A Natural Approach to Birth Control

Did you know there’s a birth control method that works completely with your own body’s fertility signs and signals? Are you aware that this method can be used safely during breastfeeding, and doesn’t require any drugs or chemicals, or contraceptive devices? It’s true! It’s called Natural Family Planning, and it’s safe, effective and easy to use once you’ve had some practice. This is a great method for a woman who is looking for a natural way to prevent pregnancy, and one which works well if she is nursing her baby.

Before we get started, it should be understood that this method can be used without artificial protection of any kind, such as condoms, so it’s best for women who are in monogamous relationships where both partners have been tested and found to be clean for sexually transmitted diseases and infections.

We’re going to talk about a specific style of Natural Family Planning called the Fertility Awareness Method. This is a method which relies on some signals from your body that you observe, to figure out when you are fertile. It’s during fertile times that you will either abstain from vaginal intercourse, or use a condom or other barrier method (such as a diaphragm), to prevent sperm from entering your vagina.

Your cycle has three phases: pre-ovulatory (which starts with your menstrual period; the first day of a new cycle is the first day of your period. This is known as Cycle Day 1); ovulatory (the period leading up to and including the day you ovulate, which is when your body releases an egg that may be fertilized by sperm if they are present in your reproductive tract); and luteal, which is the last phase and the one where you are no longer fertile because the egg either has been fertilized and will implant in your uterus, or it will die because it did not meet up with sperm to be fertilized. In learning how to use the Fertility Awareness Method of NFP, you will be watching your body’s signals to understand which part of your own cycle you are in at any given time, and acting accordingly, by either avoiding sex or using condoms during the fertile time, or enjoying unprotected sex during the phases where you are unable to become pregnant.

Your body gives you some clear signs when you’re fertile. The Fertility Awareness Method requires you to observe two things daily: your basal, or waking, temperature, and your cervical mucus. A third optional sign is your cervical height and/or opening. Your basal temperature is your body’s temperature when you first wake up in the morning, before you’ve gotten out of bed, and after having had at least two hours of sleep. You can buy a special basal thermometer at any pharmacy or discount store, and it will be sold near all the regular fever thermometers.

A basal thermometer  is specially designed to read only temperatures within a certain range, below the temperatures you might see with a fever, but a fever thermometer can be used if you don’t have a basal thermometer. They are not expensive, however, and may be more effective because they are calibrated to be more precise; many are made to read temperatures to within a hundredth of a degree. It’s also helpful to find one with a built-in light, because you’ll probably be reading your temperature early in the morning while it’s still dark in your bedroom.

The key to using your basal temperature to understand your fertility is this: after you have ovulated, your temperature will rise noticeably. Basal temps will vary from one woman to another, but what you’re looking for is a rise in temperature that is sustained over at least three mornings; it’s normal for pre-ovulatory temps to be pretty low, in the 97-degree range, with post-ovulatory temps being 98 degrees or higher. The change is not large (sometimes only half a degree or so), but you will notice it. It’s important to take your temperature at the same time every day. Taking it later or earlier than normal can affect the reading, so you may want to set an alarm to be sure you’re waking up at the same time every morning.

Many woman use a temperature chart to keep track of their daily basal temps, so that they can see the trend at a glance. You can make your own chart with graph paper, or download one from the internet; there are lots of resources online. Many people refer to this birth control method as, simply, “charting,” and you may read online that there are women using it to achieve pregnancy, too. For our purposes, the focus is on preventing pregnancy, but it is true that this method can help women get pregnant as well.

The second main sign you need to observe when using the Fertility Awareness Method of NFP is your cervical mucus. Did you know that your body produces different types of mucus, found in your vagina and made by your cervix (the lower part of your uterus), and that it changes depending on where you are in your cycle? It’s true: cervical mucus is a really interesting substance and it can tell you a lot about your body. Right after your period, your body will begin to produce mucus which will gradually change from sticky, tacky stuff like rubber cement, to lotiony, wet, and creamy, and finally, to clear and stretchy, like egg whites, as you approach ovulation.

Cervical mucus serves a very important purpose: to help sperm reach your egg. The wetter and more stretchy the mucus (in fact, the more like semen it is), the easier the sperms’ journey will be through your reproductive tract. That’s why the mucus becomes more copious and fluid the closer you get to ovulation; it helps sperm travel through your cervix to your uterus, where it will continue to swim toward your Fallopian tubes to wait for an egg to be released. Watching your cervical mucus can tell you a lot about where you are in your cycle, and can help you prevent pregnancy by avoiding vaginal intercourse or using a barrier method.

