Nancy's Talks

 

     December 3, 2014

      January 8, 2014

      January 26, 2014

      Chesapeake, VA
      February 19, 2015

      Brisbane, Queensland, Australia
      March 6-8, 2015

Southeast Georgia Health System Annual Breastfeeding Conference
      Brunswick, GA
      April 17, 2015

Annual Update for Breastfeeding Professionals
      Medford, OR
      May 15, 2015
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“Best speaker I’ve heard in a long time. Nancy is expert and wise & has an incredibly broad & deep fund of knowledge.”

“[Nancy] is gifted…great speaking voice and a talent for getting the information across in an understandable way—evidence-based and interesting.”

“Wonderful! Made a difficult topic very simple to understand.”

“An extremely good presentation with excellent research, thought-provoking, up-to-date, practical.”

“Just went to a three-day conference. This two-hour talk was as valuable.”

“Really good use of applied research.”

“Nancy speaks in a manner easy to understand--very down to earth & knowledgeable. Great information.”

“This is the BEST talk I’ve ever heard on the subject—very practical!!”


Sunday
Nov162014

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.

Monday
Aug252014

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!

Friday
Aug222014

Spanish Breast Storage Capacity Infographic

Here is the latest translation of my Breast Storage Capacity infographic. Thanks to Alison Velasco for her excellent work! French, Bulgarian, and basic Chinese translations of this infographic are also available in the Multimedia section of this website. Just click on this link and scroll down. You have my permission to use them freely. --Nancy

Thursday
Jul312014

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

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."

Friday
Jul112014

Free Apple Downloads of Breastfeeding Solutions v1.3

Focus groups of new mothers tell us that the most common reason many supplement with formula and wean earlier than planned is confusion about baby and breastfeeding norms. When I learned this, I asked myself the question: “How can I get an easy-to-use, low-cost breastfeeding resource into the hands of more new mothers?” The answer was my Breastfeeding Solutions smartphone app.

As you can see from these images, my app now has a fresher, more modern look. I have also reduced its price from $6.99 USD to $4.99 USD to make it more affordable.

My hope is to provide an alternative to random googling (which can be hugely time-consuming and lead to questionable sources) and to give many more mothers easy access to fast, reliable breastfeeding answers from the moment their baby arrives. You can help me make this happen by:

  • Sharing the link to the 2-minute YOUTUBE VIDEO DEMO
  • Downloading the app’s UPDATED FLYER (click on "Share" then the light gray "Download") and spreading it far and wide

Thanks in advance!

What’s New in Version 1.3

Along with its new look and feel, my son Ben (my app builder) and I made other user-requested improvements:

  • Larger line drawings
  • More index links for faster, easier access to more information
  • Navigation bar now attached to the top of the screen for easier browsing.
  • A clearer font  and updated styling
  • Articles section renamed Browse to clarify its purpose

Lessons Learned

I appreciate that unlike a book, an app allows me to send updates automatically. Once you’ve downloaded the app, there’s no need to buy a new edition. When you're notified of an update, just touch the “Update” button, and you receive the new, improved version instantly.

But I’ve also discovered a disadvantage to an app. With every update, the app’s reviews disappear from the Current Version tab of Apple’s App Store. Yikes! This is a problem because apps without current reviews appear lower on the App Store’s listings, so fewer mothers see them. Also mothers are less likely to take a chance on an app with no reviews on the current version.

Rewards for Apple Reviews

That’s why I’m hoping for your help. With this update, there are now no reviews of the app’s current version in the App Store. If you’ve found any aspect of my work useful and you have an iPhone or iPad, please consider helping me by submitting a review of the current version. Clicking the link below from an Apple device will take you directly to the app’s page in the App Store.

If you submit a review of the 1.3.1 version of the Breastfeeding Solutions app, as a thank-you, I will send the first 15 people whose App Store review is published a promo code for a free download of the Breastfeeding Solutions app onto any Apple device. This promo code can only be used once, and it expires 20 days after you receive it. You may share this promo code with a deserving pregnant or breastfeeding mother, a colleague, or anyone you choose.

As an FYI, it takes a few days for a submitted review to appear in the App Store. So be patient. After your review appears, just notify me by email at nancy@nancymohrbacher.com. If you are one of the first 15, I will send you a unique promo code and instructions on how to redeem it.

Android Users Can Help, Too

If you’re an Android user and you haven’t yet submitted a review, it would also be of tremendous help for you to do so now, either in Google Play or Amazon. Clicking on the links below from your Android device will take you right to the app’s page in both stores.

Supporting the Larger Breastfeeding Cause

As with its previous version, a portion of every app sale goes to the Best for Babes Foundation® to help beat the Breastfeeding Booby Traps® – the cultural and institutional barriers that prevent mothers from achieving their personal breastfeeding goals. The Best for Babes seal of approval is still prominently featured on the app’s new 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 larger breastfeeding cause. I appreciate your help in spreading the word. It means a lot to me!