Let’s Talk Sucking Issues (and the IBCLC Credential)

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Let’s talk sucking issues. Let’s especially talk to medical profession and future medical professionals. Palpable ridges along cranial sutures and plugged tear ducts. These were two things that really stood out as weird to me with Brendan, my oldest who is now 8, as a newborn. Brendan couldn’t latch at all when he was born and he had a big bruise from the suction cup from the vacuum extractor. He was also taken away from me immediately. That was extremely traumatic for me-no one heard me when I was shouting “I want my baby! I want to breastfeed!” All of those were signs of major problems and I wish that his tongue-tie, the ridges, the bruising would have been identified as issues. The doctor said he had seen worse ties and *I* must be the problem and I must not have been holding him correctly. Guess what buddy? YOU were wrong. YOU should have been more educated in to breastfeeding issues.

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My oldest son had palpable and visual ridges.  We didn’t know this was a unique situation so we didn’t focus on them trying to get good pictures but they are pretty obvious in several pictures.  You can see them on the side of his head in this picture. Taken May 2008 when he was 3 weeks old.

I am currently reading a book called Supporting Sucking Skills. EVERY doctor, midwife, RN, OT, IBCLC, “lactation consultant/nurse” that is around breastfeeding needs to read this book. If you ever have a breastfeeding patient you should read it. Do some self-educating. I get that there isn’t a lot of time in Med school, nursing school, etc to learn about breastfeeding, identify breastfeeding issues, assess mouths and sucking, and diagnose the issues but that’s no excuse to not educate yourself. There are amazing resources out there. Identify your limits. Don’t PRETEND to know what you’re talking about. It can be detrimental to a mother to tell her in any way she isn’t sufficient or to not properly support her in breastfeeding.

Doctors know when to refer to other doctors who are specialists. There are other non-doctor specialists though that everyone needs to be familiar with.

Have you heard of an IBCLC? Most of the general public has not. Many of my friends should have because it’s my passion to be one. An IBCLC is an International Board Certified Lactation Consultant. They’re the boob helpers if you will. Like doctors not all are created equal and there are some crummy ones despite having to complete 14 specific health science courses at the University level, 90 hours of breastfeeding specific education, and depending on pathway chosen up to 1000 hours of hands on clinical breastfeeding support. After all that they must pass a rigorous international exam with an international perspective. They must recertify with a lot of continuing education or resit for the exam every 5 years and for sure sit for the always updated exam every 10 years. They must know how to identify breastfeeding problems. They learn about many diseases that effect neonates and are often a front line to identify possibilities so the doctors can look in to them further. They are experts on poop, newborn and infant sleep, and normal term breastfeeding (hint-if you are not supporting a mother “still” breastfeeding a 2+ year old you need to revisit your perspectives). Many know how to assess for tongue and lip ties and while they can’t diagnose they can refer to specialists that know how to take care of them (although many are bound to refer within the system that employs them even if it isn’t the best option for the mother and baby-one of many reasons why I have chosen to be in private practice). Many recognize sucking issues. Take them seriously when you get a referral or a report from an IBCLC.

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I’ll be the first to admit I didn’t get a very good picture of this tie but you can still see this thick band that was ignored by several providers.  This was my daughter’s class 4 lip tie.  It attached down and around her gum line back in to her palate. (My youngest-taken 1/27/14 when she was 4 weeks old, her revision was in February a week later)

If you don’t know how to properly assess for a tie be honest-remember to first do no harm. Refer to a specialist that actually knows what they are talking about. www.Drghaheri.com has a lot of information about how doctors should be assessing. He has an excellent bedside manner and knows what the heck he’s talking about because he was a father of a baby with sucking issues and he went out of his way to learn how to help his wife, child, and future patients. He teaches other doctors how to revise ties.

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This swollen blistering lip was caused by my daughter’s lip moving in and out (rather than staying stationary) and continually breaking the seal while breastfeeding.  This was taken a week before her revision.

Treat mothers with respect. If a mom has a concern take it seriously. You are not in her home at all hours day and night. If you treat her with dignity and respect and her baby as well you will be well respected. Learn to properly identify sucking issues. They cause a host of problems and are a main reason why mothers give up on breastfeeding. That may not be important to you but it is to her.

Mother’s Stories: Tori and Otto’s Tongue Tie Story

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The following is a story shared with me by Tori Caswell of Oklahoma.  I first heard her story in March this year.  She has shared it publicly before but has gone through more since then.  I am beginning a project to give a voice to mothers and share their breastfeeding stories, especially their tongue tie stories.  The following is the account by Tori.

In her words: I’m a homeschooling mama of 3 boys. I love being outside, walking, biking,  running and swimming. I also love being inside baking, writing and reading. I’ve recently taken up sewing and have a goal of making stockings by December!

Otto is our third child, third son born on September 21st, 2015. This was my third time to breastfeed. I was confident, educated and had worked as a volunteer breastfeeding support person for 8 years. I was committed to nursing him. Our problems started right away and came to a crescendo at 5 ½ months. I am unbearably embarrassed that it took me so long to let in the fact that it was a tongue-tie causing our problems. I carry a deep sadness for the suffering my son endured.

I have this blame in my hands, I keep trying to pass it off, to the pediatrician that told me “posterior tongue tie isn’t real” and that Otto wasn’t tied because he could extend his tongue out of his mouth. I keep trying to hand this blame to the speech pathologist who told me his tongue looked fine and not tied, just after she watched me let tears loose over how desperate I was to feed my baby. We scheduled a swallow study for a month out, the soonest they could squeeze us in. I had tried breastfeeding, 6 types of bottles, a Haberman feeder (which passively drips the milk in baby’s mouth) and ultimately found a syringe was the only way to get the milk inside my baby, even that, I would learn was being silently aspirated into his lungs. If I had I been giving him anything but my expressed milk he would have most likely contracted pneumonia. I wanted to blame the lactation consultant who watched me struggle to feed him in her office and told me that “posterior tongue ties aren’t a thing” and I should try a supplemental nursing system (SNS) which is this little tube you tape to your breast to give extra milk when they nurse. Here I stand though, blaming myself.

