How to Prepare for Breastfeeding 

Posted on March 4, 2022 by Serena Meyer

There are many ways to get ready for breastfeeding/chestfeeding. Many parents make a list of things to purchase, but the truth is that not much needs to be done to get ready! Finding a support group ahead of time filled with like minded parents is useful. Some people like breastfeeding pillows but they are not really a necessity. Its nice to have a selection of items like nipple balms, or breastpumps, and breastfeeding gear but you really just need a comfortable place to sit with your baby and a small pillow for your lap. Every year it seems like the list of “must-haves” grows, and it can feel like you are missing out if you can’t afford fancy items and bottles. So I compiled a short list of things that might actually be useful to know ahead of time! Here are things that actually make a difference to breastfeeding and your milk supply!

  • A diet rich in healthy foods is a good idea for the recovery period after birth. Foods that are rich in iron tend to support a healthy supply of milk. Healthy doesn’t have to mean expensive!
  • Foods such as dark leafy greens, meats, prunes, and raisins contain a good amount of iron. It is important to consciously add in a source of iron to meals to ensure that replacement for blood loss during labor occurs. In some instances birthing parents who are severely anemic make less milk.
  • Iron is broken down in our bodies in an acidic environment. This means combining an iron rich meal with a source of vitamin such as orange slices, fruit or another source of vitamin C.
  • Cooking with a cast iron pot will help increase the iron content of foods.

Mental State Preparation:

  • Imagine that you are holding your baby and gazing into their eyes.
  • Write on your mirror a message of strength: I am strong, my body is capable.
  • ignore unhelpful and unsolicited advice from friends and family, people tend to share scary stories that are unhelpful.
  • The path of your mother and sisters is not your path; you will define your own motherhood/parenthood.
  • Envision a circle of light around your baby and yourself; some people find this makes them feel more secure and safe.
  • Make a birth vision board!
  • Consider the help of a Doula!

Expectations of a healthy breastfeeding relationship:

  • A healthy breastfeeding relationship will involve an intimate connection with your child. They will communicate their needs to you and as your grow together the communication becomes easier to understand.
  • Early on it will be important to preemptively offer the breast before  you even think they are hungry. They will learn to trust that they will be fed. Remember that crying is a late sign of hunger
  • Hold your baby! Not all breastfeeding/chestfeeding is about milk transfer. Sometimes babies need to feel safe and loved. They get this information by breastfeeding. The suck will not be as strong as they relax at the breast and drift off to sleep.
  • Your baby has expectations. They expect to know the landscape of the human skin. Unwrap your baby and place them skin to skin. Sometimes if they are clothed they will sleep through hunger cues.
  • You may notice breast tenderness and some nipple soreness in the beginning but it should not be very painful. If breastfeeding hurts then seek out support right away. There is no need to try and accept pain as a normal part of breastfeeding/chestfeeding- it is not.

(c) Copyright Serena Meyer RN IBCLC

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Dr. Jack Newman’s APNO Recipe

Posted on March 8, 2017 by admin

 

THE “ALL-PURPOSE NIPPLE OINTMENT” OR APNO

We call our nipple ointment “all purpose” since it contains ingredients that help deal with multiple causes or aggravating factors of sore nipples. Breastfeeding parents with sore nipples don’t have time to try out different treatments that may or may not work, so we have combined various treatments in one ointment. Of course, preventing sore nipples in the first place is the best treatment and adjusting how the baby takes the breast can do more than anything to decrease and eliminate the breastfeeding parent’s nipple soreness. Please note that the “all-purpose nipple ointment” is a stop gap measure only and that the definitive treatment of sore nipples is to help the baby latch on as well as possible.

See these other information sheets: Sore Nipples, Latching and Feeding Management.

THE APNO CONTAINS:

