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Is a Lactation Consultation worth your time and money?

9/2/2023

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Parent nursing baby
You may be wondering if the time and cost of an appointment with a Lactation Consultant is worth it. Before we start, I want to state that in this blog, I am referring to the gold standard in lactation, the International Board Certified Lactation Consultant (IBCLC). The term “lactation consultant” alone can be used by many individuals with less training. These other professionals are also invaluable in educating and supporting new parents. The IBCLC has the most extensive training. Going into this topic requires another blog for another day. 

An IBCLC consultation is fantastic even if things are going well. I recommend everyone has one consultation in the early weeks to get off to a great start. Most people are in the hospital for 36 hours to 4 days. Only a small portion of that time is devoted to working on feeding with expert help. New parents are also exhausted and this is a hard time to learn. You might have taken a prenatal breastfeeding class and that really puts you ahead but can’t replace on-the-job learning with your new bundle of joy! There is a huge gap in education therefore after leaving the hospital or birthing center.

Here is just a preview of some topics and questions covered in a consultation:
  • How to know if your baby is suckling effectively
  • Is the latch deep and correct?
  • How efficient are the feedings and what is normal to expect from day one of life to week three and onward?
  • Milk transitioning (coming in), engorgement management, nipple care, managing plugged ducts & mastitis
  • Positioning at the breast
  • Newborn reflexes and how they help babies latch
  • How to know when your baby is done nursing
  • How to know if your baby is getting enough breast milk
  • Sleep patterns, feeding frequency 
  • Why skin-to-skin and tummy time are so important
  • Can you introduce a bottle?
  • What is paced bottle feeding (responsive feeding) and why is it so important? (even if you don't breastfeed)
  • Can you start pumping?
  •  Set up and tutorial for your pump and strategies to increase milk expression
  • Flange fitting
  • Bottle skills
  • Bottle refusal
  • Reasons to reach out for lactation support​

Empowered baby
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The list above is not exhaustive.  I can’t tell you how many parents have relayed to me that they stopped breastfeeding because they werent sure how to know if their baby was getting enough milk. I also hear many parents stop when they struggle with perceived low milk supply. Sometimes we discuss it further and discover that they actually had a normal milk supply but they did not know this. They didn’t know what to expect or may have been misled by social media. And others could have increased their milk supply with the right support. 

Experienced, qualified support from an IBCLC is invaluable. Support of the right kind from family and friends is also critical in helping a new parent reach their feeding goals. We can’t do this alone. 

So what exactly does an IBCLC do in addition to all this education? What happens in a lactation consultation?

  • A thorough medical history of both parent and baby
  • History of the delivery
  • History of feeding experiences since birth and review of the current problem (if there is one)
  • Screening for perinatal mood disorders
  • Observation of feeding (breast or bottle or both)
  • Basic naked weight to track the growth curve
  • Pre-feeding weight and post-feeding weight (calculates how much milk is transferred in the feeding with a sensitive scale) 
  • Exam of the lactating parent's breasts/nipples and any limitations to mobility or comfort with handling the baby
  • Exam of the baby’s reflexes, body structure, skin, oral anatomy, and function
  • Evaluation of the pump equipment and flange fit 
  • Evaluation of a bottle feeding session if appropriate
  • Discussion of the parents' goals
  • A care plan is created with the parent's direction and input
  • A summary is sent to the Pediatrician

​All my appointments also come with 2 weeks of follow-up messaging via a secure platform. Most IBCLC’s will include either a week or two of follow up support as well. Many of my clients will still sometimes reach out after this time with simple questions or concerns. I am happy to continue to answer questions. Having reliable support has been shown to be absolutely essential to success in breastfeeding. If there is a complicated question or I can’t answer the question without a new evaluation, I will let people know this to give them the opportunity to schedule an appointment for the best care. 


Simply understanding what is normal and what isn't can really put your mind at ease when you are nursing your new baby. It can allow you to enjoy your nursing relationship. 

The IBCLC evaluates the dyad (parent and baby) and is the only healthcare provider that cares for two people together. Breastfeeding is natural but it is a learned skill for the baby and the parent. Having expert help in your corner can make a huge difference in your success and experience. An appointment with an experienced, qualified IBCLC is always worth way more than it will cost. A great planning strategy can be to ask family or friends to cover the cost of a lacation visit as a baby shower gift. Many insurances will also cover lactation. See this link below for more about your rights to lactation coverage. 
​​Benefits for Breastfeeding Moms: Understanding Health Coverage of Breastfeeding Support and Supplies   

~Cathy Walker, MA, RN, IBCLC
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Lactation Consultant with Knitted Boob
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How Can I Increase Breast Milk Supply?