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Haberman Feeder example and chart of internal mechanism
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Example of an SNS

I had literally 20 La Leche League Leaders from a Facebook group telling me “his symptoms sound like he’s tied” in response to my posts about how Otto:

  • Pulled off during letdown
  • Was noisy and fitful at the breast
  • Gagged and choked on bottles
  •  Hadn’t gained weight for a month
  • Wasn’t growing out of his 0-3 month clothing at 5 months old
  • Cried inconsolably and often
  • Had persistent thrush
  • Was overall unsettled and unhappy

When I go back and read my posts, I knew it was his tongue, but I didn’t trust myself. I wanted his pediatrician to diagnose it. I did call and make an appointment to see a dentist in OKC (Oklahoma City) who revised ties and had extra training in assessing for them, but that appointment was a month away.

I spiraled into a dark place of exhaustion, superstition, depression and complacency. I slept through my baby’s crying routinely. I spent every waking moment trying to feed him. I was growing shorter and shorter with my 2 older children. My husband would walk around the house for hours with our crying baby, so I could have a break. On March 4th, a Friday, we had yet another weight check with our pediatrician which yet again showed no growth in any way for a 2nd month. I couldn’t hold in my panic or my crazy any longer. She diagnosed him failure to thrive and we drew labs. I got a call the next day saying that his TSH was high and that they needed another sample to test for more serious things. She was thinking a hormonal growth problem. So we went to the ER and found his blood sodium was very low, dangerously low. He was admitted to OU Children’s Hospital in OKC that day.

Otto was physiologically starving, which is what was causing his low sodium. This is the reason anorexia is the most deadly mental disease, starvation is dangerous. When I look back at pictures of him during this time, I have to stop and not let it in, not unless I can go cry.

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Taken 3/3/2016 (3 days before hospital admittance).

 

One thing I’ve learned about OU Children’s as a birth doula is that they are exceptionally good at finding pathology; they will scour a mother and baby to find it and then leap to treat it, aggressively and immediately. I’ve watched the cascade of interventions play out in the context of birth a dozen times; Otto’s hospital stay wasn’t unlike that. They checked his kidneys and found them to be enlarged. They checked his kidney function, all good. They checked if he was having reflux from his bladder, no he wasn’t. They checked his heart, all good. They begged and begged me to allow them to catheterize him to check for UTI, which I eventually did agree to and yes he had one. I firmly believe that his enlarged kidneys were either unrelated to or caused by his starvation and chronic dehydration. The only doctor that would even entertain that idea was the nephrologist (kidney) doctor. The lead pediatrician continued to supplement his sodium orally for the entire hospital stay and sent me home with a prescription for sodium, which I never gave him. His sodium was checked multiple times after our stay and was normal.

3 days tube feeding

Before and After: 3 days of tube feeding, taken day before tongue revision

After 6 hours of testing, Otto’s feeding tube was placed. He had it for 3 days and had to have it replaced 2 times because he pulled it out. After 3 days of more testing, Otto’s tongue-tie was revised by an ENT doctor who came to our room. Even the doctor exclaimed, “Wow, that released a lot!” immediately following the clip he made under Otto’s tongue. It literally took 1 second and his latch was instantly better. He drained my breast for the first time in his life. I had been reading and reading on Dr Ghaheri’s website about how to stretch a tongue revision to avoid regrowth; he called it “active wound management.” (For more information you can see Dr. Ghaheri’s Aftercare instructions here.) I asked the ENT doctor if I should stretch it, he said “no.” I did it anyways.

Then the next day, I asked the speech pathologist, who had done Otto’s swallow study the previous day and found his silent aspiration, if I should stretch his tongue and she said, “no.” I did it anyways. I would have danced in the halls naked if it meant that we weren’t going back to how things were before the revision. The feeding tube was removed the following day.

Otto’s weight went through the roof. It went from 20-30 grams every 24 hours (3 days of tube feeding 2 ounces every 2 hours) to 130 grams overnight, with unlimited access to the breast. I overheard the nurse giving report, “he’s been taking the breast a little bit here and there, 5 minutes at a time.” I interrupted them even though I wasn’t included in the conversation. “He’s actually been gorging himself, filling himself to bursting and it takes him less than 5 minutes to do it.” Blank stares.

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Otto sleeping with a full belly, first feeding after his first revision; he emptied my breast for the first time, I was overjoyed.

Over the following days, I met Otto for the first time; content, fed, happy Otto. My heart was soaring and I will be totally honest, I really enjoyed the break from my older children and from cooking and cleaning. We made friends with the cleaning woman and all our nurses and doctors and even some other patients. I pulled Otto in a red wagon through the halls, smiles everywhere.

On our last night in the hospital, I woke up in the middle of the night having a terrible nightmare, hyperventilating and screaming at the top of my lungs. Deeply disturbing imagery I still can’t speak about. The nurses came running in checking on Otto and finding him ok but stirring because I was being so loud. I couldn’t speak, to ask them to take him out of the room so I could regain my composure, two nurses stood at the bedside, quietly staring at the monitors, which were off because Otto was better and discharging the following morning. I tried to explain what had happened, I called my husband and tried to calm down. Finally a nurse came in and took Otto out of the room long enough for me to calm down. I heard Otto crying from the hallway, the nurse had started undressing him and weighing him because measuring him was their only way to comfort me, to assure me that he was ok despite my terrible dream.

We were discharged 7 days after admittance on a Sunday, the 14th of March.

before and after copy

There are 9 days between these photos.  The After is the day we discharged from the hospital, he had gained nearly 2 lbs.

