The Motherwear Breastfeeding Blog

Making More Milk: Diana West talks about milk supply and answers your questions.

Welcome to another Motherwear Podcast!  This episode features Diana West, IBCLC.  Diana is best known for her work supporting mothers who have had breast surgeries through her website Breastfeeding after Reduction Surgery and her book, Defining your own Success.

Diana is co-author of a new book, The Breastfeeding Mother's Guide to Making More Milk, which will be out in December of this year and is available now for pre-order.  This is the first book to focus solely and in great detail on milk supply, and it looks like a wonderful resource.

This interview is divided into two parts.

Part One discusses what determines milk supply, what causes low milk supply, what mothers can do to increase milk supply, and what feelings are common among mothers with low milk supply.  You can listen to it on the player below, or download it.

In Part Two Diana answers your excellent questions about milk supply (shown in the comments section of this post), on topics including the impact of birth on milk supply, suggestions for maintaining milk supply when pumping at work, how stress and periods impact milk supply.  You can listen to it on the player below, download it.

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Lactation cookies.

No, this is not about cookies made with breastmilk, though I wouldn't blame you for thinking so after Monday's post.  It's about cookies that contain ingredients which increase milk supply. 

I baked a batch of chocolate chip, oatmeal "lactation cookies" for my breastfeeding support group this week.  The moms at the group thought that they were really good. 

You can find the recipe on Epicurious if you'd like to try it out.  The recommended "dose" is four cookies a day.  Oh, how I wish someone would write me a prescription for cookies.

Before I talk about the ingredients in these cookies, I should say that these cookies would certainly not be among your first options for increasing supply.  For a list of good ways to increase supply, see this page on kellymom.com, or Dr. Jack Newman's handout on milk supply.

So, what are those special ingredients?  Oats, brewer's yeast, and flaxseed meal.

Oatmeal is a frequently recommended food for increasing milk supply, possibly because it contains iron and nursing mothers are often iron deficient.  It's also a good source of fiber, and I'm told that if you ask a dairy farmer what they do to increase milk yield, they say that they increase fiber intake. 

Brewer's yeast has long been recommended to increase milk supply, though there are some doubts that it does the trick.  It does contain lots of B vitamins - another area where nursing mothers may be deficient.  At a minimum it might give you a bit more energy.  When eaten in large amounts it also might give your baby a "yeasty" smelling diaper, and I'm not sure if it's recommended for mothers who are struggling with thrush.  The recipe said 'no substitutions' for this ingredient, but I couldn't find brewer's yeast in time, so used nutritional yeast instead.

Flaxseed oil (this recipe calls for flaxseed meal) is considered by some to be a galactagogue, but I had a hard time finding much on its effects.  It does contain Omega-3 fatty acids, and many nursing mothers are deficient in that area because our stores are used in breastmilk.  Omega 3s from fish oil are considered a promising therapy for preventing and treating postpartum depression (see the podcast I did on this topic), but the Omega 3s in flaxseed oil are a different form and are not viewed as effective for this purpose.

For more on lactogenic foods, check out this great page on the MOBI Motherhood website!

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The April Carnival of Breastfeeding: "Thrush and mastitis and blebs, oh my!"

Welcome to the April Carnival of Breastfeeding!

This month we're bringing you posts on the topic of breastfeeding problems and solutions.  Be sure to check out the posts below for great stories overcoming thrush, blebs, plugged ducts, oversupply, and other breastfeeding challenges.

I'm very pleased to share a story of overcoming a tongue tie problem, written by Lisa, a mother I know and admire.  A picture of him as a baby is to the left.

In the hospital, one of the nurses looked into my son Joe's bassinet and said offhandedly, "looks like he's tongue-tied."* My husband and I were confused because the kid was crying at the time but she was gone before we could ask her what she meant. 

