Baby Led Weaning (BLW) is an approach to introducing solid foods to your baby without spoons or purées. BLW is about offering your baby age appropriate, manageable foods so they may learn to feed themselves and explore tastes and textures of food. There’s no need to wait until your baby has teeth to give them table food, there are so many foods  they can eat without teeth. You’ll be surprised what they can handle, and they will really enjoy it too! There are so many options to choose from so have fun with it.

You can give your baby a slice of apple large enough for them to hold, to gnaw on (again, this is doable even with no teeth), or try a soft steamed vegetable (carrot sticks or broccoli for example), it’s all up to you. Keep in mind, though, that you should still be weary of certain foods like nuts and honey before the age of one year, especially if there is a history of certain allergies in your family.

Your baby should be at least 6 months old, sitting unassisted, have lost their tongue thrust reflex, and have ability to grasp onto food before introducing any solids. Some parents feel rushed into introducing solids when a baby doesn’t need, nor can they properly digest solids until this age. It can also be dangerous if you chose to use BLW when they’re not yet ready. Read (http://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solids/6-reasons-delay-introducing-solid-food) to find out more about why this is so important.

Another important aspect of BLW is to skip the spoon. Place the food you have prepared for your baby in front of them and let them go for it. They will learn and figure out it is for eating (although it’s fun to play with too and that’s ok!). Don’t stress about if they are eating enough. Even if it looks like they haven’t eaten anything, you will be surprised at how much they do consume. Their diaper the next day will tell you just how much ;) Offer a variety of foods to create a balanced diet and offer breast milk or formula before their meal. Remember that their stomachs are still rather small so they don’t need to eat as much as you might think and breast milk or formula will continue to be the main source of nutrition until at least their first birthday.

The most common fear parents have about choosing Baby Led Weaning over purées is the risk of choking. However, it’s very important to know the difference between gagging and choking. As scary as it may be, your baby will gag while they learn to chew and swallow solids. Gagging is a natural, lifelong reflex to help remove whatever is in the mouth that is too much to handle or more than they are used to. Gagging simply prevents choking. If your baby is choking, they will be unable to breathe or cough out whatever the obstruction is. You should always supervise your baby while they are eating to prevent choking accidents. A basic knowledge of infant CPR is also recommended in case of emergency (http://www.redcross.org/images/MEDIA_CustomProductCatalog/m4240175_Pediatric_ready_reference.pdf).

At 6 months old, your baby’s gag reflex is very sensitive and high in their mouth (in fact it’s at about the middle of their tongue) and as they grow older, it will slowly move down into their throat. It’s nature’s way of keeping them from choking while they learn to eat. So, does it make more sense to introduce table foods while a baby’s gag reflex is so high or wait until they are older and have higher risk of choking because their reflex won’t react in time? Talk to your family doctor or pediatrician to find out if Baby Led Weaning is right for you and your baby.

References:

http://www.askdrsears.com/topics/feeding-infants-toddlers/starting-solids/6-reasons-delay-introducing-solid-food

http://www.redcross.org/images/MEDIA_CustomProductCatalog/m4240175_Pediatric_ready_reference.pdf

http://wholesomebabyfood.momtastic.com/

Immunising your baby at the breast – who woulda thunk?

First off let me say that you better get your google goggles on because there are a lot of long words that end in ‘globulin and ferrin” in this article. For some reason scientists are always doing studies to either prove that breast milk really is best (uh hello?) or prove that formula is just as good. Yeah right.

As Oprah says, this is what I know for sure.

Breast-fed babies produce higher levels of antibodies in response to immunizations.

Studies have shown that factors in human milk may induce an infant’s immune system to mature more quickly than it would were the child fed artificially. Hormones, proteins and insulin like growth factor penetrate the mucosal lining of the newborn, making it relatively impermeable to unwanted pathogens and other potentially harmful agents.

But what exactly are these hormones, proteins and factors and how do they work?

Understanding immunoglobulins

These are basically antibodies. They take five basic forms, denoted as IgG, IgA, IgM, IgD and IgE.

The most abundant type found in milk is IgA, specifically the form known as secretory IgA which shield the antibody molecules from being degraded by the gastric acid and digestive enzymes in the stomach and intestines. Infants who are bottle-fed have few means for battling ingested pathogens until they begin making secretory IgA on their own, often several weeks or even months after birth.

However breast feeding moms pass secretory IgA molecules directly to the suckling baby. She has already synthesised antibodies to whatever pathogens or disease-causing agent she may have ingested, inhaled or otherwise come into contact with and these are passed directly to the baby immunising him against the infectious agents it is most likely to encounter in the first weeks of life. Because the mother makes antibodies only to pathogens in her environment, the baby receives exactly the immunity it needs as it needs it. Secondly,  the antibodies delivered to the infant ignore useful bacteria normally found in the gut. This flora serves to crowd out the growth of harmful organisms, thus providing another measure of resistance.

Researchers do not yet know how the mother’s immune system knows to make antibodies against only pathogenic and not normal bacteria, but whatever the process may be, it favours the establishment of “good bacteria” in a baby’s gut. Nature wins again.

Other amazing molecules with big names

Each molecule of a protein called lactoferrin can bind to two atoms of iron. Because many pathogenic bacteria thrive on iron, lactoferrin halts their spread by making iron unavailable. It is especially effective at stalling the proliferation of organisms that often cause serious illness in infants, including Staphylococcus aureus.

Free fatty acids present in milk can damage the membranes of enveloped viruses, such as the chicken pox virus, which are packets of genetic material encased in protein shells.

Interferon, found in colostrum, has strong antiviral activity. And fibronectin, also present in large quantities in colostrum, can make certain phagocytes more aggressive so that they will ingest microbes even when the microbes have not been tagged by an antibody. Like secretory IgA, fibronectin minimizes inflammation; it also seems to aid in repairing tissue damaged by inflammation.

Immune cells are abundant in human milk. They consist of white blood cells, or leukocytes, that fight infection themselves and activate other defense mechanisms. Most of the cells are neutrophils, a type of phagocyte that normally circulates in the bloodstream. Some evidence suggests that neutrophils continue to act as phagocytes in the infant’s gut. Yet they are less aggressive than blood neutrophils and virtually disappear from breast milk six weeks after birth. So perhaps they serve some other function, such as protecting the breast from infection.

