Posted in Team Fox

Tips for Pumping Mothers

I frequently hear from mothers complaining that they don’t get very much milk when they pump. A breastpump is nowhere near as efficient as a baby at emptying a breast but it’s better than nothing when baby isn’t able to nurse for whatever reason or you need to save milk for future use. The amount you can pump will vary greatly depending on several factors including the type of pump, time of day, last time the breast was emptied, length of session and even level of distraction. I have been known to pump 7 ounces from one side in one session and only drops in another and every amount in between.

 

I wrote these tips in a document for the La Leche League Facebook group and I frequently copy and paste it to e-mail replies when asked for pumping help so I figured that it would be a good idea to share this on my blog for quick and easy reference.

 

Below is a list of things that worked for me when I used to pump and that have helped many of my clients. I hope that you find at least some of them useful.

The type of pump, the frequency and length of the sessions all play a role in how much you’ll get. There are different tricks, many minor tweaks that have helped me and many of my clients such as:

  • If pumping at work try to time your breaks at baby’s usual mealtimes
  • Be hydrated, drink water right before and during pumping (for myself cold water worked better than room temperature water)
  • Being relaxed when pumping is important, muscular tension can also occur in the breasts which inhibits letdown. If your neck and shoulders are tense, chances are that you will have a hard time getting much milk out. Deep breaths, relaxing music, brief meditation, whatever works for you as a quick relaxant will help. A lot of moms find that using a hands free pumping bra allows them to have a more relaxed posture than holding the flanges against your chest (you can easily make your own pumping bra out of an old sports bra).
  • Avoid multi tasking while pumping- it’s harder for your brain to have a good letdown with a machine so focusing on baby helps. Some moms use a piece of clothing that baby wore, a picture of baby, a video. Iin my case a recording of baby crying gave me more milk than a picture of him smiling and double the amount of milk than if I was just sitting there eating, watching tv, Facebooking or texting while pumping.
  • I know it’s hard to do but avoid staring at the bottles while pumping as stressing over ounces will reduce output.
  • Using breast massage and compressions before and while pumping greatly increases the output since you’re able to get milk out that the suction of the pump can’t get. This video teaches a great technique to increase production http://newborns.stanford.edu/Breastfeeding/MaxProduction.html
  • Dry pumping for several minutes after the last drop sends the signal to your body that it needs to make more milk. For me I found that drinking a tall glass of water while still dry pumping would give me a second letdown after about a minutewith an average of an extra ounce per side.

I hope that at least some of these tips are useful.

Posted in Baby Foxes

The Supplementation Trap

In over 2.5 years I have counseled over 3,000 breastfeeding mothers as part of my paid work as a WIC Breastfeeding Peer Counselor and as a volunteer La Leche League Leader.  As a supporter and volunteer for Best for Babes Foundation, I am very aware of the many “Booby Traps” to breastfeeding because sadly, I have encountered many of them myself.

 

 While I don’t get tired of talking about breastfeeding, it can be very hard to not take things personally and feel defeated when a mom doesn’t reach her breastfeeding goal.  It saddens me to see so much unnecessary supplementation and premature weaning that could have been easily avoided if mom had more confidence in herself and learned to listen to her gut.  Oftentimes I can’t blame the mom as the bad advice comes from a health authority figure that they mistakenly assume to be an expert even if their lactation knowledge is minimal at best.

 

I hear it all of the time, a nurse says “your baby lost weight, you are not making enough so you have to supplement” or “your baby has jaundice so you will have to stop breastfeeding for 24/48 hours and give formula”.  That could have been me…

 

When Shammy was 2 days old a nurse woke me up at 2am to say that he had lost weight and had to be given formula right now, I must have been the first mother in her career to question that order.  In my groggy state I had to attempt to engage my brain because the nurse was pushing all of my emotional buttons to get me to agree.  To her it was just standard protocol of infant weight loss= give formula.  She didn’t know about breastfeeding and adamant that I couldn’t wait until I asked the doctor in the morning about the formula, she insisted that my sleeping newborn had to have formula RIGHT NOW.

 

So I told her that if it’s truly such an emergency that he needs to supplemented that she will then wake up the doctor and have me tell him himself.  Obviously that wasn’t an option so I insisted that if he had to be supplemented he would be supplemented with my breastmilk so please get my a breast pump.

