Beyond the Boob: helpful breastfeeding tools and supplies

by Kate Saumweber Hogan, CPM, LM

What do you need to successfully nurse your baby? Well, if you are already pregnant, then quite simply, you already have what you need: you baby and your breasts!

Some babies love to nurse upon arrival, and already know how to be a masterful nurser…and others need a lot of support and guidance. Remember, there are two people in the breastfeeding relationship, so even if mom is doing everything “right,” baby still has to do his part of the job too.

Keeping a relaxed attitude and a sense of humor can go a long way in a nursing relationship. Since babies can feel your stress and anxiety, laughter can help to keep all of those good hormones and bodily fluids flowing!

What about all of that other breastfeeding stuff on your suggested baby registry list? Here is my list of things to consider having on hand:

1. A good nipple cream: If this is your first time nursing, there will likely be at least a tad bit of nipple soreness. If you get nothing else, it would be useful to have a good nipple cream already on hand; many moms start using it in the first 24-48 hours. In my practice, moms most often prefer Motherlove’s nipple cream and Earth Mama Angel Baby Natural Nipple Butter. These two seem to not only protect, but also heal nipples faster than some of the other common nipple creams out there. You can find these online, at Whole Foods, and also at some of our local birth related business around town.
2. Gel pads: At the first sight or sense of any nipple cracking, bleeding, or blisters, you’ll want to start using gel pads. Even if your breasts are just feeling tender between nursing sessions, you can start using these to help protect your nipple from rubbing against fabric of your bra or shirt. These incredible little inventions are like a gel sticker that helps protect and heal the nipple. You can use them in conjunction with nipple cream (after nursing apply some nipple cream, and then apply the gel pad). The two brands I recommend are Madela’s Tender Care Hydrogel Nursing Pads and Lansinoh‘s Soothies Gel Pads. Sometimes partners will put them in the fridge during a nursing session, and then you can apply the cool pads after baby is done eating. They are meant to be reused for 24-72 hours. I think it is nice to have at least one box of these on hand, especially for first time moms.
3. Nursing tank top: You won’t be able to pick out a nursing bra until your milk has come in and your supply has eve
   

   A mama nurses immediately after birth. Photo credit: Allison Kuznia Photography

   ned out (a great outing for 2-3 weeks postpartum), but it might be nice to have some stretchy nursing support options for the first couple weeks.  Nursing tank tops are tanks with some light support built in, while also allowing you to unclip from the strap to give your baby access to your nipple. Night nursing bras are like stretchy sports bras, and you would likely be able to pick out one that fits at the end of your pregnancy, that will stretch enough to support you through the first couple weeks.

4. Breast Pump: If you are planning to get a pump at some point, it can be nice to have it prior to labor. It is rare, but every once in a while it is nice to use a breast pump in labor to help stimulate contractions (nipple stimulation releases oxytocin, the natural form of pitocin, which brings on labor surges). Be sure to check to see if your insurance covers your breast pump; most plans do! I’ve been hearing lots of recommendations for the Hygeia breast pump lately since it is a closed system which is rated for multiple users. Since the milk can’t get into the motor, it is okay to share this brand of pump (of course with new tubing and parts each time), and you don’t have to worry about mold or dust getting into the motor. Most pumps aren’t meant to share, so be sure to do your research if you are considering borrowing a friend’s or buying one used on craigslist.
5. Hands Free Pumping Bra: If you are going to need to pump regularly (such as going back to work), then you will absolutely want a hands free pumping bra. This super smart apparatus holds your pump flanges securely to your breasts while pumping, freeing up your hands to do other things. Think of things like checking email, doing paperwork, reading a book, updating Facebook, even driving (just make sure you set it up before you pull out of the garage…and not recommended with a convertible or motorcycle), all while expressing milk! It will allow you to truly multitask, and maybe even justify a bit of extra mommy zone-out time!
6. Lactation Consultant contact info: Breastfeeding shouldn’t be painful! Other than a little latch pain which fades away after 10-15 seconds, and a bit of tenderness in the first few days as your nipples adjust to nursing, breastfeeding shouldn’t hurt! If it does, then something needs to be adjusted. Most often it is the latch, sometimes it’s positioning, or it could even be a baby’s short frenulum. Whatever the issue may be, you do not need to problem solve alone. We are in an amazing community that is full of support. Be sure to check out the Childbirth Collective’s member directory to get in touch with a lactation support specialist. You can even request a few hours of lactation help or postpartum doula support as a baby shower gift!
7. Privacy and Rest: Unlike many other cultures around the world, we don’t have a huge tradition of postpartum rest and pampering (unfortunately!). It is so important for you and your new family to get lots of skin to skin time together, and sometimes that can be hard to do in front of visitors. When baby arrives, allow yourself at least two weeks of lounging in bed, with minimal visitors, so that you and baby can figure out what works best for you, in your own time and pace. Have your lactation consultant and other support people come to you, so that you aren’t wearing yourself out by having to get dressed, get a diaper bag packed, and get yourself out of the house so early on.