 

My worst fears became a reality as we settled into our rhythm at home. Otto started pulling off the breast at letdown again. My supply dropped again. I called and made another appointment with the dentist who does laser revision and she got us in that same week. The 2nd revision took place on March 31st. The improvement was much slower and the recovery more painful I imagine as the cut was deeper. At this point Otto had suffered months of starvation, followed by tube feeding, poking and prodding, a scissor revision during a week long hospital stay, 2 weeks of 4 times a day oral stretches and then a 2nd revision (laser) followed by 3 more weeks of 4 times a day stretches. All this could have been avoided had my pediatrician known how to diagnose posterior tongue-tie or I had the guts to treat him for it despite her denial of it.

 

I wanted to believe that our system is set up to help mothers that have breastfeeding problems. I wanted my son’s pediatrician to know how to help us or who could help us, but she didn’t. Suddenly as our whole journey sinks in, the hospital stay, the scissor revision and then laser re-revision, I remember watching babies not latch, not gain, milk supplies tank, mothers battle sore and bleeding nipples and persistent thrush outbreaks. I suddenly realized that most of them were dealing with undiagnosed ties. They had come to me to help, but I had to tell them, “some babies don’t latch”, “some women can’t produce enough”, “some yeast just never goes all the way away”.

My experience with my tongue tied baby has left me humbled, hurting and jaded. I started this journey with very little trust and faith in our medical care system and have emerged with even less.

I feel susceptible to becoming a conspiracy theorist about this topic. I’ve learned that I myself am tongue tied and it’s led to many discomforts and traumas in my life. Colic my first year of life, constant ear infections, tubes placed in my ears, terrible overbite that required 9 years of braces to correct, removal of 4 adult teeth to fit my teeth in my mouth, mouth breathing that has led to terrible tooth decay and removal of another tooth, constant dry lips and neck and jaw tension. All these things could have been potentially avoided had my tie been recognized and resolved in my babyhood, but how many professionals then would have lost me as a patient and my parents as a customer. I’ve since learned that people aware of ties that work in hospitals like NICU staff and lactation consultants are given gag orders to not mention ties because they are not there to diagnose any condition. I’ve since learned that my situation is not unique and that ties are being missed by not just pediatricians but IBCLCs and ENTs and discounted as not causing breastfeeding problems or tooth decay problems or speech problems.
I want to see change. I want ties to be taught to all these professionals and more. I want treatment to be swift and for suffering to be avoided. I made folders containing all the information I could find for every doctor’s office in my town that saw babies and children, for our local ENT physician, for the IBCLC and the Speech Pathologist I saw. It’s how I began my emotional healing. I want to see a film made on this topic. The research is there, it’s been done, more is being done. My story is one of many.

otto happy daddy shirt

Otto, thriving and growing after his 2nd (laser) revision.

Tori is a birth doula in the Stillwater area of Oklahoma.  You can visit her website here.

If you are a mother interested in sharing YOUR story please email me at ashley@nurturingbonds.com.  I would love to hear and share your story.  All stories can help other mothers-positive or negative experiences.

What to Expect: The Realities of the First Night Home

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This picture for today’s post is meant to be ironic.  This picture depicts what society says our newborn is supposed to be like.  We prepare a fancy nursery and bring our perfect baby home and we wear white clothing and the baby never messes up those clothes or our clothes with spit up or poop…baby sleeps so soundly while we snuggle in a lovely rocking chair while our spouse dusts, vacuums, and keeps the rest of our lovely everything-white house pristine.

This isn’t reality.

I’m going to tell you a little story, not to scare you at all, but to hopefully provide an example that your first night home won’t be like.  I hope this post will help you prepare better than we did and have expectations in place before bringing baby home (or if you deliver at home you still have a first night at home).  I also highly encourage you to take a quality breastfeeding class, especially one that talks about expectations and realities because preparing in this way has been proven to support breastfeeding and increase the initiation and duration of breastfeeding.  If you’re in the Oklahoma City area be sure to check out my class details and register here.

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This adorable baby is my second son.  I can’t find my first son’s going home from the hospital picture to help illustrate my story but we can pretend that this is my first son anyways for sake of the picture (they used the same car seat at least!).

My first son was born on a Friday.  He was never able to latch on in the hospital so he was given formula (we didn’t know any alternates at the time and no one told me that there was an alternate to pumping that is more efficient with colostrum-hand expressing).  I was sent home with no pump, nothing.  I did have instructions when we were released Sunday morning to call a doctor the next day to have his tongue tie clipped and hopefully he’d start being able to nurse.  We sent my parents to pick me up a manual pump so I could try to get my mature milk to come-at the time the term “milk come in” was really descriptive of the situation because I never got even a drop of colostrum out with the hospital pump even though I leaked on my nursing pads and had drips on my breasts.  Things got real when they headed home.  All of a sudden my milk started increasing in volume enough that I was getting a little bit in the bottle.  My son got his first tastes of breast milk and I was changing out bottles so my husband could feed my baby and I could keep pumping milk.  This went on forever because he didn’t want to take formula anymore after having my breast milk.  Finally we tried to settle and go to bed and my son woke up from a nap and wouldn’t go back to sleep.  He kept screaming and nothing would calm him.  We tried walking around, bouncing him, giving him more milk.  He just wouldn’t calm down.  By 2 AM I called my mom frantically asking if it was ok to put my son in his carseat and let him sleep.  At the hospital they drilled so much that it wasn’t safe to let baby sleep ANYWHERE but laying flat on their back and we were scared new parents.  We ended up putting him in his carseat and taking a 40 minute round trip in the car where we both were so exhausted.  I don’t know when we ever got to sleep that night or for how long.  Things got better after that night but I will always remember feeling so helpless and awful that I couldn’t calm my son at all.

Mother with her newborn baby

Realities

If you have a hospital birth you’ll be coming home between your baby’s 2nd and 5th day (depending on if you had a vaginal or surgical birth).  If you had your baby at home your first night will be after your baby is born and you’re all tucked in.  In this case your baby may be a couple of hours old or almost a day old by your first real night depending on when your baby was born.  Regardless, at some point you will have your first night home on your own at some point without a call button for a nurse to help with latching or to help you calm your baby.  Reality sets in when you are in this position.