4/1/2023

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You may have landed here because you think your milk supply is low. And it might be.  But there is also a chance your milk supply is normal, and you don’t know it! I'm an IBCLC and passionate about bringing you answers and support. International Board-Certified Lactation Consultants (IBCLCs) are the experts in all thing's lactation, breastfeeding and infant feeding. We are the Gold Standard in lactation care. 

​Let's dive in.

If you are evaluating your milk supply based on what you can pump, stop and check your equipment. Is your pump good quality and working for your breast tissue? Has your flange size been optimized? Both factors greatly affect milk supply. *Don’t expect a hands-free wearable pump to create a full milk supply.

If you are evaluating your milk supply based on your baby’s weight gain…stop again. If your baby is doing a great job, weight gain can tell us a lot about breast milk supply. But if your baby has a challenge removing milk, you can have a normal or even a robust milk supply and have a baby who is not gaining weight adequately.

Now let's get into how the milk is made!

Lactation or breast milk production is maintained by regular removal of milk and stimulation of the nipple, which triggers prolactin and oxytocin release. This means Effective removal of breast milk. We need our babies to be latching deeply, comfortably and frequently to build our supply. If we cannot breastfeed, then a high-quality pump can take the place of the baby to build supply.

How much milk expression is needed? A newborn usually nurses 8-12X every 24hr. If we are pumping, aiming for a similar regimen is a good idea especially in the early weeks after birth. You can pump every 2hr during your waking hours and every 3h-4hr at night to reach 10X every 24hr. Pumping for 15-20 minutes per session is sufficient.
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If you have more questions or are struggling with supply issues, schedule an appointment with me to discuss your situation. 
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Factors that can lower milk supply:

1. Not pumping or nursing at least 8-12 times every 24hr

2. A stretch of longer than 6hr between nursing or pumping in the early weeks
3. Pain while pumping or nursing.
4. Incorrect flange fitting. (Not everyone has pain with the wrong size)
5. Poor quality pump. There are a lot of pumps out there that are just not very good at removing milk. Fortunately, there are also some excellent choices that do a great job for most people. Reach out to your IBCLC for advice. 
6. An extra stressor in your life (big life change, death in family, natural disaster)
7. Significant lack of sleep (you can't sleep when the baby is sleeping are run down) 
7. Physical illness
9. Retained placenta (usually this will cause vaginal bleeding beyond what is expected or heavy bleeding and possibly clots. Call your OB/GYN right away if you experience this). 
10. There are also some medical conditions associated with lowered milk supply. Discussing these is outside the scope of this blog. Work with your IBCLC to determine if there is a medical reason contributing.

A one-on-one appointment with me can help you figure all this out and arrive at a workable plan for your family. 
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What is a normal milk supply?

If you are nursing 8-12 X every 24hr and your baby is gaining just over an ounce a day or just over 2lb a month in the first 4 months of life, then you have a normal milk supply, and your baby is getting it!

If you are only pumping (not nursing), then you should expect to pump enough milk to meet your baby’s needs by 10-14 days after birth. Pumps are not as good at removing milk from our breasts as babies, so it takes a bit of time.
 
If you are nursing 8+ every 24hr and pumping in-between feedings a normal amount of milk to express would generally be 15.-2oz per pump session (yes, both breasts). Those crazy Instagram posts full of packed freezers are not normal. If you pump instead of nursing your baby, expect to express about an average feeding for your baby. A 2-month-old baby often would take between 2.5-4oz per feeding. A 1-month-old baby usually eats between 2-3 oz every 2-3 hours in week 2-4 of life. 
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 Tips to improve milk supply:
  1. Address any latch/feeding issues. Your baby is great at improving your milk supply if they are doing well.
  2. Use a high-quality pump.
  3. Seek out a flange fitting from an IBCLC who has been trained in the most up to date guidelines (They should watch you pump)
  4. Avoid long stretches between nursing and pumping sessions.
  5. Use Hands-On pumping. Hands-On pumping Video. 
  6. Use hand expression at the start or the end of your pump session. (ex. pump for 10 minutes, hand express for 5 minutes) (Pumps are using suction but a hands-on approach can almost always yield more milk per session). Hand expression Video. 
  7. Cover the bottles/flange set up with a blanket so you can’t watch the milk come out.
  8. Use meditation apps, music, and pictures or videos of your baby to help with letdown. Smelling your baby’s clothes is great too!
If you change something in your pumping or nursing regimen, it will take 3-5 days to see an increase in supply. If you don’t see a gradual improvement by then, reach out to your IBCLC.
 
