Working and Breastfeeding

October 13, 2018

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I never met Kerry in person. We had one of those La Leche League Leader/Mom phone relationships. She initially called me with a few basic questions about breastfeeding her newborn. She then reached out to me as she was going to be working full time. She was having trouble pumping enough milk for her baby while she is away. I asked if it was possible to visit her baby during the day. We live in New York City and Kerry’s office was two subway stops away from her office – about a mile away.

 

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Every Monday through Friday Kerry hopped on the train during her lunch break.

She had communicated with her nanny that she was on the way and that she would be nursing her baby.

This worked for Kerry and her baby as she had planned this in advance. Kerry communicated with her employer that she would take her lunch break out of the office. She communicated with her caregiver not to feed the baby a bottle at lunch.

Kerry was able to make up the difference with pumping while at work and at home in between nursing.

Employment outside the home is one of the biggest barriers to breastfeeding in the United States.

Does that mean it is impossible? No.

There are strategies and lifestyle decisions to consider.

What are the obstacles employed moms face?

  • Maternity leave duration
  • Time to pump
  • Quality pumps
  • Support from family and caregivers
  • Support from employer
  • Inconsistent information
  • Balancing home and work life

 

Tina, an attorney, negotiated her maternity leave as well as her pumping schedule while she was pregnant and still working. She noticed that many of her colleagues returned to the grueling hours and were not breastfeeding when they returned to work. Tina laid out a plan for her firm and told them what she needed. This communication helped both her and her employer. They had never had a mom who was breastfeeding once she returned towork. Tina changed the culture of her firm. Some of those moms saw her as a champion and when they had a second baby they too had more success in breastfeeding.

Women are often told they need to sleep train their babies. That she needs to have her baby sleep in a separate room. If a baby sleeps for twelve hours and the mom is gone for nine hours that leaves three hours a day for them to be together. What is a mom to do?

Stacy, a physician, nursed her baby through her residency by keeping her baby in bed with her, despite criticism from her community. She was gone for twelve hours at a time. “How else would I get to know my baby?” she stated in delight.

Unfortunately, in the US standard maternity leave is twelve weeks. Sometimes moms will negotiate for more. Others will spread it out. For example, Lisa, a bookkeeper, returned to work at nine weeks for two days a week. It was early but it gave her an easier transition. She felt this allowed for her to slowly build up to five days a week instead of being home full time and then suddenly being gone all week.

Similarly, some moms who do need to return full time will have their first day back to work on a Thursday (if she works Monday through Friday) making this first “week” away a short one.

I am frequently contacted by moms of older babies of about three or four months of age. Breastfeeding was going well until two or three weeks back to work. Her milk supply is faltering and she cannot keep up.

She is pumping but the baby is flying through her stash.

Sometimes moms nurse and pump while on maternity leave and put themselves into an oversupply. They stockpile great volumes of milk and then when they head back to the office they rely on that stash. Even if they are pumping at work they may not be pumping as much as the baby is consuming. Then suddenly there is no more stash and the mom now has a low milk supply.

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Some moms are truly not able to pump at work for various reasons so pumping during maternity leave is essential. For these moms it is important to nurse as much as possible when she and her baby are together. And she can add some pumping sessions in at home between nursing.

 

Many moms who are able to pump at work can enjoy the maternity leave without having to focus so much on pumping milk. As they transition back to work they can nurse the baby as much as possible when they are together.

To keep up and to reduce the need for more bottles and more pumping a mom can nurse her baby as the last thing she does before they part ways – either at the day care center or with the caregiver. She can then pump first thing when she gets to work to have one pumping session done. Then pump one or two more times during her workday. Then as she reunites with her baby the first thing she does is sit and nurse. This gives her and her baby the opportunity to reconnect and it also gives the opportunity for the mom and the caregiver to communicate. On days off the mom can focus on nursing her baby as much as possible.

Another challenge is the marketing of the faster bottles for older babies. This can undermine breastfeeding as the baby consumes more than he may need because the flow is faster. Once the baby has a bottle that works there is not need to move to a faster flow. Also, the caregiver can use paced bottle feeding to avoid overfeeding and flying through the milk.

