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/

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!

How do I know if my pediatrician TRULY supports breastfeeding?

How do I know if my pediatrician TRULY supports breastfeeding?

Interviewing pediatricians? Start the dialogue

by asking what they know and believe about breastfeeding.

Does this pediatrician...

believe that breastfeeding is the biological norm and formula feeding and even pumping are lifestyle choices?

A doctor that truly supports breastfeeding will never minimize your feelings in an effort to help you feel "better". Saying that "it's not that bad" doesn't help to solve the actual problem. Your pediatrician should always listen and empathize if you share that breastfeeding is not going well.

support the World Health Organization's position on breastfeeding? Or does he/she promote early weaning?

"WHO recommends that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development, and health. Thereafter, infants should receive nutritionally adequate and safe complementary foods, while continuing to breastfeed for up two years or more."

understand the WHO's definition of exclusive breastfeeding?

"Exclusive breastfeeding means that the infant receives only breast milk -not even water- with the exception of oral re-hydration solution, or drops/syrups of vitamins, minerals, or medicines."

only use the most current published WHO Infant Growth Charts for exclusively breastfed infants?

If the chart is based on breastfed babies and the baby's growth percentile has dropped, this is a red flag to take a closer look and see if breastfeeding can be improved.

understand what is normal for breastfeeding moms and babies?

This includes how much and how frequently breastfed babies typically eat (guess what- it's different from formula feeding babies!), what pumping is generally like, and what some signs of trouble are. For example, if a mom is struggling to pump enough, or if she is experiencing any breast pain or sore nipples.

seem willing to have a discussion about the importance of oral anatomy for pain-free, effective breastfeeding?

We frequently hear of pediatricians suggesting that lip tied or tongue tied babies are "fine" or that feeding "should be okay", yet mama and baby are struggling. Minimizing these issues as a medical fad is not productive or evidence-based.

consider feeding difficulties when making a diagnosis? And make referrals for lactation support?

Working with a lactation professional to rule out common breastfeeding issues that can sometimes masquerade as other problems (such as reflux, colic, constipation, or allergies) is an excellent first step before supplementing or beginning a medical treatment.

 Newborn babies nurse very often and follow instinctual feeding cues which are vital to getting breastfeeding off to the best possible start. Unnecessary disruptions to breastfeeding can have unintended consequences to the nursing relationship. Take care before starting your breastfed baby on supplements by first ruling out breastfeeding problems, but be especially wary of any health professional that suggests stopping breastfeeding without a discussion of the risks and benefits. 

When to Call For Help:

• It is sometimes difficult to latch your baby on or position feels awkward
• You are experiencing nipple, breast, or shoulder pain
• You aren't sure if you have enough milk
• Baby is fussy, gassy, spits up frequently, or you are considering an elimination diet
• Baby loses weight during the first few weeks, or isn't having yellow stools by day 4 of life. 

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

 

 

  

on the ins and outs of the lactation profession

The lovely Sarah Juliusson has featured us on the Birth Your Business blog! 

 We love what we do and feel so honored to walk with our mamas and babies on their journeys.

Photography provided by Kim Turner Photography