Dear Mama of a Brand New Baby...

Breastfeeding can still work out for you, even if you are having a hard time feeding your baby today. So much changes from one hour to the next with a newborn baby. And I know this is true, because I am living it right now!

With my prior experience as a nursing mama, with my training and education in the lactation field, and after working with countless mother/baby duos, I never expected (in a million years) that my 3rd child would be born naturally, in a beautiful home birth, and then... refuse to latch on.

I am not going to lie, the moment was a little tense. My brand new baby girl lay on my chest squalling her brand new baby cries, and after a little while, my midwife told me that she really needed the baby to nurse to help contract my uterus a bit more. And my daughter just refused to latch on. The positioning was right, and instead of showing any interest in the breast, she just screamed. Her refusal caught me off guard for a moment. Thankfully, manual nipple stimulation also gives an oxytocin response. I handed our hysterical baby to her dad for some skin to skin time while I worked on that.

With repeated offers and attempts over the next couple of hours, she did finally, reluctantly, take the breast. And when she was 36 hours old, this blog post started forming in my mind and heart. 

There are some maternity care providers or birth locations that have policies stating when newborn babies must eat by and the pressure can be overwhelming when you have just "climbed Kilimanjaro" labored and birthed a whole new person into the world. The pressure to get it all right, right away. To sustain your baby. To bond and have a loving and peaceful experience. To succeed at something you planned on doing. 

Sometimes, what you and your baby need the most is patience and the time and space to keep on practicing! If we had been in a different birth environment, or if I was a brand new mom myself, this initial setback could have easily thrown my plans to breastfeed off course. Babies definitely need to eat, but during that first day, hastily introducing a bottle to my too-angry-to-learn-to-breastfeed-newborn would have been a step in the wrong direction for getting nursing off to the best start possible. It turns out that we just needed to keep at it, learning together. I am so thankful for everything that I know about breasts, nipples, babies, and how they all work, but no amount of previous experience or knowledge could have removed my baby's need to learn how to do it for herself- through trial and error- and when she was ready to.

Gladis Rubio with her partner Robbie Hoskins, and their daughter Penelope

So, Mama of a Brand New Baby who might be struggling to nurse today, if there's one message that you take with you from this I hope it comes across loud and clear: you can still get this on track.
You can still make this work. We know you can. You might have experience from nursing another child, or not. You might have read every book about nursing, or not. You might have other challenges and obstacles to face. You might need to get help with breastfeeding. Just remember to take a few deep breaths, it's not too late to get this on track!

Lots of love,
Gladis

The Fourth Trimester
Lactation Counseling and Breastfeeding Advocacy

 (Originally written July 2013. Penelope is now a happy nursing toddler, and soon-to-be big sister!)

Can I take it while breastfeeding?

Photo credit: https://www.flickr.com/photos/22990055@N06/

There's a laundry list of medications, hormonal birth control, herbs, and supplements which are generally advised against because of the potential negative impact on breast milk supply. Decongestants are widely known to have this effect. And being that it IS cold and flu season right now it's definitely not uncommon to see a mama, suffering in her head cold wallows, to post in an online forum: "Help! I'm breastfeeding. Is it safe to take_____?"

There's actually a lot that goes into deciding if it is appropriate for that particular mama!

The evidence-based drug information that is available needs to carefully be weighed- general risks and benefits as well as the potential effect on the breastfeeding relationship of this unique mother-baby pair.

What does this mean exactly?

Well, the potential impact on milk supply caused by over-the-counter decongestants might very well be far less of a concern for the mama with a very well-established nursing relationship, who is not pump-dependent, does not work outside of the home where she is separated from her baby for hours on a routine basis, or for the co-sleeping/nighttime nursing duo who greatly benefits from peak prolactin levels with lots of baby-on-breast stimulation. These mamas may experience a slight dip in milk supply or production, but because of frequent and effective nursing, supply rebounds quickly after short-term use.

For other nursing pairs, there may be a greater risk associated with medications and herbs that are known to cause reduction in milk- perhaps we are referring to the mama of a very young newborn and her milk supply is still primarily hormonally driven, or a working mama who doesn't respond optimally to a breast pump, or a mama who has other underlying health conditions that are related to supply concerns.

Nursing dynamics are unique to each and every mama-baby, and so recommendations must always be unique as well.