  1. Mupirocin 2% ointment. Mupirocin (Bactroban is the trade name) is an antibiotic that is effective against many bacteria, including Staphylococcus aureus including MRSA (methicillin resistantStaphylococcus aureus). Staphylococcus aureus is commonly found growing in abrasions or cracks in the nipples. Mupirocin apparently has some effect against Candida albicans (commonly called “thrush” or “yeast”). Treatment of sore nipples with an antibiotic alone sometimes seems to work, but we feel that the antibiotic works best in combination with the other ingredients discussed below. Although some mupirocin is absorbed from the gut when taken by mouth, it is so quickly metabolized in the body that it is destroyed before blood levels can be measured. Most of it gets stuck to the skin so that very little is taken in by the baby.
  2. Betamethasone 0.1% ointment. Betamethasone is a corticosteroid which decreases inflammation. By decreasing the inflammation, the APNO also decreases the pain the breastfeeding parent feels. Most of the betamethasone in the ointment is absorbed into the skin by the parent, so that the baby takes in very little.
  3. Miconazole powder to a final concentration of 2%. Miconazole is an antifungal agent, very effective against Candida albicans. Because it is added as a powder, the concentration of miconazole can be increased to 3% or even 4% or decreased to less than 2%. We feel 2% is the best concentration for most situations. Fluconazole powder to 2% may be substituted for miconazole and so can clotrimazole powder to 2%, but I believe that clotrimazole (Canesten) irritates more than the other drugs in the same family. Miconazole cream or gel cannot be substituted for miconazole powder as the compound will usually separate. Where miconazole or any of the above mentioned drugs (fluconazole, clotrimazole) are not easily available as powders, it is better to use only the mupirocin and betamethasone ointments mixed together than add a cream or gel or nystatin ointment for example. By using a powder, the concentration of the other two ingredients is not as decreased as they would be if another ointment were used for the anti-fungal agent (for example, nystatin ointment). Thus, in the above preparation the concentration of the betamethasone becomes 0.05% (due to combination withthe mupirocin) and the mupirocin concentration is decreased to 1%.

Note that nystatin ointment, which we used to use and which decreases the concentration of the other ingredients, is far inferior to miconazole and also tastes bad.

I write the prescription this way.
1. Mupirocin ointment 2%: 15 grams
2. Betamethasone ointment 0.1%: 15 grams
3. To which is added miconazole powder to a concentration of 2% miconazole
Total: about 30 grams combinedApply sparingly after each feeding. Do not wash or wipe off.
NO SUBSTITUTIONS

If possible, it is best to get the prescription filled at a compounding pharmacy. You can find a list of compounding pharmacies by going to http://www.pccarx.com/. Click “Find a compounder” at the top, then add relevant information.

HOW TO USE THE OINTMENT:

1. Apply sparingly after each feeding. “Sparingly” means that the quantity of the ointment used is just enough to make the nipples and areola glossy or shiny.
2. Do not wash it off or wipe it off, even if the baby comes back to the breast earlier than expected.

HOW LONG SHOULD THE OINTMENT BE USED?

Any drug should be used for the shortest period of time necessary and the same is true for our ointment. If the breastfeeding parent still needs the ointment after two or three weeks, or the pain returns after the breastfeeding parent has stopped the ointment, the parent should get “hands on” help again to find out why the ointment is still necessary. The most important step for decreasing nipple pain is still getting the “best latch possible.” Sometimes a tongue tie has not been noticed and is a reason for continued pain.

Some pharmacists have told breastfeeding parents that the steroid in the ointment will cause thinning of the skin if used for too long. While this is a concern with any steroid applied to the skin, we have not seen this happen even when breastfeeding parents have used it for months.

Updated February 2017

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.

This information sheet may be copied and distributed without further permission on the condition that it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!

Questions or concerns?  Email Dr. Jack Newman (read the page carefully, and answer the listed questions).
Make an appointment at the Newman Breastfeeding Clinic.

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6 Ways to Tell if Your Breastfeeding Baby is Full!

Posted on February 14, 2016 by Serena Meyer

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New babies are notoriously confusing. They fall asleep after 5 minutes, and then wake up 2 minutes later starving. It’s hard for a new mother to figure out what the baby wants let alone whether they did a good job filling them up! To that end here is a short list to review!
1.) Your baby was really hungry, and had tightly balled fists. As you nurse for a while the little hands open like flowers and become relaxed. Might be full.

2.) Look for Zombie Arm. This is what I call the super floppy arm that happens when a baby is totally milk wasted. You should be able to lift the arm and it drops like a log. Might be full.

3.) Always double check the upper lip. You say you have the Flower Hand, and the Zombie Arm? Check the upper lip by tickling. If you baby hunts for the air nipple, probably not full.

4.) Your baby might look like this:
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 12742821_955771797839257_714677745407856678_n

or this:

 

 

 

 

 

 

5.) Look at your baby as a whole being. Do they seem relaxed? Are the hands relaxed and open? No tension in the arms or back? Is your baby resting in your hands as you look them over? It their mouth relaxed and not pursed. Might be full.

6.) If you cannot wake your baby up, and you have tried the follow things: A warm washcloth bath, tickled ribs and shoulders, massaged the palms of the hands, and you’ve even tried the dreaded “fake out the baby by pulling the velcro tab on the diaper” trick? Might be full.

(c) Serena Meyer, RN, IBCLC 2016

You can find Serena at https://www.bayareabreastfeedingsupport.com/

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10 Tips For Successfully Breastfeeding Your Newborn!

