Does Breastfeeding Cause Cavities?

Article written by guest blogger, Leigh Anne O’Connor, IBCLC

I don’t know many people who love going to the dentist. You know, you are reclined in the lounge chair, told to relax, and keep your mouth open as someone takes metal mirrors, mini ice picks, and drills and plays around inside your mouth for 30-45 minutes.

Now you want a toddler to do this? Did you see the latest installment of the Twilight Saga? Toddler vampires are illegal because they throw tantrums and kill entire villages.

Oral hygiene is very important. It can affect your entire health, good or bad. Poor oral hygiene has been linked to diabetes and heart disease. So what are we to do about oral health of our nursing preschoolers?  

The first thing to do is find a child friendly dentist and bring your baby around his first birthday.  Make sure the atmosphere is fun, yet not too overwhelming that they have pintsized sunglasses and silly stickers.

Be prepared for some education. I mean, you may need to educate your dentist. You may have a conversation about your nursing history. If you are nursing our baby and at night (really – does your baby actually sleep through the night?) you might get something like this:

            “You should not be breastfeeding at night, it will cause dental caries. And if you do, you must wipe your baby’s teeth with cotton gauze after each feeding.”

Does this dentist live with you? Has she ever nursed a toddler? Does she want to come over and put your baby back to sleep? Has she read the American Dental Association’s statement?

Here it is – the title is Study Finds No Association Between Breastfeeding and Early Childhood Caries

What really causes cavities? Here are a few main contributing factors:

• Diet: a diet high in sugar including dry fruit, sugary treats, especially those that are sticky and do not dissolve, fruit juices and sodas
• Bacteria Strep mutans
• Poor oral hygiene – both the infant and family
• Enamel defects
• Saliva flow:  a dry mouth is more likely to develop caries
• Mother taking antibiotics while baby is in utero.

Bottles are different than breasts. When a child nurses at the breast, the milk goes to the back of the throat – it does not pool around the teeth the way it does when a child takes a bottle. 

What can you do?

As with parenting in general – be a good role model. Go to the dentist regularly and brush your teeth regularly. Eat a healthy diet of whole foods. Avoid sugary foods, except in small quantities and for special occasions. And, then brush your teeth!

If you have poor oral health, do not share food with your child directly from your mouth. You could pass the bacteria Strep mutans to him.

There is research that strongly supports pre-mastication for babies and young children as saliva can support the immune system; however, if your mouth is full of cavities you can pass that on as well. If you have a healthy mouth, bite off that piece of Granny Smith apple and feed it to your baby

Let your baby see you brush your teeth. Let your baby brush your teeth! Make it fun. Brush each other’s teeth.

Let your baby help you in the kitchen, in the garden, and in the grocery store. These are all teaching moments. You can build upon the strong foundation you began with breastfeeding.

Babies get cavities in spite of breastfeeding, not because of it.

To learn more go to:

http://www.brianpalmerdds.com/pdf/caries.pdf

Did your pediatrician or dentist tell you that breastfeeding causes cavities?

Leigh Anne O'Connor is Lactation Consultant in Private Practice in New York City, as well as a La Leche League Leader. Her blog is Mama Milk and Me.  She lives with her husband, Rob, and their three children, Phoebe, Chloe & Finn.

What Advice Do You Wish You Had Heard Before You Started Breastfeeding?

This is a question I hear quite often, so I thought I would share my favorite tips, as well as share the amazing comments we received from our Facebook page when we asked our fellow breastfeeding mamas!

My Top 5 Pieces of Advice Every Woman Should Have Before She Breastfeeds:

1. Find a lactation consultant in your area before you have your baby. 

No one should have to google this information at 3:30 in the morning when you feel like your nipples are going to fall off.  Instead, spend a few minutes on the computer, in between your stroller and diaper research, to find an international board certified lactation consultant who seems like a really great person. Check out her Yelp reviews and ask your friends who they would recommend. 

2. Take a quality breastfeeding class so that you know what the ‘norm’ should look like. 

 This will help you to discern when you may need extra support from a lactation consultant or support group.  As new parents, we have no idea how often our baby should be peeing/pooping during those first few weeks and what a comfortable latch feels like.  A prenatal breastfeeding class should give you the basics and a nice foundation for what breastfeeding should look like for you.  It should get you EXCITED about breastfeeding, not fuel your fears.

3. Find a breastfeeding support group in your neighborhood and check it out before having your baby. 

 Find out where to park and what the flow is of the group.  Do these women look like ones you want to hang out with?  Does the support group leader seem friendly and non-judgmental?  In those first few weeks after having my son, I remember feeling quite anxious about bringing him to an unfamiliar place.  I wish I had stopped by my local breastfeeding support group, while pregnant, so that I would have been less timid to stop by when we were having breastfeeding challenges. 

4. Plan to spend time figuring out your breastfeeding rhythm with your little one.   

 Which position is most comfortable for the two of you? How long does it take your baby to have a good feeding session?  How often does your baby like to feed?  Every mother/baby pair is unique and it is important for you to figure out what works for the two of you.  Plus, there is a reason that babies breastfeed for about 45 minutes per feeding session in those first few weeks…. It is nature’s way of helping mom slow down, relax, and enjoy her baby.  When else have you had the opportunity to slow down your pace of life and be completely present?  It’s a gift!

