I Never Knew I Had Insufficient Glandular Tissue

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Jennifer Thomson's 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, Jennifer, for sharing your story with us!  I know that your words and wisdom will provide endless support to other breastfeeding moms!

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When I went for my first prenatal check up, the midwife asked me if I intended to breastfeed. I immediately replied, “I’m really looking forward to it!” Those words have haunted me for years.

My first child and I had a rocky start to breastfeeding. After her traumatic birth at almost 35 weeks, I didn’t even see her for over 15 hours and she was too weak to breastfeed in earnest for the first couple of weeks. I was so in shock after my bout of preeclampsia and sudden C-section, I nearly forgot about breastfeeding entirely until a nurse wheeled in a pump and said I’d better get started. I never got engorged, and could only pump 3-10 mls of colostrum and then milk, not that I could tell when it had “come in” other than a change in color. I dutifully pumped what I could for my little 4 pound preemie, and the nurses in the NICU were very supportive and would hold my tiny syringes of milk until I got there each morning so that I could witness a gavage feed of only breastmilk once a day. It was something, and it did make me feel a bit better.

Living in an area that has no shortage of lactation specialists and breastfeeding support, I did everything they said and nothing seemed to make a difference. Several weeks in, my mom asked one of them when I was going to get engorged. The lactation specialist responded that she didn’t expect that I ever would. No one ever mentioned why. I was so confused – everything I ever read or could find said anyone who wants to breastfeed can and should. Most people had problems with latch, or engorgement, or blisters, not an absence of milk. I blamed the C-section, the early arrival of my daughter, the traumatic birth experience, the fact that she was in the NICU for three weeks, the medicine they pumped into me for the 5 days following her birth. But the truth is I knew that there was something wrong with me and my breasts. If I went too long between pumping sessions, I would leak and could feel engorgement in some areas of my breasts. Why could I feel individual ducts, and why weren’t they everywhere?

After a few weeks I ended up on Reglan, which helped a bit, but made me depressed and I didn’t need any help in that department. Several lactation consultants vaguely mentioned Domperidone, so I started my own research and ordered some from New Zealand. It worked, at least somewhat. I was able to pump an ounce from each breast every 4 hours and I nursed my daughter as much as she was willing. By the time she was 3 months old, I grew tired of wrestling with her at the breast. She didn’t want to nurse unless it was the middle of the night. I found myself getting so angry with her denial of me that I needed to stop trying to force her to breastfeed in order to save my own sanity. She preferred the bottle, and that was that. So, I pumped and gave her 2 ounces of breastmilk followed by 4 ounces of formula until she was 8 ½ months old and I just couldn’t do it anymore.

I kept a two week supply of Domperidone on hand in case I needed it one day for another baby, wishing and hoping all the while that maybe I was normal but it was the circumstances that caused my low milk supply. Two years later I was pregnant again, but this time I was under the care of a perinatologist from the beginning, did not develop preeclampsia, and was able to carry my second daughter to 38 weeks. I did have another C-section, but this time I was prepared, awake during the surgery, and was in my room breastfeeding 45 minutes after my full-term baby was born. What a difference! She had great latch from the first try and was happy as a clam nursing for hours on end. I wasn’t engorged, but my baby seemed content and I could tell when my milk came in. But she started to lose weight, and fast. She nursed around the clock, but didn’t seem content once she was a few days old. I went to see the lactation consultants at the hospital where I delivered, and they told me I had to give her a supplement at that point. This is a big deal since this is a breastfeeding-friendly hospital, so they have to buy formula for cases such as mine. She filled a syringe with formula, attached a tube to it and taught me how to have her latch around my nipple and the tube and to gently push it in as she sucked. I didn’t even need to – she sucked so hard she got the formula herself. She looked relieved as she drank and promptly fell asleep, satiated at last. I was crushed.

So, by day 5, I was back on Domperidone. It worked again in combination of around the clock nursing and pumping, and by the time she was 8 weeks old she started to refuse the bottle. I was forcing it on her like I had tried to force my first child to breastfeed. I was so worried that she wasn’t getting enough food that it didn’t occur to me that she might actually be getting enough breastmilk until a friend pointed out that it was possible. I stopped bottlefeeding, and she stayed happy and growing. I couldn’t believe it. By the next growth spurt, though, I couldn’t quite keep up so I started giving her 3-4 ounces of formula at bedtime. That did the trick, and I still felt pretty good about the whole thing.

I took Domperidone for a full 12 months. I was shocked to find that at her first birthday my supply was as high as it had ever been and my daughter was still happily breastfeeding around the clock. I don’t think I ever had much more than an ounce or two in my breasts at a time, but it was enough. The biggest difference was that because we started out strong, even with an SNS supplement, she always preferred breastfeeding. My supply dwindled over the next year, without the Domperidone and as nursing became less and less frequent. By her second birthday, I noticed she wasn’t swallowing at the breast anymore and there were only drops coming out. She didn’t care. These two things on my chest that I had deemed useless countless times were hers and she loved them. She still breastfed just as often even though nothing came out. She still breastfed to go to snuggle, to calm down and reset her day. She still demanded to nurse before bed and upon waking in the morning. Somehow, through all the trauma of my breastfeeding experience, she was just like any other breastfed child. It’s been three months since I dried up, and she still asks to nurse a couple of times a day. We did it, together.