Posted on February 14, 2016 by Serena Meyer
  • A12721663_821694297956914_273166528_n newborn is very alert the first hour of birth. Let your baby relax on your chest without clothes. They will start to stick their tongue in an out, and knead their fingers in the breast like a kitten does. This means it’s time to latch on! Gently scoot them near the breast! Don’t rush the moment, just allow it to happen naturally.
  • Your job is to get your baby close to your nipple so that they can nuzzle and lick your skin for a while first. That part is normal and a necessary first step to breastfeeding! Babies have some expectations; they expect to be on your chest naked and they want to know you. Their experience of life is through their mouth. Relax and allow your baby to learn more about who you are through normal infant behaviors before breastfeeding.
  • Getting that first latch: tickle their upper lip, wait until they open wide, then pull your baby in towards your breast! You want to have your baby rolled inward toward you before you latch, so that you are tummy to tummy. Line your baby up close to nose to nipple right before you tickle the upper lip side to side with the nipple! I usually guide women to use the “cross cradle position” which is one hand on the breast and one hand holding the baby.

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    There is an extra helping hand here! The mother is holding the left breast with the left hand, and scooping the baby in toward the breast with the right!

  • Does it hurt/pinch? Breath through it and count to ten, if it still hurts, unlatch right away by breaking suction with a finger placed into the corner of your baby’s mouth. Slowly insert your finger into their mouth and trade out a nipple for a finger! Never pull a baby off a nipple without breaking the seal first! It will probably hurt if you do.
  • What are a few reason for the pinching? Number one is typically that their mouth wasn’t open wide enough before you pulled them toward you for latching. Be patient and really wait for the wide open mouth!  When you see it quickly pull your baby onto the breast.
  • The second common reason for a pinchy latch is that they need to be tummy to tummy with you or they end up pulling the nipple a bit. Spending time lining your baby up into a comfortable position is key.
  • New babies have three jobs! 1.) Look cute, 2.) Smell good, 3.) Open wide.
    That’s it! Your baby can’t get to you yet, so you have to really pull your baby in for a good latch to happen. Once they open wide you can stuff lots of breast into their mouth. That’s how babies get a deep latch and plenty of milk!
  • “My baby is asleep, can I let him just sleep?” A newborn is going to need to be reminded gently during the first few day that it’s time to eat. Hospitals might say every 3 hours, but as an IBCLC I’m going to share the following information. Babies that gain weight well, eat every 1.5-2 hours in the first few days. This means that long periods of rest are not normal. Try and feed your baby very frequently. Your job is to offer the breast.
  • If your baby is just born try and get a latch in the first hour. It’s not called the Golden Hour for nothing! babies that get latched on right away statistically breastfeed better, and more effectively for the following feeds.
  • In the case of a surgical birth or a situation where there is separation, do your best to either start breastfeeding as soon as you are together or start manually moving out milk no later than hour four. Ask for a pump, use breast compressions, and don’t let anyone get in the way of  your success!

(c) Serena Meyer, RN, IBCLC 2016

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The Creator’s Gift to Mothers

Posted on January 25, 2016 by Jolie Black Bear

This video discusses the importance of breastfeeding, as well as the myths that often prevent moms from breastfeeding. Breastfeeding truly is “the Creator’s gift to mothers!”

For more information about some of the topics discussed in the video, please see:
Frequently asked questions about breastfeeding and diet
Breastfeeding Myths (part 1)
Breastfeeding Myths (part 2)
Breastfeeding information for dads and partners
Breastfeeding and cigarette smoking

For breastfeeding information or support anytime:
La Leche League or toll free at 877-4-LALECHE
The National Breastfeeding Helpline toll free at 800-994-9662
WIC  (find your local office)
Breastfeeding USA
Find an IBCLC

For more information about this video produced by the Shibogama First Nations Council, please see:
The Creator’s Gift to Mothers

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Stress and Breastmilk Production

Posted on May 9, 2015 by Jolie Black Bear

stressDoes stress reduce milk production?

Consider this scenario: You are late for an important appointment. You are just starting out the door when you discover baby poops through his last clean outfit and all over you, too! Your phone is buzzing in your purse and your hands are full with baby, diaper bag, and poop. That is a stressful moment, right? Every mom experiences high stress moments just like this.

Moms often hear that they should stay calm because feeling stressed will cause milk to “dry up”. The business of daily life, finances, relationship issues, illness, etc. are all common stressors moms face. Sometimes stress is sudden and ongoing such as in the case of natural disaster or war. The woman’s body is made to not only grow a baby, but also nourish and protect him once born. Moms can continue to breastfeed despite incredible circumstances.

Sometimes moms experience stress that is severe and intense, which can temporarily inhibit letdown. This is thought to be a protective mechanism. As one doctor put it so well, you wouldn’t want to be leaving a trail of milk behind if you were running from a tiger! Over a long period of time, it is possible for chronic stress to inhibit letdown often and long enough that milk production can be decreased. This is usually not the case, as breastfeeding releases hormones that helps mothers and babies both relax and have an easier time enduring stress, even under the worst of circumstances.

