World Breastfeeding Week 2017

World Breastfeeding Week is here! We’ve been doing a few things all week long to celebrate.

First, we released this mosaic, made up entirely of our members’ submitted photos. If you zoom in, you’ll see mothers nursing babies, mothers nursing toddlers or preschoolers, mothers pumping, some photos of pumped milk, milk baths, and so much more. This mosaic is a love letter to our membership. We love you ladies!

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Second, we are offering an exclusive new apparel design, created for Milky Mommas, which is not available anywhere else! Check out this order form doc to order your shirts, hoodies, onesies, or bags in our gorgeous Word Cloud Momma design! The order will be closing soon, so don’t wait!

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Third, we have released several new advocacy graphics. Take a scroll through these lovely women and babies, we hope you feel empowered!

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Fourth, our founder Christine has created this set of graphics to help us ask for the support we need from our families, communities, employers, and healthcare providers. Feel free to download and post those that apply to you, in order to start a discussion with your loved ones about breastfeeding support.

Last but not least, many of our mommas are attending Big Latch On events in their areas. Are you? What are you doing to celebrate this week? Tell us about it in the comments!

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Mastitis

This document is provided for information purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in Milky Mommas. If you think you’re having a medical emergency, call your doctor or 911 immediately.

Mastitis is the clinical term for breast infection.

Whenever a lactating woman experiences flu-like symptoms, she should consider the possibility of mastitis, contact her provider, and begin measures to treat / prevent mastitis.

Symptoms of mastitis include:

  • Localized tenderness of breast
  • Localized heat or red streaks on breast
  • Fever
  • General sick feeling
  • Sometimes nausea and vomiting

Common causes of mastitis are:

  • Infrequent feedings or scheduled feedings
  • Missed feedings
  • Poor milk removal due to latch issues
  • Illness in mother or baby
  • Oversupply
  • Rapid weaning
  • Plugged ducts and/or blebs
  • Pressure on the breast that restricts milk flow (like tight clothing)
  • Cracks in the nipple that allow bacteria to enter and infect breast tissue
  • Maternal stress and fatigue

How is mastitis diagnosed?

  • Mastitis is usually diagnosed based on symptoms.
  • Lab tests and diagnostics are not routinely needed or performed for mastitis unless there are repeat infections.
  • Your OB or PCP can diagnose and treat mastitis.

How is mastitis treated?

  • The most important step is frequent and effective milk removal (at least every two hours).
  • Breastfeed as frequently as possible, starting on the affected breast.
  • If it hurts too much to start on the affected breast, it might help to start on the unaffected breast and switch sides as soon as letdown happens.
  • Position the baby at the breast with chin or nose pointing to the blockage to help drain the affected area.
  • Gentle massage may also help remove milk. Massage should be directed from the blocked area toward the nipple.
  • After feeding, pumping or hand expressing may help remove more milk and speed recovery.

Should I continue to nurse if I have mastitis?

  • Yes! Frequent and effective milk removal is key, and nothing is more effective at removing milk than a baby.
  • Mothers who can’t continue breastfeeding when they have mastitis, for whatever reason, should pump or hand express at least every two hours because stopping cold turkey leads to a greater risk of abscess than continuing to feed.

What should I do while recovering?

  • Rest. If possible, take baby to bed for a nursing vacation.
  • Hydrate. It’s important to drink plenty of clear liquids to help your body produce plenty of milk to flush the infection.
  • Ask your provider if an NSAID may be right for you, to relieve pain and inflammation.

Do I need antibiotics?

  • It depends. Contact your provider at the first signs of mastitis and ask what they advise.
  • If symptoms are mild, many breastfeeding experts advocate treating conservatively at home for the first 24 hours.
  • If symptoms do not improve in 12-24 hours or you are acutely ill, experts agree antibiotics should be started.
  • Your HCP will help you decide which approach is best for you and your circumstances.

What kind of at-home treatments may help relieve mastitis symptoms and hasten recovery?

  • Nurse, pump, and/or hand express as much as possible (at least every two hours)
  • Rest and hydrate
  • Your provider may recommend an NSAID to relieve pain and inflammation
  • Hot shower
  • Moist or dry heat, whichever feels better
  • Epsom salt soak
  • If inflammation is severe enough to inihibit milk flow, it may be helpful to apply ice for a few minutes before nursing or pumping
  • Gentle massage or pressure from behind the clogged area toward the nipple (use in moderation because massage can make inflammation worse)
  • Stroke gently from behind the clog toward the nipple with a comb or plastic bristled brush
  • If you have a visible bleb or milk blister, notify your provider and ask what s/he would advise

Which antibiotics are commonly prescribed for mastitis?

