Becky is fun-loving mother of three and shares her answers to my questions:

What made you want to breastfeed your baby?
“As long as I can remember, I wanted to breastfeed. I even remember as a little girl breastfeeding my dolls.”

When you breastfed your first baby, what was your biggest struggle and who did you turn to for help?
“I was very lucky that my son decided to nurse without difficulty. My challenge was being very sore and engorged. I was a nurse when I had my kids, so I had knowledge and helped others breastfeed in nursing school. That was very helpful. I was worried about production and talked to my doctor about how to increase my milk supply. I think I even cried when I spilled my breast milk!”

BREASTFEEDING FACT: Refer back to my previous blog entries to learn about soreness, engorgement, and increasing milk supply.

What was your favorite thing about breastfeeding your child?
“My favorite thing was the downtime and relaxation I felt when nursing. It was so peaceful to me. My son looking up at me and playing with my hair. Those sleepy eyes and him falling asleep in my arms like I was the safest place in the world.”

BREASTFEEDING FACT: Breast milk contains a wonderful hormone. This hormone, cholecystokinin (CCK), is released into the baby’s intestines in response to the presence of fat and protein. One response to CCK is that it  gives an overall sense of satiety, or fullness, along with sleepiness. Both mom and baby benefit from this hormone.

Any funny stories associated with your breastfeeding “career?”
“I remember with my third son I never had time to sit and nurse for long without getting called away. I  would nurse on the run.  I used a sling and nursed walking down the mall one time! No one knew what I was doing until my friend said, very loudly, “Oh my gosh, I did not even realize you were breastfeeding!” Several people turned and looked at me. I laughed because I was NOT embarrassed in doing what I needed to.”

BREASTFEEDING FACT: Did you know that Wisconsin, among 44 other states, has laws that specifically allow women to breastfeed in ANY public or private location?  Also,  Wisconsin and 27 other states exempt breastfeeding from public indecency laws.

When you teach breastfeeding at work, what is one of the most important things you tell your patients?
“The most important thing is to relax and enjoy your experience. Your body is amazing and it will adjust to your baby’s needs if you let it. It doesn’t have to be all or nothing. Any breastfeeding you do is better than none.”

Ame Fischer RN, CLC

Sources: www.ncsi.org, Breastfeeding A-Z by Karen Cadwell and Cindy Turner Maffei

Some swelling is considered to be normal. But if your baby is not emptying the breast properly or frequently, the pressure of the milk builds, blood flow slows, and milk goes into the breast tissue. This results in your breasts becoming “engorged,” which includes symptoms of discomfort, warmth, shiny skin, and throbbing. (Note: Excess IV fluids given during labor and/or recovery can also cause the breasts to swell.)

An example to demonstrate how engorgement occurs is to think of a balloon that has a tip at the end that sticks out (like your nipple). As you fill that balloon with more and more water, that tip will shorten more and more. The same thing can happen to your nipple. That is why many women who experience engorgement will say that baby latched well and fed in the hospital, but then has trouble latching when at home in 2-6 days after birth.

Some symptoms of engorgement may seem similar to mastitis (see my post about Mastitis from 12/28/11). Key differences to recognize are that mastitis usually affects one breast, and you develop flu-like symptoms such as body aches and fever.

To help minimize engorgement, frequent breastfeeding will remove the colostrum and increase the volume of milk, which allows for the extra blood to drain easier. This makes the breast fullness less likely to become painful engorgement. If your baby sleeps often, then guide your baby to the breast more often. The more minutes at the breast during early breastfeeding, the less engorgement later on. Engorgement, if not relieved after that first week, may lead to feeding problems, nipple pain, mastitis, and in extreme cases long-term milk production may be compromised.

To reduce or decrease engorgement:

1. Feed, feed, and feed your baby
2. Use an anti-inflammatory pain medication such as Ibuprofen (see your physician for specific instructions)
3. Apply cold compresses between feedings to reduce swelling.
4. Use moist heat such as a warm shower before feedings to help empty the breast. Avoid prolonged heat because it may increase the swelling.
5. Prior to feedings or in the shower, gently massage breasts to stimulate milk flow toward the areolas.
6. Breastfeed often and long. Breastfeed your baby as the baby is willing. Follow your baby’s feeding cues, NOT the clock. For any concerns about latching, contact your physician, or a lactation counselor (Sauk Prairie Memorial Hospital’s lactation counselors can be contacted at 608/643-7223).
7. If breast still feels full after feeding, hand express or use an effective breast pump to pump to comfort.

If you have any questions or concerns about latching, don’t hesitate to call your physician or our lactation counselors. Remember, this is one reason mothers get frustrated and think their milk supply has decreased, when in fact they just need to feed their baby often to prevent or lessen the engorgement period.