5. Know that while breastfeeding is natural and normal, there can be some hiccups along the way, as with anything having to do with raising a child. 

Surround yourself with supportive people who can cheerlead you through the difficult times and celebrate your successes.  A challenge does not equal a failure.  It just means that we need some support to meet our goal.

Here are the tips that were shared on our Facebook page:

Gina: Drink things other than water, like coconut water

Krystyn: It will get easier

Brittany: I knew hardly anything about breastfeeding before I gave birth.  My mom and my husband’s mom didn’t breastfeed.  I just wish I would’ve had someone with any kind of experience to help me.  I had flat nipples and a lip-tied baby.  I needed the support!

Erin: I was in shock that I was so tender at first.  That would have been great to know… then I wouldn’t have assumed that I was doing something wrong and freaked out.

Kelli: It’s natural, but isn’t always easy for everyone.  It gets better with time, patience and support!

Rena: Best advice I ever got: The two of you have to learn one another.  It’s a learning process for both of you, so go easy on yourself.

Kim: Don’t watch the clock…watch the baby and go by his/her cues.

Lynz: I wish I had known how hard it was going to be (tongue-tied, nursing strikes, overactive letdown, reflux, etc.), but with perseverance and a lot of support (from Robin and The Boob Group) it DOES get easier!

Janine: Hang in there!  After about 2 weeks, it gets SO MUCH BETTER!

Ashley: Ask for help when you need it.  No use trying to figure this out all on your own.

Liesal: Trust your body and your baby.  I was so worried that I was doing something wrong and that he wasn’t getting enough.  Babies know when they are hungry and will tell you about it until they get enough.  The best advice I got was that it gets so much easier once he can help you.  Each monthe does get easier and easier.

Shawni: Any amount of breastmilk you can give your baby is a good thing, so don’t feel guilty if you have to supplement.  Also, their bellies are the size of their fists.

Jeannine: Go with the flow!  If your milk doesn’t come in fast, don’t worry about it.  The baby is fine with colostrum (for the first few days.) 

Kelly: Not to worry about how long I feed and watch the baby to show he/she is full.  Also, that I could have encouraged my milk to not ‘dry up’ by diet and other things.

Mary: I wish I had read this to know about the first few days of breastfeeding:http://theleakyboob.com/2011/08/baby-explains-normal-newborn-behavior/

Alye: It’s may be hard for the first few months, but it’s all worth it.

Hillary: Have the number of a lactation consultant before the baby is born.

Ashley: Don’t let all of the advice and directions confuse you.  Do what works best for the both of you, as long as it’s safe and effective.

Erin: It’s gets easier!

Laura: Not all advice is GOOD advice – do a little research before the baby is born so that you know what’s true and what is not!

Veronica: Take a class! 

Katie: Don’t let your boobs get hard! Pump and feed often!  The Nursing Mothers Companion book helped me tremendously as well.

Super Cool Kids: I wish I would have started a stash right away.

Natalie: Breastfeeding should never hurt!

Allison: Listen to your baby and your intuition.

Stephanie: Research a correct latch.  Feed as often as possible in the beginning.

Joann: Breastfeeding shouldn’t hurt!

Kristine: Not every breastfeeding relationship looks the same.  You and your baby have to get to know one another and figure out what works best for you.  It’s not a textbook kind of thing.

Renee: Don’t let the nurses in the hospital discourage you.  Ask for a lactation consultant if you need help.

Suzanne: If you are not sure how much your baby is getting, you can rent a scale or stop by a support group.  If you are having a problem with let down, find a quiet place with no interruptions and relax!

Vanessa: I wish someone had told me that the amount that breastfed babies take doesn’t really increase the way that it does with formula fed babies.  I worries for a while that my son wasn’t getting enough.

Teresa: Have a lot of one-handed food on hand in the beginning because you will only have the use of one hand for a while. 

Monica: Use a wrap (like Moby) anytime/anywhere.  I didn’t know how easy breastfeeding could be with her strapped to my body.

Mei: My husband helped to make sure that I had water, snacks, and my phone nearby. 

Catalina: Persevere!

Here are a few more articles on our website, specifically dealing with breastfeeding a newborn:

Why is my newborn so sleepy?

Newborn hands: why are they always in the way while breastfeeding? 

The Boob Group podcast's monthly series: Breastfeeding Expectations

Tips for Mothers Who Exclusively Pump

Article written by guest blogger, Misti Ryan

Whether exclusive pumping is a decision or a necessity due to surrounding circumstances, there are several things you can do to make your efforts more successful.

Start early 

We know that the earlier after birth you begin expressing, milk production is set up for long-term success.  Hand expression of colostrum is often more effective than pumping in the early days and can increase your milk supply even when you begin using a pump.  You may not reach full production until around 10 days, so be patient as amounts in the early days may be very small. Here’s a fantastic video from Jane Morton at Stanford University, demonstrating Hand Expression

Pump often 

In the beginning, plan to pump about 8 times in 24 hours, for anywhere from 15-20 minutes per session.  Once you have reached full production, you can generally decrease your number of pumping sessions to 6 or 7 times a day.  You may also find you can express for 10-15 minutes and be done.