  • Dicloxacillin
  • Flucloxacillin
  • First-generation cephalosporins
  • Cephalexin
  • Clindamycin
  • If an antibiotic is needed, your provider will prescribe one that’s appropriate for you.
  • Breastfeeding compatibility can be verified at http://toxnet.nlm.nih.gov/newtoxnet/lactmed.htm, via the MommyMeds app, or by calling the InfantRisk hotline Monday – Friday, 8 am – 5 pm, CST, at 806-352-2519.

How soon should I start to feel better?

  • Improvement is usually rapid and dramatic.
  • If symptoms don’t resolve in several days with appropriate management, including antibiotics, you should call and notify your provider.

What can I do to avoid mastitis in the first place?

  • Feed on demand.
  • Get a good latch.
  • Learn to hand express so you can always empty your breasts, no matter what the circumstances.
  • Be on the lookout for signs of milk stasis (milk that is not leaving the breasts). Check for lumps, pain, or redness.
  • If you notice any signs of milk stasis, be quick to completely empty the breast, increase the frequency of feedings, and rest and hydrate.
  • Call your healthcare provider at the first signs of mastitis and ask what they advise.
  • Practice good hand hygiene.
  • Disassemble and wash pump parts thoroughly between uses (may be refrigerated for up to 24 hours) and air dry.

Source: The Academy of Breastfeeding Medicine

Additional resources:

This document is provided for information purposes only. It is not intended to diagnose, treat, cure, or prevent any disease. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in Milky Mommas. If you think you’re having a medical emergency, call your doctor or 911 immediately.

Growth Spurts

“Normal” Behavior During Growth Spurts.

Is your baby…

  • Inexplicably fussy?
  • Nursing around the clock?
  • Waking more often at night?
  • Slapping, head-butting, unlatching and relatching, pinching the breast?
You may be experiencing what is known to many mothers as a “growth spurt” or a collection of “frequency days”. Rest assured that this is a very normal part of a having a rapidly growing baby! Growth spurts typically last anywhere from 2-3 days to a week and often are gone as suddenly as they appeared.

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Why does baby ask to nurse more during a growth spurt?

Breastfeeding works on a demand, supply system. Babies communicate with your breasts by nursing more frequently, fussing at the breast, latching/unlatching repeatedly, head-butting the breast, etc. Frequent emptying and additional stimulation of the breasts creates a “demand” that your breasts fill with a greater “supply” of breastmilk.

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When do growth spurts occur?

Growth spurts often occur a pattern, though it can vary from baby to baby and remember that babies don’t keep track of calendars. Growth spurts often occur at weeks 1, 2, 4 and months 2, 4, 8 and 12. Growth spurts can be early OR late. Remember that baby’s growth may not be entirely physical and that babies need fuel for developmental leaps, emotional growth and just for comfort during these tumultuous times of their young lives.

How can I best cope with growth spurts

Make nursing comfortable, don’t watch the clock
Many mothers find that creating a “nursing nest” and making a plan to hunker down and nurse on demand helps to pass the growth spurt as smoothly as possible. Gather water, snacks and good books for yourself and spend time with baby skin to skin with unlimited nursing and throw out the clocks. For mothers with older children, preparing “busy bags” (little kits of simple toys, books, something that can keep them happy for a while), temporarily borrowing a “mother’s helper” (pre-teen, auntie, grandma, etc. that can offer a separate set of eyes on the older children) or nursing baby in a sling or baby carrier can keep things running smoothly.

