Milk Donation

I have heard many questions from moms over the years about what to use in a situation where they don’t have enough milk to feed their babies. I do not support formula companies.  However, I don’t support homemade formulas either.  Neither can come up to the specificity of human milk for human babies.

What I DO support is milk banking.  This can be done for your own child or for others.  Proper handling, labeling and storage of the milk makes this process more useful.  Here are a few helpful hints.

  1. Set out to have an excellent supply.  That means the first hour after birth is critical for baby getting the most volume – and studies are now beginning to show that moms whose babies nurse well in the first hour (or who start pumping and hand-expressing right away if baby can’t nurse) have more abundant supplies and are less vulnerable to negative events later on in their lactation. Make sure your support person is on the same page with you in helping you achieve that early stimulation and milk removal. Mothers who get 30 sessions of effective breastfeeding or hands-on pumping within the first 3 days of birth have twice as much milk at 10 days after birth as those who have less breast stimulation and removal of milk. This has been found in more than one study.
  2. Pay close attention to your baby’s effectiveness in the first four weeks. If baby is not removing milk well during this period of time, the breast will reduce milk production capacity and possibly storage capacity as well. If your baby is not removing milk well, using a breast pump after morning feedings and before bedtime can help protect your supply.  If your baby is not nursing effectively, please see a skilled lactation consultant for assessment.   Medical-grade rental breast pumps (such as the Symphony) are generally more effective in setting up a high supply than personal pumps, which are designed to maintain supply once lactation is established and a healthy baby is nursing.
  3. Store your precious milk carefully. Most women use plastic bags for storage. Use bags that are thick enough and have wide enough seams to reduce breaking and leaking during thawing. Don’t over-fill bags. Get as much air out as possible and lay bags flat for freezing. Label with at least the date of pumping. Use a sharpie on part of the bag that is not in contact with the milk (on the edges) or use a piece of tape for the label. Ink written directly on plastic will leach into the milk inside. Once bags are frozen solid, they can be stacked vertically in a plastic shoe box to keep in order in the freezer. Caution: plastic milk bags that are over-filled or have thin seams can break during freezing or when transporting in the frozen state. When stacking horizontally, put a layer of paper or plastic between rows of bags. If you are shipping milk through Fedex, contact them for information. Styrofoam lined shipping boxes with dry ice can be used to ship milk overnight. Layers of bags should be separated by cardboard or thick paper to prevent puncturing each other during transport.
  4. Think about how much to store and when to share. To avoid wasting milk, don’t put too much in a bag – a maximum of 5 ounces. If you are pumping a couple of ounces at a time, you can add to a previous amount until you get your desired amount, as long as it is all obtained within 48 hours and kept refrigerated until frozen. The best place to store milk is in a separate deep freezer that is not opened frequently. Regular freezers should be turned as low as possible, to the point that ice cream is frozen solid. Do not store your milk in the door of the freezer. Some moms start out storing a lot of milk because they have babies with nursing difficulties. Once those babies have overcome their difficulties, moms find they don’t need the extra stored. At that point, sharing becomes a possibility, and sometimes even a necessity when freezer space becomes low!
  5. What about formal versus informal milk donation? Milk banks have requirements for moms since their customers are NICU’s with very tiny, vulnerable infants whose very survival depends on milk donation.  Milk sharing done between healthy moms with healthy babies can be a little more relaxed. Some medications that are OK for nursing moms may be acceptable for another nursing mom – but unacceptable for a tiny medically vulnerable baby. Eats on Feets, Human Milk for Human Babies and other mother-to-mother sharing sites can help re-distribute milk from moms who are not eligible for milk bank donation to moms whose babies are not eligible for receiving banked donor milk. Tennessee is establishing it’s very first Mother’s Milk Bank. Here’s a link to find out more about how to donate and how to help. UPDATE: 2 Local donation sites are now available – in Nashville at Meharry General Hospital and in Memphis at Regional One. More donation sites are expected to come on line. Check the Mother’s Milk Bank site for more info. http://mothersmilkbankoftn.org/