Nursing pillows- Are they really worth all the fluff?

Photo credit: https://www.flickr.com/photos/17939157@N00/

Nursing pillows. They get mentioned a LOT by seasoned mamas, are on all of the must-have-baby-gear lists, and they tend to get a lot of flack from lactation professionals. Through our practically countless hours working with mamas to establish breastfeeding, we have developed some thoughts on the ('Boppy' vs. 'My Brest Friend' vs. no pillows) controversy, and hopefully can explain what all the hype is about so that you can make the decision that is right for you.

The first question we ask when mamas bring out the nursing pillow during a consult is this: is this currently working for you? Really dig deep on this one (remembering our golden rule that sore nipples and difficulty latching are NOT a normal phase but are a sign that something is not working).

If you think about it, the very idea of a nursing pillow implies that it is THE solution to comfortably positioning baby at the breast. But we know that moms and babies have unique positioning needs based on their anatomy. Factors include the mama's arm length, breast size, breast position on the chest wall, position of the nipple on the breast, torso height, waist size, leg length, chair height and depth, and, of course, the size of the baby. Then consider whatever other issues need to be worked on for comfort, including oral anatomy issues, supply/letdown concerns, craniosacral/chiropractic needs, or incision pain in the case of a cesarean.

Photo credit: https://www.flickr.com/
photos/edenpictures/4135954586

One important positioning tip is that the back of baby's head needs to be free, and sometimes the pillow encourages a mama to put her hand on the back of baby's head. Sometimes the pillow itself is pushing on baby's head, impeding his ability to open wide enough to get a really good latch, which can lead to nipple pain.

For a great latch, we need baby's chest to be close to mama's body so that his chin comes to the breast first and his head tips back. Sometimes, with the nursing pillow (more so with the Boppy than with the My Brest Friend) there tends to be a small trapezoidal gap between the pillow and the mother's torso. If we are trying to keep the baby ON the pillow, then his belly and chest may not be pushed up close to his mom, even if he is otherwise in a good position.

Another important point is that the baby should come to the "natural position" of the mama's breast. So, if your breasts and nipples are up high, then your baby needs to be held there. If the baby is held too low on her mama's lap because of a nursing pillow (as we see with the lovely mama pictured to the right), she will probably have either nipple or shoulder and neck pain from the nipple being pulled out of the baby's mouth or from crouching down for her breast to reach. On the other hand, if the mama's nipple or breast lies lower, or if she has a shorter torso, the pillow can bring the baby up too high, like in the Boppy billboard below.

"WE'RE # 1" Really, Boppy??

Photo credit: https://www.flickr.com/photos/roniweb/

The fact that you probably won't be dragging your nursing pillow around town with you is another reason why we, and most of the other LCs we know, don't put all of our eggs in the Boppy/My Brest Friend basket. We don't want to see you unnecessarily held back by a feeding gadget. If you need to feed your baby, you need to be able to feed your baby. And if you are accustomed to using a pillow in order to get your baby to take the breast, we encourage practicing without the nursing pillow to help you to build confidence in your ability to breastfeed on the go.

Are there times when it works perfectly? Yep!
Some nursing mamas find that the pillow is just the right height for her to feel supported. Or perhaps she is nursing twins and simply needs a soft platform to support the babies' hips during tandem feeds.

Sometimes, it just feels comfortable.

Photo credit: https://www.flickr.com/photos/theminniemoo/

5 things to do (and not do) before a lactation consultation!

We've seen a lot of mamas wonder what to do about their breastfeeding issues, and be it pain, grumpy baby, latch difficulty, colic, weird poops, or supply concerns, the answer should be a resounding "get help as soon as possible!"
It can be easy to feel like breastfeeding is rough in the early weeks for everyone, or that it's not that bad, but we truly want more for you. Once a mama has decided that things can be bettered and she's made the call... well, what next? Here are our suggestions for what to do (and not do) before a lactation appointment. 

1) Take lots of notes before your appointment. A lactation professional is going to be best able to help you get to where you want to be if she knows where you are today. Jot down some information about baby's feeds, sleeps, weights, medical events, pumping sessions, and supplements. Knowing how many diapers you have changed in the 24 or 48 hours before your appointment is also helpful.

