Blogging for Babies, Breastfeeding and Mothers

Krista Maltais writes today's article.

When you think about creating your birth plan for labor and delivery, do you associate it with breastfeeding? If not, you should! Initiating skin-on-skin within one hour after birth (or as soon as you are able to safely hold your baby after anesthesia) is associated with the best breastfeeding outcomes. A Birth Doula can ensure that this early breastfeeding initiation takes place and goes smoothly. 

A Birth Doula is not only trained to provide emotional, physical, educational, and informational services to women and their partners during labor and childbirth, she is also qualified to provide breastfeeding support. Birth Doulas undergo lactation education and training as part of their certification; they are able to understand the instinctual processes of newborns as well as the physical and emotional changes that mothers go through after birth and how these experiences impact breastfeeding. This education and training ensures that every family who hires a Birth Doula has the opportunity to get one-on-one personal breastfeeding education and support.

This one-on-one care can be especially important immediately after birth; there is no need to wait for hospital staff who may be busy performing other tasks or helping other families and no need to wonder what you should be doing to help begin breastfeeding; your Birth Doula will be by your side to offer the support and education you and your partner may need.

Research^* has shown that the “psychosocial support during labor, delivery, and the immediate postpartum period by a female companion (Doula) has a positive effect on breastfeeding. The frequency of exclusive breastfeeding one month after birth is significantly higher as are the behaviors that promote breastfeeding.”

As you create your ideal birth plan, you may want to consider how a Birth Doula can enhance your labor, delivery, and immediate postpartum experiences, especially in regards to early breastfeeding initiation!

To find out more about birth support or how Birth Doulas positively impact breastfeeding experiences, visit: www.dona.org

* Langer A, Campero L, Garcia C, Reynoso S. “Effects of psychosocial support during labour and childbirth on breast feeding, medical interventions, and mothers’ well-being in a Mexican public hospital: a randomised clinical trial.” Br J Obstet Gynaecol, 105:1056-1063, 1998.

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My lovely daughter-in-law Kelly has had an incredibly rough time with breastfeeding. Her milk production just never delivered and her babies never latched and I am in New England while she is in North Carolina. Hind sight? Listen to Kelly's response to the last blog post: Breastfeeding Burnout.

I feel like I can relate to the woman that you received an angry letter from. When I found out I was pregnant, I began to imagine how things would be after my baby(ies) entered the world. As far as breastfeeding goes, I had visions of putting the boys on my chest after birth and they would simply “know what to do”. We bought a chest freezer for food because we planned on filling our refrigerator freezer with pumped milk. I took breastfeeding classes, met with a local LC (because you live so far away), and bought everything, and anything, people said I would need to be “successful”. We even had a print out that we brought to the hospital (NO PACIFIERS, NO FORLUMA, NO VACCINES). How hard could it be? I'm healthy, I'm motivated, my husband is 100% supportive, and my mother in-law is a lactation consultant to boot! I quickly learned that I had NO CLUE how difficult breastfeeding could/would be, and the odds of succeeding couldn't have been staked higher against me.

I had twin boys, a scheduled c-section, impatient nurses who insisted on pushing the boys onto my breasts, and a hospital policy that doesn't allow you to see a LC for 24 hours post delivery. We tried to call my local LC (Leslie), but she was on medical leave. We Skyped with you, but I was exhausted, and still drugged! After day 2 in the hospital, my boys still were not nursing, or latching. I was hand expressing every drop of colostrum I could into a spoon and giving them that. The nurses thought I was crazy, but I didn't care...my boys needed whatever I could get! After a weight check reveled the boys had lost 8.1 and 6.6 % of their birth weights, I was told the one who lost the most was reaching the “danger zone”, and we needed to make a decision. After a horrible night of trying to breastfeed without success, we clearly had a VERY hungry baby that needed to eat! We gave up and asked for formula. I cried as I watched them both inhale their 2oz of formula. Seeing our two day old babies that hungry was the worst feeling I've ever had. I felt defeated, let down by my body, and like I was failing as a mother, after only two days into parenthood.

