Natural Beginnings

NEW GUIDELINES ON BREASTFEEDING
American Academy of Pediatrics Policy Statement:
Source reference: Breast Feeding and the Use of Human Milk.
Pediatrics 2005;115:496-506.

PREGNANCY NEWS LINKS

Nutrition for Babies

BREASTFEEDING IN THE NEWS

FAQS FOR THOSE BREASTFEEDING CHALLENGES

Have you been told to give formula to your newborn in
the first 3 days after birth for the following reasons?

- "...this baby is too big"
- "...your baby won't latch"
- "...why, your milk isn't in yet"
- "...your baby is just too hungry"
- "...your baby is nursing too often"
- "...that tiny amount won't satisfy him"
- "...when you pump, 'nothing' comes out"

THESE 'REASONS' DO NOT REFLECT EVIDENCE SHOWN BY CURRENT RESEARCH

WAYS COLOSTRUM ASSISTS NEWBORNS

The newborn fed colostrum exclusively has an enormous advantage over
the artifically fed baby due to protective immunities that are offered. This
makes a huge difference in the development of the immune system of your
baby (Lucas 1998).

Colostrum is a living fluid, resembling blood in its composition. It contains
over 60 components, 30 of which are exclusive to human milk
(Neville and Neifert 1985).

A newborn is birthed into our environment sterile. Immediately, bacteria
begin colonization on the baby's skin and in his mucosal membranes, which
are located throughout his body (Hanson 2004).

The newborn's stomach at birth is the size of a marble, which means that
it holds less than a quarter of an ounce of milk (Scammon and Doyle 1990).

Colostrum's small doses are designed for the human infant. These early
feeds are easily digestible. The laxative qualities encourage passage of
meconium, baby's 1st stool.

As meconium is expelled from baby's intestines, his stomach grows to
the size of his fist. This growth occurs rapidly during the 1st 3days.

Frequent breastfeeding should be encouraged. It is common for newborns
to "wake-up" on the 2nd day of life and want to go to breast often.
Frequent feedings encourage the transition to a mature milk supply to
begin as soon as possible (ILCA 2000).

Having unique qualities, colostrum is species specific and designed for
development of human infants (Lawrence and Lawrence 1999).

Even 1 supplemental bottle of artificial infant milk can sensitize a newborn
to cow's milk protein (Kalliomaki & Isolauri 2003).

Formula changes the gut flora in breastfed babies by breaking down the
mucosal barrier that colostrum provides them (Ogawa et al. 2002).

This violation allows pathogens & allergens entry into the baby's system
(Ogawa 1992). For this reason, artificial supplements should not be given
to infants who are at a high risk for allergies (Zieger 2003).

In susceptible families, cow's milk proteins may also increase the risk of
a child developing insulin-dependent diabetes mellitus (Zieger 2003).

Colostrum encourages the optimal development of the infant's heart, brain,
& central nervous system (Oddly 2002; Rivers 2003).

These qualities may account for the prolonged secretion of colostrum in
mothers delivering prematurely. Special components offer the premature
infant the best chance for optimal development of his fragile organs.
(Lonnerdal 2003)

Interviewing a Pediatrician? Here are some questions
suggested for mothers in search of a breastfeeding-friendly
doctor, to assist in interviewing for choosing her baby's caregiver.

How many babies in your practice are breastfed for ... 3 months?
6 months? 12 months? Beyond? (The doctor's explanations/rationalizations,
which are almost always offered, are equally as informative as the numbers.
Hopefully the doctor claims higher rates than the prevailing area rates.)
How do you counsel your patients about breastfeeding? Do you refer
problem situations to others? If so, to whom do you refer patients?
Who in your office handles routine breastfeeding questions from
patients? What training does this person have? (This reveals how the
office prioritizes breastfeeding support and patient education)
What do you do when a mother has mastitis? (or other breastfeeding
problems -- just looking for basic breastfeeding management knowledge
with this.)
What do you do when a 4 month old's rate of weight gain is dropping
off? (This checks the doctor's familiarity with normal growth patterns of
breastfed infants.)
Are there situations in which you would advise the use of formula?
If so, when? (The desired answer would be along the lines of, "if the
lactation consultant and I felt that we exhausted all the other options
and things still weren't working ..." Of course anyone can think of plausible
situations where formula use would be appropriate. The *attitude* of the
doctor and some reference to it being a 'last resort' is what you are looking
for.) * What is your personal experience with breastfeeding? (This may be
considered borderline inappropriate, but the AAP's own surveys of its members
show that personal experience is the single most important factor in doctors'
ability to provide breastfeeding support and correct information. So I think
its fair game.)
What handouts or other informational sheets do you have about
breastfeeding? (If the doctor has a wide variety of La Leche League
publications on hand, a copy of the AAP book to loan out, video, flyer
for local La Leche League meetings, etc., that would be a good sign.
If the doctor says, "Uhm, we don't have many people ask for that here,"
I think that also might be useful to know.

