Tag: breastfeeding

Pumping Log: back to normal.

- Julie Matheney

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

- Julie Matheney

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

- Julie Matheney

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!

 

Make it a double

- Julie Matheney

They say you can’t over feed a breast fed baby. They’re usually pretty good about taking what they need and stopping when they’re full. This is because of stomach and breast anatomy. Remember how sucking and milk flow rate at the breast are different than the bottle? This directly links to stomach anatomy.

There are two kinds of receptors in the stomach: density and stretch. Density receptors tell you how calorically dense or fat-rich your food is. It’s why at the Cheesecake Factory your belly starts to feel really full after about ten bites of Godiva chocolate Cheesecake but you can eat 3 bags of popcorn at the theater. Chocolate is much richer and calorically denser than popcorn. Stretch receptors tell you how full your stomach is from a volume perspective. Your stomach at rest is on average the size of your fist. That’s true throughout your entire life. But the stomach can stretch. Just like my stretchy pants at Thanksgiving. It can still only fill to a certain capacity. The only problem is, it takes approximately 20 minutes for your stretch receptors to tell your brain that the stomach had stretched to capacity. This is what I call the twenty minute phenomenon. You know, when a group of college boys order a pizza, they each eat a whole pizza in ten minutes and then twenty minutes later feel over full and sick. They as much as they could as fast as they could but paid for it in the twenty minute window. Exclusively breast fed babies don’t typically over eat because again, breast milk flow varies over a feeding. It starts slow, mommy goes into let down, then milk shows, mommy changes the baby to the other side, milk starts slow, mommy goes into let down, 15-20 minutes later the baby’s stomach tells the brain it’s full and the baby stops eating. Anatomy and physiology in perfect harmony.

Unfortunately bottle fed can be over fed. Bottles have these lovely ounce markers on them that tell us how much the baby needs to eat to be full. At every feeding my baby NEEDS to get a full 5 ounces of she will be hungry. She NEEDS to eat 24 ounces in a day or she will starve to death. And when baby stops eating at 3.5 ounces, I just jiggle the bottle or wait a few minutes and jiggle the bottle until baby takes that full feeding. Jiggle, wiggle, look at that she took the full feeding. Instead of listen to baby’s cuts that she’s full, we let the bottle dictate how much baby needs. And we wonder why formula feed babies have a significantly higher rate of obesity. Here’s the thing. Bottles are not the enemy. My daughter takes breast milk from a bottle five days a week while I’m at work. They are lovely devices that do an essential job. But we need to be mindful to not over feed our bottle fed babies.

Tips to not over feed a bottle fed baby (regardless of what’s in the bottle)

1. Always use a show flow nipple until 1 year of age. Slow flow most closely mimicks the flow at the breast. It also shows a baby down so the brain can keep up with the stomach (aka be mindful of those stretch receptors).

2. Watch your baby’s cues. Does he push the bottle away? Did he become sleepy? Do his hands and body relax? Does he release his iron grip on the nipple? These are signs he’s done. Over fed babies tend to spit up or vomit more because their tummies are at capacity. Don’t try to force in that last half an ounce. Respect your baby and stop feeding. Your baby will let you know if he’s still hungry.

3. In reality, babies only ever need 3-5 ounces of milk per feeding. In the first four to six months when your baby isn’t eating any solids, here’s a simple rule of thumb: Offer 2.5 ounces of formula per pound of body weight each day. For example, if your baby weighs 6 pounds, you’ll give her about 15 ounces of formula in a 24-hour period. Once a baby is six months of age and starting solid foods, offer the breast or bottle first (3-5 ounces), then offer well balanced, nutritious, solids. The solids will provide them the additional nutrition they need. (**Disclaimer : if your baby is not ready for solids at six months, that’s FINE. Your baby is ready to start solids when they can sit unsupported for a good amount of time, uses a pintcher grasp, and has the hand eye coordination of hand to mouth. If your baby is over six months and not taking solids, your baby may need additional milk per feeding.)

