A Soft Place to Land

Today is IBCLC Day. As an International Board Certified Lactation Consultant, this has a lot of meaning for me. I am remembering all the families I have supported and feeling warm and fuzzy and proud. I scroll through Facebook and see fellow IBCLCs posting positive messages about our profession. I love my job! I love breastfeeding! Human milk is so much more than nutrition. I want all the babies to have it. I am reflecting on ways I can improve my care of families and parents who want to provide human milk for their infants and….wait!

On my Facebook news feed, I saw that a friend has shared a new message (just in time for IBCLC Day) from an organization that works to directly undermine breastfeeding. My first reaction was to feel angry and frustrated. Why can’t my friends see that this organization is wrong and I am right? I wanted to rush in and share all the reasons why they should not provide a signal boost for this organization.

And then I decided to sit with it and step back a little. The real questions are: Why does this organization own the message that exclusive breastfeeding does not always work? What are breastfeeding supporters doing to push parents into the arms of this organization? FIB is providing a soft space to land for those parents who did not receive adequate breastfeeding support. How can we do better?

We need to understand that parents already know that breastfeeding is important for their health and the health of their infants. “Of the approximately 4 million babies born in 2015, most (83.2 percent) started out breastfeeding – but many stop earlier than recommended…”- CDC Releases 2018 Breastfeeding Report Card If 83.2% of US parents are initiating breastfeeding, the message that breastfeeding is critical for infant and parent health is getting through loud and clear. However, without adequate support, this message also serves to create stress and anxiety in parents who do not reach their own breastfeeding goals.

Exclusive breastfeeding for the first 6 months of an infant’s life is a very important universal health goal. In trying to promote this message in a society that does not support parents, we are placing parents between a rock and a hard place. No wonder they are running from our message. Parents who find themselves unable to exclusively breastfeed or to breastfeed at all, feel as if they are failing. But parents do not fail at breastfeeding. We are failing parents.

New parents are sent home from U.S. hospitals with no idea how to tell if their infant is breastfeeding well and no idea of when or how to appropriately supplement their infant if needed. “Fed is Best” steps in to fill this vacuum but they are not a friend to parents. They are a predatory organization that is exploiting parent and health care provider’s fears in order to undermine policies that support exclusive breastfeeding. They have shown by their lack of cooperation with recognized health organizations that they do not care about infant well-being.

In order to get the most human milk into the most human babies, the focus must shift from promotion to support. While breastfeeding is “natural” it isn’t usually easy. Most parents struggle somewhat in initiating breastfeeding. Some struggle more than others. Some experience severe pain and physical and emotional trauma. Some do not make enough milk to completely sustain their infants and we need to acknowledge that without undermining each parent’s potential to exclusively breastfeed.

Lactation is a robust system but it can be compromised. Just like any other organ in the body, the breasts can fail to work optimally for so many different reasons, including reasons outside the control of the parent. Most of the time, with excellent support, a parent can exclusively breastfeed if they choose to do so, but many of them do not get this support. If they are fortunate enough to initiate exclusive breastfeeding, most will still struggle to continue to provide breastmilk to their infants if they must return to employment outside their homes.

The United States fails parents and children with a lack of universal health care and with profoundly, criminally, inadequate parental leave policies. Parents need high quality, timely breastfeeding support that they can afford in order to reach their own breastfeeding goals. They need universal health care that pays for this high quality breastfeeding support. They need paid leave in order to spend uninterrupted time with their newborns and young children in order to establish and maintain breastfeeding for as long as they choose.

We need to provide more families with the services of the highly trained IBCLC. All the IBCLCs I know want infants to be fed. Feeding an infant is a minimum goal, not a thing that is “best.” IBCLCs do not encourage parents to risk their infants’ health in pursuit of exclusive breastfeeding. They have the expertise to help parents determine if their infants are receiving enough nutrition through breastfeeding and how to appropriately supplement if needed. They help parents meet their own goals whether it be to exclusively breastfeed, bottle-feed expressed breastmilk, inclusively breastfeed, combination feed, or wean.

In order to fully support breastfeeding, we need to support families. We do not need to tell parents that they should breastfeed; we need to remove obstacles so they can breastfeed. This is the work of the IBCLC. We can be their soft place to land.

#happyIBCLCday #fedisnormal #paidparentalleave #medicaidforall

Expressing Milk in an Emergency

Many people who pump breastmilk do not own a hand pump and rely on electricity for milk expression. If you are an exclusive pumper or just pump when you are separated from your baby, you know how important your breast pump is for your well-being and that of your baby. If your pump has ever malfunctioned, you have forgotten important parts, or if you have lost power, you may have experienced the inability to express milk when you needed to. There are alternatives to using an electric pump that may be helpful in these circumstances.

