World Breastfeeding Week 2015

"Breastfeeding and Work: Let’s Make It Work!" is the 2015 theme for World Breastfeeding Week (WBW), which in my part of the world happens August 1-7. The official WBW materials are now available at worldbreastfeedingweek.org.

As you make your WBW plans, if you like my “Made Simple” approach to breastfeeding, please consider some of my creations. If you’re looking for books for giveaways, my 2014 Working and Breastfeeding Made Simple—available in paperback and e-formats—is the most up-to-date resource for employed mothers. You can hear me talk about its approach on my latest podcast here. Want details on bulk discounts? Contact scott@praeclaruspress.com.

Brand new last week from Noodle Soup (and perfect for busy millennial moms) is my Working and Breastfeeding infographic (left), available in tear pads of 50 for $10. One side is English, the other side Spanish. You can order it online here.

Also available through Noodle Soup is my brand-new low-literacy brochure, Ten Tips for Working and Breastfeeding (right), which you can order online here. At $0.22 each, it is the newest addition to Noodle Soup’s Ten Tips series.

I always love hearing about the many ways you celebrate WBW. Have a great one!

 

Introducing Natural Breastfeeding

All mammals are born with responses that Mother Nature builds in to enable them to get to their food source and feed. Yet today, the way most mothers are taught to breastfeed ignores what our babies bring to the table, making early breastfeeding harder than it needs to be. It’s no wonder then that during the first week after birth, 92% of the nursing mothers in one study reported major breastfeeding challenges.

Instead of tackling individually each breastfeeding issue—latching struggles, milk supply concerns, sore nipples--what if there was a single way to address many challenges at once? That’s what Natural Breastfeeding is all about.

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What are the roots of this innovative new approach to early breastfeeding? To create the Natural Breastfeeding program, obstetrician Theresa Nesbitt (“Dr. Theresa”) and I drew from the work of many: the Swedish breast-crawl researchers, UK scientist Dr. Suzanne Colson, international brain-science experts, the Prague School, and from America, Dr. Christina Smillie and Dr. Brian Palmer. When we put together these diverse-but-related puzzle pieces, what emerged was our new prenatal preparation program, Natural Breastfeeding: For an Easier Start.

Every baby is born with her own internal GPS, so baby knows where she is and what to do. If a mother knows how to activate and use her baby’s GPS, she can avoid many common early breastfeeding struggles. At the same time, Natural Breastfeeding allows a mother to relax completely, so she can nurse in comfort and rest while baby feeds. In most cases, she can even breastfeed hands free. By taking full advantage of an infant's inborn feeding behaviors, even a brand-new baby can be the active breastfeeding partner Mother Nature intended.

The Natural Breastfeeding program prepares pregnant women for breastfeeding with more than 60 short videos and 100 images of diverse women learning about and using Natural Breastfeeding. This interactive program, which mothers can access on their tablets, computers, and smartphones, is mother-friendly, jargon-free, and fun.

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Amazingly, science has already weighed in on this 21st century innovation. One 2015 study found that tablet-based prenatal breastfeeding education can increase breastfeeding initiation, duration, and exclusivity. In other words, this modern, high-tech approach works, which can help more mothers reach their breastfeeding goals.

Before a pregnant woman gives birth, the demonstration videos and simple exercises in the Natural Breastfeeding program make its concepts clear and integrate its moves into her body memory. Even if her birth attendants are unfamiliar with this approach, after completing this program, a mother should be able to make it work on her own.

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Natural Breastfeeding is like the training wheels on a bicycle. While mother and baby are learning, it helps them avoid unnecessary pain, strain, and struggle. By making the most of what baby can do, Natural Breastfeeding helps mothers use the behaviors built in by Mother Nature to successfully feed and nurture their newborn.

Intrigued? To view some of our basic videos, go to my YouTube playlist, take a look at our Natural Breastfeeding Prezi, or browse the videos on my YouTube channel.

If a pregnant woman wants to prepare for breastfeeding rather than just planning to breastfeed, she can download this program at www.NaturalBreastfeeding.com.

Please help us spread the word.

Tongue and Lip Ties: Root Causes or Red Herrings?

Tongue and lip ties are red-hot issues. There’s no doubt that tongue tie causes suffering for some breastfeeding mothers and babies when baby’s "lingual frenulum" (the membrane under the tongue that connects it to the floor of the mouth) prevents normal tongue movement. Also known as ankyloglossia, ultrasound research shows that restricted tongue movement in a breastfeeding baby can lead to nipple pain and/or poor milk intake. When tongue tie is the root cause of a breastfeeding problem, this needs to be addressed pronto.

What is a lip tie? This refers to restricted lip movement from a tight "labial frenulum," the membrane that connects baby's upper lip to her gums. To tell the difference between a normal labial frenulum and one that can cause problems, see this online article by Oregon ear, nose, and throat (ENT) surgeon Bobby Ghaheri.

An Epidemic?

What started as a problem for a small percentage of babies seems now to be an epidemic. Health-care providers report increasing numbers of breastfeeding mothers self-diagnosing tongue and lip ties in their babies, often based on online information, and asking for a tongue- or lip-tie revision, a minor office procedure to release the tie. Some mothers describe taking their babies for multiple revisions with no pain relief or improved milk intake during breastfeeding.

There is very little that is "right" or "wrong" about breastfeeding choices. What matters is whether a strategy brings a mother closer to meeting her breastfeeding goal or moves her further away from it. If self-diagnosis corrects the problem, great. But if it doesn't--if the self-diagnosis is a red herring--it can prolong suffering and lead to complications, making getting back on track more difficult.

Studying Tongue Tie

A recent study offers a new perspective on the tongue-tie epidemic. It found that tongue tie is NOT a common source of breastfeeding problems and reinforced what we’ve always known. When a mother is in pain or the baby’s weight gain is low, the best place to start is by focusing on basic breastfeeding dynamics, such as how the baby latches and baby’s feeding patterns.

What did this new study find? One of the doctor-researchers trained the others to identify infant tongue tie using the Coryllos tongue-tie classification system, which defines four types, including posterior tongue tie. After making sure everyone was using the same definitions, they began visually examining the tongues of 200 healthy babies during their first 3 days of life and used a gloved finger to feel the frenulum under their tongue. During the study, the researchers were blinded to any breastfeeding problems.

