Healthy Pregnancy

If you’re having trouble breastfeeding, or if you just want to avoid trouble down the road, hiring a lactation consultant can be very helpful. But how do you know if a particular lactation consultant has the experience and skills to help you? You can start by asking your physician or midwife or even your friends for a referral.  Finally, when choosing a lactation consultant, ask about her experience and approach. Listen carefully when you talk to her about your particular concern. Be wary of guarantees and words like “never” or “always.”

Many of my clients come to me after a bad experience with another lactation consultant. I have compiled a list of statements that clients have actually heard. These are red flags! If a lactation consultant (or anyone else for that matter) says any of the following, run the other direction!

• Your baby will never breastfeed.

• Your baby is too old to learn to breastfeed.

• You’ve missed your “window of opportunity” to breastfeed.

• You can exclusively breastfeed, no matter what.

• Your breasts/nipples are too__________ to breastfeed.

• If you eat ________ it will make your baby sick.

• Your milk may not be good enough for your baby.

• Your baby is allergic to your milk.

• You’re not successful breastfeeding because you’re not trying hard enough.

• Your baby doesn’t like/want your breast.

• If you take this herb/medication I promise you’ll make more milk.

• If you’ve had any breast surgery, you will not make enough milk for your baby.

• It’s normal to have nipple pain.

• Your nipples need to toughen up.

• Babies always have to eat on both sides each feeding.

• Babies should always have just one breast per feeding.

• Your baby should stay on the breast for _____ minutes.

• Your baby is a lazy nurser.

Note: This article took over a week for me to write. Every day I’ve needed to add more false statements! So check back often—sadly, there will probably be  additions. And….feel free to write to me with other things you’ve heard!

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

“My pediatrician says my baby has reflux! She says there are medications to help. I really don’t want my baby to take medicine. He’s so little. But I also don’t want him to suffer and spit up so much. What should I do? Can you help me?”

Although the diagnosis of reflux seems ominous, keep in mind that ALL babies have reflux to some degree. The sphincter muscle that separates the stomach and the esophagus is loose and lets fluids go back and forth. That’s why it’s common for babies to spit up after a meal. If your baby seems uncomfortable, however, he may need some help.

Many of my clients have babies who have been diagnosed with reflux. Simple changes in feeding posture or management can decrease symptoms substantially. Most of my clients do not need to medicate their babies.

If your baby is squirmy, uncomfortable and excessively “spitty” during or after feeds, he may simply be eating too much or too quickly. Do you have an over-abundant milk supply? Does your baby struggle to “keep up” when breastfeeding? Is he gaining weight rapidly?  If yes, you can try:

• Give your baby frequent burping breaks.

• Keep baby on one side per feeding.

• Position your baby at an incline so that his trunk is higher than his hips and his spine is straight. Try the Pollywog Nursing Positioner at www.pollywogbaby.com.

• Try breastfeeding lying on your side with baby beside you.

If your baby has green, frothy stools in addition to discomfort, he may be struggling with a foremilk/hindmilk imbalance. This is usually corrected easily by offering just one breast per feeding. Be sure to check with your pediatrician or lactation consultant to ensure your baby is is gaining well before making any changes to your feeding routine.

For more information on infant reflux, including helpful products, please see www.pollywogbaby.com

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

Infant mammals have one thing in common. They all breastfeed. In addition, they are all equipped to squirm, crawl or swim to the breast and latch and happily suckle without the help of their mothers.

But human babies are different than other mammals, right? Don’t they need someone to “latch them on”?

Yes, human babies ARE different from other mammals. They are smarter and even more capable than their furry counterparts. After some help to get to mom’s torso, a newborn will have no trouble finding the breast and suckling comfortably. You have probably noticed that when your baby is ready to breastfeed, she turns her head back and forth on your chest and moves her body toward one breast or another while her mouth is wide open. She may also bob up and down on your chest with an open mouth. When your baby does those things, she is looking for your breast.

If your baby has been having trouble with breastfeeding, you might want to try letting her take the lead. Sit in a semi-reclined position bare from the waist up. Place your baby (also shirtless) on your chest facing you. Keep your hands close by to protect her from falling—otherwise, let her move her way. Notice how she uses her chin, cheeks and mouth to find the breast, then the nipple. When she gets close enough, she will anchor her chin to the underside of your breast, throw her head back, open her mouth wide and latch on. It may take her a few tries to get it right. You can help her by lifting the breast if necessary.

Letting your baby show you how she wants to postion herself can help you understand how best to help her–even when it’s not practical to remove your shirt!

See also, “Let Your Baby Take the Lead”

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

As a mother, you want to help your baby breastfeed. But many times our well-intentioned “help” confuses the baby and results in uncomfortable, ineffective breastfeeding.

To let your baby use her instincts, position her on your lap so her head is slightly under your right breast. Your right hand can support your breast. Your baby’s top lip will be lined up with your nipple and her head will be tipped back slightly. Support her with your left hand just behind her ears, at the base of her neck. Your hand should be between her shoulder blades. Do not touch the back of her head. Lift her so her chin touches your breast. Her nose should be away from your breast. If she’s interested in nursing, she will tip her head back and open her mouth wide. At that moment you can lift her torso slightly so she can latch on. Her upper lip will barely cover the nipple. Avoid pushing her nose to the breast. Do not try to center the nipple in your baby’s mouth.

