana.  You can also connect with Cindy and Jana on TwitterFacebook and Pinterest.

Noella was just 35 weeks into her pregnancy when her water broke. 12 hours later, her baby boy, Nathan, was born. Nathan was admitted to the neonatal intensive care unit  for antibiotics and monitoring. His first feed was a bottle of formula. Noella pumped faithfully throughout Nathan’s two week hospital stay but had little opportunity to try breastfeeding. When he was discharged from hospital, she began to offer the breast every feed but Nathan was used to bottles. Breastfeeding attempts became increasingly frustrating for both mom and baby. After two more weeks, Noella made the decision to discontinue all feeding attempts at the breast and instead focus her energy on pumping, bottling her expressed milk, and enjoying her newborn.  A month later, we received a phone message from Noella: “You aren’t going to believe it.  Nathan is now breastfeeding! I just decided to try it one day and it worked!”

Why babies may not latch at birth

Noella is not alone in her struggles to establish breastfeeding. Many babies are born prematurely and are not yet strong enough to maintain a latch. There can also be other reasons why babies don’t initiate breastfeeding right from the start:

  • Baby may be recovering from a difficult birth.
  • Baby may have a tongue tie.
  • Baby’s first feeds may have been given by bottle and baby is therefore unsure how to suck at the breast.
  • The shape of mom’s nipples may make it difficult to grasp the breast.
  • Baby may have an anatomical challenge such as a cleft lip or palate or the shape of the mouth or jaw may make latching challenging.

If baby will not latch in the first 24 hours after birth:

  • Keep your baby skin to skin as much as possible.
  • “Practice” breastfeeding: express a drop of milk on your nipple and let baby lick and nuzzle. Try to keep these practice sessions pleasant and free from frustration for both mom and baby.
  • Support baby well during feeding attempts to help baby feel secure. If you are feeding in a cradle or football hold, use pillows to support baby. If you are feeding in a laidback position, baby’s body will be well supported against your body.
  • Begin to use hand expression to stimulate your breasts to begin producing milk. (Learn how to hand express with this video.)
  • Feed any drops of milk obtained back to baby with a spoon. Baby will “sip” the milk from the spoon.

If baby continues to not latch after 24 hours:

  • Continue with “practice sessions”. If either you or the baby becomes frustrated, take a break. Calm your baby by snuggling. Remember, dad can snuggle baby if you need a break!
  • Do some massage and hand expression before attempting at the breast so that the milk is “right there” for baby.
  • In addition to hand expression, begin to use a hospital grade electric pump. We suggest you pump about every 3 hours for 10 minutes per breast (or every time the baby feeds). Please do not be discouraged if you don’t get a single drop! The pumping “tells” your body that baby is here and will need milk. Developing a good supply of milk will be key in coaxing baby to the breast.
  • Consult an International Board Certified Lactation Consultant to have a thorough assessment. The consultant will have suggestions based on the cause of the difficulties.
  • You will, of course, need to feed your baby. Your health care provider may suggest you feed baby by spoon, cup or finger feeding. The first choice is to use your own expressed milk. If, for medical reasons, your health care provider recommends additional supplement, banked human milk is the next choice. If donor milk is not available, infant formula may be used. Feeding your baby will help ensure he has the energy to continue to learn to breastfeed.
  • Some women find using a 20-20-20 principle helpful. “Practice” at the breast for 20 minutes; feed the baby in an alternate way if needed (approximately 20 minutes) and pump/hand express for 20 minutes. (Please note: the times are suggestions only. Please modify according to your baby’s cues. Sometimes babies are quickly frustrated and 20 minutes of trying may be too long.)
  • Sometimes, giving baby a little milk prior to a breastfeeding attempt may be helpful, especially if the baby is quite hungry. Taking the edge off the baby’s hunger may help baby to be more relaxed with the latching attempts.
  • Once baby is taking larger volumes, your health care provider may suggest beginning to use a bottle to feed your baby. This does NOT mean we have given up on breastfeeding! Again, it is important to feed your baby so that he will have energy to learn to feed. When baby is taking larger volumes, some babies will tire before they have been able to complete the feed. If you choose to bottle, use a rounded nipple rather than one with a flattened cross-section. Choose a slow flow nipple. Entice the baby to gape widely when taking the bottle to simulate latching at the breast.
  • A nipple shield may be useful in some instances once milk supply is established. Using a nipple shield before the milk supply is established is not recommended. Please discuss this with your Lactation Consultant.
  • Search out a mother-to-mother support group such a La Leche League.