Your baby will nurse frequently day and night.  Your baby will nurse about every 2-3 hours day and night with maybe a 4 hour stretch at some point between the beginning of one feeding and the beginning of another.  Many babies take 20-30 minutes to nurse, some take an hour.  All of this is within the range of normal.  Every 2-3 hours is just a guideline dividing  up the average 8-12 times per day that baby needs to nurse and some babies will nurse every hour.

Beb mamando

Your milk may be increasing in volume as soon as you get home.  This paired with your baby’s stomach increasing in size, your baby wanting that extra milk, and everything that comes with these things means that you may be experiencing some engorgement and discomfort.  It’s normal for engorgement to happen and it’s normal for it not to happen.  If you experience engorgement it’s important to remember that this is more than just milk.  Other fluids are in your breasts including blood and lymph and if you had IV fluids you may have other fluids resting in your breasts and feet as well.  This can be very sore.  Frequent feeding, ice after feeding, and heat before feeding to encourage milk to flow are usually the best remedies at this time.

Your uterus may be sore from contracting down to its normal size.  When you are nursing oxytocin is released which helps contract the muscles to release your milk and your uterus.  You may also be tender from delivery, especially if you had a tear or a c-section.  Nursing frequently helps your uterus to contract down to normal size quickly though and you can talk to your doctor or midwife about pain relief options if you’re interested.

It’s normal for your baby to wake up frequently.  It’s also normal due to hormones for you to sleep more lightly.  Nursing mothers often start feeling an intense need for a lot of water which means you may be getting up as frequently to go to the bathroom as you were in the late days of pregnancy.  All of this does get better over time and there are some things that you can do to help prepare for all of these things.  Knowing is half the battle though, right?

Dishes may pile up, laundry may pile up, try to put those things out of your mind.

Newborn

Here are some tips for making the first night home easier on yourself:

  • Have everything at hand: snacks, water, your cell phone, a remote for the TV if you wish, a book, etc.
  • Have a lot of pillows handy to help you position yourself and your baby during the night while you’re nursing.
  • Babies often spit up when they’re burping-keep extra burp cloths at hand.
  • Keep diapers nearby.  When your milk is increasing in volume your baby will also start having higher output…pee AND poop.  You may consider keeping an extra sleeper or two close by as well in case of a blowout.  They seem to like to happen during the night.
  • Prepare for baby to sleep in proximity to you.  Babies are more comfortable sleeping near mom because they’re biologically wired to be near mom.  For more information on normal sleep behaviors for newborns, infants, toddlers, and children the book Sweet Sleep is great to read.  The book starts off with quick information for how to prepare your bed for a safe night of sleep in your bed with your baby before you can read more information in the book to do a full set up.
  • Get the bathroom ready.  Have pads on the counter so you don’t have to fumble around.  Consider having a nightlight so you don’t have to turn on a bright light when you’re tired, waking yourself up more.  Keep your peri bottle handy and any other comfort measures as well.

Some other ideas to help during the day and night:

feedingcues

  • Babywear!  Skin-to-skin contact especially helps regulate and stabilize your baby’s body temperature, organize sucking, regulate breathing, comfort baby especially if your baby has gas or is in pain from medical procedures (always check with your doctor to be sure babywearing is safe after a medical procedure-it usually is but not always), allow you to be hands free to sit back and take a nap during the day, reduce stress in your baby because baby doesn’t have to cry (crying is stressful for babies, it isn’t a way to “exercise their lungs”), and also helps you recognize and react to early hunger cues which builds trust with your baby.
  • Call on your network!  People usually offer to help-call them!  Our society, at least in the states, is so against asking for help but they offered so take them up on it!  Let them run to the store or let them hold the baby while you take a shower or take a nap, just make sure they give you baby at early feeding cues.
  • If you are having breastfeeding issues go back to the basics.  Work on getting a deep latch or go back and read my post about what to expect in the first two hours, especially watch the breast crawl video.  Babies in the first couple of weeks especially have very active reflexes to help them breastfeed.  Take advantage of these if you’re having any breastfeeding issues.
  • Call on lactation support if you are having breastfeeding issues.  Call a LLL leader, Lactation Educator, CLC, IBCLC, or other breastfeeding support.  If your situation is beyond their scope of practice they can refer you to someone else to get you help right away.  Many areas have a 24 hour breastfeeding hotline.  Take advantage of it!  In Oklahoma you can call: 1-877-271-MILK (6455).  For urgent calls you will get called back quickly by an IBCLC.
  • To prepare in advance, take a good breastfeeding class.

If you’re in the Oklahoma City area be sure to check out my class details and register here.

What was your first night home like?  Tell me in the comments!

March Class Dates

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Can you believe it’s already almost March?  I can’t either!  Check out my March class dates.  I’m pleased to announce that I will be beginning to teach classes at Babies R Us in March.  Please feel free to share with your friends!  You can learn more about my classes here.

You can register here. Or register on my Square store.

Get Social!

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This is a picture that I took before going on Periscope before my Breastfeeding Basics class on Saturday.  Did you know that I am on Periscope?  I love to answer your questions live and demonstrate breastfeeding equipment and babywearing techniques.  Do you have any questions you would like answered live?  Please feel free to drop me a line with the subject “Periscope” so I can be sure to answer them the next time I go live.  You can find me @nurturingbonds on Periscope.  You can also check out my Katch.me if you miss the replays on Periscope.  Remember on replay on Periscope you can still tap to give hearts!

I also have a You Tube channel where I upload my videos from Periscope and other helpful videos that you can visit here. (Please subscribe!  I need 100 followers so I can request a custom URL on YouTube)

Check me out on Twitter, Instagram, and Facebook too!