This would tell you a couple of things: a) person could review the content
of said information to determine if it was really good material or not; b)
even if his/her attitude toward breastfeeding is "pro", does the pediatrician
really have the support tools on hand to help if problem does arise?
(Handouts obviously don't take place of actual observation/coaching, but
they can be an indicator of a "prepared pediatrician"); c) does the overall
attitude of the pediatrician show interest in teaching and counseling
patients? This is critical, not just for successful breastfeeding, but for
successful parenting: most pediatric problems need education, not
prescriptions.

I think the factual part of the answers is not nearly as revealing as how
the doctor phrases things and whether she/he equivocates. I not worry
too much about the exact answers (weight loss etc) but to listen 'between
the lines' to get the real scoop. Good 'hunting'!

Compiled by Sharon Mattes, IBCLC, RLC, AAHCC; September-2004

Preventing and Removing Gentian Violet Stains

While Gentian Violet is regaining popularity as an effective treatment
against oral, nipple/breast, and diaper area thrush, it can also result
in unsightly purple staining. Take heart in knowing that the purple DOES
go away, and relatively quickly, from both yours and your baby's skin.

Following are some tried and true tips for preventing as much of the
staining as possible and ideas on how to get those stains out that just
couldn't be prevented!

Tips for preventing stains or lessening the worst of them:
~ Only use 1-2 DROPS of gentian violet. Put it on a little dish and dip a
swab in it. Then squeeze all you can from the swab before painting your
baby's mouth with it.
~ The baby should then be turned over onto his stomach so that a minimal
amount of the solution is swallowed. If baby drools purple, it is too much.
~ Put lanolin, Vaseline, or olive oil on baby's lips and around baby's mouth
before swabbing with Gentian Violet. This will keep the solution from being
absorbed into the skin so much.
~ Remove all of your clothing down to the waist before swabbing areola.
Undress baby to his diaper for mouth application.
~ Wear nursing pads (disposable are best) inside bra to avoid staining it.
You can also cut up old diapers, handkerchiefs, etc. to use as "makeshift"
pads while you're using the Gentian Violet.
~ Have burp cloths on hand for catching purple baby drool. If you have any
of the disposable bed pads left over from your birth, these are great for
putting under baby when you turn her on her tummy after painting her
mouth with the the Gentian Violet.
~ When you're using Gentian Violet, wear old clothes or things that can be
easily bleached.

Removing Gentian Violet stains:

~ Gentian Violet will rub off counters and skin with rubbing alcohol, if used
immediately.
~ Spray stained fabric with aerosol hair spray; then wash normally.
~ One mom reported having good luck with ZOUT stain remover, even after
the stains were dry. Another used Didi 7 with similar results. Any item that
can be safely bleached with chlorine bleach should come clean.
~ A cotton swab/ball with vodka can get stains off baby's face. Rinse vodka
off immediately after cleaning stain. Rubbing alcohol will work on baby's face
too. One mom reported that baby wipes worked pretty well, too (she used
Huggies Supreme Natural Care Unscented wipes).

Flora, BSed, IBCLC: From tidbits shared by mothers who have battled with thrush.
Special thanks to Kelly Bonyata, LLLL and Paula Yount, CBE for helping me get this list together.

Comfort Measures For Labor

Eating & Drinking In Labor

Once upon a time women were discouraged from eating during labor, not for
any nutritional reason, but in case the mother needed an emergency general
anesthetic. If vomiting occurred under general anesthetic, food in the stomach
could be aspirated into the lungs - a potentially fatal situation. Today, except
in a true emergency, most women needing a cesarean birth opt for epidural
rather than general anesthetic. (If you have a special situation that makes a
general anesthetic a high probability, calories and fluids will be given to you
intravenously.)

Doing work requires calories and fluids, and the hard work of baby
birthing is no exception. Eating and drinking during labor are not only
safe, but necessary. Try these labor-friendly food suggestions:

Grazing (small, frequent nibbling) throughout labor is easier on the squeezed
intestines than gorging on large meals. Labor slows the digestion process.

Stick to proven favorites that you consumed during pregnancy and know
you can easily digest. For most women, proven labor-friendly snacks include
crackers, gelatins, and light soups.

