Recommended Links, DVDs, and Books

Breastfeeding:

My favorite website for breastfeeding information, kellymom.com This website is run by Lactation Consultant Kelly Bonyata, BS, IBCLC and it is BRILLANT! The site is easy to navigate and has links to ALL the latest and greatest on the Web. The site is good for all parents and health care professionals who are looking for more information on lactation issues.

 

La Leche League International; The grassroots organization that historically has supported, promoted, and most importantly protected a woman’s right to breastfeed her infant.

The American Academy of Pediatrics (AAP); Use the search function to research any parenting/childcare topic. What are the standard care practices? Visit the “Parenting Corner” and learn about current health care topics.

The Breastfeeding Policy of the AAP; Breastfeeding and the Use of Human Milk. This is a must read for all new parents. What are the known benefits of breastfeeding? What are the recommendations of the health care professionals?

Breastfeeding.com; An all inclusive website for great breastfeeding information; not only is it educational it is FUN too!

Childbirth:

Lamaze; Familiarize yourself with the Six Care Practices that support normal birth.

The Childbirth Connection ; A non profit organization that focuses on providing parents and health care providers evidenced based information on pregnancy, labor and delivery, and the postpartum period.

International Cesarean Awareness Network (ICAN); Educating families on a delivery process that involves major abdominal surgery, focusing on evidenced based information.

The Coalition for Improving Maternity Services; Promoting wellness model of maternity care.

3D Animation of Pelvic Outlet/Birth; This is a non graphic video depicting the pelvic activity and fetal movement that take place during the delivery process.

Parenting:

Dr. William Sears; This is a great website for information on childbirth, breastfeeding, and all parenting issues. I am a big fan of anything written by this family.

Attachment Parenting International; I love attachment parenting. It just make sense!

Fun & Fabulous:

Hathor the Cow Goddess and the Evolution Revolution; Do not miss the talented cartoons drawn and narrated by Heather Cushman-Dowdee. Empower yourselves! and her new website, Mama is!

Local Links:

Local GYMVOREE owner and mom, Kathy Froelich, knows how important play and music are for childrens’ growth and development. Local moms and dads LOVE the FUN they have attending her Gymboree classes in Ocean and Howell, NJ. To learn more visit Kathy’s blog, http://themamablog.com/.

Mommy Moves; exercise after delivery can be fun and include the baby. Lori Sawyer and her staff know just how to help you get back in shape, visit her website to find out about classes in your local area,http://www.mommy-moves.com/

 

Childbirth

Prenatal Preparation

Pregnancy is a significant time in every family’s life and everyone’s pregnancy is different. Pregnancy is a time of preparation. Preparing for changes that occur when a new family member enters into the equation. Sometimes thinking that far ahead is a little overwhelming and typically most pregnant women, specifically those pregnant for the first time, focus on how the pregnancy will end—-The Delivery of the baby.

Mental and physical preparation for the delivery is a good thing. I think women/families that are prepared and educated on the delivery process and what to expect, are better able to handle childbirth.

Merriam Webster Online (2008) defines LABOR as:
“Expenditure of physical or mental effort especially when difficult; the physical activities involved in giving birth (as dilation of the cervix and contraction of the uterus).”

If I told you that you were going to run a marathon in 9 months, 26.2 miles and 385 yards (42.195 kilometers), you would immediately begin to prepare. Prepare mentally as well as physically. You would change your diet, eating only healthy foods that would help you gain muscle mass and energy. You would begin physically training, working on building stamina and strength. You would mentally challenge yourself, using techniques such as visualization; visualizing yourself running through the course until you cross the finish line.

What if I told you having a baby is a lot like training for and running a marathon. It is physically and mentally challenging, and when you complete your race/delivery you will feel like YOU CAN DO ANYTHING!

Imagine the thrill of finishing the race/holding your baby in your arms. There is no other feeling quite like it. You are on an “endorphin high”. Endorphins are produced by your body during times of stress and strenuous activity. They are known for their affects as analgesics, pain relievers, and for their ability to create a sense of well being in the body. Doesn’t that sound nice?

No, you will never forget how hard or difficult your labor was, but you will not care. WHY? Because you will have a beautiful baby that will represent all your hard work and “it will be worth it”.

I recommend learning all you can. Use the information available to you. Research pregnancy and childbirth using your local library and the World Wide Web. Visit the links on my “links to the Latest and Greatest on the Web”. Begin your training.

