By: Gabrielle Hathaway M.S., IBCLC
You may have heard the term “tongue tie” in association with
breastfeeding difficulties. What is it? Is it fixable? Tongue tie, or
ankyloglossia, refers to a condition in which the small piece of skin that anchors the tongue to the bottom gum is too short. This can restrict baby’s ability to properly stimulate the breast, form a good latch, and can also cause pain to the mother during nursing. There are varying degrees of tongue tie, and less severe cases can often resolve on their own (the frenulum will gradually stretch through breastfeeding). There are some examples of the different degrees of tongue tie here, courtesy of Dr.Lawrence Kotlow, DDS. There is also a less common labial tongue tie, in which the skin between the top lip and gum is shortened.
If you are having trouble with pain during breastfeeding and have tried adjusting positioning, look at your baby’s tongue. How? Stick yourtongue out and usually, even a very young baby will try to mimic you. Does her tongue form a heart shape? Is she unable to extend her tongue beyond the bottom lip? These may be signs of a tongue-tie. Ask your pediatrician to take a look and explain your concerns. If a diagnosis of ankyloglossia is made, the pediatrician may recommend clipping the frenulum (frenotomy). As scary as this sounds, it is a simple procedure and your baby should be able to nurse right away (you may be shocked at how much better it feels!). Some pediatricians do not clip for tongue-tie and you may want to ask a pediatric dentist or ENT if they can do it. I have had a few clients recently whose babies were “clipped”right in the hospital during the postpartum stay and the affect on breastfeeding was immediate and positive.
I want to emphasize that I am not advocating for unnecessary intervention. Sometimes it seems that one condition is getting g a lot of press and everyone seems to be getting diagnosed with it! Tongue-tie is a real
condition, and can make breastfeeding difficult. The condition tends to run in families, and affects about 3-5% of all babies. Talk to your provider if you are concerned and seek help from a lactation consultant in order to have the best breastfeeding experience possible.
Gabrielle Hathaway, IBCLC
By: Gabrielle Hathaway M.S., IBCLC
I often see mothers who are taking medication, either during pregnancy, lactation or throughout both. I also see mothers who have decided not to take their regular medication because they are concerned about the effect on their baby. There is more and more research and information available about medications in pregnancy or lactation and I urge women to talk with their doctor about their choices. As a lactation consultant, I have access to studies and guidelines that your physician may not be aware of and can supply information for my clients to take to their doctor. It pains me to see mothers denying their own mental or physical health needs in order to be the best mom for their baby. A happy, healthy mom is the best mom!
What to do if you are taking medication and find out you are pregnant:
· Talk with your OB or midwife right away about your choices
· Make sure you have added support if you are going to forego medication
· Watch for a recurrence of symptoms; talk with your doctor again if you are concerned about your health
· Do NOT rule out breastfeeding! Surprisingly, some meds that are contraindicated during pregnancy are deemed safe during lactation (and vise versa). Often the amount the baby receives is very slight or the medication is not well absorbed orally. Still, consult your doctor or lactation consultant well before you deliver, so that you can make a plan that works for you. Sometimes mental health issues that were controlled during pregnancy can change in the postpartum period, due to a change in hormones. Thyroid disorders can also worsen after delivery and should be followed closely.
What about those “other” drugs?
If you are struggling with substance abuse, smoking, or alcohol, please don’t be afraid to talk with your provider. There are options during and after pregnancy that can help to increase the likelihood of a healthy baby (and healthy mom). Pregnancy is a perfect time to make changes toward a better life for you and your baby.
Here are some resources for information about medications during pregnancy and lactation:
Brigham and Women’s Hospital -
Mass General Hospital -http://www.womensmentalhealth.org/
The Infant Risk Center at Texas Tech - http://www.infantrisk.com/
National Institutes of Health - http://health.nih.gov/topic/PregnancyandSubstanceAbuse
By: Gabrielle Hathaway M.S., IBCLC
There is often discussion (and debate) about milk-sharing, but you may not know that there is a trusted resource for donor human milk right in New England. The Mother’s Milk Bank of New England (MMBNE), located in Newton, MA is the only milk bank in the Northeast and serves many area hospitals. The milk bank operates under the guidelines of HMBANA, and all milk donors are screened and blood tested. If you need breast milk for your baby or have a surplus of milk, please visit MMBNE’s website for more information and like them on Facebook.
