Ornament

The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Ornament

Breastfeeding/Nursing/Infant Nutrition

Support prenatal care and birth support for rural and under-served women!
Support the inclusion of Certified Professional Midwives in Medicaid and health care reform.

Where's the Birth Plan? by Jennifer Block - Midwifery-style care saves money and provides excellence for the new family--a great two for one proposal!  She clearly points out how the more humane style of care provided by midwives not only saves money, but also saves lives.  A new economic analysis forecasts savings of $9.1 billion per year if 10 percent of women planned to deliver out of hospital with midwives.

The Debate on Healthcare Policy Reform by Faith Gibson, a healthcare historian and policy theoretician
Learn about Health Care 2.0 and why "The problem with obstetrics is that it is all about obstetricians"

See also:

Subsections on this page:



ONGOING RESEARCH

New research project on the lactation and breastfeeding experiences of bereaved mothers after a pregnancy loss or infant death.

The impact of traumatic birth experiences on breastfeeding.



New and Notable



Patriotic Tip: Breastfeeding Relieves Strain on Health Care System

"The health care dollars saved by breastfeeding would amount to $3.6 billion" - Dr. Stephen Buescher


National Registry for Lactation Research

Dr Tom Hale and Dr. Judy Hopkinson  of Texas are starting a National Registry for Lactation Research.

Research in human lactation is sometimes rather limited  by a shortage of eligible volunteers.   This registry has been developed  to provide the scientific community with a registry of potential volunteers for studying human lactation under special circumstances.  These circumstances include certain medical conditions, problems with lactation, and use of specific drugs during breastfeeding.  Women who are currently breastfeeding, and/or women planning to breastfeed after delivery,  are included in this registry.

They are looking for moms with:

Hepatitis C
Hepatitis B
Cystic Fibrosis
"Suspected Yeast Infections of Nipple"
Insufficient Milk Supple
Persistent plugged ducts (>3/week)
Polycystic Ovarian Syndrome
Milk coagulates on storage
Planned Pregnancy while lactating
Chronic breast pain
Raynaud's of the nipple
Breast implants
Breast reduction
Fibrocystic breast disease
Galactocele
Rusty-pipe syndrome
Pathological breast engorgement
Infant with PKU
Lactation failure of unknown origin
Growth faltering after 4-6 months

or who are taking :

Celexa (citalopram)
Enbrel (etanercept)
Fenugreek
Flagyl (metronidazole)
Interferons (Betaseron, etc)
Lamictal ( lamotrigine)
Lithium
Milk thistle
Motilium (domperidone)
Neurontin (gabapentin
Paxil (paroxetine)
Prilosec (omeprazole)
Prozac (fluoxetine)
Reglan (metoclopramide)
Relafen (nabumetone)
Ritalin (methylphenidate)
Sage
St. John's Wort
Vioxx (rofecoxib)
Zoloft (sertraline)


Gerber has a 24-hour breastfeeding hotline with a Lactation Educator - 1-800-4-GERBER, i.e. 1-800-443-7237



Resources




 
 
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Breasts in Mourning: How Bottle-Feeding Mimics Child Loss in Mothers' Brains [8/27/09 from Scientific American]



 

Reducing Infant Mortality and Improving the Health of Babies - this is a 15-minute, landmark video seminar about improving maternity care in the United States.

"In the US, after taking away the preterm babies, after taking away babies that had cancers and heart defects and things like that, babies who were fed anything other than breastmilk had about a 60% increase in death as compared to those that were breastfed."


The International Lactation Consultant Association (ILCA) is the professional association for International Board Certified Lactation Consultants (IBCLCs) and other health care professionals who care for breastfeeding families.


THE BABY'S PERSPECTIVE - "A course for experienced doulas, RN's, LVN's, LC's, CLE's & Infant Care Specialists who have been working as doulas for a while and want to learn the baby's perspective."  Started by Kittie Frantz, RN, CPNP-PC


Benefits Of Breastfeeding Outweigh Risk Of Infant Exposure To Environmental Chemicals In Breastmilk

ScienceDaily (Dec. 20, 2008) ­ A study comparing breastfed and formula fed infants across time showed that the known beneficial effects of breastfeeding are greater than the potential risks associated with infant exposure to chemicals such as dioxins that may be present in breastmilk, according to a new report.
This compelling study encompassed an historical review of the medical literature and included time periods when levels of environmental chemicals were higher than they tend to be at present.

The authors of the report, Judy LaKind, PhD (LaKind Associates, Catonsville, MD), Cheston Berlin, Jr, MD (The Milton S. Hershey Medical Center, PA), and CAPT Donald Mattison, MD (National Institutes of Health), advise health care providers to continue to encourage new mothers to breastfeed their babies. In agreement with the World Health Organization's (WHO's) continuing support of breastfeeding, this study's findings, based on epidemiologic data, do not downplay the adverse effects of exposure to dioxins and other environmental toxins. However, the authors distinguish between the statistical significance of risk/benefit assessments in an individual compared to population effects.
"When breastmilk was chosen by regulatory agencies as a handy medium for measuring environmental toxins, the public became alarmed that breast milk was contaminated. The authors, eminent authorities on the subject have put these fears to rest," says Ruth A. Lawrence, MD, Editor-in-Chief of Breastfeeding Medicine, from the Department of Pediatrics, University of Rochester School of Medicine and Dentistry.


Hand Expression of Breastmilk - great video with Jane Morton, chair of the Stanford Department of Breastfeeding Medicine.  They have a nice section on Getting Started with Breastfeeding.

Report from PH at the breastfeeding conference, 200:

"Jane Morton, MD (she developed the Breastfeeding Medicine Program at Stanford) - spoke about increasing milk supply.  She says that "hands-on pumping" - her term for expression/compression during pumping - will greatly increase supply, and that babies find it easier to learn to nurse if milk flows and that volume is the determinant of flow.

First 3 days - hand express and feed with spoon.  When baby at breast - "compress compress compress" - it wakes the baby up to spur him to keep sucking.  her analogy:  we help babies learn to walk by holding their hands, we help them learn to ride bikes by holding the bike - we should help them learn to nurse!

her website for step by step teaching:

http:

useful products:
Cryovial by Econo-Lab, Inc.
easyexpression.com for halter top

new pump bra available in may - adjustable.  www.simplewishes.com

video:
"Making Enough Milk" www.breastmilksolutions.com

Also - another reminder about lightbulbs/glasses that block blue lights at night. "


How to Nurture a Mother - Mothers need to be nurtured so they can nurture their newborn.  A mother who isn't resting and eating/drinking well is more likely to have breastfeeding problems.  If you're trying to help a family member or friend with breastfeeding issues, start with bountiful nurturance.


Dr. Jack Newman is perhaps the best expert on breastfeeding.  He and Teresa Pitman have co-written Dr. Newman's Breastfeeding Handouts and Video Clips by Dr. Jack Newman

Breastfeeding - Starting Out Right

Is My Baby Getting Enough Milk?


The CDC Guide To Breastfeeding Interventions offers guidance to policy and program professionals in selecting promising breastfeeding promotion and support activities. [June, 2005]


Efficacy of breastfeeding support provided by trained clinicians during an early, routine, preventive visit: a prospective, randomized, open trial of 226 mother-infant pairs.
Labarere J, Gelbert-Baudino N, Ayral AS, Duc C, Berchotteau M, Bouchon N, Schelstraete C, Vittoz JP, Francois P, Pons JC.
Pediatrics. 2005 Feb;115(2):e139-46.

This study provides preliminary evidence of the efficacy of breastfeeding support through an early, routine, preventive visit in the offices of trained primary care physicians. Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes. Multifaceted interventions aiming to support breastfeeding should involve primary care physicians


The Milky Way, the newsletter of MOMS

Making Our Milk Safe (MOMS), the parent organization



 

LLL Breastfeeding Helpline -- US - The breastfeeding community throughout the United States has access to a 24 hour toll free helpline service by calling 1-877-4-LALECHE (1-877-452-5324). This helpline provides information, education, and support for women who want to breastfeed, and to healthcare providers and others.


Common Sense Breastfeeding - Breastfeeding carries with it a whole series of built-in instincts, and it makes sense to listen to them. These pages may help you hear yourself.


Laughter improves breast milk's health effect - FAMED for its restorative powers, it now seems that laughter also helps breast milk to fight skin allergies.  Breastfed babies with eczema experienced milder symptoms if their mothers laughed hours before feeding them, according to a study by Hajime Kimata at the Moriguchi-Keijinkai Hospital in Osaka, Japan.


Welcome to Mom's Breastaurant! - At Mom’s Breastaurant our mission is to promote a breastfeeding culture by giving breastfeeding moms a safe, comfortable, clean place to nurse during outdoor events such as street fairs, festivals, and concerts. Our tents are temperature controlled, have comfortable chairs and offer clean diaper changing stations.


The Academy of Breastfeeding Medicine


I love this t-shirt for mamas that reads, "I Make Milk - What's Your Super Power?"  Right on!!!


And, of course, how could we go through life without a Dr. Seuss-style verse about breastfeeding:

A Dr. Seuss Variation

Would you nurse her at the park?
Would you nurse him in the dark?
Would you nurse him with a boppy?
And when your boobs are feeling floppy?,
etc.


Mandy & Matt: A solution for breastfeeding attachment through co-bathing by Midwifery Birthing Services - Shows how the techniques can be adapted and used when mother and baby are having problems establishing breastfeeding. If the first hours after birth have been disturbed and mother and baby have not been able to learn together how to breastfeed, resulting problems can be corrected by creating the conditions that trigger the innate reflexes in the baby, thus enabling the baby to relearn how to find the nipple, attach and suck successfully.


Babies have mirror neurons (also called mimc neurons) that cause them to mimic others' actions.  So if you want your baby to open the mouth in a nice, wide gape to latch on, show your baby what you mean, and really stretch that mouth wide open!!! (Yes, this is the basis for the old "monkey see, monkey do" truism!)

Neural mechanisms of imitation.
Iacoboni M.
Curr Opin Neurobiol. 2005 Dec;15(6):632-7. Epub 2005 Nov 3.


Does continuity of care by well-trained breastfeeding counselors improve a mother's perception of support?
Ekstrom A, Widstrom AM, Nissen E.
Birth. 2006 Jun;33(2):123-30.

" . . . the mothers were more satisfied with emotional and informative support during the first 9 months postpartum. The results lend support to family classes incorporating continuity of care."


A Mother's Feelings for Her Infant Are Strengthened by Excellent Breastfeeding Counseling and Continuity of Care
Anette Ekström, PhD, RNM and Eva Nissen, PhD, RNMTD
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e309-e314 (doi:10.1542/peds.2005-2064)

CONCLUSION. . . . guaranteed continuity of care strengthened the maternal relationship with the infant and the feelings for the infant.


LLLI Responds to AAP Policy Statement on Sudden Infant Death Syndrome


Massachusetts Breastfeeding Coalition's Response to AAP SIDS Recommendations


Attachment Parenting International Position Paper regarding the new recommendations by the American Academy of Pediatrics


Breastfeeding Is Associated with a Lower Risk of SIDS According to The Academy of Breastfeeding Medicine


How to Find Lactation Consultants


15 Years After Innocenti Declaration, Breastfeeding Saving Six Million Lives Annually - Unicef Press release [22 November 2005] – Six million lives a year are being saved by exclusive breastfeeding, and global breastfeeding rates have risen by at least 15 per cent since 1990.


Clinical Protocols  from The Academy of Breast Feeding Medicine


Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey
Anne Merewood, MA, IBCLC*,{ddagger}, Supriya D. Mehta, PhD, MHS§, Laura Beth Chamberlain, BA, IBCLC{ddagger}, Barbara L. Philipp, MD*,{ddagger} and Howard Bauchner, MD, MPH*,||
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 628-634 (doi:10.1542/peds.2004-1636)

Conclusion. Baby-Friendly designated hospitals in the United States have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates.

Here's the list of Baby-Friendly Hospitals and Birth Centers.


Nurse-N-Glow Pillow - an all-in-one night-time nursing aid.  Seems like a great shower gift to me, and no, I'm not making any money off this recommendation . . . I'm just *so* impressed that someone would design something that is so obviously designed to make nightime nursing and co-sleeping easier.  Thank you!!!

Wow!  I can't believe I'm raving about this product because it's not the bells and whistles that produce the breastmilk, but it seems really well designed and really, really useful!


Breast is Best, but it Could Be Better: What is in Breast Milk That Should Not Be? [Medscape registration is free]  This article provides many helpful tips about avoiding toxic chemicals that could be passed to your baby through breastmilk.  [NOTE - Compounds found in air in the home could pose more of a health risk to breast-fed babies than chemicals they are exposed to through their mother's milk, researchers in the United States said on Tuesday.  They found that a nursing infant's exposure to gases known as volatile organic compounds (VOCs) from indoor air was 25-135-fold higher than from breast milk.]


Levels of Lead in Breast Milk "Quite Low" Even With High Maternal Lead Exposure


AAP Releases Revised Breastfeeding Recommendations (Feb., 2005)

The policy recommendations include:

    * Exclusive breastfeeding for approximately the first six months and support for breastfeeding for the first year and beyond as long as mutually desired by mother and child.
    * Mother and infant should sleep in proximity to each other to facilitate breastfeeding;
    * Self-examination of mother's breasts for lumps is recommended throughout lactation, not just after weaning;
    * Support efforts of parents and the courts to ensure continuation of breastfeeding in cases of separation, custody and visitation;
    * Pediatricians should counsel adoptive mothers on the benefits of induced lactation through hormonal therapy or mechanical stimulation.
    * Recognize and work with cultural diversity in breastfeeding practices
    * A pediatrician or other knowledgeable and experienced health care professional should evaluate a newborn breastfed infant at 3 to 5 days of age and again at 2 to 3 weeks of age to be sure the infant is feeding and growing well.

Of particular interest to midwifery and natural childbirth advocates are changes from the 1997 policy.  In particular, the policy includes as additional ways to support breastfeeding avoiding procedures that interfere with breastfeeding or traumatize the infant, including unnecessary, excessive and overvigorous suctioning of the oral cavity etc. Under immediate postpartum care, health care professionals are urged to allow skin to skin contact immediately upon delivery and continuing until the first feeding is completed. The policy states that a few assessment measures can be accomplished while the newborn is with the mother and lists others that should be delayed (weighing, measuring, bathing, etc.) until after the first feeding, and that the mother is an "optimal heat source for the infant."  These policy statements are right in line with what midwives already try to do!


Breastfeeding saves babies' lives

Breastfeeding and the risk of postneonatal death in the United States.
Chen A, Rogan WJ.
Pediatrics. 2004 May;113(5):e435-9.

In addition to its many known bonding and health benefits, breastfeeding appears to lower the risk of a baby dying during its first year of life, US research indicates. "Breastfed infants in the United States have lower rates of morbidity, especially from infectious disease, but there are few contemporary studies in the developed world of the effect of breastfeeding on postneonatal mortality," the researchers observe. To address this issue, Aimin Chen and Walter Rogan, from the National Institute of Environmental Health Sciences in North Carolina, analyzed data from the 1998 National Maternal and Infant Health Survey. They compared breastfeeding patterns between 1204 infants who suffered postneonatal death-between 28 days and 1 year of age, for reasons other than cancer and congenital anomaly-and 7740 who were still alive aged 1 year. Children who had ever been breastfed were 21 percent less likely to die during the postneonatal period than those who had never been breastfed, and the risk declined with increasing duration of breastfeeding. In addition, the level of protection provided by breastfeeding varied with cause of death, ranging from an odds ratio of 0.59 for injuries to 0.84 for sudden infant death syndrome. Chen and Rogan conclude that "assuming causality... promoting breastfeeding has the potential to save or delay approximately 720 postneonatal deaths in the USA each year."

We have known for a long time that breastfeeding offers very significant health advantages to babies and children.  It is time that the evaluation of all aspects of perinatal care integrate this factor in assessing safety.  For example, homebirth is exemplary in promoting breastfeeding . . . there is no separation of mother and baby as observation of unstable newborns takes place right in mother's arms, suctioning that might affect breastfeeding is kept to the minimum necessary for safety, and babies aren't subjected to the hospital germs which could make them sick and unable to nurse. The negative effects of circumcision on breastfeeding must also be considered a specific danger of circumcision.


Fentanyl during labor may impede breastfeeding

The impact of intrapartum analgesia on infant feeding
Sue Jordana, Simon Emeryb, Ceri Bradshawa, Alan Watkinsc Wendy Friswellb
BJOG: An International Journal of Obstetrics & Gynaecology 112 (7), 927-934.

Conclusions  A dose response relationship between fentanyl and artificial feeding has not been reported elsewhere. When well-established determinants of infant feeding are accounted for, intrapartum fentanyl may impede establishment of breastfeeding, particularly at higher doses.


Breast milk protects against diarrhea [10/25/04] - The Journal of Pediatrics 2004; 145: 297-303

Research findings suggest another positive reason for mothers to breast-feed their babies.

Oligosaccharides in breast milk can help to protect infants against diarrhea, researchers have found, providing more evidence in support of breast-feeding.


Milk storage diminishes antioxidant activity [10/25/04] - Archives of Disease in Childhood Fetal and Neonatal Edition 2004; 89: F518-20

Assessing the effect of storage conditions on the antioxidant content of human and formula milk.

Breast milk loses its antioxidant activity if stored for longer than 48 hours, study findings indicate, although refrigeration is better than freezing and thawing in this regard.

N. Hanna (Robert Wood Johnson Medical School, New Jersey) and co-workers measured the antioxidant activity of a range of human term and preterm milk, as well as five brands of formula milk, stored for different periods at various temperatures.

Fresh human milk had the highest antioxidant capacity of all the samples, irrespective of whether the mother had delivered prematurely or at term.

Furthermore, fresh human milk had significantly higher antioxidant activity than all formula milks tested.