When entering into your third trimester, it would be a good idea to consider taking a childbirth preparation class. This is a great way to prepare as a couple. Childbirth Classes cover many relevant topics including, stages of labor, preparation for dealing with pain, pharmalogical pain management options, routines and procedures, and most importantly comfort measures. Becoming an educated consumer will enable you to make informed decisions in regards to your delivery process. You will be an ACTIVE PARTICIPANT; the leader and head honcho.

As an active participant in your own labor, if you decide to deliver in the hospital setting, your health care providers will be following your lead. Your relationship with your care providers should be based on a mutual trust; you and your health care team will be working towards the same goal–the goal of fulfilling YOUR BIRTH WISHES, how you envision your delivery/your tentative delivery plan.

EMPOWER YOURSELVES!

Dr. Seuss for Nursing Mom*

Would you nurse her in the park?
Would you nurse him in the dark?
Would you nurse him with a Boppy?
And when your boobs are feeling floppy?

I would nurse him in the park,
I would nurse her in the dark.
I’d nurse with or without a Boppy.
Floppy boobs will never stop me.

Can you nurse with your seat belt on?
Can you nurse from dusk till dawn?
Though she may pinch me, bite me, pull,
I will nurse her `till she’s full!

Can you nurse and make some soup?
Can you nurse and feed the group?
It makes her healthy strong and smart,
Mommy’s milk is the best start!

Would you nurse him at the game?
Would you nurse her in the rain?
In front of those who dare complain?
I would nurse him at the game.
I would nurse her in the rain.

As for those who protest lactation,
I have the perfect explanation.
Mommy’s milk is tailor made
It’s the perfect food, you need no aid.

Some may scoff and some may wriggle,
Avert their eyes or even giggle.
To those who can be cruel and rude,
Remind them breast’s the perfect food!

I would never scoff or giggle,
Roll my eyes or even wiggle!
I would not be so crass or crude,
I KNOW that this milk’s the perfect food!

We make the amount we need
The perfect temp for every feed.
There’s no compare to milk from breast-
The perfect food, above the rest.

Those sweet nursing smiles are oh so sweet,
Mommy’s milk is such a treat.
Human milk just can’t be beat.

I will nurse, in any case,
On the street or in your face.
I will not let my baby cry,
I’ll meet her needs, I’ll always try.
It’s not about what’s good for you,
It’s best for babies, through and through.

I will nurse her in my home,
I will nurse her when I roam.
Leave me be lads and ma’am.
I will nurse her, Mom I am.

* I would love to give the author credit, but I am unable to find any information on who created this piece—whoever you are, THANK YOU; it’s brilliant.

Breastfeeding Myths

There are some statements that I routinely hear in my line of work that require further clarification. They are as follows:

But isn’t the breast as good as the bottle?

NO!!! Many argue they are not even comparable; it is like comparing apples to oranges. Yes, they are two different ways to feed a baby but the similarities stop there. Breastfeeding is much more than simply feeding your baby; the medicinal (including immunological), emotional, social-developmental, economical, and nutritional aspects of breastfeeding can not be duplicated. Formula exists only as the only other alternative that can provide a baby food. (Yes, there are some women who choose not to breastfeed or who choose to give their babies formula, and as long as they are making an informed decision, then they will always have my support.)

In order for Dad to participate parents need to give some bottles; you do not want to exclude Dad.

Define participation! Breastfeeding is a FAMILY AFFAIR; moms need Dad’s help, support, and love. Who said Dad would not be participating. Who else will help wake, burp, cuddle, keep an eye on progress,and encourage moms while they navigate through the breastfeeding process?

Just because a father can not physically breastfeed does not mean he will not be involved. “The desire to participate should not be confused with the need to give the baby the best of what each partner has to offer” (Baumslag & Michels, 1995). Let’s face it, only mom can give birth and breastfeed, but that does not mean that Dad does nothing or can not show the baby other forms of love and affection. Getting involved in all the other aspects of parenting is something any father can do.

You should nurse your baby 10 minutes on one side and 10 minutes on the other and repeat this every 3-4 hours.

The first thing I want to know is how old is the person giving this advice (or how old was the book they read); this advice is antiquated not to mention inaccurate. The second thing I would want to know is “did the baby get the memo”, babies do not know how to follow the rules or how to adhere to strict schedules.

Stick with the basics: babies need 8-12 feedings every day, nurse one side until your infant is done (falls asleep, falls off, is no longer vigorously sucking–using common sense to guide you, see How do I Know My Infant is Getting Enough) this is the main meal, and I always offer dessert (the other side).

