Breastfeeding in Public is Legal in California, Right?

Recently San Diego, California (aka America’s Finest City) has been hit with some pretty obnoxious breastfeeding-in-public harassment situations.  While I assumed that most Californians knew that breastfeeding in public was legal in our wonderful state, apparently, most people don’t.  Even my husband, who is an attorney and married to a lactation consultant, was unaware that there was actually a California law that protected a woman’s right to nurse in public. 

HOW IS THIS POSSIBLE????

First and foremost, it is shocking to me that we actually need a law to protect a woman’s right to feed her baby in public, but yet, I must remind myself that most people think breasts are for fun rather than functionality.

Secondly, why don’t most people know that this law exists? 

Third, how is it possible that EVEN WITH a law stating a woman can breastfeeding in public, mothers are STILL being harassed for doing so?

What does the California law actually say?

According to California Civil Code, section 43.3, “Notwithstanding any other provision of law, a mother may breastfeed her child in any location, public or private, except the private home or residence of another, where the mother and the child are otherwise authorized to be present.” 

In laymen’s terms: a mother may breastfeed her child in ANY public space!

Are you ready to hear about the situation where a mother was harassed for nursing in public?

Hope you’re sitting down for this one!

On January 8, 2013, Rebecca Garcia was breastfeeding her 8 month old son in one of the courtrooms at the Chula Vista Courthouse.  When her son started to fuss, the bailiff, Deputy Chong, approached Rebecca and asked what she was doing.  When Rebecca said she was breastfeeding, Deputy Chong stated loudly, in front of the entire courtroom, “You should be ashamed of yourself, it’s inappropriate, you need to leave and go outside, do that somewhere else private, and it is illegal to breastfeed in court!”

Rebecca reported that, “I felt embarrassed and ashamed because of the way that the Deputy was staring me down, so I unlatched my child thinking I should leave.  I did not want to interrupt the proceedings and I was so embarrassed and started to get very emotional. The judge heard the commotion and stopped the court and asked what was going on.  I explained to her what the deputy said and she said that I could stay. She also asked me if I had a cover, which I did, and gave permission to continue breastfeeding.  I was relieved to hear this from her because the Deputy was so rude and uncaring.” 

Unfortunately, Rebecca’s son started to fuss again, so she chose to leave the courtroom and breastfeed in a cubicle in the hallway, due to her embarrassment from the confrontation. 

This is where I hope you’re sitting down….

Deputy Chong followed Rebecca out of the courtroom and continued to harass her for breastfeeding in the courtroom, making many disparaging comments, including his opinion that she should be ashamed of herself.  At one point, Rebecca attempted to leave Deputy Chong’s presence, and Deputy Chong went so far as to physically block her way out of the cubicle so that he could continue the harassment.  Finally, even when Rebecca exited the cubicle, Deputy Chong followed her to say a few more disparaging comments, finishing with, “I don’t know what kind of world you live in, but it’s not okay to breastfeed in public.”

Following this incident, Rebecca filed a complaint with Deputy Chong’s supervisor.  The supervisor informed Rebecca that she would speak with Deputy Chong, but not to expect a phone call describing the resolution or any form of apology.

Again, how is this possible?  The fact that Rebecca’s right was so egregiously violated inside of a California State courtroom by a California State employee shows that awareness of this law is clearly lacking.

Fortunately, Rebecca decided that her story needed to be heard.  Following this incident, she contacted our San Diego County Breastfeeding Coalition.  Katherine Doan, another breastfeeding mom who happened to be a witness to this incident, contacted me through our San Diego Breastfeeding Center Facebook page to see if I could help as well.  I was so moved by Rebecca’s story (as were all of you), that I knew I had to do something!  Plus, ironically just 1 week before I found out about this incident, I had written an article for Lactation Matters about how I planned to create change in my community for protecting a mother’s right to breastfeed in public.  Coincidence…. I think not!

Here’s what Rebecca and I have done so far….

We’ve contacted the San Diego County Courts to request a meeting with their executive officer to discuss the following:

• A request to place a substantial segment in the court’s annual discrimination training to educate their staff regarding the language of California Civil code, section 43.3, that states a woman can breastfeed in public.
• A request that ALL San Diego courthouses display ‘Breastfeeding Welcome Here’ stickers.
• A demand that Rebecca Garcia receives a formal, written apology for the actions of Deputy Chong.