The next most common milk leukocyte is the macrophage. Macrophages make up some 40 percent of all the leukocytes in colostrum and their role is to manufacture lysozyme - an enzyme that destroys bacteria by disrupting their cell walls. In addition, macrophages in the digestive tract can rally lymphocytes into action against invaders.

Lymphocytes constitute the remaining 10 percent of white cells in the milk. About 20 percent of these cells are B lymphocytes, which give rise to antibodies; the rest are T lymphocytes, which kill infected cells directly or send out chemical messages that mobilize still other components of the immune system.

Milk lymphocytes proliferate in the presence of Escherichia coli, a bacterium that can cause life-threatening illness in babies, but they are far less responsive than blood lymphocytes to agents posing less threat to infants. Milk lymphocytes also manufacture several chemicals-including gamma-interferon, migration inhibition factor and monocyte chemotactic factor-that can strengthen an infant’s own immune response.

So know we have a rough idea of all the factors and ferrins involved in immunising our baby, lets get a little bit more specific about how they go about doing their job.

Breast-fed infants have a lower risk of acquiring urinary tract infections.

There are unknown compounds in human milk that stimulate a baby’s own production of secretory IgA, lactoferrin and lysozyme. All three molecules are found in larger amounts in the urine of breast-fed babies. Yet breast-fed babies cannot absorb these molecules from human milk into their gut. It would appear that the molecules must be produced in the mucosa of the youngsters’ urinary tract. In other words breast-feeding induces local immunity in the urinary tract.

According to the inventor of the Polio Vaccine Breast Milk Kills Polio

Albert Sabin, inventor of the oral polio vaccine, did the first study on the anti-polio properties of breast milk? He infected mice with polio and then took breast milk from 71 American women and fed it to the mice. The breast milk had an 84% success rate at neutralising polio. (Albert Sabin and Howard Fieldsteel, 'Anti-poliomyelitic Activity of Human and Bovine Colostrum and Milk', Journal of Pediatrics, 29 (1962).

Breast Milk Protects Against HIB and Meningitis

According to the journal of epidemiology, breast milk protects against HIB for up to 10 years after you have stopped breast feeding. 

'For each week of breast feeding, the protection improved.' (Journal of Epidemiology, 1997, 26: 443-450).

Breast Milk Protects Against Whooping Cough, Strep B, HIB and Meningitis

Tropical Pediatrics also found significant amounts of antibodies in breast milk to whooping cough, HIB, strep B infection and meningitis. 'Samples may indicate a protective role for breast milk against the four infections of early childhood.' Tropical Pediatrics, 1989, 4: 226-232.

Breast Milk Can Protect Against Complications From Measles

Fatality from measles in third world children was reduced by one third in breast fed children, according to

17. Lepage P. Munyakazi C, Hennart P. Breast feeding and hospital mortality in children from Rwanda. Lancet 1981;i:40911.

Breast Milk Protects Against Rotavirus/Diarrheoa

In a study in Brazil, dehydrating diarrhoea (defined by the presence of a persistent skinfold plus at least two other signs of dehydration) was 6.0 times more frequent among non-breastfed infants than among exclusively breastfed infants. If a child already had diarrhoea, the risk of developing dehydration was 3.3 times greater for the nonbreastfed infant. 

Fuchs SC. Risk factors for dehydrating diarrhea: a case-control study. Ph.D. thesis, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil, 1993. 

Victora CG, Fuchs SC, Kirkwood BR, Lombardi C, Barros FC. Breastfeeding, nutritional status and other prognostic factors for dehydration among young children with diarrhoea: a casecontrol study. Bull WHO 1992;70:467-75.

Breast Milk Protects Against Cholera

Epidemiologic studies show that breastfeeding protects against shigellosis and cholera. Breastmilk also contains antibodies against a large number of other gastrointestinal pathogens. It also protects against neonatal necrotizing enterocolitis. 

Hanson LA, Ashraf R. Carlsson B. Mattsby-Baltzer I, Motas C, Hahn-Zoric M, Mata L, Herias V, Cruz JR, Lindblad BS, Karlberg J, Jalil F. The Second John Soothill Lecture: breastfeeding, infections and immunology. In: Chandra RK, ed. Nutrition and immunology. St. John's, Canada: ARTS Biomedical Publishers and Distributors, 1992:45-60. 

Lucal A, Cole TJ. Breast milk and neonatal necrotizing enterocolitis. Lancet 1990;336:1519-23

Breast Milk Can Protect Against Pneumonia

In Rwanda non-breastfed children were twice as likely as breastfed children to die of pneumonia.

Lepage P. Munyakazi C, Hennart P. Breast feeding and hospital mortality in children from Rwanda. Lancet 1981;i:40911.

Breast Milk Kills HIV

HIV can be transmitted from mother to her child through nursing. But a surprising ingredient in an HIV-positive mother's milk may protect her baby against infection. Researchers at Duke University have discovered an antibody in the breast milk of HIV-infected mothers that neutralizes the virus and prevents it from passing to their children. The antibody may explain why surprisingly few breastfed infants get HIV from their mothers.

Source: Daily RX, 26th May 2012.

Breast Milk Reduces Cot Death By 50%

The German Study of Sudden Infant Death is a case-control study of 333 infants who died of sudden infant death syndrome and 998 age-matched controls.

RESULTS

A total of 49.6% of cases and 82.9% of controls were breastfed at 2 weeks of age. Exclusive breastfeeding at 1 month of age halved the risk, partial breastfeeding at the age of 1 month also reduced the risk of sudden infant death syndrome, but after adjustment this risk was not significant. Being exclusively breastfed in the last month of life/before the interview reduced the risk, as did being partially breastfed. Breastfeeding survival curves showed that both partial breastfeeding and exclusive breastfeeding were associated with a reduced risk of sudden infant death syndrome.

CONCLUSIONS

This study shows that breastfeeding reduced the risk of sudden infant death syndrome by ~50% at all ages throughout infancy

All things considered, breast milk is truly a fascinating fluid that supplies infants with far more than nutrition. It protects them against infection until they can protect themselves. I rest my case.

