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

How Long Does My Breast Milk Stay Fresh?

Breast milk storage guidelines can be incredibly complicated to decipher.  With each pump company and breastfeeding website having its own storage and handling recommendations, how's a mother to know which one to follow?  Plus, throw in whether the baby is full-term, pre-term, healthy, or in the NICU, and we have quite a confusing situation.

After delving into our lactation consultant guidelines for human milk storage, I think I have the definitive list for you….at least for this year!

How long does my breast milk stay fresh?

Here are the recommendations, for a healthy infant, according to the Core Curriculum for Lactation Consultant Practice, 2012:

Room Temperature 72 º:   6 -10 hrs.

Refrigerator:  5-7 days

Insulated cooler with ice pack: < 24 hrs.

Completely thawed in the refrigerator: < 24 hrs.

Freezer compartment in 1-door refrigerator: 2 weeks

Freezer door in 2-door refrigerator (not in door): 3-6 months

Deep freezer: 6-12 months

Here are the recommendations for a hospitalized infant, according to the Core Curriculum for Lactation Consultant Practice, 2012:

Room Temperature 72 º: < 4 hrs.

Refrigerator:  up to 7 days

Insulated cooler with ice pack: < 24 hrs.

Completely thawed in the refrigerator: < 24 hrs.

Previously frozen, brought to room temperature: <4 hrs.

Freezer compartment in 1-door refrigerator: not recommended

Freezer door in 2-door refrigerator (not in door): < 3 months

Deep freezer: < 6 months

How should I store my breast milk?

• Glass or plastic baby bottles

• Clean food storage containers with tight-fitting lids

• Disposable feeding bottle liners and mother’s milk bags

How do I warm my stored breast milk?

• Never use the microwave to warm up breast milk.  Not only does the milk heat unevenly in the microwave (which could cause unintentional burning), but it decreases the anti-infective quality of the milk and reduces its overall health properties (ABM Protocol #8)

• Defrost frozen breast milk in either the refrigerator overnight, by running under warm water, or setting it in a container of warm water. (ABM Protocol #8)

• There have been no studies done to provide recommendations for how long milk can be kept at room temperature after a baby has partially fed from the cup or bottle.  The Academy of Breastfeeding Medicine recommends using the milk within 1-2 hrs after baby finished feeding.  (ABM Protocol #8)  Many lactation consultants and pediatricians recommend using the rest of the milk at the next feeding sessions and then throwing any leftovers away.

Do I need to sterilize my bottles and nipples?

• Bottles, nipples, and pump pieces need to be sterilized before you first use them.

• Once a bottle, nipple, or pump piece has been used, sterilizing is unnecessary.  Instead wash everything in hot, soapy water and then rinse, or throw them in the dishwasher.

Less complicated, right?  

I hope that I was able to clarify a few of those difficult-to-figure-out questions you had. 

Now go.... breastfeed, pump, and give that delicious goodness to your child!  And, definitely check back in a few years to see if anything has changed!

Battling and Resolving Excess Lipase in Breastmilk

While it is unknown how common it is for a mother to have excess lipase in her breast milk, causing it to smell or taste soapy, I come across it often enough that I thought it would be helpful to share how to deal with it, from a mom's perspective.    Christina Williams was gracious enough to write this article, walking us through her journey battling and resolving her issue with excess lipase and her baby who refused to take a bottle, even when she went back to work.  Thank you so much, Christina, for sharing your knowledge and determination!

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In preparation to be a first-time mom, I’d been tearing through books and following countless blogs for months prior to my daughter’s arrival. I was sure I had everything in order and was ready for anything motherhood had to throw at me. I could distinguish common rashes from those that are more worrisome, had memorized the slide deck of normal infant poop, and had figured out the optimal wash routine for my growing collection of cloth diapers. Was I prepared to do the seemingly simple task of giving my new baby a bottle after we established our breastfeeding relationship? The thought hadn’t even crossed my mind.

We struggled for months to get my breastfed daughter to take a bottle. We tried every trick in the book – countless fancy bottles, different people, positions and places, and my husband even devised a few feeding contraptions. Nothing worked. She could see that bottle coming at her and would seal those cute little lips right up until it was out of sight. Everyone tried to be encouraging, “She won’t starve herself,” they would say. Maybe not, but she sure liked to scare me into thinking she would try. When I went back to work she reverse cycled, completely refusing milk during the day but eating almost constantly through the night. Staying up most of the night and working all day is not a recipe for success for a working mom. I was lucky to squeeze in two hours of broken sleep a night.