For most people, regular Effective expression will be enough to build a healthy milk supply. If you have tried all these strategies and still are struggling, there is still a lot to be done to improve your supply. You will need the expert assessment of an IBCLC to identify the cause(s) and recommend a care plan for you to see more change. Don't struggle alone. With all the factors involved, having an IBCLC be your detective is the fastest way to the answers. 
 
Cathy Walker, MA, RN, IBCLC
April 1, 2023
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Why Do My Nipples Hurt?

4/1/2023

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Parent looking for Answers
Parent looking for Answers
No! Breastfeeding should not hurt! 

Myths regarding nipple pain: 
“Breastfeeding hurts in the beginning.”
“Your nipples will toughen up.”
“Just grin and bear it.”
“Your baby is gaining weight so nursing must be going great!”

If you experienced several poor latches in the first week after birth and sustained some minor nipple damage, this can be normal. If it heals and does not recur, then it likely was just everybody learning where things go. 

Today, I’m discussing continuing nipple pain during the feeding, or after the feeding with and without visible nipple damage. Chronic pain leads to breastfeeding cessation. Don’t suffer! Reach out for skilled support. Schedule an appointment below.
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Why is a deep and comfortable latch important?
  • When babies are latched correctly, they usually remove the right amount of milk to gain weight appropriately. On the other hand, with repeated shallow or painful latches, they usually eat less than they need to grow.
  • If your baby removes less than an ideal amount of milk, your breasts will get the message to make less milk leading to a low milk supply
  • If your baby repeatedly takes less milk than they need, they will not gain weight adequately
  • Chronic pain in the body and nipple damage impacts our ability to continue nursing. It may also interfere with the letdown as the stress hormones get in the way of oxytocin which releases milk. 

What should I do right now?
One option is to pump, bottle feed and allow your nipples to fully heal. This may take up to a week. At the same time, Book a consultation with an IBCLC to determine the cause of your pain and move the needle in the right direction.
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Painful Latch
Painful Latch
What is happening?
  • Sometimes adjusting position and the baby’s position will fix your problem. If you are reading this blog, you may have already gone through all the recommended angles and positions. 
  • Your baby’s body comfort and tension can play a role in how they attach to the breast and use their tongue.
  • Your baby can sometimes appear to latched correctly but there is still pain. This may result from a high palate, a tongue tie, a lip tie, muscular or fascial tension in the jaw, tongue or floor of the mouth. 

An International Board Certified Lactation Consultant (IBCLC) is trained to assess for the cause and recommend actionable steps to get you pain free. 
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Statue of parent nursing
Statue of parent nursing

* In the setting of high milk supply, a baby who is not latched correctly can still sometimes transfer enough milk to gain weight adequately. This may continue for up to 6-12 weeks. At this point, the milk supply regulates to a slightly lower level (still plenty for your baby). When this occurs, this baby who was gaining weight normally may begin to falter. They no longer have a waterfall of extra milk just falling in. 


When you meet with me, I can assess whether or not the feeding and latch are functional. Is your baby efficient and are you comfortable? We consider this along with weight gain for the full picture. 

Pain is a signal to your body that something is wrong. This is very true when breastfeeding. Reach out for the support and knowledge you deserve and start feeling better!

Happy Nursing!
​Cathy Walker, IBCLC
April 1, 2023​​
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"Plugged" Ducts and Breast Care

9/18/2022

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I’m so excited to be able to share new evidence-based information on plugged milk ducts with you! And I’m even more excited that this knowledge has come forward and honestly has made breast care much simpler for lactating parents and clinicians alike. The Academy of Breastfeeding Medicine updated the protocol on the Mastitis spectrum this year (2022) which includes care for plugged ducts. 

At some point during lactation, you may notice a discrete lump or ball in the breast. You may feel a small area that feels hard compared to the rest of the breast. This can often feel tender or painful. This can be referred to as a plugged duct. But as you will read, this name is kind of misleading. 

The internet still largely contains outdated and potentially harmful information on managing breast care with plugged ducts when lactating. Some remedies that you should avoid are: applying heat, soaking your breasts in water and Epsom salt, deeply massaging the breasts, utilizing vibrational tools on the breasts, nursing more often, and pumping more often.  These methods were all employed with the goal of unplugging trapped milk. Unfortunately, that isn't the problem. So they don't work. And these methods also will actively make the problem worse. 

So what's really going on in your breast?