I’d love to follow you too!  Leave your Periscope, Twitter, Instagram, and Facebook usernames in the comments and I’ll follow you!

What to Expect The First Two Hours Postpartum

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You prepare for labor, you prepare for delivery.  What happens when your baby arrives though?  You’ve likely created a birth plan that says that you don’t want to be separated from baby in the first hour or two and you want to have delayed cord clamping , a quiet room, etc. (or perhaps you aren’t that far in your preparations and planning yet) but why?  Why are these things important?

Your Amazing Baby’s Reflexes

Your baby is born with an amazing set of reflexes, automatic responses to stimuli.  We once were unsure of what the purpose was of many of these reflexes but in more recent years these reflexes have been studied more and many of them help a baby begin breastfeeding.  Dr. Suzanne Colson has spent a lot of time researching videotaped newborns and babies in the early postpartum months and has recognized many of these assisting baby to breastfeed. Your baby is born READY to breastfeed.  Sometimes, though, things interfere with these reflexes or they can be triggered to make baby not respond the way they are supposed to.  Preparing for these reflexes and recognizing them can help the first two hours postpartum (and beyond) to go more smoothly.

This video is a little bit long (around 9 minutes) but shows these reflexes in action in something called the “Breast Crawl.”  Note that this video is “not safe for work” because it shows mothers and babies totally uninterrupted postpartum (meaning no shirts in the way and very little assistance from everyone else in the room).

What’s especially amazing to me in this video is that there is a woman, with what would normally be classified as having flat and possibly inverted nipples, who is able to breastfeed her baby with no problem because these reflexes were allowed to be triggered and baby was able to find its own way to mother’s breast.  Some believe that the Montgomery glands on mother’s areola (they are more predominant in pregnancy and are raised, almost pimple like) produce a lubricative oil that smells similar to amniotic fluid which helps baby to find the breast.  This oil also helps protect your nipples from bacteria and helps lubricate from the friction that occurs from baby sucking.

Baby’s stepping reflex helps baby to find his or her way to the breast.  When your breast (or something else) touches your newborn’s cheek they will turn toward that stimulus to try and find a nipple (rooting).  Baby will keep trying until he or she can find their way.  They will open their eyes occasionally and try to find the darkened target (your areola) to latch on to.  The sucking reflex is triggered once baby is able to latch which triggers your body to release milk (your milk ejection reflex which is controlled by hormones that are released as a response to your body feeling your baby beginning to suck).  All of these reflexes are helped by having baby’s front whole side to feel supported (a laid-back position helps promote this).  Sucking helps soothe your baby and your milk calms your baby.

What about Interference and Emergencies?

Of course the breast crawl and allowing baby to self latch is potentially the best means for baby to latch on after birth but it doesn’t always happen that way.  Protocols and interference do happen often (this can be minimized by having a doula attend your birth acting as an advocate and helping you and your husband or partner be able to hear all of the pros and cons of a treatment or not allowing a treatment to occur).  Emergencies also happen sometimes as well.  Reflexes can still be triggered and baby can still be allowed to have as natural as possible of a time latching (even after a c-section).  Interference should be minimized to set baby up for the best possible circumstances but know that even without the picturesque birth you can still go on to successfully breastfeed.

So what happens the first minutes to two hours postpartum?

new baby just coming into the world

Your baby is born.  The majority of the hard work of labor is done (or in the case of multiples you will still have another baby or more to deliver).  When baby is delivered he or she can be placed on your stomach to allow the breast crawl to happen.  Baby could be placed on your chest instead.  You may be eager to get baby to latch on sooner to help expel the placenta, patience is important though under normal circumstances.  Baby will still be attached to the placenta via the umbilical cord once he or she is born.  Some practitioners regularly clamp and cut this cord right away but babies are also only born with about 2/3 of their intended blood supply.  Allowing the cord to fully finish pulsating pushes the remaining blood into baby.  Emergencies can occur in which the cord does need to be clamped and cut earlier, however, even with some breathing struggles practitioners can attend to baby while still attached because the oxygen rich blood is still being pumped in to baby.

While the cord is pulsating baby can still be placed on your stomach, the cord is usually long enough, though in some circumstances it may not be.  Baby doesn’t need to be roughly cleaned up but may be patted dry with a soft towel or blanket.  If baby’s hands are left alone this may help baby trying to latch the first time (because of the Montgomery glands that were discussed earlier).  When your baby is placed skin-to-skin with you, your stress levels go down as well as your newborn’s.  Your body will help regulate your baby’s temperature but you may want to place a blanket over the two of you (keeping the room warm is probably a better idea though to allow baby to self attach easier).  A hat and other things are not necessary at this point.

Your uterus will continue contracting after a pause to work on expelling your placenta.  Some placentas come quickly but allowing the placenta to come on its own prevents ripping from pulling which can leave pieces behind that can inhibit your body from transitioning to mature milk.  (Note: If an emergency occurs though keep in mind that pieces aren’t always left behind but if you are struggling with your supply after the first few days this is a possible cause that you and your provider may want to look further in to).  Eventually your baby’s cord will be clamped and your placenta will release.  If your baby is able to latch before the placenta is delivered the first latch will encourage oxytocin to help the uterus push it out.  You will feel a tightening sensation in your uterus for the first few days when your baby is breastfeeding because oxytocin releases smooth muscles of your uterus as well as the smooth muscles in your areola that hold back the milk.  This is what helps your uterus contract down to its pre-pregnancy size.

Childbirth

Baby may self attach as in the breast crawl video or you may assist baby.  Hopefully your care providers are allowing a peaceful and non-rushed atmosphere to allow you to have your time to bond with your baby.  A doula can help facilitate this atmosphere.  As with other mammalian mothers we have a strong need for quiet and privacy postpartum to allow our hormones to work as they were designed.  Skin-to-skin contact without anything in the way helps to promote these hormones to work as well.  If baby is separated from you this can cause stress for you and baby (which can potentially cause unstable vital signs in both of you) and also inhibit your baby’s reflexes and behaviors looking for the breast.  Some of these can be compensated for (especially in emergency situations) but some difficulties can come up with unnecessary separation.