Accept help!
Remember all of those well meaning friends and relatives who said, “I’ll do anything you need! Just ask!” Assign them a task. Something as simple as picking up dinner and dropping it off at your door can be a huge help when baby is feasting at the breast buffet.
Turn to other nursing mothers for support.
Every nursing dyad experiences growth spurts. Talk with mothers who have had the same experiences who you know will offer support and commiseration instead of judgment and suggestions that can sabotage a breastfeeding relationship. Lean on your fellow Milky Mommas, check out a local La Leche League meeting or call a LLL leader (http://www.llli.org/webus.html?gclid=CMeDhpn6wbgCFSdp7AodlScAbg). Scan the board and read up on some other mothers who are dealing with the same frustrations.
Remember that this too shall pass
Growth spurts often are over within a week. The round the clock nursing sessions often give way to a few days of sound sleep for younger babies. Enjoy the reprieve!
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Sources:

Vitamin D

Vitamin D is an important nutrient for overall health. It is an important factor in bone health because vitamin D aides in the absorption of calcium and phosphorus. It has also been shown to be important for the immune system, muscle function, cardiovascular function, respiratory system, brain development, and might have cancer fighting effects. It is also believed to be connected to emotional/mental health.
Lack of vitamin D in the winter months has been connected to depression in some people. A major problem that can come from being deficient is rickets. While it isn’t as common in developed countries any longer, it can still happen if a child is not getting enough vitamin D. Rickets happens when bone tissue fails to properly mineralize, causing soft bones and skeletal deformities. This can be mild or extreme.
**Important to note here** Do not freak out that your baby/child has rickets just because they are bowlegged. Baby’s legs are naturally bowlegged and as kids grow, this changes. It isn’t uncommon to go from bowlegged to knock-kneed and then eventually have things even out and look normal. So don’t freak yourself out.
It’s also one of the most common deficiencies. For some people it can be as simple as getting enough sun every week to have optimal levels of vitamin D. It isn’t always that simple though. There are a few factors that affect our ability to have adequate levels from sun exposure; such as, time of day, distance from the equator, skin tone, season, amount of skin exposed, and sunblock use. The link below in the sources section for the Vitamin D Council has more detailed information on this.
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Because vitamin D deficiency is so common, many doctors automatically say that an infant needs to be supplemented. This isn’t always true. If the mother has sufficient levels and both the mother and baby get some sunlight regularly, the baby is likely fine without supplementation. Since it is a common deficiency, many doctors simply assume that no mother will be able to provide enough vitamin D through breastmilk and they recommend supplementation. Your doctor may even say that it isn’t passed through breastmilk at all, which is not true. A simple blood test can be done to test the vitamin D levels in any child or adult. If you are concerned, ask your doctor to do the test and see if you or your baby need to be supplementing.
If you do choose to supplement, there are a variety of brands available, some of which offer the recommended daily dose in as little as one drop.  There are also two types of vitamin D you choose from to supplement with, D2 and D3. D3 is more easily absorbed by the body. However, if you are vegan this may come with an ethical dilemma as it is derived from animal sources. It that applies to you, it is something to take into consideration when choosing a supplement.
Sources:

Poop – Evidence and Research

Resources Compiled by Pamela Holland, IBCLC
1) Bowel Habits of Normal Thai Infants
2) Jen Tow’s Handout
If you use this, please give credit to Jennifer Tow
3) Bowel Movements and Urination Patterns
Excerpt from: Discharge Procedures for Healthy Newborns, Robert C. Langan, M.D., St. Luke’s Family Medicine Residency Program, Bethlehem, Pennsylvania
Breastfed infants typically have more than three bowel movements per day and are rarely constipated. Watery stool may be normal; however, parents should contact their physician if the infant’s stools run out of the diaper.
Urination Patterns
Six or more wet diapers per day is normal for a breastfed infant after the mother’s milk has come in, as well as for bottle-fed infants
Bowel movements
More than three bowel movements per day is normal in breastfed infants.
Bottle-fed infants may have fewer bowel movements
4) Factors associated with defecation patterns in 0–24-month-old children
European Journal of Pediatrics; http://link.springer.com/journal/431; December 2008, Volume 167, Issue 12, pp 1357-1362, Date: 09 Feb 2008
Abstract
To identify the normal defecation patterns and the factors affecting these patterns in the first two years of life, a questionnaire was given to the parents of 1,021 children who were followed in a well-child clinic. The time of first meconium passage, presence of colic symptoms, frequency, color, and consistency of stools were recorded. Mann Whitney U, Wilcoxon, chi-square, and correlation tests were used in the statistical analyses. The median number of defecations per day was six in the first month of life. This decreased to once in the second month and almost all cases remained so until the end of the 24th month. At the second month of age, 39.3% of infants passed stools less than once a day. This pattern of rare defecation was seen until the end of 6 months, when supplemental foods were started. Stool frequency was higher in exclusively breast-fed infants (p = 0.0001). Infants who had colic symptoms in the first 2 months had less frequent defecation during the first 2 years of life (p = 0.0001). In addition to confirming the previously observed defecation patterns of 0–2-year-old infants, this study provides the relationship between colic symptoms and stool frequency, and showed that the second month of life was unique in the sense that the frequency of stooling decreased to half of the previous month and 39.3% of these infants defecated less than once a day.
5) Frequency and weight of normal stools in infancy.
Arch Dis Child. 1979 Sep; 54(9): 719–720. PMCID: PMC1545825,  J N Lemoh and O G Brooke

