My Battle with Insufficient Glandular Tissue

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Nikki Williams' memoir about her battle with Insufficient Glandular Tissue.  If you would like to submit your story as well, please email me at robinkaplan@sdbfc.com.  Thank you so much, Nikki, for sharing your story with us!  You are an incredibly dedicated mom and a true breastfeeding warrior!

-------------------------------------------------------------------------------------------------------------

When I developed in puberty my breasts were never perky and upright; even at 16 they were pendulous and looked like they had already nursed a dozen kids, even though I am relatively slim, and the shape wasn't inherited because my mother had no breasts to speak of (I was not breastfed in part because my mother believed she would make no milk because she was barely an AA cup.)  They have always been a source of embarrassment for me, but I resisted getting a breast lift and areola reduction because I wanted very much to breastfeed and I knew that could cause problems.  To add insult to injury, my breasts are also fibrocystic, meaning they are lumpy all the time and burn and throb in the week before my period starts. 

In June 2008, my breasts were burning and swelling as they usually do before my period, but my period never came- I was pregnant, but it took me seven weeks to figure it out.  Throughout my pregnancy, I was able to fit into the same bras- the only breast changes I noticed were dark, peeling nipples.  I checked my bra every day for signs of colostrum, but it never came.  My water broke and labor didn't start for a few days, so my midwives had me try to use a pump to induce contractions.  Nothing even came out in the several hours I pumped. 

Labor did eventually begin and I had a perfect, natural water birth ending with a beautiful, long, skinny daughter.  I really strived for a natural birth to maximize breastfeeding success, because I just had this deep feeling that something was wrong with my boobs.   Because my nipples are tiny and flat and my breasts lack fullness, the first latch didn't happen for several frustrating hours, but finally it happened and I just waited for my milk to come in.  My nipples were cracked and bleeding by 24 hours- my home nurse said my latch was great, my daughter was peeing and pooping meconium, everything was fine.  I got a prescription for Canadian Nipple Cream and a nipple shield to help shape my shapeless nipples.  

Day two and Day three:  No engorgement.  No yellow poops.  Baby was definitely a "nipper napper," so chilled out- never crying, always sleeping.  Nipples still agonizing.  Back to another LC, who checked for tongue ties and said everything was great, and that I could prod my daughter's rectum to remind her of that body part and that it has to do something.  I did, and nothing happened.  
 

Day five:  No feelings of letdown, no engorgement, no leaking...but some milk visible around my daughter's mouth.  I heard swallowing when she was awake to feed.  Still no bowel movements.  Red crystals in the diapers, which I started needing to change less frequently.  My nursing diary says I have spent 18 out of the last 24 hours nursing.  I cried with pain with each feeding.  

Day eight: We took her to get her professional photos taken, and she urinated all over the white fluffy beanbag she was posed on.  I'll never forget how dark and smelly that urine was.  But we were congratulated on no poop accidents in the studio!  

Day 11:  Something was wrong- my daughter had not pooped since the day of her birth.  She was so sleepy. I took her to the pediatrician, who weighed her.  She had lost a full pound from her birth weight.  She saw she was dehydrated and rushed out of the room to return with a case of formula.  I broke down.  I had been cruising kellymom.com while nursing (still 18 out of each 24 hours), trying block feeding, fenugreek, anything.  I was doing everything right.  The pediatrician said she didn't know what was with all of these new mothers who made such a big deal about breast milk.  I asked for a syringe or something because I was not going to feed her with that pre-mixed nipple-confuser bottle.  The doctor gave me a prescription for daily weight checks, an order to exclusively pump for 24 hours to see what I was producing, and a periodontal syringe that I could use to finger feed my daughter.  It was, and still is, the worst day of my life.  I exclusively pumped 20 minutes every 2 hours for 24 hours- I managed to collect 4 ounces.  

My daughter came alive on formula.  Her eyes opened for the first time in several days.  With her mouth moistened, my nipples were able to finally heal.  I was horrified that I had been starving my daughter while bragging to everyone how content she was.  That's something I'll never get over, as long as I live.  

In a daze, I went to visit my husband's cousin, who exclusively pumped for her son.  When she pumped, she had to use 8-oz bottles, which she would fill in 20 minutes.  I told her what was happening to me, and she mentioned she had a huge stash of breast milk in her freezer that she was about to throw away because her son was rejecting it in favor of formula.  I said I would take it.  It was several gallons' worth.  I cried and cried with relief.  During that visit, my daughter had her first bowel movement since her birth.  It was about 10 percent breast milk (2 weeks worth), then 90 percent hard nuggets of dark green formula, and she filled two diapers as I watched and rejoiced.  