Plan to rent a multi-user hospital grade pump and later purchase a single user double-electric pump to establish and maintain your milk supply

Initially, a hospital grade pump is key to reaching full milk production.  Let’s put it this way…. The hospital-grade pump is like the Ferrari and the double-electric you can purchase is similar to a Toyota.  The motor is far superior in the hospital-grade pump, but it is too expensive to purchase, therefore we recommend renting one.  The double-electric is much more affordable, yet is best for maintaining a supply, rather than bringing one in.

Ensure a good flange fit and consider having more than one flange size available. 

A poor flange fit can cause breast and/or nipple damage and pain.  It can also decrease the amount of milk you are able to pump.  Check out this article about finding the correct pump flange size.

Pump hands-free

Purchase a hands-free bra or make one out of an old sports bra but cutting small slits where the flanges would fit.  Your hands will now be free to massage that ‘hard-to-get-out’ milk that pools in the periphery of the breast.

Use hands-on pumping

You can maximize your pump output by using breast massage as you pump hands free.

Learn some relaxation techniques to promote milk let-down

Take some deep breaths after you turn on your pump.  Put on some relaxing music.  Think about how amazing your body is as it provides warmth and nourishment to your baby.  If you need a mental break, dive into one of your favorite magazines.  This will help the time fly by!

Focus on your baby 

Whether you have your baby near or you have to be away, you can focus on your baby by thinking about him and listening to a recording of him cooing or making sweet baby noises.  Have an item nearby that smells like your baby and place a picture in your pump bag (or on your phone).

Prepare to store your milk 

There are a variety of bags and containers to safely store your milk in.  Bags made specifically for milk storage take up the least amount of room and will lay flat in your freezer.  Click here for current milk storage guidelines

Set up a pump station at home and/or at work

Have everything you need for pumping within arms’ reach.  Also have some water available to sip on, the TV remote or a book if that is how you choose to relax, a snack, and perhaps your headphones.

And finally, keep up the great work! 

Remember, whether you baby is going to the breast or not, every drop counts!  You are providing a life-long gift to your baby.  And every minute you spend providing breastmilk to your baby is worth it.

Misti Ryan, BSN, RN, CCE, IBCLC, RLC

Misti has been working with moms and babies for over 12 years as an L & D nurse, childbirth educator and LLL leader.  She is married and a mom of 5 breastfed children.  Misti certified as an IBCLC in 2011 and is co-owner of Bay Area Breastfeeding and Education, a private practice lactation consulting business in Houston, Texas and surrounding suburbs.  She can also be found on Facebook at: www.facebook.com/bayareabreastfeeding and blogging at: www.bayareabreastfeeding.wordpress.com

When It's Time to Find a New Lactation Consultant

Recently, I have noticed many conversations online where breastfeeding mothers have expressed feelings of despair and frustration that their needs were not met while working with a lactation consultant. In fact, this isn't just happening online, but also in my community as well. 

Last week, my appointment with a new mom started off with her explaining that she was feeling very fragile and insecure, as she had already met with a lactation consultant and it didn't go so well.  When I asked her what happened, she described a lactation consultation that had gone completely wrong.  In a nutshell, the IBCLC told the mom that if she followed her pediatrician's advice (which I actually thought was quite reasonable advice) that she would completely lose her already low milk supply (which was absolutely not the case) and that she should just consider bottle feeding her baby if her nipples hurt that badly.  At the end of the consultation, the mom felt completely defeated and that she was a horrible mom for wanting to follow her pediatrician's advice. 

This story absolutely infuriated me! 

How could this have happened?  How could this wonderful mom, who had been proactive about resolving some minimal breastfeeding challenges, suddenly feel inadequate and ill-equipped to take care of her new baby?  How could this lactation consultant have had such a negative impact on this woman's elf-esteem, especially during such a vulnerable time?

In the midst of all of these negative stories, I felt compelled to write an article listing some situations that indicate it is time to see a new lactation consultant.  I'd like to apologize upfront.  Some may find that the tone of this article is somewhat harsh, but I have to say that I am pretty fired up right now.  I am angry about how breastfeeding mothers are mistreated.

When it is time to find a new lactation consultant? 

The lactation consultant makes you feel like a bad mother

While the purpose for a lactation appointment with me is to improve breastfeeding challenges, my utmost goal is that I help the breastfeeding mom see what she is already doing well and to offer positive emotional support and guidance.  Being a new mother can be incredibly overwhelming and I remember second guessing everything I was doing, as this was completely unfamiliar territory.  No matter what the situation, there is always something that you are doing well and that is what the appointment should build upon.  If you are made to feel like you are doing everything wrong, then it's time to seek the help of a new practitioner. 

The lactation consultant doesn't provide you with  reasonable rationale for her recommendations

You are allowed to question any advice given to you by any practitioner... that is your right as a parent.  If something doesn't seem correct, ask the LC for her rationale.  If she can't provide you with a reason for her suggestions, or she seems upset or bothered that you would question her recommendations, the it's time to find a new LC.

The lactation consultant seems more concerned that you breastfeed than meeting your individual needs

Yes, breastfeeding can be great!  Yes, breastmilk is far superior to formula!  Yes, you clearly want breastfeeding to 'work'.... why else would you have called an LC for help in the first place???  Yet, while breastfeeding is optimal for your health and your baby's health, the first questions that an LC should ask is, "What do you want to work on today and what are your breastfeeding goals?"  The consultation should be all about YOU and YOUR needs, not what the LC thinks is most important.