Hand Expression:

Learning to hand express is a valuable skill. Your hands are always available, so you can express milk even if you have no other equipment. The following video is one of my favorites for demonstrating hand expression. https://vimeo.com/65196007

Warm Jar Method:

Have you heard of the new silicon manual hand pumps? These use consistent rather than intermittent vacuum to remove milk from the breast. They work well for many who are lactating but if you do not own one, the warm jar method can also work. This method has been used for generations to express milk. First pour very warm water to fill a wide mouth canning jar. Pour slowly to avoid cracking the jar. Pour out the water and cool the rim so that the breast will not be burned. Center the jar over the nipple and hold it there. As the jar cools, a vacuum will form and milk will be drawn from the breast. Once the milk is flowing, you may try combining this method with hand expression.

Using Pump Supplies to Make a Hand Pump:

If you gave birth in the hospital, you may have been sent home with various pumping supplies that you didn’t use. Some of these supplies are used for hospital rental pumps and are not needed for personal use pumps. These supplies can also be used to make a hand pump! The following video shows how.

https://www.youtube.com/watch?v=u-vyb8Y5uBI

New Latching Video from Breastfeeding Medicine of Northeast Ohio

I am a big fan of therapeutic breast massage as taught by Maya Bolman, and shared on the website for Breastfeeding Medicine of Northeast Ohio, so I was very excited to discover that the website has a new video on latching. It shows how important it is to help your baby achieve chin contact before latching in order to stimulate a wide deep latch.

Video from Breastfeeding Medicine of Northeast Ohio

https://vimeo.com/204112635

Positioning: It’s All About the (Baby’s) Chin.

Babies and breasts come in different shapes and sizes. This may be a very obvious statement but it bears consideration when we bring babies and breasts together. Suzanne Colson, Nancy Mohrbacher, and Christina Smillie teach us to lie back to achieve good positioning. This often works very well but not for everyone. If a parent lies back and the nipple points downward, the baby cannot get in a position where the chin contacts the breast under the nipple.

In the past, breastfeeding helpers taught the tickle (the lips with the nipple) wait for a wide open mouth, and RAM (rapid arm movement) method. Some providers suggest aiming the nipple toward the palate or brushing the upper lip with the breast and waiting for a wide open mouth. But what comes next? Often the baby’s head is pushed onto the breast and the baby can’t breathe and becomes frustrated. Or the baby is brought to the breast but closes their mouth on the way causing a shallow latch. Why is it so hard?

Again, breasts and babies come in different shapes. Some babies have very receding chins. Some breasts are very round and some are flatter or softer or smaller or larger or…

The best positioning for a particular parent and baby is to be sure that the baby’s chin contacts the breast before latching. Chin contact below the nipple allows a baby to achieve a deeper latch. There are many techniques that can help achieve this positioning (try Googling “laid-back breastfeeding” or “flipple” or “deep latch technique”) but the technique needs to match the shape of the baby and the breast so they come together in harmony.

I absolutely love the following photo for showing how to position your baby.

http://www.cwgenna.com/quickhelp.html (click on “Latching Your Baby 101”)

Whatever your shape or your baby’s shape, if you can achieve chin contact before latching, you may have a more comfortable latch. If not, you might just need more help from an International Board Certified Lactation Consultant.

Choosing a Breastfeeding Helper

Parents who are struggling with breastfeeding need high-quality, timely support in order to ensure they meet their breastfeeding goals. Because optimal breastfeeding is critical for the health of Baby and Parent, it is important that they receive the best help available.

There are many knowledgeable volunteer breastfeeding supporters that can help parents to breastfeed. Often this peer-to-peer help is all that is needed to resolve a breastfeeding difficulty. For more complicated problems such as low milk-supply, painful breastfeeding, babies who have difficulty latching, and slow weight-gain, it is important to get timely professional help in order to get back on track quickly.

I frequently see parents who have tried many other professional breastfeeding helpers and did not receive the help they needed. Time, energy, and resources may have been wasted. Delays in following the best interventions often result in parents not meeting their breastfeeding goals and babies missing out on optimal breastfeeding. High quality professional breastfeeding support may seem expensive but it saves time, effort, and financial resources in the the long run. Additionally, lactation help from an IBCLC is usually reimbursable by insurance.