Beginning as soon as your period is over, you will need to check your cervical mucus every time you go to the bathroom. This seems like a hassle at first, but with experience, you’ll get used to it. Some women find it easier to do this in a squatting position on the floor, others do it while sitting on the toilet. Take your index finger and middle finger and insert them together into your vagina, and reach up until you hit something that feels like it’s hanging down inside your body. That’s your cervix. It’s the lower portion of your uterus. When you are not fertile, your cervix will feel hard, like the tip of your nose, and will be at its lowest position in your vagina. When you are fertile, it will feel softer, and will be very high up, sometimes almost too high for you to reach.

You will also notice what feels like a small hole on the tip of your cervix. This is called the os, and it’s the opening from which your menstrual blood flows out of your uterus; it’s also the part of the uterus which will stretch, or dilate, when you are in labor and delivering a baby. During the fertile phase of your cycle, this opening will enlarge, to allow sperm to swim inside more easily. A fertile cervix is high, soft and open, while an infertile-phase cervix will be low, firm and closed. Cervical texture and openness are two optional signs when using FAM/NFP.

When using NFP, you will want to retrieve cervical mucus from the cervix itself, where it will be freshest and most recently produced; this is important because it can change fairly quickly in the few days before ovulation, and you want the best accuracy when determining your fertility. Using your fingers, “squeeze” your cervix and, holding your fingers together, take them out and have a look. Try spreading your fingers to see if the mucus is stretchy at all. Infertile mucus will be pasty, gluey, white, not stretchy. Or you may see lotiony, creamy mucus, which is also probably infertile, but most people using NFP treat it like it’s possibly fertile, and will abstain or use condoms when they see it.

Stretchy, clear mucus is the most fertile kind, and unprotected sex while you have this kind of mucus is likely to result in pregnancy. Because mucus can change quickly, you will want to start abstaining or using a condom (or other barrier method) BEFORE you see the change to clear or “egg white” mucus. This is why it’s so important to check your mucus numerous times a day, especially while you’re still learning about your own body’s patterns, and getting used to observing your signs.

So let’s put it together: you have basal body temperatures, and you have cervical mucus. Low temperatures and sticky mucus are usually indicative of an infertile time in your cycle, and you will usually see both right after your period ends. As you approach ovulation, your temperature will stay in the low range (whatever is low for you, after you’ve had a chance to observe it for awhile), but your cervical mucus will be getting wetter, slipperier, and clearer, more like egg whites, in the days before you actually ovulate.

During the pre-ovulatory phase, you’ll first experience dry days, where you have no mucus, are considered safe for unprotected sex, but they usually happen early, right after your period ends. Next will be sticky mucus days, which are also usually safe, but you need to watch your cycle carefully for awhile to see how many you are getting; if you ovulate early in your cycle, you will want to use a condom or abstain sooner (many women choose to chart several cycles before ditching the condoms or other barrier methods, just to get a feel for everything before relying on FAM/NFP as the primary for of birth control). Sticky mucus will transition to creamy mucus, which should be treated as potentially fertile, and next will come egg white mucus which the most fertile type you will have, and happens in the few days preceding ovulation, also known as the ovulatory phase.

The day after you ovulate, your basal temperature will be higher than it had been (“high” is subjective; you will need to do this for a few months to get a feel for what “low” and “high” mean for your individual cycle), and it will stay elevated for at least three mornings to tell you that ovulation has occurred. You are safe to have unprotected sex on the night of your third morning of high temperatures, because you can assume that you have ovulated, and that it is too late for sperm to reach your egg to fertilize them.

Around the same time, your cervical mucus will be drying up, and going back to the sticky, or possibly somewhat creamy, state it was in at the beginning of your cycle, after your period ended. Now you are in your luteal phase, which is when the fertilized egg would implant, or if you weren’t pregnant, the unfertilized egg would eventually die, and you’d get your period, and the whole thing would start over again with a new cycle.

Breastfeeding mothers can also use this method, even if their periods have not yet returned post-partum. The principle is the same: you would watch your cervical mucus daily to observe changes that seemed to be heading toward a fertile phase. Every woman is different, and the return to fertility varies from one woman to another, and the same woman can have different experiences with each baby, too.