You are feeding too often (this is usually followed/accompanied with)– if you feed a bottle at night you will get more sleep.

I believe you can not overfeed a breastfed baby. In the beginning, when you are just getting started, the frequent removal of milk from the breasts helps to keep milk production on track. I am just going to come out and say it—Breastfed babies eat 8-12 times every day! Yes, this is often more feedings than a baby who is receiving formula. Formula fed babies eat every 3-4 hours, typically (that is 6-8 feedings daily). Let’s assume that you choose to breastfed because it is best for your baby (and for you); isn’t it worth the couple of extra feedings a day.

Pumping Tips

When should I pump?

For any missed Feeding. Your little one needs to nurse 8-12 times daily. If you are missing any feeding, we will need to use a breast pump to simulate those feedings missed, e.g. your baby is in the Neonatal Unit (NICU) and is unable to feed at the breast, you are back at work, or you and your spouse have a night out (you get the picture).

 

If you are experiencing engorgement. Your body has been making breastmilk (colostrum) since the beginning of the pregnancy and soon after delivery your body begins making a more mature breastmilk (kicking up the production). Typically moms will begin to feel “full” 2-5 days after delivery. At this time the best course of action is to feed your baby frequently, at least 8-12 times daily. The mature milk usually “comes in” in a copious amount (more milk than the baby needs) and the baby will help to keephe breasts well drained. As your body begins to respond to your baby’s needs, your milk supply will be based on milk removal (supply = demand).

 

Not only will your baby get LOTS of good food, she/he will help you feel more comfortable during this change in milk production. Sometimes during this stage moms feel uncomfortable and may report that their breasts feel full and hard; however, if the baby is nursing frequently and more important, effectively (effectively removing milk from the breast), then this discomfort is usually manageable/tolerable.

 

However, if moms feel this process is painful, it is important to assess how the baby is doing at the breast. It is a good idea to arrange to see your lactation consultant if you are in pain. Do you see/hear frequent swallowing? Is the baby having the appropriate number of wet diapers (see getting enough)?

 

Pumping is also used as a tool to manage breastfeeding issues.  There may be instances where a pump will be used as a management tool to deal with lactation issues, e.g. Mastitis, a breast infection, or supply issues. Your lactation consultant will advise you in your pumping plan.

 

What kind of pump do you need (call your lactation consultant, they can assist in your decision making process)?

 

For Occasional Pumping/Rare – Hand Expression (free), Hand Pump ($30-45)

 

Occasional to a couple of times/week – Hand Expression, Hand Pump, Single Battery/electric ($100)

 

More Frequent (returning to work/school) – Double Electric ($150-350), Hospital Grade (rent)

 

Pumping all Feedings/Maintaining Supply/Management Issue – Hospital Grade

Cluster Feeding

What do you do if your baby wants to eat ALL of the time?

1) Feed formula, you must not be making enough
2) Cry
3) Run away
4) Follow your baby’s lead and go with the flow (no pun intended)

If you answered 1, 2, or 3, I can sympathize with you , but alas “No”, these are not the best options. There is a time and place for formula, but if your baby is eating “efficiently” at least 8-12 times/day (effectively removing breastmilk), having at least 6-8 good wet diapers, 3-4 yellow seedy stool, and gaining weight appropriately, then supplementation is not medically indicated (not needed).

Running away from a difficult or frustrating situation is never a good option and crying, although allowed will not help the situation. So what is left? That’s right, “Follow your baby’s lead and go with the flow”.

If your baby wants to eat, feed them. Remember, breastfeeding is a learned art and in the beginning baby’s are doing just that—LEARNING. So if they want to eat 10 minutes after they just “finished”, let them. Perhaps your little one wants dessert, or in some cases, a second helping of dessert.

How do you know your baby is HUNGRY? What are the signs of hunger? click here to find out.

You can not overfeed your breastfed baby, so go with the flow.

You and the baby are dancing the “feeding dance” and you must let the baby lead.

There are many reasons a baby will cluster feed (feed frequently). It could be because they have an emotional need for comfort, it could be because they are ill/sick, it could be because they are going through a growth spurt (a growth spurt is a likely cause of frequent feeding), and it could be because they are HUNGRY. In any case, putting them back on the breast will help.

Getting Enough

How do I know my infant is getting enough?

