Make mine a double! Caffeine and breastfeeding

This picture kinda reminds me of “the girls”… if you know what I mean…

“I’d like a skinny vanilla latté, extra foam extra whip cream!!” One of the first questions I get from a lot of nursing moms is, “when can I drink coffee again?!?” Some doctors don’t have a problem if moms drink one a ounce cup of coffee throughout the entirety of the pregnancy. Other moms because of risk factors are told not to have any until after the babies born. Whether you have coffee or not during your pregnancy, there are a few things to know before introducing it after your baby is born. The first is that it affects infants differently than adults. The following chart was taken from Kelly mom.com. It shows the half-life of caffeine in the bloodstream. I was surprised that Caffeine will stay in the bloodstream of the brand newborn for an average of up to five days!

Their sensitivity to caffeine decreases as they age. Signs of sensitivity are hyperactivity, difficulty sleeping or sleeping for long periods of time, jitteriness, irritability, and fussiness. If you drink coffee during your pregnancy, you might not see as much of an impact on activity levels in your baby if you continue to drink after birth. However if you have stained from college and your pregnancy, you may notice changes in your baby. Per Medications and Mother’s Milk (Hale 2017, p. 139-140) caffeine is in Lactation Risk Category L2 (safer); milk levels are quite low (0.06-1.5% of maternal dose) and usually peak 1-2 hours after ingestion. The American Academy of Pediatrics has classified caffeine as a “Maternal Medication Usually Compatible with Breastfeeding.” If you’re iron deficient or iron deficiency rubs in your family, be extra careful. One study indicated that chronic coffee drinking might decrease iron content of breastmilk (Nehlig & Debry, 1994). We actually routinely give caffeine directly to premature babies in our neonatal unit for lung stimulation!

Remember caffeine isn’t just in coffee! Tea, soft drinks, sports/energy drinks (including the “sports water” products), some over-the-counter and prescription medications, and foods containing coffee or chocolate can also have caffeine!! I can’t have Haagen Daz coffee ice cream late at night because it keeps me up!!! Herbal products containing guarana/paullinea cupana, kola nut/cola nitida, yerba maté, or green tea also contain caffeine. Each food and liquid has varying amounts of caffeine. Different roasts of coffee and the way that the coffee is made also impacts caffeine level. Make sure to check the caffeine level you’re ingesting by serving size to see how much you’re getting!! According to Breastfeeding Answers Made Simple (Hale Publishing 2010, p. 521), excessive caffeine consumption by the mother (more than 750 mg per day) can result in a baby who shows signs of caffeine stimulation.

I typically recommend no more than one 8-ounce cup of coffee a day for nursing mothers (but as a note!! An 8-ounce Starbucks coffee has 250mg of caffeine while a non-gourmet brewed 8-ounce cup of coffee only has 120-160mg of caffeine!!!!!!) The important thing is to know your body and know your baby. Be informed of what you are putting into your body and what is going into your baby. Watch for how your baby reacts to that 1st cup of coffee and if you need to, cut out coffee for a little while longer or switch to decaf.

I personally have my one cup of Costa Rican drip coffee with almond milk every morning. If I’m really lucky, my husband will make me an Italian latte before I leave for work. I can only have one cup. The few times I’ve had a 2nd cup early afternoon, I am up all night. So far my daughter has never had a reaction to coffee. Although, I drink a cup of coffee through most of my pregnancy with the blessing of my midwife. As with anything you consume, if you have any concerns talk to your primary care physician or your pediatrician. You may still want to avoid the Unicorn Frap…

Pumping Log

Everyday is a new day with its own stresses and joys. The more we can take time to enjoy each day, the less we are prone to worry and stress, the better it is for our overall health as well as our milk supply. The past few days I have been working in the neonatal intensive care unit at my hospital. It is my favorite place to work. I love coming alongside mommies and their new babies and helping them feed them in their most critical time. My job on the acute floors can sometimes be stressful. I am helping elderly patients and families make end-of-life decisions. I assess patients feeding skills and decide if the patients can still eat and the options they have for nutrition and hydration. This definitely impacts my milk supply. I always see more of my own milk when working in NICU. Of course when some of those hungry babies cry I can occasionally feel my mommy hormones stimulating my own letdown. Where is your happy place? Have you noticed certain aspects of your environment or work impacting your milk supply? Where do you find your peace when pumping? This really does make a big difference. Happy Pumping!!