You can also try positioning your baby on your lap, supporting her so that her left cheek rests on top of your right breast. Hold her so that her head can move freely and the nipple is just out of reach. She will open her mouth and turn her head to find your nipple and begin breastfeeding.

If your baby is latched on correctly, it will be comfortable for both of you. Her nose should be tipped away from the breast and her chin and chest tucked in firmly against your body. You will hear rhythmic swallowing.

See also, “Your Baby is a Mammal!”

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

Why do some mothers seem to be overflowing with milk and others barely keep up with their babies? The answer to that questions remains a mystery. We do know, however, which practices enhance milk production and what may decrease milk supply.

Newborns need to eat frequently. All that early suckling before your milk “comes in” helps set the tone for later milk production. Think of as your baby placing an order to be filled at a later date. On the other hand, restricting breastfeeding in the first few days may lead to decreased milk production overall.

You’ve probably heard that milk production is based on supply and demand. That means that the more milk that is removed from your breasts, the more milk you will produce. If more milk is consistently removed from your right breast, your right breast will consistently make more milk than your left. If baby regularly sleeps from 10pm to 4 am, but breastfeeds every 2 hours during the day, you will eventually have less milk in the middle of the night than during the day.

How do your breasts know that your baby is growing and needs more milk? Very simply; the baby asks for it! Your baby will breastfeed more frequently when he needs more milk. After a few days of what may seem to be constant eating, your breasts catch up and all is well. When your baby gets older and doesn’t need to breastfeed as often, your milk supply will naturally decrease.

So let your baby be your guide and your milk supply will take care of itself!

See also: “How do I Increase my Milk Supply?“

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

Now that you’ve made the commitment to breastfeed your baby AND you’re going back to work, you may be wondering…how do mom’s really do this?

Here are some tips from experienced breastfeeding moms who have learned how to make every second count!

The night before:

Label bottles of milk with the date and your baby’s name.

Lay out your baby’s clothes and yours. Better yet, dress your baby in the next day’s clothes and forget about jammies!

Keep the pump bag, diaper bag and your charging phone by your purse or briefcase.

Ask your partner to pack your food for the day—lunch and a couple of snacks. You will probably be surprised and delighted at the quantity of food he thinks you should eat!

Add baby supplies to the diaper bag.

In the morning:

Add ice and pumped milk to daycare bag. A little cooler specifically for baby bottles is great for this purpose.

Breastfeed baby one more time before going out the door. Or leave a little early and breastfeed at the day care. That will mean less milk that you will have to pump!

General tips:

Wear clothes that give you easy access to your breasts. You shouldn’t have to take off your shirt or dress in order to pump or breastfeed. Check out www.hadleystilwell.com for professional nursing/pumping clothing.

Remember you don’t need to wash the pump parts after each pumping. Just keep them in a cooler (with ice) or a refrigerator and they’ll be ready to go for the next pumping.

Some moms love to pump hands free. There are bras and other devices that hold the pump flanges in place so you can multi-task.

Invest in extra pump parts—including bottles and caps—and keep extra at work just in case.

Take advantage of oxytocin coursing through your bloodstream. It will help you relax and enhance your creativity.

See also: “Working and Breastfeeding” and “Working and Breastfeeding: A Checklist.”

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

Women have been combining work with motherhood for thousands of years. Since babies get their nutrition directly from their mothers, society expected moms and babies to be literally joined at the hip for the first year or more. It’s only been in recent history that “going back to work” has been a potential roadblock to continuing to breastfeed. Although it is normal to work while caring for baby, our modern world and societal expectations often requires moms to be separate from baby while working.

So, is it really possible to continue breastfeeding while working away from baby?Absolutely! It takes some planning and commitment, but as a mother , you’re already committed to your baby and you’re probably a master planner and multi-tasker! Just make sure you have the tools and information you need to be successful.

If you are working more than 20 hours a week, you will need a professional-grade breastpump that is designed to be used every day, several times a day for a year or more. Expect to pay 200 to 300 dollars. Some very good brands include: Medela, Hygeia and Ameda.  (Hygeia is a brand new company.  Check them out at www.hygeiababy.com)

Talk to you employer and colleagues about your plan to continue breastfeeding while working. Find other mothers in your workplace who have pumped at work. Determine where you will pump.

Before you return to work, make sure your baby knows how to take your milk from a bottle or cup or even a spoon.   Give your baby at least 2 weeks to learn this new skill.

Store a few bottles of milk in the freezer just in case! Accidents happen—milk gets spilled, milk gets left at work, etc. You don’t need a whole freezer full of milk! Remember you’ll be replacing what your baby drinks every day!

If possible, visit your baby at lunch. Or arrange for your baby to be brought to you. Mothers who have access to their babies breastfeed longer.

Most importantly, take care of yourself. Learn to delegate! Make sure you eat well and sleep whenever you can. Remember, you have two jobs now!

See related article:  Working and Breastfeeding:  A Checklist.