The return to fertility depends a lot on frequency of nursing, as well as what time of day the nursing is happening; many women find they begin ovulating again when their baby starts sleeping through the night (i.e., going more than 5 hours without waking to nurse), because nighttime nursing seems to have a greater inhibitory effect on the hormones of fertility. Women who want to use NFP while nursing will need to be vigilant about checking their cervical mucus, and may wish to consider temping too, but that can be more difficult with a young baby and an unpredictable sleeping schedule. Many women choose to use condoms or other barrier method until their periods return and cervical mucus observation and temping can be done more reliably.

Besides being drug- and chemical-free and affordable, another reason women choose NFP is because it doesn’t rely on having a regular or even an especially predictable cycle. Some other methods (like the so-called “rhythm method,” which is unreliable and not recommended) hinge on the premise that a woman has perfectly timed cycles, getting her period every 28 days and ovulating on cycle day 14. Most women don’t have cycles like this. They may have cycles which are longer or shorter, and they may ovulate on any other day of their cycle, all of which is NORMAL. Our bodies are not machines, and we will not usually see everything happening in a perfectly-timed fashion. That’s why FAM/NFP is  great for ALL women; you’re observing your OWN body’s fertility signs and changes, and not relying on a calendar or someone else’s idea of what your cycle is supposed to be like. You can safely use NFP no matter what your cycle is like, even if you’re only getting a few periods a year.

Another great thing about this method is that it can help you spot potential problems and bring them to the attention of your healthcare provider. For instance, you will be able to tell whether you are ovulating or not; if you get consistent cycles that don’t seem to show an ovulatory pattern (based on temperature and mucus), you may want to discuss this with a professional who can test you to make sure your hormones are in proper balance.

Another interesting (and beneficial) feature is that you can figure out how long your luteal phase (between ovulation and your period) usually is; this may become important later on if you want to become pregnant, because the luteal phase needs to be long enough to support implantation of a fertilized embryo. A healthy luteal phase is one that lasts at least 10 days; most women have a luteal phase of 10-14 days. The luteal phase, by the way, is the only part of your cycle that is somewhat fixed; from woman to woman, the luteal phase length may vary, but in an individual woman, you will usually find that yours is about the same length every cycle. This means that your ovulation date determines the length of your cycle: you may ovulate on the same exact cycle day every cycle, or you may not. Many women find their ovulation date varies a bit, or maybe even a lot, from one cycle to another, but their luteal phase is usually about the same every cycle, give or take a day.

There are some great resources at the end of this post, to help you explore this method further, and see some visuals to hopefully make it seem more understandable. It seems like a lot to digest all at once, so further reading would definitely be encouraged. You may also want to discuss this method with a midwife or gynecologist, but don’t be surprised if they don’t have a lot of info for you. Many practitioners will be more inclined to recommend birth control methods which rely on drugs or devices, and some will be uninformed about FAM/NFP altogether. This is a method which often requires women to take responsibility for their own education. But those who use it find that they prefer over other methods because of its safety, effectiveness and reversibility, as well as its low cost; the only thing you really need to have is a thermometer.

Also, you should be cautious when you’re researching this method online because there are many websites devoted to helping women ACHIEVE pregnancy, as opposed to avoiding it, and the techniques and advice are slightly different for each situation, so you will want to read carefully, to make sure you are getting good tips and information for using FAM/NFP as birth control.

Taking Charge of Your Fertility, by Toni Weschler, is a very informative book and an excellent resource for learning how to “chart” for both pregnancy avoidance (contraception, or birth control), and pregnancy achievement. You can find this book in bookstores, or order it online. She also has a great website where you can learn more about FAM/NFP, and download software to help you create your own charts. Her website: http://www.tcoyf.com/

Weschler, Toni. Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health. New York: Quill, 2002.

Planned Parenthood’s website has some good information about FAM/NFP, and your local center can even help you learn to chart in person with a qualified health educator. http://www.plannedparenthood.org/health-topics/birth-control/fertility-awareness-4217.htm

The Feminist Women’s Health Center has a very good online resource for reading and learning about FAM/NFP, with good graphics. http://www.fwhc.org/birth-control/fam.htm

 

(c) Jennifer Hays. All rights reserved

 

 

 

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Good food, FAST (and cheap)!

We are starting a new category of posts here at Native Mothering called Food and Fitness. We will use this category to share inexpensive recipes that can feed a few or a crowd, as well as information about diet, fitness, and weight loss. Our first recipe is a classic meal made fast and cheap.

