Tackle your Postpartum Trouble Spots: Tummy

Written by guest blooger, Autumn Bonner, co-owner and co-founder of My Tailored Fitness.

Happy New Year Moms!  Now that the family is gone, holiday cookies are eaten, and presents are all opened, you are probably settling back into your normal life as a mom.  If you are like most people, you are probably thinking about 2014 and how you’d like to make it even better than last year.  One of the areas you might like to improve in the New Year is your health.  Let’s face it: as a mom, caring for yourself usually takes last place.  You make sure your baby’s needs are met, take care of your spouse/partner, and after that, if there’s time, you take care of yourself.  Sadly this often leaves us disappointed…with how our clothes fit, with how often we get to exercise, and with our lack of energy.

To be the best moms we can be, we must take care of ourselves. The good news is that by carving out just 20 minutes a day you can make some big changes this year!  It’s also important to know that your exercise routine can go hand in hand with your breastfeeding goals!  Research proves that exercise does not impact the quantity or quality of your milk supply.  All you need to do is make sure to eat at least 1500 calories per day and a few more to make up for the calories you burn on those days when you exercise. Here’s a great postdedicated to exercise and breastfeeding with some helpful tips. Exercise has so many other benefits for a new mom like relieving stress, helping you sleep better, and boosting your immunity, so it is definitely worth making a priority!

Over the next 3 weeks, we are going to tackle the top 3 trouble spots for moms: tummy, butt, and arms. You’ll get a plan that you can do in just 20 minutes a day.  And the best part is that your baby will be right there with you as you use your baby carrier during your workout! So let’s get started with our first trouble spot: Tummy!

No other part of our body goes through as much change during pregnancy as our tummy.  Sadly, it doesn’t just bounce back to our pre-pregnancy shape easily.  It takes 3 key things to get a toned tummy post-baby:

1. Toning – Since your ab muscles were stretched so much during your pregnancy, they lost a lot of strength. Toning exercises for your core will help you regain the strength you need in that area.  Think beyond crunches, as there are a lot more effective ways to work your core as you’ll see in the plan below.   
2. Cardio – You also need cardio to get your abs back.  Sadly, you can do hundreds of crunches, but never see your abs because they are hidden under a layer of fat.  The best exercise for fat burning is a combination of strength and cardio.  So add some cardio to the toning exercises for maximum fat burning! 
3. Healthy eating – This one goes right along with the cardio. You can exercise all you want, but if you aren’t fueling your body with good foods, you won’t see results. Fill up on fresh fruits, veggies, lean meats, and whole grain breads.  As a new mom, you want to focus more on WHAT you are eating than on cutting calories.  Just remember, as I mentioned above, you have to make sure you are eating enough calories (at least 1500 per day) to ensure that your milk supply doesn’t drop. 

Ready to get started?  Here’s your 20 minute plan to tone your tummy!  Repeat this plan twice a week.

Note: As with any exercise plan, be sure to get your doctor’s clearance before starting any activity.

Warm up – Put your baby in a carrier and head outside for a walk.  Walk at an easy pace for 2 minutes to get warmed up.

Cardio - To get your heart rate up, alternate between 1 minute of fast walking and 1 minute of medium pace walking for a total of 8 minutes. If you have any hills nearby, include that in your route.  Pick a loop where you’ll end up back at your house at the end of the 8 minutes.

Strength – Head back inside, but keep that baby in your carrier for these strength exercises. 

1 – Zig Zag – Wrap your arms around your baby using your hands to support their head. Lower into a plie squat with knees and toes pointed out. Keeping your hips and legs still, lean side to side engaging the obliques. Repeat for 10 reps each side, rest, and repeat a 2ndset.

2 – Lunge with rotation – Regaining your balance is very important after pregnancy, and comes largely from strengthening your core. Lunges with rotation help challenge your core and balance effectively.  Step forwards into a lunge making sure your knee stays over your ankle. Then twist your torso towards your front leg. Push back to standing and repeat on the other leg. You are also getting some great leg work with this exercise! Repeat for 10 lunges on each leg, rest and repeat a 2nd set.

3 – Plank – This is probably the best exercise you can do for your core. Take your baby out of the carrier and lay him/her below you on the ground. Come into a plank position on your elbows and knees (if you are newly postpartum) or elbows and toes (if you are feeling stronger).  Hold this position for 30-60 seconds, rest, and then repeat a 2nd time.

Stretch – Finish by stretching as your baby lies nearby on the floor. Also, be sure to drink lots of water throughout the day. 

If you are looking for more ideas for how to exercise with your baby in your baby carrier, check out this postnatal core video from my fitness program for moms. We have whole video series with exercises with your baby. We even have a free 30 day trial. (The workout website is compatible with Chrome or Safari, so please use one of those browsers. Make sure you have clearance from your doctor before beginning exercise. By clicking the link above, you are agreeing to the Tailored Fitness Terms of Use.  For some of the exercises, it is important for your baby to have good head control.  Modify or skip exercises as needed to keep things safe for you and your baby.)

Keeping Up Your Milk Supply During the Holiday Season

Since Winter Break has descended onto our homes, Ashley and I are taking the next few weeks off from blogging to spend some quality time with our families.  However, that doesn't mean that you'll be left without our breastfeeding support until the new year!  We have over 300 articles on the San Diego Breastfeeding Center blog, which means there is no reason for you to google 'sore nipples' at 3:30am.  Just check out our extensive article list and you will be well on your way!