Trapped milk is not the problem. The lump or hard area you feel in the breast is mainly inflammation and not milk that is trapped. If you massage it, you will increase inflammation and worsen the symptoms. “ A breast “plug” represents a focal area of swelling in the breast and more accurately reflects lymphatic fluid congestion and dilated capillaries than a discrete “plug of milk.”” (Mitchell, 2022). 

In other words, it's not milk! Your breast tissue is inflamed and there is extra fluid (not milk) collecting in breast tissue (not ducts) to deal with the problem. If we bring down the inflammation, the symptoms will resolve. Milk eventually can start to have more trouble moving around in this area if it persists. But the solution is to use ice to decrease inflammation. This allows symptom resolution and gives your milk a free path to move again.  

According to the ABM (2022) “Ducts in the breast are innumerable and interlacing (Figs. 6–8) and it is not physiologically or anatomically possible for a single duct to become obstructed with a macroscopic milk ‘‘plug.’’” 

Imagine spraining your ankle. It swells up and then you apply heat to it and begin vigorously and deeply massaging it. Ouch, right? It will swell more. And if we do this to our breast tissue, the inflammation will worsen. This can lead to tissue trauma. 

The overall guiding principle for breast care is Be Gentle! No massage is needed! When following good breast care for a plugged duct, you should feel symptoms improving within 24hr.

Now lets get to treatment:


~Continue your normal regimen of milk removal. This means don’t pump or nurse more often due to a plug. Continue your normal routine. If you add extra stimulation to the breast that has a plug, you will increase supply and add more milk to a congested area. This will worsen the problem.

~
ICE! Apply ice after nursing or pumping for 8-10 minutes (not longer than 15 minutes at a time. Do not apply ice directly to your skin. Cover it with a cloth)

~
Ask your Physician if you can take an anti-inflammatory.

~Adding a technique called Lymphatic Drainage can sometimes be called for if there is a lot of extra congestion in the breast. Please discuss this with your IBCLC. 


Most of my clients who have followed these steps have reported relief within 24hr. If you have recurrent plugged ducts, work with your IBCLC to discover why and stop the cycle! 

Mastitis is a blog for another day but please reach out to your IBCLC and an MD if your symptoms are not improving and you see things progressing. 

​Signs of mastitis are: 
*
Breast tenderness or warmth to the touch.
*Breast swelling.
*Thickening of breast tissue, or a breast lump.
*Pain or a burning sensation continuously or while breastfeeding.
*Skin redness, often in a wedge-shaped pattern.
*Generally feeling ill.
*Fever of 100.4 F (38.3 C) or greater.
Please call your MD if you have these signs and symptoms

Please remember that there are Two kinds of Mastitis: Inflammatory mastitis and Infectious mastitis. You don't always need antibiotics. Consult your IBCLC and Physician!

 
References:

Mitchell, K., Johnson, H., Rodrıguez, J.M., Eglash, A., Scherzinger, C.,  Zakarija-Grkovic, I., Widmer Cash, K., Berens, P., Miller, B., and The Academy of Breastfeeding Medicine. (2022) Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeeding Medicine, 17 (5), 360-376. https://www.bfmed.org/assets/ABM%20Protocol%20%2336.pdf

Mitchell, K. (2022, September 13). Mastitis and associated complications. Physician Guide to Breastfeeding. Retrieved September 18, 2022, from https://physicianguidetobreastfeeding.org/maternal-concerns/mastitis-and-associated-complications/?highlight=%22plugging%22 


Cathy Walker, MA, RN, IBCLC
​September 2022

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Why is breast pump flange fitting so important?

4/27/2022

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The right size pump flange can make a huge difference in your Lactation Journey! Most breast pumps come with one or two flange sizes that attach to your breast. It is unlikely that either of these sizes is going to be your best fit. It does happen sometimes. Breasts and nipples don't come in just two sizes. 
We now have options to find a more custoimized fit for our pump flanges. This is a game changer for comfort, pumping efficiency and milk output.

When we are using a size that is too large, our breast and nipple is not experiencing the proper contact and stimulation to help express the most milk for our pumping session. Additionally, often the breast itself (areola) is pulled into the tunnel of the flange along with the nipple. This can result in pain and damage. This results in less output for multiple reasons. One reason is the lack of good stimulation and the other is pain. Pain can inhibit the milk letdown especially if it is chronic. Conversely a size too small can pinch and hurt the nipple and and lead to less milk output. 

Some parents don't experience pain with the worng size flange but their pumping efficiency and milk output will likely still be affected. 