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

As I’ve stated many times to anyone who will listen, nipple shields can be helpful if a baby is having trouble breastfeeding. In the wrong hands, however, they can be downright dangerous. Just today I saw 2 moms who were given nipple shields in the hospital within 48 hours of their babies’ birth. Here are their stories:

Story number 1: Mom given nipple shield day 2 because baby was having a hard time latching. Baby was able to latch with the shield, but he nursed for 45 minutes to an hour each feeding and never seemed satisfied. Things seemed to go OK the first week, but at a routine check-up 2 weeks later, baby hadn’t gained any weight. The pediatrician told mom to start supplementing immediately and referred her to me. I saw her the next day. Her baby was 3 weeks old.

After a little guidance, baby latched on to the breast easily and nursed well. Mom’s milk supply is very low, of course, since baby was not transferring milk well with the nipple shield. Now this mom has quite a bit of work ahead to increase her milk supply. In the meantime, this baby will need to be supplemented with formula.

Story number 2: Mom was given a nipple shield after the first attempt at breastfeeding because her baby’s latch was incorrect and her nipple felt pinched. Fortunately, this mom had arranged to see me prior to her son’s birth. I saw them day 3. He latched easily after I showed his mom how to help him find the breast. He breastfed while his parents watched in awe—surprised that he could do so well without the nipple shield. Mom was absolutely comfortable and delighted that breastfeeding did not hurt!

Story number 2 turned out well. It likely would have had a very different ending, however, if this mom had continued to use the nipple shield without guidance.

The nurses who handed out the nipple shields did not attempt to correct the underlying problem BEFORE resorting to plastic. In addition, they did not teach the moms how to assess the babies’ effectiveness using the shield while breastfeeding. Finally, there was no follow-up offered or suggested to ensure that either of the babies were transferring enough milk to gain weight.

I wish these 2 stories were isolated incidences. They are not. I see more or less the same scenario several times a week. So how can you avoid this very common problem?

• Know that your baby was born to breastfeed!

• Avoid nipples shields in the first 24 hours.

• If you’re having trouble breastfeeding, insist on getting help. If the hospital cannot provide you with timely, knowledgeable, REAL help, ask a nurse for a referral to a private lactation consultant.

• If you decide to use a nipple shield, make sure someone in the hospital evaluates an entire feeding with you to help you feel confident.

• Arrange for a lactation consultant visit and a baby weight check as soon as possible after leaving the hospital.

  Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

Nipples shields are molded silicone “nipples” that fit over a natural nipple. They look a bit like a sombrero, and the rim or base of the shield extends out about an inch to adhere to the breast. There are usually 4 holes in the nipple that mom’s milk can flow through. They are very thin and made in several sizes and styles. They are designed so that baby can latch on to the shield and get milk from mom.

So why on earth would anyone want to use a plastic nipple?

Nipples shields can be helpful when a baby is unable to form a strong vacuum at the natural breast. Sometimes, if baby’s tongue is not doing what it should, a nipple shield can enable a baby to breastfeed who otherwise would need to be bottle fed.

Nipple shields are also commonly used when a baby has nursed incorrectly and caused nipple soreness. A shield can make breastfeeding more comfortable while mom and baby learn to breastfeed comfortably.

Always seek guidance from an experienced lactation consultant before considering the use of a nipple shield. Improper use can lead to inadequate milk intake and subsequent weight loss, which, in turn could lead to a decrease in your milk supply.

Whether to alleviate soreness, or to help a baby who is learning to suck properly, a nipple shield is a temporary fix. Your lactation consultant should provide you with a detailed plan for the use of the shield and when and how to discontinue its use. When your baby is ready, he will breastfeed happily and comfortably without it!

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com

Sometimes, despite doing all the “right” things, you may find yourself producing less milk than your baby needs. Here are some things you can try:

• Go to bed with your baby for a whole day and breastfeed and sleep. Arrange for help so that you are not getting up for anything but bathroom breaks. Sometimes getting more rest and a day of unrestricted breastfeeding can give your body a much-needed boost.

• Try pumping (double) immediately after feeds for 5 minutes or so. The purpose of this is to tell your breasts you want more milk. It’s ok if you don’t actually pump out any milk.

• Eat well! Now is not the time to try to lose weight. Losing more than 1 pound a week may interfere with milk production.

• Try a bowl of oatmeal every morning. Many mothers have found this delicious intervention helpful.

• Avoid hormonal birth-control methods.

• Discuss the issue with a lactation consultant. There are herbs and prescription medications that can help with milk supply but you need professional guidance. There is a possibility of side effects and incompatibility with just about anything!

• If your milk supply is truly inadequate for your baby’s needs, be sure to supplement as necessary with human milk or formula. Aside from normal weight loss in the first few days of life, it is never OK for a baby to lose weight. See your health care provider or a lactation consultant for guidance on supplementation.

See also: “Breastfeeding and Milk Supply.”

Written by Renee Beebe, M.Ed., IBCLC. Renee is a lactation consultant in private practice in Seattle, Washington. She is available for home/hospital visits and phone consultations. Renee can be reached at www.second9months.com