That donated breast milk lasted me for two months.  In those two months, I had an appointment with an OB/GYN for an issue I had with my bladder during pregnancy.  During the exam, he asked me how motherhood was going, and I broke down right there with my legs in the stirrups. I told him about my nursing difficulties.  He stopped and asked if I would like him to have a look with the ultrasound machine.  I was confused, but a few minutes later he was giving me a breast ultrasound.  He said that he hadn't done this before, but he knew what a lactating breast should look like, and mine did not look like a lactating breast.  He pointed out that my glands were clustered all around my nipple, and where there should be glands and ducts radiating out and up into my armpits, I had only fat.  That would explain it.

I dug out my copy of The Breastfeeding Mother's Guide to Making More Milk and flipped to the section about insufficient glandular tissue, a section I had skipped over gleefully in my pregnancy.  There I was, there was my chest in a sketch.  I was redeemed!  It was really not my fault!  Now I was angry that I had been led to believe that I was not doing something right by the various LCs that I had visited with.  Why didn't any of them make me show them my whole chest?  Why didn't any of them touch my breasts?   Why didn't any of them ask me if my breasts had changed during pregnancy?  

Furious google searches and research dominated my life.  I had started to use a bottle by now because the 1-oz serving through the periodontal syringe was not working anymore.  My husband was able to feed her while I banged the keyboard.  Packages of domperidone began arriving from Fiji. I found the Medela SNS and obtained it from one of the LCs I had visited, annoyed that this hadn't been offered to me right away.  I was almost immediately more annoyed with the SNS, however, and more late night research led me to the Lact-Aid SNS, which was so expensive to me at the time that I rinsed and re-used the baggies. I dominated the refrigerator with frozen milk, thawing milk, tubes, bottles, bags.  The SNS affair lasted a few weeks at most.  I couldn't endure it.

It was all very annoying and demeaning at the time.  Twiddling with a SNS and searching for more donated breast milk via Milkshare consumed my life.  I don't remember my daughter's infancy until she was three months old, when I found a long-term donor and relaxed about finding donated breast milk.  She had a son exactly my daughter's age who was born through a traumatic cesarean, but she was struggling with oversupply.  Here we were, complete situational opposites, bonding over the same horrible postpartum feelings.  She ended up donating over 20 gallons of milk to me- enough for six ounces a day for a year.  

I found several other donors here and there through Milkshare and word of mouth, bringing my total to about 30 gallons of donated milk over a year.  That's actually not very much as far as a baby's consumption goes.  To bridge the gap between that and the four ounces of milk I was making per day, I began making the Weston A. Price homemade kefir formula. My daughter struggled on the store-bought formulas- another slap in the face for me.  Chronic constipation.  Poop that smelled like a steel mill.  Anal fissures.  Suffering. I couldn't find enough donated breast milk.  Many would-be donors saw my seemingly healthy, older baby and declined to donate to me, preferring a newborn or sick child instead.  Making the homemade formula was my meditation- I was still able to honestly say that I was making my daughter's food.  She flourished on the combination of me, my donating friends, and my homemade formula.  Finally I was able to relax and be her mom.    

Alas, now I had to go back to work.  Within a few weeks of returning to work, my period returned and my milk supply dropped.  I had a 50-mile commute one way, and I would pump with one hand on the wheel and the other on a flange, and after 20 minutes of zoning out on the Capital Beltway, I would look down and see only a few drops not even in the bottle, but still in the flange.   I was also bloated and 10 pounds heavier from domperidone, and almost $1000 lighter from that and the industrial-size bottles of goat's rue tincture, a better pump, and all the SNS doodads.  It wasn't worth it.  I stopped the galactogogues.  I quit pumping at work.  I didn't offer the breast to my daughter one day when she turned six months, and she never indicated she wanted to nurse again.  That was that.  No cabbage leaves required. Easiest weaning in history.

When my daughter was one year old, I became a doula.  I was inspired by the gal who gave me all that milk- her birth story was so hard to hear and I vowed that someday I'd help her heal the way she helped me- and I was indeed able to attend her homebirth after cesarean as her doula and friend.   Now I love helping other women overcome breastfeeding problems.  It is so ironic that I only breastfed exclusively for 11 days and for 6 months total, but I am one of the biggest supporters and champions of breastfeeding that I know.  I KNOW I know more about IGT and primary lactation failure than many lactation consultants, and that hurts me.  I would have never gotten a diagnosis of my condition if I hadn't happened to be in a room with an ultrasound machine one day. 

I am so pumped (no pun intended) to see the publicity and coverage that IGT is getting these days.  As of now, I won't be having another child in part because I do not want to go through lactation failure again, but if it does happen, I will be so prepared and I will be the poster child.  My only regret is stopping nursing altogether and not giving the SNS a better try, but I have to be gentle with myself considering it was the best I could do at the time.  And I think I did pretty darn good!  My daughter is healthy, athletic, graceful and still skinny and long, the way she was born and meant to be! 