Then, when my daughter was nearly 5 months old, I tasted some breast milk that had been in the fridge for a few days. It tasted rancid, soapy, and a little metallic. No wonder she had been refusing it! I thawed some milk from my freezer stash – that was terrible, too. That confirmed it; there is excess lipase in my breast milk.

What is lipase, and what is it doing in my breast milk? Lipase is an enzyme that breaks down the fats in your milk to help baby digest it. When lipase occurs in excess, this process happens much more rapidly and can make the milk taste off or sour after a period of time. Milk with excess lipase is safe to drink, but some babies dislike the taste and refuse it. Sometimes this change happens in a matter of hours, but many women find that they have 24 hours or more before the milk fats break down enough to alter the taste. 

I think I have excess lipase. What can I do about it? Fortunately, lipase can be inactivated at high temperatures, and milk can be safely stored in the fridge or freezer. Milk must be scalded before freezing, as lipase is still active even at low temperatures. Unfortunately, many women find out that they have excess lipase after establishing a freezer stash and finding that their baby won’t take any of it. If you find yourself in this situation, consider donating. Many babies will accept this milk, and it is often used in tube fed babies who can’t taste it, anyway. My regional milk bank was thrilled to accept my milk, excess lipase and all.

The first step is to determine at what point your milk starts to taste funny. I tasted my room temperature pumped milk hourly until I noticed a difference. I found that I need to scald at work after each pump session, as I don’t have enough time before it turns to make it home at the end of the day and do it all at once. Once you’ve determined your personal timeline it will help you make a plan for scalding your milk.

What do you recommend as the easiest, most effective method to scalding pumped milk? There are two popular ways to scald – in a pan on the stovetop and using a bottle warmer. Both methods require that the milk reach a specific temperature and then cooled.  Some methods suggest heating to 180° and cooling immediately. Others*** recommend heating to 144.5° and keeping it at this temperature for 1 minute, or heating to 163° for 15 seconds and then cooling. Personally, I prefer the bottle warmer method and heating to 180°. I find it difficult to reliably heat to either of the lower temperatures and maintain those temps for the recommended length of time, so I tend to stick to the 180° method. Plus, having a new baby makes even basic tasks seem complicated, so I opt for the simplest option.

***Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

How do you scald milk in a bottle warmer? What supplies are needed? How long does it take? I scald at work 2 or 3 times per day. It takes me exactly 7 minutes to scald and clean up.

Here are the supplies I use:

-Bottle Warmer – Select a bottle warmer that doesn’t have an automatic safety shut off. You need to heat the milk to a high temperature, so having the auto shut off kick in mid-scald isn’t going to get the job done. I prefer warmers that contain the entire bottle versus those that allow half of the bottle to stick out the top.

-Stainless Steel Bottle - I don't like to heat in plastic, especially to such a high temperature, and I found that heating in glass is sketchy. My glass bottles broke in the bottle warmer on too many occasions, plus the hot glass can’t be transferred directly into cold ice water or it will shatter. It must be poured it into another container first before cooling. Too many steps if you ask me! Stainless steel allows you do all the steps without transferring containers.

-Digital Thermometer - You'll need one of these regardless of what scalding method you use.

-Container for Ice – Select a container that is deep enough to submerge your bottle and around 3-4 cups of ice. I use a large, glass measuring cup.

-Ice - I like to bring a huge bag of ice in once a week. I can never remember to pack a bag of ice from my own freezer every day, and this seems to make the whole process a little easier.

Steps:

 1. Fill up bottle warmer reservoir, fill the stainless steel bottle with milk, and set the timer for at least 5 minutes. I can usually heat 7-8 ounces in 3-4 minutes. It will take longer to heat if you are using a glass container.

2. Prep your ice bowl with a few cups of ice and cold water. I find it helpful to have this ready before I start heating the milk, as the last few degrees change very quickly and you don't want to over heat. Those last 20 degrees seem to happen in just a few seconds.

3. Start the bottle warmer and stick in your thermometer. As your milk is heating, stir it around a bit with the thermometer so it heats evenly.

