What happens in our lactation consult?

So you have booked a lactation consult with Aspire Lactation. What happens next?  If you’ve never seen a lactation consultant before, or had a home visit from a lactation consultant, here are some things that will happen during my visit to your family. I try to be flexible and not everything happens in a particular order, and not everything happens on each visit!

  • We’ll work out a time that suits you and your baby for me to visit. If mums are close by to Tarragindi I can be a little more flexible with start time but this will depend if I have other clients to see. We can talk about this!
  • Visits are usually 1.5 hours but sometimes go longer for more complex issues.
  • Aim to have the baby needing a feed sometimes during a visit – we don’t have to time this for when I first arrive as we can go through some paperwork first.  Please don’t hold your baby off if she or he is crying and starving – offer a small feed to keep them comfortable, most babies will go back  for more when I arrive.
  • With your permission, your baby may be weighed and measured, and will have general assessment from head to toe.  I find it useful to do a suck assessment with my gloved finger to feel your baby’s palate, as well as checking for restrictions that occur with tongue or lip ties.  If I have a suspicion of tongue or lip tie, we’ll talk about the providers who can diagnose and release these ties.
  • A breast examination (helpful in cases of nipple damage, mastitis, plugged ducts, insufficient glandular tissue).
  • A breast feed – or two if I’m there for a long time!
  • We will talk about your baby’s birth, plus your medical and surgical history.
  • We’ll work out a plan to suit you and your baby and talk/email afterwards to see how it is working for you.

Some families need follow up lactation help,  this is discounted as I am familiar with you and your baby.

I encourage mums to like my Facebook page and Pinterest page where I keep tabs on interesting snippets and advice.

How can I help you and your baby achieve your goals with breastfeeding? IBCLC

 

 

Low Milk Supply

worried about low milk supply?

Are you worried about whether your breastfed baby is getting enough milk? What are some of the reasons behind low milk supply?

There are SO many things that can impact on your milk supply, this list is not exhaustive.   Sometimes multiple reasons (e.g. mother and baby issues) can impact on your supply.  The good news is that you can get help and try to find the reasons behind your low supply so that a plan can be put in place.  I’ve been a low milk supply mum, and I know how exhausting and confusing it can be when you’re questioning your supply.  The only reason I got through it was from getting help and support from lactation professionals, my family and friends.  You don’t have to struggle on your own!

Some reasons for low milk supply can be:

Hormonal, sometimes seen in mothers with –

  • Diabetes (type 1 and 2), Gestational diabetes
  • Poly Cystic Ovarian Syndrome (PCOS)
  • Thyroid dysfunction
  • pituitary dysfunction

Ineffective milk removal –

  • baby with weak suck or poor latch
  • baby with tongue tie
  • baby with low tone
  • prematurity (born before 37 weeks)
  • restrictions to breastfeeding (e.g. scheduled feeding, timed feeding)

Underlying breast issue-

  • Insufficient glandular tissue (IGT) or hypoplasia. This is a great site to get further help and advice on IGT.
  • nerve damage from surgery (reduction or implants).  Having an appointment with an IBCLC before baby is born is a good start in these special cases.

If you are worried that your baby is not getting enough, you need to start looking at what is going on closer, so try to write feeds, wees and poos down. If exclusively breastfed, is your baby:

  • back to birthweight by 14 days? After return to birthweight, usual gains in the first 3 months are 175-225 grams per week.
  • Having frequent poos (bigger than a 20c coin), several times a day?
  • Has poo changed from meconium (first day or two), to green-brown (day three to four) and then to seedy mustard after day five?
  • having 5-6 heavily wet nappies after day 5? Urine should be clear and not smelly (no “rust stains” after 72hrs)?
  • Bright, alert and meeting milestones?
  • feeding 8-12 times in 24 hours with audible swallows?

If you are worried about anything in the lists above, contact your baby’s health professional and then seek lactation support ASAP from an IBCLC.  I’m available on varying days of the week and weekends, so give me a call so we can work out a good time to get together! If I can’t answer your call, leave a message and I will return your call as soon as possible.

Baby-led attachment helps breastfeeding

Babies are SMART! If you give them the right situation to unleash their natural breastfeeding instincts, they can do so well.