References:

Breastfeeding, the Immune Response, and Long-term Health
1.    Kelly M. Jackson, PhD;
2.    Andrea M. Nazar, DO
+Author Affiliations
1.    From the West Virginia School of Osteopathic Medicine and the Robert C. Byrd Clinic, both in Lewisburg.
1.    Address correspondence to Kelly M. Jackson, PhD, Professor, Medical Microbiology and Immunology, West Virginia School of Osteopathic Medicine, 400 N Lee St, Lewisburg, WV 24901-1128.E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.
 

 

Whenever I think of postpartum care, I think of an article I once read (and please forgive me for not remembering the title or where I read it!) about an expecting couple in a village in Singapore (well, I recall being a country starting with “S”, anyway.  If I’m wrong, I promise to own it but like I always say “pregnant brain never goes away”!). I will retell their story to the best of my ability.

This story has been so richly ingrained in my mind, but more importantly, my heart and soul. I didn’t just read this story, I tasted it. I felt it. I longed for it. It stands in stark contrast to what we see in many countries today.

The husband and wife lived in a small village where several midwives were vowing their full attention to the birth of this child.  The midwives went through an interviewing process, I believe, in front of the entire village. Once a midwife was selected, a celebration was held along with ceremonies, rich in community. The midwife gave her promise to not only prepare the woman for birth, but to care for her the entire six weeks after. What dedication!

It was no new news to the father that he was expected to care for the children, cook and clean and tend to the mother’s every need during this time. When and if he had to work outside of the village, other villagers would come to care for the children and mother.

The mother was expected to lie in bed.  The sanctity of birth is well regarded there. Resting, eating, nurturing, loving, and nursing were her top priorities. Establishing the mother-child bond and healthy breastfeeding relationship was essential to the family and village.

The glorious midwife, bless her, made warm, nourishing soups full of healing herbs for the mother, daily. Immediately after birth, she would belly bind the mother’s weakened abdominal muscles. This is a common practice among many cultures around the world. This midwife would use healing oils and lengthy massages for the new mother and then re-bind her wrap, daily. She would also make sure the baby was nursing well and gave specific attention to that little bundle of joy as well. This daily gift of love and attention would continue for six whole weeks! Can you imagine?!!

In our country today, this would be seen as completely unnecessary, especially when you see newborns and postpartum mamas in Walmart,  24-48 hours after birth! Postpartum care is not as deeply respected compared to that little village. That little village, which exists somewhere in the land of “S” (wherever that may be, and let’s hope I remembered correctly and it is in Singapore), has done more for society in one, six week postpartum care treatment, than our industrialized nation has done in two or more entire generations!

What spoke to me so clearly through the ancient practices so beautifully illustrated in the article, is that getting the family off to the best start possible, is not only good for the family, but good for the entire community!  A first-time mother and father walk somewhat blindly into the process, having never experienced it before. It can be a time of uncertainty and fear. What better way to adjust, than to have a nurturing, caring and loving path laid before you?

Postpartum care and how a woman is treated during labor and delivery, deeply impact a woman’s psyche and can make or break how she feels about children and family for the rest of her life.  In my opinion, the birthing process and postpartum care are single-handedly the most vulnerable a woman will ever be, not only physically but emotionally.

Physically, the healing process after birth is usually painful as the uterus begins shrinking and the wound where the placenta once was begins healing. If mama is nursing that can make uterine contractions much stronger but also helps it shrink faster and return to pre-pregnancy size. It is very important to rest, do as little as possible, keep your feet up, urinate frequently, sleep when baby sleeps, stay hydrated, have a snack while you’re nursing, and avoid foods that decrease milk supply like junk foods and soda.

Emotionally, the healing process, I believe, takes a bit longer. Getting adjusted to having baby outside of the womb can take up to the entire first year. According to Dr. Sears, author of the attachment parenting bible, The Baby Book, pregnancy is viewed as “nine months in, nine months out.” Between mother and child learning to nurse and baby’s ever-changing needs in the first year, the words of wisdom I always rely on are: “Just when you think you’ve got a predictable schedule with baby, something always changes.” Whether illness or teething sets in, we must always be ready to adapt to every circumstance. The constant changes, coupled with the hormonal rebalancing and adjustment of a mother’s body are much better dealt with, when time and patience for this healing, are allowed.

The importance of support during the postpartum period is clearly shown to be beneficial to the mother and child in the crucial bonding period necessary after birth to promote optimal survival, both physically and emotionally. The mother and baby need to be surrounded by supportive people who are dedicated to caring for the pair and responsible in helping to prevent postpartum infection and other complications, as well as prevent postpartum depression.  Rigorous postpartum care and observation by medical providers, midwives, doulas, family, and consultants can benefit not just the mother and child, but the community as a whole.

SITTING MOON: A GUIDE TO NATURAL REJUVENATION AFTER PREGNANCY

By Dr. Dao Shing Ni and Dr. Jessica Chen

BOOK REVIEW & AUTHOR INTERVIEW, by ALLIE CHEE

How does a woman quickly and safely rejuvenate after childbirth, provide well  for her baby, get back to her old energy level, and back into her old jeans? Have a sitting moon!

Sitting Moon?

In use for thousands of years, the Chinese calendar is a lunisolar calendar, indicating the phase of the moon. According to Traditional Chinese Medicine (TCM), to rejuvenate after childbirth a woman should rest for approximately one month, or one “moon”. Thus we have the title of the new book from Dr. Daoshing Ni and Jessica Chen about natural postpartum rejuvenation, Sitting Moon.

In a country where woman are often back on their feet and running soon after giving birth, one month’s rest may sound shocking, but this practice is common in many countries around the world today and throughout history. The reasons are many, but the two primary purposes are to allow the mother to regain the strength and essence she gave to the baby and lost in childbirth, thus supporting her long-term vitality; and time and ability for the mother to deeply nurture and bond with the newborn.

In case those reasons aren’t compelling enough, there is also a list of ways a woman may suffer long-term if she does not take time to heal after childbirth.

While the subject of infant care and breastfeeding are often covered extensively in books, training classes, and even some hospitals, directions for the mother’s postpartum care–if not completely ignored–certainly takes last place.

Since the mother’s health and well-being support her and the infant in all ways, this new book has an important place in every mother and care-provider’s library.

What you’ll find in the book

When I heap praise on this book, I speak from personal experience. When six months pregnant, I knew it was “now or never” to start preparing the nutritious meals I would need postpartum, so I bought a freezer and jumped on my computer to begin a search for postpartum recipes I could prepare in advance.