2) Don't clean your house! Seriously, we've seen it all. If you are scheduling a home visit for lactation, nine times out of ten you are in crisis mode and we want you to be spending those precious moments with your baby or recharging your own batteries.

3) Don't change your feeding routine. Not just yet! Wait until after we have a chance to discuss the situation as it stands before starting an elimination diet, new formula, or supplement etc.

4) "Should I hold off on feeding her before the appointment time?" is actually the number one question we get after an appointment is scheduled! DO feed your baby whenever she or he cues you before the appointment. There is no need to worry about the baby being "full" when we arrive. We like to do LONG appointments for several reasons, but one of those is being sure of catching a complete feeding cycle, sometimes two. So if you are expecting us in half an hour and baby is starting to squirm, nurse away!

5) Do schedule your appointment during a time that is the most challenging part of the day for you. For example, if your baby rejects the breast every morning, schedule a morning appointment. And if latch is hardest in the evenings, have us come at that time. We want to see how things are going at their worst so that we can properly assess.




So, what other tips would you add to this list?
As always, if you have any other questions, feel free to send them our way. 

What really worries us about informal milk sharing- and it's not what you'd think!

We have to start off by saying that we unequivocally recommend breast milk. As they say, "human milk for human babies"- it just makes sense. If a mama's own milk isn't available, donor milk from another mama is the very next best thing, and yes it's better than formula. The debate in the lactation consultant world tends to be over "informal" versus "formal" milk sharing. Formal being through an official milk bank (which blends, pasteurizes, and homogenizes... making breast milk prohibitively expensive and turning women's efforts into big business profits).

Informal milk sharing is everything else.

It's manually expressing colostrum for a friend's toddler who keeps getting sick in daycare. It's giving half of your frozen pumped stash to a mom who is going back to work and doesn't have milk saved. It's food for babies who can't tolerate artificial formula but never latched on to their mother's breast. It's cross-nursing and wet-nursing, and yes, both of those things really happen!


Informal milk sharing has some risks, and moms should be and are generally aware of them. An improper donor could pass along a disease, could have incorrectly stored the milk, or could be taking drugs. All of these reasons are why milk sharing communities widely discourage purchasing breast milk. Freely giving milk is a time consuming process, and is a labor of love. The World Health Organization recommends milk from a "healthy donor", yet some lactation consultants will universally discourage milk sharing unless the mothers are participating in the formal milk bank system because of those (admittedly rare) risks.

What really worries us about informal milk sharing is not any of those things. It's what may be happening behind all of that beautiful sharing for both the donor and the recipient. Are they getting the support that they need?

Mamas who have hundreds and thousands of bags of milk frozen may be pumping like crazy because they are suffering with an oversupply problem. They are at risk of mastitis and plugged ducts if they were to suddenly stop pumping, and may not know how to get out of this situation. Or they might not be feeding their milk to their own baby because he or she has symptoms of intestinal distress and their pediatrician or GI specialist has advised them to stop nursing and switch to a specialty formula. These women need support.

Mamas who are supplementing with donor milk may have a baby who never latched. Or they struggled with low milk supply. Or they are returning to work and don't have the appropriate tools and support in place to provide milk for their baby.

All of those things can be compounded by the continuation of the milk sharing cycle, because supplementing with breastmilk is still supplementing and still reduces supply. It can throw the whole system out of balance. The best thing women can do when they are milk sharing is to contact a lactation professional and talk over whatever concerns they might be having. And if the lactation professional gives them a lecture about the dangers of milk sharing instead of lending an ear and offering real support, we hope they have the courage to pick up the phone one more time and call someone else. 

The Fourth Trimester  is honored to be your advocate!

Call us for a free breastfeeding phone consultation-

 Gladis- 727-657-7370     Emily- 727-452-4809

Email- fourthtri@gmail.com

www.TheFourthTrimester.net

Photo courtesy of Aurimas!

Twins breastfeeding story!

 

Nursing twins can be a handful, but it is absolutely possible. If the babies won't latch- get help immediately. One twin-mom that we worked with posted this awesome love note on our Facebook wall: 

"I was ready to give up attempting to breastfeeding my twins. I had been pumping for 8 weeks and I couldn't handle it. Then I met the ladies at The Fourth Trimester and things started to change. They recognized oral anatomy issues right away. Once that was fixed they stayed in touch with me and came for a couple more visits as determined as I was to make sure my twins would latch. 