With respect to storage of human milk, however, antioxidant activity was reduced if milk was kept at either -20°C or 4°C.


Few Mothers Meet Breastfeeding Goals, Study Shows - 8/5/04 - Only 14 percent of U.S. mothers exclusively breastfeed their babies for the minimum recommended six months, according to government data released on Thursday.

I personally find this statistic incredibly shocking.  Breastfeeding is arguably the most important way to protect a baby's health, yet our healthcare system is doing so little to support it.  We have routine separation of mothers and babies in hospitals and the pushing of all sorts of interventions that are harmful to the breastfeeding relationship but are supposedly done for the baby's own good.  I don't think so!

In homebirth practices, the breastfeeding rate is over 95%.  These lucky babies will get immeasurable benefits beyond the 20% reduction in mortality.  Why doesn't our healthcare system support midwife-attended-homebirth as the surest way to protect a baby's health?


It still amazes me that hospitals cannot provide breastfeeding support 24 hours/day for such a life-saving matter.


But nobody makes money off of healthy babies. This is no exaggeration. I recently attended a CIMS Forum and was talking with someone about the title of the talk - "Economic Disincentives for Mother-Friendly Care," the woman said that they had closed the highly successful lactation center at her hospital. When she asked a hospital admin why, that was his reply.




Report warns of continuing violations of code on breast milk substitute marketing - [BMJ  2004;328:1218 (22 May)] - "[T]he Switzerland based company Nestlé was responsible for more violations than any other company,"

Boycott Nestle

OK . . . if I can boycott Nestle, so can you.  It happens that I love chocolate, and it further happens that the chocolate I love best is made by Nestle.  My favorite candy bars are Nestle's Crunch, $100,000 Bar and KitKat.  I LOVE their hot chocolate mix, and, of course, Nestle's Tollhouse Morsels.  Oh, did I mention those great new Treasures morsels with coconut?!?  Unfortunately, Nestle is actively killing thousands of babies around the world through their unethical business practices in pushing formula to families that cannot afford to use it properly and safely.  I can no longer come home from births where we struggle to help babies breastfeed because it's so good for them, and then eat a Nestle's Crunch to keep myself awake on the drive home and then make a nice cup of hot chocolate while I do birth laundry.

http: of information about the worldwide boycott, and they have a list of Nestlé subsidiaries, including the obvious ones like Nescafe, Nesquik and Nestea, but also including some surprising ones - Carnation, Alcon, Purina and Friskies.  Breastfeeding.com offers a great handy visual list of Nestlé affiliates.

If I can boycott Nestle, so can you!

If you need more motivation to boycott Nestle, then read breastfeeding.com's Stuff That Will Make You Mad

"Mr Ian Smith of York, gave his account of the company's ethics: "As one the members of Synod from York, where we have a significant Nestlé presence, I was invited, before the last debate on this subject in 1994, to meet some of their directors to discuss the issue. At that time they freely admitted that they were the market leaders of a trade that was being mishandled in some parts of the world. I observed that this resulted in many thousands of infant deaths. The response was that if they didn't sell the product someone else would. We've heard that line with regard to landmines recently: In other words, it's better that they're killed by our products rather than someone else's. Nestlé admitted that the business has its unethical side, but they still push it hard. They say they will stop - if others do too."


Let Baby Choose Which Side to Nurse On

Try this experiment:  When baby fusses, wanting to nurse, hold baby right in the middle of your chest.  You may be amazed that baby will then lunge towards one side or the other, choosing which side meets the immediate nursing need.  If baby's really hungry, they would probably choose the breast that is fuller, where the milk will come out faster and satisfy baby's hunger more quickly.  If baby just wants a little snack or is thirsty, baby may choose the breast that is less full, so that the flow of milk from the full breast isn't overwhelming.  Give it a try and please send feedback if you'd like. [NOTE - If a baby consistently prefers one side, it's worth considering the possibility that they are having some pain when nursing on the other side, possibly due to some residual birth trauma.  Try a different hold on the side they usually don't like, e.g. try the football hold, or sidelying from the top breast, or lying flat on your back with the baby on your belly.  If the baby suddenly is interested in the breast that they previously avoided, it makes sense to take them for a chiropractic or craniosacral evaluation.]

Feedback:


TRUTH IS STRANGER THAN FICTION!

"Colostrum is so important that most infants would simply die without it."  This is the claim of

"People need to understand that when they're deciding between breastmilk and formula, they're not deciding between Coke and Pepsi... they're choosing between a live, pure substance and a dead substance made with the cheapest oils available." -Lactation Consultant Chele Marmet


Some wonderful articles by Sarah J. Buckley, MD, from the section on Mothering - Care of the Newborn at Women of Spirit


Food for Thought - Call It "Early Breastmilk", not Colostrum
I have attended quite a few breastfeeding workshops in the past 3 years and they have all said that the new attitude toward early breastmilk is NOT to refer to it as colostrum, but to call it what it is - breast milk.  The people from whom I learned this were (on three occasions) Certified Lactation Consultants.  They were teaching primarily to hospital personnel and were very concerned about changing the image that the first milk is somehow not breastmilk.  This milk HAS protein and all the other components which define milk.  So it is not something OTHER than milk.


Falling in Love: The Chemistry of the First Breastfeed


Breastfeeding and CranioSacral Therapy: When It Can Help by Dee Kassing, BS, MLS, IBCLC


Breastfeeding Foundations for Nurses and Midwives - a fantastic online course from Australia.


First-Time Mothers at Greater Risk of Breast Abscess [Medscape registration is free]


The deadly influence of formula in America by Dr. Linda Folden Palmer [A Natural Family Online Special Report:]


The World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, support and promotion of breastfeeding.


Excerpt from Nursing the Caesarean Born, by Michel Odent, MD -  Midwifery Today Issue 69


Nursing Family Newsletter's Resources and Links


Breastfeedingonline.com hopes to help empower women to choose to breastfeed and to educate society at large about the importance and benefits of breastfeeding. - the web site of Cindy Curtis, RN, IBCLC!


Latching and Positioning Resources from kellymom.com.  Great set of Latch-on pictures with description


The World of Latch-On: One Leader’s Journey by Diane Wiessinger, MS, IBCLC

"Watch your language!"  By Diane Wiessinger, MS, IBCLC


nursingmother.com now has online How-To videos so that you can see what it looks like when the baby is on right and what it looks like when you have it wrong.


The  International Lactation Consultant Association offers a great document - Evidence-based Guidelines for Breastfeeding Management During the First Fourteen days (1999) - this is a terrific document available as a FREE download. The guide provides 24 key strategies to guide health professionals in providing optimal care to mothers and infants during the crucial first 14 days.  [Another link to this same document.]


Milky Way Press's Breastfeeding Basics and Beyond(TM) series:  Reading Your Baby's Body Language and Breastfeeding's Number One Question:How Will I Know My Baby Is Getting Enough Milk?by Beverly Morgan, Lactation consultant, lactation educator, author, speaker.


Breastfeeding Resources from bf.marie.org


Best practice guide to common breastfeeding problems from Australia


Breastfeeding Tips, excerpted from Pregnancy Tips, by Gail Dahl


Feeding Frenzy
How big business and politics conspire against breastfeeding mothers
by Maureen Turner - April 15, 2004


IUDs: Great Contraceptive, But Not For Nursing Moms from Dr. Dean Edell


Medications and Lactation: What PNPs Need to Know [Medscape registration is free.]

"Breast milk has consistently been confirmed to provide infants and children with unique, species-specific nutrients that are ideal for infants' immune protection, growth, development, and emotional well-being. Few maternal medications are contraindicated for lactating mothers and their breastfeeding infants "


Breastfeeding Pharmacology - from the web pages of Dr. Tom Hale, author of Medications and Mothers’ Milk


Breastfeeding Difficulties from ivillage.com


Lactation Education Resources


Pumps

FDA’s Breast Pump Website

The Medical Supply House carries a diverse product line, including breast pumps and specialty feeding devices, such as the Hazelbaker™ FingerFeeder.  (The FingerFeeder allows baby to be in control and pace the feed. It is the only special feeding method that provides the touch of the human skin. [Ed: Although you would want to be really sure the human finger doesn't carry yeast!  You don't want to add thrush to an already difficult situation!])

Gerber has a new Massaging Manual Breast Pump

Encouraging Patients to Use a Breast Pump (after returning to work) - great article from Medscape [Medscape registration is free]

Pumping Moms Information Exchange

White River Concepts - "Medical study rates WRC pump equal to nursing babies for stimulating milk production" -  An unusual pump for people who don't letdown to the usual top-of-the-line hospital pumps.  It uses compression as well as suction and is much more like baby.

Breast Pump Comparisons - this compares features of some major brands.

Medela has a web page on how to find out which breastpump is right for you.

http:

http:


Nursing Bras/Nursing Clothes

Women seem to recommend the following bras as good for nursing:

Decent Exposures

Motherwear wants to help women like you find the support and confidence to breastfeed whenever and wherever your babies are hungry. Free breastfeeding guides, along with clothes that were designed and made with you and your baby in mind.

Mother's Nature carries Nursingwear, Nursing Bras (Medela, Bravado), Medela Breastpumps and Accessories, Breastfeeding Accessories, Over the Shoulder Baby Holder Sling, Cloth Diapers, Toys, Books for Pregnancy and Childbirth. There are also new Auction Pages!!

NURTURED BABY Organic Cotton Bras, Bravado Nursing/Maternity Bras and Maternity Underwear

Clothes for the Nursing Mother


Breastfeeding WebRing


Great Site with Lots of Information and Support

Promotion of Mother's Milk, Inc. (ProMoM) is a nonprofit organization dedicated to increasing public awareness and public acceptance of breastfeeding, including 101 Reasons to Breastfeed Your Child. This site is the new home of J. Rachael Hamlet's Breastfeeding Advocacy Page.

Australian Breastfeeding Association - formerly the Nursing Mothers' Association of Australia


Breastfeeding.com - We are here to give you the best in breastfeeding information, support, humor, news, supplies, advocacy, stories, attitude and more.  [This site has good general breastfeeding information. They will also send you a lovely poster with the top 12 reasons to breastfeed.]


BestFed.com - "Breastfeeding  for as long as your child wants to is probably THE most important thing you can do for the health and wellbeing of your child after birth."


1998 Breastfeeding Resource Guide - San Diego County Breastfeeding Coalition


Lactnet Archives-http:


NURSING MOTHER’S COUNSEL (Fort Wayne, Indiana, USA - Local Chapter)
NURSING MOTHER’S COUNSEL National Organization


La Leche League


Breastfeeding and Parenting Resources on the Internet


Management of nipple pain and trauma - by Wendy Nicholson RM IBCLC 5.4.98


Joy Johnston's Resource Centre - Midwifery Care and Breastfeeding - Lactation consultation
This site has some really terrific articles on breastfeeding.


Baby-friendly Hospital Initiative (launched by WHO and UNICEF in 1991) - The BFHI, sponsored by the World Health Organization and UNICEF, is a world-wide effort to improve breastfeeding rates. Based on the ten steps to successful breastfeeding, the initiative encourages hospitals to examine their practices, make the appropriate changes and then apply for recognition as a Baby Friendly Hospital.


World Health Organization (WHO) on Breastfeeding


Kathy Dettwyler's Thoughts on Breastfeeding and her supporting medical references


INFACT Canada - The Infant Feeding Action Coalition - Canada home page


The Parent-L Breastfeeding Resources Page:


The Bright Future Lactation Resource Centre is an education and motivation resource for Lactation Consultants and others providing parents with infant feeding information.


Fenugreek: One Remedy for Low Milk Production By Kathleen E. Huggins, RN, MS
Kathleen Huggins is a Director of the Breastfeeding Clinic at San Luis Obispo General Hospital, CA. She is the author of The Nursing Mother's Companion and coauthor of The Nursing Mother's Guide to Weaning.


How to Know a Health Professional is not Supportive of Breastfeeding
by Jack Newman, MD.


The purpose of MOBI (Mothers Overcoming Breast feeding Issues) is to give women a place to discuss their emotions over not being able to breast feed successfully.


The Human Milk Banking Association of North America, Inc. represents all of the North American human milk banks which collect, pasteurize, and distribute donated mother's milk.


Project "Got Breastmilk?" - beautiful photographs of breastfeeding mothers and babies


Smoking leaves taste in breast milk -U.S. study
New England Journal of Medicine, Nov., 1998


Effects of Mag. Sulfate on Breastfeeding


I've heard that in India, breastfeeding mothers are encouraged to follow a special diet for the first 8-12 weeks, as food eaten during that time has a lifelong influence on the baby's tastes.  (Please contact me if you have more information about this.  Thanks.)


Veg Pregnancy & Breastfeeding - from vegetarianbaby.com


Midwifery and Breastfeeding Bumper Stickers - Texas Sticker Company & Label Exchange


An Overview of Milk - Biology of Lactation



Effects of Birth Practices on Breastfeeding



See also: Birth Trauma and Breastfeeding Difficulties


I was reading through a copy of my baby's hospital records, and was flabbergasted by the "Infant Recovery Record", which is a record of baby's first hour.  There were some pre-fab options for the "Activity" column, and it did not include breastfeeding!  The options were Active, Active When Stimulated, Irritable, Lethargic, Quiet, and Sleeping.  Sigh.


Wow!  This is really sad.  At my homebirth, the midwives charted the important details of breastfeeding: Rooting, Latching, Time of first latch, duration of latch, and even which breast he was on!  And the followup care papers had a separate, fairly detailed section for breastfeeding assessment at each followup appointment.


It's important to consider birthing practices that affect breastfeeding because they have a strong effect on the baby's ultimate health:

Drugs
Cesarean
Separation of mother and baby
Circumcision

There's a great book about this, Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum by Mary Kroeger.  You can also get this book from the La Leche League Store.

The breastfeeding rates in my homebirth practice are close to 100%, and if you consider how significantly this increases birthing safety, it makes homebirth significantly safer than hospital birth.


Alta Vista search for information about "birthing practices" AND breastfeeding


Effect of labor epidural analgesia with and without fentanyl on infant breast-feeding: a prospective, randomized, double-blind study.
Beilin Y, Bodian CA, Weiser J, Hossain S, Arnold I, Feierman DE, Martin G, Holzman I.
Anesthesiology. 2005 Dec;103(6):1211-7.

CONCLUSIONS: Among women who breast-fed previously, those who were randomly assigned to receive high-dose labor epidural fentanyl were more likely to have stopped breast-feeding 6 weeks postpartum than woman who were randomly assigned to receive less fentanyl or no fentanyl.


Changing hospital practices to increase the duration of breastfeeding. - an oldie but a goodie!


Hospital policies and practices that promote breastfeeding result in more mothers choosing to breastfeed following delivery


WHO/UNICEF Baby-Friendly Hospital Initiative


Hospital Support for Breastfeeding and Associated Outcomes



Homebirth Most Significant Factor in Successful Breastfeeding



In this study, 89.7 percent of babies were fully breastfeeding at six weeks.

Outcomes of planned home births with certified professional midwives: large prospective study in North America [Full-text article]
Kenneth C Johnson, senior epidemiologist, Betty-Anne Daviss, project manager
BMJ  2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416

Conclusions: Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. [NOTE - CPMs are equivalent to Licensed Midwives in California and some other states.]


What is the single most positive contributing factor for the successful establishment of breastfeeding?

Homebirth.

I assume the gentle birth, the avoidance of tubes down the baby's throat, the time to allow for baby-led nursing, and the general calm and quiet help a lot. But the studies say it's the simple fact that the midwife shows up at the home at 24 hours, 3 days, 5 days, whatever it takes to get that mom and baby nursing well.

This is the sort of thing I fret about when I hear people talking about extending hospital stays for new moms and babies.

I'm thinking - get them out of that hospital and away from the infection threats as soon as possible. Instead, use the money from the cost of an extra day in the hospital to pay for three home visits from a birthing professional and a week's worth of household help. This would go a long way towards helping breastfeeding.



Growth Charts for Breastfeeding Babies



New Pediatric Growth Charts Reflect Breastfeeding as the Norm

Acta Paediatrica: WHO Child Growth Standards

The following information is from Volume 3, Issue 3 of Research Summaries for Normal Birth, July 2006, from the Lamaze Institute for Normal Birth:

Summary: The first of a series of new pediatric growth charts have been released by the World Health Organization (WHO). The new growth standards were developed to replace existing pediatric growth charts based on growth patterns in predominantly formula-fed populations. Beginning almost a decade ago, the WHO undertook a detailed and elaborate statistical study, sampling thousands of infants from eight ethnically diverse, economically stable nations where at least 20% of women had access to breastfeeding support and followed WHO infant feeding guidelines. The healthy, term infants who participated were followed by trained researchers biweekly for 2 months, monthly up to 12 months, and bimonthly up to 24 months. An additional sample of children was followed up to 71 months. Breastfeeding support was provided as needed. Data were collected on infant growth patterns and achievement of motor skills.

The resulting infant growth standards offer pediatric providers and parents the first evidence-based information on how children should grow under optimal conditions. The researchers found that there was very little ethnic variability in average growth or achievement of motor skills, suggesting that poverty and sub-optimal nutrition are responsible for previously observed regional variability in infant growth.

Significance for Normal Birth: The WHO infant growth charts are an important step in positioning breastfeeding as the norm and reversing decades of erroneous advice to parents of breastfed infants who were told that their infants were failing to thrive because they gained weight more slowly than formula fed infants. Now, more formula fed babies will be seen to “fall off the curve” by gaining weight too rapidly, an important predictor of childhood obesity.

The results of the WHO Multicentre Growth Reference Study provide solid evidence that breastfeeding contributes to the optimal growth and motor development of infants. Interventions in normal birth, including cesarean surgery and unnecessary separation of mothers and babies impede women’s ability to initiate successful breastfeeding with their newborns thereby contributing to less than optimal infant growth and development.