I was lucky enough to photograph this adorable two week old baby, lying down on his mummy’s chest.  Even while dressed, he was able to search out the breast, move his head by bobbing and lifting to get over to the nipple and self attach for a breastfeed.  To get these baby cues even more released, try doing this skin to skin, with baby in just a nappy and you with a bare chest and tummy.

By letting a baby attach, and not forcing them to latch, they will often have their head extended, which gets a nice wide mouth happening (try doing opening your own mouth when your chin is tucked down into your chest, it’s much harder to get a wide mouth than with your head extended).

If your baby is having trouble attaching to the breast, you’re feeling stressed, take some time to hang out together in this position…you might be surprised at what happens next. For more personalised support with breastfeeding, give me a call and schedule a consult. I cover suburbs with home visits in the Brisbane South region such as Moorooka, Mount Gravatt, Tarragindi, Annerley and Greenslopes, plus many more!

Click on the photo to get a really good look at how amazing babies are.

I love my job!  Naomi x

This two week old baby shows that he knows what to do by instinct. He finds the breast and latches on with just mum’s arms supporting him. Click on the link to enlarge photo. Photo credit:Naomi Drew/Aspire Lactation. Copyright 2014. Not for reproduction.

If breastfeeding hurts – and what to do about it

As an expectant mum, you had probably heard many (unsolicited) horror stories not only about birth, but how your friends, family, (or even strangers!) breastfed through gritted teeth and painful nipples.  It may have even put you off thinking about breastfeeding before your baby was born.  As an International Board Certified Lactation Consultant (IBCLC) and someone who has breastfed two babies, I can tell you:

Breastfeeding shouldn’t hurt.

There are many reasons you could be experiencing pain.  But don't grit your teeth and put up with it!

There are many reasons you could be experiencing pain. But don’t grit your teeth and put up with it!

Sometimes all it takes is some repositioning and letting the baby approach the breast differently.  Maybe you’ve never seen a mother breastfeed her baby and you’ve had to figure things out for yourself.  Or maybe you’ve had some conflicting advice about how to hold your baby and position yourself.  There is a lot of breastfeeding information out there on the web, and not all of it is good.

It might not be something you’re doing.  Breastfeeding involves two people – you and your baby (or more babies for multiple births!).  Sometimes there are physical reasons why an infant may be struggling to breastfeed and he or she hurts you, even when you have been told you have a “textbook” latch and nobody has a clue why you are climbing the walls in agony.  Tongue ties are a common culprit and Aspire Lactation will be posting about this soon.

Pinched or mis-shapened nipples post feed can be a sign that your baby is not getting enough of the breast in their mouth. Cracked or bleeding nipples can lead to further complications if not assessed and steps takes to minimise damage.

What can you do about this, when you’re probably exhausted, worried and confused about what to do? Pick up the phone and call an IBCLC.  As your lactation consultant, I will watch how your baby breastfeeds, and see if we can find a way to make things more comfortable.  I will look in depth at you and your baby’s history and can assess your baby’s suck during an oral assessment.  Breastfeeding shouldn’t be painful and you shouldn’t have to go through this alone.  If you’re yet to have your baby and just want more information on how to get breastfeeding off to the best start, why not book a pre-delivery consult with me?

 

 

Finding your support network

In the many years I have been a nurse and as an International Board Certified Lactation Consultant, I have spent time with so many families and their babies. I have seen people from different social and economic backgrounds and from many walks of life. In caring for these babies, I often get chatting to mothers about their support networks, not just for a healthy baby, but those with sick or preterm babies.   What I hear from families is something that is becoming an increasing factor in stress in new parents’ lives. Isolation. Families that live more than a few hours away, or in another country. Parents being relocated interstate for work and moving away from their home base. Even though now the world appears to be shrinking as we Sykpe and Facebook our friends and family, actual physical contact can be so far away.  

A hug. A shoulder to cry on. Someone to listen to you without judgement. 