What Are the Odds?

Amazingly, 199 of the 200 babies were identified with 1 of the 4 types of tongue tie. However, only 3.5% (7 babies) had breastfeeding problems related to tongue restriction. A tongue-tie revision solved the breastfeeding problem in 5 of these 7 babies.

As a result of these findings, the authors suggested we change our terms. “Short frenulum,” they said, should be abolished, because the frenulum can’t be accurately measured. They suggested the term “asymptomatic tongue tie” for the vast majority of babies (192 out of 199) who had an identified tongue tie and no breastfeeding problems and “symptomatic tongue tie” for the few (7 of 199) in whom the tongue restrictions affected breastfeeding. Clearly, even if a baby has an obvious tongue tie, we should not assume it is the root cause of a mother’s nipple pain or baby’s weight-gain issues. It makes sense in these cases to see if other interventions may help alleviate the problem.

Just to be clear, this study included mothers and babies without breastfeeding problems as well as those with breastfeeding problems. Obviously, among mothers and babies having breastfeeding problems (those seen by most lactation consultants), the percentage of babies with symptomatic tongue tie would be higher.

Why Does It Matter?

If tongue-tie and lip-tie revisions are minor office procedures, why do unnecessary revisions matter? As the researchers point out, complications are rare, but sometimes excess bleeding can occur. Also, the procedure can cost parents hundreds of dollars out of pocket.

But there is an even more important reason this matters. When mothers focus only on tongue or lip tie, other issues may be overlooked and problems can continue for weeks or months. When adjusting to life with a newborn, no family needs this kind of unnecessary stress. In one study, long-term, ongoing nipple pain was linked to depression and sleep problems in mothers. A U.S. lactation consultant colleague who works in a large, breastfeeding-friendly pediatric practice put it this way:

I appreciate the growing awareness of tongue- and lip-tie issues and health providers willing to do interventions. Yet often the diagnosis is coming from friends, Dr. Google, and Facebook discussions. It has become so widespread that many mothers look first to a possible tie and other issues get buried. I now encounter the following scenarios frequently:

1. Mothers who believe their baby has a tongue or lip tie and consider this the primary cause of low supply, failure to latch consistently, weight gain issues, mastitis, nipple pain, etc., etc. They may spend so much time on a tongue-tie "witch hunt" that they fail to address other possible causes and find themselves in a bigger jam. They may be dealing with a tongue tie plus something else, but addressing only the tongue tie will not fix things completely. Sometimes there is no tie at all.

2. Mothers with well-gaining, happy, exclusively breastfed babies who experience no discomfort yet feel their baby has a tie that needs to be revised. Some mothers schedule consults for this with me after seeing an ENT doctor who has told them there is no issue. Many say that ENTs and other doctors don't know what they're doing with tongue ties, which in some cases may be true. Yet their ongoing search for a “cure” in the absence of an issue makes breastfeeding fraught with worry, rather than the satisfying and empowering experience it should be.

One Mother’s Story

During my visit to Ireland 18 months ago, I attended a La Leche League meeting. Also attending was an Irish mother coming for the first time. She had taken her 3-month-old baby to the doctor for a tongue-tie revision but was still experiencing nipple pain. The group’s leaders asked me to talk with her. As she breastfed, I noticed an obvious shallow latch. No wonder she was sore!

I asked this mother if she had ever seen a breastfeeding supporter about her pain. She said no. She had gone online, done some reading, and assumed her problem was tongue tie. She then went to the doctor and asked for a tongue-tie revision. Throughout all this, she was breastfeeding shallowly and that hadn’t changed. With a shallow latch, her nipple was compressed against her baby’s hard palate, causing pain. I told her I thought that a small tweak in how her baby latched to her breast was probably all she needed to make breastfeeding comfortable. I provided a link to the latching animation on my website and explained that there is a place in her baby’s mouth called the “comfort zone,” and when the nipple gets there, there is no friction or pressure.

#1 Cause of Nipple Pain

How often does a deeper latch solve breastfeeding problems? A French lactation consultant checked the records of her private practice during a 6-week period and found that of the 37 mothers who came to her with nipple pain, a deeper latched resolved the pain completely in 65%. Other causes of pain included bacterial and yeast infections, skin conditions, and yes, tongue tie. During my 10 years in private practice, getting a deeper latch resolved pain in about 85% of the mothers I saw. A deeper latch can also improve baby’s milk transfer, giving baby more milk with every suck.

Don’t Assume, Seek Help

Is tongue- or lip-tie revision the right thing to do for some breastfeeding mothers and babies? No question! But because tongue tie is the root cause of the problem for a minority of babies, it is a terrible place for most mothers to start. When nipple pain or weight-gain issues occur, a much better starting point is to contact someone who can help adjust baby’s latch and evaluate baby’s feeding pattern.

Free breastfeeding services are available in most areas through volunteer mother-to-mother support organizations and public health departments. Another option is to see a board-certified lactation consultant. Make it a number-one priority to quickly find and address the root cause of the problem. Trying to live with an ongoing, unsolved breastfeeding problem is a type of misery no woman should have to endure. Don't go it alone. Seek help, and always start with the basics.

Coping with Fast Milk Flow

Mother's question: "I need help! My daughter is a week old tomorrow and I can’t seem to get my milk flow under control. It just pours out and she chokes. What do I do to make it easier for her?"

During the early weeks, while your milk supply is adjusting to your baby’s needs, your feeding position can make all the difference. If you sit straight up during feedings, your milk flows downhill into your baby’s mouth, which makes coping with milk flow more difficult for her. Instead, use positions like those pictured here. Move your hips forward and lean back with baby’s whole body resting on yours so your baby’s head is higher than the breast. In these positions, gravity makes milk flow easier for her to manage. Many mothers also find these positions much more comfortable.

You can read more about these positions at this post.

Lying on your side to breastfeed can also help because baby can let overflow milk dribble out of her mouth rather than having to swallow fast to prevent choking. (Lay a towel under baby first!)

Most important is never to hold your baby’s head to your breast when she wants to pull off and catch her breath. Fingers crossed these tips help!