Nikki Williams

Entertaining a Toddler While Breastfeeding a Newborn

I cannot begin to tell you how excited we are about the 100 or so amazing questions submitted to our article, What Breastfeeding Topics Would You Like to Know More About?  From inquiries about breastfeeding after reduction surgery to dealing with a teething infant, our blog calendar is now FULL for the rest of the year, just answering your questions!  YAY!!! 

For the rest of the year, Thursday will be the day we delve into our readers’ questions, adding to our series, Help A Breastfeeding Mama Out!  We will also answer your questions on our ‘Ask the Experts’ segment on The Boob Group online radio show.

Here is our question of the week:

Dear SDBFC,

I would love to learn more about nursing a second baby with a toddler running around. I remember how hard it was with C and how it consumed everything for the first couple weeks getting my daughter to latch, and nurse, and stay awake to nurse...and I am due in October when C will be two and the thought of doing that with her running around terrifies me. Any tips?
 

Alicia
 

Dear Alicia,

Absolutely!  I remember like it was yesterday bringing home my newborn from the hospital and introducing him to his 15 month old brother.  Those first few weeks were a whirlwind, trying to figure out breastfeeding again and trying to entertain my toddler, whose world had just been turned upside down.

Tips for Entertaining a Toddler While Breastfeeding a Newborn

Tip #1: Enlist all family members and friends to come hang out with your 2 year old as much as possible.  It can be a difficult transition for an older child when a new baby arrives, so we tried to make sure that our older son had lots of attention in the beginning.  Let’s just say that Ben went to the park, the zoo, and the grandparent’s house quite often those first few weeks after his brother was born, which left me many hours to work on breastfeeding and get to know my new little one. 

Tip #2: Have a box of special toys that can only be played with when you are nursing your newborn.  My son was so excited to pull out these new exciting trains, books, and cars whenever I sat down to nurse.  I could see his face light up as I pulled out this box several times a day.  I also included small snacks in this box….ones that he could eat on his own.

Tip #3: Learn to nurse in a carrier, wrap, or sling as soon as possible.  This was an absolute lifesaver.  Let’s be honest….even with a new baby in the house, the older child (or children) still run the show J  So, I learned very early on to nurse my younger son in the ergo…at the park, at the zoo, on a walk, etc.  Then I was hands-free to make sure that Ben didn’t slip through the cracks on the playground’s play structure, all while nursing my younger infant.  It was awesome!

Here are some fantastic tips from a few of our Facebook followers:

From Nubia: puzzles : ) coloring, reading. If nothing works, their favorite tv show.

From Andrea: reading books, singing songs, talking about what you're going to do with your toddler whilethe  baby naps, give them a snack too!

From Beverly: Snacks, story time, flash card app on the cell phone

From Crystal: Cell phone!! The kid loves angry birds...hehe!

From Amber: Hand them a tampon in the wrapper. No joke. Entertainment for a good 20 minutes!

From Chrissy: Have a special basket of things they get only when mommy breastfeeds...give that time to your toddler to help make them feel special..read them their favorite story, or sing them some songs..bring out some instruments and have fun! It’s also beneficial to your nursing little one to hear you reading that story or singing those songs. You could also have some sensory bottles...look them up online. You can make an ocean bottle and various noise maker bottles with different textured things in water bottles that they can shake up and look at or use as instruments

From Ariel: I love reading books to my toddler while I nurse. When I'm in a pinch, sesame street on youtube is actually quite fun, too. But I always try to go for the books first! :)

Lastly, here are a few articles and podcasts discussing this exact topic:

/blog/2011/10/6/advice-for-a-breastfeeding-mom-with-an-older-toddler.html

http://www.theboobgroup.com/managing-a-toddler-while-breastfeeding-a-newborn/

Thanks so much for your question, Alicia!

Warmly,

SDBFC

Breastfeeding Expectations for the First Month

Do you remember what breastfeeding was like during those first few weeks after your baby was born? 

I personally remember feeling somewhat clumsy and awkward, as if my son and I were trying to master a new dance without stepping on each other’s toes.  Our rhythm was slightly off.   I constantly relied on my breastfeeding pillow and there was absolutely no dependable schedule.  I was forced to switch off my Type-A brain and learn to go with the flow, which was quite a challenge for me, to say the least!

Yet, as the months went by our breastfeeding relationship changed.  In most ways, it improved immensely, as I became a more confident mother and caregiver.  In other ways, different nuances surfaced, which taught me that breastfeeding, like parenting, is constantly in a state of motion and sometimes in need of modifications.

Listening to other breastfeeding mothers, I realized that my experience was super common.  We all found that our breastfeeding relationships with our children changed dramatically from the time our babies were born to the time they eventually weaned.  Breastfeeding a 6-week old was drastically different than breastfeeding a 9-month old or toddler, and all of the months in between.  And, what helped make these transitions manageable was knowing now common and normal these experiences truly were.