When we are fitted for the right size, the results are much better comfort while pumping. It also can often mean larger milk sprays, more milk output overall and less time needed to pump. If you are pumping, it is always best to seek a good expert flange fitting to maximize your milk supply and ensure comfort and a good experience. 

In my experience, I have worked with clients who expressed immediate improved comfort and bigger sprays of milk. This resulted in expressing more milk in a shorter period of time. Those minutes add up over your 24hr and weeks of pumping. 

What to do next? See an IBCLC who is trained in flange fitting. They should try multiple sizes with you and watch the whole pumping session to determine your best fit. New knowledge in flange fitting has been presented in conferences designed for IBCLC’s. Ask if your practitioner has taken recent courses in this specialty and book a flange fitting session! 

Takeaway? Flange fit Matters! 

Lactation Consultation at Home can offer this service at your home, in the office and virtually!

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Why do we ask permission to choose our own path while Breastfeeding?

10/14/2021

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​I sit down to write a blog when I am inspired. This usually finally happens when a theme arises in my private practice. Lately I have many parents asking “permission” to do many myriad of variations on their lactation journey: bottle feeding, adding formula, pumping less to get sleep and prioritize mental health, weaning and feeling okay about it. 


I call them variations because they are not veering off the path. They are part of the many paths of breastfeeding. 

This blog is not about the do’s and don’t of breastfeeding. That topic is for another day. Some of the common threads I hear: 
Can I give some bottles and breastfeed? Can my partner do some feedings for me so I can rest? I know I'm not “supposed” to pump for the first 4 weeks but I really need my partner to help with feedings sooner. Can I use formula while breastfeeding? Can I decide to pump and feed my baby with a bottle? Can I stop breastfeeding? 

These questions are asked in the spirit of not so much, how can I do these things, but “am I allowed to do these things?” And this is the topic of my blog. Guilt and the overarching nebulous feeling that we have to breastfeed a certain way. That breastfeeding has to look a certain way and follow a prescribed path or else we have done it wrong. 

Society has pushed all these questioning thoughts on us. It's not our fault as new parents. We want to do what is best. And breastfeeding is a new thing and uncharted territory. We look to friends, family and unfortunately social media to guide our thoughts and decisions. Some of this advice is really good. And some, not so much. And then we might turn to experts in lactation. But IBCLC’s and other lactation professionals are here to Support you. Not to tell you what to do with your baby or your body.

And yes, you Can use bottles and breastfeed. You can give formula And breastmilk. Pumping can be an option for many and No one should tell you that you Should or you Have to breastfeed or when you should stop.

In other words, it’s your journey. It’s my job to support you on your desired path and provide all the best evidence based education for you to reach your goals. You don’t need anyone’s permission when settling on your special relationship with your baby. It’s yours, it's unique. 

Feel confident in your decisions. Realize that you may change your mind every other day in the early weeks. Babies change really quickly and breastfeeding evolves and gets easier than that really tough first week. It’s ok to go back and do something different. You will know when you’ve made a good decision around feeding your baby when you feel relaxed and you breathe easier. Listen to your Parent intuition. You know your baby best and you know your family best. The rest of the world can just butt out.

Enjoy Your Breastfeeding Relationship!

Cathy Walker, MA, RNC, IBCLC

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Breastfeeding Can Bring You Joy

9/17/2021

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When clients sometimes ask me “how long should I breastfeed? I say, “for as long as it brings you joy. 

My philosophy is that feeding your baby is a moving and powerful event and should not cause undue heartache or stress. It helps to know oneself. Understanding your goals and what allows you to enjoy your baby is important on this journey.

For some, this is turning over every stone to make breastfeeding work. For others, like myself, I persisted as long as I could mentally and physically which was less time than my original goal. But I do not regret this. I feel proud that I made those decisions for myself.


When I meet a client, I want to know “their” goal. Breastfeed exclusively? Breast and bottle feed? Breastfeed initially and add bottles at a certain interval? Exclusively pump or formula feed? Yes Lactation Consultants help with bottle skills and I don’t care what is in the bottle. I am here to support you. 

One very important element that is integral to this discussion is maternal mental health. I am passionate about recognizing the signs of perinatal mood disorders and providing resources when appropriate. I also tailor my care plan to reflect the need to take care of mental health. 

Self care and sleep is also important for mental health, physical health and milk supply. I will prescribe sleep instead of frequent pumping overnight with a balance to prevent plugged ducts & mastitis & not diminish milk supply as much as possible. 

Sometimes parents know what they want out of breastfeeding. Sometimes parents explore their goals over time. I can help facilitate a realistic discussion and provide steps to reach each family's feeding goals. 

