Wednesday 6 November 2013

Breastfeeding through separation.

Families in the midst of separation have incredible amounts of stress and difficulty within their lives, add to that a young family among whom include a breastfeeding mother and baby and levels of stress and concern can be overwhelming. This topic is close to my heart having separated from my husband and father of my 3 boys including my little breastfeeding one who was only 12mths old at the time. I was to learn that maintaining the breastfeeding relationship while the martial relationship falls apart is possible and provides a lot of comfort and security in an otherwise tumultuous time.
There are three main themes that are stand out, these are how to help baby cope with her new home life. What and how to feed baby when she’s not with her mother and finally how to manage and maintain milk supply.

The biggest factor that will determine the amount of impact the separation will have on the breastfeeding relationship is probably the age of the baby. The mother of a very young baby is going to face different and varying degrees of struggles to the mother of a breastfeeding two year old.  At any age the relationship of the parents is so very important for babies comfort and security. An amicable relationship with babies best interests as the key focus is absolutely essential for breastfeeding to be preserved.

The most important factor to maintain in babies everyday life is stability. If baby is still very much feeding through the night or has been co sleeping with mum there needs to be a gentle transition from this before she can happily go with bags packed off to dads for the night. A loving gentle dad will see the importance in taking this slowly; and mum, even though she’s clinging on to these precious moments, will slowly and gently ease them to some form of night parenting that can be done equally as well by dad.
It’s not those night feeds or night cuddles that are essential for baby to feel safe and thrive but when moving between two home environments consistency is. Imagine for a moment, baby 4 months old co sleeps and breastfeeds all night long with mum 4 or 5 nights a week and then the other nights dad is trying to settle baby in a cot with a dummy or a bottle. Dad isn’t going to have a fun time and baby is going to be stressed beyond measure.
Communication is essential. Mum and dad need to discusses their wants and needs for baby. Breastfeeding is something to strive to preserve. Because a baby is breastfed it doesn’t mean dad’s time has to suffer, the whole family needs to be flexible and give and take.
While ever dad is happy with mum doing the night time parenting mum and baby can carry on as is, breast feeding, cuddling and co sleeping as much as possible because soon enough dad will be ready and wanting night time access. When dad is ready for night time parenting there are no set rules and many options. For baby it would be helpful for both houses to follow the same night parenting plan. If dad weren’t willing to co sleep it would be helpful for mum not to co sleep either. Perhaps mum could reserve co sleeping for day naps and baby goes down in her bed at night. If baby were breastfeeding through the night dad could offer a bottle through the night, this would mean effort with expressing and milk handling but would preserve those night feeds if baby is still of a young age. As baby is getting older and night feeds less important night weaning is something that can be considered at some stage. It is probably much sooner than baby would have naturally done so but can make night parenting easier all round.

“My son was 12 months old when I split from his dad. Being an attachment parent Rhys had barley left my side since he was born. He was heavily breastfed and co slept most nights. Dad was very aware this was going to be a big transition for the both of us. For the first couple of weeks we kept it to daytime and evening parenting for dad. While the nights I worked on night weaning and settling him in his own cot.
It was far easier than I anticipated. I think the age helped I could talk to him, “no boobie, nigh nighs in cot” and id lay on the floor next to his bed, tap the pillow for him to lay down and id stroke his back. There was no screaming; eerily I think he understood what was happening.
By the second week he was ready for his first night at dads, I believe he slept through for dad, and while I woke lots that night I relished the fact no one was in need of me. When Rhys came through the door the next day he ran into my arms and snuggled in for a breastfeed as happy as could be.”

Always a welcome moment when Rhys returns home.

What to feed baby when she’s away from mum will differ with the age of baby. Presumptuously there are going to be fewer young babies spending time away from mum than there are older. The older baby, older than 6 months who is eating solids and family foods can manage a longer time with out milk and really doesn’t need it replaced at all for these short-term stints. Baby should have access to lots of fruit and veg and other foods as the family eats and water from a sippy cup. Baby may like a milk feed to go to sleep, this could be ebm from mum or even just plain cows milk.
You can’t give a baby under one cows milk I hear you say?? Cows milk is inadequate as a complete milk food for babies under two, that is correct. That means if a baby’s only dietary intake is cows milk it is poor nutrition and not appropriate. If though a baby is breastfed (or formula fed for that matter) and receiving a balanced diet of other complementary foods cows milk can be welcomed in to the diet as a complementary food. Consider it the same as a drink of water or juice or custard. It’s not necessary, its not their main nutritional source, its just a drink.
The young baby however who is not yet taking solids will need more planning around time away form mum and what and how she eats. Mum can express milk for her baby; baby can take this milk from a bottle or a cup (not a sippy cup). We know bottle feeding can lead to breast refusal in some babies so cup feeding or timing visits around feeds can help to reduce the number of bottles baby receives.