Today, on The Boob Group online radio show, I am excited to announce a NEW SERIES called Breastfeeding Expectations! 

For the next 12 months, we will be following three new mothers along their breastfeeding journeys, learning how they cope with breastfeeding challenges and settle into a breastfeeding rhythm with their babies.  Jenn, Anney, and Cherri have graciously offered to share their stories, including both their successes and their struggles, as we document what it has been like for them to breastfeed their babies.

Please click here for the first episode of Breastfeeding Expectations: The First Month

For additional resources about breastfeeding during the first month of your baby’s life, check out Breastfeeding Expectations: The First Month on The Boob Group web site.  Also, join The Boob Group Facebook Page and sign up for The Boob Group Newsletter to stay informed about upcoming episodes, blog articles, and giveaways!

What did breastfeeding look like for you and your baby during that first month?

What challenges did you face and how did you overcome them?

What did you enjoy the most during that first month of breastfeeding?

Newborn Hands: Why are they always in the way while breastfeeding?

Oh, those sweet little newborn hands.  Such a love/hate relationship we breastfeeding mothers have with those hands.  We love to hold and kiss those sweet-smelling hands, yet when it’s time to breastfeed, those annoying little clawing paws won’t get out of the way!  The minute our breast is out and ready to feed, those newborn hands are like defensive linemen, blocking any entry into our baby’s pecking mouth.

So, what’s the deal with those hands? 

Why is it that immediately when our baby realizes he is starving, his hands get in the way?

 Fun fact #1: Did you know that your baby has been using his hands in this fashion while in utero?  Ultrasounds show babies bringing their hands to their faces before swallowing amniotic fluid.  This is actually a process in the feeding pattern, which explains why babies bring their hands to their mouths when they are hungry. 

Fun fact #2: Did you know that if your baby’s face is not touching your breast as you initiate a breastfeeding session, he will use his hands to find your nipple?  Newborns have incredibly poor eyesight and use all five senses to locate and latch on to the breast.  Those little hands are searching for your breast to help bring it closer to his mouth.

So, what’s a mom to do when her baby is crying to eat, yet his hands are blocking every chance she has to put her breast in the baby’s mouth?

• Let your baby suck on his fingers to calm himself at the breast.  When he moves his hands, he is already at the ‘restaurant’ and will be ready to breastfeed.
• Try not to tuck your baby’s hands under his body or swaddle him while breastfeeding.  Tucking his hands can disorient him.  Think about if you were trying to eat with your hands tied behind your back.  You would most likely feel off-centered and clumsy.  Babies need their hands to keep them stable, just like we need our arms to our side or in front of us when we eat.
• If you have sore nipples and the thought of your baby clawing them makes you yelp just thinking about it, then keep your baby’s face touching your breast.  Try laid-back breastfeeding to assist with this.  In this position, you can wrap your baby’s hands AROUND your breast and he will come in with his face instead.
• Catherine Watson Genna, one of the most amazing lactation consultants I have ever met (and also the head researcher in an infant hand-use while latching study) recommends this technique in the Lactation Matters article, An Interview with Catherine Watson Genna, “Sometimes babies do get caught in a ‘reflex loop’ of sucking their hand, moving away, and then sucking their hands again. Moving the baby slightly so his face touches mom’s breast can interrupt this loop and get the baby to move his hands away and look for the breast with his mouth again.”  More information can be found in her article, Facilitating Autonomous Infant Hand Use During Breastfeeding

So, maybe those roaming little hands are actually helping our babies to become better breastfeeders.  Who knew?

Do All Exclusively Breastfed Babies REALLY Need Iron Supplements?

When I read a policy statement from the American Academy of Pediatrics stating that exclusively breastfed babies need to be supplemented with iron starting at 4 months, I have to wonder…

Are they saying that my perfect nutrition for my baby is no longer PERFECT? 

Are they saying that what my body produces is suddenly SUB PAR? 

This caused me to do a little research.  What IS the deal with iron in breast milk? 

Does my 4 month old really need those nasty-tasting drops?

According to my research, I found that not all exclusively breastfed babies need iron supplementation.  In general, babies are born with enough iron in their system to last at least 6 months, of not until they have tripled their birth weight. (Riordan and Wambach, Breastfeeding and Human Lactation)  According to the Womanly Art of Breastfeeding, there is not a lot of iron in breast milk, yet there is not supposed to be, as it is more completely absorbed from breast milk than in supplements or formula.   Also, breast milk contains a protein, called lactoferrin, which binds to the extra iron that the baby cannot use, keeping it from feeding harmful intestinal bacteria.  Iron supplements, for a baby who is not iron-deficient, can often overwhelm the lactoferrin, causing an overgrowth of intestinal bacteria, resulting in diarrhea and possible microscopic bleeding.  WHAT???

