Tongue-ties and other Hurdles with Breastfeeding

There has been a lot of discussion among the medical community about the impact of tongue and lip restrictions on breastfeeding and oral health in general. Over my now 45 year career of nursing and lactation support, this discussion has grown from a “no big deal, just fix it” question to an “it’s an imagined problem” to where things stand now – with camps saying it’s overdiagnosed to camps saying that it’s underdiagnosed and undertreated. There are many social media groups for both moms and professionals discussing the issue and in some cases, strong battle lines are drawn. Here is my opinion.

Personally, I have had two children with restricted lingual frenulums. One received a revision at 5 days by the old GP that delivered her. The other delivered many years later, was not diagnosed and was not treated. I nursed them both, the first for 10.5 months (in a day when everyone bottle-fed) and the second 3.5 years. Both had dental issues later in life.  That’s my personal experience and occurred before I was a board certified lactation consultant. My experience says that with a genetic capacity for excellent milk supply and determination, breastfeeding can happen for some moms with babies with oral restrictions, but sometimes it can’t. There was no Facebook back then with thousands of mothers looking for support that they can’t find in their local medical community. I survived. Does that make it ok to not treat oral restrictions?

Professionally, over the course of my career, I have helped thousands and thousands of women breastfeed.  Some of the most difficult cases have been with babies with oral restrictions. And many of these have additional difficulties to overcome, some as secondary issue caused by the oral restrictions, some separate but equally challenging issues. Below are some of my conclusions.

Oral restrictions affect muscles in the body. Babies use their whole bodies to breastfeed. Sucking is the mechanism by which babies get nutrition, comfort and explore their world. When that is disturbed by difficulties of attachment due to weakness or inability to move the tongue (which is another muscle), their world is turned upside down. Compassion and understanding go a long way to increasing patience with a baby who doesn’t understand and who is biologically driven to nurse. All babies want to nurse, but oral restrictions impeded their ability to do with ease.

First, it is important to note that muscle tension can affect tongue effectiveness, giving an appearance of restriction. That is why it is important to have an experienced diagnostician who can distinguish between a mechanical restriction (like a tongue-tie) versus muscles in tension preventing movement and range of motion. Proper diagnosis is the first key to dealing with inhibited tongue function.

Next, if a mechanical restriction is diagnosed, an experienced and knowledgeable provider is the second key in improving function. The provider must know how to do a complete release and be able to show the parents what that looks like when it is accomplished, and give proper guidance for post-revision care.

The third key is effective and consistent after care done once the baby’s restrictions is released. Babies who can’t suck effectively, often develop muscle tension in other places than the tongue as they try to compensate for poor tongue function. This can result in lots of tension, pulling away from the breast, biting, etc. Some babies will develop or may have accompanying torticollis, high body tone, etc.  Body work, physical therapy, effective and frequent tummy time, baby-wearing, and skin to skin care can help calm and relax a baby. This must be done in a pattern that is effective and rewarding for baby.  Some babies need care from a speech language therapist. If baby is being supplemented, the choice of supplementation device may change as baby improves. See my post http://hopebreastfeedingsupport.com/pacifiers-bottles-and-pumps-oh-my/ for more information on the impact of devices on breastfeeding competency. Protect your milk supply while working on any latch issues as supply is driven by the degree and frequency of emptying the breast. See the link above for more info on that as well.

A lactation consultant should reevaluate baby after a release because latch techniques may need revision once baby has full range of motion of the tongue. It takes time to work through and retrain baby to latch comfortably and effectively. Most moms report it takes 2-4 weeks. Follow-up assessment during this time is important to make sure healing is progressing and function is improving. The IBCLC can further refer to body workers, speech therapy, physical therapy as needed.

Above all, when taking the journey through breastfeeding difficulties, including oral restrictions, remember that the breast is and should be not a battle ground but a sanctuary for babies. Keep baby close and comfortable (that’s skin to skin care). Keep baby at the breast, even if you have to supplement away from the breast. Breastfeeding can be an after meal snack even if your supply is low. Your journey may not be easy, but your bond can be strong as you work through challenges.

