Saturday, August 3, 2013

Breastfeeding: Myths, Tips & More Pt 2

Today is part two of our breastfeeding series!

(read part one HERE and part three HERE)

Hello all! In honor of World Breastfeeding Week (August 1-7) and National Breastfeeding Month, we are continuing our series on breastfeeding! Today's post has a very special guest writer; a dear friend of mine who is a doula, placenta encapsulationist, and on her journey to become a lactation consultant and breastfeeding educator. Angela has a three year old daughter, is expecting her second child and is also on-call for a birth right now and was very kind enough to take time out of her schedule to write for The Crunchy Mama this week. She has made some wonderful points and I hope she may help answer some of your questions.

Lies told to us about Breastfeeding

Many women begin a parenting journey with the strong desire to breastfeed. Even at the age of seventeen I knew that it was the best option for my little one. What I didn’t know, was that the moment she was born a battle had begun. Before she was born, I saw it as this beautiful bond that me and my daughter would have right from the start. Oh how naive I really was! It was a struggle from the day I left the hospital. I’m pretty sure there were days I cried more than she did. Thankfully, I had a supportive boyfriend who let me scream, and cry, but would NEVER let me give up. I honestly believe, if I didn’t have him fighting for us, I would have been another mother who “couldn’t” breast feed. Somehow, even with all these “problems” mothers have, we’ve survived as a species. How can that be possible, if it seems like nearly every woman who tried, can’t breast feed? Is it really us? Have our bodies really failed? Or could it be possible we have been fed lies that are so ingrained into our minds we see them as truth?

Making Enough Milk for Baby

This is probably the BIGGEST reason I hear as to why women couldn’t breastfeed. While this is a very real problem for a small population of women, it is not the norm. Many women are led to believe that babies will only feed every two to three hours. This is so far from the truth! Some babies will in fact go every three hours, but it’s not uncommon for a baby to want to eat as much as every half hour. That doesn’t mean you don’t make enough, it just means that’s how much your baby wants to eat. Human milk also digests much more quickly. When compared to a formula fed baby, it may seem like they aren’t getting enough milk.
(This chart shows the stomach sizes of a baby up until the first month. As you can see, a baby really doesn’t eat much per feeding. )

Your baby may out of nowhere start feeding constantly. This is nothing new, and has nothing to do with your supply. It’s just simply, a growth spurt. Your baby will have many of these during childhood. That just means you need to feed your baby when the baby is hungry. I promise, it won’t last forever!

There are also times that your baby just wants to be close. This is called NNS or Non-Nutritional Sucking. Our busy lives often conflict with this, and can cause many mothers to feel like their baby is “always” eating. The reality is, your baby just wants you!

Pumping is NOT and indication of proper milk production. There are women who have healthy breastfed babies who cannot pump an ounce of breast milk.

The best indication of proper milk production is five to six wet diapers and more than three bowel movements a day. (I should add that it is possible for breast fed newborns to not have bowel movements for up to ten days.)

The Issue of Latch

Many women, like myself, don’t expect problems when it comes to breast feeding. I personally had this problem, and ladies, I feel your pain. It is so frustrating to try and feed a baby who just cannot latch. This can be the start of many other breastfeeding problems including, cracked nipples, blocked ducts, mastitis, and reduction in milk supply, oh and crying, lots of crying.
The first thing that needs to be checked is if a baby has a tongue or lip tie. It is important to find someone who specializes in this, since many pediatricians are uneducated about tongue and lip ties. Tongue and lip ties can also be the root of other problems that most people wouldn’t think to associate with it.

In my case, I had flat nipples AND my daughter had a tongue tie. For the first few weeks I used a nipple shield which helped to not only get her to latch but also pulled out my nipples so I could eventually nurse without one. You can use a shield for the whole duration of your breastfeeding relationship. I just chose not to out of pure laziness. (I hated always washing that thing!) It is important that the nipple shield is the correct size. This illustration from Medela shows how to tell if the shield is a correct fit.

There are also products you can use to extract the nipple. This can be painful, but only for a short time, and makes it all worth it in the end.

Babies “allergic” to breastmilk
This is one I’ve heard a lot recently. Women devastated because their doctor told them their baby “needs” formula because their breastmilk is bad. While this is a real and RARE problem known as galactosemia, it that only occurs in 1 out of 60,000 live births. Galactosemia is a metabolic disorder that causes the baby to be unable to digest sugars that make up lactose.

Doctors can often misdiagnose jaundice as a breast milk allergy. It can be scary seeing a baby with jaundice as it changes the skin of the baby from pink to a yellowish color. This is caused by a build up of bilirubin. Bilirubin is a pigment in the blood when our red blood cells die. Normally, the liver will flush it out into the intestines, but for some newborns too much is created for the liver to be able to flush all of it out causing the skin to turn yellow. The cure? Breastfeed as much as possible! This can be hard, because jaundiced babies tend to be more sleepy. In this case, I would recommend using a pump and dropper just to get as much milk in the baby as possible.