Unless you’re comfortable eating any ol’ dish someone prepares or brings from a restaurant, asking someone to search out top quality ingredients and prepare the exact three meals per day plus snacks you would prefer postpartum is likely expecting too much! Naturally postpartum moms are grateful for any help, but you get the idea here.

When I sat at the computer to commence the search, there was an auspicious email announcing the release of Sitting Moon, which I ordered immediately.

What I found in Sitting Moon was far more than a postpartum meal plan. Almost any topic of interest or need for the postpartum mother is addressed: yoni care, breast care, and natural remedies from TCM for numerous ailments of mind, body, and spirit. There are also special sections that address issues and offer recommendations for mothers recovering from a C-section, which today could mean 35-45% of all mothers giving birth in a hospital.

As it is so vital to the effectiveness of a sitting moon, approximately 2/3 of the book is dedicated to the role of nutrition in healing and producing ample milk. There are recipes offered, week by week for the 4-week sitting moon, and they are specific for that week’s rejuvenation needs. They are all surprisingly simple to prepare, most include ingredients that are readily available, and they are absolutely delicious.

Forget chicken bits in a gooey sweet and sour sauce—these recipes have titles such as: Scallops with Broccoli, Vegetable Barley Soup, Baked Sesame Tofu, and most adventurous, Peanut and Pork Knuckle Soup. There are many recipes and suggestions for vegetarian moms, as well. Many recipes do include Chinese herbs, and those can be purchased from a Chinese medicine practitioner or herbalist.

As a last bit of evidence of the efficacy from my personal experience with a sitting moon, and to further encourage mothers: as a first time mom at 42-years old, I had a home birth, abundant milk supply, and was back in my old clothes in six weeks—all by taking a full month’s rest with my baby, and eating three meals plus two snacks per day of excellent food!

INTERVIEW WITH THE AUTHORS (Dr. Daoshing Ni and Dr. Jessica Chen)

I had the opportunity to speak with the authors and to inquire further on the topic of postpartum recovery and how Chinese Medicine addresses the issues.

Q. Many women say, “I feel better and ready to move around,” often as soon as 2-3 days after giving birth. How can the decision to return to an active lifestyle quickly after delivery effect a woman’s health in the long-run?

A. When women say they’re feeling great and ready for action again after a few days, this can be the adrenaline from labor. This is viewed as “false” energy. So in actuality, your body is still recovering. If you do not take some time to allow your body to heal it can run into problems in the future. A year down the line you may find yourself being more tired, having a difficult time sleeping, with difficulty in losing the pregnancy weight, or joint pain. In addition, the mother’s body is still “open”, “loose”, and “tired” in the pelvic region. Having a normal and sometimes overly active life style too quickly can cause problems in the pelvic regions such as bleeding disorders, hernia or hemorrhoids.

Q. In your book, you address special issues for women over 35 or having had a C-section. IVF pregnancies are ever on the rise, even with women under 35. What special needs do they have and would you add that category to the group who need to take special care with a Sitting Moon?

A. Care for IVF moms should fall under the category of women over 35 and c-section. The process of IVF takes a lot out of a woman, therefore it is important to bring more nourishment to their body after giving birth. Many IVF expecting mothers tend to be more emotionally tired. They will need more relaxation and personal time to heal, which is in short supply once the woman becomes a new mother. Therefore, a plan for such healing activities should be contemplated and scheduled before the labor process.

Q. It is common and said to be “normal” that women lose a tooth with a pregnancy or lose a substantial amount of hair after childbirth.  Is that to be expected or is it a sign of something that can be addressed and/or prevented?

A. It is normal to lose hair after labor due to the hair that was not shed during pregnancy. But if the hair loss is excessive, it can be a sign of lack of nutrients. According to Chinese medicine, hair is related to blood and the kidney/adrenal/reproductive system. When the blood is flowing abundantly and the kidney/adrenal/ reproductive is strong, hair will be full and strong. Naturally after child birth, the mother is deficient in both. This issue can be prevented and addressed with acupuncture (bringing more blood flow to the head) and Chinese herbs (providing nutrients to the body). Of course, eating well and getting some shut-eye is also important.

Q. The explanations one commonly hears for postpartum depression, anxiety, and/or nightmares seem to fall short, and women are often prescribed antidepressants as the remedy.  Even when women are happy with their pregnancy and adore their babies, they can experience these symptoms. Can you explain it in TCM terms and describe the approach to address these issues?

A. In TCM, mood disorders after labor can be due to depletion of blood and lack of sleep. The blood loss from the labor leads to the blood not being able to nourish the heart and spirit. In TCM, the heart is one of the organs that is related to your mood. Lack of sleep can also affect your mood. Your body heals and regenerates when you sleep. When your body does not get the  proper amount of rest, it does not provide the right amount of nutrients to your body, and can therefore further enhance mood changes.

Q. In a breastfeeding class I audited, an attendee asked the lecturing nurse about eating spicy food and junk foods while breastfeeding.  The answer provided was, “Your baby does not eat what you eat–it’s different”.  However, if the body uses what we eat to make blood, and breast milk is made from the proteins, sugars, and fat in the mother’s blood, what we eat has an immediate and direct relationship on what our baby eats. Your comments from a TCM perspective?

A. Even though the main compositions of the breast milk are fat, protein and carbohydrates, there are many micronutrients as well as other trace chemicals that tag along with the breast milk delivered to the baby. Therefore certain nutrients and trace chemicals, such as in spicy foods and cured meats, can still be transferred in a minute amount to the breast milk. This normally should not impact the baby adversely when eaten in a small amount. From the TCM perspective, it is very important for the nursing mother to eat a diverse spectrum of whole foods and stay away from manufactured foods (processed and packaged foods). This way, the baby will be exposed to different nutrients and learning how to digest and absorb these nutrients.

Q. The recipes in Sitting Moon are delicious, easy to prepare, and nutrient-rich.  Would you recommend those recipes for mothers beyond the first postpartum month?

A. Yes! The moms can continue to prepare these meals up to 1 year after delivery. They are especially good to have when the mom’s get their first menstrual flow after delivery. These meals are also excellent for women to have at the tail end of or after their menstrual flow.

Q. Can we look forward to more books on a related subject–Your Baby’s First Two Years: Recipes and Common Herbal Remedies, for example? (I would vote for that.)