You don't feel like there is a positive connection between the two of you

When you work with a lactation consultant, you should feel like this person truly cares about you and your child. Your needs and your baby's needs should come first.  Our mission is to help you meet those needs in the simplest way possible.  Sometimes the path to meet your goals is not easy...sometimes it is downright complicated (think twins with tongue-ties!),  but you should feel like the lactation consultant cares about you and your baby, both physically and emotionally.  She should support your wishes and help you to meet your goal.  And if your goal changes, she should stand behind you for those as well.

You just want a second opinion

Think about it, if you were dealing with a medical issue and you didn't totally like the doctor's recommendation, wouldn't you seek a second opinion?  When our son was having behavioral and developmental challenges, we not only spoke with our pediatrician, but also an osteopath, a chiropractor, and a nutritionist.  It was the osteopath that finally figured out that my son had a gluten intolerance, not a developmental delay, and we were so thankful that we had an opportunity to seek out additional opinions.  There have been times when I have recommended my clients to seek a second opinion from a physician, chiropractor, and even another local lactation consultant, if I felt that it would help her baby.  There's no shame is saying that you would like a second opinion.

As with all things related to breastfeeding and parenting, you should always feel supported, not judged, by your health care providers.  Breastfeeding CAN be wonderful and relaxing and joyous and fulfilling, especially if you surround yourself with supportive, caring, and nurturing family, friends, and practitioners!   There are many qualified International Board Certified Lactation Consultants (IBCLCs), around the world, who would love to provide you with the type of support you desire.  You deserve to be with the one who's the best fit for you!

*** As a side note, these scenarios could also indicate a reason to find ANY new health practitioner, as they are relatable to many different professions as well.

My Attempt to Trust My Milk Supply

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Krystyn Brintle'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, Krystyn, for sharing your story with us!  Your story is truly inspirational!

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

A Brief History of My Breastfeeding Journey (So Far) in Numbers:

32 - Number of weeks along in pregnancy when a midwife suggested I meet with an IBCLC to discuss potential breastfeeding complications

75 - Percentage of tissue found in my breasts after examination by IBCLC, compared to average woman

50/50 - Odds given that I would need to supplement

27 - Number of herb capsules (goat's rue, alfalfa and malunggay) I began taking daily after my initial consultation with the IBCLC

7 - Number of days my daughter spent in the NICU following my unplanned c-section, further jeopardizing our planned breastfeeding relationship

3 - Number of weeks it took for my daughter to gain back to her birth weight, necessitating an extra weight check with her doctor and hours of agonizing over whether my breasts were failing us both

12 1/4 - Pounds my daughter weighs as of this afternoon (13 weeks), which averages to her gaining about half an ounce a day – perfectly reasonable for a breastfed baby

17,453,519 - Number of times I've doubted my supply, or number of hours spent searching the Internet for info re: IGT, hypoplastic breasts or signs your baby is getting enough milk

0 - Number of times I will ever judge a mom who gives her baby formula, because I know now that there are extenuating circumstances beyond our control that can make the dream of EBF impossible

---------

With my borderline PCOS diagnosis and lifelong struggle with weight, my biggest concern in pregnancy was eating healthy and exercising enough to prevent gestational diabetes. Breastfeeding complications
were simply not on my radar - my older sister is still nursing my three-and-a-half-year-old nephew - until my 32-week appointment. I mentioned that I thought I was leaking a little colostrum; the midwife did a brief examination and suggested that, considering the PCOS issue, I meet with an IBCLC to discuss any potential hurdles. I made the appointment, not entirely clear about what these hurdles might be. Sure, my breasts hadn't changed during pregnancy - but I convinced myself that was because milk comes in after birth. After a physical examination, Ellen (the IBCLC) explained that there was a term for what I had always considered my unsightly breasts - I had breast hypoplasia. She went on to estimate I had about 75% of the expected breast tissue and that the "plumbing" involved in making my milk did not extend fully through my breasts and into my chest. She gave me 50/50 odds that I'd need to supplement. We went through a list of various foods and supplements to help increase supply; she explained no research had shown that prenatal use of galactagogues affects milk, but that it couldn't hurt to try. At least it felt like I was trying to help my girl, buying all the expensive herbs and choking them down three times a day.

After an unplanned c-section, my daughter was taken to the NICU for meconium aspiration. She was placed under an oxygen hood and was unable to nurse for the first 24 hours. I had read about the difficulties a c-section could pose in terms of breastfeeding; adding to that the intense stress of her condition, in addition to my IGT, I feared breastfeeding was not in the cards for us.

We worked hard to establish our nursing relationship while she was in the NICU, requesting help from the IBCLCs on staff for nearly every feeding. We supplemented with donor milk while waiting for my milk to come in, were introduced to the stressful world of pre- and post-feeding weighs - but by time she was discharged, she was relying solely on me and my breasts for her nourishment.

I scheduled LC appointments weekly. We did pre- and post-feeding weighs and determined she was getting two ounces when she nursed on both sides. When she hadn't gained her birth weight back by two weeks, I began to fear the worst: the odds weren't in my favor, and I'd have to figure out the SNS I'd requested in the hospital "just in case." My daughter's pediatrician requested we return the following week for a weight check, and she also requested I nurse the baby every two hours (instead of letting her sleep for longer stretches like I had been).