Surround yourself with love and support, keep a lighthearted attitude, and please please please ask for help at any early signs of breastfeeding troubles. Happy nursing!

Kate Saumweber Hogan is a certified professional midwife and licensed midwife, serving Minnesota and Wisconsin. She is the owner of Twin Cities Midwifery where she provides prenatal, home birth, newborn, and postpartum care. She sees families at clinic spaces in Minneapolis and White Bear Lake, and lives in south Minneapolis with her husband and nursing daughter, born at home in the water in December 2012.

Finding Breastfeeding Support: The Right Tool for the Job

Photo Credit Constellation X Photography by Cat Banks

by Tiffany Jensen Gallagher, CLC

Have you ever tried to open a package, and instead of walking across the room to fetch the tool that would slice the package right open, you reach out for whatever is most convenient and spend 10 minutes tearing away at your child’s latest 1,000-piece toy monstrosity when you could have had it done faster, more efficiently, and with less mess if you had only taken the time to grab the right tool in the first place?

Getting the right help for breastfeeding is almost the same.

Doctors, nurses, midwives, and doulas can all be incredible sources of support during and after pregnancy, but unless they have received specific training in lactation and have kept up-to-date with the latest research and guidelines, they may not be the best source for information about breastfeeding and practical assistance with managing breastfeeding difficulties. The results of one survey  published in the Journal of the Academy of Nutrition and Dietetics states that 51% of physicians surveyed reported little to no education about breastfeeding; only 9% reported that they felt they have received adequate education on the topic. A similar survey published in the Journal of Midwifery & Women’s Health showed that 70% of respondents considered themselves effective or very effective in meeting the needs of breastfeeding patients, but, still, they were less knowledgeable about specific management strategies. Birth and postpartum doulas who are certified by DONA are required to have approximately three hours of breastfeeding education, which—compared to the 1,000 hours of support some lactation consultants must obtain before they even sit for the certification exam—is not very much at all.

IBCLCs (usually known as “lactation consultants”) are the experts on breastfeeding. They’ve done hours upon hours of supervised clinical work with mothers and babies dealing with a wide variety of circumstances; taken various college-level and lactation-specific coursework; and have passed a rigorous exam. They must recertify every five years and, in the meantime, keep up-to-date on their knowledge about lactation by taking continuing education courses. IBCLCs can help with the most difficult breastfeeding problems, as well as provide support for moms in the normal course of breastfeeding. Some doctors, nurses, midwives, and doulas are IBCLCs, but unless someone has those letters after their name, they are not a lactation consultant.

CLCs (Certified Lactation Counselors) could be thought of as foot soldiers of the lactation-support world. CLCs have gone through a 45-hour course about lactation and have passed an exam. Recertification, which happens every three years, requires continuing education. For many, the education ends there, but there are others who make breastfeeding their passion. I’m one of those, and I spend a very large chunk of my time reading, writing, and learning about breastfeeding, in addition to helping families overcome problems and meet their breastfeeding goals. There are more CLCs out there than IBCLCs, and they are your go-to folks for helping with minor breastfeeding issues and helping families along the normal course of breastfeeding. Some doctors, nurses, midwives, and doulas are CLCs, but unless someone has those letters after their name, they are not a lactation counselor.

Why is it so important to use the right tool (in this case, the right person) for the job? Sometimes small, seemingly insignificant or innocent suggestions can have the potential to negatively impact breastfeeding.