Grandmothering the Breastfeeding Baby

I am the grandmother of a newborn baby boy. Born a little over 3 weeks ago, I’m sitting in the living room of his parents mulling over this new role. No, this is not my first grandchild. But it’s the first one I’ve had the joy of spending uninterrupted time getting to know his little personality, observing his parents in their roles and his older brother adapting to his new role – big brother.

As a lactation consultant, I am invited into homes to observe, assist and recommend in an active role.  There are barriers that must be broken down and boundaries to cross and an instant intimacy created by the need of the moment. As a mother-in-law, mother and grandmother, there are boundaries that must be crossed very hesitantly, if at all. My philosophy of breastfeeding applies in this instance – it is the relationship that we must preserve above all. Breastfeeding, with all its benefits, is primarily about establishing the primal relationship, not just getting breast milk into a baby. Relationship is about building love and respect into an unbreakable bond.

So what can a grandmother do to support the new family? I believe that the same three goals apply to this situation as to any other breastfeeding cohort: protect, promote and support. Protect by being positive and avoid offering solutions that interfere with breastfeeding. That means, don’t offer to bottle-feed the baby so mom can get a good night’s rest. Don’t give the baby a pacifier to hold off for a longer interval between feeds. Don’t buy another infant holding device (bouncer, swing, rocknplay). Don’t make negative observations such as: “your breastmilk looks kind of weak” or “he’s crying again – maybe you didn’t feed him enough” or “he has a rash – maybe you are eating something that he’s allergic to.”  Don’t offer to hold the baby while mom does the laundry or fixes your supper. Instead, be encouraging. Let mom know how proud you are of her, how blessed her baby is to have her, how beautiful she looks nursing your grandchild. If she doesn’t have one, get her a sling and help her learn how to use it for carrying baby. Use it yourself when she needs a break. Watch baby while he spends time in tummy position. Fix a meal, do the laundry. Take an older sibling to the park, or play with him. If mom needs you to hold the baby, by all means enjoy. Learn to hold baby chest to chest, a position most babies really enjoy.

If mom or baby are having some latch or fit issues, get help for them and be a cheerleader. Learn all you can about the establishment of milk supply and how that is done. Ask her how you can best help her reach her own personal goals. Breastfeeding is an important building block in a baby’s life foundation – but it is only one of them.  It also helps to remember that it takes babies 6-8 weeks to gain active control over feeding and moms need support during that time as they try to help their babies learn.  Nothing tops patience and perseverance in that journey!

Nothing in my life has been as rewarding as seeing my children grow up, take a marriage partner and become parents. I almost understand how God must feel when we become fruitful and start sharing our gifts and talents with others, and pass the torch along. I keep that in mind and am grateful for that. And as I anticipate great-grandchildren in the future, I hope to be able to give them the benefit of my hard-earned wisdom too!

 

When There’s Not Enough Milk

Sometimes, despite doing all the right things, there’s just not enough milk to totally sustain a baby with exclusive, mama-only, straight from the tap, breastfeeding.  Whatever the reason – genetic, environmental, iatrogenic, mother-baby separation, illness, etc., all that can be done has been done and there’s still not enough. What to do?