Average Growth Patterns of Breastfed Babies from kellymom.com, with a great list of related references and resources.

"The from the CDC Growth Charts FAQ]


Breastfeeding and Drugs



LactMed: A New NLM Database on Drugs and Lactation is a peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. The database was produced by the National Library of Medicine as part of the Toxicology Data Network. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider. The database is searchable by drug name.


Breastfeeding and Drugs - from motherisk.org


Drugs in Pregnancy and Lactation from Harbor UCLA Medical Center


CARE Northwest gives free telephone advice to pregnant and breastfeeding women about the possible effects of drug and chemical exposure. Call Monday through Friday, 8 a.m.-4 p.m.: 888-616-8484.



Breastfeeding and Alcohol



What about drinking alcohol and breastfeeding? from La Leche League


Breastfeeding And Alcohol from breast-feeding-information.com


The Breast Milk Cocktail -- the author finds contradictory info on alcohol and caffeine By Elizabeth Agnvall


Beer, Alcohol And Breastfeeding


Alcohol, breastfeeding, and development at 18 months.  [ Full text ]
Little RE, Northstone K, Golding J; ALSPAC Study Team.
Pediatrics. 2002 May;109(5):E72-2.

DISCUSSION: We were unable to replicate the earlier deficit in motor skills associated with lactation alcohol use. One reason may be that the dose of alcohol reaching the lactating infant is small, and tests of infants and toddlers have limited ability to pick up small effects. Studies of older children may resolve the question of the safety of drinking while nursing.


Breastfeeding and alcohol from Britain's National Childbirth Trust:

"Hale (Dr Thoms Hale in Medications and Mothers Milk, the international textbook on this topic, all research based) says the mother needs to have a blood level of 300 mg alcohol per decilitre of blood before her infant shows significant side effects (mainly sedation).

The legal drink driving limit in the UK is 80mg of alcohol per 100ml of blood.

100ml is a decilitre so this means you would have to be between 3 and 4 times the legal limit for driving before the alcohol you were drinking had significant effects on your baby....and actually feeding at the time you were affected, too.

Alcohol reaches the breastmilk shortly after it reaches the bloodstream - so fairly quickly, in other words, but in dilute quantities. Hale says 'the absolute amount transferred into milk is low'.

You can be sure your breastmilk is clear of alcohol when your bloodstream is clear of it, and the usual guide for this is that the body processes alcohol at a rate of one and a half to two hours per unit.

Just as your body deals with alcohol, and any effects of it are temporary (apart from people who drink chronically over years, whose brain and liver are affected) , your baby's body deals with the very small traces of alcohol in the milk.

There are reports in Hale of effects on milk supply, let down and taste, but these will be temporary."



Breastfeeding Benefits



Breastfeeding and the risk of postneonatal death in the United States.
Chen A, Rogan WJ.
Pediatrics. 2004 May;113(5):e435-9.

    OBJECTIVE: Breastfed infants in the United States have lower rates of morbidity, especially from infectious disease, but there are few contemporary studies in the developed world of the effect of breastfeeding on postneonatal mortality. We evaluated the effect of breastfeeding on postneonatal mortality in United States using 1988 National Maternal and Infant Health Survey (NMIHS) data. METHODS: Nationally representative samples of 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly or malignant tumor (cases of postneonatal death) and 7740 children who were still alive at 1 year (controls) were included. We calculated overall and cause-specific odds ratios for ever/never breastfeeding among all children, conducted race and birth weight-specific analyses, and looked for duration-response effects. RESULTS: Overall, children who were ever breastfed had 0.79 (95% confidence interval [CI]: 0.67-0.93) times the risk of never breastfed children for dying in the postneonatal period. Longer breastfeeding was associated with lower risk. Odds ratios by cause of death varied from 0.59 (95% CI: 0.38-0.94) for injuries to 0.84 (95% CI: 0.67-1.05) for sudden infant death syndrome.

CONCLUSIONS: Breastfeeding is associated with a reduction in risk for postneonatal death. This large data set allowed robust estimates and control of confounding, but the effects of breast milk and breastfeeding cannot be separated completely from other characteristics of the mother and child. Assuming causality, however, promoting breastfeeding has the potential to save or delay approximately 720 postneonatal deaths in the United States each year.


Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality
PEDIATRICS Vol. 117 No. 3 March 2006, pp. e380-e386 (doi:10.1542/peds.2005-1496)

CONCLUSIONS. Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour.

PubMed citation

This is a pretty amazing statistic, and it's important to consider this anytime you're also considering the safety of birthing practices that affect breastfeeding:

Drugs
Cesarean
Separation of mother and baby
Circumcision

There's a great book about this, Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum by Mary Kroeger

The breastfeeding rates in my homebirth practice are close to 100%, and if you consider how significantly this increases birthing safety, it makes homebirth significantly safer than hospital birth.


A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health
Kathleen Kendall-Tackett
International Breastfeeding Journal 2007, 2:6     doi:10.1186/1746-4358-2-6

Breastfeeding fights depression
08 May 2007
International Breastfeeding Journal 2007; 2: 6

MedWire News: Breastfeeding can help new mothers fight depression, research shows.

Kathleen Kendal-Tackett (University of New Hampshire) says that depression is common among new mothers, and affects anywhere from 10 percent to 20 percent of postpartum women.

"Since depression has devastating effects on mother and baby, it's vital that it be identified and treated promptly," she adds.

Kendal-Tackett says that new mothers experience an increase in inflammation due to high levels of pro-inflammatory cytokines.

Common experiences associated with new motherhood such as disturbed sleep and postpartum pain can also act as stresses that cause pro-inflammatory levels to rise, she says.

Breastfeeding can reduce women's stress levels so that their inflammatory response systems remain inactive. This then reduces their risk of depression.

But Kendal-Tackett notes this is only true when breastfeeding is "going well."

"When breastfeeding is not going well, particularly if there is pain, it becomes a trigger to depression rather than something that lessens the risk."

She concludes: "Mother's mental health is yet another reason to intervene quickly when breastfeeding difficulties arise."


Higher Concentration of Vitamin C in Breast Milk Linked to Lower Rate of Infant Atopy  CME

Vitamin C in breast milk may reduce the risk of atopy in the infant.
Hoppu U, Rinne M, Salo-Vaananen P, Lampi AM, Piironen V, Isolauri E.
Eur J Clin Nutr. 2005 Jan;59(1):123-8.
CONCLUSION: A maternal diet rich in natural sources of vitamin C during breastfeeding could reduce the risk of atopy in high-risk infants.


Breast-Feeding Cuts Risk of Respiratory Disease

[Oct., 2001]  Healthy children who are breast-fed are one-third less likely to develop a lower respiratory tract infection compared with bottle-fed babies, according to a review of the medical literature presented here Monday at the American Academy of Pediatricians' annual meeting.

"If you breast-feed for at least 4 months, your child will experience one-third the risk of hospitalization for lower respiratory disease,'' lead author Dr. Virginia Bachrach, a community pediatrician in Palo Alto, California, told Reuters Health. The protection seems to last for the first year of life, Bachrach noted.

Bachrach said that 6% of all US infants less than 1 year of age are hospitalized annually for lower respiratory tract disease, which elevates their risk for later illnesses such as asthma and creates a costly healthcare burden.



Study: Breast Feeding Cuts Infant Death 20 Percent [5/2/04] - Breast-fed children in the United States are 20 percent less likely to die during the first year of life than whose who are not nursed.


Breastfeeding as Birth Control

September, 1999 - [Medscape article] The World Health Organization asserts in the September issue of Fertility and Sterility that "...the lactational amenorrhea method is a viable approach to postpartum contraception."  [NOTE that co-sleeping will significantly increase the effectiveness as it encourages the baby to nurse during the night; some say that babies must nurse as often as every six hours in order for LAM to be effective.]

The Target Flap - December, 1998

Target's Lullaby Club advertisement carried an editorial about advantages of bottle feeding vs. breastfeeding.
This website shows a large ad by TARGET stores outlining the many advantages of bottle-feeding.  ARGH!!!  A couple advantages it states are how bottle-feeding doesn't tire mom or baby, and that it may help the baby sleep through the night, how dad can help in feeding, how you can still eat spicy foods, how since it takes longer to digest formula, baby doesn't need to be fed often (that's like saying that since disposable diapers are so absorbent, babies can sit in their own waste without leaking for many more hours than before!!!).

Target's Response


A response to Target's response:

I understand that you think you were being "fair" in presenting "both sides" of the breastfeeding vs. bottle feeding question.  Unfortunately, you neglected the "side" that is most important - the baby's.

A newborn has an immature immune system that is incapable of mounting an adequate defense against many germs, especially the more virulent, antibiotic-resistant bacteria.  Nature intended that the breastfeeding mother be an extension of the baby's immune system, providing vital antibodies and macrophages. Every newborn relies on breastfeeding to provide a defense against life-threatening infections.

Next time you wish to expound on the alleged benefits of bottle feeding, I hope you'll do so from the point of view of the person most affected - the baby.


The FDA's "Breastfeeding Best Bet for Babies":


Rachael's page on "Why Breastfeeding is Important":

This contains references to research showing, among other things, that BF'd children are smarter, healthier, have less risk of SIDS etc,


The newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.
Dr. Grantly Dick-Reed

Preliminary Growth Charts for Breastfed Babies


USDANEWS/Article5/August 1997 - The Ideal Infant Food - "Loving Support Makes Breastfeeding Work." USDANEWS GREEN LINE VOLUME 56 NO.7 - AUGUST 1997


UPI Summary of Breastfeeding Advantages


Advantages of Breastfeeding Links - This page was written in the interest of supporting and promoting breastfeeding for all moms and babies. UNICEF states that 1 million babies die each year as a result of being fed artificial formula, some die from diarrhea and other intestinal illnesses , some die from malnutrition because their families can not afford to purchase formula, and some die from the illnesses that formula fed babies are more likely to contract.


From: C-upi@clari.net (UPI / LIDIA WASOWICZ, UPI Science Writer)

Subject: Health Today [Jul 28]

Date: Mon, 28 Jul 1997 0:50:49 PDT
Breastfeeding Protects Against Ear Infections: A study shows babies who drink from the breast rather than the bottle are less likely to develop ear infections. The study by the National Center for Chronic Disease Prevention and Health Promotion shows babies fed nothing but mother's milk were 70 percent less likely to develop ear infections in their first year of life than infants who got formula only. The authors say this study is very important because only 53 percent of U.S. women breastfeed their children. That means 47 percent of babies are at increased risk of ear infections.

Breast Milk May Reduce Risk of Schizophrenia



Effect of breast feeding on intelligence



Although this study was published in 2006, it appears that it was based on data collected in 1979; it is hard to know whether the data collection standards from 1979 would hold up against today's standards.
"Setting: 1979 US national longitudinal survey of youth."

Effect of breast feeding on intelligence in children: prospective study, sibling pairs analysis, and meta-analysis
Geoff Der 1*, G David Batty 1, Ian J Deary 2
BMJ, doi:10.1136/bmj.38978.699583.55 (published 4 October 2006)

Conclusions Breast feeding has little or no effect on intelligence in children. While breast feeding has many advantages for the child and mother, enhancement of the child's intelligence is unlikely to be among them.


On the other hand, this 2004 study showed that although parental intelligence is also correlated, it appears that breastfeeding, in and of itself, also increases intelligence.

Influence of breast-feeding and parental intelligence on cognitive development in the 24-month-old child.
Gomez-Sanchiz M, Canete R, Rodero I, Baeza JE, Gonzalez JA.
Clin Pediatr (Phila). 2004 Oct;43(8):753-61.

"The results of multiple linear regression analysis showed that infants breast-fed for longer than 4 months scored 4.3 points higher on the mental development scale than those breast-fed for less time. No differences were found in psychomotor development as a function of feeding regimen or duration. The positive linear correlation observed between parental IQ and mental development scores at 24 months was also statistically significant (mother: r = 0.39; p < 0.001; father: r = 0.43; p < 0.001). It may be concluded that breast-feeding for longer than 4 months has a positive effect on the child's mental development at 24 months of age. Parental intelligence also appears to influence cognitive development."



Breastfeeding Rights



Breastfeeding in Whose Public? by Peggy O'Mara, editor of Mothering Magazine


A Current Summary of Breastfeeding Legislation in the U.S. - a state-by-state guide to breastfeeding laws in the U.S. from La Leche League.


State Legislation that Protects, Promotes, and Supports Breastfeeding: An Inventory and Analysis of State Breastfeeding and Maternity Leave Legislation


California Governor Signs Bill Assuring Right to Breastfeed in Public



Vitamin D in Breastmilk



Vitamin D

Dr. Mercola's comments on the issue of Vitamin D in breastmilk - Pregnant women have an added reason to get their vitamin D levels checked. As the study shows, if a breastfeeding woman is deficient in vitamin D, then her breast milk and breastfeeding baby will be too.

Hollis and Wagner announced their lab has determined that lactating mothers need at least 3,600 IU a day of cholecalciferol (the natural form of vitamin D) to maintain their own and their infant’s vitamin D levels. 2,000 IU was inadequate. Only when Hollis and Wagner gave lactating mothers 3,600 IU of cholecalciferol did the mother have enough vitamin D to maintain their own and their infant’s blood levels. 3,600 IU of vitamin D is about 10 times what the federal government says lactating women should get and is almost twice what the federal government says may be toxic.


Sunlight and Vitamin D: Exposing the Benefits from La Leche League


Sunlight Deficiency: Helping Breastfeeding Mothers Find the Facts from La Leche League


From what I have learned it is not necessary to supplement your diet with vitamin D alone. As long as you are nursing your baby, it is however important to continue taking your prenatal vitamins. What I recommend to clients is to also ensure eating ample varieties of foods that are high in vitamins and minerals. A food is an immediate source of nutrition and should not be regarding as only filling your belly when your hungry. Foods such as dairy products- milk, cheese-, eggs, fatty saltwater fish (such as halibut and tuna), oatmeal, sweet potatoes, vegetable oils and dandelion greens. Herbs high in vitamin D are nettle, alfalfa, horsetail and parsley. Although, I do not recommend taking parsley at all while nursing unless you wish to decrease your breast milk production. Another very simple way of implementing vitamin D into your system is just a few minutes of sunlight a day. When the skin is exposed to the sun's ultraviolet rays, a cholesterol compound in the skin is transformed into a precursor of vitamin D.


Vitamin D for Babies


Vitamin D Supplementation of Breast-Fed Infants [Medscape registration is free]


Vitamin supplements in children - Are they necessary? Are they good? A study published in Pediatrics this month suggests that multivitamin supplementation may be associated with an increased risk of babies developing asthma and food allergies. [More information about Supplements for Kids]



Newborn Self-Attachment



Delivery Self Attachment by Lennart Righard, M.D. - This video depicts a newborn's ability at birth to crawl up to a breast and ATTACH HIMSELF UNASSISTED!


Evolving Breastfeeding Practices ~ Increasing Success and Enjoyment by Jeanne Batacan - this lovely article gives a nice, short description of easy self-attachment for baby's first breastfeeding session as well as subsequent feedings.


OK!!!  I have FIRST-hand experience with this.  Sometime last year in an issue of Mothering magazine, there was an entire article on the phenomenon....even with pictures.  It was really neat.  I remember showing it to DH and saying....wow...that is really cool, but at the SAME TIME I told him....well...I am so excited about other things RIGHT after the birth that I am not really interested in repeating the experiment......but it really is neat.

WELL....after my baby was born....we were all laughing and crying and I was talking with the MW's when they got there and I didn't really notice, but my baby WAS crawling/inching her way along up my abdomen.  I DID notice because all of the sudden I said "HEY!!!"  and I looked down and she had ATTACHED her mouth to MY NIPPLE and was SUCKING!!!  It was the COOLEST thing!!!

I think this happened because as this was my first HB, no nurse or OB was RUSHING to cut the cord and take her off of me.  And secondly, this was an unassisted and there WERE NO MW's for about 10 minutes, so I said to DH and everyone, let's just keep her on my belly with the warm towels on top of her and then when the MW's get here THEY can cut the cord and all. So...my baby was on my belly for a significant amount of time....and I think THAT is what enabled the experiment to be a success even though we weren't even trying!!!

One other significant thing I remember from the article is that it is very important if you want to repeat the experiment is that you do not wash the baby's hands at ALL.  They say that the baby needs to be able to smell the amniotic fluid on their hands and that the nipple smells like amniotic fluid too and that is why they are attached to it.


Initiation of Breastfeeding by Breast Crawl - this is similar to the Breast Self Attachment video.


YOUR BABY KNOWS HOW TO LATCH-ON - Great 5-minute video from ameda.com


Study Challenges Conventional Breastfeeding Advice, Suggests Mothers Should Be Semi-Reclined to Nurse More Effectively


 Lying Down May Help Breastfeeding

"A study of 40 mothers breastfeeding in different positions found that babies' natural reflexes kicked in more easily when the mothers were lying down. . . . Dr Suzanne Colson, senior midwifery lecturer at Canterbury Christ Church University, advises women on a technique called biological nurturing where the mother lies down and lets the baby lie on its tummy on top of her. . . . She spotted 17 reflexes in babies when they were breastfed lying down, including reflexes normally associated with other mammals who feed their babies in this way. Breastfeeding in a sitting-up position only promoted the three normally seen reflexes - routing, latching and sucking. Mothers who breastfed lying down seemed to have more success and, although the majority of women in the study had initially reported problems with breastfeeding, after using the technique all the women continued breastfeeding."


Womb to World: A Metabolic Perspective by Suzanne Colson has a nice section on Biological Nurturing



Breasfeeding and Working



Rachael's page on "Breastfeeding and Returning to Work":


Insurance May Pay for Breast Pump

My insurance plan may pay for me to get the Medela double breasted electronic one. I was told I had to wait until after the baby was born (like when I get discharged from the hospital) and to have my doc write a prescription for the pump with the diagnosis of engorgement, (one can also use feeding problem, inverted nipples, premature baby held in hospital etc.) You have to go to a Medical supplier to rent/buy it if the insurance company is going to pay or help pay for it.