A. Sounds like an excellent idea! Maybe also on healthy eating during pregnancy.

Thank you. We’ll look for those!

 Breastfeeding provides an awesome bonding experience between you and your baby. It provides without question, hands-down, the absolute best nutrition for babies. 

Here are a few common questions regarding breastfeeding that you may be wondering about during your pregnancy.

What does research show about the benefits of breastfeeding for babies?

• They have fewer illness...and if they do get sick, the effects are milder.
• They have fewer ear infections.
• They are less likely to be admitted to the hospital during their first year.
• They are 1/3 less likely to die of SIDS.
• If breast fed for over a year, their risk of developing diabetes is cut in half.

What does research show about the benefits of breastfeeding for mamas?

• Chances of breast cancer, cervical cancer, and osteoporosis are reduced.
• The milk-producing hormone pro-lactin has a relaxing effect and stimulates maternal instincts.
• On-going milk production burns calories, which helps with weight loss after pregnancy.
• The bond that mama and baby will have is amazing!

How do I prepare for breastfeeding?

The best thing about breastfeeding is that you already have everything you need! You may still have questions on how it will affect daily life, how to get started, or how to handle your work situation. Feeling confident on the topic by reading up or joining a breastfeeding clinic will make the transition easier and more successful for you and your new baby.

How do I get started?

Good old Mother Nature has already taken care of most of it for you. Some general things you need to know to help you get started are:

1. How to position baby correctly and comfortably

1. Make sure you are comfortable...use pillows supporting your arms and in your lap.
2. Position baby as close to you as possible, so that he does not have to turn his head to reach your breast.
3. Support your breast so it's not pressing on your baby's chin. Your baby's chin should 'drive' into your breast.
4. Latch baby on. Encourage him to open his mouth wide and pull him close by supporting his BACK instead of the back of his HEAD, so that his chin drives into your breast. His nose will be touching your breast.
5. If it hurts, detach baby and try again.
6. IT TAKES PRACTICE! so be patient with baby and yourself.

*note: see my next blog post "Breastfeeding, Going Beyond the Basics" for great breastfeeding positions.

2. How to make sure baby is getting enough milk

If baby is getting enough milk, he will have 4-6 (or more!) wet diapers per day. The color of his urine will also tell you if he's getting enough liquid. Dark, apple juice colored urine (after the first 4 days) suggests that baby is not getting enough. You may notice a residue on the diaper, due to urate crystals from over-concentrated urine (which is normal in the first few days only). Between week one and week four, babies who are getting enough hind-milk will produce at least 2-3 yellow, seedy stools a day. Remember, baby's are super sleepy their first week or two, so don't be afraid to wake them up to feed them...they need their milk!

*note: see blog post "Breastfeeding, How to Increase Milk Supply Without Drugs"

3. How to minimize nipple tenderness

Research suggests the primary cause of nipple soreness is nipple trauma due to improper positioning of the baby on the breast. Make sure his lips are not turned under and your baby is not chewing on your nipple or tongue sucking. Make sure his mouth is wide open and surrounding your aereola. Try different positions until you find a comfortable, efficient one. Don't pull your baby off; insert a finger between your baby's jaws to break the suction first.  

4. How to manage engorgement

Engorgement is caused by increased blood supply and milk in the breast. Fullness is different than engorgement and usually decreases within the first two or three weeks if the baby is nursing regularly. If the milk is not being removed, the breasts may become tender and engorged. To treat this:

1. Try a warm shower, or apply a hot washcloth prior to nursing.
2. Massage your breasts to promote milk flow.
3. Apply cold compresses to both breasts. The cold will feel good and decrease the swelling.
4. Use hand expression of milk to soften the areola just before a feeding.
5. Feed your baby on demand, approximately every one to three hours for at least 15 minutes. Try not to miss any feedings!

A great resource, especially for first time breastfeeding mothers, is a Baby Feeding Class or Breastfeeding Clinic. There are private organizations such as La Leche League or your local hospital may have a Breastfeeding Clinic open on certain days. These clinics will have a Lactation Consultant available to answer your questions, and to provide hands-on support. A Lactation Consultant is certified in this area.

For further information and resources:

La Leche League International: http://www.lalecheleague.org 

The World Health Organization http://www.who.int/features/factfiles/breastfeeding/facts/en/index.html

Breastfeeding Basics http://www.breastfeedingbasics.com/ 

KellyMom http://kellymom.com/category/bf/ 

When milk supply seems to be low, it can be a stressful thing for a new mother. As the body adjusts to the supply and demand of baby and as baby becomes a more proficient nurser, the breasts will appear to stop producing enough milk. No fear: the breasts are still producing enough milk to feed baby. They just aren't producing MORE than they need to, which causes leaking breasts and strong letdowns.

However, if the demand for the milk lessens (ie. returning to work or a baby going on a nursing strike), the milk supply will be reduced. Stress is a common reason for diminished supply. Also, a nursing mother who becomes pregnant may find her milk supply decreases as her body's hormones switch attention to feeding the new baby.

There are many ways to increase milk supply. The two most important ways are to nurse as much as possible and maintain the determination to breastfeed.

1. Reduce stresses. Try to relax while feeding. Nurse in a quiet room. This is your opportunity to relax for a bit. The simple act of relaxing will encourage letdown and there will be no distractions for baby to make him stop nursing before he's full.
2. Drink lots of water. A body that doesn't receive enough fluid intake is going to have a problem producing fluid! Drink at least a gallon of water a day.
3. Massage your breasts. Babies will naturally knead the breast which triggers letdown. This will in turn cause the body to produce more milk.
4. Watch your diet. A diet that consists of fast food and lots of caffeine isn't good for you or baby. You will need lots of nutrients to provide a nutritious meal for your baby. Some foods can act like galactogogues (supply boosters), like oatmeal or flax seed.
5. Use natural freshly ground herbs. Fenugreek is an excellent herb to help increase milk supply. It is an expectorant and has no side effects other than causing your milk to have a maple syrup scent. Milk thistle is another great supply enhancer, though not as effective as fenugreek. You can also buy ready-made tinctures specifically for this, like Mother's Milk, or Mother's Milk Two for pregnant mothers who are nursing.

Remember! the BEST way to increase milk supply is to let baby feed on demand...often!

