Wednesday, March 11, 2009

Breastfeeding 454 - Oversupply Management II

If, after trying the pre-pumping and block feeding techniques mentioned in the previous post, your milk supply remains overly excessive, you can try various chemical means to interrupt your body's lactation. I must CAUTION you about these treatments: BE CONSERVATIVE! While they may be effective at bringing down your milk supply, taking these various treatments can also deplete and/or dry up your milk supply completely. You never know how your body will react to a treatment - so always, always try these remedies in very small, conservative increments - in order to properly ascertain your body's response!

Again, I will repeat, it is always better to try non-chemical means of managing overproduction before chemical interventions. These non-chemical techniques include:
  1. Pump off some foremilk to make it easier for baby to latch-on an engorged breast; also useful at decreasing the forcefulness of an initial letdown.
  2. Try unilaterally block-feeding your baby on only one breast for a set period of time. After this time period, switch breasts to feed on only the other breast for a set period of time. This style of feeding should help to down-regulate your body's production, with the intervals becoming shorter and shorter until you are eventually able to nurse your baby on both breasts during a feeding.
If these methods have not been effective for you, first talk to your lactation consultant about the following chemical means for reducing lactation. If the LC feels it is appropriate and safe to try these treatments, be sure to start in low doses so that you are able to understand your body's response to the treatments and proceed cautiously.
  1. Drink sage tea. Sage has a natural estrogen in it that competes with lactation-promoting hormones, and therefore has a tendency to decrease your production. Women who have lost their babies shortly after birth are advised to drink sage in order to dry themselves up - so be careful and don't drink too much! To make sage tea, put 1 tsp. of dried sage from the spice rack at the grocery into a tea infuser ball, then let it steep in a cup of hot water for about 5 minutes. You will probably want to also use another kind of tea mixed with lots of milk and sugar, because sage is very bitter. Try drinking one cup, wait 12-24 hours, and if your body hasn't responded, try drinking two cups, etc.

  2. Eat soy. Soy also contains natural estrogens that compete with lactation hormones in your body. I actually came across this remedy accidentally: I bought a number of soy-based energy bars at the grocery and snacked on them for a quick and nutritious meal during busy days with James. At the end of 3 days snacking on the soy bars, I noticed that I was producing almost no milk!! I immediately realized it had been the soy bars and stopped eating them, but it took 10 agonizing days of a hungry baby for my supply to return to normal. Again: be cautious! To obtain soy in your diet, you might try eating just ONE soy energy bar, drinking just ONE glass of soy milk, etc.
Finally, on a somewhat related note:
100-200 mg of vitamin B-6 per day will help with the swelling and pain of engorgement. I don't believe it brings down milk production, although you may feel that way since it will cause your breasts to become smaller and lose the ultra-full-swollen feeling. As with any treatment, be sure to double-check with your lactation consultant before trying it.

I'd like to encourage overproducing women that with patience, your supply will eventually regulate and hopefully you will be able to breastfeed your baby successfully. Take advantage of the ease of pumping for those of us with oversupply, and if your baby will absolutely not take to the breast, PUMP and bottlefeed! This way, you will be able to keep your supply for whenever that time arrives when your baby is ready to breastfeed. Be patient, however! For James and me, it took almost 3 months before he was able to breastfeed successfully. I believe that our eventual success in breastfeeding was a combination of factors: (1) James was more mature and able to handle my forceful letdown, (2) my milk had finally decreased to a reasonable amount, (3) the amount of foremilk had also appropriately adjusted downward so that James received more than just "sugar water" from nursing. At 11 weeks, when James finally latched-on and nursed successfully, I was ecstatic. I was so glad that I still had my supply and had not switched to formula. Ladies, don't be shy to keep pumping and offering your babies the breast. Eventually they will be able to accomplish this "overabundant" feat!

Tuesday, March 10, 2009

Breastfeeding 453 - Oversupply Management I

In continuation from yesterday's post, if you are dealing with issues of oversupply and over-letdown, you may experience difficulty in finding a lactation consultant or breastfeeding group that takes your concerns to heart. Oversupply is not as common a problem, versus women who believe they don't make enough milk -- and therefore, there is little advice "in circulation" regarding how to manage excess milk production.