4. As soon as you reach 180°, quickly remove from heat and submerge in the ice bath. I let it sit with the lid off for a few minutes while I pack everything else up.

5. After a lot of the steam has escaped and the milk is relatively cool, I put the cap on the bottle and put the container with the bottle inside in the fridge. Usually, I put a paper towel over it if I’m putting in the office fridge. It isn’t necessary to put the ice bath in the fridge, but if I leave it on the counter I will inevitably forget about it until it's too late. The fridge is a nice insurance policy for those Mommy Brain moments.

6. Once completely cooled, transfer the milk into a storage container.

Anything else I need to know? I find that my scalded milk doesn’t always last a full 7 days in the fridge. Your experience may be different, but it’s best to make sure it passes the sniff test after a few days before using. Scalding milk may reduce some of the anti-infective properties and nutritional value of the milk, but not enough for it to be of concern unless baby is getting only scalded milk all the time. Lastly, this all may seem overwhelming, but it is completely do-able, even at work. It took a bit to get in the swing of things, but now it’s just a part of my daily routine.

It took a while to get my daughter to start accepting a bottle, even after I started scalding. After all, we had been conditioning her to think bottles are full of gross milk. It took a few months of patience and persistence, but she now does most of her eating during the day and sleeps at night (well, maybe the sleep part hasn’t been worked out just yet). In true baby fashion, she hates the beautiful, enormous collection of glass bottles I picked out when I was too hormonal to know better. She loves the cheapest, least eco-friendly bottles out there. Typical.

Disclaimer: If you suspect you have an issue with excess lipase, please consult your physician or lactation consultant for advice on how to best manage your situation. I am not a medical professional, just a mom sharing my own experience.

Have you experienced excess lipase in your breast milk?  

Did it cause difficulties with your baby taking a bottle?

How To Lose Weight While Breastfeeding Without Losing Your Milk Supply

Last week, Tracy Anderson made some pretty provocative comments about women using pregnancy as an ‘excuse’ to gain weight, to eat whatever they want, and keep on the weight after having a baby.  Tracy, having given birth just 3 months ago, has already lost all of her pregnancy weight, yet remember ladies….. this is not a normal expectation for us regular moms out there.   While most of us in the real world cannot spend hours a day, or thousands of dollars, working to lose weight and tone our bodies after our babies are born, her body and exercise program is what she is KNOWN for.

Tracy Anderson Ups Ante For Losing Baby Weight (ABC News) 

What I did appreciate was that Tracy mentioned that when you are losing weight while breastfeeding, you can’t forgo the nutritional aspect of the foods you eat and the calories you need to maintain your breastfeeding relationship.  I’ve seen Tracy talk about her daily nutrition and this woman eats more than her fair share of nutrient dense foods, healthy fats, and protein, which are all going to keep up your milk supply while you exercise and gently shed those pounds after birth.

Now, here is the deal…. we ALL want to lose our pregnancy weight after we have our babies.  Yet it is really important to make sure you are losing weight healthily so that your milk supply doesn’t end up slowly sinking away.  Excessive dieting CAN reduce your milk supply.  So here are a few tips to keep in mind.

Tips to Losing Pregnancy Weight While Maintaining Your Milk Supply:

1. On average, a breastfeeding mom needs an extra 300-500 calories per day than was needed to maintain her pre-pregnancy weight to keep a sturdy milk supply. (Kellymom)
2. A healthy, well-nourished breastfeeding mom can safely lose up to 1 pound per week. (Lauwers, Counseling the Nursing Mom)
3. After your baby is 2 months old, exercising moderately can help you burn more fat while building muscle mass, therefore helping you shed those extra pounds. (Kellymom)

I also interviewed Leigh-Ann Webster, owner of 52 Healthy Weeks, who is a Licensed Wellcoach, a Certified Personal Trainer and a Nutrition for Fitness Coach.  Here’s what she had to say about eating a healthy postpartum diet while trying to lose the pregnancy weight.

"Every woman wants to return to her pre-pregnancy weight as quickly as possible. But, if you’re breastfeeding, it’s really important to focus on foods that are nutrient dense so you have the energy to care for your baby, to put towards all of your other responsibilities, and to exercise. Remember that producing milk takes a lot of your body’s resources and energy!"