Bottle Feeding the Breastfed Baby

Read through this helpful site:
Show this video to ALL caregivers:

Paced Bottle Feeding

As we know, breastfeeding is not just nourishment. The leisurely pace of breastfeeding allows a baby’s brain to realize his stomach is full before he is overfull.
Paced bottle feeding is designed to mimic the “conversation” of breastfeeding. This helps avoid overfeeding via bottle, and allows mom’s supply to keep up with the amount fed to baby via bottle.
Most breastfed babies eat 19-30oz in a 24 hour period. This amount easily meets the caloric needs of the vast majority of babies.

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What Bottle is the Best?

You likely don’t need to spend a ton of money on bottles. Use a standard bottle and the slowest flow nipple (premie or size 1). Every mom/baby will tell you a different bottle that worked for them. Trial and error will tell you what works for your baby.

How Long Should it Take to Feed a Bottle?

It should take at least 5 minutes per ounce of breast milk, or about 15 minutes for a 3oz bottle.

How Much Milk?

1-1.5 Ounces per hour, on average.
Make bottles small to start, 2-3 ounces, to reduce milk waste. Bottle size should not typically exceed 5 ounces. Formula bottles are a lot bigger, so caregivers may be confused and recommend you make bigger bottles. Gently explain to them why this is not ideally. Giving them the tear sheets linked above might help!
Read this site for more details on how much milk to give:

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When to Feed?

Feeding your baby on demand is the best way to meet baby’s needs- offer milk before the baby starts to cry and root. It takes several minutes to warm and prepare a bottle, so be ready to feed when baby is ready. Most babies eat at least every 2-3 hours.
Young babies will want to nurse to go to sleep. Train caregiver to recognize your baby’s sleep signals and to get them to sleep before they are overtired.
Here is more information on hunger cues: http://kellymom.com/bf/normal/hunger-cues/

How to Determine Feeding Schedule:

Can you nurse at drop off and pick up? Can you visit baby on your lunch break to nurse?
This will reduce your pumping needs and the amount of bottles required. Plan extra time to nurse.
Plan for first bottle to be given 2-3 hours after last feeding. And then every 2-4 hours after.
Let caregiver know what time to not feed after. Call ahead and let them know you are on the way and not to feed the next bottle, if necessary. You are in control of the feeding schedule!
Only leaving for a little bit? Nurse before you leave and as soon as you get back!

Do I Need to Practice?

Yes! But let your partner or other caregiver (grandparent, friend) feed the bottle when you are NOT in the room. Babies know when their mother is nearby and know they can nurse. Leave a soiled shirt that has your scent for use. Have caregiver put it over their shoulder.

Help! My baby won’t take a bottle!

Check out these tips to help your baby take a bottle or take expressed breastmilk from a cup or spoon.
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Bottle feeding is a normal part of breastfeeding life for many moms and babies in the 21st century. Learning to properly pump and bottle feed can offer you the freedom to be away from your baby for a date night, to return to work or school, or for some much needed self care. Rest assured, you will figure it out and your baby will be taking a bottle in no time.

Storage of Breast Milk

Storage Guidelines of Expressed Breast Milk:

Freshly-Expressed Milk
               Warm Room : 3-4 hours
               Room Temperature: 4-8 hours
               Insulated Cooler/Ice Packs : 24 hours
Refrigerated Milk
               Refrigerator (fresh milk) : 3-8 days
               Refrigerator (THAWED milk) : 24 hours
Frozen Milk (do not refreeze!)
               Self-Contained Freezer of Refrigerator : 6 months
               Deep Freezer : 12 months

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Mixing Expressed Milk:

Only mix milk at or near the same temperatures.
Freshly-expressed milk can be added to room temperature milk within 4-8 hours. Otherwise, refrigerate milk and then combine. Add refrigerated or partially frozen milk to already frozen milk.

