The Motherwear Breastfeeding Blog

My first (and hopefully last) experience nursing in the ER

We had a bad scare last week. 

On Wednesday evening, my daughter, now 19 months, went from happily playing to doubling over and screaming in stomach pain every 10 to 20 minutes.  At first I thought it was a stomach bug which has been going around.  But a few hours into it, with no vomitting and no other symptoms when she wasn't in pain, I brought her to the doctor.

Thank God for our pediatrician, who calmly told me that it was possible that she had an intestinal problem not uncommon at this age, in which a part of the intestine "telescopes" in on itself.  It causes severe pain but can be fairly easily treated if caught early.  (What I'm grateful he didn't say, but I kinda knew from reading about bowel obstructions after c-sections, is that left untreated it can be very, very serious).

So off we went to the emergency room of our regional hospital.  They have a pediatric ER, and we were seen pretty quickly.  An ultrasound confirmed our pediatrician's suspicion that it was an intussusception, and by midnight she was treated with an unpleasant but effective non-surgical procedure.  Her pain immediately disappeared.

After this was all over, the ER pediatrician said that she needed to be on a clear liquid diet for a while.  I had heard moms say that they'd been told that this meant no breastfeeding, so I asked with a little trepidation if I could nurse.  She said yes.  

We stayed overnight, and by 6:00 am next morning she was running through the halls of the children's wing.  When nurses stopped to say hello, she said "nurz! nurz!" (her current word for nursing).  The nurses replied, "You're right, I am a nurse!  What a smart girl!"   

She also came to a screeching halt when she saw a group of residents standing in the hall discussing a case, and said, "people!"  When they turned around laughing and said, "Yes, we are people!" she told them about nursing, too.  The same thing happened when we were discharged:  She told the attending physician, while he was palpating her abdomen, all about "nurz" (and then said, "bye, bye, people!" when they left the room).

Far be it for me to assume I know what's going on in her head, but nursing really seems to have been a port in the storm for her that day.  And I'm grateful for it, yet again.

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Poll: Where did you birth?

NPR reported last week that the rate of home birth has increased pretty dramatically in the last few years (up 25% between 2004 and 2009).  It's still a very small percentage of the total births, less than 1%, but the increase is still notable.

Why the increase?  NPR identified mothers' concerns about the record high c-section rate and liberal use of interventions as one driver of the increase.  One of my (hospital) midwives suggested that the lack of access to VBAC was driving more moms to birth at home.  And when I interviewed Jennifer Block, the author of Pushed, for a podcast on the Motherlove Blog she attributed part of the increase to the Ricki Lake movie, The Business of Being Born.

In any case, when I heard that piece it occurred to me that, while I've posted many polls, I've never asked you where you birthed.  So below is a poll asking just that.  You can vote more than once if you've had more thanone baby.  Me?  2 hospital births.

Guess what my baby ate?

My daughter (seen here by our chicken coop eating snow) goes to a wonderful home day care in our neighborhood twice a week. 

Each time she's there I get a report about what she ate and what she did. 

She is still an unenthusiastic eater at home, but here's what she ate on one day last week:

oatmeal with blueberries

pineapple

bread with hummus

brown rice spaghetti

brocolli

red lentils and quinoa

blueberries

nori sheets

more bread and hummus

and a smoothie with fruit, kale, flax meal, and hemp

First, am I lucky to have her there, or what?

And second, could this be the same baby who not long ago would spit everything out?

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Can you take pseudoephedrine for a cold while breastfeeding?

I had a yucky cold last week.  I was fine during the day using the usual home remedies, but one night I really wanted to be able to sleep well.  So I looked in our medicine cabinet to see what we had.

Yes, yes, I know that taking a cold medicine doesn't shorten the duration of a cold, but I don't think it's a crime to want some relief from the symptoms, especially when trying to take care of small chidren.

I've always cautioned moms against taking pseudoephedrine while nursing, but I wanted a refresher in the concern about it, and what I could take.  So I consulted Dr. Thomas Hale's Medications and Mothers' Milk, 2010.

(If you want the same information I have in this gem of a book - for free - you can call the Dr. Hale's Infant Risk Center!)

Here's what Dr. Hale says about pseudoephedrine's effect on milk supply: 

In a study of eight lactating women who received a single 60 mg dose of pseudoephedrine, the 24 hour milk production was reduced by 24%...While these results are preliminary, it is apparent that mothers in late-stage lactation may be more sensitive to pseudoephedrine and have greater loss in milk production.

Medications and Mothers' Milk has an appendix devoted to over-the-counter cold remedies, and for each of the many cold medicines which contain pseudoephedrine Dr. Hale has written "Probably safe, may suppress milk supply." 

I should note that nearly all of the cold medicines listed had mulitple ingredients, and there may be other concerns related to those medicines.  For example, for many products Dr. Hale has written "observe for sedation" (in the baby, that is).  In a handful of cases he lists medications as "unsafe."  The vast majority are listed as "probably safe," and two lonely products are listed as "safe." Again, if you have questions or concerns about a medication you want to take, call the Infant Risk Center.

Rumaging through our supplies, I found some cold medicine which had no pseudoephedrine but had phenylephrine (a decongestant).  I checked that, too, and read Dr Hale's assessment:  "Because of pseudoephedrine's effect on milk production, concerns that phenylephrine may supporss milk production [sic], have not been confirmed yet.  There is no evidence that this occurs at all."  He does not list "may suppress milk supply" in the Appendix for products containing this ingredient.

I generally ascribe to the precautionary principle when it comes to these things, but I was pretty desperate for a good night's sleep.  So, I decided to take an informed risk and use the product with phenylephrine, one time.  And it did help make it through the night.  I have a strong milk supply, and I didn't notice any dimunition.