Mini meat loaves with roasted potatoes and steamed green beans

Meat loaves

1.5 lbs ground meat (I used ground chuck because it was on sale for $1.88 a lb, but any ground red meat will work well)
1 small onion, finely chopped
cracker or bread crumbs (abt a 1/2 cup, just enough to hold mixture together–I used whole grain saltines)
1 large egg
ketchup to taste (I used an all natural brand with no high fructose corn syrup or food colorings)
chopped garlic (to taste)
salt and pepper (to taste)

Add all ingredients to a mixing bowl. Mix with hands until everything is incorporated and the ingredients hold together.

Form the meat into patties (like you would a hamburger steak). If using a very lean ground meat like venison, bison, or ground sirloin, you may wish to use a little extra virgin olive oil to coat the pan and keep your meat from sticking. Put the skillet on high heat. Brown both sides of the meat. Then, turn the skillet to medium low and cook covered for 10-20 minutes until the meat is done and the onions are tender. Serve as is, or with ketchup on the side. This makes a very tender meatloaf in HALF the time of the loaf version.

Roasted potatoes

1 lb potatoes, cut into 2 inch pieces
extra virgin olive oil (EVOO)
dried minced garlic, to taste
salt and pepper to taste

Heat oven to 400. Place cut potatoes on a shallow roasting pan or 13×9 baking dish. Toss with seasonings. Lightly drizzle with EVOO, toss to coat. Bake for 20 minutes covered. Stir. Bake an additional 10-15 minutes uncovered. Potatoes should come out tender, and slightly carmelized.

Steamed green beans

1 16 oz package frozen green beans
water
salt
butter (optional) or EVOO
dried or fresh minced garlic (optional)

Steam beans until bright green and fork tender. (You can use a steamer basket, electric steamer, or even use an inch of water in the bottom of a pan covered with a tight-fitting lid.) Drain away any excess water. Season with salt to taste. You may serve as is, or add 2 pats of butter or a drizzle of EVOO to the pot and gently toss with a little minced garlic over medium heat until the beans are slightly carmelized and have took on the flavor of the garlic.

Total cost of this entire meal was just $6 for 4 servings!

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What is Mastitis?

Mastitis can be defined as a breast inflammation (or swelling) occurring typically in just one breast that comes with a fever over 100.4 F. It can include body aches and chills (general malaise), and acute pain in the breast tissue. It affects about %10 of all breastfeeding women, although in some populations the rates are as high as %30.

The way mastitis looks:

If the mother’s skin is light, the mother’s breast will often have streaking red marks on the exterior of the breast, and it will be hot and uncomfortable to the touch. If the mother’s skin is darker you might see a redder tone in the area of inflammation, a flushed look, or streaking and the rest of the same symptoms as above. Many mothers can feel a knot or thick wedge of swollen tissue in the breast that is under the area of redness.

(We’d like to thank the mother that donated this picture to us!)

Some questions to ask yourself if you have recently been diagnosed with mastitis:

  • Have I had a blocked duct recently?
  • How is my diet? Am I feeding myself well?
  • Has my baby been biting me? Any teething behaviors?
  • Am I carrying anything heavy on one side or another? A bag, a purse, a baby carrier?
  • Has my pump been rubbing or is the fit right for my breast?
  • Has anyone in my family been sick recently?
  • What positions am I nursing in, do I need to switch it up more regularly?
  • What sort of bra am I wearing? Remember, no under-wire bras when you are nursing!
  • Am I nursing frequently enough?
  • Have I had any type of nipple trauma lately?
  • Is the spot under where my toddler rests their head?
  • Am I  stressed out about something?
  • Have I had any nipple damage lately?
  • How is my fatigue level? Am I trying to do too much?

By asking these questions, you can help isolate what has contributed to your breast infection. Some women get them repeatedly, and some women have them only once. By ruling out what might have happened right before you received the diagnoses, you may be able to take steps to prevent reoccurrance.

It is important to change positions when nursing with mastitis! If you try sitting more upright or less (depending on your natural position), lying down or something new, you might help with the blocked ducts or mastitis. Some mothers get on all fours and hang their breast over their baby and nurse in a sort of “Dangle” position. Your baby will probably think it’s fun, and it will certainly help to use gravity to get your breast drained. The objective is to unclog the blockage, and get your breast really empty.

You may have heard that when trying to promote emptiness in the breast during  a blocked duct or mastitis, the best way to do this is to orient baby’s chin towards the mass.

