The Breast Start Lactation and Breastfeeding Management

Night support assists the entire family unit

12/9/2014

As nurses, we give of ourselves without a thought when others need us. Often we don't stop to think of the impact we have on the entire family. Night nursing is no exception. Many families need extended support due to medical issues post birth either with mom or baby. The impact of what I do for families really hit home after receiving this email from extended family this past weekend.

"I have thought of writing this note many times during the last several months, because I want you to know what a gift you gave our grandchildren, daughter and son-in-law by caring so skillfully and lovingly for them on the night shift.

Today when I watch T walk across the room dressed in a fairy outfit, or Z chasing a ball, or hear B saying, “Good morning z-a-doodle and T-bee,” they are thriving, and I’d love you to see it. All of you are like the gardeners who helped tend the little seedlings for hours----it may not show on the outside, but it mattered so much!!

We feel we know you from R and J's tales of how patient, knowledgeable, encouraging, and balanced you were. They got reassurance and humor from your regular shifts, and the benefit of your countless hours of experience. It helped R to heal, get some sleep, and have contact with adults who really cared about Z and T and B, too.

So although this note does not have a hero’s medal enclosed or a brass band tribute, it comes with our full hearts of thanks. We hope that the goodness you’ve shared with so many comes back to you and your families. When we celebrate The Twins' first birthday on December 11th, you'll be there in spirit.

Warm regards during this holiday season,

H&E V

(Names have not been provided for confidentiality reasons)

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Dominican Republic-Breastfeeding Promotion

5/17/2013

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San Jose de Ocoa is a small community in the south of the Dominican Republic. Stated population in the National Census is 57,174, however, this number is understated. The population listed is only "registered" population. In this region, there are many unregistered people. Children born to women under 16 years of age are not registered and in many of the surrounding areas, registration just is not possible. This leaves many families without education and access to healthcare.

My mission this year was to increase awareness and information to pregnant women and breastfeeding moms. Breastfeeding rates in the DR are a mere 8% at 5 months of age. After 5 months, the rates decline rapidly. With little access to clean water, formula and sanitary conditions for bottle feeding, it seems only prudent to educate women on increasing breastfeeding rates. This in turn can only aid in decreasing the infant mortality rates from as high as 51% in some of these regions.

I attended the antenatal clinic at the local hospital providing breastfeeding classes and answering questions. Mariam and I saw over 55 breastfeeding and expectant moms. We showered them with prenatal vitamins and gift packs and provided the clinic with vitamins to give to women in the community that may otherwise not have access.

My aim was to seek out at least one eager mom that would be willing to provide support to area moms. Indeed, I found one such mom. This young mom is a genius when it comes to breastfeeding and she will be such a good support. I have given her information to Yanet Olivieras, La Leche League Leader in Santo Domingo and it is my hope that she can run a support group in Ocoa. I have secured the women's shelter as a local meeting place as well.

Yokasta Mordan, a lovely new mom with a passion for breastfeeding and helping others!

I feel grateful for the opportunity to speak with these women and share in their breastfeeding experiences. I am truly humbled when I return home and see how much we have and how little they have but yet how very little difference we have in the love of our babies. Every mom wants to feed their baby and I am so happy to be able to assist these and every mom in doing just that!

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Breastfeeding Demand and Supply

12/2/2012

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Babies are born with the innate ability to suck. Newborns suck for more than just satisfying hunger. Sucking is pleasurable, calming and is a pain control mechanisms for babies.

After a baby is born, their bellies are full of amniotic fluid that is swallowed continuously while in the womb. This is why for the first twenty four hours they do not feel hunger. The best time to introduce the breast is within the first hour after delivery. Sucking at breast calms her and reassures her in a world that is not known to her. After she is born an infant enters the active alert stage of wakefulness and this time is important to use as practice for latching and feeding the baby. Over the next twelve hours, newborns enter the “sleepy phase”. It’s often difficult to wake the baby at this stage as she recovers from delivery. Skin-to-skin during this time assists in maintaining her body temperature and stabilizing her heart rate. It’s also the perfect opportunity to allow her free access to the breast.

After 12-24 hours, the baby begins to get hungry as the belly empties. Cues that baby is wanting to feed or suck include:
·    Smacking the lips and tongue thrust movements
·    Bringing hands to mouth
·    Head to the side with wide open mouth

Crying is a late sign of hunger and it is often difficult to latch her when she has reached this point. Being aware of your baby’s hunger cues is important so she does not get frustrated and she can begin to trust that food will be supplied.