  1. Realize that breastfeeding is more about the relationship than it is about the volume of milk. Once a baby has made the connection between mom and comfort at the breast, the volume of milk obtained is not as important as the emotional connection that occurs. This is an important concept to grasp. Many babies nurse 3 or even more years. Older babies get a full diet of family-friendly foods, still need and want that connection with mom. But it’s not about the volume of milk, it’s about getting mom’s undivided attention and the feeling of security at the breast.
  2. For a baby to make that connection between breastfeeding and safety in the arms of mama, breastfeeding needs to continue even when full breastfeeding does not provide all the baby’s nutritional needs. Giving up breastfeeding for breast pumping may seem like a solution to address issues of low supply when a baby is an inefficient feeder for some reason, but exclusive pumping does not allow for that connection and interaction to continue. Think hard before you give up direct breastfeeding.
  3. If supplementation is required, and donor milk is available, use that to support baby’s nutritional needs as long as possible. If baby is able to breastfeed well enough, use a lactation aid at breast as much as possible for supplementation. If supplementation must be done away from the breast, use bottles in a manner that supports baby-led feeding.  See http://hopebreastfeedingsupport.com/pacifiers-bottles-and-pumps-oh-my/ for more information on selecting pumps and bottles that may interfere less with continuing the at-breast feeding bond.
  4. Recognize that babies use suckling time at the breast to help with digestion, to comfort and settle. Large volumes of milk are not needed, or even desired for this activity. Breastfeed your baby after supplementing to allow for this benefit. Breastfeed whenever possible instead of giving a pacifier. Some people call this “comfort-feeding.” In the early days, combine comfort-feeding with skin-to-skin care to build the connection between you and baby.
  5. Accept the fact that breastfeeding length and milk volumes do not have to correlate. Adoptive mothers may not have a full supply of milk, but they can still breastfeed. Mothers of toddlers aren’t exclusive breastfeeders, but they can still breastfeed. Mothers with insufficient glandular tissue may not be able to provide 100% of their babies nutritional needs, but they can still breastfeed.

Fitting Baby In

When you have a baby, everything about life changes. The love of your child may hit you like a ton of bricks. Or, like other love relationships, it may creep up on you slowly. Some parents take the coming baby experience with a laissez faire attitude. They trust they will get through childbirth and child raising by the seat of their pants. Others plan everything, like a military expedition, trying to think of every possibility and plan for every outcome. Others take a middle of the road attitude. Whatever the personal style of the parents, they will be bombarded with all sorts of advice and warnings. Some of it will be useful, and a lot of it, not.

If the parents are “researchers,” they may discover many opposing viewpoints on almost every issue. The “planners” may find this frustrating and overwhelming and make a firm commitment to adopt a viewpoint that causes issues within their relationship with each other and the baby. The “flyers” may find themselves validated when everything goes smoothly or be able to adjust to any bumps in the road they encounter. The key is having two parents on the same wave length – which often doesn’t happen! It’s a good idea for parents to discuss these things before baby comes and be prepared to change strategies if they find that the planned one is not working for them and their baby.

The truth is, babies need love, comfort, security, food, and warmth. Breastfeeding provides that very first connection that simultaneously provides all of a baby’s needs with one activity. The challenge comes in providing those needs for the baby while caring for the mother and father. Here is where family and community support becomes vital.

If you are a laissez faire sort of person, consider the possibility that childbirth may not go in a predictable pattern. It helps to have supportive folks in the wings ready to step in and give a hand if you need it. Have the conversation with family and friends so they understand your point of view, but can plan to be available in case you need a little help with coping in the first days. If you are a researcher or a planner, try to accept that there unforeseen events may occur and contingency plans may be required. Give yourself room to breathe and try not to set impossible goals as a measure of success.

Babies are non-stop needy. They go from having their needs supplied without any effort on their part before birth to a world that is cold, bright, hard and must be engaged to get anything that they need. Babies have massive brains (compared to other animals) but few connections established. Everything must be learned from scratch. Primitive reflexes such as suck, swallow, breathe that are essential to survival are present but baby must associate those with actions that bring food and satiation together. Those associations build over time. Connections between the brain and mouth and neck become more secure by 5-8 weeks. This becomes obvious to parents when baby begins to smile in response to interaction with other humans. In these early days, babies need to be near their mothers, enjoying skin to skin contact and free access to mother’s breasts for nourishment and comfort. Interestingly, this time when baby is mainly reflex-driven is also the time when mother’s milk supply is built and established. Frequent and unrestricted access to breastfeeding has been shown to increase milk supply better than scheduled and limited feeds. Frequent breastfeeding helps to increase hormone levels and sensitivity of lactation tissue to hormones of milk production. For mom to be available, it helps to have household and toddler assistance (if needed) during this early period. Slings and wraps that keep baby close to mom can help reduce stress.