The following foods will help you feel good so you have the energy to get through your day with flying colors. Well, maybe not quite flying colors due to the lack of sleep that comes with having an infant, but you will certainly feel better than you would with a low calorie and nutrient-deprived diet.

Aim to eat foods that contain high amounts of Omega 3’s. These include walnuts, eggs that have been fortified with Omega 3’s, low sugar breakfast cereals that have been fortified with Omega 3’s, salmon, basil and spinach.

Eat consistently throughout the day.  By doing this you will accomplish 3 things. First, your metabolism will stay revved up because you are constantly fueling it. Second, your body will not become depleted of vital nutrients  needed to make breastmilk. Third, your energy will remain more consistent throughout the day.

Eat lots of iron-rich foods.  Focus on foods like lean cuts of beef, spinach, lentils, black beans and leafy green vegetables.

Eat a diet that rich in complex carbohydrates.  Focus on whole grain or whole wheat products and avoid empty calories from “white” products. Eat whole grain English muffins, bran muffins, brown rice, wheat pasta, sweet potatoes and lots of vegetables.

Eat a diet that is rich in calcium and protein.  Snack on foods like yogurt, string cheese, smoothies made with milk or almond milk and a banana.

Aim to eat the color of the rainbow each day when you are choosing fruits and vegetables.

In addition, some research indicates that high-intensity exercise can lead to a build-up of lactic acid which will result in sour tasting breast milk, although perfectly fine to feed the baby. This 1992 study was fairly inconclusive.  Yet if you find that your baby begins rejecting your milk, and you have been doing intense intervals (where your heart rate would be very high), then cut back a bit and see if that helps.  Also, make sure you take a shower, as salty sweat could also change the flavor of your milk!

What tips do you have to maintain your milk supply while losing pregnancy weight?

What are your favorite foods to keep up your energy level while working out?

How Can CranioSacral Therapy Improve Breastfeeding?

Dear SDBFC,

My little guy is 7 weeks old and suddenly won’t latch right.  It feels like his tongue is flicking my nipple instead of being underneath covering his gums.  He also won’t open his mouth very wide to get the whole nipple in.  It’s causing me a lot of pain.  What can I do to encourage proper latch?

Sincerely,

Christina S.

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Dear Christina,

While I am not sure why at 7 weeks your little one’s latch started to become uncomfortable, the symptoms you are describing sound like your son's jaw and tongue could use a little unwinding. This is when I often refer the baby to a CranioSacral Therapist.  Since breastfeeding requires that a baby has full range of motion with his tongue, jaw and neck, some babies may require a little extra assistance to relax these areas and their central nervous system. One technique is CranioSacral Therapy (CST).

What is CranioSacral Therapy?

Jennifer McIsaac, a Holistic Health Practitioner and CranioSacral Therapist describes CranioSacral Therapy (CST) as a system of techniques and diagnostic tools that focus on the soft tissue structures that surround the brain and the spinal cord, as well as the nerves.  This light-touch massage, using pressure up to the weight of a nickel, can relax the brain and the body immensely!  This soft pressure works well in infants, as their connective tissue is so soft and malleable.  (The Boob Group, Episode 13)

What typically takes place during a CranioSacral Therapy session?

Most sessions include an evaluation of the baby (head to toe) and soft-tissue manipulation in the baby’s mouth (if necessary) and on the head, spine, and pelvis.  There is very little movement during the manipulations, so it may look like the therapist is not actually doing much of anything.  This is because the therapist doesn’t have to use a lot of force to manipulate and relax the soft tissue. 

What are some examples of how CranioSacral Therapy can improve breastfeeding? 

• Helps to bring the baby’s tongue out over the gum line (assuming that there is not a tongue-tie or another anatomical restriction)
• Relaxes the baby’s jaw so that he/she can open his/her mouth more widely and comfortably
• Reduces tension in the baby's neck, which may have been cuased by how he/she was resting in utero or as a result of something that took place during his/her birth (breech position, vacuum, long-stage pushing, etc.)
• Relieves tightness in the baby’s neck and jaw, which may cause him/her to feed less comfortably, and even pinch the nipple, on one side only
• Relieves tension inside the baby’s mouth, which may cause suction that is too strong, painful, or off-center or a suck that is too weak to be efficient
• Increases the baby range of motion with his/her tongue and jaw after a frenotomy (tongue-clipping due to a tongue-tie) and relieves bunching of the tongue
• Relaxes a baby’s sensitive gag reflex

Besides breastfeeding, how can CranioSacral Therapy help an infant?