In our experience, with time and patience, most babies who do not latch initially will eventually go to the breast. While working towards getting baby to the breast, stimulating the milk supply and having lots of skin to skin time are the most important things you can do.


Breastfeeding

Breastfeeding Gave Me Confidence

Krista Elliott HeadshotKim is an American living abroad in China with her husband and 2 very active boys. She enjoys cooking, cross-cultural living, and experiencing life through the eyes of her children.

When I got pregnant with my first son, Nate, I knew I wanted to breastfeed. My mom had breastfed my sister and me and talked often of the benefits. I remember as a child hearing her talk about how she wanted to “give us the best start in life possible” and not really understanding at that time what she meant. Now, after having children of my own, I understand.

Thinking through what it meant to be a mother and how God was entrusting this tiny human to my care, I was determined to breastfeed. I believed it made a lot of practical sense. Breast milk is free, convenient and healthy. I was also looking forward to the extra cuddle time and close knit bonding that breastfeeding provides.

During my pregnancy with Nate, I read lots of books about pregnancy, nursing, and newborn care. I watched other moms nurse, met with a Lactation Consultant and felt like I had a good handle on what to do. I often daydreamed of a perfectly latched baby who smiled lovingly up at me as he enjoyed the nourishing milk, flawlessly suited to his particular needs.

BreastfeedingDay one, the latch hurt.  A lot. I asked the nurse to have the hospital’s Lactation Consultant check in. She was not much help. By the end of the day, my nipples hurt so bad that I dreaded each feeding. Day two, Nate refused to latch and he began to get jaundiced. Day three, we fed him formula through a syringe because he wouldn’t latch and my milk hadn’t come in yet so pumping was fruitless. Nobody offered donor milk as an option.

Thankfully, after my milk came in, we were able to get him to latch again. I went home with him from the hospital totally terrified about nursing. This was a disaster. I was almost ready to give up right then and there. I cried. I sobbed. I prayed. I was destroyed. This was not the story I had pictured in my head. However, my heart was set on doing this. I knew in my soul that breastfeeding was important and that my baby had a right to have access to the nourishment God intended for babies. I desperately wanted my new baby boy to have all the benefits breastfeeding provides.

So I pressed on and contacted the Lactation Consultant I had seen while I was pregnant. She was incredibly helpful. She came to my home, watched me nurse, helped me nurse, and imbued me with confidence. She came as often as I needed her. She brought lanolin for my sore nipples. She worked with me for six weeks and though it got better, nursing was still really painful. The latch looked right. There was no thrush or physical abnormalities. She didn’t find a tongue tie. It simply hurt to nurse. I started to feel crazy and like a giant failure. There was no reason visible for nursing to be this painful.

Nate began to develop some other puzzling symptoms also. He coughed and choked a lot while nursing. He was extremely gassy and fussy after nursing. He had a hard time maintaining his grasp on the nipple and easily slid off or lost suction. Nursing sessions lasted upwards of an hour and so on. The Lactation Consultant recommended I take Nate to the local Dysphasia Clinic. She was out of answers and felt he may benefit from the more specialized kind of care they could provide.

BreastfeedingThe first visit at the Dysphasia Clinic was wonderful. The specialist confirmed that I was not crazy, the latch was perfect, but Nate was not using his mouth and tongue normally. She noticed that his suck/swallow/breathe rhythm was a little disorganized and that he was using a chewing instead of a sucking motion. This was the source of the pain.