After struggling with this issue with our son James, I think the first step to take when attempting to manage excess supply is to try and see things from your infant's perspective. Your baby is probably fussy and reluctant at the breast, and you are probably overcome with consternation as well. It was easy for me to feel upset with James. I thought to myself, "Why can't you just stay latched-on?!" James would often latch onto the breast and then about 10 seconds later, pull away, screaming and upset. This would, of course, make me frustrated and upset, but perhaps a bit of perspective is in order:

A woman who overproduces milk may have an overactive letdown reflex as well. When your baby attempts to nurse, he may receive an extreme and forcefully delivered volume of milk, versus the normal, manageable volume that is emptied into the infant's mouth at a slower dribble. Your infant may have trouble sucking, swallowing, and breathing in the midst of such an overwhelming letdown. Often, he may become choked at the breast - a feeling that is not only annoying, but painful!

Furthermore, in response to an overactive letdown, your infant may suck less vigorously, so as not to draw too large a volume of milk from the breast at one time. This only works, however, until the initial forceful letdown is relieved, and then the infant must suck to receive further letdowns and/or the hindmilk. With James, this proved to be quite confusing to him. He would begin a feeding with light suckling so as to avoid being overwhelmed by the milk, but he did not seem to understand that in order to finish the feeding, he needed to continue sucking strongly. Often, after an initial letdown had finished, James would become angry and hit my breast as if to say, "Hey! Where's the rest?!" Yet nothing was delivered to him because he did not continue sucking. Your infant may struggle with this same confusing learning-curve.

Secondly, if you overproduce milk, you are likely to have a great amount of foremilk. While foremilk is important, it is mostly composed of sugars and water, versus the hindmilk that comes later during a feeding and is composed of fats and proteins. Babies need both foremilk and hindmilk, but in an overproducing woman the baby may become completely full with foremilk before any hindmilk is delivered at all! This leaves the infant with a full feeling in his stomach, yet "still hungry" signals are being sent throughout his body because he has not received the proper amount of fats and proteins to complement his meal. This can cause the infant to instinctively nurse once more, but he may experience frustration at the uncomfortable, overly-full sensation he is receiving from his tummy, yet while also receiving "hungry" signals from his brain.

Finally, because an infant who recieves only foremilk during feedings has consumed only sugars and water, it can disturb the osmotic balance of the GI tract. Infants receiving only foremilk may experience quite a bit of gas and have uncomfortable, runny bowel movements.

There are a few very practical and easy solutions to these problems, which I will introduce here. If these solutions do not work, you may have to try more involved therapies (see tomorrow's post). However, these simple fixes may work well for many women dealing with initial engorgement, oversupply, or prolonged engorgement.
  1. If you are engorged, one way to make it easier for the baby to latch-on is to take your hands around the nipple/areola, and basically push back on your breast. You are attempting to push the milk BACK into the ducts, and make the areola area softer and smaller for the baby to latch on to (although you may also accidentally cause some milk to squirt out, this is not your primary goal). The milk with not clog your ducts, it will merely come back down the ducts and be released when your baby starts nursing.

  2. If you are experiencing an overactive letdown or overproduction of foremilk, PUMP OFF SOME FOREMILK before nursing your baby. Your production will slowly go down; don't worry about causing yourself to be perpetually engorged by pumping your breasts and nursing. I promise that your production will slowly decline. Pumping the foremilk may help your letdown to be less forceful, and it will give your baby the opportunity to learn that suckling is required to obtain the hindmilk.

  3. If you experience prolonged engorgement or a truly excess production of milk, try unilaterally block feeding your baby. You can read a research article explaining this method here. First, pump all your excess milk from both breasts. Then, feed your baby on only one breast for any time period of 2-12 hours before you switch breasts, depending on your level of overproduction. After the specified time period, you will switch breasts and then nurse your baby on ONLY the second breast for the same time period. As explained in the article, this technique helps to down-regulate milk production, so that your time intervals should become shorter and shorter as your milk production decreases until you are finally able to nurse your baby on both breasts at one feeding.
Tomorrow, I will cover a few more medicinally-leaning techniques for managing oversupply, but you should ALWAYS try the above suggestions first. Chemically challenging your body's lactation is necessary in extreme cases, but it can also lead to severly decreased and/or cessation of milk production! Therefore, the above suggestions which rely on physical cues only, should always be tried for at least a week before resorting to secondary techniques.

Monday, March 9, 2009

Breastfeeding 452 - Oversupply and Prenatal Warning Signs

I call this "course 452," because in my opinion, oversupply in breastfeeding is a very difficult and largely overlooked issue. Many women struggle with other breastfeeding problems, such as incorrect latch-on, sore nipples, or undersupply. However, as they say: too much of a good thing can go badly; and for some well-equipped women out there, having too much milk for our babies is just as problematic and frustrating as not producing enough.