Alyssa Milano and Breastfeeding Shaming

As if moms don’t have enough to worry about – we have a continued attack on public breastfeeding. This is a first world problem – a USA problem. Like so many other “issues,” those trying to build their ratings find something to project their biases and ignorance upon and try to get some controversy going. EVERYONE knows that if we were in a developing nation where Western marketing machinery had not yet ruined the culture and economy, breastfeeding in public would not even be a topic of conversation. Babies do not have any sense of propriety (as some would define it). They just know when they are uncomfortable and want their needs met. A young baby cannot understand that someone’s guilt might be stirred up by their need to be tended to in the same general vicinity as the casual observer.
The idea expressed in this commercial needs to be distributed.

If we are to help mothers reach recommended goals of breastfeeding to at least a year and hopefully to two, we must first help them reach their OWN goals – whatever that length might be! And currently, 80% of moms do NOT meet their own goals – whether to breastfeed 6 weeks or 2 years! Baby-Friendly Breastfeeding Initiatives and other similar programs are a first step to getting moms off right. But beyond that, the community must be engaged to support these moms. Breastfeeding should be welcome wherever it is safe for a mom and baby to be. Workplace and social accommodations must be championed. Ignorance can be cured with education. Disappointment when goals are not met must be met with determination to help the next mom – not try to downplay the goal!

If you are a friend or relative of a breastfeeding mom, do what you can to encourage and support her. Educate yourself and your community. The babies of the world will appreciate your efforts!

Adoptive Breastfeeding

I have a particular heart for adoption. I came from a large family where other children were welcomed. My brothers, sisters and extended family have adopted and now I have an adopted grandchild. If adoption is part of your journey and you would like the experience of breastfeeding, I am here to help. Breastfeeding is a normal part of comforting as well as feeding a baby. There are protocols available on the internet to help with bringing in milk prior to anticipated arrival of your child. My part in helping adoptive moms is to coach, encourage, make adaptions to the plan as needed throughout the process.

When to ask for help

Need Help?  When to ask for help….

Baby is older than 3 days old and is still not latching.

Baby is older than 5 days old and mom’s nipples are painful, blistered or cracked.

Baby is 7 days old and you are having to supplement.  Or you feel like your milk has not come in yet.

Baby is not having adequate wets or dirties without having to supplement.   A simple guideline is one wet and one dirty per day of age each day until baby is 5 days old.  After that, 3-5 dirties per day with at least one of them equal to a tablespoonful, plus 6-8 wets. Use diapers with a line that turns blue to help you track wets since babies have very small bladders and it’s easy to miss a wet. 

Baby has not gained back to birth weight by 2 weeks of age.

Baby is wanting to nurse every hour or for more than an hour at a time around the clock.

Mom is tense, exhausted and feels unable to relax while breastfeeding. Persistent neck, back or breast pain.

Mom’s breasts do not soften with breastfeeding and painful lumps remain. If mom has a fever over 101, she should contact her healthcare provider for assistance.

Other situations where help might be needed:

Adoption – induced lactation.  Yes, it is possible to bring milk in and create a breastfeeding relationship between you and your adoptive baby.

 

What to do till the lactation consultant gets there

Baby refusing the breast?
Milk supply low?
Baby not getting enough?

Remember these 3 things:
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1. Feed the baby!
2. Protect your milk supply!
3. Make the breast a happy place!

Feed the baby.The amount a baby needs depends on his or her age and size. Babies between one to 6 months need around 24 ounces of breast milk per day. A 3 day old baby needs at least 4 oz per day, a 5 day old needs 8 oz, etc. A baby who is latching effectively may actually take more than these amounts from your breast. If your baby is under a week old and you believe he or she is not getting enough from direct breastfeeding, try offering small amounts of expressed breast milk by spoon, cup or finger-feeding with a syringe. If your baby is older and requires more than an ounce at a feeding, you may consider using paced bottle-feeding techniques for giving extra milk.