Due to the publicity on our Facebook page, Caridad Sanchez, a staff member from Senator Barbara Boxer’s office, contacted me and was moved to action.  Caridad was appalled by Rebecca's nursing in public incident and inspired to help remedy this situation, as well as make sure that this doesn't continue to happen to other breastfeeding mothers.  Caridad and I plan to meet in the next few weeks to discuss how she can help connect me with state legislators to pursue an enforcement provision to the CA state law, as well as other possibilities to protect the rights of breastfeeding women.

It is my every hope that this situation resolves in a peaceful and compassionate manner.  I will continue to update this blog as more details and resolutions become available. 

In the meantime, here’s what you can do to make a difference:

• Next time you see a mother breastfeeding in public, please smile at her and show your support.
• Learn about the laws in your state that protect the rights of mothers breastfeeding in public: United States Breastfeeding Laws at Nursing Freedom.
• If you have been harassed while nursing in public, call the Best for Babes NIP Harassment Hotline to report the incident: 1-855-NIP-FREE

The more we can ‘normalize’ breastfeeding in public, or breastfeeding in general, the less common this form of harassment will be.

Supplement Options: Donor Breastmilk, Milk Banks, and Formula

This past week, we released one of my most favorite episodes on The Boob Group: Low Milk Supply: Donor Milk, Milk Banks, and Formula.  I had the esteemed pleasure of interviewing Amber McCann, an International Board Certified Lactation Consultant, fierce supporter of all things mothering, and dear friend.  I wanted to know what options were out there for mothers who needed to supplement their babies, as well as the pros and cons of each.

I pulled out the most salient points for this blog article, but you can click here to listen to the Boob Group episode in its entirety: Low Milk Supply: Donor Milk, Milk Banks, and Formula.

What are your options if you need to supplement your baby?

When feeding an infant, the World Health Organization lists a hierarchy:

• Milk taken directly from the mother’s breast
• Expressed milk from baby’s mother
• Expressed milk from another mother (wet nurse, donor milk, milk from a milk bank, etc.)
• Breastmilk substitute (formula)

Is it safe to offer your baby another woman’s breastmilk?

Making the decision as to what to feed your baby should never be taken lightly.  It is important when one is considering offering donor breastmilk to their baby to balance the risks and benefits.  You should always consider asking the potential donor mom for a copy of her prenatal blood work to check for sexually transmitted diseases and other potential pathogens.  It is also important to ask questions about lifestyle choices, such as alcohol use, smoking, diet, medication use, etc.  Eats on Feets has a Resource Guide with great lists of questions for both the donor and recipient of expressed breastmilk, as well as an extensive list of health considerations.

What are the main benefits of using donor milk?

• It’s breastmilk!  It has everything your baby needs, nutritionally and immunologically.
• It has every benefit that a mother’s own milk would have.

What concerns may arise when using donor milk?

• A number of pathogens enter into human milk if a mother is infected, however few diseases can be transmitted through human milk, itself. 
• The main diseases that cause concerns are HTLV, HIV, and CMV.  CMV is typically only a challenge for premature infants.  Fortunately, HTLV can be deactivated by freezing and HIV by flash heating.

Where can a mother find someone to donate milk?

• Start with your own social group.  If you have friends or friend of friends who are breastfeeding, there is always a chance that they or someone they know has an excess supply in their freezer or would be willing to pump for you, if they knew there was a need.  All you have to do is ask!
• Informal milk groups, such as Eats on Feets and Human Milk for Human Babies
• Milk Banks

What are milk banks?

Milk banks are non-profit organizations where breastfeeding moms can donate breastmilk, should they fit the milk bank’s criteria.  The Human Milk Banking Association of North America requires that their donors be in good health, not regularly on most medications or herbal supplements, willing to undergo additional blood testing, and be willing to donate at least 100 oz.  Donated human milk is pasteurized and then either sold to hospitals to feed critically ill babies or to families who purchase directly from the milk bank. 