Human Milk Storage



Human Milk Storage Information from LLL


Storing Expressed Milk



Breastfeeding Nutrition



Spirulina is fantastic for nursing mothers! It is filled with chlorophyll, rich in protein, contains all 8 amino acids and has B12 (important source for vegetarians). The chlorophyll nourishes blood (a precursor to breast milk in Chinese Medicine) and helps remineralize the body--including calcium, which is obviously lost during lactation & pregnancy. Spirulina helps balance blood sugar and helps with energy and stamina. I recommend a product called Pure Synergy for all my patients including pregnant and nursing moms. There's more in it than spirulina.



Newborn Who Won't Nurse



If a baby consistently prefers one side, it's worth considering the possibility that they are having some pain when nursing on the other side, possibly due to some residual birth trauma.  Try a different hold on the side they usually don't like, e.g. try the football hold, or sidelying from the top breast, or lying flat on your back with the baby on your belly.  If the baby suddenly is interested in the breast that they previously avoided, it makes sense to take them for a chiropractic or craniosacral evaluation.  This goes double for a baby who won't nurse well at all.  Compressed skull bones can make it painful to open their mouth wide enough to latch on


I don't think that the problem that I'm going to post about is GBS because these moms haven't had PROM or any of the other symptoms. But once in a while and just this last week I had the experience again, are those darned babies that refuse to nurse for hours after birth. Then the worry about hypoglycemia, dehydration etc. It seems that you just can't get anything down them at all. This last one seemed to thrust her tongue when anything was put in her mouth. She wouldn't even take my finger. We really worked with this one and finally but these babies every once in a while are what make me want to pull my hair out. You just can't get them to nurse for anything.


I agree, this is a really tough situation. I have had similar difficulties with babies in the past. I have not seen it as the result of any infectious process. I generally try the suggestions below. Perhaps this info will help you out next time.

Sometimes these babies seem to have gotten into the habit of sucking something like a fist or the side of their hand in utero ( I check their hands for a little blister like area) which seems to make them prefer to suck with the tongue thrust, and resist anything (finger, breast) deeper into their mouth. It takes quite a bit of patience and gentleness to get them to accept the finger. I try gentle stroking of the face and lips to stimulate baby and then try 'tongue walking' -walking my finger slowly from tip towards back of tongue drawing it down and forward with pad of my index finger.

Sometimes they are just what is sometimes called an 'aggressive non-nurser' - they arch away from the breast and scream and refuse to nurse. With these babies, I try to gently curl them into 'C' shape which is neurologically more conducive for feeding. Then I would try the facial stroking- starting from the nose, and stroking out towards cheek and then down towards chin- and from midline upper lip- around and down too chin and lower lip. Then try positioning them in the clutch/football hold for nursing- to maintain the 'C' curl. See if this helps.


When I worked as a hospital nurse, I used to see a great deal more of what you are describing. Some babies are born reluctant nursers. Sometimes the circumstances of birth can play a role too, as in a very long, difficult birth or sometimes, even an extremely rapid birth.

Babies who are deeply suctioned at birth (sometimes necessary if there is mec) can develop oral aversions. Also some kiddos seem to develop habits in utero that contribute to nursing problems. Last April, we had a little one born who, first of all, was somewhat depressed and needed some active resuscitation post-birth, then had some tachypnea and transient nasal flaring and grunting. Things settled down quickly but the baby did not nurse for a good 12 hours post-birth. Fortunately, the parents gave birth at my partners house, and stayed the night because they were so tired, and this allowed us more time to work with them. Finally, the other thing I discovered the following morning, was that the baby had developed the habit of sucking on her lip and was very resistant initially to the breast.

When I have babies who don't exhibit interest in nursing in the first few hours, I always look for reasons (difficult birth, any signs of distress, maybe too much environmental stimuli, and so on). I encourage skin to skin contact and consistent gentle efforts to offer to nurse. As far as getting babies to take my finger, I have found that it is helpful to be very gentle about this...... I tickle the lips with my finger just as I would have mom do with her nipple, and let the baby set the pace with accepting my finger. This seems to work well most of the time.

Finally, if baby continues to be reluctant and it is getting on to be 24 hours, I try to get mom set up with a hospital grade electric breast pump to start stimulating milk production, continue with skin to skin, etc. If mom can get some colostrum, it can be cup fed to the baby or an eye dropper can be used. If I can't get the mom to pump or get any colostrum, I would consider using formula at that point in a cup (just small amts). Sometimes, once the baby gets a little something in his or her tummy, they figure out that they want to eat.....


I wouldn't worry TOO much about them if all else seems normal. Some babies just don't want to nurse till they get hungry and it really doesn't hurt them to go for a while. (Remember the huge controversy in the 60s about "early feeding", when it was considered unhealthy to allow feeds before 24 hours?). If a baby is showing any signs of hypoglycemia - and wont nurse or take a bottle - then you can correct it easily with a tiny bit of syrup or Karo on your finger.


I would just keep an eye on these kids, keep attempting every couple hours. They might take a day or two to get the hang of life outside the womb where they have to work for their supper!

IF ALL ELSE IS NORMAL, they probably will become ravenous on day two or three when the milk comes in...


This last baby that didn't nurse finally started at 18 hours. I had the parents giving her sterile water w/sugar. This seemed to get her interested and all is well now. No I don't remember in the 60's about the delayed feeding. I think I was in high school and not even thinking about this. But I'm glad to hear it. Thanks.



Contented Babies Who Don't Nurse Often Enough



On the Popular Misconception that A Baby Won't Starve Itself

This is a common misconception. Some babies are content to quietly sleep themselves into Failure to Thrive or even death. Diaper count is useful but often hard for mom to focus on. Before meconium is passed 2-3 wet diapers a day is okay. as doulas here a couple tips to check on breastfeeding: At 2 week PP visit look at baby... talk to mom.. Does he appear healthy and alert? Is he growing well? gaining 4-8oz. week from bottom weight?

Slow weight gain has the potential to be serious...but with close monitoring and good breastfeeding management it can be turned around. Mom and baby can continue to have a happy nursing relationship.


You can boost baby's caloric intake using the settled fat from mom's own expressed milk. The mom can express some of that copious milk supply, leave it to stand then skim off the fat layer that settles out and mix it with a small portion of the thinner milk, this would supply baby with a great caloric boost to try and up the weights.

A mom with lots of milk is doing something right to keep the supply going strong. I agree that baby should be encouraged to nurse more often and as long as possible on the one breast as possible, only switching when baby seems completely done and uninterested in "working" the breast. Offering the second breast that will supply and easy "slurp" is good for a top off.



Sugar Water Is Never Appropriate



Just a little note of correction here, no baby should ever be given sugar water under any circumstance. If they are not nursing and you are simply concerned about dehydration, simple water is best. If they are not nursing or not nursing sufficiently, they should be given formula (by bottle, cup, syringe, finger, whatever). Giving a baby glucose water is like feeding them cocacola. Not good. It leads to destabilized blood glucose levels because they put out a lot of insulin when they first get the sugar and then can drop their blood glucose levels precipitously as they metabolize the sugarload. These kind of blood sugar surges and declines can lead to mild behavior changed (such as irritability and difficulty nursing -- just what you are trying to fix) all the way to coma and brain damage in a susceptible baby whose well meaning parents feed it too much sugar water.

The American Academy of Pediatrics stated a few years ago unequivocally that infants should never be fed sugar water. Regular water for dehydration prevention or to stimulate nursing is sufficient in most cases. A non-nurser needs whole calories such as that provided by pumped breast milk or formula, not the "empty" calories and sugar rush provided by glucose water.

If you are still not convinced, the next time you have to do a three hour glucose test on a woman, ask her how she feels an hour after the 100 gm glucose load on an empty stomach. Most of my clients say they feel flushed and lightheaded. Then ask them how they feel at the end of the test. Most of my clients say they feel tired and listless. Is this really what you want to put a newborn through?

I do not mean to sound harsh, I know that midwives who recommend sugar water are doing what they think is right, but I urge all of you who still recommend sugarwater to reconsider this advice and gather whatever information you need to convince yourself and you clients that pumped breastmilk or formula is best.

I cringe every time I enter the newborn nursery at my back-up hospital and see the cases of glucose water. Can't seem to convince them.


With regards to giving a newborn sugar water, I attended a Perinatal conference in Texas in 1996 and heard a speaker refer to just that! The speaker said that research has shown that supplementing with oral sugar water may actually delay the excretion of bilirubin in a newborn's immature digestive system! I am so glad you brought this subject up!



Latch Problems



During my training as an LC, we learned of the correlation between receiving IVs and poor latch (not just with narcotics).  The excessive fluids the mom received can cause edematous nipples (which are usually not noticeable by one who doesn't know what they are looking for).  So they explained the importance of getting a full birth hx on a mom with nursing difficulties. One thing to ask is if she was pitted (or had any IVs).  With such a large,  edematous nipple, latching is often more difficult for the baby.  This usually takes 24-72 hours to resolve, but as we know, if there isn't help with poor latching the first day, nursing difficulties can be long-term.  I think if a mom is aware of what the problem might be and is given tips to work with the issue, she is more likely to be armed to deal with the problem.

This helps us to remember that ANYTHING we do that interferes with the nl process of birth may cause problems later, so we all need to choose our interventions wisely and be prepared for the potential consequences.  I would never have thought of a pit IV as having problematic sequelae for latching.


A tongue-tie can make a good latch difficult or impossible, and it can be cut in a simple procedure called a frenotomy.  The connective tissue may stretch, so some mothers will take it day by day before deciding to have it cut.  If it's really interfering with breastfeeding, it probably makes sense to cut it sooner rather than later.  But if it's a borderline case, you may choose to wait and see.



Inverted Nipples



Thanks to Marsha Bearden RN, IBCLC, a lactation consultant in Alabama, who wrote to tell me that her web site offers the Niplette for sale!

Avent sent me a sample when I faxed them a request on my midwife letterhead.  I can see that it would work well, and it's got some rave reviews on some of the lactation lists.  Combined with the research, I'd say it's definitely worth a try.  However, it is pricy - $50 retail.

The sample came with a brochure listing a toll-free number; it didn't work when I tried it, but here it is, just in case: 1-888-Niplette (647-5388).  Their main number is 800-542-8368, and you can theoretically order the Niplette from that number.  Good luck.  The Avent America site has a Store Locator Page.

Most references to the Niplette appear to be British.  I did find some sites with pictures of the product in use:  Here's a British Avent site, a French Avent site and a Dutch site .


The "Niplette": an instrument for the non-surgical correction of inverted nipples.

McGeorge DD
Br J Plast Surg 1994 Jan;47(1):46-9

Inverted and non-protractile nipples are a common problem which cause psychological distress and interfere with a woman's ability to breast feed. A new instrument, the "Niplette", readily corrects the defect without the need for surgery. It is cheap and all patients found it comfortable and easy to use. Breast feeding is possible after treatment. The device should replace surgery in medical practice for this common condition.

Interesting articles from Lactnet about the Niplette:

Hoffmann's hypothesis, shells and Niplette

Re: Niplette


I have heard of the nipplette and it seems to work fairly well but is outrageously expensive. There is another product on the market that is better in my opinion. It is called Evert (?) and was invented by Edie Armstrong. You can reach her at: Edie Armstrong BSN, IBCLC, Fairfax, mailto:earmstr@erols.com

There is also an easy way to make something similar yourself: Take a 10cc syringe and cut off the end where the needle goes. A hacksaw works well. (Take off the needle first!) Take the plunger and insert it into the end you just cut off. The uncut end fits over most nipples. Have the mom place it over her nipple and gently have her pull back on the plunger. This pulls the nipple out very well and its cheap!

Another thing to do is have the mom use the Hoffman technique. Have the mom place her thumbs on the areola at 12 & 6 and gently pull her thumbs apart. Tell her to work all around the areola and do it 2-3 X a day. This helps break the adhesions that are holding the nipple in.

I have moms do these and using nipple shells starting about 30 weeks. If you don't catch the inverted nipples until after the baby is born they still work. Using the syringe right before the baby latches will really help.


Treatment of inverted nipples using a disposable syringe.
Kesaree N, Banapurmath CR, Banapurmath S, Shamanur K
J Hum Lact 1993 Mar;9(1):27-9

Seven mothers who had inverted nipples were helped to breastfeed their infants with the assistance of a simple device made from a 10 ml disposable syringe. These women were able to successfully breastfeed within one week. On follow-up, these mothers were able to sustain adequate breastfeeding.

Preparing for breast feeding: treatment of inverted and non-protractile nipples in pregnancy. The MAIN Trial Collaborative Group.
Midwifery 1994 Dec;10(4):200-14

CONCLUSIONS: in the light of the findings from this and a previous single centre trial, there is no basis for recommending the use of either Hoffman's nipple stretching exercises or breast shells as antenatal preparation for women with inverted and nonprotractile nipples who wish to breast feed. Given the lack of evidence to support these and other antenatal preparations there are no grounds for midwives to continue routine breast examination in pregnancy for this purpose.

Randomised controlled trial of breast shells and Hoffman's exercises for inverted and non-protractile nipples.
Alexander JM, Grant AM, Campbell MJ
BMJ 1992 Apr 18;304(6833):1030-2

CONCLUSIONS--Recommending nipple preparation with breast shells may reduce the chances of successful breast feeding.  While there is no clear evidence that the treatments offered are effective antenatal nipple examination should be abandoned.

You can order the Evert-It Nipple Enhancer (here's a picture) - item No 441-21, $19.95 in the Accessories section of the online La Leche League Store.


Larry's Flat or Inverted Nipples FAQ - A summary of a devoted dad's research into inverted nipples - from The Nursing Baby



Engorgement



Breast Engorgement - Prevention & Treatment


A Well-Oiled Machine by Jill Stansbury, N.D. - The little-studied and underappreciated lymph system keeps internal fluids flowing and contributes mightily to immune function.  [Although this isn't directly about breast engorgement, I think it's a good explanation of the lymph system, which is largely discounted in Western medicine.]


Oketani Breast Massage - relieves engorgement and improves milk quality

Composition of milk obtained from unmassaged versus massaged breasts of lactating mothers
FODA Mervat I. (1) ; KAWASHIMA Takaaki (2) ; NAKAMURA Sadako (2) ; KOBAYASHI Michiko (3) ; OKU Tsuneyuki (2) ;

Background: The Oketani method is a program of breast massage and clinical counseling developed by the midwife Satomi Oketani. The purpose of this study is to examine the effects of the method on the quality of breast milk by determining the chemical composition of the milk before and after massage. Methods: Milk samples were obtained immediately before and after massage from healthy, exclusively breast-feeding Japanese mothers at two different periods of lactation one <3 months the other >3 months after parturition. Lipids, whey protein, casein, lactose, ash, and total solids in milk were measured in milk samples. The gross energy content of milk was estimated. Results: Breast massage significantly increased lipids in the late lactating period but not in the early lactating period. In the early lactating period casein was increased by breast massage but was not significantly affected in the late lactating period. Breast massage caused a significant increase in total solids from the first day to 11 months post partum. The gross energy in the late lactating period was significantly increased by breast massage but not in the early lactating period. Lactose was not significantly changed by breast massage. Conclusions: Breast massage improves the quality of human milk by significantly increasing total solids, lipids, and casein concentration and gross energy. The milk of mothers treated by Oketani breast massage may improve the growth and development of infants.

More information about Oketani massage at:
http:


Treatments for breast engorgement during lactation.
Snowden H, Renfrew M, Woolridge M.
Cochrane Database Syst Rev. 2001;(2):CD000046.

"AUTHORS' CONCLUSIONS: Cabbage leaves and gel packs were equally effective in the treatment of engorgement. Since both cabbage extract and placebo cream were equally effective, the alleviation in symptoms may be brought about by other factors, such as breast massage. Ultrasound treatment is equally effective with or without the ultra-wave emitting crystal, therefore its effectiveness is more likely to be due to the effect of radiant heat or massage. Pharmacologically, oxytocin was not an effective engorgement treatment while Danzen and bromelain/trypsin complex significantly improved the symptoms of engorgement. Initial prevention of breast engorgement should remain the key priority."


Cabbage Leaves for Engorgement

The following was written by a Sister Merle Lees who has been researching this topic.

The use of cabbage leaves is a very old treatment, having been used in England as far back as 25 years ago. Cabbage leaves have also been used for various other complaints over the years.

The cabbage belongs to the "Brassicacae Family" and contains mustard oil, magnesium, oxalate and sulphur heterosides. Sulphur in amnio acid methionine acts as an antibiotic and anti-irritant, which in turn draws an extra flow of blood to the area. This dilates the capillaries and acts as a counter irritant, thus relieving the engorgement and inflammation and allowing milk to flow freely.


For Engorgement or Encouraging Letdown

If you're engorged and/or want to encourage letdown, you take a small disposable diaper ( I use them because I'm lazy and I guess a little selfish, but you can get a couple from a friend or neighbor if you don't use them) Anyway, you put about a cup of water in it and microwave it just for a few seconds. You have to experiment with it and really feel around so it's warm, not scalding hot. Then you take the diaper and mold it around your breast in your bra. It fits great, doesn't get you all wet like a washcloth and can be reheated over and over. I found this to work wonders during those first days when I was too stressed out to get a good letdown right away, and when I needed to pump and my baby wasn't able to inspire me, that warm diaper worked like a charm. 

Can anyone give me some information on the use of cabbage leaves for breast engorgement when lactation first gets going? I've heard about it but know very little.....how and why does it work? Does it matter what type of cabbage?