Protect your milk supply. Breast milk production is controlled by hormones in the beginning, but soon switches to local control. This means the more milk is removed from the breast, the more completely drained, the more it will produce in the next hour. When a baby is not effectively removing milk, this tells the breast that it is making too much. Using hand-expression and/or a rental-grade breast pump after feedings may be necessary to protect or build a supply until baby is able to empty the breast more easily. Research has shown that mothers who have effective breast drainage in the first three days (that is defined as 30 breastfeeds or hands-on pumping episodes in 72 hours) have twice as much milk at 10 days after delivery.

Make the breast a happy place. Keep baby skin to skin as much as possible. Baby should be between mom’s breasts, head facing to one side. Mom should be positioned comfortably, propped up with firm pillows with her back and arms supported. Breastfeeding is more than providing milk for your baby – it is setting up a relationship that starts out as meeting a physical need and transitions to meeting an emotional need between mother and child.

All breastfeeding techniques or assistive techniques should include these three concepts.

How to get help from Jane

Contact me by email, text or phone call – give me a little history of your issue.   We will set up an appointment according to your needs and my availability. I will respond to your contact request as soon as I am available.  On the document pages you will see examples of 2 forms I will ask you to complete prior to our first visit. The first is a Consent for Care. The second is a an Initial History. All appointments are conducted during daylight hours with limited availability on weekends. Please see my other posts for more helpful information.
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What happens in a home lactation consult?

Before a consultation appointment, you will be asked to sign a consent for care, privacy and financial responsibility acknowledgement form.  The link is available under the documents tab above for you to download, complete and email back. If this does not work for you, please contact me and I will email you the form directly. I have recently switched to an encrypted, secure electronic documentation system to enable timely communication with you and your care providers. I will send you an access link to that system once our appointment is confirmed.

  1. I will obtain a history of your prenatal, birthing and breastfeeding situation up till the day of the consult. I will ask for pre and post consult pain levels. This history form is also available as a download under the documents tab. If possible, print this out and complete prior to our visit.
  2. I will do a physical assessment of your breasts and your baby.
  3. I will do before breastfeeding weights of baby or babies without and with diaper.
  4. I will do a digital suck assessment of baby sometime during the consult as needed.
  5. I will ask you to breastfeed the baby and will observe how the baby latches, your comfort level, etc. When observing the baby at breast, I will be looking for specific functional clues to any breastfeeding difficulty’s source. These clues will help us together to design a workable feeding plan. I will weigh the baby at intervals to determine accurately milk transfer with a scale sensitive to 2 grams.
  6. As the consultation proceeds, I will make suggestions as needed for increased comfort for you and baby and increasing milk transfer, as needed. This may involve special positioning, use of extra support devices, feeding aids, etc.
  7. At the close of the consult, I will provide you with a verbal and written plan of care going forward.
  8. I will provide a written report of the consult to your healthcare providers as appropriate with the information you have given me.
  9. After the consultation, I will provide continued email or text support for 2 weeks.
  10. If I think that further treatment or assessment is required by other healthcare professionals, I will tell you at the time of the consultation and also relay this to your healthcare provider.
  11. If follow-up consultation is required with me, those services will be provided at a reduced rate.

What is different about a home lactation consultation?  

  1. We will use whatever furniture and pillows you have in your home to modify the environment.   If you need something to improve your situation, I will help you figure out what that might be.
  2. You do not have to pre-register etc.  A physician’s order is not required for a home visit, although I will communicate with your healthcare provider about the visit and my findings.
  3. Visits can take the time needed to thoroughly assess your situation. Please allow at least an hour and a half for our time together. Visits CAN last up to 2.5 hours which includes history-taking, care-planning, and pumping as well as feeding the baby. There is no additional charge for this time.
  4. I do not sell or rent equipment or supplies.  If these are needed for your continued care, you will need to purchase those elsewhere. I will provide a “shopping list” for your support person, if needed.

 

If you would like a home consult findjanehelpsopcropped out more here.