The stress of the situation really took its toll. I couldn't keep food down, I wouldn't allow myself to go to sleep for fear of missing a feeding. My midwife diagnosed PPD and told me I needed to allow myself to be okay with my husband handling a feeding so that I could get four continuous hours of sleep each day. When pumping wasn't netting enough, and when I felt my sanity slipping away due to the stress, I caved and bought a can of formula. Over the course of a weekend, my daughter had four formula bottles. And I felt like a failure.

But I also really slept for the first time since she was born. I relaxed a little, knowing she was eating even if my body wasn't producing her food. I started accepting the idea that breastfeeding didn’t have to be an all-or-nothing proposition.

When we went back to her doctor for the weight check, she had gained back to her birth weight plus an extra ounce. Knowing that all but four feedings of that weight gain came from me was the proudest moment in my young motherhood. We had our third - and final - LC appointment the following day, where the scale showed she took 78 mL of milk (and promptly refluxed 18 mL back). Ellen told me I could start weaning off the herbs and that, somehow, I was the exception to the IGT rule.

My lovely Liv has not had another formula bottle. Despite her extreme refluxing, she's gaining appropriately and is in the 50th percentile for weight - right where she should be. After everything I've been through, I've found that I am a lot less judgmental when I see mothers feeding their babies formula.  There are plenty of reasons why a mom might have to supplement, or maybe the stress of trying to breastfeed was too much - now that I've been there myself, I've come to understand that moms are just trying to do the best they can.

I'm only 13 weeks in, and my IGT story has a happier ending than most, but I can honestly say I'm incredibly proud of how I've handled what was an obstacle-laden path to breastfeeding and am so proud of the other mamas out there who are doing the same!

Krystyn Brintle

A Farewell to Na-Na: When It's Time to Wean

Written by guest blogger, Jessica Lang Kosa

My youngest is weaning. Most people assume she has long since stopped nursing, since she goes to preschool, eats everything, and has sleepovers with the grandparents.   She still usually nurses at bedtime, but sometimes forgets to ask.  Occasionally she'll drift off, and then bolt up, announcing "bedtime nana!"  She seems to be on roughly the same timetable as her older brother and sister, so I suspect she'll forget more and more often, and be weaned altogether in a few months.

Mostly, I'll be glad. My milk supply is now very low, so nursing can feel annoying sometimes. And in our household, weaning is a right of passage marked by a family celebration…. with balloons and favorite foods.  It's kind of her first graduation party.

Like all my kids' milestones, it will also be bittersweet.  I will miss the potent mothering tool that toddler nursing has been, and I will miss this part of her life.

I'll miss the magic ability to calm an overtired kiddo and stop a tantrum; from meltdown to melting-in-my-lap with the flip of a breast.

I’ll miss the intense physicality of the nursing connection, and the way it relaxes both of us.  Coming home from work used to trigger a demand of “nana on couch!” I’d sit right down on the sofa to nurse her, reconnecting first thing, rather than getting swept into the flurry of household activity.

I’ll miss nana-as-medicine.  'Tis the season for colds and bugs.  Preschool germs have been so much more manageable since I could nurse her through them when she didn't feel like eating or drinking.

I won't particularly miss some of the boundary negotiations, but I'm glad we had them. Learning as a toddler that it’s not OK to strip-search mommy is a great introduction to personal space.  It's been a opportunity to teach that critical concept: other people, even mommy, have feelings.  Someday, when she's a young woman in a relationship, I hope her subconscious will remember my gentle limit-setting and guide her towards taking care of herself while loving someone else.

Since she's my third, I know how fast they grow up.  At preschool, she has friends her own age and a cubby and art projects with her name on them.  She helps make her own lunch, and proudly packs it in her backpack. As she discovers the outside world, with all its glory and its hazards, I will cheer her on, but miss the simplicity of her time as a baby.  She’s a long way from the tiny infant I used to tote around with me, but nursing allowed me to see and feed the baby inside her.  Watching her outgrow nursing in her own time has been a privilege.  Weaning has been a microcosm of holding on while letting go.

Jessica Lang Kosa is an IBCLC, providing in-home lactation consulting for families in Greater Boston, and breastfeeding education for professionals around New England.  

Connect with her at:

http://motherfeeding.com

http://www.facebook.com/motherfeeding

Common Concerns - Do I Have Mastitis?

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!

Why is my breast so swollen???

Does your breast suddenly feel like it is going to explode, like a balloon, off of your chest?  Does it hurt to breastfeed, yet you know you have to remove your milk ASAP?  Are you starting to feel exhausted and lethargic... not something that can just be blamed on being a new mom?  Sounds like you may have mastitis!

What is mastitis?

Mastitis is inflammation of the breast, usually (although not always) from a bacterial infection.  Mastitis happens when milk gets stuck in the milk ducts and that milk stasis  causes engorgement and inflammation.  Not all mastitis is an infection of the breast and can often be treated with natural remedies.  Indications of an infection, and the need for antibiotics, are:

• Mastitis in both breasts

• Baby is less than 2 weeks old or you were just hospitalized

• Nipple has obvious infection

• Pus/blood in the milk

• Red streaking is present

• Temperature increases suddenly

• Symptoms are sudden and severe

(per Kellymom, Plugged Ducts and Mastitis)

How will I know if I have mastitis?