Breastfeeding should not sacrifice our mental or physical health. It should enhance it. It should bring us joy. It takes a village to be successful at breastfeeding and raising children. An IBCLC (International Board Certified Lactation Consultant) can be a part of that essential process. 

Enjoy Your Breastfeeding Relationship!


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How do I know if my baby is getting enough breast milk?

6/10/2021

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How do I know if my baby is getting enough breast milk?

I am revisiting this topic because it is the number one question I hear from every parent. And it is true that if we don’t know the answer and feel comfortable in our understanding of it, we might question breastfeeding altogether. 

We actually have a solid, reliable list of signs that our babies are receiving enough breast milk. Here is the list.


  1. Adequate weight gain
  2. Back to birth weight by day 10 of life
  3. Lots of wet and dirty diapers
  4. Nursing 8-12 times every 24hr
  5. Content between feedings
  6. Nipples are not damaged
  7. No pain with nursing

So let’s dive into these in some detail.

Weight gain: Babies should get back to their birth weight by day 10 of life. They should gain one ounce a day or more for the first 4 months of life. Yup they gain 2 pounds a month! This is a very accurate way to check on their progress. If you are concerned with your baby’s intake, you can ask for a weight check at your Pediatrician’s office. This is preferred to weighing your baby on your own. Home scales may or may not be accurate. User error is also common. But when you see your Pediatrician they can do an exam, counsel you and provide referrals if needed. 

Diapers: What goes in, must come out! Your baby should have 6+ wet (urine) and 3-4 + poop diapers every 24hr. In order to count, a poop should be the size of a quarter. In the first week, it is helpful to use diapers that have a ‘pee’ line. It will turn from yellow to green when the baby pees. If you see less than the required number of diapers, you should call your Pediatrician.

Nursing 8-12X every 24hr and baby being content between feedings: You may have that day when your baby eats 13X or so especially if they are going through a growth spurt. But if you are struggling and feeding your baby 17X a day, every day, this is a sign to reach out for support from an IBCLC. On the other hand, if your baby is sleepy and you cannot get up to 8 feeds every 24hr, you should also reach out. In general, babies need to eat a minimum of 8+ times every 24hr to gain weight regardless of feeding methods. We also should define a feeding. There is a range of normal but if you are nursing for 60 minutes at every feeding, this is a reason to reach out for help. Some parents will say, “ I feel like I’m always feeding my baby” or “My baby is hungry right after nursing or wakes up 15 minutes later for another feeding”.

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Healthy nipples and pain free nursing: That’s right! It’s not supposed to hurt. It's possible that in those first few days, your baby latched improperly for a brief period of time and caused some damage. This should heal and not recur with a deep, correct latch. Reach out for help if you are not able to attain a comfortable latch prior to leaving the hospital or birth center. Pain and nipple damage point to a shallow latch. When babies have a shallow latch, they will remove less milk than needed. Over time, this can lead to poor weight gain or weight loss. It will also lead to lowered milk supply if not corrected. The milk supply is dependent on how much milk your baby removes while breastfeeding. So if there is a challenge to this, the milk supply can decrease. You can combat this by reaching to an IBCLC to figure out the cause and by pumping to increase your supply. 

You will also see that when your baby is full, their body relaxes, their little fist will become an open palm and you may see some milk on their lips. You are the expert on your baby and your experiences. Trust your gut as a parent. If you are worried about your baby’s intake, contact their doctor and an IBCLC (International Board Certified Lactation Consultant). IBCLC’s are uniquely qualified and positioned to assess breastfeeding difficulties and offer a care plan that aligns with your goals. You don’t need to measure anything to figure out if your baby is getting enough milk. You now have the knowledge to evaluate their milk intake. 

Cathy Walker, MA, RNC, IBCLC

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Breastfeeding During a Pandemic

2/28/2021

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Cathy Walker, MA, RNC, IBCLC

In pre-pandemic times, having a baby is a tumultuous experience. There are many ups and downs. There is sheer exhaustion and unimaginable joy all happening at the same time. We are not meant to parent in a bubble. Breastfeeding requires support from society, family, friends, professionals and the work environment.  ““It takes a village to raise a child” is an African proverb that means that an entire community of people must interact with children for those children to experience and grow in a safe and healthy environment.” (Wikipedia, 2021) In pre-pandemic times, I see this as a struggle for many families in modern US culture. Often family does not live close by and paid leave from work is very limited. Parents have to make a concentrated effort to reach out to friends, support groups, family and medical professionals for the support they need. Some parents may just feel tired and overwhelmed and this effort is a struggle or impossible.
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Enter the Pandemic of 2020. Pregnant parents sometimes have to attend their prenatal appointment by themselves. No partner to share in the joy of milestones. No partner to support them if uncertain news or difficult news is delivered. Tablets and phones replace that in person presence. There was a brief time in some NYC city hospitals where partners were not allowed to be in the delivery rooms with their partner. This was reversed quickly but not before many people went through this amazing, difficult, scary, wonderful, momentous time in their lives essentially alone. Parents are together in the delivery rooms again and staying together in the rooms after birth.