Parents are often confused about the many different kinds of professional breastfeeding support providers available in the community. It is critical that parents have access to information regarding these differences so that they can make informed decisions about whom to hire for help. The following links explain the different types of breastfeeding supporters and the training required for each. Be aware that the term “Lactation Consultant” can be used by anyone, no matter what training or experience they have with breastfeeding.

http://uslca.org/wp-content/uploads/2015/05/Whos-Who-Short1.pdf

http://massbreastfeeding.org/wp-content/uploads/2013/06/Landscape-of-Breastfeeding-Support-03-31-14.pdf

The following article explains why I chose to become an International Board Certified Lactation Consultant.

http://feedthebabyllc.com/why-i-became-an-international-board-certified-lactation-consultant/

This site  is dedicated to helping parents find answers to their breastfeeding concerns and to provide a platform for posts regarding current breastfeeding topics. It has recently been optimized to be smartphone friendly. Breastfeeding information is easily accessible by clicking on the Menu link or Search box located at the top of the site.

None of the information on this site is intended to replace medical advice. Please consult your health care provider for medical advice. If you are not able to solve your breastfeeding difficulties, please contact a Board Certified Lactation Consultant (IBCLC) or breastfeeding peer helper for more assistance.

Find a Lactation Consultant

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The contents of this site are the property of Laura Spitzfaden. Please do not reproduce anything without permission. You are welcome to link to my site if you wish to share any of the material you find here.

Contact me: laura@feedthebabyllc.com

Milk Expression

If you are expressing milk after you have established a full milk supply, a personal pump such as a Hygeia Enjoi, an Ameda Purely Yours or a Medela Pump in Style will likely be adequate for your needs.  If you are establishing a milk supply for a baby who is not directly breastfeeding, a multi-user pump will likely be necessary.  This type of pump is also referred to as a, “hospital grade pump.”

Be sure that you check and change membranes and tubing as needed and have properly fitting flanges.  Your nipples should fit well into the flanges with just a little space between your nipple and the flange.  Your nipples should not rub in the flanges.  Your nipples should also not bobble about in the flange.   This would indicate that the flanges are too large.  You may want to experiment with flange sizes to find which remove the most milk.  Some moms have better success with alternative type flanges such as Pump in Pals.

Before begining to pump try these techniques

-Massage your breasts in concentric circles as when doing a breast self exam.

-Draw the backs of your fingers or a comb across your breasts from the chest wall to the nipple all around your breast.

-Lean forward and shake your breasts.

Use reverse pressure softening (developed by K. Jean Cotterman RNC-E, IBCLC) until you see drops of milk, then apply the pump.

Use hands-on double pumping. Whenever milk flow slows, take the pump off and repeat everthing including the reverse pressure softening and re-apply the pump. Try to do this cycle three times.

Hands on pumping:

http://newborns.stanford.edu/Breastfeeding/MaxProduction.html

Reverse pressure softening (developed by K. Jean Cotterman RNC-E, IBCLC):

http://www.youtube.com/user/IBCToronto?feature=mhee

If you only have single pumping capacity, just switch back and forth a few times using all the techniques in this article.  If you do not have a pump, use these techniques and then hand express.

http://www.bfmedneo.com/BreastMassageVideo.aspx (from Breastfeeding Medicine of Northeast Ohio)

http://newborns.stanford.edu/Breastfeeding/HandExpression.html

http://ammehjelpen.no/handmelking?id=907  (video created by the Norwegian mother to mother breastfeeding support organization, Ammehjelpen–scroll down for English video)

Maintaining a Robust Milk Supply When Parent and Baby Are Separated

I was inspired to write this post due to some recent helping situations.  I decided to compile all this information in one place.  I may add to it later.

In order to have an excellent milk supply, it is important to remove milk from the breasts at least 8-10 times a day. (http://feedthebabyllc.com/care-plan-for-milk-supply/)  When parent and baby are together, it is beneficial to keep baby skin-to-skin and allow free access to the breast.  A baby is usually better at maintaining a milk supply than a pump and the extra nursing stimulates breasts to make more milk.

When a breastfeeding parent is separated from baby, it is important to express milk as frequently as possible, at least every 3 hours from the beginning of one expression to the beginning of the next.  A double electric pump with properly fitting flanges works the best.  Be sure to check the membranes frequently and change them at least every 3 months.  A pump that is older than 1 year may not be as efficient.  See (http://newborns.stanford.edu/Breastfeeding/MaxProduction.html) for learning a technique that increases the amount of milk that can be expressed by 48%!

Read more Maintaining a Robust Milk Supply When Parent and Baby Are Separated