Ry and I thought that the stress of the hospital may be a large component to not having success and we asked to go home. They agreed to send me home, providing I took the boys into our pediatrician the next day to be weighed. Anything you say, just send us home! So, we were off...The sun was shining and we were going home as a family; we were beyond excited! However, once I got home, things weren't really any better.

My grandparents and my mother were in town awaiting the birth of the boys, and offering assistance with cooking, housework, etc...I should have known that housing three additional people (none of which could drive) would add stress and tension to bringing home the little people we are now responsible for.

As cabin fever, baby blues, and possible PPD set in, the tension and stress levels in our house grew,I did something I read was quite common in similar situations; I found myself becoming very protective over the boys. Ryland and I didn't let anyone change, feed, or burp them and we kept them in our room, with a brief appearance in the morning to say hello. Because we took on 100% of the baby care and wouldn't allow people to help, I found myself choosing between napping, showering, eating, and pumping during nap times. Napping and/or showering won the coin toss almost every time. Perhaps how I was able to drop all of my pregnancy weight in 2 weeks?!

As family started to leave, stress levels began to fall. With less family members here, we were still keeping the boys quiet, but I was able to pump more frequently. I was drinking the herbal tea and taking the supplements you suggested and still wasn't getting what I THOUGHT I should be getting.

That brings me to where I am now, three weeks after the delivery of our perfect little babies. I look at my rented breast pump and I cringe; I can't stand that machine. I feel like it's a constant reminder of the failed expectations I had set for myself and my family. I haven't attempted pumping anything in two days. However, Ry and I took a trip to Babies R Us yesterday (where we rented it from), and I didn't have the heart to bring it back yet (we've paid through August 17th). So, why am I hanging on to it? I have no clue! Perhaps part of me still wants to work on building my supply even though the other part of me is simply burned out and feels defeated.

In response to the letter you received, no one needs your permission to stop breastfeeding. The mother seems angry with herself, her body, and people who talk about how “wonderful” their breastfeeding journey has been. For her, and myself, it's been an extremely depressing, stressful, and emotional ride. I feel like she is blaming you because she doesn't have anything else left. By writing that letter to you, she gave herself permission to stop pumping/breastfeeding. You've been nothing short of encouraging, supportive, and understanding (even when I talk about stopping).

I'm sure it's difficult to read an angry letter, but you should feel comfort in knowing that what she said to you is no longer bottled up inside of her. You probably helped her more than you will ever realize. We love you and I can't wait for you, and Duncan, to get here and meet your wonderful grandsons!!!

Love Always, Kelly

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What happens when everything you try as a new mom doesn't improve your breastfeeding situation? Your spouse is saying stop; your heart says keep going and the baby doesn't seem to care one way or the other. You can't bear the thought of giving up, but the tears are coming more and more frequently.

This is an all too common scenario among today's mothers. I see it weekly in my practice and hear chatter about it on Facebook and Twitter. Obstetrics and Gynecology published a paper that looked at depression among women that experienced early breastfeeding difficulties. Conclusion?

Women with negative early breastfeeding experiences were more likely to have depressive symptoms at 2 months postpartum. Women with breastfeeding difficulties should be screened for depressive symptoms.

What is the role of the lactation consultant in this situation? Certainly screening for depression is important. But do we tell someone to give up?

I recently received a very sad and angry letter from a mother that had given up breastfeeding at three months due to a very low milk supply. She was upset with me that I had not given her permission to give up breastfeeding sooner. At first, I was taken back by the tone of her letter. Then I was terribly hurt and then I was angry. It took me 48 hours to process the letter. That's when it dawned of me that this really had nothing to do with me. This was a mother experiencing huge disappointment with her own body and perhaps depression. That's alright if she wants to blame me; perhaps it makes it easier for her to cope.

But I am worried about her. That's a lot of angry to have. And the part that doesn't make sense is that "You didn't give me permission to give up." When was I to give her permission? At her first visit on day four when no one knew what her milk supply would do? At her second visit on day ten when she was still so full of hope? Several attempts were made to contact her after her visits, but she didn't return the phone calls. That clued me in to the fact that she may be depressed, but you can't leave a message like that. So three months later she writes me this letter.