Ame Fischer, RN

While breastfeeding may not seem the right choice for every parent, it is the best choice for every baby. ~Amy Spangler

Sources: Lactation Management, Karin Cadwell and Cindy Turner-Maffei; Breastfeeding Answers, Guide for Helping Mothers, Nancy Mohrbacher, IBCLC, FILCA

Molly, what made you want to breastfeed your baby?
My mom breastfed all eight of her kids, so I was raised thinking it was very normal. In addition, being a labor and delivery nurse made me appreciate the health benefits for my baby.

When you breastfed your first baby, what was your biggest struggle? Who did you turn to for advice/help? For some reason, when I delivered, my nipples went flat. So baby had a lot of trouble latching. I got shells, which worked very well in bringing out my nipples, but they were a pain to wear. My already-swollen breasts stuck out even further, and I was embarrassed to go out in public. In addition, when my milk let down, the shells would fill with milk, so taking them off or bending over became messy and unpleasant. Although my mother had breastfed all of her children and belonged to the La Leche League, she was surprisingly hands off with my breastfeeding experience. My midwife made several home visits in the week after I delivered, and she was very  helpful. In addition, there were several mothers of large families who were very supportive and helpful.

What was your favorite thing about breastfeeding your child?
#1: The bonding. There is just nothing like the closeness that you feel when your infant is at your breast. The rush of lactation hormones is very relaxing. In addition, it’s nice to know that there is one aspect of your relationship with the baby that no one can replace. Anyone can change diapers and cuddle, but only I had that intimate, irreplaceable function. It’s also great when they get to be a month or two old and start to smile at you while nursing and look at you like you’re the most wonderful thing in the world!

#2: The accelerated weight loss postpartum!

Any funny stories associated with your “breastfeeding career?”
My kids are very comfortable with the concept of breastfeeding, and consider it to be a normal unremarkable part of daily life, like brushing your teeth. Hence, they will talk to anyone about it. One day, we were in the grocery store and my baby was hungry and fussing. A little old lady addressed my son saying “It sounds like your baby is tired.” My son responded immediately, “No, he just wants my mama’s breasts!”

Molly, when you teach breastfeeding at work, what is one of the most important things you tell/teach your patients?
I tell them to be patient, and that their difficulties are normal and it will get easier with time. I also tell them that it’s the best thing they can do for their baby and themselves.

I hope you are enjoying these mini breastfeeding interviews. Please login and post any of your stories or answers to these questions for other moms to read and relate to.

Ame Fischer, RN

“I love that I’m someone special and that I feed him. I’m the milk cow! My theory is that nursing gives you superhuman powers. How else could I be doing all this when I’m usually a sleepaholic?” ~Gwen Stefani

Please login and share your answers to the following questions so I can post them for other moms to read.  Feel free to add particular problems you may have faced with breastfeeding and how you overcame them.

Sarah B. is a wonderful mother of two gorgeous girls. She is an OB nurse here at SPMHC and wants to share her experiences. Sarah breastfed both her girls.

Sarah, what made you want to breastfeed your baby?
“The health benefits for my baby, weight loss for me, and that it’s natural”

When you breastfed your first baby, what was your biggest struggle? Who did you turn to for advice or help?
“I had very sore nipples for the first two weeks. I turned to my fellow RNs for help.”

What was your favorite thing about breastfeeding your child?
“The bonding”

Anything memorable/funny stories during  your “breastfeeding career?”
“Every day at pre-school my daughter would breastfeed her dolls because she said, ‘That’s how babies eat!’”

Sarah, when you teach breastfeeding at work, what is one of the most important things you tell/teach your patients?
“It takes about two weeks for your nipples to become ‘toughened up.’”

Ame Fischer, RN, CLC

“I breastfed all my children and I am a very strong proponent [of breastfeeding]. It was one of the most rewarding and satisfying experiences of motherhood, so far.” ~Tipper Gore

Risk factors or reasons that mothers can develop mastitis:

• Sore, cracked and damaged nipples:  Mastitis is frequently seen with sore and/or damaged nipples. This can be caused by improper latching. Improper latching leads to poor milk removal which may plug milk ducts and lead to mastitis or an abscess. Not all women with sore nipples get mastitis. The broken skin on the nipple can be an entry for bacteria.

• Infrequent breast pad changes

• Ineffective feedings:  Feedings that are hurried or limited do not let the milk empty properly.  Missed feedings, supplements or irregular feedings also keep milk in the breasts for longer periods of time.

• Overabundant milk production:  Producing much more milk than baby takes keeps the breasts full much of the day.