Imagine my surprise when she assured me with some special exercises and time, Nate would learn to nurse properly and it would stop hurting!! She assured me that this was all within the range of “normal” for babies and that some just need a little more help to learn the skill of nursing than others. She also felt that his tongue might have been a little tighter than normal, but not enough to warrant surgical correction. She also broke the news to me that my milk supply was most likely low because he was not efficiently removing milk.

Over the following weeks, I was to nurse, then pump, then feed what I pumped to Nate in a special bottle using a special technique. This would empty my breasts more adequately, thus increasing my milk supply and give Nate the opportunity to strengthen his suck and learn the proper suck/swallow/breathe rhythm.

I saw dramatic improvement within the first few visits! Although it was hard work and nursing was still not completely comfortable, we had come a very long way from the first few weeks where I cried before every nursing session in anticipation of the pain. I knew now that I would continue nursing Nate until he was ready to be done. Oddly enough, this struggle gave me a lot of confidence as a mother. I knew that I had what it takes to surmount challenges. I knew I would push through to do what was best for my children despite personal pain or hardships, that I would be able to put my children’s needs above my own.


Jaundice

Breast Milk Jaundice

What is Breast Milk Jaundice?

Jaundice is a very common condition in newborn babies that gives their skin and the whites of their eyes a yellow color.  Developing 2-3 days following birth, physiologic jaundice has usually disappeared completely by the time a baby is two weeks old.  Breast milk jaundice follows a similar developmental pattern of physiologic jaundice, though it lasts well beyond the typical 10-14 days.  It is usually not diagnosed until 10-15 days (when physiologic jaundice would be disappearing), though it can be diagnosed as early as Day 4 or 5 when a mother’s milk has “come in”.  Breast milk jaundice can last from 2 – 12 weeks, but serum bilirubin levels typically peak around Day 14.  It is the buildup of bilirubin in the blood that causes the yellowing of the skin.

What Causes Breast Milk Jaundice?

For reasons that are not yet understood, the breast milk of some mothers increases the circulation of bilirubin in her baby.  Typically, the liver filters bilirubin from the bloodstream and it exits the body through stools.  However, in newborns, bilirubin can build up faster than the liver can filter it, which is known as hyperbilirubinemia.  Breast milk jaundice is an extension of physiologic jaundice.  Researchers believe there is an unidentified substance in the milk of some mothers that causes breast milk jaundice.  It may last many weeks, but it is harmless..

How do you treat Breast Milk Jaundice?

Breast milk jaundice does not require special treatment.  In fact, the best course is to continue exclusive breastfeeding as well as to be monitored by your doctor. With the uniqueness of breast milk making it the perfect food for babies as well as the known and documented negative health implications of formula that can affect a person over his lifetime, continued breastfeeding is best.  Optimal breastfeeding positioning and latch are important for any jaundice condition, especially breast milk jaundice, to ensure the baby is able to remove as much milk as possible from the breast.  The condition will slowly resolve itself and the chances of developing bilirubin encephalopathy are rare. 1


FI-14

10 Ways to Wake a Sleeping Baby

For the first few weeks following birth, newborns can be sleepy and hard to rouse to feed.  It’s tempting to let them sleep for extended periods of time, but sleeping too long can have a detrimental impact on a baby’s weight gain and a mother’s milk supply.

In general, newborns should nurse at least 8-12 times every 24 hours.  If weight gain and breastfeeding are going well, it is fine for a newborn to have one longer sleep stretch each day, but this shouldn’t be more than five hours.  Always watch for your baby’s early feeding cues and make sure to count wet and dirty diapers as they are a good indication of how much your baby is taking at the breast.

After the first few weeks when breastfeeding is off to a good start, baby’s weight gain is on track, and she is meeting developmental milestones, it is more appropriate to allow your baby to sleep and feed on her cues without waking her up.