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Some new families stay the normal course of 2-4 days in the hospital after delivery. Some are being discharged earlier than usual. (Kuehn, 2021) That extra 24hr in the hospital allows parents to practice the latch, and take in more education on feeding and expectations over the next few weeks. Packing in 48hr of education into 24hr is hard for the staff and parents. And in the early hours after birth, a lot of information is not retained. Parents are still recovering, have adrenaline coursing through their body and are physically exhausted. 

Now parents are at home with more limited resources and access to support. Many doctors allow both parents to attend early checks for their baby. But others only allow one parent. The ability of family to travel and stay with new parents can be limited due to covid restrictrictions, their own health concerns and fear of spreading this illness. That friend who normally would drop by with coffee and a boost of cheerleading and advice from their experience can’t come over. Most support groups are now being conducted online. These are so helpful and taking advantage of all online support, connection and help is critical. But human beings miss that in- person connection. There is no doubt that this is harder. 

IBCLC’s (International Board Certified Lactation Consultant’s) have now pivoted to offering virtual consults. There are some who still provide Home Consultations. There are many issues and concerns that can be addressed virtually in Lactation. I have been amazed at what can be accomplished. But there are certain aspects that need an in-person evaluation. 

Early on in the Pandemic, people were encouraged to stay home and not see their MD unless it was urgent, putting off well checks and follow ups for medical conditions. This has resulted in more morbidity or illness. (Rosenbaum, L., 2020) The medical profession has learned, yet again, that prevention is best. With each situation being considered individually, it is being recommended now that skipping certain check ups will be more detrimental to health overall. This is certainly true for Lactation. A virtual or in-person check up at the earliest sign of issues/concerns will help prevent further problems. Usually the earlier one reaches out, the easier it is to resolve the situation. 

Some extremely positive effects have developed from this health crisis that are specific to Breastfeeding. Many hospitals are limiting visitors and keeping the babies in the rooms with parents a lot more than usual. This chance to bond, learn the babies hunger cues, feed more often on demand and have uninterrupted time to learn from nurses, doctors and lactation consultants has resulted in better breastfeeding outcomes anecdotally for many. For those utilizing the full time allotted to adjust in the hospital and ask questions and get feedback, this rooming-in without visitor interruption has a positive impact on lactation. Anecdotally it has been noted that some have experienced an earlier onset of Lactogenesis II (transitioning to mature milk with higher milk volumes). This makes sense as the babies are nursing more times in 24hr in these circumstances. Having that dedicated time to take in the teaching and ask questions is really invaluable. I have several roles in lactation. I have a private practice and I work in a hospital as a nurse and a lactation consultant. I can tell you that I don't look forward to the return of visitors. It limits our chance to provide our services. Maybe a compromise of a short window of visitation each day would be great! Those grandparents need their cuddles!!

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So what can a parent do during this Covid-19 Health Crisis? 

1.Take advantage of every single support you can! And you may have to reach out more than usual to get access to what you need. (Which is not fair). Ask friends for help with research to find extra support if needed.  Take that off your plate.
2. Schedule Zoom calls with friends to vent about all the challenges and get those tidbits of wisdom.
3. Connect with a parent support group or breastfeeding support group that meets weekly online. 
4. Take a breastfeeding class prenatally.
5. Connect prenatally with an IBCLC for a virtual visit as another option. Also just having their contact information as a backup for later is very helpful and stress reducing. 
6. Reach out to an IBCLC early if you encounter difficulties. You can always start with virtual support and move to in-person if needed.
7. Make plans before birth for in-person support with family or hired help. Planning ahead will allow everyone involved to quarantine, get tested and be as safe as possible. 
8. Acknowledge and take in that this is Hard and you can do it with your village!

References:
Kuehn, B., (2021, January 12) Covid-19 Precautions Hamper Breastfeeding Support. JAMA Network. https://jamanetwork.com/journals/jama/fullarticle/2774844

Rosenbaum, L., (2020, June 11) The Untold Toll-The Pandemic’s Effect on Patients without Covid-19. The New England Journal Of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMms2009984

Wikipedia, (2021, January 12) It Takes A Village. Wikipedia. https://en.wikipedia.org/wiki/It_takes_a_village

1 Comment

Straight Talk on Tongue-Tie!