Colorful Marbles

Once baby has been allowed to latch on, let baby determine when he or she is done breastfeeding.  Newborns have very small stomachs (about the size of a shooter marble) that can only hold a little over a teaspoon of milk at a time.

You and your new baby may be very tired after this.  You may both with to go in to a period of rest.  You may want to see visitors and show your new baby off.  Keep in mind that your newborn may want to nurse frequently because they have such small stomachs and need a lot of colostrum (this will help build your supply when your milk transitions as well).  You have done a lot of work and it’s perfectly OK to tell visitors to wait for a few hours or longer to visit you.  It’s also OK to limit the time that they are visiting because these early days are especially important to get breastfeeding off to a good start.  Babies that are kept skin-to-skin for the first two hours are able to use your body to help regulate their temperature and are able attach and breastfeed as often as he or she would like.  After this time your baby may be weighed and vital signs can be taken (some can be taken after the first breastfeeding has occurred).  Some caregivers may be antsy to get these done quickly so be sure to talk about your wishes well in advance to be sure you are all on the same page with what needs to be done and when.

Mother feeding newborn baby

If you tore or an episiotomy was performed that will be repaired, hopefully after baby was allowed to breastfeed for the first time.  Your newborn may be allowed to remain skin-to-skin while the repair is made.  You can hold your infant on your body while on your back.  You may also be transferred to a postpartum room after the first two hours as well.  Your newborn may be allowed to remain skin to skin with you during this transition but some hospitals have policies that babies must be transported separately.  You can learn about the protocols in advance so you are able to know and prepare beforehand.

If you’re in the Oklahoma City area be sure to check out my class details and register here.

For More Information Please See:

References:

Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Nancy Mohrbacher, 2010.
Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers
, Second Edition. Nancy Mohrbacher and Kathleen Kendall-Tackett, 2010.
Counseling the Nursing Mother: A Lactation Consultant’s Guide, Fifth Edition.  Judith Lauwers and Anna Swisher, 2011.
The Womanly Art of Breastfeeding, Eighth Edition.  La Leche League International.  Diane Wiessinger, Diana West, and Teresa Pitman, 2010.
Your Amazing Newborn. Marshall H. Klaus and Phyllis H. Klaus, 1998.

(As always please remember that the information and opinions provided on this website and blog are not a substitute for medical advice or consultation with a qualified medical professional; nothing contained on this website shall be presumed or shared as medical advice at any time.  Please see my disclosures here.)

 

What was most helpful to you in the first two hours postpartum to get breastfeeding off to an excellent start?

 

 

 

Put that phone down! Gaze in to those baby eyes.

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Mothers!  Put that phone down!  Gaze in to those sweet baby eyes! 

I know it gets boring to sit on the couch (or chair or wherever that comfy nursing spot is that you love) but please do remember to take some time to gaze in to those sweet baby eyes.  Bonding is a complex thing and is driven by oxytocin.

Oxytocin has an important role in breastfeeding and is also often referred to as the love hormone.  Mothers struggling to let down their breastmilk are sometimes prescribed oxytocin to help.  Oxytocin promotes love, bonding, and makes you feel good overall!  Babies are perfectly created to be able to see the exact distance from your breast to your eyes from birth.  Babies are born ready to bond!

Moms (and dads) and babies need a daily dose of oxytocin to promote bonding.  A simple way to do that is to gaze in each others eyes.  There’s a reason why toddlers will often shout “No phone!” to a well meaning mama who is feeding the little one for the umpteenth time.  Babies (and older kiddos) are hard wired to want your attention.  It’s also good for you.  Some theorize that oxytocin can help treat depression.

It’s totally ok to want to be on Facebook, read a book, read your Kindle, watch TV, etc while nursing but please do take some time to gaze in to those baby eyes every day.  Take some time to snuggle!  Even better, wear your baby and get some skin to skin time in as well.

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If you want to learn more about Oxytocin here are a few sources to get you started:

Basics of Oxytocin, Psychology Today

“Love Hormone” Promotes Bonding, UC San Diego

What do you like to do with your baby to promote bonding?

If you’re in the Oklahoma City area be sure to check out my class details and register here.

 

 

Breastfeeding and Babywearing Part 2

First Published: Sep 18, 2015 2:28 AMbreastfeedingandbabywearing
Babywearing is a must for many breastfeeding mothers. Not only can you keep baby close and enjoy the benefits of skin to skin contact but you can also recognize baby’s early feeding cues and many mothers are able to breastfeed right in the carrier. Different carriers will work better for different mothers. Try it out with a few different carriers before going “out in the wild” and see what works best for you. Many mothers are able to nurse discreetly and have one or two hands free to do what they need to do. I certainly encourage nursing mothers to sit down and get their feet up as much as possible but recognize sometimes there are things that need to be done as well. This post will give some ideas and tips for nursing in a carrier. As always, I recommend some hands on help. Certified Babywearing Educators can give specialized one on one help with all aspects of babywearing including (but not limited to by any means) helping moms to breastfeed in their carriers.

If you want to learn more about the how babywearing supports breastfeeding be sure to check out this post!

Babywearing makes breastfeeding easier! (From this article)

“Breastfeeding mothers who practice baby wearing find it easy to nurse their babies more often. This may help babies gain more weight. The shorter the time between feedings the higher the fat content in mother’s milk. By wearing baby, a mother can easily respond to his early feeding cues:

When a baby is near his source of milk and comfort, he does not have to use much energy to get his mother’s attention; he can use this energy to grow instead. (Sears and Sears 2001)

If a mother thinks that she will feel uncomfortable breastfeeding in public, baby wearing can help her overcome this worry. Breastfeeding in public is likely to attract more attention if the baby has reached the point that he is crying frantically when mother tries to offer the breast. If baby is already close to mother in a sling, she can respond as soon as he shows early feeding cues, such as rooting for the breast or sucking on his hands. She can adjust his position and her clothing and have him peacefully nursing before anyone even notices. The extra fabric from the sling can easily be pulled over baby’s head, and mother can continue shopping or eating dinner without any fuss. With the fabric of the sling blocking out distractions, baby will settle down to the business of eating and may nurse quietly off to sleep.”