I was determined to breastfeed, and while the milk was there and the effort was definitely there on both of our parts, Joe was not able to get a good latch.  He would get just about in the right place, but there wasn't the right seal and he couldn't stay on the breast.  The nurses told me that I didn't have any of the common problems like inverted or shallow nipples, so surely it would work out fine. We both kept trying and were told that it takes time and is a learned process.

When I took him to his first doctor's appointment after we got home from the hospital, I told the doctor that I was still having trouble breastfeeding.  She told me "Oh, it's easy" and that was the end of it.  I showed her what I was doing and she said it was right, just keep trying.  My mother told the doctor that she thought Joe had "brick dust urine," and she said she'd never heard of that. I said that I had heard that he might be tongue tied, and she said that he wasn't. It was very discouraging because my nipples were cracked and bleeding, I was tired, sore, and now starting to panic that my son was starving.

Luckily, our hospital offered an evening breastfeeding clinic, so I left the doctors and went to see Tanya. She was calm, reassuring and took the panic-y edge off.  We tried different positions, and she suggested trying a nipple shield to see if it would be effective, but nothing seemed to help; he just couldn't get that seal right.  He would try to latch on and then just scream. Tanya noticed that Joe's frenulum (that little piece of skin that connects the tongue to the bottom of the mouth) was very short and it was up near the tip of his tongue. His tongue only moved back; he definitely could not stick it out. When he cried, his tongue looked kind of heart shaped. Tanya also looked up the signs of dehydration, and he had several.

Tanya was worried about Joe, and suggested that I give him a bottle of formula. It took him a very long time – maybe 40 minutes - to take a few ounces from the bottle.

It was pretty late by then, and that night Tanya faxed the pediatrician and told her of the problem. The next morning the doctor called four times to tell me that frenotomies are rare and "major surgery." She said that she consulted another pediatrician, who wouldn't do the procedure, and he in turn referred her to another pediatrician - best pediatrician in town – who also wouldn't do it but might refer us to see an ear, nose and throat specialist.  I immediately made an appointment with the "best pediatrician in town" and he sent me to the ENT specialist.

There was a consensus among everyone that yes, the frenulum was tight, but no one was sure that having it released would have any positive effect.  We did a little research, and decided that we needed to try something. Also, a big factor in my decision to go ahead with it was that I actually dated someone in college who was tongue tied. He didn't have a speech impediment or anything, but he was self-conscious of it, and truth be told...he was a very bad kisser (!).

The actual procedure was a lot like an ear piercing--a little numbing spray, one quick stroke and it was over.  I held Joe the whole time and he only cried for a minute. It took 30 seconds and there was as much blood as a tiny papercut.

Here's the best part:  he latched on perfectly in the waiting room-I could feel the difference.  His lips made a seal this time. He's been nursing like a champ ever since, and he's still nursing now - at 18 months!

The general attitude I got from all of the doctors was that I was making a big deal out of nothing. I heard a story later about midwives in olden days keeping one of their fingernails long so they could just slice through any frenulum that looked remotely tight.  How did we get to this?

Be sure to check out more posts on breastfeeding challenges on the blogs listed below (updated throughout the day):

• Mama's Magic writes about needing to supplement after birth complications.
• Half Pint Pixie writes about oversupply, blebs, plugged ducts, and mastitis.
• Speech Act writes about plugged ducts and blebs.
• Tales of Life with a Girl on the Go writes about milk supply and the mini-pill.
• Nurturing Notes writes about thrush and thrush treatment.
• Breastfeeding Mums writes about sore nipples, engorgement, and taking medications while breastfeeding.
• Blessed Nest Perch writes about sore nipples, mastitis, and low milk supply.
• Hobo Mama writes about supplementing with a finger feeder during the first week.
• Breastfeeding 1-2-3 writes about using Gentian Violet and grapefruit seed extract as thrush remedies.

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Overcoming challenges: Becky's story.

I'm happy to share Becky's story today.  She overcame lots of obstacles to make breastfeeding work, including one of the toughest - breast refusal.  If you have a story to share, please email me.

My story is probably more common than I know. 