12/5/2020

0 Comments

 
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Hi everyone! I’m back to talk tongue-ties again. I see this problem a lot because I’m a lactation consultant. People usually call me when something isn’t going well. Lots of times it is Not a tongue-tie! Phew. But sometimes it is. I know it can be an exhausting and frustrating topic. Let’s get to the bottom of what you really need to know as a parent facing this issue.

Let’s get some myths out of the way…


MYTH: Tongue-ties are a fad

Nope. They are being recognized more often due to increased breastfeeding initiation rates in our country and better training. 

MYTH: My baby can stick their tongue out of their mouth so they don’t have a tongue-tie.

Maybe. But the extension of the tongue is only one motion of the tongue that is evaluated and elevation is critical to many functions especially breastfeeding.

MYTH: My baby’s doctor said my baby does not have a tongue-tie.

Maybe. Has your doctor had extensive training in identifying a tongue-tie? What screening tools did they use to evaluate your baby’s tongue? Did they watch a whole breastfeeding session and take a full feeding history? Were their suggestions helpful in resolving your concerns? If not, seeking out an IBCLC can be key.
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Now onto the good stuff. If you suspect that your baby has a tongue-tie, please consult an IBCLC (International Board Certified Lactation Consultant). We do not diagnose conditions but many of us are trained to assess for these issues and know when to refer to a trained MD. Also please find out if your IBCLC is experienced with tethered oral tissues. (TOTS)(tongue-tie, lip-tie) 

Common Symptoms of Infant Tongue and Lip Tie

Poor Latch/inability to latch
Sliding off the nipple
Fatigue during feeds
>12 feeds in 24hr-endless feeding
<8 feeds in 24hr
Sleepy feeds
Poor weight gain
Clicking during a feed
Maternal nipple pain and damage(compressing, chewing, gumming, pinching, scraping the nipple)
Increased maternal nipple/breast infections
Low milk supply
Milk oversupply
Dribbling milk at the breast/bottle
Digestive issues (gassiness, ‘reflux’ due to extra air being swallowed and poor control of the milk during swallowing)
Various other feeding challenges

*Keep in mind that you can experience some of the above symptoms for other reasons as well. Your IBCLC will be able to figure out the cause with your help.

Your IBCLC is your Quarterback on this journey. An IBCLC trained in TOTS will be invaluable for you and your baby’s journey to better health. Since tongue-ties can potentially lead to challenges with other issues throughout the lifespan it is worth having this addressed even if you elect not to directly breastfeed. And yes, we help with bottle skills, pumping, and safe formula preparation too!

Imagine that you have a limp and discover that you need some surgery on your knee. You go to the orthopedist and they repair your knee. They hand you a prescription for physical therapy and say, “you must complete 20 sessions of physical therapy to ensure proper healing, maintain range of motion and return to full function”. After having undergone the procedure you dutifully report to PT and slowly improve. What would happen if you skipped PT? You might experience stiffness, difficulty walking, continued pain and it’s possible you would not improve at all or end up feeling worse. 

This is similar to a tongue-tie release which is called a Frenectomy. The tongue is connected to the floor of the mouth and the muscles and fascia of the body. The tongue has not been lifting in a natural way due to the restriction. Therapy to address the overall body tension or compensations is critical to a good release and recovery afterward. Specific tongue exercises are necessary to gain the best function and results after the release. 

Manual therapy is recommended in a sandwiched approach. This may be done by a chiropractor, osteopath, craniosacral therapist, or physical therapist who is specially trained in very gentle approaches for infants and newborns. It is best to do this before and after the release. The tongue exercises are directed by your IBCLC and chosen specifically for your baby to assist in their individual challenges. 

Your IBCLC will have observed a feeding or several and examined your baby. They will be able to guide you on the timing of these appointments and what professionals may or may not be necessary in your specific case. IBCLC’s help you manage the breastfeeding and milk supply throughout this process, carefully adjusting your care plan as needed. We monitor you and your baby’s progress through these steps. We partner with the Doctor who performed your baby’s Frenectomy. We partner with any additional professionals you consult to ensure more informed and wraparound care. 

The takeaway? There are a few needed steps for good results from a tongue tie release. This process does not need to be stressful or full of mystery. If you have an IBCLC on your team, you can focus on enjoying your baby! Isn’t that what it is all about? 


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    Cathleen Walker
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