Here are some of our favorite tips for keeping up your milk supply during the holidays

1. Holiday recipes often include herbs that can affect supply.  Don't eat too much sage or mint - these are herbs used to temper down or dry up a mom's milk supply.  One mint cookie won't do it, but be aware of the amounts you are consuming.
2. Continue to breastfeed or pump at regular intervals.  It's very easy to skip feedings and/or pumping sessions with all of the holiday festivities, which can lead to plugged ducts and mastitis.  Yuck! Try to stick to your regular breastfeeding/pumping schedule to prevent your breasts from getting overly full and uncomfortable.
3. Traveling during the holidays, expecially with a baby or toddler, can really wear your body down.  To keep up your milk supply, stay hydrated, bring tons of nourishing snacks for the trip, and do you best to get good sleep.  Plus, follow your child's lead and squeeze in a nap or two throughout the trip.  Your immune system will definitely thank you for it!
4. Find your comfort level with breastfeeding around family members.  Enlist your partner as your cheerleader and advocate so that you can feel comfortable breastfeeding your baby in all holiday situations. If you feel timid around certain family members and friends, invest in a breastfeeding cover, like this one from Bebe Au Lait, so you don't have to leave the room everytime your baby is hungry.  It's also a good idea to practice at home in front of a mirror, you'll see how very little of your breast is actually exposed and this may help you to feel more comfortable.
5. If you start feeling under the weather, stick with herbs and over-the-counter medications that don't dry up your mucus membranes, as they may dry up your milk supply as well.  Herbs that support your immune system, that are safe to take while breastfeeding, are echinacea and vitamin C.  If you feel like you are coming down with a cold, you can take homeopathic oscillococcinum and yin chiao to build your immune system and speed up your recovery.  For over the counter medications recommendations, listen to our Boob Group podcast with Dr. Frank Nice, Breastfeeding and Medication.  You can also contact your local lactation consultant and ask her to look up a particular medication to see if it is safe to take while breastfeeding.

Lastly, here are some of our most popular breastfeeding articles to help you through the holiday season:

Advice for the Newly Breastfeeding Mama's Partner

Help A Mama Out; Ways Partners Can Bond with Baby Besides the Bottle

Help A Mama Out: Overcoming Nursing in Public Anxiety

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

Common Concerns While Breastfeeding: Yikes!  Why are my Nipples Burning?

Common Concerns - Do I Have Mastitis?

We wish you a beautiful, peaceful holiday season and look forward to sharing more judgment-free breastfeeding resources with you in the new year!

Warmly,

Robin and Ashley 

Breastfeeding My Type 1 Diabetic Daughter

Almost 2 years ago, a dear friend of mine found out that her 19 month old daughter had type 1 diabetes and was fighting for her life.  Here's Theresa's triumphant story of how she was able to preserve her breastfeeding relationship while healing her daughter.  

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About a month ago a friend alerted me to a Facebook post that brought a wave of memories flooding over me from a day that changed my life forever as a parent.  A day that I will never forget, even though I wish I could.  It was literally the worst day of my life, but one that I will always be grateful for because it was the day my daughter’s life was saved.  

The Facebook post was from a worried mom whose child was hospitalized after being diagnosed with type 1, “juvenile,” diabetes that very day.  The mama was breastfeeding and was terrified not only for her child's life, but that she would lose the best way she knew to feed and comfort her baby.  A little over a year and a half ago I was in her shoes.  At 19 months old, we were told that our daughter had type 1 diabetes, was in diabetic shock, and needed to be rushed to the emergency room.  She came very close to losing her life and was in critical care for a week at a children’s hospital. 

While she was at her sickest (almost admitted to the ICU), she was not allowed to nurse.  For as comforting as breastfeeding can be, not being able to do it during a time of crisis was torture.  My daughter was barely conscious, was in pain and terrified while she was awake, and I could not even hold her because she wanted to nurse.  I hope no other mama has to experience the excruciating helplessness you feel in a situation like that.  Our children's hospital has no lactation consultants and, by the time they could find a pump for me, we had already skipped about 7 or 8 feedings.  I was scared to death and in physical pain myself.

When we were finally given the okay for her to eat, I had to fight tooth and nail to be able to breastfeed her.  The doctors finally consented to her having breast milk, but because she was not a tiny baby, the doctors did not think it was important.  They told me that she absolutely had to drink from a cup or bottle.  (I had a manual pump at home and did not respond well to it at all.  I could not imagine how difficult it would be to have to exclusively pump.)  I begged them to let me nurse her.  It was my milk after all, whether it came from a pump and was poured directly into a cup or came straight from my breast.  No mother should ever have to beg to be able to feed their baby.  It took hearing our daughter scream and sob hysterically for the doctor to finally take pity on us and let me breast feed her.  As I held my tiny girl in my arms, it was the first time I began to feel like there was a possibility that she would be okay. Still, we were encouraged to not let her nurse after that.

Eventually, we were able to meet with the hospital's diabetes dietician who helped me calculate the average amount of milk I produced per feeding.  We looked at the amount of milk I was able to express with a pump then, by using the general amount of carbohydrates contained in breast milk, we were able to determine a rough estimate for carbohydrates per feeding.  Together we came up with a plan to space out her feedings as much as possible to keep her blood glucose stable (after each meal and to go to sleep).  The dietician was a lifesaver and a champion for us!  She spoke with our doctor on our behalf and convinced him that including breastfeeding as part of our daughter's nutrition was in her best interest.  The doctor has since become supportive.

Continuing breastfeeding brought my daughter so much comfort in the months of learning to live with daily multiple injections and painful finger prick blood tests.  It was something normal and peaceful for both of us during a stressful time of adjustment.  It supported her overall health.  It was a perfect source of nutrition for her combined with solids and was amazing for bringing her blood glucose back up to a safe level if she began to drop low at night (we do use a fast acting sugar, like juice, instead if she is below a safe threshold).  I am so thankful that we were able to continue our nursing relationship until she was 32 months old.