Although Australia is a large country, it is sparsely populated and this can lead to families being geographically isolated from their loved ones, and their support. Parenting (and therefore breastfeeding) skills that were once passed down from older generations are lost as we move away from relatives and parents are having to figure out things on their own, or from a barrage of baby books.¹ However, human beings are social by nature and studies have shown that social support has a direct effect on decreasing stress hormones and blood pressure.² Positive social support can lead to increased oxytocin.   Oxytocin is the “feel good” hormone that causes the Milk Ejection Reflex (or “let-down”), which you’ll see when baby starts rhythmically sucking and swallowing.  Another good thing about oxytocin is that it reduces anxiety and promotes sleep in mothers.  Breastfeeding mothers have lower blood pressure, and decreased psychiatric and cardiovascular issues than those who bottle-fed their babies.³

Meme credit: Matthew Gallagher. Used with permission

Meme credit: Matthew Gallagher. Used with permission

So what can we do as a community to support mothers who are socially isolated? Friends may need to step into the role that family once did, and provide advice on parenting and settling their baby. Rather than coming around and visiting the baby, do something helpful for the new mother (who likely has only just changed out of her pyjama pants and brushed her hair for your benefit). Bring some meals she can freeze or eat later. Do the dishes. Hang a load of washing out. Fold washing. Before coming over, ask the new parents if they need any milk or bread, that you can pick up on the way.

Set mum up when she is breastfeeding, so that she has everything within arm’s reach: a snack, water, something to read.  Partners can have the baby ready for a feed by changing bub up and bringing the baby over (this is especially good at night).  If mum needs to pump, her partner can make sure the pump pieces are washed and ready to go.  Support breastfeeding, by engaging an International Board Certified Lactation Consultant (IBCLC) if things are not going to plan with your partner.

You don’t have to help someone you know: help a mother get her groceries out of the trolley while she has her baby strapped to her (it gets hard bending into the trolley to get the last items out and I always appreciated the offers from my local Woolies checkout supervisors). Invite that mum on the table at the coffee shop to join your mothers group. Get a new mother in the shops talking about her gorgeous baby and make her feel positive during what could be the only grown-up interaction she has until her partner gets home!

My thanks:

Thank you to our families for the help over the last few years.   I might have seen ungrateful for your help at times, but it was probably just my stubborn proud streak that made me ashamed for not “having it together” enough in my eyes.  

Thank you to my husband, especially for those instances when I need some “me time” and you took a frazzled baby or toddler off on a walk so I could rest or gather my wits. Thank you for understanding that my level of cleanliness has changed considerably and not griping about it!

Thank you to Sunny who stopped by when she herself had 4 month old and brought quiches to keep us going in our early weeks post first baby.

Thank you Kirby for coming over with a slice that was so amazing, it got us through “3:30-itis” for the rest of the week, when we were exhausted with a new baby. I still remember it nearly four years later :)

Thank you Bec for bringing your baking, fresh fruit and helping hands over to visit with both my babies. Even if I declined your offer to do housework, because I was just happy to have your company! 

Thank you Claire, for giving me your phone number the day we met at the local chemist for a baby weigh.  It felt weird for me to ask for a number (kind of like asking for a date!) but we have found some great friendships in the local mothers group that came out of random meetings.

Oh, and I’m no longer a new mother.  But if anyone wants to fold the three or four loads of washing on the sofa as I type this, I will gladly accept your help! I’ve been walking past it for two days and I think it’s not planning on going anywhere soon….

Washing monster!

 

Where else can you meet other parents to create your support network?

  • Queensland ‘s Child Health Service has a program which runs for one month for new mothers.  After the program is completed, mothers can swap contact details and arrange to meet up in the community as a group.  This is often booked out quickly as it is very popular, so contact your local office.  For those in other states, contact your local child health service.
  • Playgroup Australia has listings of open playgroups that allow new mums to join, search your local area.
  • The Australian Breastfeeding Association runs local groups and is another way to meet parents
  • Some churches may have groups, such as MOPS (Mothers of Preschoolers)
  • You may have even struck up a friendship with other parents at antenatal classes or on the postnatal ward. Swap details and keep in contact!