Today is the first day I have ever heard the term “insufficient glandular tissue”… there is a name for this? I asked around to see if it was common to be missing what I called “breast tissue” and I never really found an answer anywhere. I am relieved to hear that I am not alone. That being said, I am so thankful for the support I did receive from my perinatologist, my obstetrician, countless lactation consultants, my primary care physician, my cardiologist, the hospital where I delivered, my husband, my friends, Dr. Jack Newman, the New Zealand pharmacy, the local compounding pharmacy, and the area where I live that has lactation rooms all over the place. I want to share my story so that other women in this predicament know that they aren’t alone, that they can have a breastfeeding relationship with their child even if they aren’t making enough milk. One lactation consultant told me once that I was breastfeeding, no matter how much I needed to supplement. It seemed at first like a silly thing to say. But it stuck with me. You are breastfeeding and your child is breastfed if they are receiving a drop of breastmilk. Just ask my two year old, who still thinks my empty breasts belong to her.

Jennifer Thomson

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!

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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!

Foremilk vs. Hindmilk: The Unnecessary Controversy

Foremilk vs. hindmilk seems to be quite a popular topic among breastfeeding mothers.  If I switch the baby too soon to the other breast, will he get the hindmilk?  How do I ensure that my baby is getting all of the fatty milk that he needs?  Sometimes I feel like too much breastfeeding information can add stress to a new mom.  And this is why….

All breastmilk, whether it is 1 minute into the feeding session or 25 minutes into the feeding session, has both foremilk and hindmilk.  As your baby drinks from the breast, she/he gets both the low-fat milk (foremilk) and the cream (hindmilk.)  The better your baby drains your breast per feeding, the more hindmilk she/he has access to, as this creamier milk hangs out back further in the milk ducts, so it has further to travel.

Here are some ways to know that your baby is getting enough breastmilk in the first few months:

• Your baby is feeding 8 or more times in a 24 hour period
• Your baby is gaining 4-7 oz. per week
• Your baby is having several wet a day
• Your baby is having several yellow-poop diapers a day
• Your breasts feel softer and more pliable after your baby feeds

If your baby is meeting the above criteria, then there is really no need to look at the clock or worry about if she/he is getting enough of the creamy hindmilk.  Follow your baby’s cues….she/he will let you know when she/he is full or ready to feed from the other breast.

Now, what if your baby has green, frothy poops, lots of gas, and chokes while breastfeeding?

Looking at these symptoms, the first question I would ask is, “Do you have enough breastmilk to feed an entire village?”  If the answer is yes, then what we are probably working with is an oversupply.   If the answer is no, then it is probably time to look into your diet to see if your baby is intolerant to something you are eating. (We will discuss this next week in a different article)

If you have a tremendous supply, your baby is probably drinking a lot of breastmilk.  Since the cream (fat) hangs out further away from the nipple, your baby has to take in more milk to bring down that cream.   When this happens, lactase (an enzyme in your baby’s tummy) is overwhelmed by the sheer quantity of breastmilk lactose it has to digest, so that lactose starts to ferment, causing gas.  By gently slowing down your milk supply, your baby won’t feel so full before she/he gets to all of the milk fat she/he needs, thereby allowing the lactase to breakdown a manageable amount of lactose.

How do you gently slow down your milk supply?

Lean back

If your baby is choking and sputtering while breastfeeding, it is possible that your flow is overwhelming her/him.  It’s like the garden hose has been turned on and there is no reprieve!  So, lean back.  Picture yourself in a lazyboy chair, with your feet up, all relaxed.  When you lean back, gravity naturally slows down your fast flow, thereby helping your baby tolerate your flow and control how much she/he is taking in at a time.  For more information on laid back breastfeeding, see our article Laid-back Breastfeeding: Physically and Mentally and the Biological Nurturing Web site.

Place your baby in an upright position

When your baby is in a more upright position (head higher than bottom) your baby can tolerate a fast flow more easily.  You can do this in many ways:

• Have your baby straddle your leg, almost sitting up, and leaning into your breast
• If your baby likes to feed in more of a cradle position, lower her/his bottom into your lap so that she/he is more diagonal (head above bottom)
• If you are using a breastfeeding pillow, place a blanket under your baby’s head so that it elevates it above her/his bottom

Breastfeed one side per feeding

Feed your baby from one breast per feeding.  This will help to gently slow down your milk supply, as your milk supply is based on how much milk is emptied at each feeding.  Now your baby will pull all of that fatty milk down through your milk ducts, thereby helping him/her to feel more full and satisfied before he/she takes in too much milk. 

Please note: When breastfeeding from one side per feeding, it is important to pay attention to your breasts.  If they begin to feel overly full and uncomfortable, you will want to offer that side to reduce the pressure.  Think of that side as dessertJ  If your baby is not hungry anymore, you may need to hand express or pump the skipped side for a minute or two, just to relieve the pressure.  Once you have been doing this for a while, your milk supply should regulate. 

Another note: Always pay attention to your baby’s feeding cues.  Around 2-3 months of age, many babies end up needing to feed from both sides again.  This means it is time to start offering both breasts during a feed again.

Herbs

Sage tea is a great way to gently reduce your supply.  Since each mother reacts to herbs differently, it is important to try this slowly.  One mom I worked with noticed that her supply decreased by 50% every time she drank sage tea, so she only drank it when her supply had drastically increased over time.  Another mom I worked with drank a cup once a week and noticed that it kept her supply in balance.  Again, pay attention to your body and work with a Lactation Consultant if necessary. 

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