Mastitis often starts as a plugged duct.  This pesky blockage starts to get harder and more painful over a few hours as the milk stays 'stuck' in the milk duct.  As with a plugged duct, mastitis typically affects one breast, rather than both.  Plugged ducts often resolve within a few hours to a few days, and while uncomfortable and tender, they are relieved with a few comfort measures over time. 

Mastitis, on the other hand, has a few additional symptoms:

• Painful, hot area on the breast

• Breast may have a red streak over the hardened area

• Breast looks swollen and the affected area is tight and uncomfortable

• Mom feels like she has the flu - extreme exhaustion, achy, chills

How can I treat mastitis?

Once you start feeling like your plugged duct is exacerbating into mastitis, you want to start treating it as quickly as possible.  Mastitis can often be treated with many natural remedies, rather than needing antibiotics.  The reason we want to leave antibiotics as a last resort is that they kill off both the bad bacteria, as well as the good bacteria, leaving your body wide open for increasing your risk for thrush... Huge bummer!

Here is a list of my personal favorite natural remedies for treating mastitis:

• Bed rest! This is your body's way of telling you it's time to rest and take care of yourself. Think of yourself as having the flu. While mastitis is not contagious, you definitely need to remove your milk and feed your baby. The best way to do this is to spend the rest of your day in bed.

• Fluids and nourishment. Drink lots of fluids (like water, coconut water, and green smoothies) and eat warm nourishing meals (like soup.) The laundry can wait, I promise!

• Remove milk every 2-3 hours. If it hurts too much to breastfeed on the side with mastitis, you will need to pump instead.

• Castor oil compresses - Castor oil used topically helps to move things under the skin. Pour castor oil on a face cloth (it stains, so not on a nice one) and place the face cloth on your sore breast. Place a heating pad over the face cloth, as the heat will help the body absorb the castor oil and move the blockage. Check every 20 minutes and use as long as it takes to soften your breast.

• Dandelion tincture. Dandelion is a natural antibiotic and a great way to battle any infection. Two droppers full, 3-4 times a day, can often do the trick. The flavor is definitely intense, but well worth it!

• Vitamin C and Echinacea. Mastitis is your body's way of telling you it's time to slow down. Both vitamin C and Echinacea boost your body's immune system. A safe dose to take is 3000-5000mg/day (mega dose to be used acutely during mastitis) of Vitamin C and 900mg of Echinacea per day (acutely).

• Homeopathic belladonna. These tiny little pellets can make a world of difference to reduce your temperature while battling mastitis. Plus, you cannot overdose on homeopathy... if it isn't working, then you just stop taking it. 2-3 pellets, under the tongue, every 30 minutes for up to 6 hours.

How can I prevent mastitis?

Once you get mastitis, you definitely never want to get it again, so how can you prevent it from happening even in the first place?

Ways to prevent mastitis:

• Effective and frequent removal of milk. Engorgement or ineffective removal of milk can cause your milk to get backed up in the ductal system, causing inflammation and mastitis. Tongue-ties, latching problems, oversupply, limiting baby's time at breast, nipple shields, sleepy baby, and skipped feedings can all decrease the baby's effectiveness at breast, thereby allowing the breast to fill up too much.

• Make sure certain areas of your breast are not being constricted. Tight, under wire bras and restrictive clothing can put undo pressure on a particular area of your breast, which may cause a plugged duct.

• Seek help ASAP when you have cracked or bleeding nipples, as these wounds increase your risk for infection.

• Support your immune system. Having a new baby can be draining on your body and immune system, especially if you are recovering from an exhausting birth, cesarean, or just too many visitors in your space. In many cultures, new moms don't leave their homes for 6 weeks and their family and friends cook all of her meals and help her take care of her new baby. Unfortunately, in the United States, that is simply not the norm. When our immune system is run down, we are much more susceptible to illness and inflammation. Limit visitors in the first few weeks to only HELPFUL visitors, and ask them to bring food. Relax and rest during and in between breastfeeding sessions to let your body heal after the birth. Eat warm, nourishing foods to keep your blood flowing and your body healthy. Take an Omega 3 supplement (from a reputable company, like Nordic Naturals) to reduce inflammation.

Disclaimer: Most herbal treatments have not been thoroughly researched, particularly in regard to lactation. Herbs are drugs, and some caution is necessary. I am presenting this data as is, without any warranty of any kind, express or implied, and am not liable for its accuracy nor for any loss or damage caused by a user’s reliance on this information.

Breastfeeding and Going Back to Work: Roundup

With so many of my friends and breastfeeding support group mamas going back to work by the end of the year, I thought I would do a round-up of my favorite Going Back to Workarticles (written by me, as well as some of my colleagues.)

Here's what you'll find on the San Diego Breastfeeding Center website:

Hi ho, Hi ho, It's Off to Work We Go: Part 1 - Starting the pumping and bottle feeding routine.

Hi ho, Hi ho, It's Off to Work We Go: Part 2 - Making plans with your employer and your rights as a breastfeeding/pumping/working mom.

How Long Does my Breast Milk Stay Fresh? - Take the guesswork out of how long your pumped milk stays fresh.  Here are all of the answers you'll need.

Help!  I am Going Back to Work and My Baby Won't Take a Bottle! - Top 10 tricks to get your little one to take a bottle before you return to work.

So, You’re Going Back to Work - one of my favorite memoirs from a local breastfeeding, working mom!