If you are finding transitioning to parenthood and breastfeeding difficult, speak to your partner, family, close friend or health care professional. Having an IBCLC such as Aspire Lactation as part of your team, will help you find the road to confidence and breastfeeding success.  For your comfort, you don’t even need to get out of pyjamas when I come to your home for a consult. I won’t judge, and I will support you.

A health care professional can help identify the signs of postnatal depression and arrange support and follow-up for you. For more information visit Beyond Blue. 

References

1. Porter, B. (1990) ‘Abandoned’ Parents – A Challenge for Health Professionals, Clinical Pediatrics, 29: 610-613

2. Kikusui, T., Winslow, J.T. & Mori, Y. (2006) Social buffering: relief from stress and anxiety, Phil. Trans. R. Soc. B 361, 2215–2228

3. Groer, M., Davis, M., & Hemphill, J. (2002) Postpartum Stress: Current Concepts and the Possible Protective Role of Breastfeeding, JOGNN, 31, 411–417

Breastfeeding and exercise

So, you’ve got the all clear from your health care provider to resume exercise after baby. Can you do this and breastfeed?  Sure! What about those who want to do a little more than walking to the local park with their bub, such as training for a race?  A little forward planning helps, such as running after a breastfeed when breasts are softer, wearing a supportive bra – you may need to be refitted since pre-baby days – and building up your routine gradually.

When my youngest was around nine months old and still breastfeeding, I ran the Bridge to Brisbane 10km.  It gave me a goal to work towards: I “Aspired” to fit into a bridesmaid dress while still breastfeeding.  I realised that even though I was slower than my old pre-baby time, I was still able to run, lose weight and still keep feeding my baby.  I had low milk supply and I was nervous about anything that could negatively impact it, but found it was unchanged.  I just needed to make sure I kept hydrated, particularly in our hot summers.   Having the time to exercise was also tricky, with two young children, so we bought a second hand treadmill for my birthday.  That way, when they went down for a nap, I was able to go for a run and keep an eye on the baby monitor in case the baby woke up.

Jacinta, who was already into running and other sports prior to having her babies, says:  “Basically I timed my runs straight after a morning feed, put them in the pram, ran them off to sleep and just kept running while they slept (both were 30min nappers mind you!!) Weekends were a treat, feed baby in bed, give to husband and enjoy a peaceful run with NO pram. I never found evening running successful, with likelihood of an unsettled baby, feeding times less regular and too else much to do and too tired to do it!”

“Breastfeeding burns calories, so why do I need to exercise too?”

Mothers who fully artificially feed their babies have been found to be heavier than mothers who exclusively or partially breastfed their babies at six months post birth.  We already know that your amazing milk-making abilities help with weight loss.  But combining breastfeeding and exercise increases weight loss, along with increased cardiovascular fitness, strength and endurance.   This impacts on bone health and may reduce the chance of having osteoporosis when you get older.   Not only that, but exercise can be beneficial in uplifting your mood.  When combined with other treatments, exercise has been found to have a positive effect on reducing postnatal depression.  On my hardest days with the children, sometimes just the act of pushing that pram up our hill and around the streets brushed out the negativity in myself (and gave the kids something new to look at other than my cranky face!).  After taking the pram or baby  in  my carrier out for a stomp, it usually made the day more manageable.

Out of the pool, and into mum's arms

Out of the pool, and into mum’s arms. Photo used with permission.

Tammy was training right up to 24 hours prior to the birth of her daughter; she returned to the pool two weeks after birth and was back in squad one week later, training five days a week. Tammy’s dedication both as a breastfeeding mother and looking after her health makes me very proud of her achievements!

For Tammy, “when I started training with a baby I had no expectations, and any opportunity to remain fit was a bonus.  Looking back, the social and physical benefits of turning up to swimming squad every day has alleviated much of the stress that parenting as a new single mum might have precipitated”.  Some tweaks to her swim included wearing a maternity bra under her swimmers so that she could feed during training. With time, her baby was content during a 90 min swim if she fed prior.  “When Winter hit, my coach found me his son’s old Speedo coat.  Lined like a wind-cheater, it reached from shoulders to knees, and had a hood.  I would feed with most of my little girl lying against the coat, rather than my wet togs and bra.  This prevented the usual post-feed change of her clothes that had been practical in Summer, but would have been unacceptable when the temperature dropped below 15 degrees.” When Tammy also took up running, she found that breast discomfort was eased by a doing a breastfeed prior, and that some runs, particularly in the afternoon, she had to stop and feed on the side of the road.