• All rights reserved by hollyloo (Flickr)Reduces and resolves plagiocephaly (misshapen head)
• Relieves torticollis (muscle tissue that is tight on one side of the neck, causing a shortness in those neck muscles)
• If used early on, it can reduce the baby’s need for a helmet, due to plagiocephaly and torticollis

Will CranioSacral Therapy hurt my baby?

Actually, it is quite the exact opposite.  Most parents describe watching their babies ‘melt like butter’ on the massage table while receiving a treatment and that their babies look completely relaxed.  Often times, babies who have tight jaws and necks may not be sleeping well at home, so after a CST treatment they may take a wonderfully long nap.  Many babies will actually sleep through the treatment.

How often should I expect to take my baby to CranioSacral Therapy?

This definitely depends on the baby and the issues he/she is presenting.  Most babies respond quickly to this treatment, as their bodies are so malleable and receptive to bodywork.  These babies may only need to be seen for 2-3 treatments and then their issues are resolved.  Others might need ongoing treatment and may be seen once or twice a month for several months.

How can parents find a CranioSacral Therapist?

The Upledger Institute has a search function where you can find a therapist in your area.  Most Doctors of Osteopathy are also trained in CranioSacral Therapy and may actually be covered under your insurance.  Before considering treatment from any practitioner, it would be wise for the parent to ask the practitioner about his/her experience working with infants and what type of training he/she received.

I hope that this helps answer your question, Christina!  

Warmly,

SDBFC

Additional resources:

La Leche League International: Considering CranioSacral Therapy in Difficult Situations

CranioSacral Therapy: When Can It Help, by Dee Kassing, BS, MLS, IBCLC 

JM Therapeutics: What is CranioSacral Therapy

Kellymom: CranioSacral Therapy and other gentle body work for breastfeeding problems

How Can a Tight Frenula Affect Breastfeeding?

Tongue-ties and tight frenula are definitely a hot topic among breastfeeding moms and lactation consultants.  While I had never heard of these 6 and 7 years ago, when my kids were born, they are now the FIRST thing I check for during a lactation consultation when a mother is describing painful breastfeeding and pinched, damaged nipples.  And, while a tight frenulum is not always going to cause breastfeeding challenges, there are many breastfeeding mothers who are in excruciating pain even when their babies seem to have the ‘perfect’ latch.

So what are the signs of a tight frenulum, for both mom and baby? 

When should a baby’s parents consider clipping their baby’s tight frenulum? 

How can this surgery (frenotomy) improve breastfeeding?

A few weeks ago I had the esteemed pleasure of interviewing one of the top ENTs in San Diego about the effect of tight frenula on breastfeeding.  Dr. James Ochi, of Children’s ENT of San Diego answered all of these questions and more.  Plus, the three breastfeeding moms in the studio were able to share their experiences as mothers with tongue-tied babies.

Click here to listen to our episode Tight Frenula and Breastfeeding

Here are also a few of my favorite articles about breastfeeding and tight frenula:

AAP article: CONGENTIAL TONGUE-TIE AND ITS IMPACT ON BREASTFEEDING

La Leche League International: Tongue-Tie and Breastfeeding

Low Milk Supply: Tongue Tie and Suck Dysfunction

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

Does A Free Can of Formula Really Benefit Anyone?

Just last week, the American Academy of Pediatrics approved a resolution that advised pediatricians not to provide formula company gift bags, coupons, and industry-authored handouts to the parents of newborns and infants in office and clinic settings.

In their rationale, they explained that: Research has demonstrated that the free distribution of commercial materials, such as formula samples, diaper bags, formula coupons, or other gifts via commercial infant formula marketing implicitly endorses formula feeding and creates the impression that clinicians favor formula feeding over breastfeeding, and research demonstrates that this activity decreases exclusivity and duration of breastfeeding.

Enfamil bag with free formulaSo, how does this really affect both breastfeeding moms and formula-feeding moms? 

Does a can of free formula really benefit anyone?