In the unit where I work in Victoria, Australia, we use fresh, cold cabbage leaves frequently for the postnatal women for breast engorgement. It works fantastically and feel very soothing as well as reduces the supply.


A comparison of chilled and room temperature cabbage leaves in treating breast engorgement.
Roberts KL. Reiter M. Schuster D .
Journal of Human Lactation. 11(3):191-4, 1995 Sep.

ABSTRACT: This study compared the effectiveness of chilled and room temperature green cabbage leaves in reducing the discomfort of breast engorgement in postpartum mothers. Twenty-eight lactating women with breast engorgement used chilled cabbage leaves on one breast and room-temperature cabbage leaves on the other for a two-hour period. Pre-treatment pain levels were compared with post-treatment levels for both conditions. There was no difference in the post-treatment ratings for the two treatments; mothers reported significantly less pain with both treatments. We concluded that it is not necessary to chill cabbage leaves before use.


Cabbage leaves are commonly used to treat engorged breasts. I advise women to separate two fresh (not cooked) leaves and gently bruise the inner side with a kitchen utensil i.e. rolling pin. Then one leaf is placed on each breast for 15- 20 minutes. This can be repeated as often as desired. There have been a few studies that demonstrate efficacy, but they have had small numbers.

Other advice for engorgement or mastitis include hot compress before feeding and cold afterwards.

A randomized, controlled trial was conducted to evaluate the effect of cabbage leaves on mother' perceptions of breast engorgement and the influence of this treatment on breastfeeding practices. The subjects, 120 breastfeeding woman 72 hours postpartum, were randomly allocated to an experimental group who received application of cabbage leaves to their breasts, or to a control group who received routine care. The experimental group tended to report less breast engorgement, but this trend was not statistically significant. At six weeks. woman who received the cabbage leaf application were more likely to be breastfeeding exclusively, 76 and 58 percent (36/35 vs. 29/50;P=0.09) and their mean duration of exclusive breastfeeding was longer. (36 vs. 30 days; P=0.04) The greater breastfeeding success in the experimental group may have been due to some beneficial effect of the cabbage leaf application, or may have been secondary to reassurance and improved confidence and self esteem in these mothers
BIRTH 20:2 June 1993


Growth Spurts



Growth spurts from kellymom.com


Breastfeeding During a Baby's Growth Spurt from about.com



For Increased Milk Supply



NOTE - Recent insertion of an IUD with hormones might reduce your milk levels.

NOTE - If you think you need to increase your milk supply because the baby has suddenly seemed hungry all the time, needing to nurse every hour or so, consider that the baby is having a growth spurt and may be ramping up the milk production through the increased nursing; then you don't need to do anything but nurse the baby and keep up the nutrition, hydration and rest that allow your body to make all the milk that your baby needs.

NOTE - If a woman doesn't respond to efforts to increase her milk supply as expected, consider the possibility that there may be underlying thyroid problems.  Even if she's already had her thyroid tested in this pregnancy, consider doing another thyroid test or referring to a physician for evaluation.


The Breastfeeding Mother's Guide to Making More Milk: Foreword by Martha Sears, RN (Breastfeeding Mothers Guide) by Diana West and Lisa Marasco

One of our local doulas strongly recommends this book: "This book is excellent for figuring out why there is low milk production (which is the first step) and how to bring it back up. Out of all the lactation books that are for problem solving this is the best I have read so far. Organized and clear with a lot of problem solving ideas and multiple routes to solutions that are specific to the problem. The only thing that I did not like is that one of the websites it refers to throughout the book is no longer supporting the text it refers to."


I like MegaMam from Tri-Light Herbs; it's a tasty glycerine formula so my clients will actually take it! and they like not taking alcohol-based herbs while breastfeeding.


Has anyone tried Go-Lacta™?  It's the leaves of the Malunggay tree (moringa oleifera), an Asian lacatagogue from Sugarpod Organics.


These suggestions can be found in After the Baby's Birth by Robin Lim and Earl Mindell's Herb Bible:

Alfalfa - 3 to 6 daily (capsules) or 1 tablsepoon with 8 ouces hot water brewed into tea daily.
Anise - 1 teaspoon powder (crush seeds) in 1 cup boiling water 3 times daily.
Borage
Dill - 2 teaspoons seeds steeped in 1 cup hpt water for 10-15 minutes.
Strain. Take 1/2 cup 2 to 3 times daily.
Comfrey
Fennel - 10 to 20 drops in water  of extract daily. Can purchase as a tea.
Fenugreek - 2 capsules 3 times a day
Red raspsberry leaf tea
Blessed Thistle - 2 capsules 3 times a day
Caraway - 3 to 4 drops of extract mixed in liquid 3 to 4 times a day. Can brew herb into tea.
Brewer's yeast - 2 capsules 3 times a day.
Shatavari - an Ayurvedic herb. up to 3 grams of powder in a cup of warm milk with honey and ghee.

Can buy a variety of prepared commercial products:
Mother's Milk Tea by Traditional Medicinals

Magnetic Mama Lactation Tea with blessed thistle, borage, alfalfa, red clover, raspberry, fenel, nettles, hops, peppermint from Moonflower

Midwife Formula 6-L: Mega mam with milk thistle, chast tree, fennel, borage, red raspberry, lemon balm from Spirit Led


Fennel is a good lactation stimulant and one of the easiest ways to take it in quantity is the candy coated seeds you get from Indian food shops. If you've no Asian food shop close (and it has to be the sort frequented by Asians, rather than the Asian run corner shop) just boil normal fennel seeds for five minutes, strain and add honey if you want. If she doesn't like the taste of fennel, other lactation stimulants are fenugreek, celery and nettle.


Sometimes a mom's milk supply appears not to come in because she's having so much difficulty relaxing during a feed.  This can be the result of a difficult previous birth or breastfeeding experience, ambivalent feelings about breastfeeding or body image, or whatever.  Obviously, you want to address the basics - helping her to get completely relaxed, maybe nursing baby in a warm bath or with her feet in warm water or wrapped in a warm blanket, aromatherapy, lots of warm loving support, and . . . music, music, music!

I was delighted with the results we got when a mom started listening to Renee Smith's music - it's a wonderful combination of more traditional lullaby styles with more nurturing lyrics.  My personal favorite is her Angels & Mermaids CD, with her Lullabies For My Little Angels a very close second.  Her Seeds & Songs To Make 'em Grow is a wonderful collection for "older children", i.e. toddlers and pre-schoolers, not to mention their parents!  I don't know what it is about this music, but it always makes me so happy!  Cheaper than therapy and lots more fun.


Chiropractic Helps New Mothers Produce Milk

An article in the March 2007 issue of the scientific periodical, the Journal of Clinical Chiropractic Pediatrics, presents three documented case studies of chiropractic care helping new mothers who were unable to produce adequate mother's milk.  A reduction in mothers milk, known as "Hypolactation" can be a serious problem that can create health issues for both the mother and child.

The first case was a women who went to the chiropractor on the referral of her midwife.  She had given birth 10 days earlier to her second child and unlike her first, she was unable to establish a milk supply for her second baby.  The patient had no other medical issues other than difficulty in swallowing a glass of water.

An examination determined that she had a subluxation, and specific chiropractic care was initiated to correct that issue.  After her second visit the patient commented that she found it much easier to swallow. By the third visit she noticed visible changes in her breast and the production of milk.  This improvement resulted in a positive weight gain for the infant who was forced to depend of formula until the mothers milk issues were resolved.

The second patient went to the chiropractor for upper back pain but was also unable to produce sufficient milk to feed her one month old infant.  Her examination showed no medical history for her problems, however, the chiropractic portion of her exam showed subluxations.  She began a series of specific chiropractic adjustments for subluxation correction.  By the forth visit the patient was noticing breast enlargement and the production of milk.  She also became pain free from the upper back pain she was experiencing.

The third case was a women who came into the chiropractor's office with her daughter six days after birth.  She was sent there on the recommendation of the hospital lactation consultant. As in the previous cases, subluxations were found and care was initiated to correct them.  In this case it took only 24 hours for the positive results to show, and for this mother to be able to feed her infant naturally.

Based on their case studies and the volumes of previous research, these researchers concluded that subluxations and the neurological interference they cause play a major role in Hypolactation.  The researchers suggest, "Chiropractic evaluation for subluxations would be a key element in the holistic assessment of the failure to establish milk supply in the postpartum patient."


Ellen Roos - Passion Flower Music - Songs that see and stir, love and forgive, lift, bless and free! Her first album is Lavender and Morning Sun.



Herbs/Homeopathics for Breastfeeding (Galactagogues)



The FDA just issued a black box warning about the prolonged use of Reglan. Basically it has been found to induce tardive dyskinesia symptoms in rare patients AFTER several months of use.

I would suggest that mothers use Reglan only for a month or 2 at most and then taper off of it.

Tom Hale Ph.d., 6/21/09


Galactagogues from Dr. Thomas Hale's web pages, including discussions of domperidone, reglan, blessed thistle, fenugreek, oxytocin nasal spray, lovonox.


Herbal Galactagogues Compiled by Gretchen Humphries [March 02, 2000]


Herbs for Milk Production

Blessed Thistle IS awful - so bitter. I make up tea for my moms with 2 oz fennel seed, 1-2 oz of other aromatic seed (fenugreek, dill, caraway, anise - whatever I have), sometimes an ounce of Oatstraw (or Chamomile), and a few PINCHES of blessed thistle. It is quite powerful, and the other aromatic seeds are also good milk supporters, so no need for more. You can't taste it at this concentration.

This makes 2-3 quarts - enough for a week or two unless correcting a real problem with supply. Steep in a closed jar at overnight. I like to give moms a little baggy of it for mental support that first time they think "ACK, no milk". The few that really need it buy more on their own.

I don't add raspberry leaf - I think someone mentioned it counteracts milk-supporters to some degree. Anyone else heard this?

I suppose you could take BT in capsule form if more was needed, but have never encountered that degree of problem.

To increase milk try any of these (or combo): fennel seed tea or capsules, hops tea (or good quality non-alcoholic beer), two 500-mg capsules morning/evening of vitex (chaste berry), blessed thistle, aniseeds, nettles, raspberry leaf tea/capsules, fenugreek, nurse often, marshmallow root, alfalfa, brewer's yeast pills, zinc, selenium, vit E, iron, soy, wild yam, and a lot of fruits and vegetables.


I've had moms use Blessed Thistle to increase the fat content of breastmilk and had it work wonders.


From our local herbalist:

I have much experience with this (the Fenugreek part anyway!).  The dose of Fenugreek depends on her situation (i.e. how much milk she's already making and how much increase she needs).  I recommend starting with a low dose of 3 caps three times a day.  With our Fenugreek, she should see results within 24 hours or less.  If the increase hasn't been achieved, then she can go up to 4 caps 4 times a day.  Fenugreek should be taken as a "single" meaning not blended with anything else.  This is because the Fenugreek dose needs to be consistent and regulated for best results.  When it's in a blend, it's nearly impossible to regulate how much FG is in each dose, which can cause an up and down supply, or for some, a decrease.  When she's achieved her goal and her supply is stable, she can then slowly wean down from it and be done.  Here's more on Fenugreek and how to use it correctly.  We have it in vegi-cap and tincture (liquid extract)  - it's organic, very fresh and according to our clients, works much better than any FG gotten off a store shelf.  This is probably a freshness issue.  Here's the link:

http:

And for more ideas on how to increase milk production:

http:

She may not necessarily need FG.  Once she starts, she needs to be consistent until ready to wean down.  I do a lot of this work, and would be happy to talk to her about her situation and what would be most helpful for her.  In order to have it affect her blood sugar, she would need to take very large amounts of it - grams.  I tend towards low blood sugar, and I did not notice any effects when I was taking FG.  It should not be  a problem at all.  Again, I'm happy to speak with her about this.


Homeopathics for Milk Production

Lactuca Virosa - A true galactogogue that really brings in milk. Take 4 pellets, 4 times per day.

"A new mother may experience great stress if her new baby has difficulty with breastfeeding. This stress often becomes part of a vicious cycle, further exacerbating the problem. Homeopathic Silicea (taken by Mom and imparted to baby through the breast milk) helps the delicate infant who needs appetite stimulation, and helps with watery stools and vomiting after nursing."  For other tips on homeopathics for nursing and newborn care, see the EMAZING.com archives of the Homeopathic Health Tip of the Day


Don't Touch Baby on Back of Head While Nursing

Dr. Maryelle Vonlanthen spoke at the 1995 Arkansas Midwifery Conference. In her talk she stated that newborns have a reflex on the back of their head that makes them arch backwards when that part of the head is touched. She suggested that those helping a mother with her first nursings should be careful not to touch the back of the babies head since that would only make the baby come away from the breast not toward it. She suggests holding the baby by the nape of the neck instead of the head to bring it into the breast.

Herbs to Avoid During Lactation from HerbLore (scroll down the page)



Domperidone



Serious risks associated with domperidone

FDA Warns Against Women Using Unapproved Drug, Domperidone, to Increase Milk Production - [Mon Jun 7, 2004] "Breast-feeding women should not take the drug domperidone to boost milk production, because it may put them at risk of serious heart problems and sudden death . . ."

I have personal experience with it and have done much of my own research.  I recommend looking at what Jack Newman has to say- he is definitely an authority on the subject.  http: Also, read Medications and Mother’s Milk, by Thomas Hale.

As for how it will work, if her supply is low due to a hormonal issue, it is likely to work as it increases prolactin.  Sometimes there is no way to know the cause and the only way to know if something works is to try it.  I second what others said about Reglan…I would definitely steer clear of that!  Domperidone is not available in the US, which is why Reglan is often prescribed, but Domperidone is easy to get from overseas through www.inhousepharmacy.com.  My understanding of why it has not been approved in the US is because there was an incidence of heart failure associated with BUT it had been given through an IV to an immuno-compromised person.  It has been used for quite some time to increase milk production with apparently good/ safe results.  I, myself, had a good experience with it. I tend to be pretty anti-pharmaceuticals and given my situation, I was pretty comfortable taking it.   In my case, I took it for about 4 or 5 mos and once I weaned off of it, I was able to maintain the supply I had while taking it with no problem.  I also used many herbs, acupuncture, etc. first and decided to try Dom when they weren’t quite getting me to where I needed to be.

Lastly, I recommend any mom who is truly struggling with low milk supply (or any other unusual BF difficulty) to join the Mothers Overcoming Breastfeeding Issues yahoogroup.  (mobi@yahoogroups.com).  This group has been an amazing wealth of support and information and she will hear all kinds of research and personal experiences with Dom on this list.  The author of Making More Milk is also a regular on the MOBI list.


The majority of my moms have excellent results even after a few days. A few have felt a little dizzy or off, but once they adjusted the dose things cleared up. Dr. Jack Newman uses it routinely for supply issues. (Also check his website out) and it is widely accepted and used in Canada.  Thomas Hale’s Mediations in Mothers Milk 2008 edition has some good information about the drug also.  I agree that Reglan has been a nightmare for most of the moms I work with.  The CNS side effects are not pleasant and who needs more anxiety and depression after having a baby.



Initial Breastfeeding Pain



One thing that bothers me about lactation consulting and "experts" in nursing is the premise that breastfeeding is always comfortable (ie not painful).  All I ever see is unmedicated babies and mothers.  100% of the time breastfeeding hurts at first.  This is with a good latch and well-educated mothers in advance of the birth.  I am of the mind that it's supposed to hurt and that telling the mother that something is wrong when it hurts is very undermining.  I think the idea of painless, comfortable first week nursing is a result of most babies being born medicated out of their little minds.  The anaesthetized baby does not suck like a barracuda.

Just as birth does not progress at home in a watertub the way "they" say it "should", breastfeeding with a conscious mother and baby is very different from what I read in books and articles.  Naturally born babies, whose cords are left to pulse, and who find the breast for the first time in a relaxed, easy way
1. don't lose any weight
2. bring the milk in on Day 2
3. cause some initial soreness and trauma to the nipple that is unavoidable

I'd like to hear from others on your observations. I think we need to be cautious in telling mothers that something's wrong if breastfeeding hurts at first.  With good positioning (close to chest, tummy to tummy; ear-shoulder-hip in straight line) the mother/baby pair will sail through that initial soreness without a big deal and the nipples will toughen.  I've just had a client who was advised that it should NEVER hurt and she is essentially bottle-feeding now because she was told that the latch was wrong whenever she expressed discomfort to her lactation consultant.  It all looked fine and normal to me and I was of the mind to just persevere on through.  I'm very upset that her breastfeeding confidence was so undermined and am now of the mind to ban lactation consultant advice for the first week. The lactation cons. involved is someone I greatly admire and I know she has done wonders for women in her area but I think she's just not used to naturally born barracudas (oops I mean babies!).


I tell my clients that the baby's job is to suck, suck, suck to bring the milk in and that babies who do this are very smart babies.  They know that by bringing the milk in as quickly as possible, they'll have milk before they exhaust their birth resources.  I reassure them that once the milk is in, the baby won't need to nurse as strongly or as much, because the luscious, nutritious milk will just flow into their mouths with gentle sucking.  And it's almost always true.



Cracked Nipples



Moist Wound Healing

Nipple wound care: a new approach to an old problem.
Cable B, Stewart M, Davis J
J Hum Lact 1997 Dec;13(4):313-8
A moist environment is critical for epithelization, the proliferation and migration of epithelial cells across the surface of a wound during healing. Nipple wounds also heal by this process. Using a particular type of wound dressing, a hydrogel sheet wound covering, on a nipple wound offers several advantages. These dressings help maintain a moist environment, decrease the chance of bacterial infection, are easy to use, and provide immediate pain relief.

Moistness-The Secret of Healing Sore &  Cracked Nipples: from the San Diego Breastfeeding Coalition at breastfeeding.org


Information about Sheet Hydrogels with a list of manufacturers.