Don’t Miss It! Breastfeeding Solutions App FREE August 1 to 7

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This year my World Breastfeeding Week (August 1-7) gift to the world is to make my newly redesigned Breastfeeding Solutions smartphone app (usually $4.99) FREE to everyone. No need for a promo code. For this limited time, my app will simply be FREE from AMAZON'S APPSTORE (for Android phones) and the APP STORE (for iPhones). Due to Google Play’s pricing rules, it will be 99 cents there.

Download it now AT NO CHARGE, and all future updates will be FREE, too.

To see how my app works, check out its 2-minute YouTube video. You are also welcome to share the above image. The badges below are direct links to download the free app.

Will you please help me spread the word? I’d love for my friends around the world and the mothers they help to take advantage of this unique opportunity to take my app for a test drive.

Happy World Breastfeeding Week!

Reviews of the Breastfeeding Solutions App

KellyMom.com: "Need a great breastfeeding app? The Breastfeeding Solutions app by Nancy Mohrbacher, IBCLC, FILCA is it! I installed it as soon as it was available, and have found it to be easy to use, and full of excellent information."

Best for Babes Foundation: "It appears that Nancy Mohrbacher, IBCLC, FILCA has created the WORLD'S BEST BREASTFEEDING APP. If you don't want to waste hours googling answers to your breastfeeding issues, or reading through thousands of threads, this app is for you." 

Elise F. (mother-to-mother breastfeeding counselor): “I find myself using the app all the time when responding to questions from new moms.  It's easy to navigate and gets me to the answers I need quickly.  I am also able to use it as a sort of 'checklist' when sharing info with moms to make sure I've not forgotten anything.”

Radiolana:“An app written with the new mother in mind—concise and respectful troubleshooting with links to information for further reading. Have seen no app better than this!”

amaag4:"Just recently I became concerned with my BFing supply. I was very worried and google was giving me mixed answers. An LC in my area posted this, so I decided to buy it. Within the first 10 seconds of looking through the app I found exactly what I was looking for. I can't wait to read through other concerns!"

Dana Thomson: "Worth every penny! Helped save my breastfeeding relationship! I recommend this to anyone who wants to breastfeed. Regardless of whether or not you have a problem."

Free Publicity?

What business wouldn’t love free publicity? Well, for one, lactation consultants, when the free publicity is coming from a company that violates their professional ethics.

Day before yesterday I received an email from Erin, who works for a public-relations firm representing infant bottle manufacturer, Munchkin. It started, “In light of your very focused blog content around breastfeeding I wanted to touch base with some news from a company that is offering a unique solution and unrivaled support for breastfeeding moms.” She went on to describe how Munchkin’s new bottle line is “like the breast” and has an “anti-colic valve.” Of course these are the same kind of baseless claims made by all of the bottle manufacturers, and I knew better to accept them at face value.

However, that wasn’t the worst of it. Erin went on to say:  

"Taking it a step beyond traditional bottle manufacturers to fully demonstrate their support of breastfeeding mothers, Munchkin is also providing moms with a Lactation Consultant Database (http://www.munchkin.com/latch-locator) because they understand just how many challenges they may face in this process and want to help them achieve their individual breastfeeding goals."

That got my attention. When I followed the link to the Munchkin site, above its Lactation Consultant Locator was copy that sounded for all the world as though lactation consultants endorsed its products. You have to read the following very carefully not to get that impression:

"We partnered with lactation consultants to develop our [xyz] bottle because we believe they offer the best expert advice for breastfeeding Moms. While we worked with a select few, there are thousands across the country that can help you reach your breastfeeding goals. If you’re a mom who needs help on how to get a good latch, how to increase milk production, or how to find the best breastfeeding position, find a Lactation Consultant in your area by simply entering your zip code or address below:"

When I entered my zip code in the locator, I noticed that all of the IBCLCs in my area came up. It appeared as though Munchkin had created this list from other sources. And I was almost positive that none of those listed knew that their names were connected online to this company and its products.

I responded in two ways. First I wrote back to Erin to say:

"As an FYI, I left a lucrative position with a company when it started to market its infant feeding bottles and nipples directly to parents, which is in violation of the World Health Organization's International Code of Marketing of Breast-Milk Substitutes and counter to my code of professional conducts. Munchkin’s marketing claims are part of the problem, not part of the solution.

"I know that many of the IBCLCs currently listed on Munchkin’s Lactation Consultant Locator have no idea that their names are connected to Munchkin in this way. It needs to ask permission before including their names and contact information on its website. Please remove me from your contact list."

Then I posted on Lactnet, my professional listserv and included Erin’s email, her links, and my reply. Just as I suspected, the emails began coming from colleagues thanking me for letting them know and copying me on their emails requesting they be removed from the locator. When checking the locator, one lactation consultant found her home address listed. Another was listed at her husband’s office. To be removed, call or email Monica Kapadia, Marketing Manager at Munchkin, at: 818-221-4241 or Monica.kapadia@munchkin.com. You can also contact Munchkin directly at this link.

As a side note, just before uploading this post, I got word that Munchkin had taken down its locator, no doubt due to the unexpected pushback. (If you need to find a lactation consultant, go instead to the website of lactation consultant professional association, which has permission to list their contact information.)

Were those at Munchkin doing a good deed for the breastfeeding community? Some of them may have thought so. But they were also using the good name of our profession to hawk its products and imply our endorsement. Is all publicity good publicity? Not in this case.

Green Poop: When Should You Worry?

Baby poop is high on many new parents’ worry list. How often should baby poop? Does baby’s poop provide clues to how breastfeeding is going? What do color and consistency mean? When should you worry?

 

Normal Color and Consistency

Baby’s first stools are the black and tarry meconium that was in her gut at birth. When breastfeeding is going well, by about the third day, baby’s poop changes to “transitional stools,” which have a dark greenish color. By the fifth day or so, the poop’s color changes again to yellow. Its consistency now (and until baby begins  consuming anything other than your milk) may look like split pea soup, liquid with seedy bits in it. But if your baby’s poop is all liquid and no seeds, this is also normal.  

