TIME – the Most Precious Commodity of All

Most mothers are stressed when they have a new baby. I absolutely remember how tiring it is to be a mother – and especially when you’re a breastfeeding mother. Being tired is on my mind right now, because in the midst of working with a new breastfeeding mother of a six-day-old, she flat-out told me that, “this breastfeeding thing is taking way too much of my time.” I was left flabbergasted and flap-jawed. What I wanted to say and what I did say were two very different things. What I wanted to say was “Well, what were you expecting? Did you think you were going to drop the baby in the umbrella stand on the way in and out of your front door?” What I actually said is “Tell me how I can help you.”

The mom went on to explain that nursing every two hours was beginning to grate on her nerves. I went on to explain that babies had tummies the size of golf balls and that breast milk was a “perfect food” that made it digest and move through the stomach very rapidly. I quoted how each DROP of colostrum had 3 million cells (the majority being immune cells). Breastfeeding is as much nurturing as nourishing (hoping the old adage would help). I also described cluster feeding as being analogous to a camel getting ready to cross the desert; feed, feed, feed and then you get the big sleep (maybe 4-5 hours max). In my first book “Start Here; Breastfeeding and Infant Care with Humor and Common Sense” I tried to call the hours between 6-10PM the “arsenic hours,” but the publisher opted for something safer like “the witching hours.” I guess that “every hour on the hour” cluster thing is what put this new mother “over the edge.”

So, here are some suggestions I’ve come up with to help you save time during your busy breastfeeding days.

• If you have an exceptionally sleepy baby (or just have to get the show on the road once in a while), I find that you can feed on one side while you simultaneously pump on the other: Tarzan Pumping (at least that’s what I call it). That trick alone can save you up to a half hour per feeding and maximize your milk supply. Your body will react as it you’re feeding twins (because both sides are going at the same time) and perhaps even increase supply a bit. It will also expedite your feeding and have your baby feel as though a bigger, stronger twin was on the other breast helping him or her out. Now you’ll want to feed that milk to your baby at some point (perhaps during cluster feeding time), as when I previously instructed another mom to do this, she was giddy with her new frozen stash; problem was the baby hadn’t gained any weight in a week…whoops; I should have been more clear with my instructions.
• Anyone who tells you to sleep when the baby sleeps probably doesn’t shower, do laundry, use the bathroom, open the mail or eat; I never understood that suggestion. I mean, that’s the only time you have to do ANYTHING, isn’t it? So, ALLOWING others to do things for you will help put time back in your day. You shouldn’t feel as though you’re not a good mother if you don’t do everything and do it well (do as I say, not as I do/did). I remember 28 years ago how I came creeping out of my house to get the mail and was spotted by my neighbor. She promptly sent her “nanny” over to my house with instructions to “help that poor woman out.” Problem is that I wouldn’t let the well-meaning nanny in! As I look back on it, I was afraid that I’d be found out; that I’d be “exposed” and my neighbor would know how I wasn’t really holding things together as a mother “should.” In my experience, many mothers feel that same way. They’re overwhelmed but think that they’re the only mother experiencing that. I’m here to tell you that MOST mothers feel overwhelmed in the beginning and if they tell you otherwise, I’d be wary.
• Remember the saying “time is fleeting,” so are these stages!  Many times these cluster feeds will pass quickly and after a couple days you’ll have an entirely new baby.  It’s important to keep in mind that babies patterns change quickly and you won’t always be feeding around the clock. 

When I heard this mother complaining about time, as I think more about it, I’m suspicious there might be something else going on. Is she depressed? Is she lonely and needs to get out of the house for companionship, does she simply have cabin-fever, or are her expectations unrealistic as to how much time infants take out of a mothers day? What do you think?

Blog written by  Kathleen F. McCue, DNP, FNP-BC, IBCLC-RLC, 

Owner of Metropolitan Breastfeeding

Oversupply of Breast Milk-What to Do

Concern about not having enough breast milk to feed your infant, is the number one reason that mothers wean their babies early, but having too much milk can also be a problem. When you consider the fact that a small percentage of women don’t have the capacity to produce enough milk for their babies no matter what they do, then
having too much milk is a relatively good breastfeeding problem to have, and is usually fairly easy to resolve.