And, my biggest RED FLAG went off when I found a Letter to the Editor of Pediatrics, called Concerns With Early Universal Iron Supplementation of Breastfeeding Infants.  In this article, the executive committee of the Breastfeeding Section of the AAP states that they have “major concerns about universal iron supplementation at 4 months in breastfeeding infants” and that the authors of the above policy “acknowledged that this report was submitted for review to the AAP Section on Breastfeeding, but they did not mention that we disagreed and provided our additional recommendations 2 years ago.”

HMMMMM!  So, clearly my breast milk is much more perfect than the AAP was trying to make it sound and universal iron supplementation of exclusively breastfed babies over 4 months is NOT ideal.

So, how would you know if your baby actually needs iron supplements?

Which babies are more at risk for iron-deficiency anemia? (according to www.kellymom.com)

• Babies who were born prematurely, since babies get the majority of their iron stores from their mother during the last trimester of pregnancy.
• In addition, there is evidence that babies whose birth weights are less than 3000 grams – about 6.5 pounds – (whether term or premature) tend to have reduced iron stores at birth and appear to need additional iron earlier.
• Babies born to mothers with poorly controlled diabetes.
• Theoretically, babies born to mothers who were anemic during pregnancy could have lower iron stores, however medical studies do not show this to be a problem. Babies born to mothers who are anemic during pregnancy are no more likely to be iron deficient than those born to mothers who are not anemic during pregnancy.
• Babies who are fed cow’s milk (instead of breast milk or iron-fortified formula) during the first year of life.

If your baby falls into one of these categories, you have the right to ask for your baby’s hemoglobin to be tested for anemia, rather than automatic iron supplementation.  And, if your baby does test positive for anemia, there are many Iron-only drops that you can give your little one.  No need for that multivitamin because your breast milk has all of those vitamins already in it!

In addition, when your little one is over 6 months and ready to start solid foods, consider those with a healthy dose of iron, like the ones listed on one of my favorite baby food sites, Wholesome Baby Food.  No need to try that boring white rice cereal, just because it is fortified with iron!

Common Concerns While Breastfeeding - Help! I’m Engorged!

Welcome to our blog series…. Common Concerns While Breastfeeding.  These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls I receive.  Rather, these are the questions that come from clients and friends in the middle of the night, by text or by email, that don’t necessarily warrant a lactation consultation.  They can often be easily resolved with a few simple tricks.  So, I would like to share those tricks with you!

Check Out My Cleavage!

I remember the first time I knew my milk had ‘come in.’ It was 4am.  My son was 4 days old.  And I woke up to my breasts looking like I had visited the local plastic surgeon a few hours prior.  I immediately woke up my husband and announced with pride, “Take a look at this cleavage!”  Even without a bra I had cleavage!  It was amazing!

Several hours later, those taut, perky breasts had become quite sore and I was searching for any remedy to help soften their powerful fullness.  I knew that they weren’t engorged, but I also didn’t want to get to that point of challenging return.

What is engorgement?

Photo by Lindo Nkwanyana on Unsplash

While breast fullness between days 2-5 postpartum is normal, your breasts should still be somewhat pliable.  Think of a full balloon.  While a balloon is taut, you can also squeeze it and shape it.  This is how your breasts should feel as your body transitions from making colostrum to your ‘fuller milk.’ 

Engorgement is much more severe.  When your breasts are engorged, they can feel heavy, tender, and/or painful.  Sometimes engorged breasts will look tight and shiny, as if the skin is being stretched beyond its elasticity.  Engorged breasts can become so congested that it is difficult to even remove the milk. Engorgement is most common those first few days postpartum or as your baby gets older and begins to sleep for more consecutive hours at night.

What causes engorgement?

Engorgement is caused by milk stasis (milk not moving out of the breast.) There are many reasons that a mom might become engorged.

• Several birth interventions, which may result in lots of IV fluids in the hospital

• Poor latch where the baby is not removing milk efficiently – definitely see a lactation consultant for this issue

• Subsequent children - I was a lot more 'full' with baby #2, than with baby #1. Your body has a memory and your milk often comes in more quickly and forcefully with each subsequent baby

• Your little one slept longer at night than usual

• Skipped feedings

• Inflammation

• Low immunity (caused by lack of sleep, stress as a new mom, stress of going back to work, etc. – Can you imagine that????)

How can I reduce my breast fullness or engorgement?

• Breastfeed frequently and effectively from both breasts. In those first few weeks, your baby should be breastfeeding 8 or more times in 24 hours, actively sucking for about 30-40 minutes per feeding session

• If your baby cannot latch because your breasts are so engorged:

  • Use ‘Reverse Pressure Softening’, which pushes the excess fluid away from your nipple, helping your baby latch more easily.