{Note from The Crunchy Mama here. When my daughter was born, she wouldn't nurse right away and we struggled as well. We dropped pumped colostrum for a while to prevent nipple confusion. Another way to prevent jaundice other than ensuring breastfeeding is delayed cord clamping, which you can read more about here. Making sure all of baby's blood is returned to their body before cutting the cord really helps!}

Lastly, if you think your baby may be allergic to your breastmilk, it is more likely they are allergic to something in your diet. Some of the common allergies are, diary products, eggs, spicy foods, and gluten. However, it could be anything, I knew of a baby to had a sensitivity to cucumber! Don’t assume anything is safe.

The real reasons women can’t breastfeed

There are obstacles that come in our way, that can cause us to fall into the trap of not being able to breastfeed. At certain times in our lives, these can be very real and very discouraging factors.

The Role of Stress and Breastfeeding
Stress hormones are a basic part of survival for animals and human alike. Our ancestors would have never survived if it weren’t for the ability to respond to high stress situations. Today, we don’t live in fear of being attacked by animals, but nonetheless, stress fills up our lives every day. This constant stress can negatively affect many parts of our lives, including blood pressure, heart rate, digestion, and yes, breastfeeding.
When a mother is consumed with stress it makes it difficult to tend to her baby the way the baby really needs. On top of that, the stress hormones, adrenaline and cortisol, inhibit prolactin levels. (Prolactin is directly related to milk production.) 

A quote from Ina May’s Guide to Breastfeeding “I am certain that one of the reasons all the women in my community were able to breastfeed their babies was that we created a largely stress-free culture for women and babies without making life unpleasant for everyone else.”

Ina May lived in an area that honored breastfeeding. Women weren’t required to “cover up” or leave the room in order to provide their baby with food. Unfortunately, most women in our culture do not have that luxury. Many women constantly live in fear of what others are thinking while the only thing they should need to focus on is their baby. I had this fear myself – are you ready for this confession? I wouldn’t breastfed in public. Yes, you heard me correctly. I was still living with my parents at the time and was constantly shamed for not covering up, but my daughter hated it. At least at home I could hide in my room, but if my own family was so grossed out by what I was doing, how could I do that in front of strangers. Now I know better and my next babies will be fed whenever, where ever, however they want!

This isn’t something that NEEDS to ruin your breastfeeding experience. Even after all my struggles, I was able to nurse my daughter until she was eighteen months old.

I don’t know if I can say this enough, but the BEST way to successfully breastfeed is to surround yourself with people who are supportive of breastfeeding. There are groups, locally and online that can help remind you, you aren’t alone. If you don’t feel you are properly supported keep looking for people until you do.

{Another note. I can absolutely relate to what Angela was writing about stress affecting the breastfeeding relationship. My family is a fairly "modest" family and I knew their opinions about uncovered nursing and it made me VERY nervous to feed my daughter around them for a long time. But we were a determined duo, and I wanted her to eat when she needed no matter where we were or who we were around. If a baby can eat with a bottle in front of anyone, I knew my breastfed baby could do the same, and we pushed through the struggle and slowwlllyyy became more comfortable with nursing in the open, and soon... in public. Don't be scared. It can be hard. Just do what you're comfortable with. It took us a while! Whether it be with a cover, the two-shirt trick, or totally uncovered, feed your baby however you need.}

Your Birth Experience and Breastfeeding
Our birth experiences are much more significant than mothers are led to believe.  Birth brings delicate hormones that can be easily interrupted when a birth becomes a medical procedure. Things as simple as a woman’s position in labor can affect the ability to breastfeed. In 1979, an article by Dr. Roberto Caldeyro-Barcia was conducted. This research study showed that women who were in a “vertical” position during labor had less fetal distress than woman who had a “horizontal” position. If an infant goes into fetal distress during labor, it can cause an infant to be less likely to latch on following birth.

Pain relief is common for many women, but what women don’t know is this can cause problems for the breastfeeding duo. It can cause the baby to come out less responsive as babies who were not exposed to drugs.
If a birth is filled with interventions, it is likely that birth will end in cesarean. This can prevent the mother from even seeing or touching her baby for hours after the child is born. While c-section mothers may get off to a slow start, it doesn’t mean it is impossible to breast feed, just more difficult. It is crucial to get the baby to the breast as soon as possible, not only for breastfeeding purposes, but also for breastfeeding to be established.
No matter what way your birth turns out, breastfeeding is possible. Rooming in with baby, Resting as much as possible with your baby, and constant skin to skin time can greatly improve breast feeding outcomes.