Type 1 diabetes (T1D) is a life-threatening, autoimmune disease in which a person’s body attacks their pancreas, causing it to stop producing insulin, a hormone needed to properly process carbohydrates in the food we eat.  People with type 1 diabetes check their blood glucose levels every few hours and must inject insulin several times every day or continuously infuse with insulin through a pump.  There is no known cause of type 1 diabetes and, at this time, no cure.  It will never go into remission and cannot be reversed.  As a mom, you can't help but wonder if you caused it somehow but, it just isn't possible that you did.  It is not connected to poor diet or lack of exercise.  Our daughter never has had a drop of formula, never had sugar other than that naturally occurring in fruit, never drank juice prior to needing it to treat hypoglycemia, and eats primarily homegrown, organic solid food.

Not many people think that a baby or toddler can develop type 1 diabetes, however it is definitely possible.  Not all doctors think of it either and it is commonly misdiagnosed as the flu, with deadly results.  It is very important to know the possible warning signs.  I would recommend all moms be aware of any major changes in nursing.  A sudden onset of increased nursing (past the length of time a growth spurt or teething would account for) along with much more frequent wet diapers can be a signal of diabetes.  Diaper rash (especially without a history of it) and yeast infections can be symptoms of high blood glucose.  Also, consider vitamin D supplements if a blood test returns low for vitamin D levels and investigate further if the test results are extremely low.  The researchers think there may be a link between low vitamin D and diabetes, however they don't know if it is a cause of diabetes or a symptom of it.  Our daughter had increased nursing and wet diapers, weight loss and developed labored breathing. Thankfully our pediatrician picked up on the problem and took action immediately.

Warning signs of type 1 diabetes can include:

 • Extreme thirst

 • Frequent urination

 • Drowsiness, lethargy

 • Sudden vision changes

 • Increased appetite

 • Sudden weight loss

 • Fruity, sweet, or wine-like odor on breath

 • Nausea or vomiting

 • Heavy, labored breathing

 • Stupor, unconsciousness

 • Sugar in urine

Most importantly, if you feel that something is wrong, go with your gut and keep asking until you find answers!  A quick finger prick test to check the blood glucose level can rule out diabetes.  For this test, a small drop of blood from the tip of the finger is sampled.  Results are often immediate.  A simple urine test can also check for abnormalities.  Undiagnosed and untreated T1D can become deadly very quickly.

If you have a little one diagnosed with diabetes, ask to speak to the nutritionist about continuing to incorporate breastfeeding into their nutritional plan.  By pumping once and measuring the amount expressed or by weighing the baby before and after feeding they can help you determine the general amount of milk and therefore carbohydrates they receive at the breast with each feed.  (Because it is an estimated number and not exact, they can often account for the difference in the allotted carbohydrate plan.)

Also, there are amazing support resources available for small children with T1D!  Facebook groups like “Diapers & Diabetes” and organizations like JDRF offer support for families, education, a place for children to feel encouraged and like any other child, and help navigate the uncertain and ever-changing waters that are type 1 diabetes.  Additionally, JDRF funds research and is constantly striving to improve life for type 1 diabetics.  Most importantly, they are fighting for a cure for type 1 diabetes.

*** Please note that these are just our experiences.  I'm not giving medical advice and don't claim to be an expert on diabetes--I'm just a breastfeeding mom doing everything she can to keep her daughter healthy!  Seeing her grow and thrive, and watching her play momma and nurse her baby dolls, I think I might be doing an okay job.

If you want to learn more about type 1 diabetes, www.jdrf.org is a wonderful resource.  For a glimpse into our life with it or to help fund a cure, please visit:

 http://www2.jdrf.org/site/TR/Walk-CA/Chapter-SanDiego4053?px=2922459&pg=personal&fr_id=2382

or watch our story at: https://www.youtube.com/watch?v=2Fc6r8HEnn0

My Village of Breastfeeding Support

 Over the next few weeks we will be sharing stories of triumphant breastfeeding mamas and their biggest supporters who helped them reach their personal breastfeeding goals.  If you would like to share your breastfeeding story and thank your biggest breastfeeding cheerleaders, check out the details in our recent blog article.

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Here is Stephanie's story.

It has truly taken a village to help me be successful in nursing both of my babies!  I knew I wanted to breastfeed, but, after the birth of my first son, my passion and commitment to it were a surprise to even me.  I was also caught extremely off-guard by the difficulties both of my boys encountered as we began our breastfeeding journeys together.  Tongue ties, lip ties, low weight gain, low supply, poor latch, pain/cracking/bleeding, overactive letdown, and more were all hurdles we had to cross.  There is absolutely NO way I could have made it to 13 months formula-free with my first son and still going strong and formula-free at 6 months with my second without these amazing people.

My husband!  My passion and commitment to breastfeed my babies surprised him also, but he never questioned it and stood by me no matter what decisions I made!  He became just as committed and passionate about it, knowing it was the best thing we could do for our boys.  He came to appointments, helped get the baby latched on time after time, stood up for me when others questioned why I didn’t just quit, and let me cry when it all just became too much!  He has truly been my rock through all of this, and I can sense his gratitude for the sacrifices I have made to give our boys this amazing gift!

My Lactation Consultants! Four different lactation consultants have come alongside my babies and me in our journey together.  Every single one of them encouraged me that I could do it when the hurdles seemed insurmountable.  They provided a listening, sympathetic ear when I just needed to vent or cry or talk it out.  They provided help, advice, referrals, and life-changing solutions that kept us going!

My tribe of other breastfeeding Mamas! Friends I have known since childhood, friends I’ve made in recent years, and people I met through the breastfeeding process made it all possible - others who had or were experiencing some of the same challenges, some who didn’t have trouble but believed just as passionately in the benefits of breastfeeding, some who visited, some who called, and one who even created an on-line community to connect us all!  There were many people in my life who didn’t understand why I didn’t give up when they saw the emotional and physical toll it was taking on me, but these other Mamas got it!  They knew why I couldn’t quit, why no challenge was too big!  