How should I choose between donor milk, milk from a milk bank, or formula?

This is such a hard decision and definitely not one to take lightly!  What is most important is to look at your needs, your baby’s needs, what you feel most comfortable supplementing with, and what’s the best choice for your family.  So, sit down, research all of your options, and choose with your heart and knowledge. 

As a follow up to this article, several moms submitted stories about their experiences using donor milk or donating to a friend or milk bank.  Stay tuned, as we share them during the rest of the week!

If you have a story about using donor milk or donating breastmilk to a friend or milk bank, and you want to share it with our readers, please email it to me at robinkaplan@sdbfc.com.

Did you have to supplement your baby with donor milk, milk from a milk bank, or formula? 

How did you choose which supplement to use?

Update on 2013-01-24 15:36 by Robin

Here's your Call to Action:

Too many breastfeeding mothers have no idea that human milk sharing is an option and we want to change that!

If you are a breastfeeding mother and have used donor milk or have donated your own milk, we would love to hear your story!  Other breastfeeding moms need your support!  Just knowing that someone else out there went through a similar experience.... well, that can make all of the difference in how a mother views her own breastfeeding experience!  Your stories are beyond powerful!  They need to be heard!

If you would like to have your stories posted on our website, as well as The Boob Group's website, please send your story to robinkaplan@sdbfc.com.  

We will begin posting your stories as soon as we receive them! 

Toddler Nursing Part III - Super Breastfed Baby!

Written by guest blogger, Andrea J. Blanco, IBCLC

My seven year old is really, really into the Super Diaper Baby series. So much so (embarrassing story for which I will pay for dearly in 10 years coming up right now) that the other day, he fished through all the dirty clothes to find 8 (yes, 8!!!!) underwear to put on simultaneously along with a cape so that he could reenact parts of the book. I’m not entirely sure why clean underwear couldn’t be used, but hey, welcome to the gnarly world of 7 year old boys. I’m still getting adjusted.  Anyway, whenever he yells “SUPER DIAPER BABY!!” all I hear is “SUPER BREASTFED BABY!!!” (you better have read that in your booming announcer voice; if not, please go back and reread).

Super Breastfed Baby is not a baby anymore. He’s a toddler who can leap off everything, get all bruised up and bounce right back up. He can run amazing distances while laughing hysterically at you chasing him and fall over 15 times, but who’s counting? He scoffs at the mere thought of you trying to clean. Or sit. Or cook. Or sleep. He knows what he wants and isn’t taking no for an answer. This is the breastfed baby magnified – the one that I was reminded of as I read some of your comments to Toddler Nursing Part I and Toddler Nursing Part II of the Toddler series. Super Breastfed Baby is who we’re going to tackle today.

The Scenario: You and Super Breastfed Baby are home and you are trying to get things done around the house.

I hate to say it, but nothing about this will ever get easy. But it can get easier. Having a child, nursing or otherwise, around the house means being very strategic in all that you do. Your toddler wakes at 7, you say? Well then, 6:15 is the time to set the alarm so you can chop veggies for tonight’s dinner, put a load of laundry in the washer, and prepare a to-do list for your partner. Waking earlier than your little one doesn’t work for you? Try naptime or after bedtime. When they’re awake what they want is to be entertained. By you. Because you’re the awesomest. EVER. And no one else can compare to the way YOU entertain them. And when you aren’t in the entertaining mood? You still have breasts. Which they love. All I keep thinking as I’m typing this paragraph is “That which you resist, persists.”

It’s easy to get caught up feeling like “I HAVE TO DO THIS NOW”, but sometimes, if you stop for a second and give in to Super Breastfed Baby’s demands (of nursing or block building or nursing while block building), you will find that time to do what you were looking to do suddenly appears afterwards. And if it doesn’t appear? And you still have to vacuum? Rip a play out of my dear friend’s book and wear your baby right around naptime. She vacuums the floors, makes the bed, washes the dishes and sometimes even mows the lawn with her toddler strapped to her back in the Ergo. Most times he’s too busy loving the view, but sometimes, her little superhero falls asleep while she’s at it. 

The Scenario: You and Super Breastfed Baby are, well, just home.