Bringing home your baby for the first time is one of the unexpected joys of motherhood.  Introducing him to the dogs, the bed, the couch, the bouncy seat: it is fun to start doing all of those “firsts” with the baby! The comfort of being able to snuggle and nurse my boys in my own bed while watching Star Trek and drinking my tea (yes I’m a super Trekkie) was probably the best time for me.  I spent days in bed just taking in every little bit of them while enjoying integrating them into my life and introducing them to the things I loved.  Eventually though, you start to get back into your usual responsibilities and if you are anything like me, you may find yourself doing all sorts of crazy housework.  If you have other children who are home, this “back to reality” may come even quicker.  I had the luxury of my mother taking my oldest for a week after I delivered my second so that I could recover and not be quite so tired and sore while trying to handle two little ones.  It was a huge help, but of course, I also missed my oldest and it was great to have him back home.  

There are many things about postpartum recovery that you may hear, and many things you won’t.  You’ll probably hear a lot about other women’s accounts of their levels of pain and soreness after coming home.  The key to remember is that there is no way to predict how your body will handle the return home.  Being in the hospital afforded me the opportunity to sit around and do nothing if I so chose.  But once I returned home, the dishes, laundry, and dogs were staring at me wondering why I was being so lazy and after a few days, the guilt got to me and I started getting “back to work.”  Here’s where you want to accept any and all help you can get; if someone wants to come see the baby, ask them if they can throw in the laundry for you, take out the garbage, or watch the baby while you take a shower.  We often don’t ask for help, even when we need it, so here’s your opportunity to ask for it without feeling like you are imposing.  Your activity level will be dictated by how you are feeling physically and emotionally, so try to take it easy on yourself on both accounts.  I realized I was doing too much physical activity when on my 4th day home, I began bleeding much heavier than I had since I had returned home.  When I called my OB, she told me that it was my body’s way of telling me to slow back down.  This wasn’t something anyone had warned me about, but it was nice to know that my body was trying to send me a message and trying to “push through the pain” (I had a 3rd degree tear so I was incredibly sore and in a lot of pain) was actually doing more harm than good.  My OB instructed me to slow down and continue to rest with ice packs between my legs to help relieve some of the discomfort.  Within a day of moderating my activity and tuning back into my body, I was feeling much better.

You Will Likely Be Exhausted.

I always tell people that even though I was never a big party person as a young adult, my late nights of socialization and nights where I got nearly no sleep, got up and went to work just to come home and go socialize again were NOTHING compared to the “tired” I felt as a new mom.  This too shall pass though.  Again, your body just did an amazing thing by giving birth; your body feeling tired is its way of telling you to take it easy so it can regenerate and recover.  Nap when the baby naps, (this is how I became a huge proponent of safe co-sleeping) and don’t go on a spree of doing chores.  Break it up into small tasks and do them every so often.  Don’t unload the dishwasher, re-load it, clean the counters, take out the trash, sweep and mop the floor, sort and start laundry.  Unload the dishwasher after breakfast and don’t worry about putting the dirty ones in until after lunch. Sort the laundry and let the next person who comes to visit you and the baby carry the basket and throw the load in.  

Taking it easy is going to allow your body and mind to recover, as well as facilitate bonding and the nursing relationship (if you are breastfeeding).  The more time you spend with the baby, (even if it’s just sitting next to him reading a book while he sleeps next to you - or in my case on my chest) is beneficial.  Babies who are breastfeed and have ample opportunities for attachment and bonding their moms are at an advantage.  Babies who do not get these things as often are at greater risk for attachment issues, social interaction difficulties, intellectual challenges, and many more.  

If You Are Physically Able, Wear Your Baby! 

Oh I can’t tell you how much easier it was to get stuff done when I wasn’t running back and forth between wherever I was doing something and where the baby was sleeping.  I had a video monitor and I still had to check on #1 every few minutes because I was just beside myself with joy and worry (the worry eventually subsided a little bit once I got used to being a mom.)  I had a Moby wrap, a generic sling, and a Baby Bjorn, all of which got a ton of use.  Plus, if my son was a bit fussy, he usually calmed down pretty quick by the motion of being carried around while being able to rest his head on my chest.  Here is a great article on babywear.

Use That Peri-Bottle (And Put Witch Hazel In It)! 

I still have mine, and I STILL use them occasionally!  Especially if you have stitches, you’ll love the relief of being able to rinse yourself with the peri-bottle both after using the toilet, as well as when you’re in the shower.  I didn’t want anything to do with putting pressure much less touching myself below the waist after I gave birth, so it was nice to have a clean alternative to relying on wiping to clean up.  Of course a little pat dry was necessary, but much less terrifying than the thought of wiping anything.

Try to make some time for yourself, and for your partner.  Especially if you are nursing, you are going to be literally attached to that baby for the next few months (at least).  It’s easy to get wrapped up in the love and responsibility of motherhood, but don’t lose yourself in it.  Ask your partner or another support person to watch the baby so you can take a long shower or bath, or go to the store to grab milk.  Even as little ten minutes to yourself each day where you aren’t responsible for running to the baby if he wakes up will help you retain some sense of your individuality.  Also, remember that your partner may be feeling a bit sidelined now that the baby is here.  It’s okay that you are paying so much attention to the baby, and it’s okay that your partner feels a bit left out; this is all part of trying to figure out and adjust to the dramatic change that your lives and relationship have just gone through.  Trying to make a point to spend some time together each day will allow you to retain (or potentially restore) your intimacy and relationship so that nobody feels left out.  

Here’s where I’m going to get on my soap box...

You can find my full article on Postpartum Depression here, so I won’t get too in depth here since this is about general recovery.  It is imperative that you keep your eyes and ears open to your mind and body; if you are not beginning to feel as though you are getting back to normal, talk to your practitioner.  Bringing a baby into this world is full of wonderful and challenging events.  There are a number of symptoms of PPD, but not all are required for an official diagnosis.  It is normal to feel tired and overwhelmed, but if you are feeling significantly exhausted and down for more than a few weeks, it may be in both you and your baby’s best interest to seek the help of a licensed mental health counselor.  As a counselor in training, a mother who had PPD, and as a student who just completed a major research project on PPD, I can’t stress enough that it is not something you need to suffer through alone.  If your practitioner just wants to put you on medicine, consider asking for a referral for a counselor in addition to meds (and ask if you can try counseling without using the medicine first.)  We often feel alone (even when we are surrounded by support) and sometimes just having someone to vent to that won’t judge you or feel hurt by your feelings can make a world of difference.  One of the most shocking things about the postpartum period for me was that it put a lot of strain on my relationship with my husband.  Luckily, we managed to get through, but it wasn’t easy.  PPD can also affect your baby’s development; if you are having a difficult time bonding or caring for the baby, the baby’s physiological and psychological development is potentially at risk.  Of course, not every woman will get PPD, and their babies are not necessarily at a huge risk of being damaged; but there are ways to help yourself feel a bit better which will only benefit your baby even if you aren’t suffering from PPD, but still feel a little overwhelmed and isolated.  