 
After almost 15 minutes of arguing she finally gave up and came back with a breastpump.  My milk wasn’t in so I pump some colostrum and she complained about how that wasn’t enough but put it in the fridge anyway.  Shammy never got that milk.  The next morning I asked the doctor and he agreed that while supplementing with formula would help, it wasn’t necessary and I did NOT have to do it.

 

The next day my milk came in and Shammy gained all of the weight loss plus some.  But how many new mothers know to question a nurse?  They think the nurse knows it all, oftentimes they mistakenly assume that the nurse is acting on doctor’s orders.  How much supplementation could be avoided?  Also a lot of mothers think that supplementation = formula.  It doesn’t occur to them that their baby can be supplemented with their own breastmilk.

 

A lot of people say “it’s just one bottle, what harm can it do?”.   If you spend 1 day with me at the WIC office and you’ll be surprised at how much damage just one bottle can do to breastfeeding.  Not counting the fact that a lot of nurses and doctors tell a mother to supplement but don’t tell her for how long so mom thinks she will always have to supplement when in reality they could have stopped days ago and by the time they get to me we are faced with the problem of dropping milk supply, lazy latch, nipple confusion, etc.

 

Jaundice does not equal formula supplementation.  Zen was born Coombs +, what this means is that his blood type is different from mine so he gets jaundice while his blood clears out the leftovers from mine so he had to be under bili lights as a preventative and still got mild jaundice. On top of that he had (at the moment undiagnosed) posterior tongue tie and upper lip tie so his latch was not good and he was losing weight due to improper milk transfer.  The first nurse said that I could only nurse for 20 mins every 3 hours due to the lights.  The second nurse said that I had to supplement because he was losing weight and his bili levels were rising.

 

I saw another argument like the one with Shammy’s nurse brewing but thankfully this time it was daytime and my demand for a doctors order wasn’t so unreasonable.  I knew that limiting nursing would only make his jaundice and weight loss worse but the nurse was set in her ways.  The doctor agreed with me and I got permission to nurse on demand by getting under the lights with baby as long as I wore sunglasses.  The doctor had no trouble discharging us from the hospital despite still rising bilirubin levels and weight loss because she knew that I would “nurse him a million times a day”.

 

Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
Jaundice did not interfere with exclusive breastfeeding but only because I fought for it.
As soon as we were discharged I made an appointment with Dr. Punger to get Zen’s tongue tie and upper lip tie diagnosed and fixed and while his jaundice took a while to fully clear, we never had to supplement, we never had to go back to the hospital and he gained all of the weight loss plus some.
The moral of the story is:
  • Always ask questions if you are told that your baby has to be supplemented.  If a nurse tells you to supplement, demand to hear it straight from the doctor.
  • Know that you can supplement with your own breastmilk.
  • Pediatricians can still be quick to recommend supplementation when it’s not truly needed so it’s ok to get a second opinion and talk to an IBCLC
  • If you are told to pump and dump or stop breastfeeding due to medication, contact an IBCLC or LLL that can look up the drug on Hale’s Medication’s and Mother’s Milk.  Doctors and pharmacists play it safe and tell you not to breastfeed because they don’t know better when in reality it’s perfectly safe.  Most drugs are compatible with breastfeeding.  Lactmed and the Infant Risk Centers are also good resources for this. (You can use the Lactnet search widget on the right column of this page to research a medication).
  • If you are told to supplement “until your milk supply increases” know that your milk supply will go further down because production is supply and demand and every ounce of formula that baby drinks is one less ounce that baby will drain from the breast sending a signal to your body that it’s not needed.  While pumping can help, a breastpump is not as efficient as baby to increase milk supply.
  • If you must supplement it doesn’t have to be with a bottle (anything but a bottle is preferred; SNS, syringe, cup, spoon or finger feeding are options) and get clear instructions on exactly how long that is necessary while getting counseling on how to protect your milk supply and baby’s latch.
I believe that breastfeeding support is important for pediatric practice and which that all pediatrician offices either have a CLC/IBCLC on site or were quick to refer a mother to one as needed.
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Posted in Baby Foxes, Team Fox

Second Pregnancy Blues

I commend those very active mother bloggers that are able to post content several times a week. They obviously don’t have a stream of consciousness writing style like mine as it’s near impossible for me to finish typing a thought before getting interrupted. I really wish that I could write more, there is so much I want to share!