I can not thank them enough for their help." 

Seeing this mom's joy in her success makes it all worth it.



image courtesy of MultiplesParent!

What to do if you need professional lactation support but can't afford it

     

        Photo credit: https://www.flickr.com/photos/17939157@N00/  

If you are having difficulty breastfeeding, it's important to get help early to get things back on track as quickly as possible. Newborn babies nurse very often and follow instinctual feeding cues which establish the foundation for a solid breastfeeding dynamic. Not reaching out for help during the early postpartum period can have unintended consequences for the future of your breastfeeding relationship. But this doesn't just apply to the newborn period- sometimes problems crop up later on down the road as well. Delaying getting help when you have sore or cracked nipples can lead to infection on the nipple, or even mastitis.

We believe that all mamas and babies deserve the vital support that lactation professionals provide. Please do not let your financial situation stand in your way of reaching out for support. When a stumbling block is encountered and it seems like hiring an LC is financially impossible, consider these potential solutions!

• Ask your insurance company to cover the fee. That is their obligation under the Affordable Care Act. Lactation services are categorized under preventative health care and should be covered with no co pay or cost sharing. Because this legislation is still new, your mileage may vary.

• Use your HSA card!

• Or, pay first and seek reimbursement from your insurance provider after. We always provide a coded bill to our clients so that they can be reimbursed after a lactation visit.

• Consider a payment plan. This could be an arrangement with your LC herself to spread out the fee over time, or using Paypal to "Buy Now Pay Later". Rest assured that she has probably been asked before if she would take the fee for a lactation visit in installments and, while she may or may not offer that service, she won't think less of you for asking.

• Ask for it as a baby gift from friends and relatives. Someone wants to shower you with more baby stuff? Your coworkers want to go in on a "big gift" together? Ask for the funds you need to cover these valuable services.

• If possible, plan ahead and save a little money each month during your pregnancy that is ear-marked for getting breastfeeding off the ground. This might include lactation visits, breastfeeding supplies, or chiropractic care. You may never need to spend the money in your "lactation fund", but if you do need to, you'll know it's there. 

• Sell items you have been meaning to get rid of. I can personally think of at least 3 things in my home that we aren't using or loving but that have real value to someone else. Bonus to selling these items to pay for a lactation consultant is that you will free up valuable space in your home!

• Temporarily rearrange some categories in your budget. Can you give up 2 date nights or cut your grocery budget in half one week? Do you have both Hula and Netflix, and could you give up your subscription to one of them? 

• Borrow the money, or collect on money that a family member might owe to you! Did your sister's family say that they would pay half for a vacation rental you shared and you both said you'd get the money back "later"? Now is a great time.

• Offer a barter of services. Are you a web designer or math tutor? Does your partner have his own business doing landscaping, accounting, or catering? We truly believe that everyone has something to offer, and while the LC you are trying to schedule with might not be interested in a barter, it is worth it to ask! It is, at any rate, more respectful to all parties to offer to trade the equivalent value of your time and skills for her time and skills than to simply ask for her to waive or lower her prices.

• And finally, utilize the many free support options that are available to you. La Leche League groups, Baby Cafes, WIC peer counselors, and free hospital moms groups are great places to start. We tend to refer moms to in person support with a trained leader over internet support simply because breastfeeding advice given online without being able to actually observe the mother and baby can sometimes do more harm than good. But there are so many places moms can get breastfeeding support for free! Remember that volunteer breastfeeding helpers are passionate, but can only do so much because they have families and work of their own. However this option may buy you a bit of time while you figure out one of the other suggestions above.

Know when to ask for help: If it is sometimes difficult to latch your baby on or positioning feels awkward, if you are experiencing nipple, breast, or shoulder pain, if you aren't sure if you have enough milk, if baby is fussy, gassy, spits up frequently, you're considering an elimination diet, baby loses weight during the first few weeks, or isn't having yellow stools by the 4th day of life, we'd like you to know that things could be better!

The Fourth Trimester is honored to be your advocate. Call us for a free breastfeeding consultation. 

Gladis  - 727-657-7370     Emily - 727-452-4809

Email: fourthtri@gmail.com  www.TheFourthTrimester.net