According to a small study done with women who were attempting different types of breast massage to clear their blockage, a different approach worked better, with less discomfort (Cambell 2006, pg 304),

“Clinicians stopped recommending massage from behind the plug, but instead suggested massaging in front of the lump of milk toward the nipple, as if “trying to clear a pathway.” The woman begins her kneading close to the nipple, pushing toward it. “

You can try the massage by itself, or during nursing. It makes sense that during nursing would be the  most effective.

A few things to do if you think you have mastitis:

  • Contact your healthcare provider; breast abscesses can form from untreated mastitis. Those really hurt!
  • If you are prescribed antibiotics, take the whole dose and don’t stop taking them early.
  • Keep breastfeeding, don’t wean!
  • Nurse frequently, varying your position.
  • Use breast massage while nursing, to help clear your blockage and empty your breast.
  • Consider alternating cold/hot compresses to reduce the discomfort.
  • Have someone give you a hand with your baby or housework.
  • Try and get some rest.
  • Take a bath!
  • Yes, it is safe to nurse when you have a breast infection! It will not hurt your child.
  • If it is absolutely too painful to nurse, please pump every time you nurse on the unaffected side.
  • If you have been prescribed antibiotics for the infection, think about the fact that they make you vulnerable to yeast growth, and use some kind of probiotic in your diet.
  • If you already have the breast abscess, protect the wound from your child’s mouth. Your baby can directly introduce normal oral bacteria into a place where they are normally tolerated (inside your breast), which may make it harder for you to heal. Change the position so that your baby’s mouth doesn’t touch the drainage in place.
  • For a mother who is getting repeated mastitis, the supplement Lecithin is a possible suggestion.  Lecithin acts to break down fat molecules ( an emulsifier), it is present in your body normally, but some mothers have more/less than others. Some women having allergies to soy (lecithin supplements are associated with soy) so it would be wise to talk about any supplement with your Dr before you take it.

 

References:

Cambell, Suzanne IBCLC. Recurrent Plugged Ducts J Hum Lact August 2006 22: 340-343

Riordan, Janice RN, EdD. A Descriptive Study of Lactation Mastitis in Long-Term Breastfeeding Women. J Hum Lact June 1990 vol. 6 no. 253-58

Spencer, JP. Management of Mastitis in Breastfeeding Women. Am Fam Physician. 2008 Sep 15;78(6):727-31

(C) Serena Meyer, IBCLC. all rights reserved. No portion may be copied or used without expressed permission from the author.

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Breastfeeding During Emergencies

Rainsville, AL after the April 2011 tornadoes–Copyright Mike Wilks (used with Permission)

Emergencies can happen at anytime, often with little or no warning.  Natural disasters can force families to live without power for days at a time. Families may be evacuated to a safer area, displaced due to loss or damage to their homes, or forced to live in less than ideal situations due to storm damage and inaccessibility to shelter.

Even in the USA and Canada, infants are especially vulnerable to malnutrition and disease during emergencies.  The cleanest and safest food you can give your baby is your milk. Breastmilk protects babies against diseases like diarrhea, cholera, pneumonia and other respiratory infections, and ear infections. Breastfeeding is also comforting for your baby and you–something that is even more important when safety is a concern.

During an emergency, breastfeeding saves lives!

  • If you are pregnant, plan to breastfeed after birth.
  • Ask your nurse or midwife to show you how to hand express shortly after your baby is born. This simple skill is safe, sanitary, and can help you build or maintain your milk production.
  • If you’re already breastfeeding, keep breastfeeding! The American Academy of Pediatrics recommends that infants be breastfed exclusively for the first six months of life and continue to be breastfed with the addition of complementary foods (solids) for at least the first year. Mothers are strongly discouraged from weaning during a disaster. Preparing infant formula requires clean water and fuel, and formula is difficult to preserve without electricity. By contrast, human milk is always clean and ready to eat. It contains antibodies that fight infection and provides complete nutrition for your baby. Additionally, breastfeeding releases hormones that lower stress and anxiety in both babies and mothers–a very important benefit in any stressful situation.
  • Exclusively breastfed infants do not need extra water, even in very hot conditions. Water supplies often become contaminated during emergencies. Exclusive breastfeeding protects infants against water-borne pathogens (germs that can make people sick). Continue to breastfeed when your baby shows signs of hunger or thirst, and keep yourself hydrated by drinking when you are thirsty. For more information on breastfeeding in extreme heat conditions, please see: Baby, it’s hot outside!