The best energy-providing and stomach-friendly foods are
carbohydrates: fruits and juices for quick energy, grains and pasta for a
steady supply of time-released energy. Honey provides a quick burst of
energy at a low point, especially if you don't feel like eating.

Avoid gassy foods, fatty and fried foods, and carbonated beverages.

DON'T BECOME DEHYDRATED - it throws your body's physiology off,
depletes your energy, and slows labor. As you progress in labor, your body
diverts some blood and energy from your digestive system to the system
working the hardest - your uterus.

Therefore, if you overload, even on liquids, your stomach is likely to
expel its contents.

Take sips after every other contraction, a thirst-quenching job your
partner can assist you with. Here is a time-tested recipe for "Laborade":

1/3 cup lemon juice
1/3 cup mild honey
1/4-1/2 tsp. salt
1/4 tsp. baking soda
1-2 calcium tablets, crushed

Add water to make one quart. Another 8 ounces of water may be added
for a milder flavor, or you can flavor with your favorite juice.

©THE BIRTH BOOK: Everything You Need To Know To Have A Safe &
Satisfying Birth 1994; p 213 William Sears, M.D., Martha Sears, R.N.

Day Brighteners for Mothers on Hospital Bedrest While you wait
for your baby

Have a Special Someone bring you some yummy massage lotion or oil from
a place like Bath and Body Works. Then (this is the best part) have them
massage your achy shoulders and back when they come to visit you. Ask them
to pay special attention to the area between your shoulder blades (but not on
your spine) and your lower back (sacrum). Be sure to turn on your side put a
pillow between your legs, and just let go.

Have someone bring you the envelopes for the baby announcements and
address them.

Ask your care provider to send a physical therapist in to see you. She will be
able to help you learn "stretching exercises" to keep your arms and legs in
shape gently without causing harm to your baby. (Helps you sleep better, too)

Take time each day to focus on your breath. Breathe with the rhythm of life...
slowly. This is especially helpful if you need medications to slow or stop
contractions.

Pick a name for baby, then announce your decision to your partner when they
come to visit (timing is everything)

Call La Leche League and talk with a Leader about breastfeeding - they love to
talk and are very helpful. http:www.lalecheleague.org

Keep a journal - write poems to baby, jot down world events, feelings about
baby, record glimpses of your experience

Ask someone to bring a pillow from home. The familiar fragrance is soothing.

Spray your favorite fragrant herbal or flowery mist into the air.

Keep a Digital camera/phone in your room and take pictures of those "angels"
who help you everyday. You may want to put these in your baby book.

Keep your hands busy - if you crochet or cross-stitch, make something for
baby -- if you don't know how to do these things, have someone show you!

Read books totally unrelated to pregnancy, birth, babies - ask friends to bring
their favorites to you.

If you just have to read about pregnancy, etc. focus on the newborn --
The Baby Book by William Sears, M.D. is a great resource.

Ask someone to bring tapes of relaxing music (not Aerosmith) and spend some
time each day - 15 to 20 minutes, consciously practicing relaxation.

Call on friends- just to talk, to vent, and to ask questions.

ESSENTIALS FOR BABY (Things I MUST have for Baby)

Q: I'm already 30 weeks pregnant.Why should I spend all this time learning about nutrition?
I thought that was only important in early pregnancy.

EXERCISE IN PREGNANCY

Q: I'm not sure which exercises to do or when to start. What about walking?

In childbirth Preparation classes, you will learn about Kegels, Tailor sitting, Squatting, pelvic tilts, 'Butterfly" exercise and more for toning muscles you'll use giving birth. Exercising generally helps the birth process and gets you back into shape faster
after your baby is born. It's never too early (or late) to start. Elizabeth Noble has
an excellent book called Essential Exercises For the Childbearing Year.

If your midwife or doctor has given you the OK, start walking, swimming, or doing
any other type of exercise. Most women find that walking 30 minutes or more five times a
week helps them sleep better, increases their sense of well-being, gives them more energy, and
helps balance weight gain.

Have a toddler? Get a wagon, put a blanket in the bottom and pull your little one
behind you. Use a sling or a stroller and take toddler along. As long as they're in
your arms or in a wagon or stroller, you will be able to get a decent workout. Then choose other times to allow your littleone to walk alongside you. You'll examine
spiders, doodle bugs, flowers and so much more - practice your squats at these
times and most of all, enjoy your time together with your little one !
|

MOTHER AND BABY BOTH WINNERS AT THE WEIGHT LOSS GAME
~ January 4, 2006 (Schaumburg, IL)

According to a recent study which appeared in The American Journal of Epidemiology1 the breastfed infant’s risk of future overweight declines the longer breastfeeding continues. While even one month of breastfeeding reduces this risk by 4 per cent, statistical analysis of 17 original studies revealed that breastfeeding through nine months of age, reduced the rate of future overweight by thirty percent.