 

Baby’s yellow poop is made mostly from the fat in your milk. During the first six weeks, babies gaining weight well usually poop at least 3 to 4 times a day with stools at least the diameter of a US quarter (22 mm) or larger. There is no such thing as too many poops. (Lots of pooping just means your baby is getting lots of milk, which is great.) But too few poops mean it’s time for a weight check.

 

If your baby is younger than 6 weeks old, is pooping fewer than 3 to 4 times per day, or her stools haven’t turned yellow by the fifth day, a weight check will tell you if this is just a normal variation or a cause for concern. It’s not until after 6 weeks that some healthy breastfed babies poop much less often, sometimes even once a week. Check baby’s weight at a health-provider’s office. A bathroom scale just won’t do. A weight gain of about 1 oz. (30 g) or more per day indicates that all is well. No matter what your baby’s age, as long as she is gaining weight well, don’t worry if she has fewer stools than expected.

 

Causes of Green Poop

Despite what you may have heard (see the next section), green and brown are in the normal range of poop colors. They are not a reason to worry if baby seems well and is gaining weight. What can cause green poop?

  • Your diet. Eating lots of greens or other green foods or drinks (green gelatin, green sodas, green sports drinks) can turn poop green. Natural and artificial food colors can change the color of both your milk and baby’s poop.
  • A tummy bug. When your baby is ill, this can cause a change in poop color that may last for weeks. Keep breastfeeding! It’s the best way to help baby recover.
  • Oversupply. If you produce so much milk that your baby receives mostly high-sugar/low-fat milk, it may overwhelm baby’s gut and cause watery or green stools. (Click here for more details and tips for adjusting milk production downward when needed.)
  • Ineffective breastfeeding. If on the fifth day, baby’s stools turn green instead of yellow, as in the case of oversupply, this may be a sign that baby can't drain the breast well enough to get past the low-fat/high sugar foremilk. In this case, though, a health or anatomy issue (like tongue tie) may be the cause. Unlike oversupply, baby’s weight gain may or may not be below average. Now is the time to see an IBCLC.
  • Sensitivity to a food or drug. When a sensitive or allergic baby reacts to a drug you’re taking, something in your diet, or something baby consumes directly, this may turn her poops green or mucusy. You may even see bits of blood in it, which is not considered serious. (Click here for info you can share with your health-care provider.)

Food sensitivity occurs most often in families with a history of allergy. When this is the cause, expect to also see other physical symptoms, such as skin problems (eczema, rashes, dry patches), tummy upsets (vomiting, diarrhea), or breathing issues (congestion, runny nose, wheezing, coughing).

 

What about Foremilk-Hindmilk Imbalance?

Many new parents read online that “foremilk-hindmilk imbalance” is the most likely cause of green poop. This term was coined in a 1988 journal article that reported the experiences of a few mothers who breastfed by the clock, switching breasts after 10 minutes even though baby hadn’t finished on that side. Its results have never been duplicated, and newer findings call into question this article’s conclusions. Many now wonder if foremilk-hindmilk imbalance even exists. To learn more, click here.

 

Setting Worries to Rest

In most cases, green poop is nothing to be concerned about. But it helps to know what’s normal, possible causes, and some of the common myths about this experience. If your breastfeeding baby is healthy and thriving, that’s the most important thing you need to know.

Supporting You & Helping to Beat the Booby Traps®

Big news! Starting today, everyone who downloads my Breastfeeding Solutions smartphone app gets more than a go-everywhere source of breastfeeding help. They also support the amazing work of The Best for Babes® Foundation.

A portion of every app download goes to Best for Babes to help beat the Breastfeeding Booby Traps® – the cultural and institutional barriers that prevent parents from making informed feeding decisions and prevent mothers and babies from achieving their personal breastfeeding goals.

The Best for Babes seal of approval is now prominently featured on the app’s home page, and links to the app are featured on the Best for Babes online shop.

When you recommend Breastfeeding Solutions, you provide reliable help to the mothers in your circle and you support the greater breastfeeding cause. Please help spread the word! You can download the updated flyer here. Click on "Share" and then "Download."

 

   

 

Breastfeeding Solutions 1.2

The Breastfeeding Solutions version 1.2 smartphone app (now expanded and improved) is available on the App Store, Google Play, and Amazon.

Thanks to many of you, the Breastfeeding Solutions app has been a resounding success. More than 1200 people in 18 countries have downloaded the app since it debuted at the end of October. If you have helped spread the word about this groundbreaking new breastfeeding support tool, please accept my heartfelt thanks.

Reviews of Breastfeeding Solutions

For a demo of how the Breastfeeding Solutions app works, see the review by the U.K. group Andover Breastfeeding Mums or visit my Pinterest page. More online reviews of the app are at The Badass Breastfeeder and Breastfeed Chicago. It has been gratifying to receive such positive feedback from some of my favorite breastfeeding support people:

KellyMom: "Need a great breastfeeding app? The Breastfeeding Solutions app by Nancy Mohrbacher, IBCLC, FILCA is it! I installed it as soon as it was available, and have found it to be easy to use, and full of excellent information."

Best for Babes: "It appears that Nancy Mohrbacher, IBCLC, FILCA has created the WORLD'S BEST BREASTFEEDING APP. If you don't want to waste hours googling answers to your breastfeeding issues, or reading through thousands of threads, this app is for you."

What’s New in Version 1.2

Today—in response to suggestions from users—we launched the new and improved 1.2 version of the Breastfeeding Solutions app. Those who already have the 1.0 or 1.1 versions on their smartphone or tablet should receive notification of this update from wherever they purchased it, the App Store, Google Play, or Amazon. If you have already bought the app, there is no charge to download its 1.2 version, which features three main improvements.

A new Index. The app’s home page (above right) now features a button that takes you to its Index (left), whose purpose is to make it even quicker and easier to find what you’re looking for. Now to find a specific issue, instead of browsing through the app’s Articles section, you can use the Index to go straight there.

The screenshot on the left shows the new Index landing page. To find your burning issue, press the button that corresponds to its first letter.

More content. As one example of new content, if you’d like to read about reflux, press the index button “R.” On the next screen (right), below each index heading are buttons with page titles that correspond to every page within the app where that topic is mentioned. Press whichever button title best meets your need.