Some people are using ClearSite - a gel dressing. Call Sue Cornell at 1-800-765-8375 ext 2391 to request samples.


There's a lovely vegan product called Breast Balm from MaternaCare.


I have used this or another type on 2 women now with really good results. Both loved the way it feels, immediate relief from the pain of severely cracked nipples. I have also used it in conjunction with Lansinoh.

I have just cut them to fit around the site of the crack. I do not cover the whole nipple. So far it has worked just to tuck them into the moms bra. With a woman with smaller breasts I would have to play around and see what would work, tape maybe? I try to be sure that we have corrected the problem that has caused the crack and have the mom be fanatical about correct positioning.

So far I have been really happy with the results and have not seen a problem from the continual moisture. Small sample, I know, but I haven't heard any bad reports from lactnet either.


Geranium leaves for intractable cracked nipples. Lansinoh is also very good.


Lansinoh Samples Call (in the USA) 1-800-292-4794 and Lansinoh Laboratories will send you free samples with an informational brochure that includes LLLI's endorsement, history and phone number. They will send you a supply monthly.


Fat Babies Are Happier


Breast-Feeding Cuts Infant Infection Risk



Painful Letdown or Persistent Pain - Nipple Vasospasm and Raynaud's



Vasospasm suggests overactive muscles in the ducts; this could be the result of a magnesium deficiency, and increasing magnesium is one of the simplest remedies to a lot of problems stemming from muscular overactivity or calcium/magnesium imbalance.  [NOTE - Magnesium oxide will cause your stool to be looser; magnesium citrate has less effect on your bowels.]


Vasospasm and Raynaud’s Phenomenon from Dr. Jack Newman

Sore Nipples by Dr. Jack Newman

Treatments for sore nipples and sore breasts: All-Purpose Nipple Ointment by Dr. Jack Newman


Seeking Relief - Excellent page from LLL site about diagnosis and simple and more complicated treatments for nipple vasospasm


Raynaud's Phenomenon of the Nipple May Cause Painful Breastfeeding by Laurie Barclay, MD [Medscape]

Prompt treatment allows mothers to continue to breastfeed pain-free, and it avoids unnecessary antifungal therapy for misdiagnosed C albicans.


This article on Using Gentian Violet has some helpful points about diagnosing thrush vs. nipple vasospasm.  In particular, they write, "The pain caused by a Candidal infection is generally different from the pain caused by poor positioning and/or ineffective suckling. The pain caused by a Candidal infection . . . Frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast to the pain due to other causes that usually hurts most when the baby latches on, and gradually improves as the baby sucks."


If you're trying to find a doctor who will prescribe Nifedipine, you should start with your family doctor, OB or pediatrician.  If they're reluctant, show them the research paper.


Hi.  I have a client who describes a painful let down.  This is the third baby, she has successfully BF the other two with no problem.  She says this is not a latch issue, and I have checked and it looks great.  The let down is painful.  Any one have any information or insight or suggestions.


I have a client who is currently mid-pregnancy.  With her previous baby, she weaned early because of  EXTREME pain with let-down.  She described normal early tenderness with initial latches that subsided with time, but increasing intense pain with let-down so that pain extended from the breast through to her back.  She confirmed there was no pain with suckling, no nipple pain, only with let-down and this included let-down from sexual stimulation and simple showering in warm water (even described as "contractions" in the breast, feeling the milk flow as "burning"). She is eager to nurse this next baby but is wary of the same experience.  She has not had issues with yeast in the past and did not describe symptoms that would jibe with thrush (in my practical experience).

Can anyone share a similar experience and how I might help her with this?


I think it always makes sense to treat persistent pain (beyond the first week or ten days) with holistic thrush treatments.  In addition, you want to rule out Raynaud's.  You can also try lobelia for spastic letdown similar to the spastic cervical dilation during labor.


I have experienced this.  It was like "pins & needles" with let-down.  I simply used labor breathing and relaxation to get through let-down, and it did get better as baby got older. By 18mo it was gone. [Ed. This sounds like a much milder version of the EXTREME PAIN that others experience.]


Resources about Nipple Vasospasm and Raynaud's

This is a very painful condition characterized by pain, numbness, burning, tingling, and extreme color changes of the nipple.  These symptoms are exacerbated by cold and emotional stress.

Treatments for Raynaud’s Phenomenon (blanching of the nipple) [search about halfway down on this page] - "The first choice for treatment is:

    * Vitamin B6. This has shown to work by trial and error, but it does seem to work. There is no scientific evidence that it works, but it does nevertheless. It is safe and will do no harm. The dose is 150 mg/day once a day for four days, followed by 25 mg/day once a day. The mother continues it until she is pain free for a few weeks. It can be restarted if necessary.

If vitamin B6 does not work within a few days, it probably won’t. It is then useful to try:

    * Nifedipine. This is a drug used for hypertension. One 30 mg tablet of the slow release formulation once a day often takes away the pain of Raynaud’s phenomenon. After two weeks, stop the medication. If pain returns (about 10% of mothers), start it again. After two weeks, stop the medication. If pain returns (a very small number of mothers), start it again. Very few mothers I am aware of took more than three courses. Side effects are uncommon, but headache does occur. "

Raynaud's Syndrome and Breastfeeding from breastfeeding.com

Nipple blanching and vasospasm

NIPPLE VASOSPASM - A MANIFESTATION OF RAYNAUD’S PHENOMENON AND A PREVENTABLE CAUSE OF BREASTFEEDING FAILURE - A good comprehensive site

Raynaud's Phenomenon, and High Arched Palate from The Compleat Mother archives.  [This contains some overlap material from the above sites.]

Nipple Pain And Vasospasm from multiplebirthscanada.org


Raynaud's phenomenon of the nipple: a treatable cause of painful breastfeeding. [Free full text article]
Anderson JE, Held N, Wright K.
Pediatrics. 2004 Apr;113(4):e360-4.

" . . . Raynaud's phenomenon has been reported to affect the nipples of breastfeeding mothers and is recognized by many lactation experts as a treatable cause of painful breastfeeding. . . . Because the breast pain associated with Raynaud's phenomenon is so severe and throbbing, it is often mistaken for Candida albicans infection. . . . To diagnose Raynaud's phenomenon accurately, additional symptoms such as precipitation by cold stimulus, occurrence of symptoms during pregnancy or when not breastfeeding, and biphasic or triphasic color changes must be present. . . . Treatment options include methods to prevent or decrease cold exposure, avoidance of vasoconstrictive drugs/nicotine that could precipitate symptoms, and pharmacologic measures. . . . Nifedipine, a calcium channel blocker, has been used to treat Raynaud's phenomenon because of its vasodilatory effects. Very little of the medication can be demonstrated in breast milk and thus is safe to use in breastfeeding mothers. Of the 12 mothers in our series, 6 chose to use nifedipine, and all had prompt relief of pain. Only 1 mother developed side effects from nifedipine. Pediatricians and lactation consultants should be aware of this treatable cause of painful breastfeeding and should specifically question their patients, because most mothers will not provide this information to the breastfeeding consultant. Prompt treatment will allow mothers to continue to breastfeed pain free while avoiding unnecessary antifungal therapy."


Nipple vasospasms, Raynaud's syndrome, and nifedipine. [Full text]
Garrison CP.
J Hum Lact. 2002 Nov;18(4):382-5.

This case report describes a situation in which a mother who experienced prolonged nipple pain with her first child sought help from a lactation consultant at the birth of her second child. Despite being very attentive to positioning and latch, similar pain was experienced from the first feeding with the second baby. The mother's history and symptoms were explored, and nipple vasospasms related to Raynaud's syndrome were suspected. After reviewing the literature and consulting with her personal obstetrician, the mother (a pediatrician) chose to treat with nifedipine. The mother was pain free after a 2-week course and nursing without difficulty at 4 months postpartum.


I once had a patient with painful/burning latch.  As an IBCLC I see a lot of yeast problems, latching problems and I've even seen a handful of Raynaud’s, but this patient didn't have any of that.  The baby was four months old, she had the exact same thing with her first child.  The kid had a perfect latch, she underwent a course of nystatin, followed by two courses of Diflucan (200/100 x 10 then 400/200 x 10), both she, her milk and her newborn cultured negative for yeast or bacteria.  We did a course of procardia without relief and there was no blanching with cold (even when I tried ice, no blanching).  In the end I figured it sounded more like neuropathy than anything else.  I consulted with our neurologist who agreed that ANY nerve can present with neuropathy.  We started her on a course of Neurontin and IT WORKED.  It took a little fiddling to find the right dose that would give her some relief.  The pain never completely resolved, but it did get much better.  In the end she nursed for six months and then stopped both nursing and the neurontin.


I also tend to association burning deep in the breast with yeast when it is beyond the normal "pins-and-needles" sensation.

Had a client recently who seemed to have BOTH problems. Deep burning in the breast - to the point of making her weep. And excruciatingly worse with cold that seemed like Raynaud’s. No particular pain with latching and as far as we could see - everything looked completely normal.

Her breasts looked completely normal and the baby was gaining, so it took a little while before we all figured it out (we being a pediatrician, two midwives and a lactation consultant). The Diflucan helped some, but not enough and she ended up weaning early.



Thrush



see also: Candidiasis/Yeast Infections


Information Sheet and Care Plan for Yeast (Candida) from breastfeeding-basics.com


Adding caprylic acid to the mother's diet can be helpful as caprylic acid is an anti-fungal made from goat's milk or other organic products.


Grapefruit seed extract (sometimes called Citricidal) is also very helpful in knocking out thrush and other candida infections.


This is from a very respected lactation consultation:

I have worked with hundreds of mom/baby pairs with thrush over the past 20 years and I have to say it has become a major problem and the reason why moms choose to stop breastfeeding.  This does not have to be the case. Mom or baby can be asymptomatic, but one can give it to the other. Both must be treated.  Also, over 50% of the strains of yeast that cause thrush can be resistant to the Nystatin.  If not resistant, many parents are applying it incorrectly and not swabbing directly on the tongue, checks and gums of the infant or they are not doing it often enough. I would suggest that the parents see a Naturopathic Doctor to work on their immune system and look at their diet. Take a good ProBiotic (45 Billion Live Organisms) we use/sell the Kendy’s Brand it is not grown on Dairy, put some on the nipples before feeds and sprinkle some in the diaper area. Most moms end on Difulcan/Fluconazole with a loading dose of 400 mg, then 200mg there after for at least 2 weeks with one refill.  Some moms have to take it for longer.  They also need to take it until the last symptom (for mom or baby) has been gone for at least 7 days.  Baby needs to be treated also. The amount of Diflucan that passes through the breastmilk is not therapeutic at all and will do nothing for the baby. The baby may be put on the same medication for the same length of time, if no response to the Nystatin or Gentian Violet.  Also, we need to watch for a secondary infection such as Staph.  When we have that much tissue break down it can happen and treatment needs to happen.  Many doctors will prescribe Dr. Jack Newman’s APNO (All purpose Nipple Ointment) for the mom to apply to the nipple to take care of this potential problem and help speed healing.


[Editor's note - Gential violet is not a plant product; is it a toxic, carcinogenic product which may be useful as a treatment of last resort, but please don't make it the first remedy you try!]

This article on Using Gentian Violet has some helpful points about diagnosing thrush.  In particular, they write, "The pain caused by a Candidal infection is generally different from the pain caused by poor positioning and/or ineffective suckling. The pain caused by a Candidal infection . . . Frequently lasts throughout the feeding, and occasionally continues after the feeding has ended. This is in contrast to the pain due to other causes that usually hurts most when the baby latches on, and gradually improves as the baby sucks."

This article on Seeking Relief gives a good description of Raynaud's or nipple vasospasm.


Gentian Violet is a deep purple dye.  Which can be the crystals dissolved in an alcohol base often called A tincture of Gentian Violet or was commonly dispensed in water aqueous gentian violet. Gentian Violet is actually a combination of 3 dyes methylin violet crystal violet and rosaniline violet. It is held to be antiseptic and disinfective and believe it or not as a pupil midwife I painted newborn babies umbilical stumps with this to prevent infection - the cords were on for AGES so it probably was very effective!


I am a midwife old enough to have used Gentian Violet for thrush with considerable success. You need an aqueous solution not the tincture for the baby's mouth and your nipples.  I have phoned my local pharmacist who says that while she hasn't got any, possibly some larger independent pharmacist may be able to get hold of some and dispense it.  It comes if I recollect, in the forms of crystals which the dispenser dissolves in water I do not recollect the prescription i.e. what the weight of crystals are to the volume of water but it isn't rocket science. If you have got access to a "Martingales" I'm sure it is in that.


We fought thrush for the first 12 weeks of my daughter's life.  Nystatin didn't work.  It was awful.  Here's what I did that finally worked:  1) I gave my baby Jarrow Baby Acidophilus (mixed with water to make a paste) on my finger and rubbed it on her cheeks (check with your doc, mine said it was fine) and 2) I took a mega dose of acidophilus.  One container of Bio K acidophilus (at whole foods in the cooler) a day. It was great and worked and ended the nightmare.  This stuff is THE BEST and was a lifesaver for us.  3) You can dip your nipples in apple cider vinegar/water mix after feeding.  4) Look up thrush prevention on kellymom.com.  My doc also said it usually takes care of itself by 6mo when the babies immune system kicks in.


Natren produces a probiotic product designed specifically for infants. Life Start is made with Bifidobacterium infantis - the beneficial bacteria which is most prominent in infants.  This can be beneficial for newborn thrush, newborn diarhea or diaper rash.


BioFlora makes a product called Infantiflora, containing B. infantis, which colonizes the baby's mouth with probiotics that suppress yeast.


The makers of Floradix also make an Infant's Blend Probiotic Blend, containing B. infantis, which colonizes the baby's mouth with probiotics that suppress yeast.


If seeking help for your baby from a pediatrician, you may run into the problem that they will not also treat the yeast in the mom's breasts!

There are some options that this new mom can take.  She can get help from a lactation consultant who can be the third party to educate her existing pediatrician that mom needs to be treated too, or she can be her own advocate and provide her pediatrician with the necessary literature so that the pedi will learn as well the importance of treating both mom and baby.  The lactation consultant here gave me literature on Breastfeeding and Thrush that I would be happy to fax to you. It's not uncommon for this to happen with healthcare providers.  Our Lactation Consultants are constantly educating Pedi's and OB's on solutions to breastfeeding problems.


Yeast/Thrush from Breastfeedingonline


Identifying and Treating Thrush by Cheryl Taylor White, CBE from Dr Jay Gordon's information


It can be difficult to diagnose yeast.  A trivia-mad medical student sent me the tip that yeast fluoresces under black light.


Great all inclusive thrush information - http:


Good News for Breastfeeding Moms: Treating and Preventing Thrush By Chris Hafner-Eaton


Alternate Tx for thrush - Feb 03, 2004g - In my practice, I rely on essential oil of rosemary when treating thrush & coincident candidal infection of a nursing mom. An herbalist who I'd taken care of told me about this. It has been reliable, pleasing to the infant's taste buds and not messy. I have the mom dilute 2 drops of essential oil of rosemary in 1/4 tsp. olive oil, mix well then swab the tongue & buccal mucosa with this three times a day. Mom can just use her finger to do this. I also ask that the mom purchase cocoa butter and add 2 drops of rosemary to 1/4 tsp. cocoa butter (warmed in the hands to soften it). This mix massaged into the nipple and 1 1/4 inch radially of the surrounding breast up to 6 times/day has both addressed the candida infection and helped heal up the raw areola in my experience.


My favorite remedy is for thrush/yeast infections. It is oil of oregano. Two drops in a teaspoon of olive oil rubbed on baby's feet can treat them. That same solution can be applied topically to the nipple. Most use two drops under the tongue (mom's, NOT baby's) three times a day.


Midwives (and all care providers!) need to be aware that putting our bare fingers in a baby's mouth may be the transmission vector for yeast, which then becomes thrush.  I think we're kidding ourselves if we think we're not carrying yeast under our fingernails!


Thrush can be hard to diagnose - sometimes the signs are really obvious, but it can still be making it painful for baby to nurse.  If baby nursed really well for the first few days and then things fell apart, it may be that a sub-clinical thrush infection is causing baby pain with sucking and swallowing.  Especially if mom is also having strange stabbing pains in the breast, it could be thrush.  Try mild treatments for thrush and see if things improve.


I used the baking soda treatment on my breasts and in my son's mouth after every feeding, I cut out refined sugars from my diet, and washed sheets and underwear with an apple cider vinegar rinse. I think it's very important to keep hands very clean--washing them before and after nursing. You can use diluted apple cider vinegar on your breasts too after each feeding. My son had a yeast rash as well as in his mouth (the yeast will eventually travel to baby's bottom--just a matter of time) so I gave him frequent baths in diluted apple cider vinegar and let him go without a diaper as much as possible.

Acidophilus capsules work really well too, but I found just eating plain yogurt everyday helped tremendously.


Acidophilus, like all live cultures, can be terrific but babies don't manufacture the same bacteria in their guts that grown ups do, including acidophilus.  Their system are much more regulated by bifidus, which would be a terrific thing for thrush. Also, homeopathic Borax I've seen used with some degree of success. I would also hold off on the gerber foods until you figure out the thrush because a lot of canned foods already have a high yeast content as well as extra sugars that yeast thrives on.


I would add to this that gentian violet available without a prescription (call your local pharmacy as it may take them a day or so to get it.) It is very purple and stains everything but does wonders for thrush and baby's might not reject it as much as baking soda.  The goal with the baking soda or vinegar solution is to change the PH.  I also don't recommend petroleum anything as it leeches minerals out of the skin (re: Adelle Davis among others).  Lansinoh (a purified form of lanolin) would be an option for a mom who is having tissue damage with the dryness of the yeast.


I love this treatment,  but lll doesn't recommend it any more  because of  liability.  i hate that they fell prey to the medical pressure and and our litigious society,  do you think its just to make themselves appear more legit to the med community?