Now that we have this study I have more tools in my toolbox. Look at this from the study: "Women who disliked breastfeeding in the first week were more likely to experience postpartum depression at 2 months." I sensed from the beginning that this woman disliked breastfeeding. There are not many women I meet that cause me to feel this way. Now I will be more alert to this and will ask, "Do you really want to breastfeed? Do you enjoy it?"

I do not judge anyone by the choice of feeding they make for their child. There are many issues leading up to delivery that impact a woman's feeding choice and certainly once the baby arrives breastfeeding problems make it harder, if not impossible to enjoy breastfeeding or even to continue.

For those women that choose to continue breastfeeding even when they are having problems, my mantra is and always will be Diana West's mantra:

Each woman defines her own success.

One woman pumped an ounce of milk a day for her baby's first year and she was delighted. Another mother of triplets pumped 18 ounces a day until their first birthday and she was very proud of herself. Another mother stopped breastfeeding for six months and then started pumping and built her supply back to 18 ounces a day. Do I tell someone when to stop? I feel my responsibility is to support her 100% whatever decision she makes and perhaps that is where I failed this mother. Did I forget to tell her this? Was I too full of hope for this mother? I can't be a fortune teller, knowing who will and who won't make a full supply of milk. Breastfeeding does not have to be all or none. I don't want to be and shouldn't be the one to define a mother's success.

Every ounce of breastmilk you give your baby, for as many days and weeks as you can, is like money in the bank for your baby's health.

Help me think through this and learn from this letter. How can I and others that work with breastfeeding mothers be a better support to the mothers we work with? What would you have wanted me to say to you?

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Today's blog post is by Krista Maltais. She is a post partum doula and breastfeeding counselor.

Babies seem to bring out the love – and advice – and opinions – in everyone! From the choice of birth place to the choice of baby’s name, there will never be a lack of unsolicited thoughts given to expecting (and existing) parents! 

That is one of the reasons why so many families are hiring Doulas! Doulas do not adhere to a specific method or approach because their job is to support the family’s educated choices, philosophies, and parenting styles - all without judgment or unwanted advice. 

There are two kinds of doulas; a Birth Doula works with the mother and partner prenatally and will stay with them for the duration of the labor and delivery process. A Postpartum Doula works with the family once the baby is born for the first weeks or months of the baby’s life. Along with doctors, midwives, and lactation counselors, doulas are trained to help their clients have successful birth, postpartum, and breastfeeding experiences. 

Successful breastfeeding experiences should begin with building a network of professional and personal support. Breastfeeding mothers should try to build a network of support with professional and personal resources because, uUnfortunately, the choice to breastfeed does not escape the litany of comments, stories, and debates from family, friends, and total strangers! Fortunately though, doulas undergo a rigorous certification program before obtaining their credentials; this includes specific education and training about providing breastfeeding support. 

A doula can offer education, techniques, and resources about breastfeeding as well as emotional support and encouragement to reinforce parents’ decisions. Doulas are also great buffers for those who would try to discourage or dissuade mothers from breastfeeding; being able to step in and offer a well chosen comment or gently correcting misinformation is all in a day’s work for a Doula. 

So the next time someone starts in with their unwanted comments, jump in and say “Oh gee thanks. I’ll talk to my Doula about that!” and then keep doing what is right for you. 

For more information about Doulas, or to find a Doula in your area, visit: www.dona.org

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It's fun watching my lovely daughter in law making breastfeeding work for her 1 week old twins. These past seven days have been challenging for her to say the least.

Boys born at 38 weeks via C-section is the number one challenge. Then they were separated from her, taken to the nursery and bathed before they ever learned their mother's unique smell and the feel of her breast and the taste of her milk. Brought back squeaky clean and swaddled and the breast is now a foreign object that they just didn't know they needed.

But Kelly is amazing. Tavish and Sawyer snuggled skin to skin on Kelly's chest and she happily reported that this was their favorite place to be. I could hear the delight in her voice. She hand expressed around the clock those first 48 hours and started pumping on the second day. It's not easy pumping when feedback is absent. I could tell she was growing weary and of course she was exhausted. I stepped back, not wanting to put any pressure on her. Afterall I am the Meemie or the Gammy (haven't decided who I am), not the lactation consultant. So I waited for her to ask questions.