  • Hand express or pump on a low setting before latching your baby, to help your breasts to become more pliable and easier to latch onto.

• To reduce inflammation, treat your breasts as you would a swollen ankle – ice packs/frozen peas in between feeding sessions to help reduce the swelling.

• Use warm compresses right before breastfeeding. The warmth will help to open your blood vessels and hopefully help your milk to begin dripping, thereby making it easier for your baby to latch on.

• Take a warm shower and lean forward. The gravity and warmth should help reduce inflammation. Use very gentle massage only, as deep massage can cause more inflammation.

• Take care of yourself and your immune system – rest, drink lots of water, eat immunity-supporting foods

• Eat cucumber and watermelon to reduce all-over body swelling (like your hands and feet)

• If your baby isn't latching well or removing milk efficiently, you may find it helpful to pump for about 10-15 minutes after breastfeeding to remove the backed-up milk in your breast.

• Ask your doctor/holistic practitioner for recommendations for inflammation-reducing medication, herbs, and homeopathy.

If your breast engorgement foes not resolve within a few days, becomes worse and turns into plugged ducts or mastitis, definitely call a lactation consultant for some additional assistance!

Breastfeeding Multiples

Every time I meet a mom with twins, I am completely in awe of how she is functioning on a day to day basis.  While my boys were practically Irish twins, I still had mastered breastfeeding and sleep by the time my second son arrived.  So when I stumbled upon this article, 10 Tips for Breastfeeding Multiples, I just had to share with my readers.

All rights reserved by viernulvier via FlickrFor those with singletons, there are a few gems for you, like ‘find your breastfeeding cheerleaders’ and ‘set up a nursing station’…which, by the way, I like to refer to as the Breastfeeding Basket.

For those with multiples, I love that this article breaks breastfeeding down into a few critical tips to get breastfeeding off to a great start.

In my humble opinion, the only other thing I would add to this list is to find a Breastfeeding Multiples class, if there is one in your area.  While a typical prenatal breastfeeding class is helpful, one specifically for multiples should also cover breastfeeding premature babies, as well as the unique situations that breastfeeding mothers of multiples may face.

And, definitely don’t forget to:

• Pick up Karen Kerkhoff Gromada’s book, Mothering Multiples, and check out her website.
• Find a lactation consultant in your area that you can speak to prenatally, if possible.
• Find a twins club in your area

My Newborn Is So Sleepy!

How am I supposed to breastfeed my newborn, 8+ times in 24 hours, if I can barely keep her awake?

Why does my newborn fall asleep as soon as he starts to breastfeed?
How can I keep my newborn awake while breastfeeding?

These are very common questions that I get asked from moms on a weekly basis.  Newborns are so sleepy.  And if they've had a long, challenging journey into the world, they are often even sleepier!

So, what is a new mom to do to keep her little one active and efficient while breastfeeding?

In order for your baby to gain sufficient weight and to stimulate an adequate (and hopefully copious!) milk supply, your baby needs to breast feed 8 or more times in a 24-hour period.  Many newborns are very sleepy in the first few weeks, making it difficult to keep them awake to have really ‘efficient’ feeding sessions.  An 'efficient’ feeding session may be characterized by active sucking at breast for a total of 15-20 minutes, with less-vigorous sucking throughout the rest of the feeding.  You should hear swallowing throughout the feeding, as well.  Your baby should also be meeting his/her diaper counts and gaining weight that is appropriate for his/her age.

If your baby seems to fall asleep often at the breast and is not having 8 or more ‘efficient’ breastfeeding sessions 8 or more times in 24 hours, you can use the following techniques to help him/her until he/she begins to stay awake on his/her own.

Tips fo keep your newborn awake while breastfeeding:

1. Loosen his/her clothes or undress him/her down to his/her diaper.  Skin-to-skin contact will keep him/her warm while feeding.
2. Dim the lights in the room.  Newborn babies are very sensitive to bright lights and they may cause him/her to close his/her eyes and fall asleep.
3. Gently rub the palm of his/her hand with your thumb.  Babies have a feeding reflex there and this stimulation often helps to rouse them and remind them to keep feeding.  This also works if you rub along your baby's backbone or his/her foot.
4. Use breast compressions (picture squeezing your breast like an orange and holding it for 10 seconds at a time.) This should give your baby a squirt of milk in his/her mouth and wake him/her up.
5. Switch to the other breast when your baby begins to lose interest in active nursing (this is called switch nursing.)  As soon as your breast is removed from his/her mouth, this should wake him/her up.  Also, when he/she latches on the other breast he/she should get the benefit of another let-down as he/she vigorously sucks.  You can do this every few minutes, if needed.  Your baby should eventually begin to stay awake on his/her own.
6. Burp and change your baby’s diaper.  Sometimes this change of position will rouse him/her enough to go back to breast and try again.