Moms often ask why babies suck all the time. Remember that sucking is not just a response to hunger. She may suck to relieve tummy pain, to feel close to mom, to fall asleep. As a response to the frequent sucking, moms often state they “do not have enough milk”. This is common perception occurs because we were not born with volume windows on our breasts! Mom will make milk (supply) as a response to the baby’s sucking (demand). With breastfeeding, demand must occur before supply happens! This is why free access to the breast in the first few weeks is the best way to support your milk supply. The more the baby sucks, the more the breasts are stimulated to make the milk the baby needs, especially after the first few days when the baby will have lost weight. Weight loss is normal in newborns as the body transitions to the extra-uterine world. With good feeding, the baby should regain her birth weight in the first two weeks.

The use of pacifiers when breastfeeding is not recommended until mom and dad can be reassured that baby is not hungry. The basic rule of breastfeeding is: if the baby wants to suck, let her do so on
mom so that milk production is regulated to her needs. Pacifiers in the first few weeks alter the supply of milk in mom because the baby is not “demanding” that mom supply the milk. In some babies, pacifiers can also alter their suck pattern and interfere with a good latch causing mom pain and discomfort.

In situations where mom and baby are separated, it is important to support mom’s milk supply with the use of a breast pump or hand expression. The demand still needs to occur if baby is not present to stimulate the milk production and support the supply. Double pumping is preferred over single pumping because it increases the hormones in mom’s body that are responsible for milk production. It also saves precious time! If milk cannot be used right away, it can be stored for later use.

Milk supply normalizes in the first two to three weeks. The breastfeeding rule of thumb is: if baby wants to suck (demand), allow her to do so at breast to assist and maintain the milk production (supply). As you and your baby get to know one another, it will get easier to distinguish her needs and you will become confident that your body is making the necessary supply.

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Post Partum Hemorrhage & Milk Production

11/30/2012

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After delivery, a woman's body is recovering from the "Boston Marathon" of birth! Adrenalin starts to ebb and muscles are tired and sore. The uterus continues to contract as it works to get back to it's pre-natal size. What happens when the uterus stages a sit-in?
Well, it's not pretty! Post partum hemorrhage causes excessive blood loss either during delivery or immediately after. But what does that have to do with milk production? Let's take a look.

The pituitary gland is responsible for secreting prolactin and oxytocin, two hormones essential for milk production and milk ejection. After post partum hemorrhage, the pituitary gland goes into shock and for a short time does not perform its regular duty.

The Prolactin Reflex
1. (Long arrow) Nerve impulses from sucking go to brain
2. (Short arrow) The pituitary gland releases prolactin into the blood
3. (Breast) This causes the alveolar cells to secrete milk and swells the alveoli

The Milk Ejection Reflex
1. (Long arrow) Nerve impulses from sucking go to the brain
2. (Short arow) The pituitary gland releases oxytocin into the bloodstream
3. (Breast) This causes muscles around the alveoli in the breast to squeeze milk to the nipple

As a result of pituitary dysfunction, prolactin and oxytocin levels are low and consequently, milk production is as well.

It is important that mom feed or pump frequently to stimulate the prolactin and oxytocin frequently. After post partum hemorrhage, it is common to have delayed milk production for 4-6 days and insufficient milk supply for as much as two weeks or more. Mom and babe require close follow-up to ensure milk production and weight gain.

For more information on post partum hemorrhage or breastfeeding concerns, contact The Breast Start.

Picture and information reprinted from http://www.thebreastway.com/index.php/how-it-all-works-breastology/physiology-of-breast-feeding-and-milk-let-down

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The Breast Crawl

10/19/2012

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By natural instinct and smell, newborns will gravitate to the breast all on their own by between 30 and 60 minutes. Unicef created this video to show how babies perform the breast crawl immediately after birth.

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Why do I recommend nipple-to-nose?

10/19/2012

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Many of the breastfeeding challenges I see stem from poor positioning. If nipples are cracked, bleeding, painful or blistered, positioning and improved latch often fixes this.

To achieve a deeper latch, I often recommend the nipple-to-nose technique.

Use your thumb to slightly angle the nipple upward.
Place your nipple just below your baby's nose. Babies smell mama's milk and it often stimulates them to open wide.
Keep baby's chin tucked into the breast and when he opens wide, use your thumb to gently guide the nipple deep into babe's mouth while bringing him slightly upward toward the breast.
Your baby should have a good portion of the areola (the dark part of the breast) inside the baby's mouth and not just the nipple. More of the bottom than the top of the areola is preferred but you have to find a good fit for both you and your baby.

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Night support assists the entire family unit

Dominican Republic-Breastfeeding Promotion

Breastfeeding Demand and Supply

Post Partum Hemorrhage & Milk Production

The Breast Crawl

Why do I recommend nipple-to-nose?

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