For example, it’s not unusual for a mom to arrive at her baby’s first doctor’s appointment to find that a baby has lost a certain percentage of his birth weight. It is absolutely normal (and expected) for a baby to lose some weight after birth, especially if a mom has received IV fluids. Lactation professionals know to consider if fluids were received and to calculate weight gain from the baby’s lowest weight instead of a baby’s birth weight. However, since many doctors do not have a good understanding of how breastfeeding works or what is normal, the doctor may suggest a supplemental bottle, which, if not managed properly, is quite likely to lead to further problems down the road. The immediate issue—helping a baby gain weight—is fixed, but breastfeeding is not supported in the long term.

What a doctor, nurse, midwife, or doula should do—and what any professional, in any field, should do—is refer a patient or client to the best person for the job. As a CLC, there are some questions I cannot answer or issues I cannot resolve within my scope of practice, and I readily refer to IBCLCs, doctors, midwives, or other care providers. One of the signs of a professional who knows what she is doing is, in my opinion, whether or not she’s willing and able to refer clients to the best resources possible.

If you’re experiencing breastfeeding difficulties or have questions about breastfeeding, I do hope that your care provider is armed with good, evidence-based information and can help support you on your journey. If you feel that your needs are not being addressed, ask for a referral, or seek out a lactation professional on your own. You’ll thank yourself for taking the extra step to reach for the right tool.

Tiffany Gallagher, CLC is a Certified Lactation Counselor, WIC peer breastfeeding counselor, and postpartum doula serving families in and around the Twin Cities. Known as The Boob Geek, she’s a member of The Childbirth Collective and Pregnancy and Postpartum Support Minnesota, and loves to help families be the families they wish to be.

References:

http://www.journals.elsevierhealth.com/periodicals/yjada/article/S0002-8223(05)01554-3/abstract

http://onlinelibrary.wiley.com/doi/10.1016/S1526-9523(00)00010-6/abstract

http://kellymom.com/bf/normal/weight-gain/

http://www.theboobgeek.com/blog/putting-scope-under-the-scope.html

Reflections of a First Generation Breastfeeder

by Cara Kreuziger CD(DONA)

When I became pregnant with my first son, over 7 years ago, there was no doubt in my mind that I would be trying to exclusively breastfeed. Note that I used the word “trying.” I had only ever seen one person in my family nurse their baby. I was very unsure of myself. My late grandmother, who was born in 1913, didn’t nurse her three babies. I have a fond and sad memory of her seeing me breastfeed my 3-month-old as she sat in her wheelchair. She was always self-conscious of her large breasts and remarked that it was a shame that she never used them for nursing a baby.

My earliest memory of breastfeeding takes me back to about the age of 4 or 5 when I was in the bathroom during a wedding reception. A woman walked in with some strange device. I must have either looked at her funny or asked what it was. I learned that she was pumping the milk from her breasts to feed her baby. She slipped into a bathroom stall, and I left the bathroom. I am somewhat ashamed to admit that I found that experience gross because the idea of feeding your baby from your “boobs” was just odd to me. I have remembered that moment for over 30 years. I don’t recall having ever asked an adult in my life what breastfeeding is all about. It just was not a part of my “culture of birth.” (I often ask my clients to describe the culture of birth that they grew up in.)

As I prepared for the birth of my son, I read a lot of books and learned as much as possible about breastfeeding. I felt a lot of pressure to get it right with high expectations of myself and low expectations of getting support from my family. They were never unsupportive; I just knew it wasn’t something that they had experience in. My husband and I were pretty much on our own.

The first week or so of breastfeeding was filled with frustration, tears, pain, and insecurity. My son had a pretty obvious tongue-tie that I recognized the moment he was born, but it was not corrected until he was about a week old. By not having someone standing by my side who had been there before, I feared that he wasn’t getting milk, that we were doing it wrong, etc. I credit my stubbornness and the unending support of my husband for our breastfeeding success. Without him, I would have given up. He learned and read along with me, brought me water, let me rest, woke with every night feeding and brought our son to our bed for his feedings. Behind every breastfeeding woman, there needs to be a ton of support, whether that be from within your “culture of birth,” utilizing women who have gone before you, or in the foraging of a new path with your partner’s help.