Every parent should know the signs that indicate their infant is receiving enough breastmilk. Knowing the signs of good nutrition and hydration will offer parents the feedback they need to assess how breastfeeding is going.

Here are the basic signs:

  • A minimal of 8-12 feedings every 24 hours; One wet diaper for however many days old the baby is e.g. 1 Day Old = 1 Wet Diaper, 2 Day Old = 2 Wet Diapers, 3 Day Old = 3 Wet Diaper–I think you get the picture. By day 6, the 6th day after the baby was born, you should expect 6-8 wet diapers daily and 3-4 yellow seedy like stool; by day 6 you should not be seeing any dark tarry meconium stool
  • Regained birth weight by day 10, approximately 2 weeks after delivery. Then 5-7 ounces of weight gain/week.

Weight will be assessed at your well baby visits, focus on number of feedings daily and wet and dirty diapers. If you are not get 8-12 feedings daily or the number of wet and dirty diapers expected, call your pediatrician.

Lots of parents ask me “how long should I feed on each side” and my answer is as long as the baby wants with common sense as your guide. I really believe that anyone who gives a specific time on how long a baby should nurse on each side per feeding does not know what they are talking about. There are simply too many variables for anyone to know for sure and every baby and situation is different.

Face the facts:

  • Every baby is different (maturity, sucking strength, abilities)
  • Every mother is different
  • Both of mom’s breast are different (the right is never the same as the left; there are often differences in size/shape/nipples/glandular tissue/milk ducts)
  • Milk production changes throughout the day

……..Basically, what I am trying to say is that no two feedings are exactly the same.

So how do parents know how long is enough?

Well, let’s follow the baby’s lead to start with. You usually alter the breast you start with for each feeding. For example if you begin the feeding at 8 am on the right breast, then the next feeding at 10 am should initiate on the left side. I call the first breast you offer, THE MAIN MEAL. The baby will stay on this first side until they are DONE with their MAIN MEAL. (We don’t want to offer dessert until the MAIN MEAL is concluded).

How do you know they are DONE?

They stay on until they fall off, fall asleep, or they are no longer vigorously sucking—using common sense as your guide. I am not worried about overfeeding (I do not believe you can overfeed a breastfed baby) so I am only truly concerned about feedings that are short, cumulative 5-10 minute feedings in the beginning, the early days, make me nervous. As your baby grows and develops and proves they know what they are doing, feedings may become shorter, but infants should remain VIGOROUS on the breast. Vigor is defined as actively nursing and transferring milk. SO this means if your infant nurses for 5 minutes and falls off or falls asleep (in the first few days), my first instinct would be to wake that baby up and get them to nurse more on the same side or nurse them frequently and often. When your little one is done with their main meal, I ALWAYS offer dessert (sometimes the baby wants dessert and sometimes they do not, but I ALWAYS offer). In the beginning, it is not uncommon for a baby to takea small break after eating THE MAIN MEAL, only to awaken soon and look for dessert.


Hunger Signs

What are the signs of hunger?

SUCKING

ROOTING

STICKING TONGUE OUT

WAKING UP

HANDS TO FACE (and FEET)

Let’s face it if their eyes are open, that
is an opportunity!

Signs of Satiety (getting enough) AKA “Milk Drunk”

WHAT IS THE LATE SIGN OF HUNGER
(meaning you missed all the other signs)?

Latching and Positioning

When people talk about latch and positioning, they usually refer to them as if they are the same thing; however, this is not the case.LATCHINGRefers to the way the baby takes hold and takes in the breast tissue (the nipple and surrounding areolar area). Good latching is crucial to a good breastfeeding experience. A good latch helps to ensure efficient milk removal (remember milk production is based on milk removal). The better the latch the better the baby is able to remove milk.

There are many different techniques for latching; however the best way is a baby lead latch. In most cases, babies left to their own devices will find a way to latch onto the breast. A comfortable and pain free, latch that allows good milk transfer is ALWAYS the goal.

Some suggestions:

1) Find the right moment

You Ask: How will I know when the right moment comes?
Me: That is easy, look for those early hunger cues (sucking, rooting, mouth motions, tongue sticking out, hands/feet to face, and remember eyes open is an opportunity to feed an alert infant).

2) get COMFORTABLE

3) Unwrap the baby, I love to unwrap the baby before bringing them to the breast.

You Ask: Why, aren’t you afraid of the baby getting too cold?
Me: No, I know that mom will keep that baby warm. I like to get mom and baby as close as possible; the
blankets just get in the way and make it harder for mom and baby to find their groove.