I had my first baby with a few complications, in spite of the fact that I was 36 and high risk.  The doctor had to use forceps, which I was against, but we were at a dire moment.  The baby would not breastfeed after that.  I am sure that her little head was very sore. 

The pediatrician said not to worry, that she was a big baby, and that everything would be fine.  Not the same story the next day when she still wouldn't latch.  I had the lactation consultant come up the second day and she gave me a lesson without the baby.  When the baby got there and she kept pushing her head onto me to get her to breastfeed.  Needless to say, she wanted none of this. 

I was released on a Wednesday.  By Saturday I was back at the hospital buying a session from the lactation consultant.  We went home, and I cried when she wouldn't eat.  I held out for a day and gave her formula, just to get some food in her.  I called La Leche League.  A woman came to my house within half an hour.  I was frantic.  She tried to help, but I did not see results.  I would try to nurse, give a bottle, then go pump.  It was a 3 hour process. 

My aunt, who works in a hospital in the next city over recommended her lactation consultant.  I went after two weeks.  The baby was accepting the formula, which I hated.  The new lactation consultant gave me nipple shields that fit, and a finger feeder.  She was the one who kept me going.  She gave me some positive feedback and made me feel like I had done the right thing by sticking with breastfeeding.  The next week I went back and had a yeast infection on my nipples.  For any of you who haven't experienced this, it's like glass slicing you when the baby nurses.  I also later found out that they make pump shields in different sizes.  I had the smallest size and need the x-large.  I later struggled to get my baby off of the nipple shield.  In the middle of December, the thing fell off, she didn't miss a beat and kept right on going.  Soon after, we never used those again.

I had the baby in August and went back to work in November.  I am a teacher and the first thing I did when I got back was to ask my administrator if I could pump twice a day and once on my lunch break.  He said it was fine if I arranged it.  So, I went about finding someone to cover my class for 10-15 minutes in the morning and again in the afternoon.  Apparently, people didn't like this, and there was some talking behind my back - all of them women.  One mother/teacher called me to her room and told me that she hadn't been allowed time to pump when when she was nursing, and that I shouldn't be allowed to either.  She then yelled at me in front of students that she was going to go to my supervisor and report me.  This was to my back as I walked out of the room and went straight to our principal. 

I told him that I had been verbally attacked, and he asked if I could cut back on the pumping.  He didn't want to rock the boat with his staff.  Needless to say, I called the teacher's union.  They returned my call and said that from the superintendent's office the word was to acomodate me in any way they could.  The union rep also said that the teacher who had confronted me should be told to mind her own business.  I later found out that this woman did not want to breastfeed and gave up.  After all that I went through to be able to breastfeed, I was not going to give it up.

My daughter is now 19 months old and I'm so glad I stuck with it.  She still nurses 3 times a day.  I am proud to be a breastfeeding advocate and always will be!

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Does beer really increase milk supply?

It's the day after St. Patrick's Day and it just occurred to me that it would be a great time to investigate the age-old advice to down a Guinness to increase milk production. 

Here's what Dr. Thomas Hale says in the must-have guide to medications and breastfeeding, Medications and Mothers' Milk:

Beer, but not ethanol, has been reported in a number of studies to stimulate prolactin levels and breastmilk production.  Thus is it presumed that the polysaccharide from barley may be the prolactin-stimulating component of beer.  Non-alcoholic beer is equally effective.

Dr. Hale also cites two studies which suggest that, in the immediate period after mothers consume alcohol, milk production declines significantly and babies take in less milk. 

So it appears that barley, a traditional food for increasing milk supply, makes beer effective at increasing prolactin levels, but that the alcohol in it causes babies to take in less milk. 

Of course, drinking alcohol while breastfeeding can pose risks for your baby if it's not consumed in moderation.  And beer, non-alcoholic or not, would not be the at the top of the list of recommendations for increasing milk supply. 

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How can daylight savings mess things up so much?

Here's one of those things you wish people would warn you about:  daylight savings turns a baby's world - and by association yours - upside down.