My virtual breastfeeding community!  Although I will never meet most of these women in person, the support, advice, commiseration, and encouragement they have provided have truly been critical!  To be able to jump online in the middle of the night when it just seemed like I couldn’t do it and have others on there to tell me that, yes, I could do it got me through many rough moments!  They have calmed nerves, answered questions, given virtual hugs, and just been an amazing support system!

My babies! Even from the very start and even in the face of all of our challenges, my babies have always loved nursing!  They didn’t quit so there was no way I could!

Nurturing your Child's Potential with Voila Montessori

This week, we’re highlighting a local practitioner who is helping parents establish and integrate their parenting beliefs and styles into a peaceful, nurturing environment for their children.  She also offers Skype consultations for those not located in San Diego.  I’m thrilled to introduce Jeanne-Marie of Voila Montessori!

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1. What does it mean to have a Montessori home?  

A Montessori home is one that is adapted to meet the child’s ever changing needs, as well as it being nurturing, peaceful and respectful to all family members. It is a home where obstacles to children’s natural development are minimized, enabling children to become life long independent and confident learners.

2. What modifications do you help parents make in their homes?  Why are these modifications important?

When helping parents make simple adjustment, I first look at the four main areas depending on the child’s age and the size of the home. These areas are the sleeping, feeding, personal care and movement areas. For example the feeding area at first will be for the sole purpose of bonding with the child while breastfeeding. I usually recommend a quiet, comfortable place where the caregiver can give a 100% of their attention to the infant. This area will then change once the child is introduced to other foods. 

To name only a few simple ideas I share with parents: make sure children have access to real child-size utensils to do ‘real work’, such as cooking, cleaning, personal care, caring for animals or plants as well as creating a quiet reading area just for them etc. I also recommend many different activities to set-up depending on the age and interest of the child.

(photo credit: Laura Christin Photography) 

These modifications evolve and change as the child grows and their needs are different; they are not going to be the same for an infant as they are for a walking toddler or a preschooler. These changes are also about being mindful parents, aware of the child’s needs by learning to observe and never interrupting when they are concentrating on their own self-construction. 

I believe that these changes are important in that they help the entire family to live in peaceful harmony.  These are small modifications that will make a world of difference for everyone involved. They are wonderful tools for the development of the child’s will as well as their self-esteem “I can do it!”

3. How does clutter in the home affect a child's ability to reach his/her full potential?

Clutter is actually an obstacle to their development. A home that is cluttered with too many toys and activities can be very overwhelming for a young child. Children have a real need for order and routines in their early years. External order brings internal order. Young children are absorbing so much information in these early years that it is helpful for the home to be clutter free and orderly to help them make sense of it all. I am always overjoyed to hear parents tell me how much their child’s behavior improved by simplifying their play area. 

4. How does having a Montessori home go hand in hand with Positive Discipline? 

Beautifully! There are a lot of misconceptions about Montessori that it is a place “where children are left to do whatever and it is a free for all”. Montessori is actually a very simple and intuitive way of life and educational method, where all freedoms are within limits. Positive Discipline is a great compliment to Montessori since it is a very respectful way of guiding children. It is firm and kind at the same time believing that connection before correction is crucial for the child’s healthy development.

5.  What type of consultations and classes do you offer to local parents?  Do you conduct Skype visits?

I have many different types of consultations. I work with expectant parents helping set-up a baby-focused nursery as well as parents, grandparents and any caregivers of young children from birth to six years. My consultations are for families wanting guidance on how to adapt their home to meet their child’s needs as well as for families who need help with having children be more cooperative and respectful. 

I offer workshops throughout the San Diego County. Small workshops can be created for specific parent groups.

I am also available to help set-up larger learning environments such as home daycares or family home school co-ops.

Yes, I do offer long-distance consultations either by phone or via Skype.  Parents from different parts of the country and world have asked for advice, so I needed to make myself available.  I’m also working on developing some online webinars.

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Jeanne-Marie's multicultural upbringing and travels planted the seeds of a lifelong curiosity regarding the fundamental needs of children and families.

Her goal is to help parents appreciate the true importance of their role – not as servants or teachers, but as supporters and guides of their children’s natural development. Families who work with Jeanne-Marie reap the benefit of her Masters in Montessori education, her two AMI Montessori certifications covering childhood development from birth through age 6, her Positive Discipline certification for both parents and the classroom as well as her extensive classroom experience, and first-hand parenting knowledge. 

She launched Voila Montessori in response to the overwhelming demand from parents for advice and guidance for raising children in a gentle, peaceful, and supportive environment that’s conducive to their full development – psychological, academic, artistic, spiritual, physical, cultural, etc.

Jeanne-Marie describes herself as “genuine, passionate, and straightforward”. She’s honest and direct, because she realizes that clear and precise information is what will help parents cut through the overwhelming amount of advice that engulfs them.

To learn more about Jeanne-Marie and how she can support you and your children, please visit www.VoilaMontessori.com and like her page, Voila Montessori, on Facebook.

Jeanne-Marie will be offering a monthly workshop at Nature’s Whisper Yoga starting Thursday, November 21, 2013.

Breastfeeding for the Adoptive or Intended Mother

Last week I had the pleasure of speaking at a workshop for families considering adoption and/or surrogacy.  The topic of my presentation was Breastfeeding for the Adoptive or Intended (through surrogacy) Mother.  Most of the families in the audience had no idea that a woman could breastfeed without birthing her child and their faces just lit up when I discussed that this was a possibilty for them.  

While I have worked with several mothers in San Diego to induce lactation for an adopted baby or baby born by surrogate, I thought I would invite my colleague, Alyssa Schnell, to answer a few questions about this process.  Not only has Alyssa personally experienced inducing lactation for her adopted daughter, but she also recently published a book on this topic as well, titled Breastfeeding Without Birthing:  A Breastfeeding Guide for Mothers Through Adoption, Surrogacy, and Other Special Circumstances (Praeclarus Press, 2013)

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Why would a mother consider breastfeeding her adopted baby or baby born by surrogate?