Furthermore, oversupply seems to be a relatively rare issue among women, meaning that literature or advice on ways to deal with too much milk is hard to come by. While scavenging my area's breastfeeding groups for help, I attended fully 9 groups before I found one where the leader took me seriously as I walked in the door and declared, "I have too much milk." Needless to say, I latched-on to that group!

It sounds rather like an oxymoron: "Too much milk? How is it possible to have too much milk? What a gift! Pump it, freeze it, donate it! Count your blessings!" However, what most people don't realize is that making too much milk often leads your breasts to take liberal license with prolonged engorgement and the letdown function. This means that long after most women have resolved their engorgement issues, each time the oversupplying woman attempts to feed her baby, she is basically drowning him in a non-intentional, yet ever water-boarding-fashion. It's no wonder the infant of an oversupplying woman doesn't want to nurse at the breast!

I mentioned earlier that one of my very first problems with breastfeeding lay in the fact that I never anticipated oversupply until I was already in the thicket of it! Instead, try to learn to read your body's signs during your prenatal (pregnant) time, in order to prepare for what your body may do after the birth of your baby.

First, don't believe the myth that oversupply is related to breast size (aka. only very large women are at risk for a struggle with oversupply). As in the case of women who are worried about undersupply due to a small bust, breast size has nothing to do with milk supply! Before pregnancy and even now that I am nursing, I have an average bust of about 36-C to 36-D, depending on the bra. I am a very tall person, so my bust simply fits well within my frame. In contrast, a woman in our breastfeeding group who is large-busted struggled quite a bit to make enough milk for her new baby. I realize this example is quite anecdotal, but it makes the point: Supply is NOT related to breast size! I have not experienced that this problem is common in my family either, as neither my grandma, mom, or sister have had such problems. However, for your own sake or for support, you may want to ask your mom or sisters if they have struggled with this issue.

Second, be aware that most women have some amount of leaky breasts before their babies are born. When this happened to me, I assumed it was a normal hormonal change, and did not seek any advice about it. However, what I didn't realize is that my experience with leakage was far out-of-the-ordinary. I started leaking something close to colostrum about week 8 of my pregnancy. By the time I was about 16-20 weeks, I was leaking through my shirts if I didn't have some kind of pad in my bra. In the mornings, I would wake up with two big wet spots on my nightgown, and by the end of the pregnancy I soaked through my sheets at night.

If any of these things are happening to you, consider whether you may need help with oversupply/over-letdown. Because all groups differ slightly, it's important to find a breastfeeding group and/or organization that fits your "chemistry." All groups have solid advice, but it comes in different forms and variables. As mentioned before, I was attending my tenth breastfeeding group before I found a leader who took my overproduction seriously, and whose style of instruction matched my needs for learning. If you are not sure where to start looking for a group, ask at your OB/GYN's office if they can refer you to a local postpartum or breastfeeding meeting. You can also ask the same question at your future pediatrician's office.

In the next week, I'd like to divulge further the intricacies of managing oversupply, as it really can be quite difficult to find a lactation consultant with a good base of knowledge in this area. (Please remember, I am NOT a lactation consultant; I speak only from my own experience and research!) However, I've learned so much about how to approach this problem, I feel it would either be: (1) informational overload to put it all in one post, or (2) simply unfair to abbreviate the information in order to merely be succinct. Thus, "sleep on" the current information, with more to come tomorrow!

Friday, March 6, 2009

Breastfeeding 101

I couldn't think of an appropriate title for this post. If you are a new mom - in a sense - there is no such thing as "Breastfeeding 101." You merely have to "learn as you go." Please excuse my rudimentary choice of a title.

In my opinion, breastfeeding is a particularly elusive part of having an infant, due to lack of information. And I don't by any stretch mean a lack of "how-to-breastfeed" information. There's enough information on the techniques of breastfeeding to make a woman blue in the face. What I mean is a lack of "how-difficult-it-is" information.

La Leche League International has done a marvelous job, beginning in 1956, of promoting the natural benefits of breastfeeding. At that time, breastfeeding an infant was considered a mark of poverty and ignorance: (1) breast milk was considered nutritionally inferior to manufactured formulas, (2) inability to afford infant formula displayed one's poverty and lack-of-class, and (3) there were various Freudian rumors about how breastfeeding might "damage" your child, especially boy babies.