If your baby continues to have difficulties staying awake for a full feeding at breast, it is worth it to have a lactation consultant observe your breastfeeding session.  

Most of this sleepiness is very temporary and you will be amazed by how efficiently your baby will breastfeed as he/she becomes older and stronger

Managing a Toddler and a Newborn

This is Kim, Robin’s sister-in-law. I have three amazing daughters, one which was just born 4 days ago. In my 4.5 years of being a mom, I’ve read a fair amount about parenting and have gotten some really great (and some really terrible, uninvited, and/or borderline-criminal) advice along the way. I thought I’d share some of the highlights with you from time to time.

When my second daughter was born, my first was 22 months old. Like most moms adding another child to the family, I was concerned about how I would manage two little ones and how my first would react to a new baby joining our family. I sought out tons of advice and suggestions, and I’ve included the ones I found most helpful below. Now, as a caveat, I think these suggestions are great when the older sibling is a toddler. Some of them probably work no matter what the age, but obviously some will not apply if you have a preschooler or older, or if you’re having your kids super close together. So, try what makes sense to you, and disregard what won’t work - which, incidentally, is my approach to all parenting advice.

Before the baby is born:
Quick summary: Before the baby was born, we had two main objectives: We wanted to make sure that our first child 1) was aware she was getting a new sister and viewed it as a positive experience and 2) had already learned concepts like patience and independence.

Introducing the concept
We wanted our first child to understand that our lives were going to change, but to view this change positively. So, we made sure she was prepared, had some sense of exactly what would change, and knew that her role as big sister was important and appreciated. Here are some things we did:

* Once I started showing, we told my first about the baby coming. She didn’t really understand what we were talking about, but it was good to start getting the thought in her head and introduce her to the idea gradually.

* We talked about the new baby when it made sense, but not constantly. A toddler’s concept of time is different than ours, so spending so much time talking about something that’s not happening for months would most likely have bored, annoyed, and confused her. However, if we saw a baby at the park, I would say, “Your baby sister is going to be small like that!” or “When your baby sister comes, Grandma is going to come visit! Won’t that be fun?” We always kept the conversation positive.

* We got some positive books about being a big sibling and read them every now and then. Our two favorite titles: My New Baby and I’m a Big Sister (also comes in Brother). I really like the first book because it doesn’t have any words. You can make up your own story about what it’s like to have a new baby, and more importantly, you can let your child narrate and get a sense of how they’re approaching becoming a big sibling. I enjoy both books because they are POSITIVE about the experience and don’t assume that the older child will have feelings of jealousy or anger. If that ends up happening after the baby is born, deal with it then. Don’t put the idea in the kid’s head before it’s even a problem!

* We encouraged my first to be a part of the preparations for the new baby. We let her “try out” the bouncy chair and sit in the crib. She picked which books would stay in her room and which would go into the bookcase for the new baby. This will helped foster the idea that being a big sib is an important and fun job, and reassured her that she was still very much a valued member of our family.

Tomorrow’s post will be the continuation of Kim’s journey of managing her toddler and newborn.

Encouraging Independence and Patience:
The fact is that when there’s a newborn in the house, everyone else takes a back seat. Since I was either nursing or attached to a pump for like 80% of the day, I needed my first to be able to entertain herself and do things for herself. However, I didn’t want her to feel displaced by the baby or feel like the baby caused all the changes (even though she basically did). So, we started practicing patience and independence before the baby came. Here are some things we did:

* We introduced and practiced activities that she could do independently, such as drawing, puzzles, and playdough. This way she got used to playing on her own for an extended period of time before it was directly related to me being busy with her sister. If she asked for help, I would kindly redirect her to doing it herself. ESPECIALLY IMPORTANT both before and after baby: when my daughter was doing activities herself, I was always watching and providing specific feedback and praise that let her know I was paying attention and still interacting with her. An example: “Wow, you drew a red truck! Do you want to add some wheels?”

* I started taking a while to do things and asking her to wait. At first, this seemed silly since I could have done when she asked immediately, but again, this was getting her used to the concept of having to wait for things. I didn’t have to frame it negatively. For example, if she asked, “Mommy, can I have some juice?” I would say, “Yes, in one second. Just let me finish this article I’m reading.” Then if she waited patiently, I would be genuinely appreciative (again, with specific feedback): “Thank you so much for waiting. I really appreciate how patient you were.”

* We started working on independent self-care. Anything I could think of that she could do herself, we started practicing. This included: putting on her own shoes, climbing into her carseat and buckling the top buckle, getting cups and utensils herself from a low-level cabinet, filling her own water cup from the fridge. Again, specific and genuine praise whenever possible. “Did you buckle your carseat yourself? Wow, you are such a big girl! I’m really impressed!” My daughter LOVED to do things herself, so this wasn’t a tough sell. And when her sister arrived, she was already well-practiced at these tasks and it saved me a ton of time and energy when I was suddenly trying to take two kids to Safeway.