4. It is OK for volumes of feedings to be didn’t throughout the day. We take for granted that babies can know their bodies. They can tell us when they’re hungry and when they’re full. Sometimes I’m really hungry in the morning and I eat a Grand Slam breakfast. Other times I only want a piece of toast. It’s OK to have your baby eat a ton one meal and very little the next. Remember, there are no ounce markers on the breast. Exclusively breast fed babies do this all the time. And there’s no amount of nipple jigging that will get them to take more in a feeding.

Here’s the big take away: it’s OK to take the pressure off feeding, especially if your a working mom trying to keep up with pumping. As long as your baby is following their growth curve, making enough wet and dirty diapers, and happy, keep doing what you’re doing. If your baby is not getting enough nutrition, not gaining weight, or unhappy, please have your pediatrician write a referral to a pediatric clinic ASAP or give me a call and we can dialogue through a plan of action.

Happy feeding!!

Pumping Log: pumping is a full time job

- Julie Matheney

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 #3

- Julie Matheney

Every pumping session is a new session. Calories in breast milk range from 13-35 calories per ounce. The average amount of calories in typical breast milk around 20-22 calories. This fluctuation is due to changing fat content. The amount of fat in human milk changes depending on the degree of emptyness of the breast (empty breast = high fat, full breast = low fat). The longer a mom goes between pump sessions, the more water is in the milk and the lower the fat content. This is because the mom’s body thinks the baby is getting dehydrated and the water content is to rehydrate the baby. A breastfeed baby can take in the same amount of calories from different volumes of milk. For example, 4 ounces of 15 calorie pumped milk early in the morning has the same calories as 3 ounces of 20 calorie breastmilk pumped only a few hours later. This is unlike formula. Standardized formula has 20 calories per ounce.

For more info on the nutrition facts in breastmilk, check out these websites!!

Children’s Hospital of Philadelphia 

Kellymom.com

Happy Pumping!!

Pumping Log #2

- Julie Matheney

What’s in my pumping bag. A well stocked pumping bag is the most essential item you will need when you go back to work. Packing the bag efficiently and with necessities can help eliminate stress and worry while pumping at work. Here are a few of the things in my pumping bag. Obviously the pump is the most important piece. Make sure to check that you have all the pieces and parts in the morning before you leave for work. I had forgotten one or two pieces several times. I actually now keep a spare pump in my car that is always ready to go in the event that I forget something. I always keep instant oatmeal, mothers milk tea, and honey sticks ready for a quick snack on the go. When I know I am going to work the next day, I bring empty bottles to put my milk in. That way I can keep it in the fridge and handy for the next days feedings. If I know I am going to be home the next day, I use disposable milk storage bags. I’ve tried several brands and really like the Dr. DuDu. They’re sturdy and have a double zipper. Plus they come in a handy 8oz size for streamlining in the freezer. I can put my pumped milk in the freezer and it will be ready to go the next time I’m at work. I always keep extra nursing bra pads. I wear washable ones made of bamboo fiber. But you never know when you might need to change them. I keep it small stash of disposable ones in my bag at all times. Another necessity is my stash of essential oil’s. I use fennel to help keep my supply up. Serenity, lavender, balance, and citrus bliss help elevate my mood when I’m feeling down at work. What’s in your bag?

Pumping Log #1

- Julie Matheney
  • Not only am I a lactation consultant, I am also a full time working mom with an 8-month-old at home. I’m gone around 40-50 hours a week for work and am pumping on the go. At the hospital where I work there is an employee lactation room. Half the time I’m in here by myself and the other half there is another mother behind a curtain pumping with me. It is amazing to see how universal our concerns are with breast-feeding.The number one complaint I hear about from the other side of the curtain is that the mom is “not pumping enough” or “can’t keep up with the baby”. I have never been a super pumper and have always had to really work on my supply. It is amazing to me how from day today, pumping to pumping, I can get varying amounts of milk. It’s depends on my stress level, what I’ve eaten, how much water I’ve been able to get in, and how often I can get away to pump during my shift. Pumping is also very psychological. It’s honestly hard to “feed a machine” instead of my baby, but the more I look at pictures and videos of her or FaceTime with her while pumping, the more I tend to make. Here are the top tips I give to the other moms pumping at work:

1. Shake the girls. Give your breasts a good shake before each pumping session. This wakes up the breast and helps release hind milk from the back of the breast.
2. Use the stimulation and let down modes on your pump more often. Use the stimulation mode for 2 minutes followed by the let down mode for 4 minutes. Go back to the stimulation mode for another 2 minutes followed by the let down mode for another 4. Do this up to 4 times in your pumping session to see an increase in your milk. Massaging your breast from top to bottom in a clock wise motion will also help empty the breast. End your pumping session with a few minutes of hand expression.
3. Keep well hydrated. Water water water!!!
4. If you feel like you did not pump enough during the day at work, add in an extra pumping at night before you go to bed. Keep this extra pumping going even if your home with your baby for the weekend. You can stock up this milk in your freezer for those occasional days where you don’t pump enough on your shift.

 

For more tips and tricks, feel free to give me a call, attend one of my working mother classes, or schedule a personalized consultation!

Tongue Tie and Breastfeeding

- Julie Matheney

Tongue tie, technically known as ankyloglossia, is a condition present at birth that affects an estimated 2-5% of all babies born. It is characterized by a short, thickened, or abnormally tight lingual frenulum, which is the tissue that connects the tongue to the floor of the mouth. Depending on the severity of the tongue tie, range of motion of the tongue can be restricted. In very severe cases, the tip of the tongue can appear to be heart shaped. Because of this anatomical difference, sometimes tongue tied babies can’t maintain a latch for long enough to take in a full feeding. Others may appear to breastfeed for long periods of time without actually be effectively transferring milk. Some tongue tied babies will successfully breastfeed only during “let-down”, when the milk flows on its own from the breast into the babies’ mouths, but won’t be able to actively express milk out of the breast on their own. Many babies with tongue tie also have a lip tie, an abnormally tight membrane attaching their upper lip to their upper gums. This can be seen by rolling the upper lip upward. Babies with lip tie often have difficulty flanging their lips properly to feed which impacts their ability to latch well. This can cause them to take in excess air during breastfeeding which often makes these babies gassy and fussy.

While many pediatricians do not see tongue tie as an issue, current research and literature suggests that it can have a significant impact on breastfeeding. However, the American Academy of Pediatrics, among others, have documented the negative effects of tongue tie on breastfeeding. The most common complaint of mothers with tongue tied babies is sore nipples, which is due to poor latch and inefficient sucking. Other breastfeeding problems for the mother can include recurrent plugged ducts, mastitis or thrush, vasospasm, and supply difficulties. Babies with tongue ties typically have difficulty latching, make click sounds while nursing, may be gassy and fussy during feedings, and have slow weight gain despite having mothers who use correct positioning and nurse frequently.

Some babies with very short or thick lingual frenulums are able to compensate well and breastfeed without difficulty. Tongue tie needs to be diagnosed by function and not just appearance, so what the baby’s tongue looks like is not as important than what it can do. According to one study, simple inspection of a tongue-tie is not enough to determine which infants will need medical intervention. However skilled professionals will complete a clinical assessment which includes observation and measurement of the effectiveness of feeding to help determine appropriate action to improve breastfeeding skills. This is not a comprehensive list for tongue function, but it may give you an idea for why your baby is having breastfeeding difficulties:

  • Does the tongue elevate? When the baby cries the front edge of the tongue should come up at least as high as the corners of the baby’s mouth.
  • Does the tongue extend? The baby’s tongue should be able to protrude or stick out at least past the lower gum  if not to the border of the lower lip
  • Does the tongue lateralize, or move side to side? Tracing the baby’s bottom gums triggers a reflex for the tongue to follow the finger..
  • The baby’s tongue should be able to lift towards the roof of the mouth and touch behind where the upper teeth will come in. Is there a membrane there that prevents the tongue from lifting? When very tight from tension, the membrane may appear white.