Thanks to organizations like LLL, breastfeeding is now widely promoted and accepted as a wonderful way to nuture an infant, both nutritionally and emotionally. Unfortunately, the flip-side of this marvelous advance in child rearing is a nagging sense of guilt when a mother is unsuccessful, unable, or chooses not to breastfeed. Literature on breastfeeding is presented in a "how to successfully..." mindset. While this is positive and optimistic, it may leave a woman who has not been successful reeling in confusion: 'Which step in the "how-to-successfully list" haven't I followed? Maybe my infant is tounge-tied. Maybe I have inverted nipples. Maybe I have flat nipples. Maybe I'm holding him incorrectly. Maybe I have too much milk. Maybe I don't have enough milk. Maybe the latch is wrong. Maybe we need more skin-to-skin time. Maybe he's not hungry. Maybe he's too tired. Maybe he's bottle-bound. Maybe I didn't try hard enough. Maybe he doesn't love me.'


Before the birth of their babies, women may often think to themselves, "How hard can this possibly be? I will have breasts that lactate and a hungry infant who is born with a suckling reflex. Piece-of-cake: it's natural!"

However, shortly after the birth of their babies, many first-time mothers discover that "natural" does not necessarily mean "comes to one naturally." Rather, for a mother who wishes to breastfeed, especially if it is her first child, the experience can be riddled with questions, uncertainties, awkward situations, and feelings of ineptitude.

I myself had QUITE a time getting our son James to nurse. I have problems with overproduction (more to come on Monday)... but of course, I had no inkling that that would be the case until I was already engorged, deflated, and in the demanding service of a 3 day-old newborn. While I was generously leaking through every bra, nursing pad, and diaper stuffed down my shirt, you can bet that (despite our feeding problems) the last thing on my mind was to make time to dress myself and take my baby to a breastfeeding meeting!!

Without entrenching on the topics of Monday's post, I would simply say this: if you are pregnant and planning to breastfeed your infant, PREPARE. If you are an over-achiever like myself, don't consider this to be just another easy task in the long line of successes you have trailing behind you. Go to a breastfeeding meeting NOW, before your baby is born. Learn what you can now. Listen not to the "how to successfully..." list, but rather listen to the questions of mothers who are having difficulties. Write down what techniques are recommended to them and whether the mothers report success with certain suggestions. Ask your mom if she had problems breastfeeding, what they were, and how she overcame them.

Breastfeeding is a fantastic and easy way to feed your baby without too much hassle. I highly recommend it! However, the elusive nature of breastfeeding may very well be one of the most frustrating hurdles you will cross as a new parent. Thus, the next few blogs will cover this topic in brief. I hope you find it useful and nutritious!

Thursday, March 5, 2009

Infant Massage - Part VI: Movement and Wrap-Up

The final part of infant massage is to practice some muscle-movement with your baby. This allows them to passively strengthen their muscles, explore the range of motion of their various joints, and increase their awareness of how muscle groups can be coordinated to produce movement.

Newborn and young infants will likely not have a large range of motion, as they are used to having their arms and legs tucked close to their bodies, in utero. This is fine - simply practice movements with your baby to the extent that he is able. As your baby gets older, his range of motion will grow as well.

The final movement on this video (an exercise of the abdominal, back and neck muscles), should not be done on babies younger than about 3 months. While the exercise is designed to help your baby gain "core strength," he must already have at least some amount of head and neck control in order for this movement to be safe. Never to this type of exercise with a newborn or very young infant, as his head may simply" dangle,"causing a lot of damaging stress on the neck and spine. However, after your baby has gained some head control, this exercise is excellent for helping him to continue building the abdominal and back strength that he needs along the developmental path of rolling, sitting, crawling, and walking.

As a wrap-up, you may have noticed during many of these videos that James is quite wiggly, and not always content to be laying on the floor. I have done my best to present all of the massage techniques as "visibly" as possible. However, in reality, you will need to change your techniques as your baby grows and becomes more mobile. For example, if you start a leg massage and your baby rolls on his tummy, do a few strokes of the back massage. If he flips again, rub his arms. Do a quick chest massage when you get your baby out of the bath, or a face massage to distract him at the changing table. You can easily fit a body massage into your baby's day, but you may have to get creative! Using rhymes and games during the massage may also help to keep your baby's attention as he gets older.