Sometimes parents are tempted to use artificial carriers such as car seats, Rock ‘n Plays, swings and other devices that put baby in a semi-upright position and provide movement and/or noise like the uterine environment. The thought is that these devices will give parents a break and are harmless. Studies, however, show that babies who spend too much time in these are more likely to develop acquired torticollis, reflux and plagiocephaly. Here’s an article that gives more information about one product. By age 3 months, babies have progressed and gained more head and neck control and can use these products without some of the side effects.

As babies grow and mature, they become more sociable. Stomachs grow and babies can take more milk in at a session and sometimes go longer between feedings. Feedings can also be shorter at times. The unique personality of your baby becomes more obvious as time goes on. Your relationship grows and develops. Most moms find that after 3 months, breastfeeding becomes easy – and so much easier than all the work it takes to bottle-feed a baby. Breastfeeding becomes more than just a way of transferring nourishment to your child – it is a communication tool, a way of comforting, and a way of teaching about relationship.

In most non-Western cultures, breastfeeding to 2 years and beyond is the normal pattern. Of course, older babies do not nurse as frequently as newborns and some sessions may last only a couple of minutes. Extended breastfeeding (breastfeeding exclusively for the first 6 months and thereafter as long as the child desires) is associated with better development of facial structures, reducing the need for orthodontics in children nursed over 18 months. Family-friendly solid foods can be introduced starting at 6 months of age. For more information on introducing solid foods to older babies, check out this website:

Whatever your parenting style, know that it is possible to grow and adapt as time goes by. You are not committed to one style of parenting forever. You can compromise and change as you need to. Love, after all, is the most important gift that you will ever give your child.

Pacifiers, Bottles and Pumps, Oh MY!

What does a breastfeeding mother and baby need besides each other? Clearly, they need time and proximity so they can adjust their relationship from a continuous but unconscious provision of warmth, comfort and nutrition by mother of baby to a deliberate but more intermittent provision of those same requirements for baby by the mother. Mother needs the support of those around her to meet her physical and emotional needs while she meets those of the new baby. And this process takes time to develop its rhythm. Like new dancing partners, the dyad must become comfortable and intuitive in their actions, developing trust and coordination over time.

But — what if a separation must occur. Mom can no longer be ever-present to meet her baby’s needs. Or what if baby or mother has a physical issue that affects milk supply or delivery? How can we provide a substitute for both mom and baby that doesn’t undermine the breastfeeding relationship? The market steps in to offer its solutions: bottles, pacifiers and breast pumps! These tools offer and purport to be a temporary solution to bridge the separation on a short term basis, but often present their own challenges to mother and baby.

So, how do we select when presented these “solutions?” First, understand the basic physiology of breastfeeding. How do mothers make and release milk? How do babies obtain that milk? What is the biology that we are trying to mimic? What are the properties of the man-made materials that we use to create these tools? Over the years, inquiring minds have looked at various products on the market to try to determine how these products work and to what degree they either simulate breastfeeding or offer less interference with breastfeeding when used. The problem is, most of the methods used to test products don’t truly match what a baby does when they use the products. Ultrasound studies may show the mechanics baby uses on a bottle, for instance, but can’t really measure the baby’s adaptation to the materials or how the baby changes flow rates by altering the quality or actions used during sucking. Only a very sophisticated real-time system using pressure gauges, ultrasound and sequential weight checks can adequately assess the way a bottle performs for a particular baby. And even that can’t determine how a baby is adapting and accommodating to the bottle.