The fact that this pregnancy has kicked my ass hasn’t helped matters. With Shammy I was huge and uncomfortable but didn’t have reason to call the midwife at all. This round I have had to call the Dr more than once a week for several weeks and have had to seriously contemplate the possibility of a trip to L&D more than once. I am at a point that any type of physical activity beyond moderate walking triggers painful and regular contractions. I can’t even load the dishwasher or do laundry without being out of commission for an hour afterwards while I try to get the contractions to stop. The Doctor’s response? “listen to your body… lie down and drink lots of fluids…. I don’t care if your house gets dirty…”

I do care that the house is getting out of hand, we’ve never been the poster family of OCD clean but I hate that something as simple as picking up toys from the living room floor is beyond my scope. So imagine how easy it is for me to chase after the toddler when I’m home alone all day, I usually feel like death by the time he finally goes down for a nap.

This round it feels like making it to 31 weeks is an accomplishment but enough whining about me…

 

I’m starting to become annoyed at the fact that so many websites/books make a mom feel like she can’t breastfeed without a breastpump. I know that I felt that way too the first time around and securing the right pump at the right time became a source of stress. I am not anti-breastpump, they are great, they have their place, but they’re not a must have item like consumerist advice sources seem to make us feel, specially if mom is not going back to work again. There can be some cases in which a mom may have to pump in the first few days (baby in the NICU, etc) but having it “just in case” seems to cause more trouble than is needed. I’ve seen cases of oversupply, nipple confusion from introducing bottle too early and unnecessary stress about milk supply because a pump is a horrible indicator of how much milk a breast truly has.

I’m not trying to tell people to not get a pump, but rather hold off on it until AFTER baby is born to see if you truly need it (they’re expensive!), I don’t recommend pumping for at least the first 2 weeks and if you must for a medical reason, the hospital or WIC can set you up quickly.

So what if you need to pump milk and don’t have a pump? Hand expression is free and not that hard. Feel like you must have a pump? go ahead, just don’t become its slave and let it mess with your confidence.

Speaking of WIC, there is a new petition floating around the internet to have WIC provide cloth diapers to low income families. As huge of a cloth diaper advocate that I am I did not sign this petition. Why? Because it will never happen! I’m not against the government helpingwithcloth diapers but this is not the program for that. WIC is a nutrition program funded by the US Department of Agriculture, cloth diapers are not food. It takes an act of congress to change anything about what WIC gives and even if congress wanted to support fluff, it will never be through the WIC program.

Speaking of fluff, I have become quite the fluff-activist lately. I’ve had the opportunity to teach a couple of cloth diaper classes and during Real Diaper Week in April I converted no less than 9 moms to cloth diapers, yay!

 

Shammy has gotten a new nickname from my husband, he is now the “boob zombie” because when he wakes up in the morning he walks around groggily saying “side…. side…. side….” until he finds my boob. (side is the word that he uses for nursing).

Even though he’s not going to finish weaning anytime soon, he is taking steps in that direction and my pregnancy hormones are making it very hard for me to cope with it emotionally. The first time he went to sleep without asking to nurse I cried. The other night I woke up in the middle of the night, remembered this poem and cried uncontrollably for almost 2 hours over the last 3 lines of it.

Wean Me Gently

I know I look so big to you,

Maybe I seem too big for the needs I have.

But no matter how big we get,

We still have needs that are important to us.

I know that our relationship is growing and changing,

But I still need you. I need your warmth and closeness,

Especially at the end of the day

When we snuggle up in bed.

Please don’t get too busy for us to nurse.

I know you think I can be patient,

Or find something to take the place of a nursing –

A book, a glass of something,

But nothing can take your place when I need you.

Sometimes just cuddling with you,

Having you near me is enough.

I guess I am growing and becoming independent,

But please be there.

This bond we have is so strong and so important to me,

Please don’t break it abruptly.

Wean me gently,

Because I am your mother,

And my heart is tender.

~ Cathy Cardall

 

my cloth diaper advocate rocking his mohawk even when sleeping