I use whatever containers I have clean!! My pumping always decreases as the day goes on.

Pumping Log: right vs left

Unfortunately breasts do not come with markers on them. When you are an exclusively breast-feeding mom you never really know how much your baby is getting. We teach in lactation to watch for the signs that tell you your baby is getting enough milk. You look at swallowing patterns, wet diapers, and the overall health and weight gain of your baby. When you are pumping mom though, we are meticulous in knowing how much milk comes out of our tatas. Have you ever actually stopped and looked at that milk? I’m sure you have. I’m sure you analyze every drop that comes out of your body. Did you know that the left and right breast can make different amounts of milk? One research study found that stereotypically moms always make more milk out of the right breast. Which is interesting in light of the fact that most women have a slightly larger left breast. (Click on text to read the research articles) It really goes to show that size does not matter for production. Size is related to fat in the breast tissue and not the actual glandular tissue that produces milk. I love breastfeeding. And I try really hard to rotate which side I start on when I’m breast-feeding my daughter. When I am at work or use a double pump to pump both of the girls at the same time. It has been always consistent for me. My right always make slightly more than my left. Usually not very much more, but enough to be noticeable. And science still doesn’t really know why!! Oh, our fascinating bodies!!! Happy Pumping!!!

Pumping Log: back to normal.

Us pumping mamas tend to freak out about how much we pump. Can I get an amen?!? When our supply drops we freak the freaky freak out.  But what if we weren’t pumping. Would we actually notice any of these drops, or what our babies just happily do what they do and not even give us education that something has changed? Would we even have periods because we would be exclusively nursing And supply changeseould be a non issue? Yesterday I took my deep breaths and talked myself off the “I have no milk” ledge. Today my period is officially over. And low and behold my milk supply is back up. Remember, hormones do funny things to our bodies. Do what you can but don’t freak out over every little change. Stay the course. Love yourself. Love your body.

Pumping Log: One of those days

Is been one of those days. Let me tell you about it. I found a cockroach on my breast pumping bag this morning (I had it next to our 1920’s era fireplace where I was pumping last night). I lost my employee badge and can’t find it anywhere. I forgot my lunch on the counter. When I got to work I realized all my pump parts were sitting in the bottle drying rack at home. My stress was so high I pumped less than 3 ounces my first session (I was thankfully able to use the lactation room in the NICU) which only made me stress more. Then I remembered my own advice. Don’t partner with worry or stress. I have to actively choose joy and peace. I made myself a cup of mothers milk tea and a cup of oatmeal (at least those are always in my pumping bag) and took a deep breath. I made sure to eat a good lunch (I had a certificate for a free lunch in the hospital cafeteria) and treated myself to an ice cream for dessert. I’m already up to 3 ounces at my second pumping. Peace comes from within and not from external circumstances. Joy is a choice that needs to be embraced. Breathe in, breathe out. You’ve got this, mama.

Sometimes being a woman sucks

More specifically, having a period because you’re a woman sucks. Not only are there mood swings and cramps to deal with, there’s also my monthly dip in milk production. Time to make some lactation cookies with extra chocolate chips and a cup of Mrs. Patel’s Milk Water Chai Tea. At least my daughter hasn’t seemed to notice. I was with her the past four days on a mini vacation and she’s been more interested in eating off my plate than my chest. Today I went back to work and knew it would be a lower volume day. Although I always note thamy the milk I pump during my period is a little creamier and more fat sticks to the sides of the bottle. I hope showing these pictures encourages you that is OK to have high and low volume days and not get discouraged. Love your body. Love the process. Worry and stress don’t help anything. Keep eating healthy, drinking plenty of water, taking your prenatal vitamins and taking supplements as needed. Happy pumping!