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This mother is nursing in a woven wrap. She has brought her breast up to baby rather than dropping baby down.

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Mom has brought baby down a little to her breast and brought her breast up a little to her baby. Baby is not in a full cradle position like many moms use in a ring sling. There are a lot of options. Experiment to find what works best for you!

Some practical tips:

  • Practice in different carriers. Because every mother is shaped differently, sometimes different wrapping methods or trying a different carrier will help you nurse your baby better than one you may be struggling with.
  • Be sure baby has a good latch. It’s helpful, especially with a small baby learning to latch, for baby to be nose to nipple and for you to give a little extra help the first few times trying to nurse in a carrier (or possibly after the first few times).
  • Try different shirt methods. Some moms are comfortable with shirts or tops that pull down from the top, other moms are more comfortable with a two shirt method where you pull the top shirt up and pull the bottom shirt down or to the side. A nursing tank can easily be made by cutting slits off to the side of your breast in a well fitting tank top (off the center of your nipple towards your arms). T-shirt material will not fray so you don’t have to sew it but if you’d like to stitch around the new opening it will help it lay flat under your shirt.
  • You can bring baby to your breast by lowering baby in the carrier or lift your breast to baby, or a combination of the two-experiment with what will work best for you both.
  • In a ring sling be sure that baby’s head is opposite the rings when laying your baby in a cradle type position. You will have to reverse the shoulder if you want to nurse on the other breast.
  • In a soft structure carrier or mei tai you can drop the waist band down and loosen the arms to bring baby down to your breast or you can lift your breast up. If you are doing the two shirt method you will want to be sure to lift your top shirt above your waistband before trying to get baby in position and may want to tuck your bottom shirt in to your pants to help it stay where you want it.
  • In a woven wrap you can lay baby in a side laying position (be sure to check baby’s breathing at all times!) or drop baby down. Front wrap cross carrier is an excellent nursing carry. You can lift baby up and pull legs up and out of the crosses, lay baby to the side and pull the wrap down over the bottom and a little down the legs to make a pocket. When baby is done nursing, put baby back upright, put those little legs back in to the crosses, and untie and retighten the carrier. With practice this can be done while baby drifts off to sleep.
  • Get immediate help for breastfeeding struggles. See an IBCLC for breastfeeding help.
  • Get some hands on babywearing help if you still are struggling with nursing in a carrier.
  • Remember to always bring baby back to an upright position high and tight after baby is done actively nursing (before baby drops off to sleep). You may have to unlatch baby early. This is to protect baby’s airway and the rule is not the same when you are nursing a sleeping baby outside of a carrier.
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Nursing in a Boba 4G carrier using the two shirt method. I have pulled my top shirt up and pulled the slit over and pulled my nursing bra down. With practice this becomes easy and quick to do. Baby was lowered by loosening the waistbelt and arm straps. A hood can be used for extra security if you wish.

I’m a visual learner and I really enjoy videos. Here is a playlist of YouTube videos that I have found helpful and you may as well.

What are your tips and tricks for breastfeeding in a carrier?

Traveling With Baby

First Published: Sep 8, 2015 6:01 PM traveling

Whenever you have to waver from a baby’s routine life can become challenging. Babies also often have a lot of extras: toys, clothes, diapers, burp cloths, layers in case it’s chilly, car seats, etc. Babywearing helps simplify traveling and allows extra hands to carry the extra items your baby needs to be comfortable. Some of these tips may also help.

Traveling by Car

  • Plan an extra day or several extra hours to get to your destination. It will be worth it to take a lot of breaks rather than trying to power through. Consider doing the longest stretches while baby is napping or sleeping. Possibly consider traveling overnight if you can get enough sleep to make up for missing the sleep during the night.
  • Plan breaks in towns with a park or somewhere you can all get out and stretch your legs, walk around, and play for a few minutes. Packing a frisbee or other toys that you and your children love to play with and chase will help everyone get some fresh air and exercise and make the time in the car go more smoothly.
  • Plan for plenty of snacks and drinks. This will make everyone have to go to the bathroom more often but having plenty of water will keep everyone from getting dehydrated.
  • Leave a place next to baby if possible so if you’re tag team driving with your spouse or another adult an adult can sit next to baby and play peek-a-boo and sing songs if baby is bored.
  • Try to make nursing feel as much like home as possible-be sure to pack your nursing pillow if you use one or something else that will remind baby of home.
  • Babywear and snuggle as much as you can to make up for the skin to skin time baby is used to. You can wear baby as soon as you get out of the car and during bathroom breaks and then play together and stretch legs. Follow your baby’s cue. Many parents find that if they wear baby as much as possible in the hotel or when they reach their destination it will help baby feel better and the car ride will go more smoothly. Start this a couple of days before your trip if possible.
  • Bring plenty of extra clothes and diapers. Sometimes babies get upset tummies in the car or have extra messy diapers when traveling.