Here are 10 tips to wake a sleeping baby:

  1. Change her diaper
  2. Take off her clothes and hold her skin-to-skin
  3. Wipe her face with a damp cloth
  4. Gently stroke her ears, back, legs, arms, or tummy
  5. Take off her socks and tickle her toes
  6. Talk to her, sing to her, tenderly call her name
  7. Rock her or take her outside for some fresh air
  8. Turn on soft lighting – you don’t want the room to be dark but you don’t want your baby to have to squint from the brightness either
  9. Gently roll her from one side to the other
  10. Express some milk and touch it to her mouth – wait to see if she eats it and wants more.  She may nurse if you have a drop of expressed milk on your nipple – if so, that is great!  Research shows that babies can nurse effectively while in a light sleep.[1.Colson, S., et al. (2003) Biological Nurturing increases duration of breastfeeding for a vulnerable cohort. MIDIRS Midwifery Digest, 13(1), 92-97.]

 


Thumbnail-4

Perseverance at the Pump

Mary Straits HeadshotMary Straits resides in North Carolina with her husband of ten years and two energetic boys, ages six and three.  She earned a B.A. in English and music from Columbia College and a Masters of Education from Liberty University.  In her spare time, Mary teaches 8th-grade English and somehow finds time to blog at www.marystraits.blogspot.com.

When our ob gave us the list of classes the hospital was offering for soon-to-be parents, we actually said, “Nah.  We don’t need the breastfeeding class.  I mean, how hard could it be?  It’s natural, right?”

Out loud.  To each other.

It took about two hours of mommy-hood for me to realize that breastfeeding, albeit natural, is an art form.  It takes coaching and practice and patience and sometimes a trip to the ER at 2 am.

When my first son was freshly born, we started nursing about two hours later. I came to the hospital ready.  I didn’t just have a Boppy—I had a “My Breast Friend.”  I had my own pump and all the parts.  I thought breast-feeding was going rather well until the nurse came in and started saying things like, “Nope.  He’s not latched.  Let’s try it again.”  And, “It’s not supposed to hurt.  You’re wincing.”

Then, when they called in the lactation specialists, things got real.  I learned about all sorts of positions that involved stacks of pillows.  They gave me something called a nipple shield.  Then came a syringe with a tube to connect to the shield.  In the tube, we put formula.  The idea was to make baby associate my breast with his food source.  But we couldn’t use the shield too long or he would become dependent on it.  And then we’d REALLY have problems.  I was to feed baby with the system and then pump to get my milk to come in faster.

Two days later, we went home with a shield and a syringe feeding system, which I promptly abandoned once my milk came in the next day.  In fear, I used the shield off and on, and pumped after each feeding.

When our pediatrician’s lactation specialist called me at home to see how nursing was going, I stupidly said it was going fine.  And no, I didn’t need to see her.  She didn’t let me off the hook, though.  When she found out we were bringing baby in for his weight check, she said, “Great!  I’ll check in with you then!”

The next day, however, I came down with a high fever and chills that would not go away.  Being that our baby was five days old at this point, we ended up in the emergency room at midnight and I endured all sorts of trauma I hope I never relive.   I was discharged hours later with a heavy dose of Tylenol and a label of “Fever of Unknown Origin.”

When we showed up at the pediatrician the next day, I looked like a mess.  But not your average mess.  A HOT mess.

The lactation nurse took one look at me and said, “Oh, you poor thing.”  Then, when we showed off our breast-feeding ritual, she knew we were really in bad shape.  My nipples were raw and cracked in several places.  She said I had a touch of thrush as well and gave me a concoction of creams to put on my nipples after every feeding:  Neosporin, Monistat, and Lanolin.  We were to use only the shield until my nipples healed and continue pumping in between.  And see her again in two days.

A few days later we checked back in, and my skin was on the mend finally.  Baby, however, was not latching properly.  Come to find out, his frenulum was tight, which prevented him from latching properly.  We had to drive across town to the pediatrician who could clip his frenulum and then continue on with the work of breast feeding.  With the shield, pumping after a feed.