Stress and milk production

Studies have found that stress does not decrease or stop milk production. Mothers need not wean because of stress and insecurity. If a mother is feeling anxious or stressed, the milk ejection reflex can be temporarily delayed or inhibited. If you feel your milk is taking longer to “letdown,” you might find it helpful to try some of these tips before and during breastfeeding:

  • Find a safe, comfortable, and private place to breastfeed.
  • Before beginning to breastfeed, take a few deep, cleansing breaths. Tense, then release your muscles. Visualizing calm, peaceful scenery may help you feel more relaxed.
  • Hold your baby skin to skin. This contact is comforting and familiar to both of you, and it also triggers the release of oxytocin, the hormone that causes milk ejection.
  • Gently massage your breast to help stimulate letdown.
  •  Try Reverse Pressure Softening (RPS), a technique used to decrease engorgement and aid in latch on. It also assists with oxytocin release and milk ejection.

Relactation during emergencies

Sometimes mothers find themselves in situations where they want, or need, to start breastfeeding again. Relactation is possible even under less than ideal circumstances.  It is easiest when a baby is young, will latch on, and has weaned recently. Mothers who never started breastfeeding can relactate even if it has been weeks or months after birth. Here is some helpful information:

ENN: Relactation in Emergencies

Infant Feeding in Emergencies – Module 2, Version 1.0 for Health and Nutrition Workers in Emergency Situations

Expressing milk without power: Planning ahead

Mothers who are exclusively pumping with an electric pump might find it helpful to be prepared for power outages:

  • Practice hand expression and hands on pumping–not only does it help increase overall milk production, but it also makes hand expression easier and familiar if you are faced with a situation in which you cannot pump.
  • Have an alternative power source available for emergencies if your pump allows for it. Some manufacturers offer options like car chargers or battery packs.
  • Manual pumps (hand pumps, pedal pumps) are inexpensive and widely available. Note that some popular electric pumps can also be used manually, so this may not require a separate purchase. See your manufacturer’s instructions for more information.

Protecting your freezer stash of breastmilk during power outages

Worries over extended power loss can be especially troublesome for families who are dependent on a freezer stash of milk to feed their babies. If you have warning that your area may experience power outages, here are several options to consider:

  • Purchase, rent, or borrow a generator for your home. They range in price depending on the amount of power they generate. Remember that you’ll also need fuel for the generator as well as a place to safely store the fuel.
  • Ask for help storing your milk. Some mothers have found that hospitals, clinics, churches, and even grocery stores are willing to temporarily store breastmilk.  Another option is to ask your neighbors–someone with a generator and freezer space may be willing to help.
  • Fill your freezer as full as possible in advance of the storm. You can freeze containers of water (plastic drink bottles, freezer bags, freezer boxes, etc) or gel ice replacements such as “blue ice” several at a time to help fill free space. The fuller the freezer, the longer it takes to defrost. Separate meats from your milk and other foods so they won’t contaminate them if the meats should start to thaw. Ensure the freezer temperature is on the coldest setting. Plan not to open the door until the power is back on unless you’re moving your food to another location. The more often you open the door, the higher the freezer temperature will rise. Consider options for maintaining freezer temperature, such as dry ice or block ice.

If power goes out unexpectedly:

  • Quickly group frozen foods together as this will help maintain the temperature of the food, at least temporarily. Separate meat from other foods as best you can. Take out foods you will eat immediately (including your milk if it will be used within 24 hours) and store it in a cooler. Close the freezer door and plan not to open it unless it becomes necessary.
  • Cover the freezer or refrigerator/freezer unit with a blanket to help maintain its temperature (avoid putting the blanket on top of the compressor).
  • If possible, consider obtaining dry ice or block ice to help maintain freezer temperature.

If you must travel with frozen expressed milk (or temporarily store your milk in a cooler):

  • Choose a well-insulated cooler
  • Rather than covering your milk in ice, use a gel ice replacement such as “blue ice.” Because water freezes at a higher temperature than breastmilk, covering your milk in ice can actually speed up defrosting. Gel ice replacements freeze closer to the temperature of breastmilk. * For reference, water freezes at 32 degrees F. Human milk freezes between 26.6 and 28.4 degrees F.
  • Line the bottom of the cooler with ice replacement.
  • Add your milk to the cooler, then use crumpled up newspaper to take up air space between the containers of milk and between the milk and the cooler.
  • Add more ice replacement to the top of the cooler then seal the cooler tightly. Plan not to open it until it is necessary.
  • For better insulation, some mothers store their milk in a cooler inside another cooler (such as a small foam cooler inside a slightly larger plastic one) or a thermal food bag (like the handled silver bags often found near the frozen foods section of grocery stores) inside a cooler. This is especially helpful when the weather is extremely hot.
  • Duct tape around the seal of the cooler and a heavy blanket on top can help slow down heat transfer. Remember to keep the cooler away from direct sunlight and sources of heat.
  • If you do not have gel ice replacements on hand, and your milk is still hard frozen, the same steps can help your milk stay frozen. Remember to pack it together tightly and fill in gaps with newspaper (air space promotes thawing).