Now that you've perused all of our articles (and I can guarantee there are more waiting to be written over the upcoming months), here are a few of my favorite resources beyond our web site:

United States Breastfeeding Committee - FAQ's: Break Time for Nursing Mothers

Kellymom - Links: Working and Pumping Tips

Toddler Nursing Part II – Toddler vs. Breastfeeding

Written by guest blogger, Andrea J. Blanco, IBCLC

Have you ever read Dinosaur vs. Bedtime by Bob Shea?

“ROAR!! I’m a dinosaur! ROAR! NOTHING CAN STOP ME!”

It’s a cute little book about this dinosaur who faces many challenges, and wins all but one. The dinosaur is FOR SURE a toddler. I just know it.

In my previous post, we talked about some of the reasons why nursing a toddler can be a helpful transition for you and your little one. Dealing with a little person who has so many changes going on all at once can feel a lot like those battles in Dinosaur vs. Bedtime. Here are some suggestions for turning the tables on your little dinosaur or dinosaurette.

I want to keep nursing, but am being pressured to quit.

In this society, if you happen to be nursing your 3 month old, you are in the minority. Six months? You are an anomaly. If you’ve gotten to the point where you’re thinking of nursing your toddler, then it is safe to assume that not everyone around you will understand or agree that you are doing a very important, *normal* thing. However, dealing with that lack of support is crucial to your wellbeing and to the likely continuation of your breastfeeding relationship. So what can you do if the people closest to you don’t necessarily share your same enthusiasm?

First, have a conversation about their concerns. Be a good listener and find out why continued nursing is bothersome for them. It’s rarely about YOU nursing YOUR toddler that is offensive to them and has to do with other concerns, like spending time with you (in the case of a partner) or spending time with the baby (in the case of extended family) or concerns (real or perceived) over your work duties (in the case of an employer). If you’re able to get to the real issue for which breastfeeding is taking the hit, making small changes to show you are conscientious of their concerns will get the attention off the nursing and you and your toddler can continue your breastfeeding relationship.

There are times when despite your best efforts, it will feel like a lonely journey. However, in this day and age, that needn’t be the case. A lot of communities offer breastfeeding support groups and even breastfeeding toddler groups. Check with your local hospital or La Leche League chapter to see if there are any in your area. When my first was approaching toddlerhood, I found my support through online forums where I met some great, like-minded mommas whose virtual support was key to our continued breastfeeding success. If you’re on Facebook, become a member of one of the many groups there are offering mother-to-mother support. Are you on Twitter? Search #breastfeeding and for the most part, you’ll be met with tons of virtual kindness. What about downloading some great podcasts from The Boob Group? You don’t need an army of people cheering your name – sometimes one person who gets what you are going through is enough. Toddler Nursing vs. the World? Toddler Nursing WINS!

My toddler is very demanding about wanting to nurse, even when I don’t want to.

As you’ve probably realized, toddlers are VERY demanding about EVERYTHING. Nursing will definitely not be excluded. It’s easy to continue to fall into this routine of “on-demand” nursing when you’ve been at it for so long, but with your child’s developing language comes the understanding that we live in a world where patience and manners are necessary and there are boundaries. While breastfeeding does still serve a nutritional purpose in that second year of life, it probably isn’t what your toddler is surviving on alone. In the same way that you are curbing the throwing of sippy cups on the floor so hard that the top comes off and the water (if you’re lucky, it’s just water!) spills everywhere, you can begin to curb the octopus arms toddlers suddenly develop when trying to get to the breast. Model the behavior you wish to see and be gentle, but firm about it (laughing or smiling and cooing at how cute it is that your little one grabs at your shirt and pulls so hard while yelling for some milkies when you’re trying to say no isn’t very effective). Octopus Hands vs. Nursing Manners? Nursing Manners WIN!

But, what if I’m out and my toddler still wants to nurse?

Maybe nursing a baby in public has been a challenge for you. If so, then the idea of nursing a toddler in public is really intimidating. Because toddlers are all about exploring the world around them, they are [generally] easy to distract when you’re out. There was, however, that one time at mass when my little angel decided that the crayons and snacks I’d brought along weren’t going to cut it. Nothing like hearing “BOOOOOBIEEEEEE” being yelled out in a quiet room built to echo. As mortified as I may have been at the moment, it’s also one of my most cherished memories. If distraction isn’t working, with a little quick thinking, there’s always a quiet place you and your little one can go for that needed pit stop, breastfeeding under the choir robes included. Also, while you are aware you’re nursing a toddler, most people wouldn’t even think of it, so just as in the case of a baby, to a passerby, it can look like your child is sleeping on your lap, and nothing else (this, of course, doesn’t apply if your son has already announced his plans to the entire congregation). Boobie vs. Echo? Boobie WINS!

When all else fails, don’t forget – you can set boundaries. It doesn’t have to be all or nothing. I’ve dealt with countless clients who, by the time their child gets to a certain age, are having a hard time continuing the nursing relationship because of these demanding moments. If you are at your wit’s end and feel like you want to keep nursing but…, try to find a middle ground. If you are able to target the most stressful times and/or nursing behaviors, you can then find ways to work around them. Maybe that means finding gentle ways to say no by way of distraction more often than you are used to, but if it goes hand in hand with keeping your sanity and in turn, continuing your nursing relationship, then, whether your toddler agrees with you at the particular moment or not, it’s still a win/win situation. Demanding Toddler vs. Boundaries? Boundaries WIN!