What can I do if  I’m in a situation where I’m under ongoing, chronic stress and it is affecting my letdown? 

Letdown can be triggered by associations, such as sights, smells, and emotions. Below are some tips for initiating letdown before and during breastfeeding or pumping. You can try any combination of these that makes sense to you.

  • Find a location to feed your baby (or pump) where you feel very comfortable and safe. Choose a place that is free from intrusion and distraction.
  • Make an effort to relax as much as possible before feeding or pumping. Listen to music, take a few cleansing breaths, pray, smell a relaxing scent, or do anything else that helps you feel at peace.
  • Consider trying breast massage prior to nursing or pumping. It has been shown to assist with milk ejection and overall milk removal.
  • Bend over at your waist so that your breasts dangle from your rib cage, and shimmy your shoulders (move them back and forth) so that your breasts shake. This movement helps loosen tension in your neck and shoulders and assists milk in moving forward in the breast.
  • Consider using Reverse Pressure Softening (RPS) to promote letdown: “Steady stimulation of the nerves under the areola automatically triggers the milk ejection reflex, propelling milk forward in the breast, nearly always within 1-2 minutes or less.”–Jean Cotterman
  • Enjoy the moment. If you are with your baby, smell his head and stroke his hair. If you’re away from your baby, smell a piece of his worn clothing and/or listen to his cries on a recording. Some moms like to watch videos of their baby cooing, crying, or breastfeeding on their phone. This creates an emotional connection, and can help promote milk release.
  • Visualize milk spraying forth from your breasts like a waterfall or a rushing river. It sounds strange, but it often works!
  • If you are with someone you trust and feel comfortable asking, have them rub your shoulders and apply pressure between your shoulder blades. This, too, can help trigger the release of oxytocin and assist in milk ejection.
  • Drink water. Moms often sip water while nursing, so that alone may initiate letdown through what is known as conditioned response.
  • If you’re pumping, the hands-on pumping technique can aid in milk ejection and help you maximize milk removal.
  • Consider breastfeeding while bathing with your baby. This can help release tension in your muscles, and may help your milk flow freely.
  • Between feedings, spend time in skin-to-skin contact with your baby. This will help you  both relax, and aid in release of hormones associated with breastfeeding.


Breaking free from stress

  • Talk to a counselor or traditional healer.  Ask family and friends for support. Stress is often relieved by talking through your feelings and concerns, even if there isn’t a solution to your current problem.
  • Contact your IBCLC, WIC PC, or volunteer breastfeeding counselor for continued support, including tips to manage stress as it relates to mothering and breastfeeding.
  • Eat well and exercise. Eating nutrient-dense foods gives your body the necessary vitamins, minerals, and energy needed to overcome stress. Exercise is a well-known stress buster. Even a 30 minute walk around the block can lower blood pressure, ease tension, and clear your mind.
  • Contact a medical or mental health professional if you’re experiencing ongoing, chronic stress. They can provide information for stress management, and evaluate for related issues like depression and anxiety.
  • Consider talking to your doctor about taking a magnesium supplement.  This mineral is often depleted during times of chronic stress, and some experts suggest that supplementation may help reduce stress-related symptoms.

Stress Resources:

Coping With Perinatal Stress and Depression by Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

Mental Health Care for Postpartum Depression During Breastfeeding by Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM

American Heart Association: Four Ways to Deal With Stress

American Psychological Association: Coping with Stress and Anxiety

Working Moms and Stress Relief

Stress Management for Parents

Uppity Science Chick: The stress-lowering effects of breastfeeding (list of reference articles)

The Toxic Effects of Stress on American Indians


References:

Chen, D., Nommsen-Rivers, L., Dewey, K., & Lonnerdal, B. (1998). Stress During Labor and Delivery and Early Lactation Performance. Obstetrical & Gynecological Survey, 68(2), 81-82.

Dewey, K. (2001). Maternal and Fetal Stress Are Associated with Impaired Lactogenesis in Humans. The Journal of Nutrition, 133(11), 30125-30155.

Groer, M., Davis, M., & Hemphill, J. (2002). Postpartum Stress: Current Concepts and the Possible Protective Role of Breastfeeding. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 31(4), 411-417.

Heinrichs, M., Neumann, I., & Ehlert, U. (n.d.). Lactation and Stress: Protective Effects of Breast-feeding in Humans. Stress: The International Journal on the Biology of Stress, 195-203.

Lau, C. (2001). Effects of Stress on Lactation. Pediatric Clinics of North America, 48(1), 221-234.

Mezzacappa, E., & Katkin, E. (2002). Breast-feeding is associated with reduced perceived stress and negative mood in mothers. Health Psychology, 21(2), 187-193.

© Jolie Black Bear 2015

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