To answer this question, I had to combine my Lactation Consultant (IBCLC) training with my mom-who-had-to-use-formula opinion.  After much thought, my answer was a wholehearted NO!  I absolutely believe that free formula at the pediatrician office does not truly benefit either the breastfeeding mom nor the formula-feeding mom.

And here is why….

1. As newly breastfeeding moms, we are constantly self-doubting our supplies and our capabilities to fully nourish our babies.  I mean, without a scale, we really don't have an accurate way of knowing how much our babies are taking from the breast.  When we receive a free can of formula from our pediatrician, it is as if that highly respected person in our community somewhat doubts our capabilities as well.  If this statement was untrue, then why do we have so many mothers in the United States who are not meeting their personal breastfeeding goals, even at three months postpartum?  

This thought was further substantiated when I brought up this AAP resolution during my most recent recording of The Boob Group radio show on Saturday.  The three panelists (breastfeeding mothers) said that they had never considered using formula until the free sample was staring them in the face during a growth spurt or during a particularly long cluster feeding session.  While all three moms decided not to use it, they claimed that it definitely was a consideration during these times when they were questioning whether their babies were getting everything they needed from their breasts.  Fortunately they were surrounded by breastfeeding-supportive friends and family to substantiate that they were doing a fantastic job at breastfeeding.

2. The Affordable Care Act, which will come into full effect on August 1, 2012, is requesting that American insurance companies cover lactation support (provided by an IBCLC).  What does this mean for the new mom?  This means that the Unites States government feels that breastfeeding is so important that it wants you to get all of the assistance you need to make it work, and will cover it under your insurance plan.  If struggling moms can have access to the breastfeeding help they need, then free formula is not super necessary at the pediatrician’s office

3. Formula marketing in breastfeeding pamphlets is not inadvertent.  The purpose is to advertise their formula products.  When pediatricians use breastfeeding pamphlets from breastfeeding-supportivecompanies, THEY are advertising that they are fully invested and supportive of breastfeeding and will do everything they can to help a mom meet her personal breastfeeding goals. Free pamphlets written on a formula company’s letterhead sends quite the opposite message. 

4. If formula is medically necessary (such as when a mom’s supply is not fully meeting her baby’s nutritional need and she doesn’t have donor milk), and free formula is not an option, then pediatricians may now be more willing to refer this mother to an IBCLC.  Without free formula, the parents are now fully responsible to go to the store, purchase the formula, and follow the pediatrician’s recommendations.  Instead, if these parents are under the care of an IBCLC, the baby will be fully monitored and the parents will be carefully instructed on how to use the formula AND protect the mother’s milk supply.  Also, the IBCLC will hopefully be able to identify the root of the breastfeeding challenge, rather than placing a Band-Aid (formula-supplementation without protecting mom’s milk supply) on the situation. 

5. If formula is needed or desired, it is readily available pretty much all hours day and night.  Lack of a free formula sample is not going to hinder a formula-feeding mom’s access to feeding her baby.   

6. If a mother chooses to formula feed her baby, then she is already purchasing formula from a store or online anyway.  The free container from the pediatrician is not going to make a substantial reduction in her formula budget, so it doesn’t really help her out either.

7. Check out when this policy is actually put into practice!  In 2009, the California WIC agency changed its formula-giving policy so that there was no routine issuance of formula in the first 30 days for breastfeeding infants and individual assessments of mother and baby were conducted for breastfeeding concerns and problems immediately postpartum and at the first postpartum visit.  Within 6 months after implementation of these changes, the rates of food packages for fully breastfeeding infants increased by a very impressive 86 percent. (WIC Works: Policy Changes Raise Breastfeeding Rates)

So, what do you think? 

I know, I know… Whoopi is definitely not going to LOVE this policy.  

This is the deal, though.... This resolution is not about discriminating against formula-feeding moms.  It is about removing a sabotaging element from breastfeeding mothers' lives.   Banning free formula and formula marketing in pediatricians' offices may truly help a few moms find the support they need to meet, and surpass, their personal breastfeeding goals.

How to Prepare for Breastfeeding Before Your Baby is Born

Dear SDBFC,

What should a first-time expectant mother who wants to breastfeed expect at the (big, traditional) hospital in the way of breastfeeding support? It would be nice to know what we're allowed to expect/ ask for. Should the hospital lactation consultants be sufficient or should we plan on working with an independent LC right away? Is there anything we can do before birth to help ensure smoother breastfeeding?