I believe that certainly is a major component.  LLLI's professional advisory board is just that--chock full of very reliable and highly supportive medical and related individuals well versed in the breastfeeding ideals through the auspices of LLL leaders and mothers around the world.  Their decisions are based on research and is conducted very carefully. When a LLL leader shells out advice such as this situation on thrush, you can bet that for experienced leaders and the mothers, it's quite accurate.  The old LLLI recommended book "You Can Breastfeed  Your Baby ...even in special situations" by Dorothy Patricia Brewster has been a well used reference book of mine since I got it in 1979.  Some old fashion remedies STILL work quite nicely IYKWIM.  I would like very much to learn if the book is out of print or revised in recent times.  If anybody happens to know, I'd appreciate hearing.   I retired after 14 years in 1991, so advising the baking soda treatment for me isn't a LLL endorsement any longer, and it still works if done according to instructions.  We always advise seeking a health care provider if no improvement within a reasonable time.


Yes.  Have you tried a solution of baking soda?  You dissolve a teaspoon of baking soda in a cup of water.  After each nursing, swab baby's mouth firmly and thoroughly, under the tongue, inside the cheeks, and on the gums.  Use a fresh cotton swab each time.  This removes the milk and gives the thrush fungus less to live on.  Also after each nursing, wash your nipples (gently) with this solution from a separate cup labeled for yourself.  Apply a light coating of lanolin or petroleum jelly to counteract dryness.  Don't suspect that you aren't carrying the fungus just because you don't exhibit the miserable pain some mothers do.  Make a fresh solution each day and don't give up until baby is completely well.

This is an old LLL tip I always recommend to my mothers both past and  present.  I hope you'll get this thing licked...thrush can be a very persistent annoyance!


ah, I meant to mention this step too. I warned about blankets, t-shirts and bibs, but didn't say what to do about it. Vinegar makes a good rinse. I've heard baking soda can also be used -- anything to change the normal Ph.  And bleach should work to sterilise -- if your clothes can handle it.


I have found that using lanolin at any point during a thrush infestation only furthers the problem, even after a good cleansing, as it lives down in the cracks and crevices. It's great for sore nipples, but is a hindrance in the battle of thrush.  I suggest using gentian violet and acidophilus. Get a gauze 4x and dip it in a little of the acidophilus and swab the baby's mouth really well, and then the mothers nipples. Lots of stuff will come off of the baby's mouth. After that, use the gentian violet, remembering to keep only old clothes and old blankets on the baby, as it stains EVERYTHING. Doing this treatment for about 10 days has worked very well! Also use the gentian on the mothers nipples, wearing old T-shirts, and use older sheets and blankets on the bed.  I battled thrush for a full 8 months before I figured out the gentian thing. I even broke down and did nystatin and diflucan, which never worked anyway!


If you're using a bottle to have the dad give the baby some expressed breastmilk, it's very important to make sure that you boil all bottle nipples and if you are using pacifiers those also.  (I would add a couple of T. of apple cider vinegar to the boiling water.  All plastic bottles, nipples, etc. are notorious for helping keep thrush alive.  You have to treat both you and the baby or it does no good to treat one of you.


Yeastie Beasties FAQ


Good News for Breastfeeding Moms - Treating and Preventing Thrush by Chris Hafner-Eaton (from Mothering Magazine)


Using Gentian Violet by Dr. Jack Newman


Adverse effects of topical gentian violet - possible carcinogen, although perhaps not in very short term use???? [Medline is disappointing on this topic - there are no abstracts for the few relevant papers.  However, the titles in the Cambridge Environmental Publications List are pretty scary.  There are more scary references at The Carcinogenic Potency Project.]


I battled thrush for ten months with my nursing son.  I tried it all, vinegar, gentian violet 2% topically and dietary changes. Eventually I tried Nystatin and Diflucan all to no avail.  What worked was the Beat the Yeast triple kit of herbal tinctures from The Herbalist (6500 20th NE Seattle, WA., 98115).  I took the tinctures as advised and in days the thrush was markedly better.  I quit the herbs, the thrush came back.  I took the tincture regularly for two months with no recurrences and take it now as needed for vag yeast infections.  Combining herbs with a sugar and simple carbo free diet finally worked.  It was miserable!


I have this mom with sore and cracked nipples. Her baby is 14 months old, and they have been apparently passing yeast back and forth for a while. She is concerned that gentian violet will cause a tattooing of her nipples and areolae, because the skin there is so abraded. does anyone know if this could happen? Does anyone have other suggestions for the treatment of a situation like this? She is getting desperate enough to consider weaning...I don't know what else besides nystatin they have tried. I would assume they have tried the baking soda solution and the vinegar solution treatments. Is diflucan safe or effective in a situation like this? All suggestions both allopathic and alternative gratefully accepted.


A few ideas:

Mom and baby should probably both be taking acidophilus; Primidophilus or ABC dophilus (sp?) for baby.

Garlic rubbed on nipples, unless it stings from being too cracked.

Tea Tree Oil on the nipples. [NOTE - There is serious concern that tea tree oil may be harmful to the nursing newborn.]

Watch for secondary staph infection in nipples.

Oral Nystatin powder rather than the suspension. Costs more, tastes nasty, but it works. Dip damp finger in water, then in the Nystatin and rub around baby's mouth.

Expose nipples to brief periods of sunlight, if possible.

Plantain seeds or psyllium seeds may be soaked overnight (a teaspoon at a time) in the frig. The mucilagenous goo that results is antifungal. Can also be used on a yeast rash. Nice and cool. You can use just the goo and leave the seeds.

The gentian violet should not cause permanent coloring. Never heard of it anyway.


Pediatrician gave me this formula:

Nizoral 1/4 tab crushed once a day for 4 days for the baby Diflucan 150 mg daily for mother - usually 7 to 10 days will do it. It's a hard problem to fix.



Hazards of Gentian Violet



From the Gentian Research Network - Gentian violet is a water soluble dye (coloring substance) used primarily in medicine to stain bacteria, but also in other histological procedures.   It is not derived from gentians, but got its name since it is pink-violet like some gentians in the genera of Centaurium,  Gentiana, and  Gentianella. Gentian violet is derived from coal tar.


Is gentian violet safe?  [Related Articles]
Phillips V.
J Hum Lact. 1993 Mar;9(1):7-8.


The FDA's 2006 Over-The-Counter List:

ANPR    PR    FR
IIIE        IIE     pending


My research shows that there is no consensus on the safety of gentian violet on a mother's nipple or a baby's mouth.  The baby's mouth is a mucous membrane, which is less protective than skin.  It makes sense to try other remedies first, and if a clear diagnosis of thrush has been made, and the thrush is not responsive to any other treatments, then the benefits of using gentian violet may outweigh the risks.


Gentian Violet  (Topical) from Medline Plus

"Breast-feeding—Gentian violet topical solution has not been reported to cause problems in nursing babies."


From noaa.gov - "May cause skin irritation. Harmful if swallowed. May cause respiratory and digestive tract irritation. May cause severe eye
irritation and possible injury. May cause reproductive and fetal effects."

Another NOAA page "Harmful if swallowed."


From Solving Common Breastfeeding Problems::
The use of aqueous gentian violet 0.5 per cent in the treatment of nipple thrush is no longer recommended, as recent studies suggest it is a potential animal carcinogen. It can now only be obtained by prescription.


Thrush - Treatment - from the Royal New Zealand College of General Practitioners
"The use of aqueous gentian violet 0.5 per cent in the treatment of nipple thrush is no longer recommended."


From an FDA site:
"Demonstrated the carcinogenic activity of several FDA-regulated compounds including: gentian violet, sulfamethazine, and doxylamine."


Chronic toxicity and carcinogenicity studies of gentian violet in mice.
Littlefield NA, Blackwell BN, Hewitt CC, Gaylor DW.
Fundam Appl Toxicol. 1985 Oct;5(5):902-12.

"Gentian violet is a dye belonging to a chemical class known as the di- and triaminophenylmethanes.  . . . [G]entian violet appears to be a carcinogen in mice at several different organ sites."


From the AAP Policy Statement on "

Gentian Violet Policy Withdrawn - from VETERINARY NOTES - "Gentian violet is not GRAS [Generally Regarded as Safe] or GRAE for any veterinary drug use, and therefore is a new animal drug subject to section 512 of the Act."


Obstructive laryngotracheitis secondary to gentian violet exposure.
Baca D, Drexler C, Cullen E.
Clin Pediatr (Phila). 2001 Apr;40(4):233-5.


Gentian Violet can be great but it can also cause some secondary problems. I ended up in the ER with a subsequent hospital stay with my 3 week old daughter after she had an allergic reaction to GV and her esophagus got so swollen she couldn't breath well. I had never heard of it before but then had a client a few months later whose baby had the same reaction. When I put it out to my online mothering group, a few other mothers came forward with similar experiences.

I'm not saying not to use it, just make sure you're watching the baby carefully over the next few days (assuming you find the GV) to make sure he isn't having a reaction to the treatment.


I just want to throw out a cautionary note about gentian violet.
Its name is confusing and makes it sound like an herb, kind of like calendula.   But it's not from a plant.  It's a chemical compound and is potentially carcinogenic.
There may be times where the benefits outweigh the risks, but I wouldn't rush to use it.



Oversupply



Lots of moms are very conscientious about drinking lots of fluids while they're nursing; there's a chance that this may stimulate additional letdown.  So if you're trying to reduce the letdown, consider NOT drinking fluids right while you're nursing and notice how this changes your letdown.


Case Report: Overabundant Milk Supply: An Alternate Way to Intervene by Full Drainage and Block Feeding - C. GA van Veldhuizen-Staas


Very helpful information about oversupply from La Leche League


Oversupply: Too Much Milk By Anne Smith - IBCLC


Oversupply from bf.marie.org


Oversupply from parentsplace.com


You might want to try some of the suggestions below, for suppressing lactation, but use these techniques in moderation.



Suppressing Lactation



Lactation Suppression: Forgotten Aspect of Care for the Mother of a Dying Child [Medscape is free]


Lactation Suppression from Breastfeeding Basics


The effects of immersion and exercise on prolactin during pregnancy
Katz VL, et al.. (Eur J Appl Physiol. 1990)

Immersion in water, especially deep water immersion, reduces prolactin levels.  Women who are trying to suppress lactation may want to take frequent, long baths.  (Women immediately postpartum should consult with their care providers about the advisability of immersion.)  Since hot water can stimulate lactation, the water should preferably be on the cooler side.  A swimming pool would be ideal.


Why cabbage leaves while weaning? from ParentsPlace Lactatation Consultant Debbi Donovan , IBCLC


I would really advise that she try cabbage leaves inside her bra for suppressing lactation. To use a cabbage leaf compress, put one layer of chilled, washed fresh green cabbage leaves inside her bra cups so that the breasts are completely covered.  Leave them in until they "cook"-become soft, fragrant and translucent and start to wilt. They should then be replaced. This has been shown to be super effective and a bit smelly.


Other suggestions, were not to stimulate the  breasts (hot water, or other ways:), and to use ice packs, or frozen green peas wrapped in cloth molded to the breasts.


Eating parsley can reduce milk supply.


Homeopathic remedies include lac caninum and sometimes pulsatilla. Some people recommend Urtica Urens 1X, every 6 hours to suppress milk flow.



Mastitis



Plugged Ducts and Mastitis by Kelly Bonyata, BS, IBCLC from kellymom.com.


The role of bacteria in lactational mastitis and some considerations of the use of antibiotic treatment
Linda J Kvist, Bodil Wilde Larsson, Marie-Louise Hall-Lord , Anita Steen and Claes Schalen
International Breastfeeding Journal 2008, 3:6doi:10.1186/1746-4358-3-6
Published:  7 April 2008


With my twins, I was pumping so much and I stopped counting how many times I got mastitis after about 25 or so.  I became somewhat of an expert on how to get rid of it and I never had a case that lasted more than 48 hours and I never had to go on antibiotics.  I strongly recommend the Poke Root, which was mentioned earlier.  I also got mine through www.herblore.com.  Pam Caldwell is a fantastic herbalist and she can help you (by phone) with your mastitis and other breastfeeding questions.  You can also take echinacea and lots of vitamin C.  Before breastfeeding or pumping, I would wet a towel and microwave it to warm it up (maybe 15-30 seconds), wrap it around your breasts and then nurse or pump.  Get in the hot shower and try to hand express.  It will hurt a lot, but it is important to work that milk out. Drink tons of water and rest, rest, rest.   I also had to be very careful to clean my pump regularly and I would spread a little breastmilk around my nipple after I was done nursing or pumping to try and kill any bacteria. With twins, I had to rely heavily on other people to take care of my babies when I had the mastitis.  Most of my cases happened in the first few months and then a few times toward the end when I was weaning.  i finally resorted to sage tincture to stop my milk production because I kept getting plugged ducts when I would try to go longer in between pumpings.  After 2 days of the liquid sage (also an herblore product), my milk was totally dried up. Hang in there.


I had a bad case with my then 4 month old. My mom is a nurse and she told me hot showers/compresses and make sure you completely empty your breast, even if you have to pump. Keep your pump super clean if you are using it and eat extra healthy. Vitamin C is a major plus. However she said if it didn't go away in a day or so then I would need to see my dr. I called the dr. and they told me the same  things :) Good luck.


We've seen a huge difference in women who drink at least a gallon of water a day. Sounds like a lot but it works!  I personally have seen a difference with my 2 y.o and the 2 breast infections I got.  Yes, I let the water go and yes, I got a hunkin' breast infection.  Sounds so simple but we both swear by it!


I'm not a certified Lactation Consultant but I did do some LC training. However, most of my experience with mastitis comes from my own personal experience. I was prone to it, including the systemic symptoms. I had 5 or 6 bouts like this over a 9 year nursing history. I think some women are anatomically prone to it. For me it was almost always my right breast that caused the problem. I ended up with a tiny lump of scar tissue after one particularly bad bout.

I never took antibiotics or acetaminophen. I did go to bed (couldn't do anything else as totally out of it, delirious). Dragged myself to the tub and soaked the breast in hot, hot water. Took lots of vitamin C and nursed, nursed, nursed in all positions. Especially with baby's chin in direction of sore spot. This ended up in some pretty weird configurations of bodies.

I found that the fluishness always passed within 24 hours. The tender spot remained longer but I made a concerted effort to pay attention to it with the old Heat, Rest and Empty Breast. For the women I have helped this has always done the trick. I don't know of any who have taken antibiotics including one woman who had the most massive, blackest "bruise" I have ever seen. I did not counsel this woman and only saw her after the worst was over. She got through it without antibiotics.

I am not convinced that antibiotics are the answer to mastitis. I think it might be similar to Mendelson's comment about [name the affliction] "if you take antibiotics it will be gone in a week. If you don't take the antibiotics it will be gone in 7 days." It is possible they could contribute to the problem by not letting the body have a chance to fight infection off itself.

Echinacea was not "on the scene" yet when I was nursing. It may be helpful if taken at the onset. But it is an immune strengthener and while the immune system becomes involved in mastitis, it is the cause that needs to be treated, i.e. the "plug".

For this woman I would suggest all the other things you have suggested already. Now that she has experience with it, she should be able to recognize that sore, bruised feeling immediately and take measures to minimize its progress. I think the rest component is absolutely essential. I have found that women really need to pay attention to slowing down before mastitis resolves.


If you use homeopathic remedies at all Phytolacca and Belladonna are the two biggest mastitis remedies to consider. We often use cold packs alternating with the hot ones; also liquid chlorophyll, echinacea and one of my new favorite "natural" remedies Nutribiotics which is found in health food stores. It is a grapefruit seed extract that really knocks infections down quick!!! Can be bought in combination with Echinacea. As well as increased Vitamin C - increased Vitamin A - 50,000 to 100,000 iu for about 3 days only. That last recommendation is from a Clinical Nutritionist who says it isn't toxic this high if only using it for a short period (she says no more than 5 days at 100,000) I usually only do it for 3 days and don't need it more than that, also will usually only go up to about 50,000 or 75,000. My policy on that one is this: I use it at that high of dosage on myself and my family, no problems with it, usually only a couple of times a year when we're really battling something. I tell my clients about it and say they would have to make their own decision on it, also sharing about how FDA, AMA says Vitamin A is too toxic in that high of dosage. Definitely don't do this during pregnancy, but have seen it help in mastitis.

Since this is cold & flu season, I'll also share info about Engystol-M from -Heel Co. Have to buy it direct. This is fantastic for viruses. It helped a friend of mine get over Mononucleosis in record time.


Sudden onset mastitis is vicious! I use Echinacea 4-6 caps with Vit. C 1000 every two hours along with the things you had her do. Babe is the best pump. No lying down to nurse unless the baby is on mum's right side and she nurses the left breast. (Almost lying on the child but drains even up into the arm pit if she can manage the position.) The other thing I ran into was a woman who had 5 infections in a row, antibiotics et al. She would start feeling better and come down again. It turned out that her bra style had seams coming diagonally across the cup from the arm pit toward center. It made a VERY FAINT line as her bra wasn't very tight but enough to block off part of the flow on each side to some of the ducts. I had her change her bra style and she never had another one.


We have used garlic and echinacea with great success, at the very first sign of possible infection we have them start taking 2 tabs of garlic and one droppersful of echinacea every 15 min plus drinking 1/2 gal of water within the next 2 hours and rest.  usually knocks it by then.


Poke root is an absolute wonder cure for breast infections!  The homeopathic version (phytolacca) is also great!


Mastitis Treatment:

Lifestyle:

Natural Remedies: Meds/Antibiotics: Prevention:

Midwifery Today Summer 1992 Mastitis: positive Interventions by J. dever. She says that:

Sheila Kitzinger recommend using an oxytocic nasal spray to help with let down and apparently it can "sweep down" an infection. Can be used in conjunction with anti-biotic therapy

other things mentioned


sounds like the things that caused the breast infection are the same things that are preventing it from disappearing even with use of anti-biotics. Is she resting a lot? I know of midwives who tell their clients who are beginning to get signs of a plugged duct to get into bed with their baby and stay there until all signs have gone.