When a mother has more milk than her baby can handle, the following behaviors may be common:
• Baby cries a lot, and is often very irritable and may become restless
• Baby may sometimes gulp, choke, sputter, or cough during feedings at breast
• Baby may seem to bite or clamp down on the nipple while feeding
• Milk sprays when baby comes off, especially at the beginning of a feeding
• Mom may have sore nipples
• Baby may arch and hold himself very stiffly, sometimes screaming
• Feedings often seem like battles, with baby nursing fitfully on and off
• Feedings may be short, lasting only 5 or 10 minutes total
• Baby may seem to have a “love-hate” relationship with the breast
• Baby may burp or pass gas frequently between feedings, tending to spit up a lot
• Baby may have green, watery or foamy, explosive stools
• Mother’s breasts feel full most of the time
• Mother may have frequent plugged ducts, which can sometimes lead to mastitis (breast infection)

Moms who produce too much milk may experience a few seconds of intense pain as the letdown (or milk ejection) reflex occurs, because it is so forceful. The cause of the problem is usually a combination of an overactive letdown reflex along with a foremilk/hindmilk imbalance. Let’s say that the ‘average’ mother has one half ounce of foremilk (the thin, sweet milk produced at the beginning of the feeding that is high in lactose but lower in fat) and two ounces of hindmilk (the higher calorie, thicker milk that is produced as the milk lets down and moves through the ducts, collecting fatty particles). This ‘average’ mother’s baby will get a total of about five ounces of milk if he nurses on both breasts. The mother with too much milk, on the other hand, may have an ounce of foremilk and three ounces of hindmilk in each breast. This
means that the baby may get four ounces of milk on the first breast, and if you switch him to the other side, he may be so full that he will only get the ounce of foremilk that comes out at the beginning of the feeding. This results in a disproportionate amount of foremilk. Why is this a problem?

Foremilk is high in lactose, a normal and necessary milk sugar that in large volumes causes gassiness and discomfort, frequently with green, watery or foamy stools. Over a period of time, undigested lactose can irritate the lining of the intestines, causing temporary secondary lactose intolerance and possibly small amounts of bleeding into stools that can be misdiagnosed as a food allergy. Adjusting breastfeeding to increase the amount of fat the baby receives (“finishing” the breast before switching) usually corrects the problem.

Here are some tips that can help you reduce and cope with an overabundance milk supply:
1) Offer only one breast at each feeding. Let your baby nurse as long as he wants to on that side. If he has nursed less than 15-20 minutes on that breast, and wants to nurse again in less than an hour or two, put him back on the same breast until he has stayed on for at least
15-20 minutes.
2) If he does nurse for 15 minutes or so on one side, don’t offer the second breast unless he seems to want it. He probably got all the milk he needed on the first side. Many babies (especially newborns) will take the other side if you offer it, not because they are hungry, but just because they love to suckle. If the other breast gets uncomfortably full before the next feeding, express just enough milk to relieve the discomfort, but not enough to empty it completely.
3) Try altering your nursing position. Lean back slightly, and hold him so that he is facing your breast, and straddling your leg, with his head elevated above our nipple. Lying on your side may be helpful as well. You also may try lying on your back, with your baby lying on top of you. In all of these positions, the force of gravity will reduce the flow of milk and let your baby control his intake more easily. If your baby is very small, try using the football hold, but make sure that his head is higher than the rest of his body. In any of these positions, you may want to use a towel or cloth diaper to catch the leakage,
because there will probably be some as the excess milk dribbles out of his mouth.
4) Try to relax during the letdown. Usually the milk will spurt out in forceful sprays in the beginning, and then slow down. You may want to catch the initial forceful sprays in a towel, put him on the breast after the sprays have settled down into steady drips. You many also want to express a little milk into a cup before you put him on the breast. Save this milk – it’s great for cereal later on. If your baby starts to choke or gag during a feeding, take him off the
breast, express a little milk, and then put him back on after he calms down.
5) Babies who gulp and choke when their mom has a forceful letdown will often swallow air. Burp him often, especially if you hear him continuing to gulp during the feeding. Don’t be surprised if he spits up a lot, especially while your supply is adjusting. Spitting up most often occurs in babies who are gaining weight well, but are taking in too much milk at a feeding. It’s usually more of a laundry problem than medical problem. However, if your baby spits up forcefully after every feeding, isn’t gaining weight well, or has other signs of illness such as fever or diarrhea, it may indicate a medical problem and you
should consult your healthcare provider.
6) Try to avoid pumping or expressing your milk unless you absolutely have to. Pump or express only if you need to relieve the fullness, because if you pump to empty your breasts, you may be more comfortable temporarily, but you will be sending your body the signals to make more milk.
7) Drink a cup of sage tea at bedtime. Sage contains a natural form of estrogen that can decrease your milk supply. Discontinue use when your supply begins to level out.
8) Usually within a week, you will notice a significant decrease in your supply as it adjusts to meet your baby’s demands without overproducing. You may findthat you need to use a pacifier if your baby wants to do a lot of ‘comfort sucking’.