You may have noticed that when you’re home or *gasp* sitting down, your normally easy to distract child becomes Mr. Grabby Pants (which definitely feels like a superhero quality), demanding to nurse every. five. minutes. This one is a little trickier to fend off because mommy sitting = easy target. Most toddlers nurse that frequently out of boredom and/or familiarity. If you’re like most moms, for the last year, most of you and your baby’s breastfeeding took place either sitting or laying down. So it just means that your little princess was paying attention and now that she sees you sitting or laying down again, she thinks it’s nursing time. If you have realistic expectations of what’s about to happen, then you may be better prepared to deal with it. Another way to fend off Mr. or Ms. Grabby Pants is to “relax” in a new or exciting (but safe) environment. Toddler areas at local museums or indoor play gyms tend to be enclosed – use that to your advantage. Your busy, curious, newly independent toddler will be much less likely to think of nursing when there’s other stuff to do and see.

The Scenario: You and Super Breastfed Baby are at an impasse and you’re not too sure you want to continue nursing.

You’re trying to set boundaries, but it seems nothing is working. It’s not so much that you want to wean Super Breastfed Baby (or maybe it is), but you would like for nursing to feel like it’s more on your terms than at his demand. First, there is absolutely NOTHING wrong with you feeling that way. Nursing is a mutual relationship – both you and your child have to want to continue. As I mentioned in Part II, if you’re feeling like you want to slow down the demands of nursing or even wean, first try to pinpoint which is the MOST difficult nursing time for you. For me, it wasn’t the morning, nap and night – those I could deal with. But it was all the in-betweens. However, I didn’t realize that I could deal with, and actually cherished, the morning, nap and night until I was able to really cut back on the in-betweens. It took lots of creativity and motion, but after a few weeks, he didn’t even realize the in-betweens were missing. As with any change to a child’s sense of normalcy, employing gentle techniques combined with lots of love and patience along with waiting (if you can) until the child is communicative enough to understand, even if he doesn’t agree, will yield the best results.

The Scenario: You and Super Breastfed Baby have found your groove, but sometimes, she acts like there isn’t enough milk.

Super Breastfed Baby is one smart cookie. Maybe it’s that x-ray vision or her supernatural senses, but something has alerted her that there is less milk. Did you read that sweet momma? LESS MILK. Less milk is different than “NOT ENOUGH” milk. A few months ago, when you started solids because your little one showed all the signs of being ready, the weaning process began. Your body naturally slowed down its milk production to meet your baby’s needs and has continued to be super efficient in adjusting to those continued needs. Yes, you do have less milk, but, in conjunction with the other foods he’s eating, he’s still getting exactly what he needs. In addition, Super Breastfed Baby knows what he’s doing when he seems to be kneading the breast or trying to “play” with the other nipple. He’s actually trying to elicit a faster flow of milk for himself. For most moms, the kneading is nowhere near as exasperating as the nipple twiddling. Toddlers need to learn manners, too, and where better to learn them then at the breast where they are happy and relaxed and met with love? If you’re trying to curb behaviors such as nipple twiddling, be consistent each time. Explain to your toddler that it hurts momma. Use words she can understand. And repeat each and every time. Sometimes, along with consistency, a little bargaining might help, too. “Instead of hurting mommy by touching my breast that way, you can [insert substitutive, less exasperating behavior here]”.

So many of my past New Year’s Eves were spent with a baby in arms, or in a sling, or on the breast, picking confetti (or food) out of their beautiful, thick brown hair. Some years, it seemed I would never have my body free at midnight – or ever. My Super Breastfed Babies are babies no more…I can’t even say they are in jest. This year, we weren’t nursing at midnight. I wasn’t holding them. Yet, there we were, all of us snuggled up and interlocked when the clock struck 12. Maybe not as it had been in years past, but then again, not much different either. Maybe it was because, as others would say, I “nursed them *forever*”. Or maybe it’s because, through the nursing process, I realized there’s nowhere else I’d rather be.

Happy New Year! 

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.

Do you have any additional questions for Andrea about nursing a toddler?  Share them in the comment section and we'll ask her to write another article!

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!

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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

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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.