“Rhys was a good eater, wed been doing baby led solids from about 5 months of age. He would go to dads with no hesitation and eat happily with his brothers, he would drink water and you would assume he wasn’t even a breastfed baby. Dad would give him a bit of warmed up cow’s milk in a bottle before bed at night where he’d fall asleep in dad’s arms, sometimes drinking all the milk sometimes not. It wasn’t long before dad even ditched the bottle and just offered a big nighttime snuggling where Rhys would fall asleep in his arms. On days he’s with mum he continues to have free access to the breast and would breastfeed to sleep every time.
As time went by he was even able to go camping with dad, sometimes for three nights and 4 days, apart from asking where mum was a couple of times he never missed a beat, he was happy and contented in family life with dad. He’d always come home to mum and snuggle up for a boob and a welcomed mummy cuddle”.

Rhys has daddy time, camping with brothers and family.
Clearly not a care in the world.

So as mums come to terms with the time she now has away from her baby, she may even be enjoying some of this new found “me” time. The final skill to master is the juggling of milk making, engorgement, pumping and expressing, all the joys of finding your self in the position of being a full time milk maker and part time mum.
How you manage and how much your supply is affected will depend on the age of the baby and how much she breastfeeds. If you break it down and try to not over think it, it presents as quite simple.
1 – when baby is with you allow free access to the breast.
2 – when baby is not with you pump when baby would normally feed. If baby feeds regularly this is easy, if baby feeds all over the place like an older baby might, just choose a couple of times that work for you.
3 - if you need to supply ebm to feed baby while she’s away you will need to add pumping to your normal day routine. For example two pumping sessions a day, say after morning feed and after lunch time, on top of your normal feeding/pumping might over the week give you enough milk for babies time away.
If your baby is older and supply is less of a concern you could just see how your breasts cope. You might find you can go all afternoon and just have a hand express in the shower before bed for comfort and stimulation sake (so your body thinks baby is still drinking this milk). You could do the same in the morning or you might be comfortable enough till baby comes home again.

“Initially I pumped using a hand pump when Rhys was away to maintain supply. Rhys was eating well and I chose not to send milk with Rhys as he didn’t drink much from the bottle any way. The milk I was pumping I put in freezer bags and donated them to mums and babies in need of donor milk. As time went by my supply had reduced, id lost a lot of weight by this time and wasn’t looking after myself the best I could.  I was finding it increasingly hard to pump. It was a round the time Rhys was 18mths old that I went form feeding on both breasts to just my left breast. My left side had always produced better and by this time 24hours could go by with out a breastfeed. I chose to feed on the one breast only because it meant the one breast would be fed on more frequently, I could focus on expressing just the one but simply just because I and Rhys preferred it.
Some times I worried about the little amount of milk that was there but all I had to do was think of Rhys and see how unphased he was by it all. He was so happy at the breast, he was still feeding to sleep and he was so happy in his busy little life with two homes. I completely relaxed and let Rhys lead. When he wasn’t with me id hand express in the shower and if I didn’t get around to it I wouldn’t worry. I never had a problem with engorgement or lop sidedness."

"these days are numbered" Rhys nearly two.

"Rhys was such a busy little toddler; even now I say he’s two going on 7. Every thing his brothers do he can do. I think back at the end of his breastfeeding journey and think he actually was torn when he was feeding because he wanted it but it was something the big kids weren’t doing. Rhys weaned himself so gradually and I’m so proud that his weaning was really led by him. I believe his living arraignments hastened the weaning process in terms of supply and him knowing he was fine with out it. But the access was there and my willingness for him to continue had he wanted to.
Slowly slowly a busy day would happen and boob didn’t come up, he’d now come home from dads and a game with brothers or a toy was more important than having a boob straight away. His feeds became so brief; he’d say ‘ah finished’. Eventually it was a couple of days between boobs.
Rhys snuggled into me the morning of his second birthday, a week or so had gone by since his previous boob. He looked up at me and with our saying anything tapped me on the boob (this was how he always asked for it), he latched on and suckled for a moment, then popped off and said finished. This was his last feed. I was fully aware of it and captured the moment in my heart.”