To learn about reflux, press the button “Reflux and the Breastfeeding Baby,” which takes you to the page below left and is new content in version 1.2. Other Index headings that lead to this same new content are “Spitting up” and “Vomiting after feedings.”

More links. To make the Solutions section of the app easier to use, more links have been added to improve navigation. The goal is to make it easy for any mother to quickly get her question answered. All of the updates in version 1.2 were designed to do just that.

Please email any feedback you’d like to share about Breastfeeding Solutions to my app-comment address: nancy@nancymohrbacher.com. The beauty of an app is that unlike a book, it’s easy to update what you already have on hand without the need to buy a new edition. If you buy the app now, you automatically receive future updates.

Click here to download the app’s updated flyer and help spread the word. Thanks in advance for sharing this new helping tool with women worldwide!

For the Caregiver of a Breastfed Baby

As some of you know, I've written a book for employed breastfeeding mothers, Working and Breastfeeding Made Simple, that's available on Amazon and through Praeclarus Press. This is its handout written for the breastfed baby's caregiver. You may also download it as a pdf here.  --Nancy

For the Caregiver of a Breastfed Baby

You already know that you make a difference to the breastfeeding baby in your care. But you may not know what a key role you play in helping baby’s mother meet her breastfeeding goals. Here are some of the many ways you can support her.

Avoid Overfeeding

If baby takes too much milk while mother is away, baby will be less interested in breastfeeding when they are together. Less breastfeeding puts mother’s milk supply at risk. She may also need to provide more pumped milk. Anything you can do to reduce the amount of milk mother needs to pump makes her life easier. Here are more basics.

Know breastfeeding norms. Most breastfed babies take smaller feedings and feed more often than babies fed formula. At an average feeding, a breastfed baby older than 1 month takes 3 to 4 ounces (90 to 120 mL) of milk.

Feed when baby shows signs of hunger rather than on a schedule. Cues such as rooting and hand-to-mouth mean it’s time to feed. It is common for breastfed babies to feed more often during some parts of the day than others.

Feed slowly using paced bottle feeding. When fed slowly, baby feels full with less milk, reducing mother's need to pump. If baby is older than 6 to 7 months, she may be fed by cup. If bottle fed, expect feedings to take about 15 to 30 minutes. Here’s how paced bottle feeding works:

  • Hold baby semi-upright or upright (see photos) and tap her lips with the nipple until she opens wide.
  • Help baby latch far enough onto the nipple so her lips close on the nipple’s base rather than its shaft or tip. (Gagging means baby needs a shorter nipple.) If baby’s lips are pulled in, use your fingers to flange them out.
  • During feedings, hold the bottle nearly horizontal, so the flow isn’t too fast.
  • Build in pauses every few minutes by lowering the end of the bottle so milk runs out of the nipple. Or remove the nipple from baby’s mouth and rest it on her lower lip.
  • Repeat throughout the feeding until baby is done. Switch sides halfway through.
  • Stop when baby stops, even if there’s milk left.
  • Burp baby after feeding to bring up any air.

 Encourage Breastfeeding

One key way mother keeps her milk production steady is frequent breastfeeding. You can help by encouraging her to sit down and breastfeed just before leaving baby with you and as soon as she returns. To make this easier:

  • Make comfortable seating available.
  • Offer a private area for nursing, if desired.
  • Make it clear that breastfeeding is welcome and encouraged.
  • If mother is due to arrive soon and baby seems hungry, feed just a little milk until she can breastfeed.

The more times each day a mother breastfeeds, the less milk she must pump. Breastfed babies need on average about 25 to 30 oz. (750 to 900 mL) per day. The more milk baby gets directly from mother, the less pumped milk is needed.

Store & Handle Milk with Care

You can also support mother by handling her milk with care so that little milk is discarded.  

  • Let mother know if baby regularly takes less milk than is in her containers.
  • Follow the milk storage guidelines she provides.
  • Thaw and warm milk gently and gradually, keeping heat low. Swirl the milk to mix layers. Don't shake it.

Milk can be thawed in the refrigerator or overnight. You can also thaw or warm milk in other ways.

  • Hold the container under warm running water for a few minutes.
  • Hold the container in water previously heated on the stove. Do not heat the milk directly on the burner.

If you use water to thaw or warm milk, tilt or hold the container, so the water cannot seep under the lid. Feed thawed milk right away or refrigerate it.

Do not thaw or warm milk in a microwave, which changes the milk and heats it unevenly. Even if you swirl or shake the milk afterwards, hot spots remain that can burn baby’s throat.

By supporting breastfeeding in these ways, you can provide great quality of care for the breastfed baby. And at the same time you can make life easier for mother and the entire family. 

Hanging Out

Yesterday I took part in my first Google+ On Air Hangout, where I enjoyed the enthusiasm and thoughtful questions from the winners of our Facebook Rafflecopter contest, "Win a Hangout with Nancy." The awesome Lara Audelo, author of one of my favorite books, The Virtual Breastfeeding Culture, moderated the event and kept its pace lively. The 19-minute Hangout is now available for viewing on my YouTube channel.

During our Hangout, whose purpose was to answer questions about the Breastfeeding Solutions app, we discussed:

  • Why the App Store gave Breastfeeding Solutions a rating of 17+ (I’m sure you can guess), and how that age restriction might affect the app’s availability to younger mothers
  • What motivated me to develop the app
  • How best to contact me with suggested changes or improvements
  • Why some of the app’s buttons are pink and others are aqua
  • The importance of submitting positive reviews to Google Play and the App Store to encourage more mothers to download and use the app

It has been two weeks since the app became available for Apple and Android devices, and the response has been gratifying. More than 550 people worldwide have downloaded it, nearly 400 from the U.S., 57 from Canada, 45 from the U.K., and 33 from Ireland, as well as some in Australia, Mexico, the Netherlands, Israel, Switzerland, Norway, Sweden, Singapore, Taiwan, Hungary, Germany, Estonia, and New Zealand. Thank you all!

My hope is that breastfeeding supporters will add the app to their own devices and show it to mothers. If you’d like to know more, take a look at a step-by-step demonstration of how the app works on my Pinterest page. That page also includes a jpg of a newly designed flyer you can share with mothers (download its pdf here). Until the end of the year, to make downloading the app easier for you, I’ve reduced its price by nearly 30% to $4.99 USD.