* Credit: Kittie Frantz, RN, CPNP-PC

If your frozen expressed milk thaws partially:

USDA food safety guidelines suggest that if a food is still partially frozen (slushy, with visible ice crystals), it can be refrozen. Some experts recommend mothers follow this advice with their frozen breastmilk, ensuring that they use the refrozen portions as soon as possible. Be sure to check with your health care provider before refreezing partially thawed milk for your baby.

Interestingly, a 2006 study by Rechtman et al. looked at the effects of freezing and thawing on unpasteurized donor milk. The results showed that human milk was more robust than previously thought and thawing and refreezing had remarkably few effects on the milk.

Breastmilk that is fully thawed should be used within 24 hours or discarded.

For more information about breastmilk storage, please see:
Breastmilk Storage and Handling Guidelines

 

More information:

Emergency preparedness
Ready America

Information for parents, professionals, and anyone who works with breastfeeding mothers

American Academy of Pediatrics: Infant Nutrition During a Disaster, Breastfeeding and Other Options

International Lactation Consultant Association: Position on Infant Feeding in Emergencies

 Emergency Nutrition Network

Wellstart: Infant feeding in emergencies

UNICEF: Breastfeeding in Emergencies

World Health Organization: The Importance of Breastfeeding During Emergencies

Webcast: Dr. Karleen Gribble speaks on the importance of breastfeeding during emergencies

World Alliance for Breastfeeding Action: Breastfeeding in emergencies

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Breastfeeding myths busted: The lowdown on common breastfeeding misconceptions (part 1)

myth vs fact

Myth: It’s important to wash your nipples before breastfeeding.
Fact: It is not beneficial to wash your nipples prior to breastfeeding. In fact, washing can remove the lubricating, anti-bacterial oils that are secreted from the Montgomery glands. Rinsing with warm water during your daily bath is sufficient for hygiene purposes. It is recommended not to use soap on your nipples unless your health care provider or lactation consultant recommends it, as this can cause dry skin and irritation. Additionally, your unique scent helps your newborn find his way to the breast. Babies prefer mom’s to scent to any other!

Myth: You can’t breastfeed if you’re taking medications.
Fact: Most medications are compatible with breastfeeding. In rare instances when a medication is not compatible, there is often an alternative drug or treatment that is compatible. Talk to your health care provider about any medications you are taking or plan to take. If you or your physician need help finding information about whether or not a medication is compatible with breastfeeding, call the InfantRisk Center.  Alternatively, consult the print resource Medications and Mother’s Milk.

Sometimes health care providers are not aware of the resources that offer the most accurate, up-to-date information about breastfeeding and medications. Common medical resources such as the Physician’s Desk Reference do not always offer complete information about the use of medications and breastfeeding. If your health care provider tells you that you that you must wean or temporarily pump and dump in order to take a prescribed medication and you do not feel comfortable with that recommendation, you can always call the InfantRisk Center for specific information about the medication’s effect on breastfeeding and your baby, as well as other options that are more compatible with breastfeeding. You can then share that information with your health care provider or even choose to seek a second opinion. You can also do your own research with the LactMed database, and/or ask your IBCLC for help finding information about the prescribed medication and breastfeeding. She can also offer suggestions for effectively communicating with your health care provider.

Myth: You should stop breastfeeding if you get sick.
Fact: During any ordinary illness (cold, flu, mastitis, diarrhea, for example) you can continue breastfeeding. By the time you have a fever or feel sick, your baby has already been exposed to the germ as you have likely been infected for days before you feel symptoms. Your baby’s best protection against illness is continued breastfeeding. If he does get ill, the protective effects of breastmilk will help decrease the severity and duration of the illness.