I don't understand how one hour can make such a huge difference, but it never fails.  Babies are fussier, and sometimes insist on nursing all the time.  And if your baby has a nap schedule, it gets thrown out the window.  Mothers are of course more frazzled, and everyone is grumpy for about a week.  Seems like every mother I talk to this week tells a story like this.

Sound familiar to any of you?

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Seven myths about thrush.

For a while now I've had a serious bee in my bonnet about thrush treatment.  Thrush can be so painful, and so hard to get rid of.  But worst of all, it seems to be the problem which elicits the worst advice and treatment. 

Here's my list of myths around thrush and thrush treatment.  Feel free to add your own in the comments section.  And here is Dr. Jack Newman's Candida Protocol, a wonderful resource on thrush treatment.

1)  There is a reliable test to diagnose thrush. There is no reliable test for thrush, so you have to go on difficult to detect detect things like the shininess of skin, the type of pain, the color of skin.

2)  If the baby doesn't have yeast in the mouth, you don't have thrush.  Lots of mothers are told this.  Then they treat for thrush, and the symptoms go away. 

3)  All burning pain is thrush.  Lots of women are treated repeatedly for thrush before discovering that they have Raynaud's Vasospsam of the Nipple.  The pain with Raynaud's is similar to thrush, so they are confused often.  La Leche League offers a list of other possible causes of pain here (scroll to the bottom).

4)  Nystatin is a good anti-thrush medication.  Nystatin is the medication most doctors prescribe, but it's effectiveness is pretty limited.  When I heard Jack Newman speak last year he said that it works on about 30% of yeast.  While it works sometimes, it often takes a full 10 day course to see a big improvement, and that's just torture for most mothers.  See #5 for a much more effective treatment.

5)  Gentian violet is a dangerous treatment.  Gentian Violet got a bad name from a really bad study, and now doctors are reluctant to recommend it.  However, the American Academy of Pediatrics' Breastfeeding Handbook for Physicians lists it as one of two recommended treatments.  Yes, it is messy and gives your baby a bit of a goth look.  And somehow thrush always knows to strike just before a big family gathering where lots of pictures are going to be taken.  But it's very effective against thrush, and it's considered safe. 

6)  If you have deep breast pain with thrush, you should take a one day course of Diflucan.  I've seen lots of women who have been diagnosed with yeast inside the breast (intraductal yeast).  But they've been prescribed a one day course of Diflucan.  This would be great for a vaginal yeast infection, but for intraductal yeast, they need a longer course, usually two weeks worth.

7)  Treating only the mother, or only the baby, is effective.  Some doctors won't treat both the mother and the baby, even though the yeast is being passed back and forth.  This just makes the recovery take longer and prolongs the agony.

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How to choose a nursing necklace.

Today I'm happy to share some thoughts from Raelynn (shown to the left), owner of Mommy and Me nursing necklaces, and creator of some beautiful designs, on choosing a nursing necklace.  If you'd like to create your own, check out Angela's post for instructions.  At the bottom I've posted a picture of my old nursing necklace, which is a great reminder of those days.

The twisting, the pinching, the pull -- ouch!  How in the world can you alleviate the hair pulling and distracted twisting of a nursing baby?  Nursing necklaces can be a great solution.

Whether you're in the market for a bright, whimsical design or you'd rather go with something a little more subdued and stylish, there is something out there for everyone.  After making nursing necklaces for over three years, here are some recommendations I'd offer when you're ready to give one a try:

1.  Safety first.  You're probably feeling as though you can't take one more scratch, but it's important to buy something that will do its job and won't pose a choking hazard.  Make sure you are purchasing from a reputable company that has a proven track record and has invested the time and thought into their safety features and designs.  Look for their safety information, read through their purchase policies, and try to find a company that offers a breakage guarantee.