At this point, my milk supply was very profound, as I was pumping off 4-5 ounces after baby was done with a feed.

A few days later, the fever came back with a vengeance.  It hit me almost instantly, and I struggled to even pick up the baby to feed.  I somehow loaded up the baby, lifted the car seat, and headed to the ob-gyn, who said I had a bladder and sinus infection.  They gave me a z-pack and sent me on my way, and I felt remarkably better in about 6 hours.

At this point, I tried abandoning the nipple shield, but it didn’t take long for me  to get a little crack and then have shooting pains during a feeding.  I promptly used the compound the lactation nurse told me about.  A few days later, we found out both baby and I had thrush.  At this point, I didn’t try to feed him straight from my breast, but just pumped and bottle fed until we both were cured.

The next week or so, the fever came back AGAIN on a Saturday.  This time I had a red patch on one my breasts, which really freaked me out, but I took ibuprofen and waited for my primary care doctor to open on Monday.   All the while, I continued to pump for feedings, as I was too weak to try and latch baby.

On Monday, all mysteries were answered.  My primary care doctor finally figured out what was causing the fever:  Mastitis.  There is a specific antibiotic that treats it, and he advised me not to feed the baby the milk I was expressing but to be sure that I completely emptied my breasts often.

At this point, my milk supply reached epic proportions, as I was pumping for a long time every two hours or so.

After I finished the antibiotic, my husband and I decided that we had enough drama with this breastfeeding journey.  But, it was so important to me that my baby had breast milk.  For one, I knew it was the best for him.  For two, formula feeding would have cost us $30 a week (at least).  For three, we had a great pump and my supply was ample, to say the least.

I ended up pumping on a schedule of 5:45 am, 8:30 am, 11:15 am, 3:15 pm, 6:30 pm, 10:30 pm, and maybe during the night if baby woke up.  It took me about 10 minutes to totally empty both breasts, which was a lot easier/ faster for me than before.  After a while, I was able to drop a pumping session and still maintain my milk supply very well.  In the end, in fact, I ended up giving my sister bags and bags of frozen milk and using the other bags of frozen milk in baby food purees.

I found pumping much less stressful than our previous experience, which I learned later was pretty extreme.  When I ran into the lactation nurse on a routine pediatrician visit when Noah turned one, she congratulated me on making it a full year and assured me that pumping “counted.”  For some reason, I had it in my head that I wasn’t really breastfeeding by pumping full-time, but I couldn’t bring myself to give up and quit.  And I knew it was best for my baby.

When our second son was born, as soon as we started having latch problems and I started getting cracked nipples, I broke out the pump and began pumping full time.  With a very energetic almost three-year-old, I did not have the stamina and the time for any semblance of our first go round.  I brought out my trusty pump (Medela, if you’re wondering!), and once again, had a solid supply in about 5 days time.

The second time around, though, I worked on pumping a bottle right before baby would eat so that he could have fresh milk more often than not.  I ended up having an epic milk supply the second time around, all from the pump.  At one point, I had so many bags of milk in the freezer, that our freezer actually broke.  Ha!

The point of my story is this:  If you’re passionate about breast feeding and struggling to find peace from any challenges you may be facing, consider pumping full time.  Don’t listen to the masses, who tend to view a breast pump as a ball and chain.  It was an awesome avenue for us to be able to give our boys the most optimal start. And saved us hundreds of dollars!

{Note from Nursing Nurture: Mary’s determination allowed her to give her babies breast milk even when the medical system really failed her.  Though every issue she had could have been remedied with good, qualified lactation support this mother – like so many – did everything she knew to do.  If you are experiencing breastfeeding issues and your lactation support is not helping solve the problems at hand, find someone else!  Look for an IBCLC – which is the only certification showing a lactation consultant is a specialist.  And, if your IBCLC is not helpful, find another (just like you would any medical doctor you weren’t pleased with).}


FI-29

Relactation

What is relacation?