It is not known why infants who are breastfed have this reduced risk of obesity. However, there is some speculation about the effects of nutrition on the developing areas of the brain that control appetite and body weight.

It is also not clear whether the effect continues beyond the ninth month of
breastfeeding since the study did not consider breastfeeding beyond this point.

Although most of the studies analyzed included infants who were only partially
breastfed, it seems logical that exclusively breastfed infants might derive even
greater benefits. The American Academy of Pediatrics and most health organizations worldwide recommend exclusive breastfeeding for the first six months of life with continued breastfeeding along with complementary foods after this time.

Previous studies have also shown that breastfeeding mothers also returnto their
pre-pregnancy weight sooner than their formula feeding counterparts. It appears
that breastfeeding mother and baby are both winners of the weight loss game.

La Leche League International is a nonprofit organization that offers information
and encouragement primarily through personal help to those women who want
to breastfeed their babies. LLLI is the world’s largest resource for breastfeeding information. LLLI has a Health Advisory Council of more than 40 professionals in the
areas of pediatrics, obstetrics, allergy, nutrition, psychology, family practice, and
related fields. LLLI is active in 69 countries and on the worldwide web.

Harder, T. et al. Duration of Breastfeeding and Risk of Overweight: A
Meta-Analysis. American Journal of Epidemiology 2005 162:397-403.

For more information about breastfeeding, call 1-847-519-7730.
or visit the LLLI web site at www.lalecheleague.org

BREASTFEEDING - EVEN IN SPECIAL SITUATIONS ?

Published first by Baby Dallas Magazine in two parts Fall 2000, and Spring 2001

When a woman contemplates breastfeeding, she may feel her personal circumstances
are unlike thoseof most other women. Even after reading about routine breastfeeding, she still has reservations about how nursing can work for a woman facing unique challenges. Motivated women have succeeded at breastfeeding despite all kinds of obstacles. Whatever the specific situation, she may be surprised to find that nursing, whether partial or exclusive, is probably feasible.

The Effects of Bed Rest On Postpartum Recovery & Breast Milk Supply:

The current technology in fertility has brought an increase in twins and
higher multiples. Along with this trend comes an increase in prematurity,
pregnancy induced hypertension and other medical situations which call
for long periods of bed rest for many more pregnant mothers.

Bed rest effects every major organ system rapidly, with head down bed
rest having more rapid and profound effects. The intensity of side effects
of bed rest increases by the length of bed rest, and the type of activity
restrictions.

Bed rest is a type of sensory deprivation - an environmental sameness that
is not typical of everyday life. As a result activity restriction leads to sensory deprivation and social isolation, which continues to increase until inactivity is terminated. Sensory deprivation leads to a dulling of the cortical processes.

Postpartum recovery from bed rest varies among women and depends
upon how long and how severely activity was restricted as well as how
quickly the woman is able to remobilize.

Aside from the emotional stress to a mother and her entire family, the above
are very real physiological effects, which you rarely anticipate and which may
cause you to feel that there is something "wrong" with you. Knowing what
physical changes to expect may help you to adapt your expectations and to
recover more rapidly.

Breastfeeding Twins and Higher Multiples:

Nursing twins is certainly possible and can be very rewarding. Breastfeeding
triplets can also be accomplished and more than a few women have nursed
higher multiples, usually partially. Advance knowledge and intense commitment
can be major strengths. Before she embarks on breastfeeding multiples, she'll
want to consider the following unique challenges and be prepared to focus on
ways to prepare herself and her family.

Babies are likely to have increased risks for medical problems including
prematurity, cesarean delivery and respiratory distress, which may cause a
delay in beginning breastfeeding with the possibility of supplemental feedings
and separations from mother.

Maximizing milk supply is best accomplished by obtaining a hospital grade
electric pump if any doubt exists about either twin's ability to nurse well.
The goal is to establish a generous milk supply from the start and as the
babies grow and mature and are able to obtain more milk with nursing,
you can taper your use of the breast pump until you no longer need to
express residual milk.

Many helpful techniques for nursing multiples can be found by contacting
your local La Leche League Group Leader, or Lactation Consultant, and
reading. (see Mothering Multiples by Karen Gromada)

Breastfeeding After Breast Surgery

Many women have concerns about the possible impact of breast surgery on
their ability to breastfeed. If surgery is a future possibility, care can be taken
choosing the surgical method least damaging to function. If surgery has already
been done, careful checking on the type and location of incisions will help assess whether supplementation may be required to complement your milk supply.1

Breast Augmentation: Generally, women who receive implants are advised that
the surgery will not affect their ability to breastfeed. This can be evaluated based
on some of the following factors.