Oops! I didn’t use/need what I HEATED!

Thawed milk needs to be used within 24 hours. Keep refrigerated until next feeding. Heated or warmed milk needs to be used within 2-3 hours. Simply smell milk if you think it may be bad. Don’t toss the milk! Use “bad” milk in the baby’s bath!

Does the milk have a metallic taste or smell funny?

See link for more info:

Helpful Information:

CDC Recommendations:

The STUDIES the Storage Guidelines are based on:

Nipple Shields – A Note from our IBCLC

Consider this a PSA about nipple shields. Nipple shields can be a valuable tool for certain breastfeeding problems.

Here are a few examples of those problems:

  1. Preterm babies, some studies have shown that a nipple shield can be effective when working with babies that aren’t term.
  2. Babies with tongue tie, if you are waiting on a referral to get a tongue tie revision a nipple shield can be helpful and it extends far enough into the baby’s mouth to maintain latch.
  3. Babies with poor muscle tone can sometimes benefit from the rigidity of the shield.

 

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Here are some reasons NOT to use a nipple shield:

  1. Baby will not latch, if you are using a shield, baby is still not latched.
  2. Breastfeeding is painful, if breastfeeding is painful it is because baby isn’t latching well. If you are using a shield, you still have a baby that is not latching well only now it is to the shield.
  3. Baby keeps coming off the breast, if baby stays on with the shield, please have infant evaluated for tongue tie/lip tie.
  4. If you are using a shield for any reason, please note that there is s good chance that your milk supply will diminish over time. This is because your baby’s saliva doesn’t come in contact with your nipple and stimulation is decreased by the layer of silicone.
I like to think of nipple shields the same way that we would consider antibiotics. With judicious use, they truly can be a lifesaver. But most of the time they are not necessary and they certainly aren’t going to do a thing for the common cold (or sore nipples).
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Birth Control and Breastfeeding

Most methods of birth control are not harmful to nursing infants but any hormonal birth control can cause issues with milk supply. Progestin-only birth control is generally considered breastfeeding compatible, but combination birth control (containing estrogen and progestin) is typically not recommended.

Breastfeeding can cause the delayed return of fertility for some mothers, but only if certain conditions are met. Like any method of contraception, there is a certain rate of failure and many factors can affect the success rate. Check out the graphic below for more information on this method.

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For more information on hormonal birth control:

 

Long-acting Reversible Contraception (LARC) Methods

LARC methods include the intrauterine device (IUD) and the birth control implant. Both methods are highly effective in preventing pregnancy, last for several years, and are easy to use. Both are reversible—if you want to become pregnant or if you want to stop using them, you can have them removed at any time.

The IUD is a small, T-shaped, plastic device that is inserted into and left inside of the uterus. There are two types of IUDs:

  1. The hormonal IUD releases progestin. One hormonal IUD is approved for use for up to 5 years. Another is approved for use for up to 3 years. The progesterone-releasing IUD delivers its hormone directly to the lining of the uterus, which only leads to a slight increase in progesterone levels in the blood stream (much lower than that found with the progesterone-only pill). As a result, there is much less chance of side effects from the progesterone than from the injection or mini-pill.
  2. The copper IUD does not contain hormones. It is approved for use for up to 10 years.

The birth control implant is a single flexible rod about the size of a matchstick that is inserted under the skin in the upper arm. It releases progestin into the body. It protects against pregnancy for up to 3 years.

For more information on LARC:

 

Other Methods

Other birth control options include barrier methods and fertility awareness methods. They are not harmful to nursing infants and don’t affect milk supply.

For more information on other birth control:

Whatever method of family planning you choose, we love to recommend that any person with a uterus read the book Taking Charge of Your Fertility, to better understand your reproductive system, and truly take charge of your body.

Jaundice

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Often, one of the first challenges a mother faces is jaundice. Doctors and nurses may indicate that all jaundiced babies must be fed formula, but evidence suggests that this is not case. Infants can absolutely overcome jaundice and grow into healthy babies while consuming only breast milk. Although management of breastfeeding and jaundice varies among the nations, the principles and recommendations outlined in the link below apply universally.

Click here to read through the Academy of Breastfeeding Medicine’s Guidelines for Management of Jaundice in the Breastfeeding Infant Equal to or Greater Than 35 Weeks’ Gestation.