Pacifiers

Some fairly good research has found that pacifiers introduced after the first two weeks and limited to less than 2 hours use during the day do not appear to inhibit milk supply or shorten breastfeeding. In this study, a one-piece pacifier with a rounded nipple and slight flange at the base was used for all babies in the study.(1) In this study, all babies were healthy babies with no identified risk factors such as tongue-tie etc. Early introduction of pacifiers may interfere with baby’s learning curve where he identifies and correlates sucking and swallowing with latching to the breast. Pacifiers are made of materials much firmer than mother’s breasts and do not conform to the baby’s palate. This imprinting period can last up to 6 weeks. An analogy I have sometimes used is this: introducing a pacifier is like giving a young teen porn – it is artificial, highly stimulating, and does not resemble the real shape, feel or action of the real thing. Ear, nose and throat specialists who work with babies with tongue and lip-ties have noted that babies who have used pacifiers a great deal can have issues learning how to open widely and actively extend the tongue to latch onto the breast. If possible, delay pacifiers until they are absolutely necessary, after comfortable and effective breastfeeding is established, and then limit use to less than two hours daily. Avoid orthodontic, flat or bulbous pacifiers.

A skilled IBCLC can assess a baby’s sucking technique, evaluate suck strength and make recommendations for supplementation methods if needed. They can offer suggestions to help the nursing couple to address and overcome any issues encountered.  They can also evaluate mom’s supply and make recommendations for techniques, equipment and supplements as needed.  They can communicate with other healthcare providers to coordinate breastfeeding and family-friendly care.

Bottles

The research that has been done on bottles includes direct ultrasound and indirect flow studies using a pump setup to mimic the vacuum levels babies use on bottles.(2) Some bottles will deliver nearly an ounce in a minute! This fast of a flow rate will cause a baby to take too much at a time from a bottle, may cause gassiness and fussiness and spitting up. Some bottles will deliver a fast rate of flow if the baby bites on the nipple. When babies must use a bottle and the flow rate or method of obtaining the milk (compression instead of sucking) varies from what is normal during breastfeeding, it can cause bottle or breast rejection. Bottles that drip when held sideways do not necessarily flow fast when baby is sucking. And, bottles that don’t drip, are not necessarily slow flowing when used by the baby. Generally, 5 ounce Newborn Dr. Brown’s bottles with regular size neck, not wide-mouthed, Special Needs Feeders, used with the small line lined up with baby’s nose, Calma feeders, and Munchkin Latch bottle are considered slow-flow, non-compression bottles. Bottles not recommended include Avent, Tommee-Tippee, Momma original, Evenflo original, and many others. This list is subject to change, however, as manufacturers constantly change or quit making products over time. The best way to test a bottle is to buy one only, try squeezing the nipple where baby’s gums would go to check for compression, and offer to baby.

When bottles are recommended for supplementation, it is a good idea to have a lactation consultation to evaluate the baby’s suck and mother’s supply. This can help in choosing the right bottle or another method for supplementation that can help preserve the breastfeeding relationship.

Check out my hand-out on using a bottle under resources. .baby-led-bottlefeeding

Pumps

When I started nursing my first baby in the early 70’s, and needed to go back to school, the best you could do for a breast pump  was one of these: Image result for bicycle horn breast pumpThis thing was hard to clean and could only hold maybe an ounce. Needless to say, not too many moms used them for very long or with much success. By my second child, See the source imagethis kind of pump was available.  A little better, still not great.  Fortunately, I was able to delay returning to work until he was over a year and I didn’t need to pump. By my third, the first electric piston pumps were available in hospitals.  They looked like this:   Image result for breast pump piston and cylinder For the everyday working mom, manual pumps were still the only option. By 1987, when I opened the first Outpatient Lactation Service in Nashville, heavy duty hospital pumps were available for rental.  Battery pumps also became available, like this:Image result for gentle ease battery breast pumpbut weren’t super comfortable or effective. By 1989, along came a lighter weight rental pump Image result for lactina This pump could do both breasts at once and was portable! By mid-1990’s the first Pump In Style, a lightweight single user pump that could double pump was available for purchase. Image result for medela pump in style original Medela continued pioneering work in the lab, building on the work of Egnell and Whittlestone, trying to design a pump that would be efficient, effective and yet portable and quiet. Variable speed and vacuum pressures were investigated and the Symphony was invented in 2003. Image result for symphony breast pump Medela as well as many other manufacturers have since built and sold breast pumps of various sizes, colors and technologies. There is a huge market of mothers who realize that breast milk is what babies need but have to be away from their babies and need to provide that milk when they are apart.