I encourage all of my clients to call me with any breastfeeding issues as early as possible so they can get the help they need. My personal experience with a wide variety of breastfeeding hurdles, such as tongue-tied newborns (all 3!), birth trauma from shoulder dystocia, thrush, recurring mastitis, infant GERD, and returning to work/pumping/supply issues has given me a lot of knowledge that I enjoy passing on to others.

Cara Kreuziger is a certified birth doula. She lives in south Minneapolis with her husband and three sons who at certain points have been nicknamed “Nurser,” “the Nursing Machine,” and “Nurser Mayer.” She has been lactating for 4.5 of the last 7 years and is still going strong! Her website is www.lapleinelunedoula.com

The latest trend in breastfeeding: laid-back!

Baby June and mama Lindsay. Photo Credit: Allison Kuznia Photography. 

In the last few years, a new idea called laid-back breastfeeding, or biological nurturing, has called in to question many things we’ve been teaching mothers about breastfeeding for decades!  It’s not a new idea really, but despite being accredited La Leche League Leaders since 2008, we didn’t hear about this concept until the latest edition of The Womanly Art of Breastfeeding was published in 2010.

Suzanne Colson, a midwife and researcher from the U.K., has published research on biological nurturing, and has a great book and website on the subject. Not only does this position make so much sense to both initiate breastfeeding and solve breastfeeding problems, but it is research-based as well.  Surprisingly, positions we’ve been teaching for years (the football hold, the cradle hold, etc.) are not based on research.

So what is biological nurturing or laid-back breastfeeding?  It’s not just a position, but a philosophy of approaching breastfeeding in a more laid-back way. It is less instructional than the more typical holds and can help a mom feel more confident and successful because there aren’t any “rules” to follow. Instead of sitting upright and using lots of pillows to support the baby, mom lies back at any angle that is comfortable for her.  She should avoid lying flat on her back, but any other angle works.  Then, the baby lies on top of mother, tummy to tummy.  It often works well if baby lies vertically, with his head by the breast and his feet pointing down toward his mother’s feet. But, with this position, baby can actually lie any way across mom that works for both of them.  For example, a mother who had a cesarean birth might choose to lay her baby across her body instead of up and down, to avoid her incision.

Babies have dozens of inborn reflexes that can either assist with breastfeeding, or get in the way.  In an upright position like the football hold or the cradle hold, babies might bob their heads, which looks like they are pulling away from the breast.  They also kick with their legs and push off with their hands, sometimes making moms think their babies don’t want to breastfeed!
However, in the biological nurturing position, head bobbing allows the baby to find the breast and even latch on their own.  Leg movements actually help the baby crawl to the breast, and arm movements help the baby find his way and also helps release mom’s milk.

Biological nurturing also uses gravity to help babies achieve and maintain a deep latch, which is critical for mom’s comfort and for milk transfer.  In upright positions, gravity is pulling the baby down and off the nipple which can cause serious pain and damage!

Lastly, biological nurturing places an emphasis on mom’s comfort.  Holding the baby in an upright position causes a lot of tension in the shoulders, neck and back, and moms tend to slouch over time. With laid-back breastfeeding, the first step should be for the mother to get very comfortable, either on a couch, in a recliner or in her bed, leaning back into pillows at the angle that feels good.  Once mother is comfortable, the baby is placed on top, and finds his way to a good latch.

Laid-back breastfeeding can also be used in public.  Mom will simply adjust her body slope to lean backwards so that her body is supporting more of the weight of her baby, and her arms are doing less of the work.

Want to learn more?  Visit Suzanne’s website at http://www.biologicalnurturing.com.  Under the “For Mothers” section she has a lovely video that will give you a great visual of what this idea is all about!

Anne Ferguson is a birth doula, Hypnobabies instructor, and La Leche League Leader.  Vickie Albright is an Internationally Board-Certified Lactation Consultant and La Leche League Leader.  Together they teach a breastfeeding class called “Nourish and Nurture: Breastfeeding Simplified” which is comprehensive class based on the concept of laid-back breastfeeding.  Visit Vickie’s website, www.mamawiselactation.com, to learn more about these classes.