And then I started getting worried that she wasn't pumping enough. Oh yes, I forgot to mention that neither baby was latching. Poor momma, how hard is that? I couldn't keep the LC in me at bay for long. I began to ask her more about her pumping. How often? Is it a priority? That's when it suddenly dawned on my that all the dreams in the world won't make breastfeeding happen. It has to go much deeper than a dream; it has to come from your very core. To breastfeed or not to breastfeed: that is the question.

Now let me be the first to jump right in and say, "I understand." I understand:

1. Ten people came into your hospital room and left you with five things no one else has told you. Who do you believe?
2. Perhaps no one encouraged you to stay skin to skin until your baby fed and then in between every feeding. And, oh no, they bathed your baby before she fed.
3. Our culture makes it very difficult to get out of the hospital with a breastfeeding baby that is
• breastfeeding without causing nipple pain
• getting plenty of colostrum
• not getting any formula
• not getting a bottle
4. Did they tell you that day 2 is the most important day for programming your body to make lots of milk?
5. Did they schedule you to see an IBCLC within 24 hours of going home and give you her number so you or dad can call with any concerns or questions?
6. Did they tell you that breastfeeding can go downhill in two feedings and that if your baby is too sleepy to stay awake when feeding, he's not feeding? Get help fast, as in NOW!

Oh no! What did they tell about preserving yourmilk production? What did they tell you about breastfeeding? Did they tell you that breastfeeding doesn't hurt? Pain is abnormal but very common in our country, but have you talked to your sisters in breastfeeding countries?

Mothers of this brave new world will change the world of breastfeeding. I have been seeing this miracle bud and bloom and blossom over the last three decades. It starts with conviction that breastmilk is phenomenally different than formula even with modern technology. Want to really get convicted that breastmilk is amazing and neccessary for babies? Do your homework while you're pregnant. Want a really deep dig? Read Lars Hanson's The Immunobiology of Human Milk: How Breastfeeding Protects Babies. Here's some other blog posts to read. If you're not still convinced or convicted, call me @ 978-422-9070.

• Dr. David  Newburg
• Breastmilk for Preemies
• Dr. Mark Cregan
• Breastmilk Kills Cancer Cells
• Breastfeeding Reduces Ear Infections
• Breastmilk Induces Different Genes
• Why is Breastmilk Critical?

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Watch this hilarious video. I never knew there were so many names for our mammary glands. Breasts and breastfeeding. OMG!

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I work in Central Massachusetts seeing mother and babies every day. Most of them are a few days after delivery. Most of the babies are sleepy and most of the mothers are scared. Breastfeeding problems abound.

It was interesting listening to Suzanne Colson speak about the increase in breastfeeding problems since breastfeeding teaching was standarized. She quoted a 1985 study, which I don't have a link for. The number of latch problems have increased. Now we know that many variables influence this including the rise of  labor interventions. But one does need to question what may be wrong with what we are teaching mothers.

Suzanne and I had our babies in the 80's when no one around us interferred with our instincts to breastfeed. We figured it out and so did our friends. One of my friends got mastitis and an abcess, but none of the rest of us had any problems other than some transient nipple soreness. And the friend with the abcess? She was scheduling the feeds every four hours and 8-12 hours at night. Hmmm... duh!

When I tell mothers I want them to be comfortable they are shocked. Really? But the ______ told me to do this and she told me to do this and she told me this. And the website said this and the forum said this. And the support group said this. Oh dear. A pediatrician sent someone yesterday and told her she needed one person helping her figure things out, not ten. Go see Debbie. Thank you Dr. Howard.

One client recently told me that someone told her not to use her breastfeeding pillow because the baby wasn't old enough yet. "Use these soft pillows under your arms for the first few days." Don't even get me started on pillows. How many problems I see related to breastfeeding pillows. Especially the experienced mother with her second baby who was told she HAD to use a pillow! "But I didn't use a pillow with my first baby." Inventions are not necessarily necessary.

But, back to the orignal thought. Breastfeeding problems abound. Why? Why did you have problems? Can you put your finger on any one thing? I'm doing an informal study to look at breastfeeding problems with a first baby. If you had any problems breastfeeding, please consider taking this survey and passing it on to your friends.