So how do you choose an effective pump that’s right for you? First of all, look at your need. Have you established a good milk supply with a healthy nursing baby? Milk supply peaks at about 4 weeks postpartum and regulates at about 8 weeks. Minimum requirements for babies from 1-6 months is about 750 ml per day. That’s about 25 oz. Research has shown that a breast pump needs to be able to remove at least 70% of mom’s available supply to maintain production. More complete removal can increase production over time. Less complete removal will decrease production. This is a normal process and is how breastfeeding works when a baby nurses. If a mom only needs to be away from her baby on an occasional basis, any pump that gives her some relief and removes some milk is useful, as when she and baby are together again, the baby can remove the extra milk left behind.  Or if a mom is very full and needs some extra relief, a simple vacuum pump such as the Haaka Image result for silicone one piece breast pumpis inexpensive and can do an adequate job for many moms. The Harmony pump by Medela, Image result for breast pump harmonyis a simple single manual pump that can be used.  For moms returning to work and needing to pump quickly, Medela, Spectra, Ameda and many other companies sell pumps. You can look at Amazon reviews. Here is the FDA’s review of breast pumps.

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/BreastPumps/default.htm

If you have a low milk supply, a baby in the NICU or you are in the hospital, a hospital rental-grade breast pump is the best type of pump for helping increase supply. The pump needs to be able to stimulate a let-down and then apply enough vacuum to empty your breasts quickly when you have a let-down. The flanges should fit your nipple. There are YouTube videos available and several blogs. Here’s one: http://www.medelabreastfeedingus.com/tips-and-solutions/13/choosing-a-correctly-fitted-breastshield.  Look into hand-on pumping, do hand-expression after milk flow has stopped, and gentle breast massage before pumping. Some moms find that using coconut oil (if you are not allergic) inside the breast flanges improves comfort. In addition, hands-on pumping can help improve milk-removal, thus improving supply.  http://med.stanford.edu/newborns/professional-education/breastfeeding/maximizing-milk-production.html

What if you don’t feel let-down? Milk squirting or fast-dripping into the pump flange is the best sign of let-down. But constant staring at the bottles can inhibit let-down! Playing music, drinking something warm, looking at a picture of your baby and even letting the baby nurse on one breast while pumping on the other, if possible, can help your body learn to respond with let-down. Let-down is essential as the breast pushes the milk out with tiny muscles around the milk collection areas towards the nipple. Vacuum created by the baby or the pump stimulates your brain to release the hormones that cause the muscles to contract and the hormone that causes milk to be produced for the next feeding session.

Pumping is one of those things that moms do to get by. It is never the best option, but in some cases it is the ONLY option a mom has to provide her milk for a baby who can’t get do the job. It is hard work for many moms, but it is something only YOU can do, as your milk is the milk best suited for YOUR baby!

(1)Does the Recommendation to Use a Pacifier Influence the Prevalence of Breastfeeding? Jenik AG, Vain NE, Gorestein AN, Jacobi NE, Pacifier and Breastfeeding Trial Group J Pediatr. 2009;155:350-354 (2) Comparison of Flow Rates between Commercial Bottles Karen Gromada, IBCLC unpublished communication.

Tools for Breastfeeding

I often get asked this question by pregnant women: “What are the essential tools I need for breastfeeding?” My answer is almost always this: At least one breast and at least one healthy term baby. That’s it! Provided everything goes well with birthing, you are able to avoid mother and baby separation and you are able to keep your baby skin to skin, things should go well.