If you do have a fussy baby who needs to nurse for comfort, offer the same breast during a two- hour period instead of switching sides every few minutes. Five minutes on one breast, then five on the other can result in him taking in too much foremilk, leading to symptoms of intestinal discomfort.

Usually, the problem of too much milk will resolve as your baby matures
and is able to handle the flow better, and also as your body settles down to make the milk your baby needs and not a lot extra. Like all other breastfeeding problems, this too shall pass.

excerpts from breastfeedingbasics.com

What is Mastitis? Cause, Treatment and Prevention

Mastitis occurs when bacteria enter your breast through a break or crack in the skin of your nipple or through the opening to the milk ducts in your nipple. Bacteria from your skin’s surface and baby’s mouth enter the milk duct and can multiply — leading to pain, redness and swelling of the breast as infection progresses.

Mastitis is often caused by Staphylococcus aereus and Escherichia coli bacteria. It is an unwelcome guest, especially to first time moms who have a difficult enough time trying to establish a breastfeeding routine with their baby. It is also unwelcome to those of you who have already experienced cracked nipples, have thin or sensitive skin, engorgement or a weakened immune system. Mastitis is often preceded by engorgement, plugged milk ducts or cracked and bleeding nipples.

Symptoms of mastitis include:
• A red, sore spot or “hot spot” on your breast
• Breast tenderness or warmth to the touch
• Swelling of the breast
• General malaise, or feeling ill
• Overall, flu-like symptoms
• Fever of 101 degrees F or 38.3 C or greater
• Red lines following the troubled milk duct’s path

Because many healthcare providers will prescribe antibiotics, it is up to the mother to find, in addition to the antibiotics, other remedies and comfort measures to help shorten the episode of mastitis, ease the pain and help to continue to breastfeed your baby.

Self-care remedies. Resting, continuing breast-feeding and drinking extra fluids can help your body overcome the breast infection. If you are prescribed an antibiotic, the course of therapy will usually be ten to fourteen days of antibiotics. Even though you may feel better after 48 to 72 hours of taking the antibiotics, be sure to finish the antibiotic regimen to ensure your breast infection is resolved.

To relieve your pain and discomfort:
• Maintain your breastfeeding routine-Yes; you can still breastfeed your baby with a breast infection. It is safe for you and for your baby. It is also recommended by the La Leche League to continue breastfeeding on the affected breast through mastitis to help shorten the episode of the infection and avoid abscesses. Mastitis need never be the reason to discontinue breastfeeding your baby
• Avoid prolonged engorgement before breastfeeding your baby. The mother needs to reduce the fullness as much as possible at each feeding to ease the inflammation and expel any milk plugs that may be present. Some babies may be reluctant to breastfeed on the infected breast because of elevated sodium content in the milk. If the baby cannot be persuaded to nurse, the mother needs to express milk to keep her breast soft.
• Use different positions to breastfeed your baby; sometimes the same position causes pressure points on a certain area of the breast, thus causing a plugged duct which can lead to mastitis. Be sure you are in a good and comfortable position before your baby latches on
• Drink plenty of fluids! Did I mention this before? This is important enough to repeat!
• If it is too painful to breastfeed on the affected breast and/or your breast is too sore to have babe latch on, you can pump and hand expressing your milk
• If you have difficulty emptying a portion of your breast, apply warm compresses to your breasts, take a warm shower, or kneel in your tub filled with warm water and submerge your breasts before breastfeeding your baby or pumping
• Wear a good supportive bra
• While waiting for the antibiotics to take affect, take a mild pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Motrin, Advil, others)

Prevention
Minimize your chances of getting mastitis by fully draining the milk from your breast while breastfeeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses only a few minutes on the second breast, or not at all, start breastfeeding on that breast at your next feeding.

Alternate the breast you offer first at each feeding, and change the position you use to breastfeed from one feeding to the next. Make sure your babe latches on properly before each feeding. If your baby is not latched on properly, break the suction with your finger. If baby fusses a few seconds, that is okay. This is better than you developing cracked nipples that can lead to mastitis.

Finally, do not let your baby use you as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they are not hungry.

Breastfeeding your baby is the most fulfilling action in the mother-infant bonding process. It should be pain free and fulfilling.

by Angel J. Miller, MSN, CNM

Excerpts from Mayoclinic.com on Breastfeeding problems; La Leche League (lll.org)