 

Pumping Log: the pump room

I’m sure every workplace has their own unique style of pumping room. It is a place of sanctuary and safety for many nursing moms during the day. At the hospital where I work, we have an employee lactation room on the first floor. Inside are two somewhat comfortable chairs, each with its own table, two curtains to separate them, and a sink. We are actually very blessed to be in a baby friendly hospital  where they at least attempt to take care of their breast-feeding moms. I have read about pumping room horror stories, though, of “pump rooms” that are nothing more then broom closets or electrical rooms with folding chairs. The law states that all employers must provide a non-bathroom room for breast-feeding employees. But their definition of “non-bathroom” is occasionally taken liberally. The room in which you pump can definitely impact your milk output. If the room you are in makes you stressed, you will see a decrease in milk production. If you are in a calm environment and don’t feel rushed, your milk will have a higher chance of letting down. Do you whatever you need to do to make your pump room as comfortable as possible. Make sure to surround yourself with plenty of pictures of your baby and since it is your break, if you can FaceTime or Skype your baby.

My hospital’s employee lactation room

I do have a funny story about my work pump room. The tables are older and one of them had a broken table leg. The table looked like it was going to collapse at any second. I put in a complaint through the proper chains. I came in the next day and the table was gone. But the two chairs were facing each other with the table in the middle as if anyone pumping at the same time would have a pump off! I don’t Think the maintenance department quite understood the purpose of the room 🙂 with a quick phone call to HR we were able to get a second table and move the chairs back to the proper positions. What are your funny pump room stories? Feel free to share your pump room pictures.

Let’s have a pump off.

Happy pumping!

Pumping Log: pumping is a full time job

I’m a lactation consultant. I’m also a first time mother. My daughter will be nine months old next week. I went back to work when she was just twelve weeks old. I’ve been pumping since then. No one told me how much work that would actually be. Pumping while at work is literally a full time job in and of itself. For most moms that plan to continue breastfeeding after they go back to work, you need to plan to pump when you would typically feed your baby. Feed the baby or feed the pump. That’s how you keep up supply.

But that can be tricky when you’re working. I try to pump three times in an eight hour shift. Every two and a half to three hours. For ten to twenty minutes depending on my break. I’m typing this over my lunch break as hard plastic suction cups suck on my tender bits.  It takes scheduling and planning. Some days are easier than others. Some days the milk flies better than others. The most important thing is to not give up and not get discouraged. In the end the benefits definitely far out weigh the risks. Like reducing my risk of breast cancer. Reducing the risk of allergies, eczema, respiratory and ear infections for my baby. Saving the environment from extra trash. Not to mention saving almost $3000 a year from formula costs. You definitely need to keep your goals and your humor about you to persevere.

This is a comparison of several days. My baby has always had enough. Every once in a while I will pump at night before bed to give me a little extra milk if I have a lower day. As you can see, first pump of the day (on the left) always gives me the highest amount with amounts dropping as the day goes on. That is normal for every mother whether she pumps or nurses.)

what have you found to be most helpful for keeping your supply up while pumping at work? Feel free to comment!!!

Pumping Log : Storage

We’ve talked a bit about increasing milk supply and about pumping. So now that we have all this yummy milk, what are we going to do with it? Let’s talk about milk storage.

The U.S. Centers for Disease Control and Prevention (CDC) offers ranges of time that milk can safely be left at for certain temperatures. Use this link to go directly to their website. But there is a simple rule that fits within these ranges and is easy to recall, even when you’ve had less sleep than a college kid in finals week. Just remember 5-5-5.

  • 5 hours at room temperature. If the room is very warm (more than 85 degrees F), 3-4 hours is a safer time range.
  • 5 days in the fridge (the back of the refrigerator is the best place to store your milk since it is the coldest.)
  • 5 months in a regular freezer (the separated compartment in a typical fridge/freezer unit) According to the CDC, milk frozen for longer than the recommended time ranges is safe, but may be lower in quality as some of the fats in the milk break down.

Other time ranges that don’t fit as neatly within the 5-5-5 rule, but are still helpful:

  • Human milk can be stored for 6-12 months in a chest or upright deep freezer.
  • Human milk can be safely stored with ice packs in insulated storage bags for up to 24 hours.