Sometimes they will follow with this question: “But what things do I need to know or know how to do?” My answer is this: Get comfortable with handling your breasts and nipples. Review reverse pressure softening and hand-expression, especially areolar expression. Review breast massage. Watch some YouTube videos on baby-led latch. Talk to your partner about protecting you and your baby so that you have the private time you will need for learning.
Breastfeeding is a relationship between mom and baby. All relationships require one on one time to foster closeness and confidence. Pregnancy is like a Facebook romance where you communicate only with pictures – and the other party can’t speak back to you! You make a commitment to that person before you ever meet face to face, know what they really look like or anything substantive about their personalities. You sign the marriage contract (like an arranged marriage) with a vast unknown before you. You consummate the marriage – and then you begin to learn about your partner.

The next question I may get is this: “But what if there are issues? Are there any products or supplies you would recommend to have on hand, just in case?” Here is my list:

1. Breast pump – double electric. If your baby has some issue that makes it difficult for her to attach and draw milk from your breasts AND you need to establish your milk supply, I strongly recommend temporarily renting a Symphony from your local rental agency. You can use your breast flanges and attachments from a Medela personal pump, but will need to purchase a conversion kit if you have not received one from the hospital. Breast milk supply potential is established in the first four weeks of breastfeeding. Failure to remove milk from the breasts signals lactocytes to shut down production. It is easier to protect your supply from the beginning than to try to rebuild a supply later on. Medela Pump In Styles are my favorite personal pump, but I will admit prejudice. Your insurance company may provide you with this. This style of pump was designed for helping moms transition back to work and for occasional use when you have a healthy nursing baby.

2. Tendercare Hydrogel Pads by Medela. These are sold online, by Target, Baby’s R Us and hospital boutiques. For sore nipples. There are other brands but Medela pads can be cut in half to go further, if needed.

3. Microwave sterilizer bags. These save a ton of time if you need to sterilize/clean breast pump parts, pacifiers, bottles etc. You may never need these for your baby. They make great bags for steaming broccoli and other vegetables if you don’t need them for baby supplies. And they’re reusable!

4. Nursing pads – disposable or re-washable. Soft cotton pads are very comforting especially if your nipples are sensitive but not sore.

5. Bacitracin. A great topical antibiotic for scrapes and cuts and useful, should you need it, for treating nipple trauma.

6. Ice diapers. Make these yourself. Take 4 disposable diapers. Open them out and wet them. Drape them over a cup in the freezer. These are great for soothing tight breasts throughout the engorgement period.

7. Nursing support pillow. There are lots of styles and brands. One of my favorite is the Boston Billow. This can be found on-line and in stores (check with the website). Additional pillows, some firm, some more adjustable, may be needed. Make your own wrist support. This can be made from a long tube sock filled with rice and tied off. The wrist support can be placed strategically to help support your hands, arms and the baby during the first few weeks while baby is unable to support his own head.
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Breastfeeding Confidence: Are you gaining or giving it away?

Entering Motherhood Unsupported

Let’s face it.  Our culture has totally undermined our confidence and security in ourselves as being dearly loved children, created lovingly and capably by a gracious God. What does that have to do with breastfeeding? Many women have bought into the idea that they are not good enough physically, mentally or emotionally just as they are, to be a woman, a wife or a mother. First, we feel the need to mold ourselves to the Victoria Secret models’ shapes and appearances. We feel a need to use whatever femininity we have to attract a mate. Then, when it’s time to have children, instead of being empowered through education to guide us in doing what we were created to do, birth becomes a maze and we are taught we can’t birth without medical technology. Even when this technology is needed, the way it’s administered can leave us feeling more like victims instead of capable mothers.  Finally, once the baby has been “delivered” (notice the disempowering language of  delivered instead of the mother who partners with God in giving birth!),  we are then expected to produce the life-giving, unduplicatable fluid that the baby needs, on demand, in time and in sufficient quantity.

Every new phase of womanhood is just that–new, uncharted territory!  Everyone’s experience is unique, so despite the best education possible, or no education at all, we venture into the breastfeeding relationship as rookies.