From an herbalist:  Generally when a breast infection (mastitis) appears, it is all too often because the mother is run down and needs rest. The number one thing is to get rest, and bed rest is suggested but more often than not for most, unrealistic. Next, be sure to nurse on the affected side as much as possible, keeping the breast as empty as you can, thereby allowing the infection to clear. Taking immune boosting herbs is important such as echinacea, propolis, astragalus, lemon balm, oatstraw, fenugreek, etc. These may be administered via infusion (tea), liquid extract or capsule--which ever way the client is inclined to take her protocol. Foods are important to remember also; alliums are great for boosting the immune system. Garlic, onions, chives- also burdock root, dandelion root and dandelion greens are highly nutritious and splendid sources of nutrients and minerals to boost immunity and lymph health. I always recommend a cabbage poultice to any woman experiencing breast tenderness and surely for Mastitis. It works wonders for clearing blockage and infection. Simply place a raw cabbage leaf (or a few) on the affected breast. I like to say you should treat both breasts, as with ear infections, it's very common for the infection to go from one side to other and then back again, just when you think it is clearing up. If you would like to soak a few of these cabbage leaves in warm water, that is fine too. Warmth will soothe the tender breast as well. Cabbage leaves are a perfect shape for cupping the breast, it's neat to think of their nature and how they work so effectively for this cause. Worst case scenario, poke root is great for clearing breast infection. Poke root is a highly heroic herb, a little -- I mean a little, like 5 drops extract max, goes a long way. It has been known to clear even the most persistent infection up readily; although I only go there for last resort.



Plugged Ducts



Anatomy of the Breast shows the overall breast anatomy, including the suspensory ligament, and here's the lympathic system.  Notice the main drainage pathways, which can help identify plugged ducts.


Add lecithin to her diet - works wonders for clogged ducts - the best form is the granular form - 1600 mg daily for alleviation and prevention of clogged milk ducts.


Blocked Ducts and Mastitis from Dr. Jack Newman - discusses the use of ultrasound for a blocked duct:

If a blocked duct has not settled within 48 hours (unusual), therapeutic ultrasound often works. This can be arranged at a neighbourhood physiotherapy office or sports medicine clinic. Many ultrasound therapists are not aware of this use for ultrasound. The dose is:

2 watts/cm², continuous, for five minutes to the affected area, once daily for up to two doses.

If two treatments on two consecutive days have not worked, there is no point in continuing with ultrasound. Get the blocked duct re-evaluated at the clinic or by your own physician.   Usually, however, if ultrasound is going to work, one treatment is all that is needed.   Ultrasound also seems to prevent recurrent blocked ducts that always occur in the same part of the breast. Lecithin, one capsule (1200 mg) 3 or 4 times a day also seems to prevent recurrent blocked ducts, at least in some mothers.


I am a labor and delivery nurse and recently had my third child.  I breastfed successfully with the first two children.  I developed a persistent and recuring problem with blocked nipple pores and clogged milk ducts.  Very Painful!!  I consulted everyone at the hospital, including lactation consultants etc...  I read books and tried everything offered.  Nothing worked.  Finally one of the female MD's who used to work with midwives told me to try putting cabbage leaves in my nursing bra to soften breast tissue. Everyone laughed and thought she was crazy.  Needless to say, I was very skeptical and felt a bit silly. However, I was desperate. It worked like a charm!!!


My first action, would be to eliminate all refined sugars and flours, treat with acidophilus, increase raw foods, alternate hot/cold packs (hot before nursing and cold after).  Is she running a fever, even a low grade fever?  Yeast overgrowth is many times revealed in recurring breast infections.  I would personally use echinacea and either golden seal or oregon grape root.  Check the baby's mouth for thrush also.  If the latch has changed, then it could be due to undetected thrush.  I would also revert back to early nursing days, getting back into bed to rest, nurse and drink lots of good water.  Outside of these steps, I would consult a reputable lactation consultant.


A good friend of mine needs help with clogged ducts. She is nursing her one year old baby, and has had trouble with painful swollen clogged ducts for a full two months now. She has tried everything we can think of, and now we need your suggestions.

Two months ago a duct clogged and caused a swollen hot area under her arm the size of a cigarette pack! This original area has gone up and down, but never resolved completely. She has also shown no signs of infection in that two months. Within the two months this spot has been a problem, other ducts have clogged and unclogged with her efforts. (all on the same side)

She has tried cabbage leaves, ginger poultices, hotpacks, no bra, two bras, massage, nursing in every funky position she can think of, and now she's  been having ultrasound treatments of the affected breast. Sometimes after a treatment, she'll be nursing and a clog will suddenly resolve itself. But never this original one. And other clogs continue to come and go.

She's talked to three lactation consultants, and her midwife. None have any advice that's worked. She suspects his latch has changed??? But why at one year would he have this problem, why only one breast, and how can she fix it? She does not want to wean entirely, and even wants to avoid weaning off the affected breast due to concerns about lop-sidedness.

my thoughts are that since the worst area continues to be swollen, sometimes worse than others, but never resolved completely.... It seems some milk keeps getting through, otherwise the duct would have dried up completely by now, right?


I too had a blocked duct in my left armpit while nursing my newborn son (he's 3 months now and the problem is gone) mine was more the size of a golf ball this is what I did via the advice of my LLL leader.

1) apply heat 5-10 min prior to nursing (warm bath water, hot pack)
2) ice in between nursing, oddly this felt soooo good
3) nursed this side frequently and hand expressed the other to keep milk up
in both breasts
4) took as much bed rest as possible (had 2 infections that knocked me out,
nice bonding time with baby to lay in bed together all day, getting up had
me in tears)
5) constant self massage, though I was advised that if it didn't clear up to
call a massage therapist who is skilled in lymphatic drainage
6) in the big ball I could feel the smaller duct, I squeezed this and found
backed up milk coming out of the pore above it.  totally relieved the
pressure at times.

Anyway, the swollen duct shrunk in size by the end of the week.  Every now and then I feel it building slightly, but not with the swelling.  Good luck to your friend.


One of my clients who nursed twins gave me some really good advise about plugged ducts.  She said she would put baby on the floor and nurse hanging from above so that the breast was completely hanging straight down. (She was on all fours).  She said that always took care of the problem.


I tell my mamas that they should be humming  "rock around the clock" when using this breastfeeding position. The beauty of it is that the mom can rotate (like the hands of the clock) and make slight or major changes in where the pressure is felt on her nipple as well.  Mom might well wind up in a position impossible to create while seated or lying down unless she wants to try and have her baby wrap his/her legs around her neck!!  LOL Oh one more thing. When I advocate something like this I also quickly grab one of my baby dolls and demonstrate/model it for them.


She might want to look very closely at her nipple and see if there is a tiny white bump under the skin anywhere. There might even be a little clear blister over it. She may want to try lifting the clear skin and giving it a tiny squeeze and there is a chance that a calcified piece of milk with come out. This sometimes happens and creates the blocked duct. You can also take lecithin to help prevent these calcifications. At one time this was in the LL literature.



Plastic Bottles are Unsafe



The Adiri™ Natural Nurser™ Ultimate Baby Bottle is soft, safe and simple. With an easy to use and dishwasher safe Fill, Twist and Feed™ system, the only nipple truly shaped like a mother's breast, soft polycarbonate-free and bisphenol-A free materials, and a unique Petal™ vent that helps reduce colic, the Adiri Natural Nurser enables the ultimate safe bottlefeeding experience.


If you're planning to give your baby expressed/pumped breastmilk at some time after 3 weeks of age, please be aware that plastic baby bottles have recently been shown to disrupt a baby's hormones; glass bottles are safe.


Toxic Baby Bottles


Toxic Baby Bottles - Scientific Study Finds Leaching Chemicals in clear plastic baby bottles


I switched to glass bottles a few months ago and I LOVE them.  Throw them in the dishwasher and they clean up so nicely.  You can buy them at Babies R Us, but I ordered mine through Amazon.com.  It looks like Amazon is only selling the 4oz size right now, so I also know you can order them online through Radiant Life :
http:

The glass bottles are made by Evenflo. They have all the sizes available.  I was shocked and happy to see them at Babies R Us when I went there a few months ago.

The nipples that come w/ the glass bottles are not great (in my opinion) but you can substitute just about any standard nipple.  I put the Dr. Brown's nipples on mine and they worked fine.

The "safe" plastic bottles that you are referring to are at: http:


WF's sells a new brand of baby bottle called "Born Free' that does not contain the chemical.  They also make sippy cups.


http:

  etc. etc.

  And from Mothering mag:

  I am planning on breastfeeding but wanted to know which baby bottles are best for when I will need to pump. Any insight would be appreciated.
  Recent, studies have raised concerns about certain types of baby bottles. Fortunately there are plenty of safe options readily available to new mothers. The following tips will make it easy to know which products to look for and which to avoid.
  Products to avoid
Polycarbonate bottles: Bisphenol-A is a component of #7 polycarbonate plastic, the clear, rigid variety of plastic from which many baby bottles are made. This substance has been shown to be "estrogenic": it is an endocrine-disruptor in lab animals, altering reproductive organs and functions. Bisphenol-A can leach from polycarbonate, especially when exposed to high temperatures and repeated washings.
  Rubber Nipples: Many bottle nipples are made of rubber, which may contain low levels of contaminants known as nitrosamines. These substances, found also in some foods and in tobacco, cause cancer in lab animals and contribute to tobacco-related cancers in people. Nitrosamines can be ingested through bottle nipples; however it is unknown whether this kind of exposure increases the risk of cancer. Because of cancer concerns, The Food and Drug Administration regulates the amount of nitrosamines allowable in rubber nipples, but low levels are still permissible.
  Products to look for
Glass bottles: Because the risks to humans of bisphenol-A are unknown, it makes sense to limit your baby's exposure to it. Glass baby bottles are a time-tested alternative to polycarbonate plastic. Glass is a renewable resource, easily recyclable, and does not leach toxic chemicals. Glass bottles are, of course, subject to breakage, and there are risks of serious cuts to your child. Additionally, glass can chip or crack, and can break when sterilized, allowing glass splinters to end up in baby's beverage. The American Academy of Pediatrics urges parents not to let babies go to sleep with a bottle, and toddlers should not be allowed to walk around with a bottle. These precautions help prevent tooth decay and mouth injuries; they also help prevent breakage and injuries from glass bottles. As with plastic, careful and regular inspections of the bottle allow parents to detect any flaws in the glass. Recycle any scratched, cracked, or chipped glass bottle.
  Safe plastics: Although polycarbonate bottles containing bisphenol-A are the most common kind of baby bottle on the market, there are other plastic baby bottles available that do not contain bisphenol-A. These opaque bottles are made of polypropylene and polyethylene, which are not known to leach carcinogens or endocrine disruptors. Recycling symbols can provide some information about the plastic: polyethylene has #1, #2, or #4 on the underside, and polypropylene has #5. The surest way to know whether a bottle is made of polycarbonate is to call the manufacturer. Keep in mind, though, that all plastic bottles are petroleum products, requiring the use of non-renewable resources.
  Silicone nipples: Replace standard rubber nipples (amber-colored) with clear, silicone nipples. Not only are silicone nipples free of cancer-causing nitrosamines, but they last longer. Inspect nipples regularly and discard any with cracks or tears, which can harbor bacteria and also pose a choking hazard.
  Shopping Suggestions
Baby Bottles (#5 Plastic)
Rubbermaid Chuggables Bottles
Rubbermaid Sippin' Sport Bottles
Evenflo Colored Baby Bottles
Evenflo Baby Bottles (opaque, pastel)
Gerber Baby Bottles (colors)
Medela Baby Bottles
  Baby Bottles (Glass)
Lansinoh Glass Baby Bottles
Lamby Glass Baby Bottles
Evenflo Glass Baby Bottles


One word of caution - the glass bottles cracked the plastic part of my breast pump that you screw the bottle onto.  I noticed the suction slowly getting to be less and less until it basically didn't work.  When I called Ameda to see what was going on, one of the questions they asked me was if I used glass bottles with it.  The cracking is very fine, so you don't really notice it.



Age for Introducing Bottles of Expressed or Pumped Milk



I tell each mother that latching on is like riding a bicycle.  At some point she will look down and realize that her baby latched on without any conscious effort on her part.  When latching on gets to be that easy is when she can consider introducing a bottle.  I say that for many mothers that is around six weeks but it might be earlier or later for her.

In the case of separation, La Leche League's recommendation is to start preparing 2 weeks before you will need to be separated from baby.  I usually try not to be any more specific than that because babies have their own personalities.  Some babies will never take a bottle, some will decide a bottle is easier if started too soon, and some babies will quite happily take a bottle at 2 weeks and then reject it completely at six weeks.

I haven't seen any research indicating that daily bottles are more or less effective at keeping babies willing to take bottles.  Anecdotally, I've heard from a fair number of mothers who did give daily bottles only to have baby reject bottles later on anyway and they sometimes wonder why they went through such a hassle when it didn't work.  So I try to feel out where the mother is - if she's stressed about the logistics of leaving baby, daily bottles might be comforting to her.  If she's stressed about the emotional impact of leaving baby, daily bottles might take away what little time she feels she has.

I also make sure to present other options, such as grandmother going with daughter and baby to school so daughter can breastfeed before and after class - this works if she has a one or two hour class and then a break. Also easier than trying to find a place to pump, as many schools are way behind places of employment in terms of offering pleasant places to pump and store milk.  Or if baby is at a baby sitter's, feeding right before class and checking in right after.  There are also the alternatives to offering a bottle:  cups, syringes, finger feeding.  Although the research on cups doesn't indicate it avoids "nipple" confusion, at least cup feeding avoids the superstimulus on the roof of baby's mouth that seems to be one of the problems with switching back and forth from breast to bottle.



Age for Introducing Solids



I have spent most of my adult life around long term breastfeeders. Most kids will reach out for food on mothers plate by about 8-9 months but , obviously as not all kids are the same , some show no interest. My own daughter barely ate food till 14 months and I know lots of woman whose kids started 'socially developing' their own need to eat solids past  the 'usual' age.  It seems to be a question of child led or not. Children are capable of deciding when they are ready to involve themselves in 'social' activity.

If you question most woman further you will find that the child does eat solid food but is getting the majority of nutrition form breastmilk. This means that they pick at bits of food and will entertain finger foods but do not sit down to what we in the Western world consider 'a meal' with a bowl and a specially prepared tin of something or even a hand ground organic something!!

The principle of what to give a one year old is the same as at 6 months ,although by one year there is less worry about milk allergy so that gives more choice. The only thing that is of any concern in my opinion is past 6 months the breastmilk does not have enough iron. In the areas where i lived (home birth rate of over 50% and long term BF normal, there was quite a high incidence of anaemia. It is routine to check babies for anaemia in California and apparently 20% of all kids have deficiency so my area may not have been higher than general population because they were long term breast feeding. I have commented a couple of years ago on the list about the difference between kids born to home birth midwives who do not cut cord till placenta out and those who do the cut cord immediately technique (which is most common here in the UK). When a cord is not cut the child gets more blood and therefore logically has more iron stores.

Finger foods such as apricots and mushy dark greens etc. are good sources of iron. I actually gave  my daughter a teaspoon of floradix twice a week from 6 months onward until i knew she was eating enough solid compared to breastmilk. There are lots of website and books. Look under 'natural' baby.

Someone mentioned jaw development ,but I have never been able to find any evidence about the validity of this assertion save for one small research article which i am not able to locate right now. I know that Jack Newsman will definitely have it at his fingertips and his web articles  can be found by searching under his name. This will also bring up lots of good web sites on breastfeeding and they almost always have info on weaning. Jack Enkins  book for mums is brilliant - the best i have found.

The 'jaw development' and 'child will be a late speaker' is a purely British thing that health visitors tend to mention and IMO its an urban myth and perhaps dare I say it, yet more shroud waving.

Research does show that breastfeeders have better jaw development and speak sooner than non breastfed babies.

For email support , the Natural Nurturing Network has an email list if you join the organisation. She may want to consider this attachment parenting organisation. It is one of the only ones in Britain and the majority of members (currently over 300) have all been in the same boat.



Extended Breastfeeding



“I Still Nurse My 5-Year-Old” - Have you even wondered why anyone would breastfeed a child who’s old enough to walk, talk and even go to school?  Meet a mom who’s happy to explain.


A Natural Age of Weaning by Katherine Dettwyler, PhD.  Another article, When to Wean, contains amazing information about what the actual optimal length of breastfeeding is for placental mammals. [This last article is available at birthlove.com, a subscription site that is well worth the small cost!]


From Breast Milk to Solid Food: When's the Best Time to Make the Switch By Colleen Huber, Naturopathy Works



Tandem Nursing



In my experience as a midwife, it seems that nature intended most pregnancies to take place while the mother is still nursing an older child . . . this causes an increase in normal toning contractions (unfortunately, often mistaken for preterm labor), and in the baby's coming a few days earlier, thus resulting in a much easier labor and birth.


While Pregnant and After (Tandem Nursing) from bfmarie.org


Nursing During Pregnancy and Tanden Nursing - from Kelly's AP web site.  And her own list of related links, some duplicates.


Tandem Nursing from Mothering Magazine


La Leche League's FAQ on Tandem Nursing



Formula for Better Baby Formula



I'm not advocating using formula but found this interesting if it's needed for some reason:

Healthy Alternative to Conventional Infant Formula Part 1 (from Dr. Mercola)



Elimination Communication



This section has been moved to:  Miscellaneous Newborn Care/Natural Infant Hygiene aka Elimination Communication

 




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