After the Baby is Born
Quick Summary: After our second was born, our goal was to integrate her into the family while changing our oldest’s life as little as possible. We felt this would minimize any feelings of jealousy and would lead to a strong bond between them. This started when my oldest first came to meet her sister at the hospital and continues today.

At the hospital:
* We had a framed picture of our family of 3 displayed prominently in the room to show our oldest we were thinking of her while we were away.
* When our oldest came to visit for the first time, Grandma came in first and took the baby, then Dad brought our oldest in. That way, when she came in to see me for the first time, my arms were open to hug her and give her attention. Her first visual was not “I’ve been replaced by a baby.”
* We had a present for her on-hand that was “from her sister” (for us it was a book). At first I thought this was totally patronizing to her, but man did she LOVE it! Baby sister made quite the first impression!

At home and beyond:
* We made every effort to keep the normal routine. Big sister still went to school even though I was on maternity leave, and we kept up our regular playdates.
* I wore the baby whenever possible in a baby carrier so that I still had hands free to interact with my oldest. (“Why yes, lady at the park, my boob is out since I’m nursing a newborn in a wrap and using my free hands to help my daughter off the swing! Your point is....”)
* Continued specific feedback and praise for all examples of patience and independence.
* One-on-one time with our oldest as much as possible, both with Dad and with Mom. We wanted to make sure that our oldest felt special for being a big sister, not forgotten.


So, there you have it folks. Again, these are the suggestions and tactics that worked best for our family. Our girls have a great relationship. I could, of course, conclude 100% that it was my “excellent parenting and preparation” that led us to this point, but it’s also possible that we could have done none of this and they’d still be best friends, or we could have done all of it and we’d still be trying to prevent the oldest from smothering the youngest in her sleep. But you have to start somewhere, right?

Common Concerns While Breastfeeding - Sore Nipple Therapy for the Breastfeeding Mom

Help!  I Think My Nipple Just Fell Off!

Welcome to our newest blog series…. Common Concerns While Breastfeeding. These aren’t the complicated, ‘come-to-my-house-immediately’ phone calls I receive. Rather, these are the questions that come from clients and friends in the middle of the night, by text or by email, that don’t necessarily warrant a lactation consultation. They can often be easily resolved with a few simple tricks. So, I would like to share those tricks with you! 

12 hours before sore nipples! Painful, sore nipples are the worst thing EVER when you are a breastfeeding mom! My youngest son is almost 5 years old and I can still remember crying every time he woke up to breastfeed that first week of his life.  There are so many horror stories about painful nipples out there that some women are petrified of breastfeeding. 

Well, my friend, let me give you the low down about sore nipples and how to prevent and overcome them!  With a few simple tips, and the support of your ‘circle of breastfeeding support’, you should be able to avoid painful nipples, or at least know how to get your nipples back on track.

Symptoms:

• One side of the spectrum is nipple tenderness. This is normal. When’s the last time you had hours of nipple stimulation in a 24 hour period? My guess is NEVER or NOT SINCE THE LAST BABY WAS BORN.

• Middle of the spectrum is painful feedings with maybe some cracking. This shouldn’t happen, but it could have been the result of a poor latch here and there. Have a lactation consultant or a support group leader take a look, just to make sure.

• The opposite side of the spectrum is bleeding and cracked nipples. RED FLAG!!! This is not supposed to happen. This is your body’s way of telling you that you could use some assistance from a lactation consultant to see what is causing this pain. Don’t wait!

Prevention:

Look at this gorgeous latch!

• Nice wide latch – you don’t need your whole areola in your baby’s mouth, but the latch should be more than just on your nipple.

• Your baby’s lips are flanged like a fish’s mouth

• Don’t push on the back of your baby’s head to bring him/her to the breast. Instead, try a laid-back feeding position. Bring your baby’s torso into yours. His/her head will follow.

Treatment:

• Express breast milk on your nipples after your baby has fed and then let the ‘girls’ hang out for a few minutes.

• Some sort of nipple chapstick: Organic coconut oil, organic nipple cream, etc.

For those breastfeeding parents with cracked and bleeding nipples, you might need to try a few other options

• Hydrogels – wet wound management to place on your nipples in between breastfeeding

• All-purpose Nipple Ointment – can be prescribed by your physician to be made at a compounding pharmacy. This link, from breastfeeding expert, Jack Newman, includes the ingredients to give to your care giver.

• Don’t hesitate to call a lactation consultant! When a baby is latching correctly and his/her tongue is doing what it should, a mom’s nipples should not become cracked and bleeding. A lactation consultant should be able to figure out the cause of your pain and offer suggestions of how to fix the situation, ASAP!