My baby love. 

I’m sure our breastfeeding relationship provided so much more safety and comfort for me over those 12 long moths of being newly separated and finding my new way. Our children are so resilient the only thing they need to thrive is love and care; we work so hard at trying to provide them with this we often forget about ourselves.
Relax, trust your body and your baby and most importantly trust your ex partner. Trust that they have your little ones interest at heart as much as you do and while you’re no longer living together you can work together to co parent and lovingly raise these babies that really are so lucky to have not one but two loving and safe homes.

Tuesday 23 July 2013

Milk sharing ~ a little joy for you, a lot of life for another.

“These babies must only have breast milk. They are not to be given formula” Says the big authoritative neonatologist to the wide eyed scared first time mum. This is me; babies only 6 hours old after a long difficult labour and birth of baby twin boys born 9 weeks early. I didn’t question the man and without any more words exchanged the importance of human milk for these little boys and babies everywhere was concreted in my brain forever.

Over the next days and weeks as my sick babies fought to grow ex utero, I struggled to express enough breastmilk to keep up with their needs. The words of the big stern doctor rung loud in my head as I looked at the measly 20ml id managed to painstakingly squeeze from my breast. Fortunately for me, I wouldn’t have to go against the doctors orders as each baby took turns being sicker and would both be nil by mouth and this would buy me some time to stock pile some milk. I would pump every spare moment I had.

These early mothering experiences laid foundation for my later experience of milk sharing. How much pressure this new mum would have been free from had the neonatologist been able to say to me “these babies must get breastmilk, don’t worry if you cant pump enough to start with, we have a plentiful store here in our milk bank”. If only. If only for all sick babies everywhere this was the norm. The very first option after his mothers own milk. Unfortunately this wasn’t the case and still isn’t. Milk banks just don’t exist in (all but one or two) towns and cities across Australia.

Busy with my baby twins, I breastfeed the months and years away. I learn more, I study, I become a lactation consultant. I learn of all the struggles some mums go through to make sure their babies receive the little breastmilk their mum can make. I am inspired by these mums and want to help.

I give birth to a healthy full term baby boy and breastfeeding is a breeze. I realize that for me to feed my little baby with out a second thought isn’t fair. Its not fair to the next mum who is pumping, comping, on medication, using supply lines and struggling with the thought that she still doesn’t have enough milk for her baby to be exclusively breastfed.

I came across the human milk 4 human babies Facebook page. I posted that I have some milk in the freezer that id be happy to part with if any mums and babies were in need. I was connected with a few passing mums and babies here and there. Then I was put in touch with a mum who wanted donors to contribute milk for her baby on a long-term basis. This was something I could do. It took just 10 minutes of my time to help a mum and baby in such a profound way. I got into a sweet groove of pumping one breast while baby Rhys had the other boob. One pump per day would yield about 120mls. Rhys was sharing his milk, about 1 litre a week with another human baby, my milk would only cover a little over a days worth of the other babies needs but between my self and the other donors and her mother she was at times receiving wholly human milk.

Rhys with his sharing milk 

I got nothing other than the sheer feeling of doing something good for others out of sharing my milk. It wasn’t at all a selfless act because when mum and baby would make the couple of hour round car trip to collect milk, handing the little stash over in the esky felt wonderful.

It was becoming difficult to keep up my pumping, Rhys was big and wouldn’t share me with the pump as easily. The recipient babe was also now over one and mum was managing her demand much better with less need of donor milk, so I decided to stop pumping for donation.

There were still many occasions where a local mum would get in touch with our local natural parenting group at a time of need and ask for one off donations and if there was milk at hand id happily part with it.

I urge you to look up human milk 4 humanbabies, if you’re struggling with supply and keeping up with your babies need for milk than there are other options than just formula top ups. Maybe you have a freezer full of milk that your baby will never make his way through. Don’t let it go to waste, there are babies out there that need it, and mums that would cry to see it go to waste.