Nursing a toddler, like having a toddler, isn’t always easy, but if you so happen to embark on the journey, you may find it is always worth it. It gives you another mothering tool to help navigate those battlefield moments and is a sure fire way to connect with your child amidst this busy life we lead. One day my little one got his finger caught in the door and came wobbling over to me, tears of pain streaming down his soft, round toddler cheeks. Instinctively, I lowered my shirt and offered the breast. The older one, worried about his brother, came over and said to him “You see, B? There is love in there so you’ll be ok.” I realized the only reason he felt that way was because of what he experienced at the breast by way of watching and doing. I couldn’t have asked for a bigger reward from my nursing relationships. Toddler vs. Breastfeeding? Love always wins. 

Andrea Blanco is an International Board Certified Lactation Consultant at The Milk Collective Lactation Care, working with families in the Miami/Ft. Lauderdale area. She is the proud mom of 2 loving, spirited boys, who teach her humility, patience, humor, and the rules to more sports than she thought she’d need to know every day. When she’s not helping families achieve their breastfeeding goals, you can find her on the sidelines, at karate tournaments, or with her toes in the sand. She can also be found at themilkcollective.co, on Instagram @themilkcollective_ , facebook.com/themilkcollectivelactation or by email at: andrea@themilkcollective.co.

Breastfeeding with Hypoplasia

Today, on the San Diego Breastfeeding Center blog, I'm honored to share Fakiha Khan'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, Fakiha, for sharing your story with us!  It's stories like yours that make me want to be the best mom I can be! 

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When my son was born 2 and 1/2 years ago, I wanted nothing more than to be able to breastfeed him.  He was in the NICU for a week after he was born, and I really did not get to nurse him until he was a week old.  By that point, he had trouble latching on, and my milk just was not coming in.  For the next five weeks, I did what I could.  I tried to nurse him every hour and a half, I pumped, I took herbs, and I finally went to see a lactation consultant. 

I will never forget how shocked she was that my son transferred only 1/2 an ounce at the age of five weeks.  Other than telling me to continue pumping with a hospital grade pump, the consultant had no other ideas of why I was not producing milk.  She kept saying to me - it is the most natural thing to produce milk.  It's all about demand and supply.  If you keep putting him on your breast, the milk will come. Well, I kept trying, and after weeks of emotional torture and physical discomfort, I finally gave up.  I was producing an ounce of milk from both breasts at that point.  And, giving up was not easy.  I felt like a complete failure, like I could not do the thing that is supposed to be so natural. 

I got a second chance when my daughter was born two months ago.  I figured that, with my son, I just didn't get started on nursing quickly enough.  This time, I decided to be proactive even before the baby was born.  I talked to people and a lactation consultant prior to giving birth.  This consultant suggested that I might have a physiological problem such as hypoplasia, but I would not know until I got checked out.  I didn't get a chance to do so before I gave birth, but I went into the birth with hope of doing better this time. 

When the baby was born, I immediately put her on my chest and I nursed her within a half hour of birth; I kept her with me nonstop, nursing her whenever I could.  But, within the first two days, it was clear that I was not even making enough colostrum.  I had to give her some formula.  My fuller colostrum finally came in at day 3 and the milk first came in on day 5.  But, despite nursing every hour and a half, the baby was still fussing and clearly unsatisfied. 

Those old feelings of frustration and failure came rushing back to me.  I kept thinking, this is supposed to be so natural.  Every mammal mother makes milk for her child, yet, I can't feed my baby who is trying so hard to get out a few drops of milk from me.  All of the instructions from the breastfeeding class kept repeating in my head.  I kept thinking, maybe today I will suddenly make the milk my baby needs, maybe today.   

Before giving up, I went to see my doctor to find out if I had hypoplasia.  The doctor told me that hypoplasia was not possible, as I did not have the physical signs (tubular breasts that are set far apart) and because I was making some milk even if it was only an ounce at a time.  So, I thought, ok, there has to be something I can do.  So, I did some research and found out about fenugreek.  I began taking that, and immediately I got a boost in my milk supply.  But, then within a week, it started going back down again.  At this point, I was ready to scream, but before giving up, I decided to consult another lactation consultant.

As it happened to be, this consultant specialized in low milk supply.  She finally told me what I had been suspecting - I have insufficient glandular tissue.  The consultant suggested a number of herbs and medication, all of which I tried.  Again, my milk supply went up very quickly, but now after 3 weeks, I see it going back down again.  I still don't know if any of the medications or herbs (which I understand work by increasing hormone levels) really work with insufficient glandular tissue.  Can they create tissue where none exists?  No one can seem to answer this question for me. 

Now, I continue pumping during the day, saving the little bit of milk I made (about an ounce and half), and mixing it with formula.  I nurse when I can and regularly throughout the night.  But, I have resolved myself to the fact that I will not be able to exclusively rely on breast milk.  It's a very sad realization, and I wish I had a solution, something to fix this problem, or even a bit more information.  Alas, I do the only thing I can and, in the process, laugh at myself when I am proudly toting home the four-ounces of breast milk I take home after pumping 3 to 4 times at work.  To a regular breastfeeding mom, four ounces is probably how much she produces in one feeding.  For me, it's a day-long effort, and at the end of the day, I carry it home with the same pride as if I had just discovered gold!