{For more info on another procedure which inhibits breastfeeding, click HERE and HERE.}

Real Medical Reasons
For a small percentage of women, breastfeeding really isn’t an option. Insufficient glandular tissue, wacked out hormone levels, and certain medications can force some women to end their breastfeeding
 Insufficient glandular tissue or Mammary Hypoplasia are disorders of the breast tissue. These disorders occur in very rare cases, and can be detected by visual markers.

What are the visual markers of hypoplastic breasts? In a study of 34 mothers by Kathleen Huggins, et al. (2000), the researchers found a correlation between the following physical characteristics and lower milk output:
•widely spaced breasts (breasts are more than 1.5 inches apart)
•breast asymmetry (one breast is significantly larger than the other)
•presence of stretch marks on the breasts, in absence of breast growth, either during puberty or in pregnancy
•tubular breast shape ("empty sac" appearance)
Additional characteristics that may indicate hypoplasia are:
•disproportionately large or bulbous areolae
•absence of breast changes in pregnancy, postpartum, or both

With the help of a SNS system (pictured right), mother who truly can’t breastfeed still have the ability to bond with their infant.

{Also helpful for moms who may have struggled with nipple confusion and want to try nursing again!}

The virus HTLV-1 (human T-cell leukemia virus type 1) can develop into a highly malignant disease that is nearly always fatal. This virus is not common in the US or Europe, but is on the rise in parts of Africa, South America, Japan and the Caribbean. Since breastfeeding is a major route of transmission for this virus, it is recommended that women who are carriers of the virus not breastfeed their infants.
There are times when the mother becomes sick and needs to go on medication in order to stay healthy. This can interfere with breastfeeding, but doesn’t always have to. Even though most medications given to breastfeeding mothers pass into the mother's milk, the majority of over-the- counter and prescription drugs are considered compatible with breastfeeding. Although, the baby should always be closely monitored for adverse affects.
Le Leche League provides questions to be asked before exposing any child to a medication.

•Has the drug been given to infants? A drug commonly prescribed for infants is usually a good choice for a breastfeeding mother.
•Has the drug been given to other breastfeeding mothers? A drug that has a history of use by breastfeeding mothers is a better choice than a new, possibly untested drug.
•What is the duration of the drug therapy? The duration of the drug therapy can affect its compatibility with breastfeeding. A drug considered compatible with breastfeeding when taken for a few days might not be compatible when taken over a long period of time.
•Is the drug short-acting? A short-acting form of the drug may be a better choice for a breastfeeding mother than a longer-acting form that stays in the mother's system for a longer period.
•How is the medication being given? A drug given by injection or by mouth is less concentrated than one given intravenously. However, a drug may be given intravenously because it is inactivated or not absorbed by the digestive system, so the baby's digestive system would also inactivate or not absorb the drug.
•How well can the baby excrete the drug? Some drugs accumulate in a baby's system and can potentially build to toxic levels. A drug that is quickly eliminated by the baby is more compatible with breastfeeding.
•Does the drug interfere with lactation? Some drugs should be avoided by breastfeeding mothers because they affect breastfeeding itself (the let-down or milk supply).

To the Mother’s Who “Couldn’t”
I’m sure many of you will read this and immediately get defensive. Please don’t feel like you need to. If you feel like you tried your best with the resources you had, then you did! Your baby is lucky to have a mother that tried against much adversity. Don’t blame yourself for “not knowing any better” because, most of us didn’t. I didn’t know better with my first, but I took that and learned from it. If you feel you actually didn’t try your best, that is something to evaluate in your own life, but I’m not here to judge.

Cole, Melissa, and Bobby Ghaheri. "The Basics of Tongue and Lip Tie: Related Issues, Assessment and Treatment." The Leaky Boob. N.p., 19 Nov. 2012. Web. 03 Aug. 2013.

"Right Size of Breastshield." . N.p., n.d. Web. 03 Aug. 2013.
Newman, Jack, and Teresa Pitman. "Jaundice." The Ultimate Breastfeeding Book of Answers: The Most Comprehensive Problem-solving Guide to Breastfeeding from the Foremost Expert in North America. New York: Three Rivers, 2006. 133-38. Print.

Gaskin, Ina May. Ina May's Guide to Breastfeeding. New York: Bantam, 2009. Print.
Cassar-Uhl, Diana. "Supporting Mothers with Mammary Hypoplasia." LLLI. N.p., 18 July 2010. Web. 03 Aug. 2013.
"Medela SNS Supplemental Nursing System." Medela SNS Supplemental Nursing System. N.p., 25 Aug. 2010. Web. 03 Aug. 2013.

Sturges, Pat. "Medications and Breastfeeding." LLLI. N.p., 14 Oct. 2007. Web. 03 Aug. 2013.

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