Regular massage may help your baby to develop a sense of "body awareness," and an ability to tell when he is tense. As a toddler or older child, your (former) baby may be able to ask for a massage when it's appropriate because he will know what it feels like to be tense. Often, we as adults have no idea what this "tenseness" feels like, because we haven't developed a good sense for what "relaxed" feels like.

Hopefully baby massage will prove to be a great bridge of communication between you and your baby during these rapid developmental times!

Wednesday, March 4, 2009

Infant Massage - Part V: Face

Massage of the face and head is a great relaxer and rejuvenator. Think of the times when you've been up late at night, at the computer finishing work, folding laundry, or rocking your baby. What do you do? Like many tired moms, you probably reach up and massage your head, tug at your hair a bit, and maybe pull the skin across your forehead. We read this as a sign of exasperation... but guess what: massaging the face and scalp is a great way to bring extra circulation up to your brain! No wonder that's our natural reaction when we're tired! Our bodies are "telling us" what to do!

I actually like to do a quick face massage on myself before I begin massage with James. It is VERY relaxing, and it only takes a minute. I always feel better after a quick face massage, and I'm much more relaxed to be patient when James when he is fussy.

Although these benefits are available to your baby as well, keep in mind that getting their faces rubbed - while ultimately soothing - is a bit strange. It's important to talk to your baby throughout a face massage, to let them know that everything is fine and that they're cheeks aren't being pulled and prodded for no reason.

Also, you should not use oil for face massage. If you have oil on your hands from the rest of the body massage, that is fine (Remember, it should be an oil from the cooking isle!), but you don't need to add extra oil to your hands just for the head and face.

Let your hair down and try this massage on yourself before massaging your baby. It will feel great!

Tuesday, March 3, 2009

Infant Massage: Part IV - Chest

Baby massage of the chest and arms is a great way to help your baby, especially if they may be experiencing "tight chest" congestion due to a cold. It's important however, NOT to use any sort of vapor rub, either brand-name or generic (Vicks is the typical brand name), as these rubs are medicated, and in children under 4, can be dangerous. Instead, you can use Eucalyptus, Myrtle, or Peppermint essential oils. These essential oils can generally be found in health-food stores.

For a baby with chest congestion, you need to dilute the essential oil of your choice (see above) by at least half with the massage oil of your choice (i.e. almond, olive oil, etc). You can then use this diluted oil mixture during a soothing chest massage, to help your baby breathe more easily and relax his chest.

The massage of the chest expands into massage of the arms, which is very similar to the techniques which you have already learned for massaging the legs. Congratulations - you already know arm massage, without even watching the video! Finally, chest massage, like back massage, is great as an easy, clothes-on relaxer for tense situations like the airport or waiting in lines.

Monday, March 2, 2009

Infant Massage: Part III - Back

The back massage is, in my opinion, the nicest part of infant massage. It is very easy, quick, and - because we as adults often give and receive back rubs - it is the easiest massage for me to imagine the nice, relaxing feelings that my baby is receiving.

Even if your massage techniques are wonderful, it may be hard for your baby to be patient and relaxed through an entire full-body massage. I find the back massage is a quick choice for massaging your baby, without going through all the body areas. You can even do it without taking off your baby's shirt - just give them a nice massage while sitting on the bus, or waiting at the doctor's office!

I also like the back massage before bed. After you baby has had his bath is a great time for a back massage. Again, it is quick and easy to do as a relaxation technique before bed, without getting into the whole rigamarole of the full-body massage.

To give a good back massage, a quick bit of anatomy may be useful. In the video below, I describe massaging two long muscles that parallel the spine. These muscles (one on either side of the spine, running long-wise) are each called the Erector spinae. You can see a picture of them here (the label for Erector spinae is about 2/3-way down on the right side). These muscles help your growing baby to hold himself up, sit up, and bend backwards. When you carry your baby, these muscles may often be the ones you feel are "sore."

Also, in the video, I describe massaging the bottom part of the spine, where it meets the sacrum. If you are not sure the area which I am describing, it may be difficult to find on a wiggly baby! You can feel it on your own back first: the spine meets the sacrum just above where the two cheeks of your bottom come together. Here, your spine will "dead-end" into a flattened area of bone, which then spreads out to become your hips. You can see the pointy-tips of the sacrum (sacral spine), where it is met by the (lumbar) spine on this diagram. If you feel carefully, you may be able to feel two bony, pointy areas just above your bottom, or your baby's bottom. This is the top of the sacrum. Your goal is to massage this junction.

Back massage is easy and relaxing. Enjoy this quick technique!