Relactation is a breastfeeding term for a mother who had a biological child and either never breastfed or has already weaned but later goes back and stimulates her milk supply to breastfeed that baby.  She may have nursed her child for a short or long time and it may have been recently or years earlier that she weaned her baby.  Either way, the “re”-lactating is reversing the weaning.  This is different from induced lactation where a mother hopes to stimulate her milk supply to nurse a child that she has not given birth to (adoptive breastfeeding).

Important questions to consider

  • Did the mother ever breastfeed this child? If so, for how long?
  • How long has it been since she last nursed this infant? The shorter the gap since last breastfeeding will typically mean it takes less time to re-stimulate a milk supply.1
  • Why did she wean?
  • Were there any maternal issues such as flat/inverted nipples, insufficient glandular tissue, low milk supply, or nipple pain?
  • Were there any infant issues such as illness, prematurity, tongue tie, poor latch, inability to suckle effectively, etc.? Have these issues been resolved?
  • How old is the infant? What is the likelihood of him latching again on the breast? In general, the younger the baby (particularly within first three months), or if the baby was breastfed for most of the first year, the higher the chances for the infant to latch and breastfeed again.2  Please read strategies for encouraging baby to breastfeed.
  • Is the mother able to be with baby throughout the day and night or is she separated for periods of time?  If she is separated, can she reduce/eliminate this separation temporarily while re-establishing her milk supply?
  • What are the mother’s goals – full breastfeeding, partial breastfeeding, comfort at the breast, nursing at the breast with an at-breast tube feeding device, etc.?
  • How motivated is the mother to relactate?
  • Does the mother have a supportive network around her?  Having a strong support network of family and friends, and a qualified lactation consultant to work with, are essential for successful relactation.

Strategies for relactation

  1. Frequent and effective breast stimulation/milk removal
    There are many things that will help a mother relactate but this is the most critical component.  In fact, no amount of additional tools (galactagogues, skin-to-skin, etc.) will effectively build a milk supply without this first step.  Until beginning solids somewhere around the middle of the first year of life, babies nurse 6-12 times a day (or more!).  You will need to stimulate your supply at regular intervals both day and night.
  2. Stimulate your supply while feeding baby
    If a baby will latch and suckle at the breast, a mother can use an at-breast tube feeding device.  This allows her milk supply to be stimulated by her child rather than pumping or hand expressing.  It reduces a step because while you are “pumping” you are also feeding your baby.  As a mother begins to develop a milk supply she can reduce the amount supplemented in the tube feeding device.  It is important to make sure a baby has a good latch in order to effectively stimulate the milk supply.
  3. Pump if baby will not accept breast
    Frequent and effective breast stimulation (and milk removal once milk appears) is essential.  If your baby will not accept nursing at the breast with an at-breast tube feeding device, pump (ideally with a double electric breast pump) regularly – at least 8 times every 24 hours, for 15 minutes on both sides.
  4. Skin-to-skin
    Lots of skin-to-skin time together!  Breastfeeding is about more than the nourishment but also a relationship.  Skin-to-skin is wonderful for bonding as well as a mother’s hormones that help her breast milk supply.  It’s not just for newborns either.  Mothers and babies need lots of time together to build a mother’s milk supply and skin-to-skin contact is a wonderful way to spend this time.
  5. Galactagogues
    Galactagogues are herbal or pharmacological substances that can increase a mother’s breast milk supply.  Domperidone is generally considered the safest pharmacological option and fenugreek and blessed thistle are common herbal options.  Eating oatmeal several times a week or even daily may also increase milk supply.
  6. Acupuncture
    Acupuncture may also increase a mother’s milk supply through enhancing the secretion of the hormone prolactin, which is necessary for milk production.3
  7. Surround yourself with a tribe of support
    Relactation is not always easy!  It can take a lot of determination, work, and perseverance.  Having a support system around you cannot be overestimated!  Family and friends that can support and encourage you as well as getting involved in a local mother-to-mother breastfeeding support group are essential.  There will be challenges with relactation.  Having others to encourage you and share their experiences will help you tremendously.