Why use donor milk?
Babies who receive donor milk vs. formula have fewer illnesses and receive benefits that even specialized formulas can’t deliver (see this post). Human milk is for human babies!
Is it Safe?
HMBANA milk banks follow strict guidelines that include testing of both mother and mother’s milk, pasteurizing, and re-testing. According to the MMBNE, “In more than 40 years of modern milk banking, there has never been a documented case of an infant harmed by donor milk from an HMBANA milk bank.”
What about Cost?
Milk banks usually pay for screening costs (both for donor and recipient), shipping and handling but charge a processing fee to cover this. Sometimes insurance will pay for donor milk, particularly as more hospitals are beginning to offer donor human milk as there standard of care for infants in the NICU who can’t receive their own mother’s milk. The cost of donor milk is still offset by the health advantages, especially in preemies. The health benefits can mean a shorter hospital stay and a better overall recovery.
Please think about supporting and utilizing this wonderful resource. If you want more information, contact the Mother’s Milk Bank of New England at: 617-527-6263 or by email at: email@example.com.
By: Gabrielle Hathaway M.S., IBCLC
One of the questions I am often asked is, how do I prepare for breastfeeding? I could answer that there is no preparation needed and that breasts are "ready to feed". However, there are things you can do to maximize your chances of having a successful breastfeeding experience.
Attend childbirth and breastfeeding classes and don't be afraid to ask questions. When friends and family ask about shower gifts include a Brest Friend (the best nursing pillow) and an electric breast pump if you'll be working and breastfeeding. Prepare meals in advance and freeze them so you'll have more time to devote to baby after the birth.
During the birth: An awake and aware childbirth is the ideal precursor to breastfeeding. Make sure to have a birth plan and let all of your providers know that you wish to breastfeed. Ask to have your baby with you as soon after birth as possible (within 30 mins is reasonable) for skin to skin contact. Finally, ask for help! Breastfeeding is natural but doesn't necessarily come naturally. Be sure to ask your nurse or hospital IBCLC for help and room-in with your baby if the hospital allows it. Even one bottle of formula can negatively affect your baby, so try to avoid supplementation. Finally, if you don't feel comfortable nursing when you leave the hospital, contact a lactation consultant or your local La Leche League* for help. The hospital may also offer a free VNA visit after you go home; many of these nurses have breastfeeding training and can help with latch and positioning. It is well worth the effort to get breastfeeding off to a good start and can help you to avoid problems later.
So, although breasts are made for breastfeeding, there are ways to prepare for a successful nursing experience. However, if you need more help or have special circumstances (medical conditions, breast surgery, etc.) contact an IBCLC during your pregnancy to develop a plan of action – knowledge is power!
*go to http://www.llli.org/webus.html to find a group or leader near you
By: Gabrielle Hathaway M.S., IBCLC
Every so often, I will get a call from a frantic mom whose baby (usually 3-6 months old) has suddenly and inexplicably stopped nursing. Mom has tried coaxing, cajoling, and even begging baby to nurse, but she is adamantly refusing the breast.
What’s going on??
What is probably NOT going on is: Mom had onion soup for lunch or the baby is ready to wean (younger than 9-12 months).
We often call this a“nursing strike” and there can be a variety of causes. Assuming that your milk supply is adequate and baby was nursing well up until now, here’s what could be happening.
Is your baby drooling, fussier than normal, chomping on her hands, and might even have a diaper rash (excess saliva can cause a more acidic output)? Babies can start teething as early as 2-3 months and not even get their first teeth until much later. Teething is uncomfortable and your baby will want to nurse for solace, but can be frustrated if nursing hurts her gums. Try comfort measures like a cold washcloth to gum on, a teething ring, or if your pediatrician approves, some teething gel. Then, try to get baby back to the
breast. You will find that teething is an ongoing process but hardest with the first teeth (gravity – they are on the bottom, and the newness of the sensation).
· Ear Infection:
If your baby has a fever, is tugging at her ear, or is crying more than usual (often high pitched), she could have an ear infection. Breastmilk has been shown to reduce the risk of ear infections, but they can still occur. If you suspect your baby has an ear infection, consult your pediatrician for their recommendation. In the meantime, try nursing in an upright position so your baby isn’t laying flat. You can also massage the breasts so that she doesn’t have to work as hard to stimulate let-down.