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This came as a surprise in Saturday's mail. Remember hearing me talk about Breastfeeding Trivia on Facebook? This was the group of Pediatricians that played. They were a great audience and as a result I've had some wonderful conversations with several of the doctors.

The Breastfeeding Trivia stimulated great discussion that evening. They all seemed to have fun. These doctors want to know how to support breastfeeding among their patients. They asked questions about nipple shields, how often the babies feed, how to deal with the five different people that go into mom's room each giving their own opinion about "how to breastfeed" and more. They are concerned about the mother's well being when breastfeeding isn't going well. They are obviously committed to providing the best for their patients.

Then the tide turned and they played Stump the Lactation Consultant with questions such as, "What exactly does it mean that breastmilk digests in 90 minutes? Is that how long it takes to be  absorbed from the small intestines?" Where was Marsha Walker when I needed her. I knew there was a reason I didn't go to medical school. I didn't breastfeed long enough to get those extra seven to ten IQ points. What a pity– my dream was to become a doctor, though now I wouldn't trade my "job" with anyone. My passion truly lies in surrounding myself with breastfeeding mothers and babies and always being on baby time.

One question came from Dr. Howard Zinman about having a protocol that each physician could use to problem solve breastfeeding issues. What a great idea! That's my next project. I'll keep you posted about this.

A big thanks to Central Massachusetts Independent Physicians Association for inviting me to spoke. A big thanks to Dr. Zinman for suggesting me as a speaker and a huge thanks to the physicians for great and lively conversation around playing Breastfeeding Trivia.

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Many moms come to me asking about giving their babies a bottle. Which is the best bottle? Which is the best nipple? How can I keep my baby from chugging a bottle down in five minutes?

Think: eating at home vs. going through the drive-through. Which lifelong habit do you wish to instill in your child?

Breastfeeding is slow feeding until a baby learns the skill well, which typically takes a baby six-seven weeks. Once they master breastfeeding for efficiency, they will feed more quickly. A baby can master a bottle in one feeding because it takes little to no effort: gravity forces it down and the baby gulps to keep up. Bottle feeding can prepare a child for a life time of loving fast food restaurants, unless you rein him in. "How do I do that?" asks mom and/or dad. Here's how:

Pace Feeding

1. Rest the nipple just under the baby's nose or the philtrum.
2. Wait for a wide open mouth beefore inserting the bottle.
3. Hold the bottle as horizontal to the floor as you can so the baby is in control of the flow of milk instead of gravity.
4. Now pace the feeding so baby drinks some and then you let him stop to rest for a second or two.
5. Before you know it your baby will start to pace himself.
6. Let the feeding take 20 minutes— it takes that long for the message to get from tne belly to the brain.

Which Bottle is Best?

• It's not necessarily the bottle, but the method of delivery as I outlined above.
• When looking for a bottle, look for a nipple that has a short teat. (This is not the perfect or necessarily ideal nipple, but it demonstrates the short teat well.)
• The nipple should gradually get wider so baby can maintain a wide mouth around it. Note: many are too wide for baby's mouth.
• A slow flow nipple, but beware: many manufacturers advertise slow flow when indeed they are fast.
• Gulping is a sign your baby is drinking too fast (just like I am typing too fast and making many typos!).

Bottom Line?

You want bottlefeeding to mimic breastfeeding as much as you can, so slow down the feeding. S....L....O....W....!!!!!!!

What bottle worked for you? Did your baby have any problems going between breast and bottle?

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I wonder if anyone knows how many babies/children are alive today because of Kangaroo Mother Care (KMC)? It goes back to 1976 when Dr Rey and Martinez started the KMC program in Bogota, Colombia. A shortage of incubators as well as the premature babies contracting severe hospital infections prompted these doctors to try skin to skin contact between mother and baby. Well it worked miracles and today many babies are thriving due to S2S and breastfeeding through KMC. Dr. Nils Bergman speaks around the world on KMC.

KMC offers a certification course for nurses and other professionals working with newborns, especially preemies and sick babies. How wonderful if every hospital believed in the value of KMC. Here is the brochure for the 5th annual KMC Certification Course. I would love to attend, but don't think I can justify it this year.

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