FI-7

5 Challenges of Adoptive Breastfeeding

Mothers who are inducing lactation, trying to relactate, or planning to breastfeed an adopted child will face many challenges.  These difficulties are not insurmountable by any means. Most mothers who have been through this are thankful for the opportunity and believe the challenges are well worth it.

In fact, breastfeeding will not only provide your baby with the best start in terms of nutrition and health but also to help forage a strong bond between mother and baby.  Breastfeeding is a normal part of development and will allow your adopted child to participate in this important stage of life.

Being aware of the challenges mothers face will help prepare and equip you for the potential difficulties as well as strengthen your chances for success.

These are five common challenges adoptive mothers face when breastfeeding:

  1. Not having enough preparation time before receiving baby
    Rarely do parents know exactly when they will receive their adopted child.  Many parents start the adoption process and it takes years to complete.  Other parents receive their babies with just a day’s notice.  Stimulating your milk supply years in advance is no more tenable than expecting to have a milk supply overnight.  Even when a mother begins to stimulate her supply thinking it will just be a few months away there could be a roadblock in the process that causes an unanticipated delay or a milestone that eliminates the waiting entirely.  So, not knowing when a mother needs to have milk can lead to a situation where, for one reason or another, she finds she is receiving her baby and she hasn’t stimulated her milk supply.If you find yourself in this situation, there are a couple routes you can take.  You can put your baby to the breast immediately using an at-breast tube feeding device so that you can begin to bond through breastfeeding while allowing your baby to stimulate your supply.In addition, you can talk with your health care provider about taking Domperidone – a medication that has been shown to increase breast milk supply.  You can also take herbal galactagogues such as fenugreek and blessed thistle, along with eating oatmeal, to further help your supply. Another option is to try the accelerated Newman Goldfarb induction protocol which requires waiting 30 days before beginning to stimulate supply.In most situations, if your baby is willing to latch on your breast, there are many advantages to stimulating your supply breastfeeding with an at-breast tube feeding device rather than waiting to have your baby suckle.
  2. Finding the time to stimulate your milk supply
    If you already have older children, work outside the home, or have other competing demands on your daily routine it can be challenging to find the time to add in regular pumping sessions throughout the day and night.  Women can begin to feel exhausted or overwhelmed and question whether their bodies will respond with a milk supply and if it is really worth it, especially when many adoptive mothers don’t even know if their baby will latch and take to breastfeeding.  Hang in there – with dedication, determination, and regular stimulation your breasts will begin to make milk!
  3. Stress and worry about milk supply
    It is common for mothers to worry if their bodies are producing enough milk, if their baby is getting enough milk, and how to maintain breast milk expression when a mother must travel (especially with international adoption) to pick up her baby.  When stimulating a milk supply for adoptive breastfeeding, it is important to have the counsel of a qualified lactation consultant to help you in your specific situation.  She can help you figure out how much milk your body needs to make, if your baby is getting enough, and give tips for how to express when traveling – including hand expression when electrical currents are different.
  4. Helping baby transition to the breast
    Building a milk supply takes dedication and work, and most adoptive mothers don’t know if their infant will ever take to nursing at their breast.  In general, the younger the baby (particularly within first three months), or if the baby has been breastfed before adoption, the higher the chances for the infant to latch and breastfeed from the adoptive mother.1  Mothers worry that all their hard work to build a supply might still not afford them the opportunity to nurse at the breast.  However, while there are no guarantees, many adoptive babies can transition to the breast with time and patience.  Expressing milk on the nipple before latching the baby on is one technique to encourage an adopted infant to breastfeed.  Lots of skin-to-skin contact and availability of the breast – but without pressure – are other great strategies.  It is important to give an older baby time to trust his adoptive mother and feel safe at the breast; always make the breasts a happy place!  (You may also enjoy reading Strategies to Encourage Your Adopted Baby to Breastfeed.)Ultimately, even if your child doesn’t take to nursing at the breast, you can give her your expressed milk and do so in a way that still promotes bonding – paced bottle feeding at the breast, skin-to-skin contact while feeding, etc. Your milk is a special gift of love no matter how your baby takes your milk!
  5. Pumping and equipment difficulties
    Adding a new little person to a family is a major transition.  Sometimes “small things” can present large amounts of stress in these times.  Learning to pump, ensuring the flanges fit properly, and setting up a routine can present worry and stress.  Other mothers use an at-breast tube feeding device which can present additional steps – filling the supplement in the bottle, running the tubing, working on proper latch, cleaning and sterilizing the equipment afterwards, knowing how much milk to supplement and when to decrease the amounts…you get the idea.  It cannot be overestimated how important it is to surround a mother with support – from family, friends, other breastfeeding mothers, as well as qualified lactation assistance.