The Breastfeeding Solutions app is not intended to replace in-person help and describes how--when needed--mothers can use the www.ilca.org website to find IBCLCs in their local area. But it can be a great first resource, as it covers many of the most common problems and questions and when it's downloaded into a smartphone, it goes with mothers everywhere. Check out the first independent review of the app, which appeared this week on the Breastfeed, Chicago website.

Thank you again to Lara Audelo, and all those who participated in yesterday’s Google+ Hangout On Air: Tova Ovits, Susan Pack, Katy Linda, Ali Kulencamp, Johanna Iwaszkowiec, and Amie Norris. And thanks to all of you who have helped make the Breastfeeding Solutions app such a resounding success! The next step is to get the word out to more mothers. Any help you can give in spreading the word would be greatly appreciated!

 

 

 

My New Breastfeeding Solutions App

I am thrilled to announce the release of my new Breastfeeding Solutions smartphone app for mothers and breastfeeding supporters. It is now available worldwide for Android and iPhones on Google Play and the App Store. Take advantage of its early-bird pricing to save nearly 30% through 12/31/13.

 

What Does the App Do?

Based on my book of the same name, Breastfeeding Solutions does not track feedings or diapers, like most other breastfeeding apps. It helps mothers meet their personal breastfeeding goals by providing straightforward solutions to the 30 most common breastfeeding problems.

 

This new app covers every stage of breastfeeding, from birth to weaning. To find a problem’s cause, use its interactive “Solutions” section. For answers to common concerns, browse its comprehensive “Articles” section.

 

Unlike a book, this app goes with you everywhere for easy reference. The app’s testers say it’s a great resource for those who take breastfeeding helping calls away from home.

 

What’s Included?

Breastfeeding Solutions is an alternative to the apps available to mothers from the formula and breast-pump companies. But before you can recommend this industry-free app, you’ll want to try it for yourself.

 

To make this easier, I’ve lowered the price by nearly 30%. Until December 31, its price is $4.99 US. Once downloaded, you receive any updates as they are published. The app is all-inclusive and requires no in-app purchases.

 

Enter the Contest

If you’d like to learn more about the Breastfeeding Solutions app, my friend Lara Audelo, author of The Virtual Breastfeeding Culture, will be moderating a live Q & A with me about it on Google+ Hangout. This event will take place on Wednesday, November 6 at noon Central time and will be recorded and posted at a later date on my YouTube channel. To participate, you must give permission to be recorded.

 

There is room for 8 people in this live Hangout. To choose them and 2 winners of a free copy of Breastfeeding Solutions or The Virtual Breastfeeding Culture books (book winners restricted to U.S. residents), we’re having a Rafflecopter contest. To enter, click on the blue Rafflecopter “Giveaway” tab on my and Lara’s Facebook pages or on this link.

 

Lara is available if you need help using Google+ Hangout. Best of luck!

Block Feeding Dos & Don'ts

This morning I talked with a breastfeeding mother whose story is becoming all too common. Her 1-month-old third baby was having trouble coping with her fast milk flow. At many feedings, she coughed, sputtered, and sometimes pulled off the breast crying. This mom assumed from this behavior that she had an overactive let-down (OALD) and started a strategy called “block feeding.”

 

What is Block Feeding?

Block feeding involves restricting baby to one breast for 3-hour or longer blocks of time before giving the other breast. It is very effective at bringing down milk production when a mother is making way too much milk. Allowing the breasts to stay full for a set period of time sends the signal to slow milk production.

 

Block Feeding Dos

This strategy can be a lifesaver in some cases, as oversupply (aka “hyperlactation” or “overabundant milk production”) can decrease quality of life for both mother and baby. For a mother, the drawbacks include regularly full and uncomfortable breasts and recurring plugged ducts. For the baby, oversupply can cause a very fast milk flow that can be hard to manage. In this case, block feeding used for no longer than 1 week can be a boon for both mother and baby.

 

Block Feeding Don’ts

What seems to be more and more common, though, is the assumption that any struggle with milk flow is due to OALD or oversupply, when there is usually another cause. As a result, some mothers bring down their milk production with block feeding when their supply is actually at a healthy level, leading to other problems, such as slow weight gain.

 

As I told the mother this morning, during the early weeks, most newborns cough and sputter during breastfeeding some of the time. It takes practice and maturity for babies to learn to coordinate sucking, swallowing, and breathing during breastfeeding. Some episodes of milk flow struggles and pulling away are completely normal and are not necessarily signs of OALD or oversupply.

 

How to Know If Block Feeding Will Help

The most reliable gauge of whether block feeding may be helpful is baby’s weight gain. If breastfeeding is going well, during the first 3 months, most babies gain on average about 2 lb/mo. (0.90 kg/mo.). If baby’s weight gain is double this or more, block feeding for no longer than 1 week makes sense. If baby’s weight gain isn’t this high, it is likely that block feeding will cause more problems than it solves.

 

Alternatives When Baby Struggles with Milk Flow

What can you do if your baby’s weight gain is average but she is struggling with milk flow during breastfeeding? The best strategy is using feeding positions that give baby more control over flow. The most difficult feeding positions for babies from a milk-flow standpoint are those in which milk is flowing downhill into their throats, such as all those in which mothers sit upright.

 

In the feeding position shown at left, however, milk flows uphill into baby’s mouth, giving her more control. See this post to read more about these types of feeding positions and their advantages.

 

If baby continues to have consistent problems with milk flow, it's time to see a lactation professional to check for anatomy, swallowing, and breathing issues. To find a lactation consultant near you, go to this website, click on the "Find a Lactation Consultant" link, and enter your zip or postal code.

 

References

Caroline, G.A. & van Veldhuizen-Staas, C. G. Overabundant milk supply: An alternative way to intervene by full drainage and block feeding. International Breastfeeding Journal 2007; 2:11.

 

 

Latching Struggles and My New Smartphone App

Thought some of you might enjoy listening to the podcast I recorded recently with the Boob Group on Latching Struggles. It went live today and it's free at this link.