Sunday 21 July 2013

Finding your breastfeeding groove ..... how to find it sooner.

Part 2 

Apart form sore nipples weeks down the track that are usually easily turned into normal nipples with a simple adjustment here and there, the other common reason holding mums back from finding peace within their breastfeeding experience is the doubt that their baby is getting enough because of how frequently baby feeds. Once it is clear to mum the reason baby feeds so often and mum embraces the frequent feedings mum can then embrace breastfeeding with peace.

Why do babies feed often?

In the early days (days 0-3) they are getting hungry. Baby is waiting for mums milk to come in.  Baby isn’t trying to bring mums milk in, baby doesn’t know its not there yet, all baby knows is that the breast is the source of food and after 48hours or so some babies are getting quite the appetite and the small volumes of colostrum aren’t quite cutting it any more. This is normal, baby does not need any formula to top her up, she simply needs access to the breast, the milk will come in and baby will soon be sated. It really is patience on mums behalf and an understanding that baby isn’t starving; the colostrum she’s getting is nourishing her plenty even if she’s adamant she wants more.

Breastmilk is a complete food, baby uses up every last bit of milk, and there is very little waste product. Breastmilk is largely water and is digested very readily. 

Babies regulate their own intake. Unlike bottle feeding where for example 150ml is taken in on time, every time. A baby feeding at the breast will take in a different amount every time. What she takes in is dependent on her appetite, when she last fed, how sleepy, how warm or cold she is, among many other factors. How much she takes will then directly affect when she feeds next. Little feed, little sleep. Big feed, big sleep. In theory J

Breastfeeding is so much more than just food. Do you only eat breakfast, lunch and dinner? All your baby needs is access to the breast and she will tell you how much and how often she wants it. It might feel like a lot. Its not a lot though, when you consider that’s what your baby needs to grow and thrive and be content because she’s not just hungry, she’s thirsty, she’s cold, she's tired, she’s lonely.... she’s smart.

Baby Louie at the boob.

Louie is slung in mums arms, he is grizzly after a car ride to the park.
He boobs.
He breaths, he drinks, he sleeps.
He lets go the boob, he's warm and full.
Brother comes bounding.
He wakes with a start,
Hes ok.
He looks all around, he's cold.
He cries.
He boobs.
He coughs and splutters, he goes back in for for more.
He's done.
He gets passed around.
He doesn't like that much.
Back to mum.
He boobs.
He's not happy, he fusses, he farts.
 He doesn't want to be put down so brother can be tended to.
He gets mum back.
 He gets the other boob.
He breathes, he drinks, he sleeps.

baby louie 6 weeks

Tuesday 9 July 2013

Finding your breastfeeding groove....... and how to find it sooner! (The myth of the magic 6 week mark)

Part 1 ~

I remember as a midwife, before I had children, I used to teach mums that there was nothing to worry about if they were having breastfeeding difficulties in the early weeks, not to worry because it will all magically get better as soon as the baby turned 6 weeks old.

Then I had my twins, they were 9 weeks premature so by the 6-week mark they were only just beginning to really feed from the breast. Ok so 6 weeks corrected age must mean it will all be sorted… Still no. The nurses that visit my home tell me “oh it’s because there’s two of them, it will all be good by 12 weeks”. 12 weeks?!?! That’s 3 months of sore nipples, annoying nipple shields, managing with low supply and medications and herbs to boost such supply. And two babies feeding on and off around the clock. I was struggling.

The question to continue and persevere or wave my arms in surrender tormented me, mostly during the long lonely days when everyone else was at work. The family and friends that were a steady flow of traffic in the early days had pretty much disappeared, after the exciting arrival of the twins their lives all returned to normal, mine didn’t, I was trying to come to terms with what my life now was. By now I had postnatal depression, somehow I knew that for me to give up breastfeeding would have made me spiral down worse. I pushed through, the following months were a struggle and a bit of a blur but I do remember a very gradual feeling of things slowly looking up.

I remember when the boys started eating foods at around 6 months I felt the pressure ease a lot. With the load lifted off me a little I was able to come off the herbs. At 8mths old someone said to me “Geez, they’re nearly 1 are you going to stop breastfeeding soon?” STOP? I only just got the hang of it!

My twins at 8 months, breastfeeding was finally a breeze. 