 

Here are some strategies to keep nursing while working:

  • Establish a good supply from the beginning
  • Communicate with your employer
  • Communicate with your caregiver
  • Pump when you are away from baby
  • Use a slow flow bottle
  • Nurse your baby when you are with your baby
  • Nurse all weekend (or on your days off)
  • Pump as soon as you get to work (this gives you a jump start)
  • If it is possible: visit your baby during the day so you can nurse
  • Have your baby sleep with or near you

It is important to remember that breastfeeding is not just a way to get a baby fed. Breastfeeding is a complex relationship. By nursing a mother and her baby’s bodies are communicating. Bacteria are passed back and forth to build baby’s immune system. Hormones are passed back and forth to tell a mom’s body to make milk, to give her baby melatonin. There is feedback we do not entirely understand. And breastfeeding does not have to be all or nothing. If a person needs to supplement they can keep nursing for however much works for her and the baby. Working does not have to mean weaning.

 

 

Independence Day

July 4, 2018

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Independent:

Not subject to another’s authority or jurisdiction, autonomous, free

 Not relying on another or others for aid or support

 Not influenced or controlled by others in matters of opinion, conduct, etc. thinking or acting for oneself.

 

On this, Independence Day,  July 4th I cannot help but think of babies and their parents. There is such a cultural push to have babies become independent. There seems to be a fear of babies being too dependent on their parents. I hear the words “needy” “bad habits” “spoiled” bandied about in reference to babies’needs. But that is what they are: NEEDS.

Babies need to be held and fed and spoken to and socialized. They are not ready to be independent until at the earliest 18 years old.

Routine and structure are important but separation or rejection is not healthy. If you meet your baby’s dependency needs they will grow independent in time.

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Nurse In

October 5, 2017

In 2005, Barbara Walters spoke on The View about her discomfort with nursing in public and particularly called out an incident on an airplane where a woman nursed her baby next to Ms. Walters. A group of parents and activists gathered outside the studio in a peaceful protest. I was pregnant with my third baby and was excited to be part of this nurse-in. http://www.nytimes.com/2005/06/07/nyregion/lactivists-taking-their-cause-and-their-babies-to-the-streets.html

Much has changed over the last decade. Breastfeeding is promoted by celebrities and is seen as a good thing generally speaking.

 
As an IBCLC I mentor up and coming Lactation Consultants.

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I was contacted by, Perrine, one of my interns last week. She told me that her friend was asked to move and to cover up at a store in Columbus Circle. Perrine is from France and wanted to know what the rules and laws are in the US and NYC.
The laws are clear, you have a right to breastfeed where you have a right to be in NYC.https://www.nysbreastfeeding.org/laws-and-legislation/

My first thought was, “we need a good old fashioned Nurse In!”
Perrine was thrilled. Thrilled to be able to stand up for her friend, to do something that could effect change and to take action.
It was easy to put together. A quick Facebook event and a bit of sharing.
Last Friday, September 29, just before 10:00am I arrived at the Shops at Columbus Circle and the first thing I noticed just outside the store were these beautiful twelve foot Adam & Eve sculptures by Botero.
They are impressive bronze statues that are nude. Of course, Adam & Eve are nude.
I find it ironic that a woman wanting to feed her child in the most normal manner is told to turn away so no one can see her while twenty feet away from these colossal nudes.

By 10:10 several moms and babies arrived at the atrium and gathered in the shadow of the Botero sculptures. A camera man from a local news station walked into the mall. I asked him if he was there for the nurse in. He was but told me he could not film inside the mall. We walked outside the mall and he began to focus his camera on me. A security guard approached us and told the camera man he could not film there. The camera man told him he had cleared it with head of security and to go ask him. As the guard swiftly went in search of his boss I spoke into the camera. I told whomever would be listening that it is important to normalize breastfeeding and that people should not be shamed for feeding their babies. I said that the breast is overly sexualized and that people in our culture cannot separate the sexual from the simply functional.