Large Nipples, Small Baby

Large Nipples, Small Baby

Nipples and breasts, just like babies, come in all sorts of shapes and sizes; rarely does nature mix up babies and breasts. However, when a mother has exceptionally long nipples and a baby is very small, it may take time for a baby to grow into her mother’s nipples. Statistically speaking, long nipples are less of a breastfeeding concern than inverted nipples.1 Nonetheless, large nipples can be a cause excessive weight loss and/or slow weight gain in the first week following birth. 2

What breastfeeding challenges can large nipples present?
Extra long nipples with an accompanying small baby can cause an infant to gag and then slide off the nipple to cope with its length. This poor latch can cause milk supply issues and breastfeeding pain for a mother as well as allow her baby to learn a lazy attachment at the breast. A newborn may learn to have a shallow latch while nursing which could then continue even when he grows bigger and the size of his mother’s nipples would not prevent him from actually latching much deeper. This shallow latch could impact a mother and baby negatively in a variety of ways:

  • Poor latch can decrease a mother’s milk supply. This is especially of concern in the beginning days/weeks of lactation when a mother’s milk supply is being established.
  • Poor latch can cause pain. Sore and cracked nipples can make a mother more likely to supplement or wean her baby altogether.
  • A shallow latch can cause slow weight gain or even failure to thrive in baby.
  • A shallow latch in a baby can mimic bottle feeding and limit breastfeeding’s effects of proper oral-facial development.
  • A shallow latch can be harder to correct later when a baby does grow into her mother’s nipples.

What can I do if large nipples are a concern?

First, it is important to have your baby’s oral anatomy checked. There could be a tongue tie, lip tie, hypertonia, cleft, or other developmental variation that is affecting how deep of a latch your baby has on your breast. Sometimes these can be easily corrected and allow your newborn to quickly breastfeed better.

If your baby’s oral anatomy is normal then it may be a matter of protecting your milk supply until your baby grows and is able to latch properly. There are several steps to take to protect/build your supply:

  1. If your baby’s weight gain is not adequate and/or she does not have enough wet and dirty diapers/nappies then you will need to pump your breasts following each feed. If your baby struggles to latch and suckle, you can then top off your baby with this expressed milk (or, alternatively, give it as the “appetizer”). This should help your baby gain strength and energy and give her time to grow into your nipples.
  2. Make sure to take necessary steps to protect yourself from developing sore or cracked nipples.
  3. Some mothers may need to exclusively pump in the beginning to build their supply, protect their nipples from pain and cracking, and give their babies time to grow.
  4. Make sure to spend as much time as you can skin-to-skin with your baby. You may want to carry your baby in a wrap or sling, take a bath together, or hold her this way even when giving a bottle. Skin-to-skin promotes bonding, growth in baby, and a mother’s milk supply. If she spontaneously tries to suckle at times, let her! In fact, continue to offer to breastfeed at your breasts as much as possible so that the transition to exclusive breastfeeding can be smooth.

The important thing to remember about large nipples and a small baby is that this is temporary. Babies grow very quickly and your baby will grow into your breasts. Large nipples do not make breastfeeding impossible but having lactation support in the beginning is essential.