Everything may be wonderful and stay that way once you arrive home.  If it isn’t though, that’s okay too.  Having a baby is a life changing event in ways you can’t truly understand until it happens for the first time.  Postpartum time is your time to reevaluate and adjust your life.  This may take a while, and that’s okay too.  Just like your EDD was estimated your recovery time is not set in stone so take the time you want and need to ensure that you can enjoy this journey of motherhood as you should-the best way that is right for you!

 Go back to: Step #8: Initiating & Maintaining Breastfeeding

Go to: Birthing Methods Menu

If you plan to return to work while breastfeeding, your transition will be easier if you have a game plan in place before you give birth.  Once your new baby is in your arms, the last thing you’ll want to do is deal with any more logistics than absolutely necessary.  Here are a few tips that should help you plan if you’re a first time breastfeeding mom.

• Buy a good quality pump. There are so many pumps and setups finding the one right for you can feel overwhelming. Research online, ask other moms at any support groups (like LLLI) you might go to. I love my Medela portable pump: 2 babies and 3 years later, it still works great.
• Start stockpiling. Opinions vary on when you should start pumping, and it all depends on when you plan on returning to work.  Since your supply is contingent on demand (the more you nurse, the more quickly you will “refill,”), you don’t want to overdo pumping too soon or else you’ll have so much milk you will feel like the Dairy Queen. About 3 weeks before I returned to work, I began pumping once or twice a day (after my baby nursed to satisfaction) and froze what I got.  By the time I returned to work, I had enough milk to last him about two full days of me being gone.  This allowed me to have some extra in case I had plans to go out and someone would need to watch the baby for me during an irregular time.
• It is important that you know your rights. Federal law has passed that requires all employers to provide a NON-BATHROOM, private space for mothers to pump and reasonable breaks to do so.  Discuss your plans to pump before you go out on maternity leave in order to provide “reasonable” time for your employer to make any necessary accommodations.  If your employer gives you a hard time about it when you return, take it to human resources immediately.  I know the last thing most of us want to do is start raising a riot at our jobs right after coming back, but it is YOUR RIGHT to reasonable accommodations to pump.  Don’t give up on pumping at work just because it’s frustrating.  Remember, mommy’s milk is best for babies, you got through pregnancy, labor and delivery. You can get through ANYTHING, especially with federal law on your side!
• Introduce a bottle before you return to work. This is another one of those “opinions vary” situations about how and when, but you definitely don’t want to wait until your first day back to ask the sitter or your mom to attempt giving your baby his first bottle.  This Dr. Sears article has some great tips.  With my first son, my husband was going to stay home with him when I returned to work.  Once a day about 3 weeks before I went back to work, I would give my husband a bottle of about 2 ounces of pumped breast milk to feed my son and I’d disappear out of sight.  He protested at first, but only for a few moments.  He never developed any “nipple confusion” and everyone had a pretty easy time with the transition.  Not everyone is quite so lucky.  Talk to other moms about their experiences and see what worked for them if you are unsure or are having difficulties.

Your decision about how to feed your newborn doesn’t seem like it would have any bearing on birthing in a hospital. If you plan to breastfeed, it is essential to make this decision and stick to it once your baby is born in the hospital. Breast milk is far superior to formula, (watch this video to see why).

The key to successful breastfeeding after a hospital birth is making your choices known, and knowing how choices during labor may affect breastfeeding.  Here are some things to think about that may help you in the first few days while you’re getting the hang of nursing.

If you are planning to breastfeed, make sure you inform the staff and explicitly ask that they not give your baby ANY formula or pacifiers. It is also advisable to have the baby room in with you so that you can nurse on cue so that your milk comes in as quickly as possible. Artificial nipples are “easier” to suckle from than the natural nipple as the flow is immediate and constant. If you introduce artificial nipples before the nursing relationship is well established, the baby may become lazy or developnipple confusion when nursing from you since it requires a stronger suck.

Medications used during labor, including narcotics and epidurals, have the potential to cause a newborn to be drowsy and have some difficulties latching. These pain relief interventions can cross the placenta to your baby. I personally did not have this experience, and many moms don’t, but it should be a factor when weighing the risks and benefits of choosing pain relief during labor.

Immediate skin to skin contact and initiation of breastfeeding will facilitate the nursing relationship. Insist on immediate skin to skin contact (have your baby placed on your chest as soon as he/she is born) and initiate breastfeeding as soon as possible.  See if your baby does thebreast crawl . Your new baby may not suckle for long, but the sooner you start the sooner your little one will get the hang of it!

Utilize the lactation consultant. Most hospitals have acertified lactation consultant on staff during the day.  If you are a first time mom breastfeeding (or a mom who didn’t before and wants to now), it will likely help to have one of these wonderful women come give you a hand.  They will watch you nurse and give you suggestions about different holding positions, as well as how to get the baby to initially latch correctly.  Nursing shouldn’t hurt, but it can be uncomfortable at first.  They can help you figure out if difficulties are a problem with your technique. Don’t be afraid to ask for help, even if you need to ask multiple times.  The time I spent with the lactation consultant in the hospital after my first son was born helped IMMENSELY!

If you want to breastfeed but you can’t (such as baby is in the NICU), request a pump IMMEDIATELY. Hospitals havehospital grade pumps available.  If you can’t nurse your baby on demand, request a pump and start pumping as soon as possible.  While it may not be the way you’d like to feed the baby, it is the next best thing. Especially if your baby needs special care , your baby will benefit from having thecolostrum that was meant for him.  The colostrum has a number of health benefits and its natural origin is far superior to formula. Your baby does not need any more nutrition than colostrum the until your milk comes in, and then breastmilk is all your baby will need for atleast six months.