Back inside as we all gathered I was approached by a man in a suit whom I assume was the head of security for The Shops. Our exchange went something like this:

Him: Hi, what is going on here?”
Me: “Oh, my friends and I are going to do some shopping at Williams Sonoma. And, we may feed our babies if they get hungry.”
Him: “alright.” He nodded his head and smirked a knowing smirk.

We walked into the festively decorated shop, it smelled of cranberries and roasted turkey. We were offered tastes of their mulled cider. It was delicious.
A baby started to wiggle and her mom said her baby was ready to nurse. We were standing next to a beautifully appointed table and I asked an employee if my friend could sit and feed her baby. She smiled and replied, “of course.”
Then other moms pulled out the chairs and nursed their babies. It was beautiful and peaceful and ordinary. I watched the moms one by one get comfortable in their act of “defiance.” A bit sheepish at first then, one by one, easing into a setting of just a few moms sitting around talking and nursing and admiring the beautiful décor.

I asked if I could take their pictures. One of the moms was at first shy about being photographed and then as time went on she said, yeah, I can be photographed. She smiled and looked up at me and said, “I am a Lactavist!” She held her head a bit higher and she beamed at her baby and at herself.

I decided to “out” us. I asked the woman who allowed us to use the table and chairs if I could speak to a manager about an incident that had occurred earlier in the week. She seemed genuinely disturbed that there was an incident and got the manager immediately.
August is a tall man with dark hair pulled into a neat ponytail. He approached me and when I told him of the Perrine’s friend he was upset. He wanted to know which employee it was who had made this mom so uncomfortable. He assured me that the store policy is that a person can feed their baby anywhere and they do not have to hide or cover up. This was heartening and I wondered if I had made a big deal out of an isolated incident.
I approached the moms some of whom were nursing their babies and others whose babies had drifted off into milk drunkenness.
When I told them they were happy. They commented that they were happy to be a part of something.
I realized this is important for them, for the store manager, for the employees, the head of security and the channel 7 camera man.
This was not a big rally but it had an impact. The ripple effects will carry on. The social media sharing that happened continued throughout the week. Every little bit makes a difference. I cannot be quiet when it comes to social justice. I may not always have the right things to do or say but I will not sit idly by and let people be harassed for feeding their babies.

We quietly dispersed, I went home, got my gear and went to see a couple of families in their homes to help them feed their babies. Just another Friday!

 

This week I was in lactation nirvana.

On Tuesday I attended an all day conference on TOTs – this is Tethered Oral Tissues – this includes tongue tie, lip tie and buccal tie. The conference was put together by Dr. Scott Siegel, a physician and dentist who is uses laser to release these ties. The event was multidisciplinary with sessions given by and attended by IBCLCs (International Board certified Lactation Consultants), SLPs (Speech Language Pathologist) CNMs,(Certified Nurse Midwife) OTs (Occupational Therapist) Orofacial Myologists, doulas, and more.

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I have been in Private Practice as an IBCLC for 15 years. I have worked with hundreds of tongue-tied babies and even nursed two tongue-tied babies. I learned so much and more importantly had explanation for the things I knew instinctively and saw in my practice but could not quite explain. I have a better understanding of the impact of TOTs on people of all ages.

Wednesday night I attended a reading of the book, The Big Letdown by Kimberly Seals Allers. The subtitle is How Medicine, Big Business and Feminism Undermine Breastfeeding. I live this book everyday. The obstacles against breastfeeding are immense. They keep coming. As we solve one issue another pops up.

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I was asked by a journalist yesterday to answer a few breastfeeding questions. One was “Does my ethnicity affect my ability to breastfeed?” My gut response was, “heck, no! Mammals are mammals.” But the reality is that breastfeeding is a learned and cultural experience.

What needs to happen is that families need to be supported on many levels. Education is imperative. There are so many obstacles. (More on these later.)

Sometimes I get weary of the repetition of some of the problems that could be resolved with education and normalizing breastfeeding. I never get weary of empowering and educating families. And I NEVER get weary of holding babies.