I am also in the process of finishing a smartphone breastfeeding troubleshooting app based on my Breastfeeding Solutions book. My millenial sons Ben (the app-builder) and Peter (the project manager and artist) and I (content provider) have been working on it since January. I'll be telling you more about it in the weeks ahead. Just a teaser for now...

 

Formula Use & Breastfeeding: The Moral of the Story

Scale.jpg

Earlier this week a study appeared in Pediatrics that has the media buzzing about whether giving formula in the first few days can actually improve breastfeeding rates. Both Time magazine and the New York Times featured stories on this. Not surprisingly, the media stories (and in my opinion, the researchers themselves) missed the central point.

This study compared breastfeeding outcomes in two groups of mothers whose babies had lost enough weight shortly after birth to be considered at risk. Both groups were given lactation help. In the control group, the mothers were encouraged to exclusively breastfeed. In the intervention group, after each breastfeeding the mothers were instructed to feed their babies by syringe a tiny amount of formula supplement: 10 mL, or about one-third of an ounce. This is about how much colostrum babies consume at each breastfeeding during the first 2 days of life.

The study found that more of the mothers who gave this small amount of formula after feedings breastfed longer and more exclusively than the mothers who didn’t.

Unlike the authors and the media, I don’t interpret these results to mean that early formula can help breastfeeding. In addition to all of the valid points made by other breastfeeding supporters, what was noteworthy to me was that the mothers in the intervention group were taught to supplement their newborns with biologically appropriate feeding volumes consistent with the recommendations of the Academy of Breastfeeding Medicine.

Many parents who supplement—including I’m sure those in this study’s control group—overfeed their babies incredibly, either without realizing it or because they are unwittingly instructed to do so by health professionals. Yesterday I spoke to a mother who was told by a pediatrician to make sure her jaundiced 4-day-old took 2 oz. (60 mL) at every feeding, which is twice the size of a 4-day-old’s stomach. To accomplish this, she was pumping, adding formula to her milk, and force-feeding this massive amount to her newborn.

My take-away message from this study is that any mother who supplements her newborn (whether with expressed milk, donor milk, or formula) should learn the appropriate amount to feed so she can prevent the kind of rampant oversupplementation that undermines breastfeeding and increases later risk of obesity. Babies overfed at this magnitude breastfeed much less often and milk production suffers.

What are the long-term effects of early overfeeding? One study followed to adulthood 653 people who were formula-fed from birth. Amazingly, greater weight gain during the first 8 days of life was associated with increased incidence of overweight 20 to 30 years later.  These researchers concluded that the first 8 days may be a “critical period” during which human physiology is programmed.  This may mean that breastfed babies’ greater weight loss after birth and slower return to birth weight may help promote a healthier metabolic program, which reduces the risk of overweight and obesity during childhood and beyond. At the very least, it most certainly means that parents and health professionals should be extremely wary of overfeeding newborns. To me, that’s the real moral of the story.

References

Academy of Breastfeeding Medicine.  ABM clinical protocol #3: Hospital guidelines for the use of supplementary feedings in the healthy term breastfed neonate.Breastfeed Med 2009; 4(3): 175-82

Bakalar, N. How formula can complement breastfeeding.New York Times, May 13, 2013.

Flaherman, V.J., Aby, J., Burgos, A.E., Lee, K.A., Cabana, M.D., & Newman, T. Effect of early limited formula on duration and exclusivity of breastfeeding in at-risk infants: An RCT.Pediatrics 2013; 131(6):1059-65.

Naveed, M. et al.    An autopsy study of relationship between perinatal stomach capacity and birth weight. Indian J Gastroentero 1992;11(4):156-58.

Rochman, B. How formula could increase breastfeeding rates.Time, May 13, 2012.

Stettler, N. et al.  Weight gain in the first week of life and overweight in adulthood.Circulation 2005; 111:1897-1903.

Stuebe, A. Early, limited data for early, limited formula use. Academy of Breastfeeding blog. May 13, 2012

My New Book: Breastfeeding Solutions

Celebrate with me the release of my new book, Breastfeeding Solutions: Quick Tips for the Most Common Nursing Challenges! The book will be in stores and its e-version will be available on Amazon on April 1, but if your order is shipped to a US address, you can receive 30% off the paperback version today at www.newharbinger.com! (If possible, please use a browser other than Internet Explorer, which appears to cause issues with the shopping cart, or through Friday you can place your order by phone between 9 am and 5 pm Pacific time at: 800-748-6273.) For the special code you need in order to receive this 30% discount, go to (and please “Like”) my professional Facebook page at www.Facebook.com/NancyMohrbacherIBCLC. This special US offer, which was originally scheduled to end on Sunday, March 24, has been extended to Wednesday, March 27.

How does Breastfeeding Solutions differ from Breastfeeding Made Simple? Its focus is on problem-solving, and this slim volume was written to simplify mothers’ lives by cutting to the chase. A quick read, it features line drawings, bulleted lists, charts, and other visuals for fast, easy access to the best and most current breastfeeding strategies. It is also organized to make it easy for a mom to skip straight to her burning issue without having to read earlier chapters first.

If you’d like a sneak peek of the book…check out this special excerpt on breastfeeding the teething baby: www.newharbinger.com/teething!

Breastfeeding Solutions will also be available on April 1 through the following distributor:

UK: On June 20, Breastfeeding Solutions will be available in the UK through the distributor Constable & Robinson. For all the info, see this link. It will also be available at www.amazon.co.uk.

The Mother's Partner and the Breastfeeding Baby

For most couples, the weeks and months after the birth of a baby are some of the most joyful and stressful times of their lives. Along with the miraculous wonder of staring into a newborn’s eyes, comes the fatigue of sleepless nights and the emotional vulnerability of changing roles and shifting relationships.

During this time of transitions, breastfeeding affects family dynamics. Although many couples breastfeed in part for the closeness it brings, they are often unprepared for the intensity of this physical link between mother and baby. Nursing can be more than feeding; for many it is also an act of intimacy. Breastfeeding hormones relax the mother and heighten her sensitivity to her child, evoking an intense desire to respond to his cries. The nursing baby experiences his mother through all five of his senses, finding security and comfort as well as milk at his mother’s breasts.