If it is determined that the tongue tie is indeed the culprit for breastfeeding difficulties, some pediatricians, ENTs and dentists can perform a frenotomy or frenectomy. This is a quick procedure to cut the frenulum which returns the full range of motion of the tongue and upper lip. Specialized scissors may be use to simply cut the tongue or lip tie. Some prefer to use lasers, which have the benefit of minimizing the amount of bleeding during and after the procedure and decrease the chance that the frenulum will grow back. Many practitioners use a local topical anesthetic to numb the area before the procedure and some use an injection of anesthetic as well. Babies can breastfeed as soon as the procedure is done. Post-procedure care should be done to minimize the frenulum from growing back. Current research shows this is a safe, easy procedure with minimal risk to the baby. The majority of mothers notice an immediate difference in breastfeeding effectiveness and a significant reduction in nipple pain.

When should the frenotomy be done? Current research shown between 2-6 days after birth to establish proper breastfeeding patterns. This same study showed that waiting more than four weeks for frenotomy drastically increased the likelihood that mothers would abandon breastfeeding all together.

If you suspect your baby has a tongue or lip tie, set up a consultation for a full assessment of your baby’s oral motor skills.

For more resources and articles, see Breastfeeding a Baby with Tongue-Tie or Lip-Tie at kellymom.com

  1. Lalakea, M. Lauren; Messner, Anna H. (2002). “Frenotomy and frenuloplasty: If, when, and how”. Operative Techniques in Otolaryngology-Head and Neck Surgery. 13: 93. doi:10.1053/otot.2002.32157. 
  2. Wallace, Helen; Clarke, Susan (2006). “Tongue tie division in infants with breast feeding difficulties”. International journal of pediatric otorhinolaryngology. 70 (7): 1257–61. doi:10.1016/j.ijporl.2006.01.004. PMID 16527363.
  3.  Emond A1, Ingram J, Johnson D, Blair P, Whitelaw A, Copeland M, Sutcliffe A. “Randomized controlled trial of early frenotomy in breastfed infants with mild to moderate tongue-tie.” Arch Dis Child Fetal Neonatal Ed. 2014 May;99(3):F189-95.
  4. Jack Donati-Bourne, Zainab Batool, Charles Hendrickse, Douglas Bowley “Tongue-Tie Assessment and Division: A Time-Critical Intervention to Optimise Breastfeeding/” Journal of Neonatal Surgery 2015; 4(1):3
  5. Nicholson WL. Tongue-tie (ankyloglossia) associated with breastfeeding problems. J Hum Lact.1991;7 :82– 84
  6. Lawrence R. Breastfeeding: A Guide for the Medical Profession. 5th ed. St Louis, MO: Mosby-Year Book; 1999
  7.  Jain E. Tongue-tie: its impact on breastfeeding. AARN News Lett.1995;51 :18
  8. Huggins K. Ankyloglossia: one lactation consultant’s personal experience. J Hum Lact.1990;6 :123– 124
  9. Messner AH, Lalakea ML. Ankyloglossia: controversies in management. Int J Pediatr Otorhinolaryngol.2000;54 :123– 131
  10. Messner, Anna H.; Lalakea, M. Lauren; Aby, Janelle; Macmahon, James; Bair, Ellen (2000). “Ankyloglossia: Incidence and associated feeding difficulties”. Archives of otolaryngology—head & neck surgery. 126 (1): 36–9. doi:10.1001/archotol.126.1.36. PMID 10628708. 
  11. Tongue Tie – What Do Parents Need To Know? Submitted by jessicabarton on
  12.  Rosegger H, Rollett HR, Arrunategui M. [Routine examination of the mature newborn infant. Incidence of frequent “minor findings”]. Wien Klin Wochenschr.1990;102 :294– 299
  13. Wright JE. Tongue-tie. J Paediatr Child Health.1995;31 :276– 278
     

Nursing Bras

- Julie Matheney

Many moms need to breast pump for a variety of reasons, from going back to work, to increasing milk supply, to feeding a preemie in the NICU. I think it’s pretty safe to say these models have never seen a breast pump in their life. And if they have, I think they may need to see a plastic surgeon to help with their nipple placement! For help with fitting your breast pump, nipple shield, or nursing bra, feel free to set up an appointment with me!