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I will continue to help families, educate myself and keep sharing my knowledge – even when met with resistance.

 

Babies & Holidays

November 22, 2016

The holidays are upon us and for new parents it can be fraught with anxiety. Whose family do we spend the holidays with? Do we travel? If so, how: car, bus, train, airplane?

Should we just stay home and have family visit us? But how will we be able to host people? I can’t even feed myself half the time let alone a dozen guests? And my baby just got into a somewhat predictable routine! Help!

Many families are eager to show off their new baby and want to have holidays with family and friends. It is not impossible to enjoy the the festivities with some planning and a change of expectations.

First, expect that your baby who is used to somewhat of a routine may want to be in the arms of her parents more. She may also nurse more than usual – nursing is calming for a baby, she feels safe in your arms, safe at the breast.

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Depending on where and how your baby sleeps, her sleep may be different when traveling or when you have company. This is not uncommon and know that you can get back into a routine once you get back home or the guests leave.

Sometimes it works to invite people over to your place so that your baby’s routine is fairly regular. Make it a potluck to take the pressure off. Make definite times for your event:

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People want to help but often need direction.

Assign jobs: setting the table, washing dishes, vacuuming, etc.

Some new families like to keep it simple and stay home and create their own traditions.

One family has a tree trimming party in early December. They make it an open house with set hours where people do not have to stay the whole time. Their friends bring ornaments and food. This is a great way to see friends and family in a festive way without the overwhelming scene of everyone all at once.

Another family started a tradition of staying home, eating their favorite junk food and watching silly movies. They wear matching pajamas. No friends or extended family – just their little family.

This may be the first time many of your loved ones are meeting your new baby. They all want to hold her. That does not mean she wants to be held by all of them.

I recall my sister’s wedding was the the first time many of my family were meeting my oldest for the first time. She was nine months old. She was comfortable in the arms of my husband, my mom, my sister and me. But everyone wanted to hold her. I have lots of photos of her with tears or a red face. It was overwhelming for her. After a while I told everyone they could take a picture with me holding her. Those photos show a smiling baby with her cousins and aunts and uncles – and me!

Some people may be critical that your baby is “clingy.” Your baby is in survival mode. You may be met with criticism of how often your baby nurses.

Speaking of nursing your baby may nurse more than usual or she may even get distracted and nurse less. If she nurses less your body will let you know! Just take her back and nurse her if your breasts are getting full. If she is distracted go to a private room – take a nap together! This can be your escape excuse!

Some have never nursed in front of family. Practice in front of a mirror or with a group of other nursing moms and you will see that very little skin shows. If you are one who feels like you need to partially undress to nurse, a pretty scarf can help offer some privacy.

Before these gatherings discuss your plans. If Aunt Martha is always critical of your parenting and you have to see her, plan on a few replies to her comments.

    “My that baby isn’t dressed warm enough! I would never have let my babies dress like that.”

     “Aunt Martha, thank you for your suggestions, we will consider them, for now things are working for us.”

    “My, that baby sure nurses a lot, you may want to give her some cereal in her bottle!”

    “Aunt Martha, our pediatrician says we do not need to give her cereal, my milk is all she needs.”

 

Many couples have an escape plan. They have a code for when the time is up.

It could be a wink or a phrase. “Honey, I left the oven on.” “Sweetheart, I have on two different color socks!”

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Make sure you take lots of photos. These memories should be preserved.

Happy Holidays!

 

 

Tandem Nursing

August 10, 2016

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Tandem Nursing means nursing two babies at once. This can be twins or it can be siblings born at different times i.e. an toddler and an newborn.

Many people believe that you cannot get pregnant while nursing or that if you are nursing when you are pregnant you need to wean.

You can get pregnant while nursing.

Breastfeeding can be birth control under specific conditions. There is the Lactational Amenorrhea Method (LAM).