Let your baby nurse as much as s/he wants to. Let’s face it; you’re in the hospital with nurses to get you whatever you want, no laundry or dishes to do, and a remote controlled bed.  While most people don’t “enjoy” the hospital, take advantage of the time you have here to focus on your nursing relationship with the baby.  The more practice both of you get, the more quickly both of you will get the hang of it.  Keeping the baby on the breast as well as skin to skin will promote your milk production, as well as help facilitate your bonding. Here’s ahandy sign to put on your hospital door, or your front door.

If you are planning to return to work, here are some tips to consider.

Once you’re home, keep nursing on demand as much as you can. Everyone’s milk comes in at different times.  If your baby is 3 days old and your milk hasn’t come in, don’t stress when your best friend says she got her milk 36 hours after birth.  Everyone’s body is different.  If you are concerned about your supply for some reason (your baby isn’t gaining as much weight as the pediatrician is expecting, or your baby is not nursing for very long), consult a certified lactation consultant.  It is rare that a mom simply “doesn’t make enough milk.”  More often, mom’s supplies don’t build up enough (or drop) because the baby is not nursing properly.  Lactation consultants are trained to evaluate mom and baby, and identify a problem that is inhibiting supply. It is also important to keep a diaper log as that can give you and the consultant/physician a better idea of baby’s intake, and your supply.

Surround yourself with supportive people. This goes with everything birth related, but it is especially helpful when you have people who support your choices standing behind you.  Breastfeeding is natural and the best way to meet your baby’s nutritional needs.  Don’t let people with negative attitudes or snide comments about you pumping or nursing in public dissuade you.  If you begin to feel like it is too much work and frustration, join online or real life mom groups where nursing is supported and even promoted.  I found a great deal of support and courage when I connected with other moms who were nursing and facing similar challenges.  You are not alone; the more you support and inform yourself, the more likely you are to be successful.

Everyone knows that “Breast is Best,” but there are some reasons you may not be able to, (or may choose not to) breastfeed such as if you need to take certain medications that transfer to breast milk which are not safe for the baby, (such as antipsychotic medications.) While there are a number of medications deemed “safe” by the FDA and WHO, there are a number of medications that are not safe, or have not been studied enough for these organizations to claim that they are safe.  It is important to remember that even though many drugs are deemed safe, the safest choice is to not take medications unless absolutely necessary.  If you aren’t sure how necessary a medication is, you should discuss the necessity with your primary care doctor, OB/Midwife, AND the pediatrician.  All of them can provide valuable information and insight that will help you make the decision.<br><br> Everyone knows that “Breast is Best,” but there are some reasons you may not be able to, (or may choose not to) breastfeed such as if you need to take certain medications that transfer to breast milk which are not safe for the baby, (such as antipsychotic medications.) While there are a number of medications deemed “safe” by the FDA and WHO, there are a number of medications that are not safe, or have not been studied enough for these organizations to claim that they are safe.  It is important to remember that even though many drugs are deemed safe, the safest choice is to not take medications unless absolutely necessary.  If you aren’t sure how necessary a medication is, you should discuss the necessity with your primary care doctor, OB/Midwife, AND the pediatrician.  All of them can provide valuable information and insight that will help you make the decision.

If you are considering formula over nursing, I would encourage you to do as much research as possible before you finalize your decision. Despite popular belief, formula is not considered second best; formula is LAST on the list of recommended ways to feed a newborn, (behind pumping,making your own formula, or using donor milk).

Go back to Step #7: Planning for Labor

Go ahead to: Step #9: Postpartum Recovery

Go to Birthing Methods Menu

One of the hottest topics out there at the moment is breastfeeding, thanks to the Attachment Parenting cover of Time magazine. We all know it is important for babies to get good nutrition so that they can be healthy and strong. Some mothers find it really difficult to breastfeed for various reasons. It is so important that mothers understand that there are ways to improve the breastfeeding experience, and that chiropractic can offer a helping hand with many of these issues.

“It’s painful to breastfeed”: Adjustment for baby

The first reason why it may be painful to breastfeed is that baby has a problem with his/her TMJ function and/or the muscles around the jaw, including the tongue, which is causing baby to suck in a strange way that may cause pain for mum. An injury to the jaw can take place during the birthing process, especially with presentations such as breech presentation, mentum (jaw) presentation, or a shoulder dystocia. Sometimes a normal, incident-free vaginal birth can cause problems with the way the jaw moves and can create a lot of tension in the muscles in the area. Taking your baby to a chiropractor to assess the function of their TMJs, cranial bones, neck and muscles is something that may help improve your breastfeeding experience.

The second reason why breastfeeding may be painful is that the baby has a tongue tie. This is more common than you would think, and is easily dealt with by cutting the tie (of course this must be done by a doctor, and there are many around who will do this in rooms). Seeing a chiropractor can also help to release any muscles that may have become tight from the altered feeding action that a tongue tie causes.

“I don’t have enough milk”- Adjustment for mum

Breastfeeding may be painful because something is limiting milk production for mum, and often it’s a lot of things all at once. Stress, nutritional deficiency, and medications are just a few examples. Chiropractic may be of help to mum by relieving postural strain and problems that may affect milk production. It’s also important to remember that breastfeeding is about supply and demand – the more baby feeds, the more milk you will produce!

“My baby will only feed on one side”- Adjustment for baby

This seemingly insignificant problem is actually a big one! Think of the implications – baby won’t feed on one side, which means that mum has to express from that side and the decreased flow of milk means higher incidence of mastitis or other infections, etc. Feeding effectively from both sides is important if breastfeeding is going to continue. Wanting to feed only from one side often happens because baby has a problem in the upper neck, affecting his or her ability to rotate the head, a necessary motion if baby is going to effectively breastfeed. Chiropractic can help by restoring correct motion to the upper neck, allowing breastfeeding to continue on both sides.

This is a very brief summary of some ways that chiropractic care can help with breastfeeding, and of course is not the answer to all the problems that you might be having. If you need more help or advice please ask your lactation consultant, midwife, doctor or chiropractor.

References

• Miller, J.E., Miller, L., Sulesund, A.K., Yevtushenko, A. (2009). Contribution of Chiropractic Therapy to Resolving Suboptimal Breastfeeding: A Case Series of 114 Infants. Journal of Manipulative and Physiological Therapeutics, 32(8): 670-674. Abstract.