• Consistent pressure on the breast:  This can be caused by several things:
  • Ill-fitting/tight bra or underwire
  • Continuous breast shell use
  • Stomach sleeping
  • Tote or baby carrier often in the same spot of a breast

• Rapid weaning: Weaning too rapidly may cause too much breast fullness for too long. If a mother with already diagnosed mastitis weans too quickly, her mastitis can actually worsen or it may develop into a breast abscess.

• Anemia

• Stress

• Fatigue

Possible mastitis signs and symptoms:

• Fever, usually 101 degrees F or higher
• Chills
• Body aches
• Headache
• Some have reported nausea and vomiting
• Normally one breast is infected but in some cases both can have mastitis
• Swelling, tenderness and redness in a certain area of the breast
• Red streaks may be noticed in the area that is infected
• Very sore hard area on infected breast

Teatment/Care:

• If you suspect mastitis, contact your doctor or lactation counselor. If it is mastitis, your doctor will usually prescribe antibiotics. With prompt treatment, symptoms may subside and get better within 24 hours. Symptoms should completely resolve within five days if properly taking antibiotics. Make sure the full course of antibiotics is taken. NOTE: You may continue to breastfeed your baby while on most antibiotics. If there is any question or concern contact your pharmacy, ask your doctor or call a lactation counselor.
• Go to bed… get lots of rest!
• Increase your fluid intake.
• Remove bra if that will make your breast more comfortable.
• Nurse at least every two hours and begin each feeding on the affected breast. It is important to nurse frequently during this period, otherwise your healing may slow and may lead to an abscess. NOTE: You do NOT need to worry that baby will get ill while you have mastitis. The breast infection involves the breast tissue, NOT the milk. Also, your baby has plenty of antibodies transferred to her through your breast milk.
• Apply moist heat for about 15-20 minutes prior to nursing and as needed between feedings.
• Check temperature every 4 hours. You may take acetaminophen to reduce any pain or fever. (Follow correct dosages.)
• An increase in Vitamin C may help healing and recovery.
• Massage affected breast prior to and while nursing.
• Gently pump breast after feedings that are too short in duration or if a feeding is skipped to drain the breast.
• If you have any lactation questions or are unsure if you have mastitis, please call your doctor or a lactation counselor at Sauk Prairie Memorial Hospital & Clinics. We are always willing to talk through lactation questions and meet at your convenience.

Wishing you the “breast” of health!
Ame Fischer, RN, CLC

Sources:  The Nursing Mother’s Companion by Kathleen Huggins, RN, MS; The little Green Book of Breatfeeding Management, 4^th Edition by Gail S. Hertz, MD, IBCLC; Pocket Guide for Lactation Management by Karin Cadwell and Cindy Turner-Maffei; Breastfeeding Answers Made Simple by Nancy Mohrbacher, IBCLC, FILCA; Breastfeeding, A Great Start by Diane E. Moran RN, LCCE, ICD, G.Byron Kallam, MD, FACOG

Breast milk: the gift that keeps on giving!

Infrequent feedings can lead to lower levels of Prolactin, the hormone that aides in milk production. Milk production is regulated by supply and demand. The more frequent you nurse your baby, the higher levels of Prolactin, therefore more milk making potential for proper growth and development.

What are the hunger cues?

• Sucking on her tongue or lips
• Sucking on her fingers
• Moving her arms and hands toward her mouth
• Fussing or fidgeting while sleeping
• Turning head from side to side
• Crying can be the last sign of hunger

What are some things you can do to keep up my milk supply or increase it?

• Encourage more frequent feedings and as long as baby wants
• Offer both sides at each feeding and let your baby end the feeding
• Proper latch and proper positioning plays a role in milk supply
• If your baby seems sleepy during some feedings, switch breasts often during that feeding. This idea is called “super switch nursing.” This involves switching sides two or three times during each feeding. Mothers can watch the baby’s sucking and switch to the other breast as soon as the sucking begins to slow down. Repeating this several times during the breastfeeding increases breast stimulation.
• Limit pacifier and supplementary bottle use
• Rest, relaxation, proper diet, and enough fluids
• If your baby does not nurse long during a feeding, skips a feeding, or your breasts still feel full after a feeding, then pump until you feel less full (usually about 5-15 min, no more then 20 min). More frequent, shorter pumping sessions are more effective than fewer longer sessions.
• Aim for 8-12 breast/pumping sessions in a 24 hour period
• Keep in mind that some medications play a role in milk supply. Check with your provider or pharmacist.
• Contact a Lactation Specialist for more information and support if you are concerned about your milk supply. If your goal is to exclusively breastfeed and you question your supply, try these suggestions and call for support.