“I’ve heard it can make my baby fussy if I breastfeed after exercising?”

A small study in 1992 suggested that fussiness or breast refusal occurred after high intensity exercise, however the design of the study had some flaws (babies were given milk from a dropper, not breastfed; only small (1-3mL) milk samples were collected.).  The fussiness in babies was thought to be from the acidic taste of milk resulting from lactic acid in breastmilk, which occurs during exercise.  Further  recent studies have found that although there was a rise in lactic acid up to about an hour after maximal effort exercise, there was no link to refusal of milk post this type exercise intensity.   Less intense activity did not have the same rise in lactic acid levels.  Although babies may fuss for a variety of reasons, it’s unlikely this would be a problem for  you.

 “I’m worried about my milk supply being reduced from exercise”

Although there is limited scientific information on this, 4 trials were analysed in a review.  No differences in weight gains or growth were found in those babies whose mothers breastfed and exercised.  If you are concerned about what might happen to your supply, start by slowly building up your exercise intensity and ensure you continue to eat and drink appropriately to keep yourself healthy.

Sarah, on the move

Sarah, on the move. Photo used with permission

Sarah writes “I took up running a few months after having my second baby. I put on quite a bit of weight having two babies 18 months apart and was keen to get back into exercise. I was really worried about the potential impact of such strenuous exercise on my milk supply as I didn’t have oodles to start with. I am happy to say I didn’t notice any reduction in my supply at all. I am now training for a 10km run and still happily breastfeeding my son with no problems. I waited until [he] was 8 weeks before I started properly exercising so his feeding was a bit more regular and there were less interruptions. I try and feed before and after my workouts. Manoeuvring a sports crop top can be challenging but you just make it work. I had to feed him once mid way through a gym session. Lucky he is a quick feeder so it really wasn’t a problem.”

Even if you’re not planning on training for an event or just wanted to get fit and healthy, there are plenty of ways you can incorporate exercising and breastfeeding.  You could join a gym with childminding facilities, so that you can feed your baby if needed during a workout.  Local councils such as the Brisbane City Council often run free exercise classes in the park for mums and bubs, which I found a great way to get out and active.  Personal trainers such as Belinda Dever’s Mums-ercise run classes especially for mums; she also conducts some of the free BCC classes on the south side of Brisbane.  I’ve recently heard about a baby-wearing exercise class running in some areas of Australia!  Why not invest in a sturdy and comfortable pram and take your crew (including your fur-babies) for some fresh air? Maybe even swing by a coffee shop and enjoy a sneaky quiet coffee before the baby is old enough to start nagging for babycinos and biscuits!

Aspire to achieve….like these amazing mums have.

If you need support with your breastfeeding, why not book a consult with me? Visit my Services page for more information on my pricing and consult options.

Naomi Drew, IBCLC

References

  1. Daley, A.J., Thomas, A., Cooper, H., Fitzpatrick, H., McDonald, C., Moore, H., Rooney, R.& Deeks, J.J.  (2012) Maternal Exercise and Growth in Breastfed Infants: A Meta-analysis of Randomized Controlled Trials Pediatrics, 130, 108-114
  2. Lovelady, C. (2011) Symposium on ‘Nutrition: getting the balance right in 2010’ Session 1: Balancing intake and output: food v. exercise Balancing exercise and food intake with lactation to promote post-partum weight loss. Proceedings of the Nutrition Society, 70, 181–184 
  3.  Mortensen, K., & Kam, R. (2012) Exercise and Breastfeeding. Breastfeeding Review, 20 (3), 39-42
  4. Wallace, J.P., Ingar, G. & Erthshausen, K. (1992) Infant Acceptance of Postexercise Breast Milk, Pediatrics, 89, 1245-1247
  5. Wright, K. S.,  Quinn, T.J. & Carey G.B. (2002) Infant Acceptance of Breast Milk After Maternal Exercise. Pediatrics, 109, 585-589