Most people are not even aware that it is possible to breastfeed a baby who arrives via adoption or surrogacy! The lucky few adoptive or intended (through surrogacy) mothers who learn that breastfeeding is possible for them usually learn about it through their own diligent research.  Many times, breastfeeding is just a sentence or two in a book about adoption.  

What are some benefits of breastfeeding an adopted baby or baby born by surrogate?

Breastfeeding is the normal, healthy way to feed and nurture babies.  All babies.  And babies who arrive via adoption or surrogacy may benefit from breastfeeding even more than most babies. 

• Human milk protects babies against illness.  The protection can be especially important for babies who have experienced adoption since adopted babies - for several reasons - are more likely than other babies to get sick (Gribble, 2006).
• Breastfeeding helps babies attach to their adoptive or intended mothers. All babies who experience adoption or surrogacy experience a disruption in attachment, because babies begin attaching to their mother in utero (Gribble, 2006).  Some adopted babies experience multiple breaks in attachment if they are in foster or institutionalized care before adoption.
• Breastfeeding helps babies to develop normally.  Babies who experience adoption are more likely to be developmentally delayed due to drug or alcohol exposure in utero, parental abuse, and/or institutionalized care.

Are there benefits for the mother, as well?

Yes, breastfeeding is just as important for mothers as it is for babies.  And, just as with babies, adoptive and intended mothers may benefit from breastfeeding even more than other mothers.

• Breastfeeding is a normal part of the female life cycle.  It provides protection against breast, ovarian, and uterine cancers, osteoporosis, and cardio-vascular diseases.  For women who do not experience the health benefits of pregnancy, breastfeeding can be especially important (Ip et al., 2007; Collaborative Group on Hormonal Factors in Breast Cancer, 2002). 
• Breastfeeding can help heal the loss associated with infertility.  Breastfeeding provides a unique opportunity for the adoptive or intended mother to participate in her baby’s birth cycle. 

Can a mother breastfeed without making milk?

Yes!  A mother can most definitely breastfeed without making milk.  She can feed her baby at her breast using an at-breast supplementer (a feeding tube attached to the breast) such as a Lact-Aid or Supplemental Nursing System (SNS).  Or, she can bottle-feed her baby and comfort nurse her baby at the breast (just as a baby might suckle on a pacifier for comfort).  Breastfeeding is so much more than making milk!

Photo credit: Barbara Robertson, IBCLC 

If a mother wanted to make milk for her adopted baby or baby born by surrogate, what are her options?

Even without being pregnant, frequent stimulation of the breasts and nipples - usually by a nursing baby or an electric breast pump - can cause a woman’s breasts to start making milk.  Taking medications or herbs can help the breasts to start making milk sooner and/or more abundantly.  Most mothers who induce lactation, or make milk without pregnancy and birth, will produce some milk and a few will produce a full milk supply.  Many adoptive or intended mothers will use an at-breast supplementer so that they can fully feed at the breast even if they are not producing a full milk supply.

Several protocols, or step-by-step instructions, have been developed to help adoptive or intended mothers induce lactation.  In my book Breastfeeding Without Birthing, I describe five protocols for inducing lactation, ranging from very simple to more intricate.  The simplest protocol for inducing lactation has been used by adoptive mothers in developing countries where there is no access to breast pumps or medications for inducing lactation.  Another protocol uses an electric breast pump and herbs but no pharmaceutical medications.  Another uses an electric breast pump as well as a couple of pharmaceutical medications.  Each adoptive and intended mother is encouraged to choose a protocol that suits her individual values and circumstances or, with the guidance of an International Board Certified Lactation Consultant, to mix-and-match the established protocols in order to customize an approach just right for her. 

An adoptive or intended mother can start the process of inducing lactation, or making milk without pregnancy and birth, several months or weeks before her baby arrives.  She can also wait until her baby is in her arms to begin.  There really isn’t one ideal time to start inducing lactation, since each mother’s circumstances are unique. 

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About Alyssa: 

I am an International Board Certified Lactation Consultant (IBCLC) in private practice, a La Leche League Leader, and mother to three breastfed children – two by birth and one by adoption.  Breastfeeding my adopted daughter was a highlight of my life – something so special and so important to both of us that I want to do whatever I can to help other adoptive or intended mothers and their babies have the same opportunity we did.  For more information on breastfeeding a baby arriving by adoption or surrogacy, see my new book Breastfeeding Without Birthing:  A Breastfeeding Guide for Mothers Through Adoption, Surrogacy, and Other Special Circumstances (Praeclarus Press, 2013). It is available through my website www.BreastfeedingWithoutBirthing.com or on Amazon.  My facebook page is another great way to keep in touch!  www.facebook.com/BreastfeedingWithoutBirthing .

References:

Collaborative Group on Hormonal Factors in Breast Cancer. (2002). Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50302 women with breast cancer and 96973 women without the disease. Lancet, 187-195.

Gribble, K. (2006). Mental health, attachment and breastfeeding: implications for adopted children and their mothers. International Breastfeeding Journal, 1(5). doi:10.1186/1746-4358-1-5

Ip et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries: evidence report/technology assessment no. 157. Rockville, MD: Agency for Healthcare Research and Quality.

Breastfeeding in the Operating Room

Over the next few weeks we will be sharing stories of triumphant breastfeeding mamas and their biggest supporters who helped them reach their personal breastfeeding goals. 

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This story is from Dawn.

I have to thank my hospital TEAM for my breastfeeding success! 

When I gave birth to my son 5+ years ago, it wasn’t what any first time mom would like to experience. I was having problems with maintaining my blood pressure and when my little boys’ heart rate dropped too low, I was rushed into an emergency c-section. It was an extremely frightening process that didn’t even enter my mind as a possibility. The months that followed were hard. We struggled at finding a proper latch and feeding became such a difficult task, I dreaded it.