3) Pick a position that you and the baby are comforatable in (see below)

4) Place the baby skin to skin on mom (babies love this)

5) Let the baby lead

6) Be patient and try not to rush the process

7) You can help guide the baby onto the breast, but try not to push or shove (babies do not like that–who would?)

* If the latch is uncomfortable, you can put your finger in the side of the baby’s mouth while they are suckling, break the seal and take the baby off the breast, and try again. If you are unable to obtain a comfortable latch and/or you find that damage is being done to the nipples or areolar area, the area surrounding the nipples, call your lactation consultant to set up a visit. In cases where an infant is not latching well, not only will damage occur to the nipple/areolar area, milk transfer will not be optimized.

Would you like to see a great video on perfecting your baby’s latch? Visit this link and watch a video created by Ameda.

POSITIONING

Refers to the way the baby and mom are positioned during the feeding. Although many mothers worry about finding the RIGHT position, I am less concerned. I think mom and baby will find a position that works best for them. Any position that feels right for mom and baby is a good one. Over the years I know that creativity can play a role in finding a good position for your baby to feed, so feel free to try different and new positions out.

However, for the sake of discussion, let me give a brief explanation of some of the positions you may read or hear about in other breastfeeding references.

The Cradle Hold


I would bet that this is the most commonly used position to hold a baby in. In fact given no instruction most parents instinctually hold their baby in this position. Although infants’ sight is not as developed as an adults’, they can see objects and shapes that are approximately 8-12 inches away, and because of that, I believe that they enjoy this position too. As a mom gazes into her baby’s face, the baby can begin to put the familiar sound of their mother’s voice together with the shape and appearance of their mother’s face (infants can hear in the womb and studies show that they prefer the shape of the human face when compared to other shapes).

The Cross Cradle


Although this is my favorite position for helping moms and babies who are having difficulty latching, I recognize that for many this can be an awkward position. In many ways mom ends up holding the baby the opposite way she wants to.

Let me explain. If a baby is going to breastfeed on their mother’s right breast, instead of holding the infant with her right arm, mom will instead support her baby with her left arm while her right hand is positioned near the right breast. I like to use this position for babies who might need a little guidance and have not yet mastered the learned art of breastfeeding. In this position moms can offer assistance and guidance to babies who might need the extra help.

Side Lying


This is my favorite postion for night feedings, in fact I do not know how I could have survived without learning how to nurse lying down in bed. Moms often find it helpful to have a pillow to support their lower back behind them and a pillow in between their legs. Some moms find this position a little tricky in the beginning, but the reality is that babies often love this position and the close contact with mom.
The Clutch or Football Hold
In this position, the baby’s body is place on the same side as the breast offered. Meaning, if you want to nurse on the left side, the baby gets tucked comfortably under moms left arm (see picture). You want to position the baby back far enough that they can easily latch. Use a pillow under the baby to help with the positioning. Moms who may end up having a cesarean delivery, may like this position, since it prevents pressure on the abdominal area.

Breastfeeding; Getting Started

WOW, this was not what I expected!

In the beginning it is not uncommon for many new parents to find breastfeeding a little overwhelming. Breastfeeding is a LEARNED ART and you and the baby are learning at the same time.

Getting off to a good start will help ensure a successful breastfeeding experience.

Many parents I meet in the hospital setting, during the first day or two after delivery, are in the process of finding “their own way”. What does this mean? There is not ONE WAY to breastfeed; instead every family must find their own way.

Conflicting Advice and Information:

Many parents grow increasing frustrated over the conflicting information and advice they receive from family, friends, and health care professionals. Please try not to let that aggravate you.

Instead realize that this is a great example of how everyone breastfeeds differently; there is not one way to do it!

I recommend that you take all advice in and then pick and choose what you like and what you think will work best for you. Remember there are some guidelines that are important, but there are NO Rules for this.

On a side note there is research showing that one of the reasons parents introduce supplements earlier than intended is the lack of support and conflicting information received from health care professionals (Taveras,et al., 2003). Plan for this; line up good support before the birth. Have your lactation consultant on speed dial.

Taveras, E.M., Capra, A.M., Braveman, P.A., Jenvold, N.G., Escobal, G.J., Live, T.A. (2003). Clinical support and psychosocial risk factors associated with breastfeeding discontinuation. Pediatrics, 112 (1), 108-15. Retrieved February 17, 2006, from Academic Search Premier.