LAM works like this:

  • No return of menses since birth
  • breastfeeding on demand, night, and day
  • baby does not take any food or other liquids regularly
  • baby’s sucking needs met primarily at the breast (no pacifier or bottles) baby is less than 6 months old.
  • baby does not go longer than four hours during the day and longer than six hours during the night between nursing

 

With LAM there is about a 1-2% chance of getting pregnant – similar to taking birth control pills.

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Many people get pregnant while nursing. Often moms are advised to wean their older baby if they become pregnant. There is no need to wean unless you are at risk for premature labor and you are advised by your health care provider to refrain from intercourse.

What can you expect while nursing while pregnant?

About halfway through pregnancy your milk changes from mature milk to colostrum. Colostrum is thicker and does not flow as easily as mature milk. Some toddlers get frustrated and wean. Others hold on for dear life!

One telltale sign of pregnancy can be sore nipples. Some moms find nursing painful or they become averse to nursing and they choose to wean their older baby.

Others will put limitations on nursing – one mom used counting as her strategy – “you can nurse for ten seconds – 10, 9, 8 . . .“ Another mom had a nursing chair where they could only nurse sitting in the chair in a quiet room.

Some advantages of tandem nursing can be:

  • nursing toddler can help relieve engorgement
  • older baby not feeling left out
  • mom doesn’t feel she is abandoning the older child
  • she still has her magic toddler wand
  • sibling bonding
  • stronger immune system of the toddler

 

Disadvantages:

  • mom may feel touched out
  • judgement from family, friends and health care team

 

When nursing twins it can be a good idea to alternate breasts for the twins. This can be every feeding or everyday – Twin A gets the left breast while Twin B gets the right breast for one feeding and then alternate the next feeding or on Monday Twin A gets left breast and Twin B gets right breast and on Tuesday Twin A gets right breast and Twin B gets left breast and so on. Many moms of twins will choose to nurse one at a time once they get older to have one on one time. In the early days it can be a time saver to nurse both at once.

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How does one manage tandem nursing babies of different ages?

Elizabeth Tandem nursing Read the rest of this entry »

The Last First Day

September 9, 2015

This morning as I dropped off my youngest child at school I was weepy. Was this Kindergarten or PreK? No, this was fifth grade. Finn is over five feet tall. He has been going to the same school since her was four years old. Why was I weepy? This marks the end of an era for me – as a mom, as a community member, as someone who is seeing time go by in my middle years.

This is my last First Day of School at the Earth School.

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My first First day of Earth School was in September of 2000. For the last fifteen years I have been trekking up and down Avenue B in the East Village of New York City

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Just north of 14th Street is Stuyvesant Town where we live. I have walked in snow, sleet, rain and in the blazing sun to get to our beloved elementary school. I have walked with babies in my belly, babies in slings and babies in strollers. I have seen teachers come and go and some come back! I have been through three principles. I have fund raised and recruited other families. I have escorted countless field trips often with a toddler in tow!

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At Earth I have found community. I have met some of my closest friends. My family has forged relationships with other families with whom we share holidays and birthdays.

I remember the first annual Earth School Auction.

I have enjoyed the art on the walls and read some inspiring poetry and memoirs by the wonderful children who populate the halls and hearts of our community.

I remember when the roof garden was an idea and then it became real.

I have seen families grow and I have seen families leave. I have seen tragedy and great joy and simply ordinary days at Earth. I was at Earth that terrifying morning on September 11, 2001.

I have watched children perform on the stage.

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I have nursed babies in the halls and in the lobby. I have sold popcorn and cookies in the lobby. I have done on-the-spot lactation consulting in the lobby.

I have grown as a human at Earth. I have watched my children grow and thrive. I have seen them learn to tie their shoes and learn conflict resolution and learn to construct a sentence and to defend an original idea.

I have learned about community building and about celebrating the seasons by marching in Tompkins Square Park to celebrate solstices and equinoxes.

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I learned about what education is. I have learned so much more. I have learned to let go and watch my babies grow into smart, confident people.

In nine months my youngest child will graduate from the Earth School. But today is the first day of fifth grade for Finn. I will embrace this day and open my heart to the Earth community.