Since the mother’s partner lacks this intense physical link and natural source of comfort, what does this mean to his or her relationship with the baby? In studies, some fathers of breastfeeding babies report feelings of frustration and inadequacy because they were unable to easily comfort their babies during the mothers’ absence. When they realized their relationship with their baby was different from the mothers’, they reported feeling a sense of loss. Even so, these study fathers continued to support breastfeeding. Those who wanted to be most actively involved with their babies reassured themselves that this difference wouldn’t last forever and found other ways to be involved in their babies’ care. Rather than attempting to duplicate the breastfeeding relationship, they found they could develop their own unique relationship with their children.

For some partners, though, feelings of frustration and inadequacy cause them to back off and become even less involved in their baby’s care, leading to resentment and jealousy at their partners’ absorption with the baby. Some partners perceive the mother-baby bond as a threat.

What should a couple do if the partner begins to develop feelings of resentment or jealousy? In her book, Mothering and Fathering: The Gender Differences in Child Rearing, Tine Thevenin writes:

The adjustment that comes with having a child takes effort and understanding. Instead of allowing misunderstandings about each other’s feelings to create a rift, I would suggest that both partners explore and acknowledge their own–and each other’s–emotional responses, while at the same time adopting an attitude of, ‘How can I be of greatest help in our relationship and our family?’

No matter how the baby is fed, the mother’s partner has an important choice to make. Will he or she feel left out and become a bystander in the baby’s care or take an active role in developing a positive relationship with the baby?

The relationship between the mother’s partner and the child is intimately linked to the emotional health of the whole family. The couple’s relationship will be affected, as well as the mother’s ability to meet her own needs. When a mother has confidence in her partner’s good relationship with their baby, she will feel freer to take the time she needs for herself. And when she sees her baby and her partner happy together, it makes her feel even better about her partner.

WHAT ABOUT BOTTLES?

Although feeding is one way to interact with a baby, many couples have found that giving bottles doesn’t guarantee closeness. Julie Stock, mother of three, discovered this when she walked in on her partner absent-mindedly feeding their firstborn a bottle with his eyes glued to the football game on television. They decided to forgo bottles with their next two children and later she came to the conclusion that during their babyhood “my partner actually felt closer to the two children who didn’t get bottles, because he had to invest more of himself and be more creative during their time together.”

If the partner will be giving bottles, such as when the mother is out for a few hours or when caring for the baby after mother goes back to work, it is best to wait until the baby is about a month old before introducing them. Some babies have difficulty going back to the breast if artificial nipples are introduced early, while they are just learning to breastfeed. Once a baby has been breastfeeding well for three to four weeks, this problem is much less likely to occur.

In the book Becoming a Father pediatrician and father of eight, Dr. William Sears writes:

I discourage supplemental bottles especially during the first month because of the risk of disturbing the breastfeeding harmony that mother and baby are working so hard to establish. Instead I encourage fathers to understand, respect, and support the uniqueness of the breastfeeding relationship….In the meantime, supplemental nourishment from dad should go to the mother.

WHAT PARTNERS CAN DO

There are many other ways a partner can develop a loving relationship with a breastfeeding baby. First, be aware that mixed feelings are normal. And if a baby obviously prefers mother and is unresponsive to the partner at first, it may feel frustrating and discouraging. But even if this happens, it is important to continue to work at the relationship. Some babies take a while to warm up to the partner’s overtures. Sensitivity and patience go a long way toward building closeness.

One way to show sensitivity to a baby is recognize and respond to her cues. Notice what happens when you talk to her. Tiny babies have a short attention span and are easily overstimulated. If she turns away, seems uninterested, pensive, or drowsy, just hold her close or try again later. Eye contact, reaching out, or smiling may mean that she’s ready to interact. Just like adults, each baby is a person with preferences. She may like some ways of touching, holding, and playing and not others. If she likes what you’re doing, keep it up and try it again another time. If she does not respond or seems upset, try something else.

In his book, Becoming a Father, Dr. Sears confesses that he didn’t learn how to be fully involved until his sixth child. His suggestions for partners with babies younger than three months (the age that many find particularly challenging) include a lot of touching and holding, which he feels helps a partner and baby “feel right” together. Some of these early activities include:

  • the “neck nestle,” in which the baby nestles her head against the front of the partner’s neck;
  • the “warm fuzzy,” in which the partner drapes the infant, skin-to-skin over his or her chest with the baby’s ear over the heartbeat
  • various holds that the partner can use to comfort baby
  • bathing together
  • wearing the baby in a carrier or sling
  • infant massage

HOW MOTHER CAN HELP

The mother’s role in encouraging a strong partner-child relationship is one that is very difficult for many new mothers to carry out. During the time when nature programs a mother to protect her baby at all costs, she needs to overcome her natural inclination to hover while the partner cares for the baby. She needs to keep quiet when she feels the urge to comment on or criticize the partner’s efforts. (Does it really matter if at first the baby’s shirt is on backwards and his diaper is a little loose?) She needs to step back and let the partner-child relationship develop without her. The more of a perfectionist the mother is, the more difficult this can be.

Ginny Rossi, a first-time mother, tells how she helped encourage her partner and son to become close:

We started off slow. During the early weeks my partner would sit next to us while we nursed, touching and caressing Marco, and afterwards he would do the burping. Eventually, after burping, Marco began to fall asleep on his dad’s chest and got used to being close to him. After some weeks of this, Marco was more willing to be comforted by his dad.

Now that Marco is eight months old, my partner takes him for a couple of hours every day, and they both look forward to their time together. Not only does it make me happy to see them enjoying each other so much, but this gives me a needed break, which helps me feel better about full-time motherhood. I am convinced that their closeness today stems from their early time together.

In this age of equal partnership between the sexes and in same-sex couples, one of the lessons of pregnancy, childbirth, and breastfeeding is that sharing an equal commitment to parenthood does not mean fulfilling the same roles. Baby stands to benefit most when mother is most fully mother and her partner takes a different role. During a breastfeeding baby’s early weeks and months this may mean that the relationship between mother and baby is more intense. But a newborn needs to develop other relationships, too, and this need grows as he matures. With partner and baby, just as with any relationship, greater investment brings greater rewards.