As part of my routine, if I work the next day, I put my milk into separate bottles and stick them in the fridge when I get home from work. That way my husband can feed them to my baby the next day while I’m at work. If the next day is a day off, I put my milk into disposable milk storage bags to stick in the freezer until the next time I work. The bags are labeled with the date they were pumped and always put in order from oldest to newest milk. This method saves going through a bunch of milk bags and saves both time and money. There are several brands of milk storage bags. I’ve found I really like the Dr Dudu bags. They’re larger size and with the double zipper I don’t need to worry about leaks in my lunch bag during the work day.

Milk from different pumping sessions/days may be combined in one container – use the date of the first milk expressed. I frequently pour all of my milk from one day of work into a larger bottle. This helps even out the calorie count and fat content since we know different pumping seasons yields different milk content. Avoid adding warm milk to a container of previously refrigerated or frozen milk – cool the new milk before combining. Breastmilk is not spoiled unless it smells really bad or tastes sour.

Safely Thawing Breast Milk

As time permits, thaw frozen breast milk by transferring it to the refrigerator for thawing or by swirling it in a bowl of warm water. You should avoid using a microwave oven to thaw or heat bottles of breast milk. Microwave ovens do not heat liquids evenly which could easily scald a baby or damage the milk. Bottles may explode if left in the microwave too long. Excess heat can also destroy the nutrients in your milk. It is recommended that you do not re-freeze breast milk once it has been thawed. Although I read on kellymom.com that if the milk had only been partially thawed and there are still ice crystals in it, you can safely refreeze the milk and thaw it on a later date.

When the fat in your milk separates in the fridge or freezer, make sure you swirl the milk to incorporate it back into a smooth, creamy mixture. Breast milk has living components in it which help protect your baby’s gut and promote digestion and immunity. Shaking breast milk actually denatured, or breaks down, the shaped molecules of the protective proteins, leaving them in pieces. Lactoferrin, lysozyme, and other protective components work their protection magic when they are in their original shaped molecular structure.

Other helpful website for breast milk storage Kellymom.com

Pumping Log : Boosting Supply

Every working mother I know it’s concerned about her milk supply. We are terrified that if we don’t make enough milk while at work our babies will starve to death. I’ve had my moments of discouragement where I, too, feel like a failure as a mother because I had a low pumping day. Of course this stress only causes a further decrease in supply which becomes a vicious cycle of stress and poor pumping. While I can’t turn my boobs on line a faucet to pump specific amounts of milk each pump session, there are several things I do to promote the best possible milk supply.

1. Hydration. The best hydration is to drink to thirst. Since times in the busyness of my day, though, I forget to stay well watered. I keep a water bottle in my pumping bag and try to drink while pumping. I also work feeding patients. So each time I go into the kitchen at work I try to grab a cup of water.

2. Nutrition. Eating the right kinds of foods also help with adequate milk supplies. Fresh fruits, vegetables and plenty of protein help keep my body working at its best. Oatmeal is also a staple in my diet. Oatmeal contains a protein that may increase prolactin, the hormone that facilitates milk production in mammals. Other whole grains such as quinoa and sesame also contain this same protein.

3. Supplements. Fenugreek, mothers milk tea, and fennel are all known galactogogues, a fancy word for milk makers. I try to drink a cup of tea every night. I’ll admit I’m not the best at taking the fenugreek, but I definitely notice a boost in my supply when I do. Another supplement known to help breast milk production is brewers yeast. Brewer’s yeast comes from a single-celled fungus and is a byproduct of beer making, though it can also be grown as a nutritional supplement. A good source of iron, chromium and selenium, brewer’s yeast also contains several B vitamins, though not B-12. Brewer’s yeast has a history of use as a galactagogue, which is a food, herb or medication that increases milk supply in nursing mothers. Some mothers find drinking a single beer can immediately increase milk supply (although drinking beer is best left to evenings or weekends). You can also buy a powdered brewers yeast from the store or Amazon. It can be added to smoothies, cookies, or other recipes. Here’s one of my favorites!!