It never occurred to me that our difficulties at latching could have been because of the birth experience.

In early 2012 we received good news, we were expecting! I did my best to set everything up for a different birthing experience. I searched out a CDC accredited Baby Friendly Hospital in my area, researched VBAC’s and educated myself on the benefits of skin-to-skin.  It wasn’t until closer to my due date that I was informed I couldn’t have a VBAC.  No hospital would even consider me as a potential VBAC candidate because of my small heart issue as well as my age.  After fighting and pleading, I had to acknowledge that I had no other option, but another C-section.

I may have lost that battle, but I was going to do everything in my power to have skin-to-skin with my little girl. I was aware of the evidence-based research on the benefits of skin-to-skin and its success rate with c-section births. I talked to my pediatrician about this and he agreed.  (I since found out that it is the pediatrician who is in charge in the OR!)  I wrote my birth plan with the intentions of doing skin-to-skin immediately after the c-section unless there was a medical reason not to. 

Alas, I wasn’t able to make it all the way to my scheduled c-section date. This time I was low on amino fluids and baby’s lack of movement put me into the hospital at 36 weeks. With concern, my OB and the pediatrician, agreed, that under supervision, they would monitor me and try to get us to the 37th week and do the c-section. 

Now, prior to this, we made sure to talk with all the right people about our wishes for skin-to-skin.  Everyone was on board: our OB, the hospital’s labor and delivery nurses, and staff.  In fact, the hospital staff has been championing the change in procedures to allow skin-to-skin in the OR without success. 

The day of my C-section, my regular pediatrician was out of town and his standing replacement wasn’t comfortable at all.  I had to conveince the standing pediatrician that this was in my and my baby's best interest.  The hospital's Head Labor & Delivery nurse helped us get to a compromise!  She is my angel!  She proposed that if everything looked good my little girl would be immediately placed on my chest, without ANY other intrusion.... meaning the vernix would be wiped off her while she was on my chest and she would be weighted and measured later. 

When the hour came for us to have the c-section more drama around skin-to-skin unfolded, this time all the way up to the director of the Family Birth Center.  The director of the Family Birth Center was completely opposed to it and tried talking my OB out of it.  We were lucky we had enough support and commitment from the labor and delivery nurses and my OB to move forward. We finally got our wish!

I have to admit, because she was coming 3 weeks early, I wasn’t sure we would even get the option of skin-to-skin, but our little girl emerged perfectly!  She was screaming and quickly confirmed in perfect health! 

When she was placed on my chest and covered with a warming blanket, I was in awe.  This little 6 pound bundle was just perfect.  After a little while, she actually scooted and rooted for my breasts and eventually latched and nursed!   I just didn’t think I would get that experience since she was early.  The remembrance still makes me cry.  It was such an amazing experience.  I was so happy I had the team in my corner and the hospital went forward with my wishes.  

When I was first told I would have to have another cesarean, I felt completely out of control and very disappointed.   Creating a birth plan around my c-section allowed me to take a bit of control back and talking with all parties that come with a c-section allowed me the skin-to-skin connection that was deeply important to me.  

It has been over a year since Beth was born.  We are still nursing strong and have a connection that I attribute to the wonderful team that helped me get skin-to-skin in the OR! 

Side note:  I have since heard that they have allowed other moms the same experience!  The hospital team not only helped me, but also have persevered in getting policy “changed” at the hospital!  

Dawn Alva

Rumina Nursingwear

Comebacks for ‘Why Are You Still Breastfeeding?’

Any woman who has ever had a breastfeeding challenge or has breastfed longer than than someone else deems ‘normal’ has been asked this question at one time or another.

“Why are you still breastfeeding?”  

Sometimes this question is passive aggressive with undertones of “I can’t believe you have breastfed your baby for THIS long.”  Other times it comes from a place of love meaning “You seem like you are in pain... are you sure you still want to try this?”

Regardless, if you are anything like me, the snappy comeback or educated response that I SO desired to say only comes after the situation is long gone and I am kicking myself for not defending myself and my choice to breastfeed the way I wanted to.

Well, ladies... look no further!

Here are some handy, snappy (evidence-based) comebacks that you can tuck away in your back pocket, only to whip out at the most appropriate times, pun intended! (P.S. These comebacks also work if someone asks why you are STILL exclusively pumping!)

Top 10 Comebacks to Answer the Question: Why Are You Still Breastfeeding?

 

1. “It’s the perfect food for my child. 24 hours a day, 7 days a week!”

• Babies can digest human milk more easily than the milk of other animals, probably because human milk contains an enzyme that aids in this process. 
• Breast milk forms softer curds in the infant's stomach than cow's milk (the basis for most formulas) and is more quickly assimilated into the body system. 
• While it contains less protein than does cow's milk, virtually all the protein in breast milk is available to the baby. By contrast, about half the protein in cow's milk passes through the baby's body as a waste product. 
• Similarly, iron and zinc are absorbed better by breastfed babies.

2. “Breastmilk doesn’t lose it’s nutritional value.  Can you say that about the food YOU eat?”

• Even at a year, breastmilk continues to pack a powerful punch for nutritional value.
• In the second year (12-23 months), 448 mL of breastmilk provides:29% of energy requirements

• • 43% of protein requirements
  • 36% of calcium requirements
  • 75% of vitamin A requirements
  • 76% of folate requirements
  • 94% of vitamin B12 requirements
  • 60% of vitamin C requirements

Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1), from Kellymom.com Breastfeeding Past Infancy Fact Sheet

3. “Breastmilk protects against disease for my baby.  Don’t you want my (our) baby to be healthy?”