2.  Invest in quality.  Most moms are on a budget and are drawn to lower prices.  However, most nursing necklaces offered at cheaper prices use weaker beads and won't give you an all-around bang for your buck.  Try to find a retailer who makes an effort to offer good prices but also doesn't skimp when it comes to necklace composition and safety.  Compare photos from various vendors, really look at the nitty-gritty parts of the necklaces.  Invest in safety and functionality. 

3.  Consider your needs.  Depending on your baby's age and personality, you may need a totally different nursing necklace than me.  Do you have a gripper or a pincher?  A grabber or a twiddler?  Watch your baby while he nurses.  What does he do with his hands?  If your baby is a gripper or grabber, some of the more elegant, fixed-pendant designs may work for you, but if you have an extreme twiddler on your hands, you may want to look for a necklace that has moveable, engaging beads and will really keep him busy.  Plus, it's really great for tactile development! 

Whether you purchase a stylish Mommy Inspired Design or a playful Baby Inspired Design, wear it proudly!  Even after your nursing relationship has ended, your necklace can serve as a special reminder of that time you two shared.  Good luck on your search! 

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Motherwear Podcast: Postpartum depression, breastfeeding, and why you need your Omega 3s.

I'm very pleased to bring you another Motherwear Podcast!  This one was very eye-opening for me, and I hope you'll learn as much as I did.

My guest is Dr. Kathleen Kendall-Tackett, a psychologist and professor at the University of New Hampshire.  She is also a lactation consultant and La Leche League leader.  She has written several books and articles on postpartum depression in new mothers.

This interview was long, so I've divided it up into two parts.  Both address the growing recognition that depression is related to inflammation.

The first part can be heard above or downloaded as an mp3.  This part answers these questions:

• What are the causes of postpartum depression and post traumatic stress disorder following birth?
• Why is postpartum depression unheard of in some cultures?
• Is there such a thing as depression during pregnancy? 
• Is a mother has been depressed with one child, will she be depressed with subsequent children?
• What is the relationship between breastfeeding and postpartum depression?
• What is the depression risk for mothers who are having breastfeeding difficulty?

The second part can be heard above or downloaded as an mp3.  It answers these questions:

• Is there a paradigm shift happening in our understanding of the causes of postpartum depression?
• What are the treatment options for breastfeeding mothers with postpartum depression?
• Why do Omega-3 fatty acids work in the treatment of depression, and how much are women recommended to take?  Which brands are recommended?  Why are pregnant and breastfeeding mothers likely to be deficient?
• Are anti-depressants truly safe for use during breastfeeding?  What are the medications of choice?
• Are there effective and safe alternative treatments for treating depression?
• How can women advocate for a breastfeeding-friendly treatment plan?

Here are a few more resources from Dr. Kendall-Tackett on breastfeeding and postpartum depression:

• The breastfeeding and depression page on Breastfeeding Made Simple.  It includes the Edinburgh Postnatal Depression Scale - a quiz you can take to see if you are having depressive symptoms.
• "Can Fats Make You Happy?"  A handout explaining the relationship between Omega-3s and depression, with a list of recommended brands.
• A handout on how other cultures prevent postpartum depression by creating a distinct postpartum period.
• A curriculum for health care providers on breastfeeding and postpartum depression from Dr. Kendall-Tackett and the New Hampshire Breastfeeding Coalition.  You may want to print this out and ask your health care provider to read it.
• Dr. Kendall-Tackett's article on inflammation, depression, and breastfeeding in the International Breastfeeding Journal.
• Two books mentioned in the podcast:  Medications and Mother's Milk (note: this book is updated every two years and the current edition is 2006), and A Medications Guide for Breastfeeding Moms.

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General anesthesia and breastfeeding.

VideoJug: Does general anesthesia affect breastfeeding?

If only all breastfeeding advice was so clearly put.  I have to say that this not the advice I hear women given when they go in for a surgery.  Usually they're told to pump and dump for anywhere from 2 to 24 hours.

There's more good information on this topic here and here.  And for a post on breastfeeding and MRI or CT scans, see this post.  Thanks to Angela for posting about this a few months ago!

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