Does your baby have white patches in her mouth that don’t rub off? Are you or she on antibiotics? Thrush is caused by an overgrowth of yeast and can affect both baby’s mouth and mom’s breast/nipple area. Some babies can have thrush and it doesn’t seem to bother them, while others are very uncomfortable and won’t want to nurse. Thrush is easily treated by your health care provider and nursing can continue during
There are other reasons your baby may be “on strike”. Older babies with teeth sometimes try biting mom and the resultant response (“AHHHH!!”) scares the baby off the breast (Pavlov, anyone?). Babies may also
react negatively to a new perfume or lotion or may have a stuffy nose from a cold (try some saline and a nasal aspirator before nursing). In most cases, you have to gently encourage the baby to return to the breast. If pain is the issue, relieving the discomfort before nursing should help. If there is a psychological cause, try nursing in the bathtub (you would be surprised how well this works!) or when baby is sleepy and calm (often
**Two Important Notes
*If your baby is not nursing at the breast, you need to pump! Sometimes babies will take the pumped milk via bottle – if your baby is older than a month, she should return to the breast once the ‘strike” is over.
*Offer the breast frequently rather than trying to wait the baby out – this will keep baby familiar and you are more likely to catch her when she’s ready.
If none of these suggestions work, check in with your pediatrician or lactation consultant, especially if you have a young baby (under 3 months). Take heart, though –strikes are often short-lived and baby will return to the breast with gusto. Keep up your supply and don’t give up!
By: Gabrielle HathawayM.S., IBCLC
I recently went to NYC with two of my daughters. I grew up in Manhattan, but have raised my children on Cape Cod. I had forgotten the frenetic pace in the city, especially at Christmastime. We visited Times Square and throngs of people were shopping, sightseeing, and getting ready for New Year’s Eve. I saw a few babies, but they always seemed to be sleeping, perhaps trying to tune out the chaos; we weren’t so lucky.
I am reminded of the way that nursing forces you to slow down sit down (most of the time!) and focus on your baby. As tired as I was in those newborn days, I remember the gift of nursing my baby in the middle of the night when everything was quiet and still. I never got over the amazement in knowing that I created this little being.
So, in this last post of 2012, I urge you to hold your children close and enjoy this time. Your kids will eventually sleep through the night, eventually wean, and someday be able to entertain themselves. For now, savor the early years – you won’t believe how fast the time goes!
HAPPY NEW YEAR!
From A to Z
Advantages of Breastfeeding
Gabrielle Hathaway, M.S., IBCLC
Mothers are entering or continuing in the workforce more than ever and, sooner than ever after childbirth. Can you breastfeed and work? YES, and pumping is a valuable part of this balance. There are three things that can help to insure a positive breastfeeding and working relationship.
The Right Pump
The right pump is: double, electric, and NOT your friend’s pump she only used twice! If you are working more than one or two days a week, I would suggest using a double electric pump. A double pump is more efficient and effective, as well as easy to use. One caveat: Do not borrow your cousin’s pump or buy one on ebay!! You can buy a new pump (shower gift?), ask for one from your insurance company, or, if you are a WIC client, ask for a rental from your local office (*I can help with the last two options – email me). Think about where you will be pumping, as some pumps come with a car charger and/or battery pack.
The Right Plan
The right plan: I recommend starting to pump and store milk at least two weeks before you return to work. Try pumping in the morning, when milk supply is usually high, and start accumulating a reserve in theefrigerator or freezer*. Look at your work schedule and map out a preliminary schedule, with break times for pumping (see an example below). If possible, return to work on a Thursday or Friday. This enables you to see how things go while having a few days to tweak your plan before starting a full work week.