Traveling by Plane/Train/Boat/Bus

  • Pack plenty of treats and snacks for the diaper bag. The TSA allows enough snacks and fluids for the flight (check their website for current information).
  • If possible pack a few toys and books that your baby has never seen before or hasn’t played with in a long time to keep them entertained. Freecycle.com is a great place to find these or a local virtual garage sale page. Trading baby toys with friends for your trip is also a good idea.
  • Pack some funny things like bubbles (be sure to check fluid amount guidelines) to play with while waiting for the plane/train/boat/bus, etc.
  • Try to stretch little legs and parent legs as much as possible right before your flight. Getting all the wiggles out will help many babies settle before boarding and buckling up.
  • Consider getting baby their own seat for their car seat or gate check baby’s seat. Sometimes if there are extra seats and you gate check they will let you buckle baby in their seat at no additional charge (depends on the airline though). Gate checking often keeps your car seat safer too.
  • Babywear as much as possible for a few days before your flight. The extra skin to skin contact will help “charge baby’s batteries” especially if baby won’t be a “lap child.”
  • If possible, nurse during take off. If not possible, offer a pacifier or clean finger (with short nails) pad side up to the roof of baby’s mouth. This will help little ears from feeling too much pressure.
  • Pack extra diapers and clothes. Sometimes babies get upset tummies or have extra messy diapers. Sometimes flights are delayed.

Carriers usually aren’t allowed through security (the TSA says they are not allowed on their website as of this writing but check their website for current information) but you can wear baby up to security and after. Buckle carriers and ring slings allow for quick ups and downs and make this go more smoothly but woven wraps are also quite lovely if you have long layovers, you may consider putting one in your carry on though or waiting to wrap until after you get through security and can get off to the side somewhere.

Have a happy trip!

What are your favorite tips for parents traveling with babies?

Babywearing in the Heat and Sun

First Published: Aug 7, 2015 6:01 PM
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We’re deep in to summer right now but I wanted to share some tips for babywearing in the heat and sun. Oregon heat is different than most of the U.S. but I am from Utah (and moved during the summer when my second was over 8 months) so I have some experience with good old all summer heat. The past two summers have been exceptionally hot in Oregon and most people do not have air conditioning in their homes so when the temperature has reached 106* and several 100* days a lot of parents find it hard to cope. I hope you all find these tips and tricks helpful. Please share your tips and tricks in the comments as well!

  • It’s important to keep in mind that regardless of the carrier you are using a baby is hot! You are wearing a little heater and no matter what it will feel hot. Some carriers are better than others and some work better for some parents than others so experiment.
  • Be sure to drink plenty of fluids. Breastfed babies do not need extra water when they are under 6 months especially, make sure you offer the breast often and choose a carrier that is easy to do that in. Carry a water bottle with you. I’ve tried several and personally LOVE the Hydroflask because I can fill it all the way up with ice in the morning and keep adding water from a drinking fountain throughout the day and have really cold water.
  • Wear a hat and have baby wear a hat. The hat will help keep sun off of each of your faces and keep you a little cooler. If your baby is over 6 months be sure to put sunscreen on because sun burns will make you feel even hotter.
  • Plan to spend a lot of time in the shade. Also plan your activities whenever possible to have a cool area to go to if you’re starting to feel tired. The sun drains you and it’s good to have a place to have a break from the sun and heat-even if it’s driving around in your car for a little bit to cool off.
  • Wear lightweight clothing. Looser shirts help air circulate better-100% cotton will help breathe and absorb the sweat and allow it to evaporate better which will help cool you off.
  • If you live in a dry climate using a spray bottle with cool water can help cool you off, especially if you can mix that with a personal fan.
  • Wearing baby will help you to know when baby is getting too warm because you will feel it (especially in lightweight clothing). When you feel like your baby is getting too hot-escape to the cooler place you planned on or the shade and continue to drink lots of fluids.

What carriers are best in the heat?

This really depends on you! No matter what though, 1 layer of fabric is probably the most you will want over you. You can make nearly any type of carrier work in the heat. I will talk about how to make each type work for you but you know your body and baby best. If one is too hot for you try another. Most people (at least in the States) have a babywearing group within reasonable driving distance and many have a lending library or carriers to try out.

  • Ring Sling: A ring sling is pretty nice in the heat and sun. You can use the tail to shade you if you need to or let it hang down. You could always wrap it around the rings to make it not hang down as long. Ring slings are really supportive for newborns but can be great for toddlers too, especially if they are made of thicker material or linen or converted from a woven wrap. Another option is to hop in the pool with a mesh water ring sling.

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  • Woven Wrap: Single layer carriers are best in the heat. Cotton and linen fabrics are cooler usually than others. Kangaroo is really breezy around your underarms and breasts. A simple Rucksack or a a Reinforced Rucksack (especially stick to the reinforced with a seat popper) is a great back carry with one layer. Front Wrap Cross Carry is doable but has more fabric which means a little less air circulation. I will discuss these carries in later posts. You can always hop in the pool with a water wrap though and some may work outside of the water as well. Gauze wraps and hybrids may be breezier but may be better suited for babies under 20-25 lbs because at that point many parents find that they become diggy in the shoulders no matter how careful and tight you wrap.

  • Soft Structure Carrier: Many of these are great in the heat but especially ones with mesh panels. I love my Kinderpack with cool knit in the summer but I have also worn Ergo, Beco Butterfly (which has a panel between you and baby which can help absorb some sweat but it also makes it harder to feel how hot baby is-this carrier has been discontinued but still can be easily found new or used online), Boba, Onya Baby, etc. There aren’t huge differences between them in the heat but some do find mesh panels make a difference or using a lighter or sport version helps.
Thank you Katie Waugh for the awesome daddy wearing picture!

Thank you Katie Waugh for the awesome daddy wearing picture!

  • Mei Tai or other Asian Inspired Carriers: Don’t discount these. Like a soft structure carrier these have one panel over baby. If you stick to one with ties that are just long enough for you (rather than long enough to do fancy tie offs) you may find these are great for summer. One tip though, stay away from Minky in the summer. It’s super soft but feels like you’re wearing a blanket (I found this out the hard way).

The information and opinions provided on this blog post (or any blog post on this blog) are not a substitute for medical advice or consultation with a qualified medical professional; nothing contained on this website shall be presumed or shared as medical advice at any time.

What are your tips for summer and hot weather babywearing?