So for my first babies, all be them twins I hit my breastfeeding groove at 8mths of age. My third baby, 5 years later, I was shocked to find that at 10 days of age I found my self with really sore cracked and grazed nipples. I reminded myself how diligent I had to be with attachment, soon enough I hit my groove. I was on day 12.

The breastfeeding groove is simply defined as when breastfeeding becomes easy. When breastfeeding goes from taking a lot of time and effort, to just happening with out even thinking about it. When it goes from a lot of painstaking agonizing about whether it’s the right thing to do, to keep going. To it becoming a quiet peace in your mind, you realize you haven’t thought about it for a while now, it feels right.

As you can see, from my story alone, reaching that peace, the breastfeeding groove, takes time. The amount of time is different for everyone. And different for each baby. When I think about what slowed me from reaching my groove sooner I identified two main things, these were also common in all the women I see in my practice. The two things that I believe will impact how soon you reach your breastfeeding grove are understanding what normal breastfeeding should feel like and what breastfeeding babies behave like. (The latter will be discussed in part 2)

“Your nipples might be sore, but breastfeeding shouldn’t HURT you.” After sifting through and tossing out a lot of “what breastfeeding should feel like” quotes I decided on this one of my own. Words like Breastfeeding should be 100% pleasant and comfortable and pain free can be wrong on so many levels.

Nipples that have never been sucked on before, or not sucked on in a while (be it years, months or weeks) will become quite tender from all the sucking. They might be extra sensitive if you brush past them, you may need to protect them in the shower as the water streams can feel like needles.

Nipples can be sore when the baby first latches but as the breastfeed continues breastfeeding shouldn’t hurt. When the baby first latches, you have newly sucked on sensitive nipples adjusting from being warm and soft and safe inside a bra to firm and erect and stretched down to the soft palate of the baby’s mouth. Tender, yes, toe curling even, but it’s normal, its not causing damage so its not HURTING you. This whole process might take 10 or 20 even 30 seconds. After the nipple reaches the soft palate and baby sucks rhythmically any pain should disappear. If the pain continues then the latch is not right, it is no longer normal; the feed will HURT you because the pain is signifying there is damage occurring.

What do I do if pain is continuing throughout a feed? Seek help. Someone well trained in breastfeeding support should be able to identify the source of pain and work with you and baby to find strategies to help resolve the pain so that breastfeeding no longer hurts and damage is no longer occurring. The source of pain may be easy to identify, simply a positioning issue perhaps. It could much more difficult to pick up, something like a posterior tongue-tie or an oddly shaped palate could be the culprit.

Don’t let anyone tell you that your baby’s latch at the breast looks good so it must be ok. It might be textbook picture perfect as far as your midwife/nurse is concerned. Big wide mouth, flanged out lips etc. if you are experiencing pain throughout the duration of the feed you need a thorough feed assessment to ascertain the source of pain. (And visa versa, you could be told the latch looks terrible but if you are pain free and comfortable and you observe baby taking in milk it can look as crap as you like.) 

Rhys' latch here on around day 7 was really uncomfortable. Initial latch was 
very painful and a dull pinching pain continued through out the feed. To look 
at it nearly "ticks all the boxes" of a good latch. When i put my LC hat on and
adjusted a few things, the comfort levels were much improved, and from there 
my nipples were able to heal and got better from here on in.

Adjustments made here to improve this attachment: Rhys had to be lifted higher 
across my other breast and turned in more tummy on tummy. Bringing him in
 closer so his chin is compressing the breast and allowing him to latch deeper
 into the breast. His top lip often had difficulty turning out. I was able to flip it out
 with my finger, allowing him then to draw the nipple back a little further.
  By releasing this latch and retrying for a better one, a better, more asymmetrical
(more of the breast on the chin side in than the nose side) was achieved, making 
it much more comfortable on the nipple.

Basically the point i am trying to get across is if you can be knowledgeable as to what correct attachment should feel like and what a damaging latch would feel like you have all the tools you need to have breastfeeding bliss from the very start of your journey. To wait until 6 weeks ticks by, waiting for something to magically change is silly and unnecessary. As soon as you assume something is not right, seek help. With the correct help you can have all the difficulty turned around and you'll be cruising in your groove before you know it.

Good luck on your breastfeeding journey.


Part 2 will cover - normal newborn behaviour and how understanding it can help you reach your breastfeeding peace sooner.