• Because the mother makes antibodies only to pathogens in her environment, the baby receives the protection it most needs-against the infectious agents it is most likely to encounter in the first weeks of life. 
• Here are a few ways that breastmilk helps make a healthy baby:
  • Breastfed babies also have less diarrhea and fewer gastrointestinal infections than babies who are artificially fed.
  • Six months or more of exclusive breastfeeding reduces risk of food allergies. 
  • Breastmilk decreases a child’s risk of Crohn's disease and ulcerative colitis in adulthood.
  • Breastfed babies have lower risk for developing recurrent wheezing when they are older (age 6 or more) – asthma
  • They have less reflux
  • They have less eczema 
  • Breastfeeding protects baby against respiratory infections
  • Women who were formula-fed as infants have higher rates of breast cancer as adults. For both premenopausal and postmenopausal breast cancer, women who were breastfed as children, even if only for a short time, had a 25% lower risk of developing breast cancer than women who were exclusively formula-fed as infants.

4. “There are incredible health benefits for my breastfed baby.  Do you really think it’s wise to limit my baby’s intellectual and physical potential?”

• Breastfed children have higher IQ
• Breastfeeding reduces a baby’s risk of SIDS by 50%
• Breastfeeding protects baby against vision defects.  Breast milk is generally the main, if not the only source, of vitamin A during a child's first 24 months of life (or for the duration of breastfeeding).
• Suckling at the breast is good for a baby's tooth and jaw development, as the constant pulling at the jaw muscles promotes a well-formed jaw and healthy teeth.

5. “Breastfeeding improves my overall health.  Who’s going to cook all of the meals and take care of the home if I’m not healthy? (I know...super snarky!)”

• Breastfeeding decreases mom’s risk of postpartum hemorrhaging as it stimulates contractions to shrink he uterus back to pre-pregnancy size.
• Breastfeeding reduces mom’s risk of osteoporosis
• Breastfeeding reduces mom’s risk of anemia, as breastfeeding postpones the return of menstruation for many women. 
• Breastfeeding reduces mom’s risk of breast cancer. Women who breastfeed reduce their risk of developing breast cancer by as much as 25 percent. The reduction in cancer risk comes in proportion to the cumulative lifetime duration of breastfeeding. That is, the more months or years a mother breastfeeds, the lower her risk of breast cancer.
• Breastfeeding reduces the risk of uterine and ovarian cancer.

6. “Breastfeeding promotes mother/infant bonding and emotional well-being.”  

• Babies feed for about 45 minutes per time in the first few months.  This is nature’s way of making moms sit down and relax and promote her postpartum healing.
• Breast milk actually contains chemicals that suppress pain (endorphins). This is the perfect remedy for a child who accidentally hurts himself and is in need of some pain relief and comfort.  It's like having a boo-boo-healing superpower!
• Babies can also feel the warmth of mom's skin, take in her scent and hear her heart beating. This helps to neurologically center thebaby after birth and help him/her adjust to the outside world.  
• Breastfeeding also decreases a mother’s risk for postpartum depression.

7. “Breastfeeding can promote a positive relationship between mom and a supportive partner.”

• Partner support is crucial during breastfeeding, especially when there are challenges along the way.
• In the beginning, when baby is pretty much just eating and sleeping, mom and her partner can spend this time together, hanging out while the baby is feeding, getting to know one another as parents, not just partners.
• This is a great time to reconnect with your partner as the both of you get to know your baby, as this is a new time for your family.
• You are also a team during this time.  Partners can make sure that all visitors offer positive breastfeeding comments, especially when breastfeeding is a challenge.  No sabotaging comments allowed!

8. “Breastfeeding is definitely more convenient and less expensive than formula.  I thought we were on a tight budget!”

• Breast milk, in any supply, is free. Ready-made formulas can cost families $800 to $1800 per child, annually.
• Nipples, bottles, bottle brushes and bottle bag inserts are additional costs, as well.
• Breastfed babies are ill less often, meaning that their parents miss fewer days at work and spend less on prescriptions, doctor's visits, and hospital stays.

9. “Breastfeeding, just like parenting, has bumps along the road and I won’t quit on my worst day.”

• As all thing that have to do with parenting, what works some days, doesn’t work on others and most things don’t go smoothly as planned.  
• Your baby is born with a personality and a style that requires becoming familiar with and understanding.  
• What works for some babies and children may not work for yours, so seek support anywhere you can find it: friends, family, lactation consultants, websites, Facebook groups, physicians, etc.  
• Don’t quit on your worst day.  Let 24 hours pass to gain some perspective and reach out  for help during that time.  
• Have an IBCLC evaluate your situation and provide a plan for overcoming your challenge.

10. “I promise you that my child won’t breastfeed until his high school graduation, but if he did, he’d probably be the smartest, healthiest graduate there!”

• Ok, maybe that’s a little too sassy, but you get the point.  It is your choice to breastfeed for as long as mutually beneficial for you and your child.  Every drop of breastmilk your child gets is liquid gold and you are a superstar for producing that for him/her!  So stay strong, mama, and know that your ‘breast friends’ have your back!  Happy nursing!

Top 10 Ways to Stop Caregivers from Overfeeding Your Breastfed Baby

I hear it all the time. 

Mom and partner get home from a much-needed date night to find out that grandma gave their 4-month old two 6oz bottles in 4 hours.

Mom picks up her baby from daycare to find out that her 6-month old took three 5oz bottles, plus the backup 5oz bottle in the freezer, in 8 hours.  She pumped 12oz at work and thought that would be plenty for the next day. (which it is!)

Mom comes home from getting a haircut to find that her partner gave their 3-month old a 5oz bottle.  The baby only ate 3oz, so her partner threw the extra 2oz away.

Who ever said there’s no crying over spilled (or wasted) milk never pumped breastmilk for her baby!

It’s hard work to pump… who has extra time when taking care of a newborn to pop on some plastic milk-extracting contraption and just sit for 15 minutes?  Um… no one!  So when a caregiver over feeds a baby, or throws away breast milk that could have been used at another time, it can be very frustrating and defeating for a mom.  And as that extra freezer stash starts to dwindle because of misuse and over feeding, moms might feel their stress levels spike to an uncomfortable high.