Mixed Messages

In today’s world, the internet, social media and television/radio broadcasts have informed us dramatically that breastfeeding can fail us and the baby. But we are also confronted with the growing body of evidence that breastfeeding is essential and necessary. What to do? Many moms are trying to be preemptive in their preparation. They research all the best herbs for increasing milk supply. They search for the best breast pumps. They look into special diets and techniques. When their babies are born, they are quick to assess and intervene for any perceived difficulty. For other moms, however, the possibility of failure is so daunting, that they never even begin the journey. They opt to formula-feed from the beginning. Better safe than sorry!

Imagine a Better Way: Birth, Breastfeeding and Beginning Again

What if?

But imagine with me for a moment what the world could be like if we could breach the chasm between flying and the fear of failing.  What if moms could find a middle way that empowers women from birth to breastfeeding? That way might include research to identify the best environment for birth for their newborns and themselves. It might include education about the normal progress for mothers and babies during the early time after birth and making plans and contingency plans should unexpected difficulties occur.  But, above and beyond all this planning, let’s include trust. Trust in the birth caregivers she has chosen. Trust in her partner to protect and support her desires. Trust in her family to honor her decisions.

What if moms could develop relationships with other mothers who have journeyed and reached the goal desired? What if they could find supportive professionals to answer questions and guide the journey when needed? What if we treated the breastfeeding relationship as normal and necessary, but respected it as so important that we celebrated the RELATIONSHIP part of it as much as we did the milk-making (FOOD PRODUCTION) part of it? Those who have gone before us could celebrate the choices made, whatever they are, for what they are worth, choices made in the best interests of mother and baby? We could stop blaming ourselves and each other for the past mistakes and sins and move forward from here, learning from the stories of life and love that we each bring to the table.

One Team

I am so tired of hearing about “mommy wars” and “breastfeeding Nazis” and “need for more research before pushing breastfeeding on mothers.” What would happen if we took out the word “breastfeeding” and replaced it with “sex”? No one would stand for a war on sex to make it only used for reproduction!  No one would shame a woman (or man) for seeking professional help if there were issues on either the relationship or reproductive front. Then why is there so much shaming of something just as natural and essential to producing and maintaining life as feeding our children? We need to re-prioritize and support women trying to navigate motherhood and breastfeeding.

Love, Not Fear

Let’s change this paradigm and create an environment that is normal, helpful, supportive and non-shaming to mothers no matter how they feed their babies, while continuing to educate and celebrate what has sustained humanity up until the 20th century.

Let’s start now.  If you are reading this and you didn’t breastfeed your child, or you didn’t breastfeed “properly”, let me be the conduit of forgiveness.  You operated within the knowledge and barriers of your time.  Yes, you had responsibility.  It’s OK to own that and say, “I wish I had known better” or “I wish I had had better support” or “I wish I had made better choices.”  It’s OK to own it.  Then give yourself grace and forgiveness.  When you own something, you are then able to use it for good. Perhaps you will help someone by supporting them or offering to find them the support they need. You don’t have to be in denial or defense, you just move forward.

If you are reading this and in the middle of a feeding struggle, then get the help or accept the help you need, but cherish what you already have. If your issue is low milk supply or latch, don’t give up the breastfeeding relationship, the cuddling and skin-to-skin and eye-to-eye language without words. If you have plenty of milk, but a baby who can’t or won’t latch, take off the pressure. Make bottle-feeding as much like breastfeeding as possible with positioning, allowing baby control etc. Take as much of the stress away as possible by taking each day as it comes. Pray blessings over your baby.

In summary, loss of confidence comes when we allow fear to take control of our actions and thoughts. Fear is paralyzing but it can’t be overcome by will. Perfect love casts out fear (1John 4:1) F.E.A.R. equals False Expectations Appearing Real. Let those who love you understand what your desires are and accept acts of love that are truly loving and supportive. Let love be your guide, knowing that love is the antidote to fear. As you make small steps, your confidence will grow and you can then help others along the way.