Sample BF/Work Plan
6 am Nurse and pump (bf one side, pump one side, or nurse both, then pump after)
8am Nurse at home (or daycare)
10am Pump during work break
1pm Pump at lunch break
4pm Pump during work break
6pm Nurse at home
9pm Nurse at bedtime
Late Night nursing
The Right Support
The right support: Try to get supports in place ahead of time. Ask your boss about break times, places to pump, and flexibility in your hours. Ideally, you will have a private space (not a bathroom) to pump and access to a refrigerator or cooler for storage (don’t forget to label!). Talk to your child care providers (have a back-up!) and make sure they understand how to store and use expressed breast milk. Finally, know your rights. Recent legislation requires companies of 50 employees or more to provide breaks and a place to pump for nursing moms. See the full provision here.
You can do this! Babies who are breastfed are healthier and that means fewer missed work days for you, as well as continued health and happiness for both you and your baby.
I have been working in the field of lactation for more than 12 years. The question that I hear the most, year after year, is: “How do I know my breastfed baby is getting enough milk?”
· First, let’s start with the size of a newborn’s stomach. It’s TINY! Day one is about the size of a small marble, day three is a larger, “shooter” marble, and day
seven the newborn’s stomach measures about the same size as a ping pong ball.
Breastfed babies need to be fed, on average, every 2-3 hours in the newborn period. When I hear that a baby is “so easy, she sleeps all day!” that is a warning sign that baby may not be getting enough. A newborn who is hungry may quickly adapt by sleeping more to conserve energy and what looks like placidity may actually be hunger. So, I tell moms to feed the baby on demand (even if it means waking a sleeping infant), but not less than every 3 hours, day and night. If a baby has been struggling to gain weight, I advise feeding every two hours until weight gain steadies. This may seem like a lot, but remember that by day 7, the stomach is only as big as a ping-pong ball and breast milk is used and digested very quickly (about 20 mins). It may feel as if you are nursing all the time, but this initial period is so important in establishing breastfeeding and building the milk supply. If your baby is not meeting these“diaper goals”, consult a member of your health care team, as babies can quickly get into trouble with dehydration, especially in the newborn period.
Still not sure baby is getting enough? What comes in must come out. An easy way to see if your newborn is getting milk is to watch her wet and poopy diapers (better smelling with breast milk!). By day 3-4, babies should be stooling at least a couple of times a day and the product should resemble seedy mustard. Babies this age should also have at least 3-4 wet diapers. At the one week mark and for weeks beyond, you should see 6-8 wet diapers and 3-4 stools per day. It is not uncommon for breastfed babies to reduce their stooling frequency after the first month and, as long as it is still soft, it is not usually a problem.
What about the baby that is nursing 8-12 times a day but is losing or not gaining any weight? It is normal for babies to lose some weight in the newborn period, but pediatricians like to see a return to birth weight by the two-week mark. If baby has not regained, we first look at the latch. It is possible for a baby to be sucking frequently but not effectively. The baby’s mouth should be over the dark area surrounding the nipple (the areola), so that the sucking will reach the milk ducts, not just the nipple itself. If a baby is sucking only on the end of the nipple, the result will be like biting on a straw – a closing off of the milk flow. Sucking on the nipple is also likely to cause pain for the mom, so if you are experiencing pain and/or your baby is not gaining well, evaluate your latch, ideally with the help of a lactation consultant, La Leche leader, or WIC peer counselor. Many visiting nurses are also trained in breastfeeding support and I urge mothers to take advantage of the free VNA postpartum visit that is usually offered through the hospital.
Breastfeeding is a natural process, but doesn’t always come naturally. Remember, taking the time to fix small problems at the beginning can help ensure a successful breastfeeding experience for both you and your baby.
Still have questions? Email me at firstname.lastname@example.org and check out my blog at www.hathawaylactation.blogspot.com
Cape Cod Mommies is excited to add once again to our Board of Advisors! Join us in Welcoming:
Gabrielle Hathaway, M.S., IBCLC!
Gabrielle is an International Board Certified Lactation Consultant and holds a Master's degree in Health Communication and a B.S. in Maternal/Child Health. been a La Leche League Leader for 12 years and an IBCLC since 2008.Gabrielle works part-time for the Outer Cape WIC program, counseling mothers and teaching classes in both breastfeeding and parenting. She has a love for children and a desire to support and empower mothers. Gabrielle and her family live in North Eastham.
We look forward to her blogs and advice! You can contact Gabrielle at:
Gabrielle Hathaway, M.S., IBCLC
P.O. Box 202,North Eastham, Ma 02651
Cape Cod Moms