So how can a mom ensure that her baby’s caregiver isn’t overfeeding, or unnecessarily throwing away, that precious liquid gold she spent time to pump out?

Top 10 Ways to Stop Caregivers from Overfeeding Your Breastfed Baby

1. Keep bottles in small increments (2-4oz, depending on the weight and age of your baby) and tell the caregiver to wait in between bottles to assess the baby’s mood (to see if he/she is really hungry) – Haley

2. Use the slowest flow nipple you can find and use the 1oz per hour rule (offer 1oz per hour that you are away from your baby) – Miranda

3. Pre-make bottles in small increments. For example, leave two 3oz bottles so caregivers don’t have to divide a 6oz bag into two separate bottles. – Shelly

4. Go over Kellymom’s article with your baby’s caregiver, How to bottlefeeding the breastfed baby, which talks about paced bottlefeeding – Tova and Megan

5. After baby has taken the bottle, try other soothing techniques (i.e. rocking, singing, swaying, take on a walk) rather than offering more breastmilk in an extra bottle.

6. Keep a few extra 1oz bags of breastmilk in the freezer or fridge. That way, if your baby’s caregiver really needs to offer your baby a little bit more, it is a small amount and won’t go to waste.

7. Talk to your baby’s caregiver about reusing breastmilk. While there are no definitive studies that state the exact amount of time that breastmilk must be used within (once the bottle has been fed from), most lactation consultants believe that if a bottle of breastmilk isn’t completely finished, it is safe to place it back in the fridge and the remainder used within 4 hours. (Kellymom.com article - Reusing Expressed Breastmilk)

8. Use the milk calculator to figure out how much your baby will need per bottle. Keep in mind, this is only accurate until your baby weighs 14lbs. After that, your baby’s breastmilk need plateaus at about 28-35oz per day. It won’t go up beyond that, so those 6-8oz bottles are really unnecessary.

9. Have a heart to heart discussion with your baby’s caregiver. Let him/her know how important it is to you that your baby isn’t overfed while away from you. Show empathy and explain that you understand how challenging it is to read your baby’s cues and that things are easier for you because you can always soothe your baby with your breast, which is something the caregiver cannot do. Explain how much milk your baby truly needs in a bottle and during the time you are gone. Anything over that is too much for your baby and makes it difficult for you to keep up. Come up with unique ways for him/her to bond with and soothe your baby, rather than just relying on giving more breastmilk in a bottle.

10. This advice came from a nanny, which was written so well I didn’t want to paraphrase it. ‘I nannies a breastfed baby for about a year and communication with the mom was very important. I also stuck to a schedule. If it was getting close to time for another bottle and I expected her home soon, I would text or call her to see if she wanted me to wait if she was on her way. Also, we would talk in the morning and she would let me know if she planned on coming home for lunch so I knew not to make a bottle. When I noticed that her son’s appetite was increasing, I would let her know that he was acting more hungry increased his bottles 1oz at a time. We also worked on adjusting his schedule so instead of 4oz every 2 hours, we found that 5oz every 3 hours kept him happy. That way he only needed 2 bottles while she was gone (10oz) instead of 3-4 bottles (12-16oz). A big help was her freezer milk in a variety of ounces. I was able to defrost what I needed to give her son without wasting any. As a breastfeeding mom myself, I did my best to respect the hard work she put into building a stash of milk for her son. – Catie.

Help a Mama Out: Nurturing Your Breastfeeding Relationship when Back at Work

Help a Mama Out Topic of the Week: What are your favorite ways to nurture your breastfeeding relationship when you work outside the home?  

Sarah – When I was working out of the home, I pumped at the times my daughter would take a bottle.  Then, when I came home I would exclusively nurse her.  She was fine with 2 or 3 small breastmilk bottles a day, then nursed the rest of the time.  She always preferred the breast and when it came time to wean, I was nervous….but at 13 months she just did and that was that!

Alicia – Comfort nursing on the weekends and morning nursing cuddle time.  I always nurse as soon as we get home from work/daycare.

Alyssa – My favorite part of my working day (as a teacher) was when I sat down in the glider at daycare and nursed my son before taking him home for the night.  We were always so happy to see each other and it helped wipe away any headaches from the day.  Plus, I developed a friendship with his teacher and got to hear all about what he did that day, which was way better than just reading a quick note on a daily info sheet!

Jeanne – Co-sleeping helped us and a feed before I leave and ASAP when I get home.  I also pump 3-4 times at work and always demand feed when I’m home. 

Katie – We nurse in the evenings, when she wakes up in the middle of the night, and at least once more before I leave for work.  It’s funny, as soon as I pick her up after work, I think her mind lights up with ‘milk!’ because she immediately wants to nurse regardless of when her last feeding was.  I can tell that she misses that when we’re a part, as do I.

Janell – As soon as I get home, he’s on the boob.  The rest of the night, he is on the boob.  We spend all weekend with him on and off the boob.  Time consuming, but I love the connection time and it forces me to sit down and breathe with my son.

Rachel – I sit with my daughter every evening after work.  Even if she goes to sleep, we spend the entire evening and night together because we co-sleep.  I make a point to forget about all of the housework I have to do and just relax with her because I know that she won’t be little forever!

Rachelle – One of my favorite things is when I get home from work, I shower (I’m a paramedic).  After I shower, I fill the bath and my husband brings me the baby and we usually relax and nurse for 20-30 minutes.  It is my wind-down time and it is quiet with few distractions.  I love it! 

Sarah – If possible, try to arrange a mid-day nursing session.  I used a local daycare that I was able to visit at lunch and nurse, rather than pump.  It greatly helped my supply and we were able to EBF for 13 months without any supplementation.

Amanda – I asked out childcare provider not to feed our little one within 90 minutes of when I planned to pick up.  That way I could nurse as soon as I got there.