Ame Fischer, RN CLC

Sources:  www.llli.org, Breastfeeding, A Great Start by Dianne E. Moran, RN, LCCE, ICD, and G. Byron Kallam, MD, FACOG, The Center for Breastfeeding

Knowing  the benefits of breastfeeding is so important in your decision to breastfeed your child. This increased knowledge empowers mothers who plan on breastfeeding to want to do it as long as they can. Breast milk alone  is sufficient to support optimal growth and development for about the first 6 months after birth. The American Academy of Pediatrics (AAP) recommends that breastfeeding continue for at least 12 months, and thereafter for as long as you and baby desire. The World Health Organization recommends continued breastfeeding up to 2 years of age or beyond.

Benefits for full-term infants:

• Breast milk transmits proteins(IgA), which  are antibodies against disease-causing organisms to which the mother has been exposed. These proteins are unique in that they line the infant’s respiratory and  digestive tract, forming a protective covering. This covering prevents many bacteria and viruses from invading the baby’s body.
• SIDS (Sudden Infant Death Syndrome) is less common in newborns that have mother sleeping near the baby and breastfeeding. Breastfed infants are more easily aroused from active sleep at 2-3 months of age than formula fed infants. Breastfeeding reduces the risk of SIDS by 50%. SIDS peak at 2-3 months of age.
• Breastfed babies have less spitting up, constipation, and diarrhea because it is so easily digested.
• Night time feedings are easier because the breast milk is always right there and at a perfect temperature.
• Children who are breastfed are at reduced risk of obesity. Studies have found that the likelihood of obesity is 22% lower among children who were breastfed by their mothers.
• Suckling at the breast is good for your baby’s jaw and tooth development. Babies at the breast use different muscles to get the food than those you drink out of a bottle.
• Breast milk has all the nutrients, calories, and fluids your baby needs to be healthy. It has growth factors that ensure the best development of baby’s organs.
• Mothers of breastfed babies make fewer trips to the doctor’s office. Research studies have shown that exclusive breastfeeding was associated with a significant reduction in the risk of:

Atopic dermatitis (skin disorder)
Gastrointestinal infections (stomach infections)
Asthma
Type 2 Diabetes
Childhood Leukemia
Bacterial meningitis
Urinary tract infections

Benefits for the breastfeeding mother:

• Research studies have shown that mothers who breastfeed are more likely to return to their pre-pregnancy weight and get their figure back sooner.
• There is a reduced risks of breast and ovarian cancer.
• The hormones associated with breastfeeding help a new mother feel motherly. Breastfeeding helps mothers relax and feel good.
• Breastfeeding is fulfilling. Mothers feel proud of breastfeeding for the rest of their lives. It helps her feel irreplaceable.
• Most mothers who breastfeed do not get their period for a while (although another pregnancy may be possible). This can prevent iron loss during that time.
• Breastfeeding save LOTS of money and is an ecological choice. If 90% of U.S. moms breastfed exclusively for 6 months, the nation would save $13 billion a year!
• Breast milk does not need to be prepared and is always available.
• Women who breastfeed tend to have increased bone mineral density later in life, which is a protective factor against fractures of the hip and other sites.

I had a my first baby three months ago, and I am proud to say I am still exclusively breastfeeding my little girl. All the benefits listed above are what continue to motivate me to want to provide the healthiest start in my baby’s life. My absolute favorite part about nursing my baby is what I only can provide for her and the bond we have with breastfeeding. I am very happy with the choice I made to breastfeed, and hoping you will feel the same.

So go ahead and breastfeed your baby!

Ame Fischer RN, CLC

Sources:  Center for Disease Control; World Health Organization; The Healthy Children Project; The Complete Book of Breastfeeding by Sally Wendkos Olds, Laura Marks, MD & Marvin S. Eiger, MD; American Academy of Pediatrics

Breastfeeding is a basic human right of every mother, and is essential to fulfill every child’s human right to adequate food and to the highest attainable standard of mental and physical health. – Towards Healthy Environments for Children

Today is an exciting day! It is the beginning of SPMHC’s Breastfeeding Support Blog. Tracy Brownlee, RN, CBE, CLC, and I will author the blog. As Lactation Counselors in Sauk Prairie Memorial Hospital’s Obstetrics Department, we educate moms-to-be about breastfeeding and give one-on-one help at the hospital.  Tracy and I want to extend that support once mothers go home and continue to breastfeed.

Our vision for this blog is to increase the confidence in breastfeeding mothers. We hope to enable and encourage  longer breastfeeding relationships between  moms and their babies by providing  answers, insights and detailed information weekly on lactation. We want  moms to feel comfortable in asking questions and voicing concerns or difficulties they are experiencing. It seems almost everyone is networking and communicating through the internet these days.  So,  I want nothing more than to make reaching out for help very easy for moms when they go home with their new bundle of joy.

Thank you to all joining our breastfeeding blog community! Enjoy…

Ame Fischer, RN, CLC

A 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.  ~Grantly Dick-Read