Myth: Formula and breastmilk are the same.
Fact:  Formula will never be the same as breastmilk. Breastmilk is species specific, meaning it is the natural food for baby humans. It changes in composition over the course of a feeding, throughout the day, and for the entire course of breastfeeding in order to meet the baby’s needs. It is easily digested and the nutrients are readily absorbed. Breastmilk contains numerous important components that are not found in formula as they cannot be duplicated. Breastmilk is a living substance that not only provides optimal nutrition, but also protection against infection and future disease.

Myth: Many moms do not make enough milk.
Fact:  Moms who breastfeed (or express if they are unable to breastfeed directly) frequently and regularly with baby latched on well are generally able to produce enough milk to meet their baby’s needs. Breastfeeding as soon after the birth as possible and frequently thereafter helps moms to establish milk production. Shortly after birth, control of milk production occurs inside the breast. Milk building up in the breast signals the milk producing cells to slow production. The breasts being well-drained of milk signals the milk producing cells to increase production.  The more milk that is removed, the more milk is produced to replace it.

Only a small number of women (estimated <5%) cannot produce enough milk to meet all of their baby’s needs.  Sometimes medical conditions, medications, previous injury or surgery, or hormonal and/or glandular issues can affect a mother’s ability to produce milk. In these rare (and often physically and emotionally draining instances), there is almost always a way to continue breastfeeding with additional supplementation. Breastfeeding does not have to be all or nothing and every drop counts!

If you are concerned about milk production issues, please contact a lactation consultant. The number one question mothers ask is if they are making enough milk. Most often, the answer is yes. When it is no, a lactation consultant can help you figure out why and help you create a plan to get your milk production to where it needs to be. You can do it!

Read more: Breastfeeding myths busted: The lowdown on common breastfeeding misconceptions (part 2)

 

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Baby, it’s hot outside!

 Staying cool and hydrated can be a challenge for anyone when the temperature is dangerously high. Extreme heat and humidity is not only uncomfortable, it can lead to serious health problems in vulnerable infants and young children.  Here are some tips to help you and your breastfed baby stay safe and comfortable during the hot summer months.

  • Drink plenty of fluids. Don’t wait until you feel thirsty to drink! Keep plenty of water close by for frequent sipping. A thermal cup or carafe helps keep water cool.
  • You will know you’re drinking enough if your urine is pale. Dark yellow urine can be a sign that you need more fluids.
  • Be aware that baby may prefer to nurse more frequently and for shorter periods of time than normal in order to quench thirst.
  • Toddlers may request to nurse more frequently, too. Offering more water at meals and between nursing will help meet his need for additional fluids, and possibly reduce increased requests to nurse due to thirst.
  • Healthy, exclusively breastfed babies do not need extra water even in very hot weather.  Your milk has the perfect balance of water and nutrition.
  • If your baby is less willing to breastfeed, it may be because he feels hot and uncomfortable. The sweaty, sticky feeling from body contact can add to the discomfort. Try dressing baby in  light a cotton shirt, or keeping a muslin or thin cotton receiving blanket between the two of you to create a barrier against sweat. Consider taking a break from the heat and nursing while lying down in a cool room or in a tub of slightly warm water. Sponging baby off with a slightly warm damp washcloth may help, too.
  • Babies who are old enough to feed themselves might enjoy a refreshing “momsicle” (frozen breastmilk popsicle) as a treat.
  • To help keep toddlers hydrated, consider offering small, frequent snacks that include food with high water content such as watermelon, cantaloupe, cucumber, tomato, sorbet, fruit smoothies, and fruit juice popsicles.
  • If you’ll be wearing your baby, dress both of you lightly and adjust your carry to allow better air circulation.

A gentle reminder:  Never leave your baby alone in a car even for only for “just a few minutes.” The temperature inside a vehicle rises quickly, even on a slightly warm day. When the temperature is very high, the danger is exponentially increased. “In hot weather in an open parking lot, the inside temperature of a car can rise by 7 degrees Fahrenheit in five minutes, 13 degrees in 10 minutes, 29 degrees in 30 minutes and 47 degrees in an hour.”  Always take your baby in with you and check your car before you get out (many tragedies are caused when a baby is forgotten in the car). Assure anyone who is transporting your baby does the same. For more information, please see:  Never leave your child alone in the car and Where’s Baby? Look before you lock. 

Please see these resources for more information about keeping your entire family safe and comfortable in extreme heat conditions:

Extreme Heat: A Prevention Guide to Promote Your Personal Health and Safety

FEMA: Extreme Heat–Are you ready?

Last updated 6/30/14

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