...Disruption of milk ducts - Surgery may cause injury to milk ducts if
incisions are made around the areola, which may decrease a woman's
chances of providing a full milk supply.

Breast Reduction: This surgery is more disruptive than augmentation surgery
and carries an increased likelihood of nerve or duct damage and subsequent
inability to provide a full milk supply.During this surgery, excessive breast tissue
and skin are removed, the breasts are re-shaped and the nipples are often
repositioned at a higher level. Sometimes the nipples are removed and reattached during the procedure, while in other instances they can be repositioned without
being removed. A large amount of milk producing alveoli may also be removed
which may affect milk production ability.
Breast Biopsy: New needle biopsy techniques are available and have less
chance of interfering with normal breast function. As in previous discussion,
the location of the incision determines whether this surgery affects a mother's
ability to produce a full milk supply. If an incision is in the vicinity of the areola,
cuts milk ducts preventing proper drainage, it can interfere with normal milk
flow and production.
Breast Cancer: We know that radiation therapy for breast cancer causes
radiation damage to the milk glands and ducts, preventing full lactation from
that breast. The treated breast often does not undergo normal pregnancy
changes and the milk does not come in abundantly on that side at delivery.
However, breastfeeding from the breast that was not irradiated is still
possible. Baby can receive an ample milk supply by nursing exclusively from
the untreated side.

© Breastfeeding and Human Lactation, 2nd Edition K. Auerbach, PhD, IBCLC & J. Riordan, EdD, RN, IBCLC, FAAN, 1999,
Jones & Bartlett Publications

Breastfeeding Through a Pregnancy and Tandem Nursing

Many women are still breastfeeding when they discover they are pregnant again. Although breastfeeding offers some protection against conceiving, particularly during
the first six months after birth, it is certainly possible to become pregnant while nursing.
Here are some of the most common questions.

Q. Does pregnancy cause any negative effects on lactation?
A. Although some women state that their milk supply does not change, for most
women the milk supply rapidly decreases within months of conception as the milk
returns to a more colostrum-like composition. This change is thought to be caused
by pregnancy hormones, which may heighten nipple sensitivity, causing some women
who were comfortably nursing to become extremely sensitive for no other apparent reason. This condition is unique to each pregnant woman.

Q. Is it necessary to wean because of the pregnancy?
A. For a mother breastfeeding a toddler who is already receiving other sources
of nutrition, obtaining less milk from nursing will not likely place him at risk. On
the other hand, if mother is exclusively nursing a young infant, the change could
cause failure to thrive as a result of mother's diminishing milk supply unless baby
receives supplemental nutrition.

Q. Are there harmful effects of nursing on the developing fetus?
A. A well-nourished mother should have no difficulty providing for both the unborn baby and the nursing child. She should be sure she is gaining weight at the appropriate rate and adding nutritious foods to her diet as well as getting sufficient rest.

Q. Can breastfeeding during pregnancy cause premature labor?
A. A small percentage of women may experience uterine contractions during breastfeeding. In most cases, breastfeeding will not affect the fetus in any
way, and there is no evidence that uterine contractions are associated with
fetal loss. (Sexual intercourse also causes uterine contractions, and is not
normally contraindicated during pregnancy.)

Q. Will the new baby receive colostrum?
A. Yes, the colostrum is present at the end of pregnancy and increases after delivery, and later transitions into mature milk. There is evidence that the body produces a
greater amount of colostrum when a toddler nurses through a pregnancy. The true
milk has been found to come in sooner after birth when the mother nursed during a pregnancy and the colostrum content of her milk was higher longer into the postpartum period and early weeks after birth.

Q. Can you continue nursing the older baby even after the newborn's arrival?
A. Of course! The new baby has a real need for mother's milk to fill nutritional requirements. In the early weeks, the newborn should nurse first, before the older nursling, for the full benefit of the colostrum. You should alternate breasts and feedings between the two nurslings, as the newborn needs both foremlk and hindmilk as well as extended sucking. The older nursling may adapt more easily
to a new sibling because he does not feel "ousted".

© "Nursing Two, Is It For You?" Gail Berke, La Leche League International, 1989

© "Breastfeeding Through Pregnancy and Beyond", Nursing Mother's Association
of Australia, La Leche League International, 1999

'HOLD OFF ON SOLID FOODS UNTIL BREASTFED BABY IS SIX MONTHS' (6) (University of Rochester Medical Center)


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The WHO Child Growth Standards - 2006