I hope that you all make it through cold season in one piece, and that you take advantage of the Infant Risk Center for medication questions!

* This post is provided for educational purposes only.  Please consult your health care provider for care related to this topic.

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Sometimes you don't know how much you're nursing until you aren't.

I was in California over the holidays visiting family.  I went first with my daughter, and my husband and son followed a week later when school got out.

When my husband arrived he said, "she's nursing a lot."  I said that I hadn't noticed.

Then, about a week later, my husband took her to see some friends for the day.  And by mid-afternoon I was in trouble.  You know what kind of trouble.  Thank goodness for hand expression.

So I guess he was right.

(To the right, nursing in front of a giant redwood at Big Basin State Park)

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Welcome our new sponsor, Motherlove Herbal Company!

I'm very pleased to announce that Motherlove Herbal Company is now a sponsor of this blog! 

Motherlove makes some my favorite galactagogue products, and I've often recommended them to nursing moms who are working to increase their milk supplies. 

I especially appreciate their Goat's Rue and More Milk Special Blend (with Goat's Rue) because it has helped a number of mothers I know who have had low milk supply due to insufficient glandular tissue (also known as breast hypoplasia), and is also reputed to help mothers who have polycystic ovary syndrome (PCOS).  I've also used their Green Salve on my kids, for everything from rashes to bug bites to sunburn.

They are absolutely meticulous about the quality of their products, and all of them are rated a zero (the best rating) on the the Environmental Working Group's Skin Deep database.  In fact, they were just named a Champion for Safe Cosmetics.

I also write for Motherlove's blog and produce their podcasts, which I hope you'll check out!  The podcasts are also available at their free iTunes store.

And finally, the mother daughter team who run Motherlove, Kathryn Higgins and Silencia Cox, are just lovely people to know and be associated with!

(If you're interested in advertising on the Motherwear Breastfeeding Blog, feel free to email me.)

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Favorite posts from 2011

In case you missed them, here are some of my favorite posts from the Motherwear Breastfeeding Blog in 2011:

A visit to the Mother's Milk Bank of San Jose

"There is no nutritional emergency"

What's in donor milk?

First baby wearing second baby

What did your cankles have to do with your baby's weight loss?

"Booby Traps" in your OB or midwife's office

Breastfeeding and race:  Why we need more lactation consultants of color

Can you "supplement" your baby with Vitamin D by increasing your own levels?

Can you guess which role I had in the Passover play?

Six misconceptions about extended breastfeeding

Cows engineered to produce "human milk," and why Bessie will never, ever replace you

Lactation after Loss: A brochure to support mothers experiencing perinatal loss

Seven reasons why breastfeeding is usually easier the second time around

When the Booby Fairy doesn't arrive:  New podcast on insufficient glandular tissue.

New podcast on Baby-Led Weaning:  Can you really skip the purees? 

How do other mammals nurse?

Joint Commission urges moms to "speak up" to get evidence-based care.  But isn't that their job?

Review and give away:  Breastmilk jewelry

Wikileaks shows U.S. Embassy lobbied against Philippines formula law

Breastfeeding, the second time around

Here's how I know that it can hurt to nurse when you're teething

I can nurse, too

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New post on cultural issues in the hospital, at Best for Babes

I have a new post up at Best for Babes which I want to point you to. 

It's about how cultural differences can be overlooked in the hospital setting, and the impact that has on breastfeeding.  It's a topic I love thinking and learning about.

It starts with a story about a mistake I made a few years ago.  Check it out!

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Breastmilk study paper published

If you've been reading this blog for a while you may know that in recent years I've had the privelege to be involved with a research project at the University of Massachusetts which uses breastmilk to study breast cancer.

I'm very pleased to report that the first paper to come out of one of these studies has recently been published.  The results, which were announced to great press attention earlier this year.

I was just explaining this research to a friend of mine, and I thought I should do the same here, especially because the paper is pretty technical.

Dr. Kathleen Arcaro (at right, visiting one of my breastfeeding groups) studies breast cells for evidence of DNA changes which might be associated with the development of breast cancer.  She gets breastmilk samples (that's where I come in), extracts the breast cells which are naturally present in the milk, extracts the DNA from those cells, and looks for "methylation" of specific genes.  She's looking for methyl groups which attach to some important genes, such as tumor suppressor genes which, as the name suggests, inhibit the growth of tumors.  That's a gene you want functioning, right? Well these methyl groups can "turn off" the functioning of those genes, increasing your risk of developing cancer.  Your DNA can get methylated through behaviors - smoking, poor diet, environmental exposure, for example.  So Kathleen is looking for

Why would we want to know about this?  Because 1) it's possible to reverse methylation, through behavior changes and through emerging drug therapies, and consequently reduce cancer risk, 2) anti-methylating drugs may be able to reverse the course of cancer someday, 3) because this research could yield a method of giving mothers a personalized assessment of their risk of breast cancer, just by analyzing a sample of their breastmilk, and 4) because one day mothers might be able to send a milk sample for analysis in lieu of having a biopsy (and being told, as they often are, to wean first).

The beauty of this research (or one, I should say), is that when you look at breast cells in breastmilk you get cells from all parts of the breast.  The alternative, a biopsy, can only look at cells in one part of the breast.

We're recruiting for several studies locally now, so if you're in Western Massachusetts, check out this page to donate!

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I can nurse, too.

My daughter nursed her doll for the first time the other day.  Here's what it looked like.

At times she had the funniest look of concentration on her face.

Her positioning left something to be desired.

And then she decided to have baby feet for a snack.

Do your babies nurse their babies, too?