Sincerely,

Jenny

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

Dear Jenny,

That is an excellent question, and to be honest very difficult to answer.  The type of breastfeeding support you will find at a hospital will vary greatly depending on which part of the United States you live in, whether the hospital is Baby-Friendly, its yearly breastfeeding rates, if they have certified lactation consultants (IBCLCs) on staff, and if their postpartum nurses have had recent breastfeeding training.  One hopes that the hospital lactation consultants will be fabulous, but that may not always be the case.  Also, a new mom typically won’t even see a lactation consultant in the hospital unless she is high-risk for breastfeeding challenges or she asks for one directly.

Since much of this may feel like it is not under your control, there are many steps YOU CAN make to ensure that breastfeeding gets off to a great start, regardless of the breastfeeding savviness of your hospital.

Here are my top 10 tips to prepare for breastfeeding before your baby is born:

1. Have a long chat with your partner.  Take turns discussing each person’s goals for breastfeeding and what type of support you may need from one another as a new parent.  Our article Partner Support: Can it make or break your breastfeeding experience shares different ways a partner can support a breastfeeding mom.

2. Take a fantastic breastfeeding class!  Don’t settle for the status quo.  Search for a class that not only covers the basics (latching, common concerns, how to know that your baby is getting enough), but also discusses local resources and is taught by a dynamic teacher with a background in lactation.  My favorite comment I saw on an evaluation of a breastfeeding class was, “the teacher even made my husband wish he could breastfeed!”  Now that’s a great class to attend!

3. Do some research about which hospital/newborn procedures are necessary during and after a birth.  Some hospital procedures are protocol, yet are not medically necessary for every baby, and can often negatively impact breastfeeding. 

4. Read an informative and fun breastfeeding book, such as Latch: A Handbook for Breastfeeding with Confidence at Every Stage. (Written by our very own, Robin Kaplan!)

5. Attend a breastfeeding support group, prenatally!  First, you can see the lay of the land (where to park your car, where the group is located, and if the women seem like the type of ladies you would want to hang out with.)  Secondly, you can see women breastfeeding in their ‘natural habitat’….meaning, baby on boob, minus the cover, without feeling the need to cover up.  Thirdly, you can sit next to a woman who has a newborn and ask her all of those questions about being a new mom that you have been dying to ask someone.  Last, but not least, you will feel an abundance of support for your desire to breastfeed and know that this is a safe and fun place to return to after your baby is born.

6. Come up with a ‘Visitor Policy’.  Those first few days after your baby is born are critical in establishing your milk supply and helping your baby become a successful breastfeeder.   When the entire family and neighborhood are camping out in your hospital room, it might be difficult to feel entirely comfortable taking your top off and letting your baby find his/her way to your breast.  This is YOUR time to figure out breastfeeding, not to practice breastfeeding in front of an audience.  So, decide on a policy with your partner and stick to it.  Remember, your friends should understand that this is your time to get to know your baby and that they can all come and see you once you get home.

7. Choose a breastfeeding-friendly pediatrician.  The is most likely a physician you will see more in these next few year than any other you have ever seen before.  Make sure that the pediatrician is supportive and knowledgeable about breastfeeding.   Ask to interview him/her BEFORE your baby is born so that you can make an informed decision.

8. Create a hospital-plan that will optimize your breastfeeding success.  Items to include are: rooming in, no pacifier or bottles, no formula unless medically necessary, limiting visitors, delaying your baby’s bath, and keeping your baby skin to skin as much as possible.

9. Ask for assistance from a certified lactation consultant, or a well-trained postpartum nurse, while at the hospital.  Have her check positioning and your baby’s latch.  You are paying for these services, so  take advantage of them!

10. Look for a local lactation consultant while you are still pregnant.  Spend time perusing the Internet to find a local IBCLC that seems like a good fit for you.  Attach her name and contact information to your fridge, so you can find it quickly if you need it.  This way you aren’t calling the first person you find, out of desperation, after the baby is born.

*** I know I said Top 10, but I couldn't forget to include this tip.... Hire a birth doula.  The easier your birth is and the fewer birth interventions you encounter can definitely get breastfeeding off to a great start.  Doulas can make this happen:)

Thanks for your question, Jenny!  Hope this helps!

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?