To Pump or Not To Pump

July 26, 2017

This is a question many new parents are faced with. People do not realize the amount of information thrown at new and expecting parents until they are expecting and new parents themselves.

One of the big decisions parents have to make is how they are going to feed their baby. It seems like most Americans consider breastfeeding. There are many obstacles that interfere with breastfeeding – that is a post for another day but let’s talk pumping milk.

I recall when I was pregnant with my first baby I took a breastfeeding class. I knew I wanted to breastfeed but did not have many role models so I listened intently on how to breastfeed. I remember the instructor talked about pumping and how it is best to rent a pump – I am not sure I remember much more. When Phoebe was born I struggled with how to get her latched and how often to feed her and I had a striped scab across one of my nipples and a hickey on the other from her latching onto the areola. I remember in a fit of frustration telling Rob WE NEED TO RENT A PUMP! NOW!

 

It took a few days for us to figure out how and where to rent a pump – this was 1995! Phoebe and I found our rhythm – she found my nipple I found how to listen to her cues. The pump arrived and I stared at it.

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For three and a half weeks. We rented it for four weeks. I knew I needed to use it before returning it and having spent over $80 renting and buying parts. I put the shields on my breasts and was impressed that milk came out of my breasts.

Later that night Rob came home from work. This was summer and there had been a storm. The electricity was out. Phoebe started to root around. “You have to give her this bottle! Now! My milk is going to go bad and we do not have a refrigerator and it is 99 degrees!”

Rob grabbed the bottle and tried to feed our screaming baby. I walked out of the room. My breasts began to tingle and leak.  Rob was sweating, Phoebe screamed louder and louder. Her head spinning like Linda Blair in the Exorcist. I started to cry. I think Rob was crying, too.

“Give me the baby.” I latched her on and we both chilled out.

“What do I do with this?’ asked Rob.

“Pour it down the drain,” I told him.

It turns out I did not need to pump. The company I was working for went out of business so I became a full time mom.

I asked Rob if he felt he needed to feed Phoebe to bond. He laughed and told me he felt bonded with here.

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And eventually I became a La Leche League Leader and then a Lactation Consultant (IBCLC).

 

As someone who has been in the breastfeeding business for two decades I have seen different trends. With the Affordable Care Act offering up pumps to expecting parents and with social media there is a big pumping culture. And there is so much information shared that it can all be confusing.

If your baby latches on, you feel comfortable and your baby is gaining weight there is no need to pump.

Conversely, I have seen women who were told not to pump for two weeks or for one month or whatever someone told them was a rule. Or no one told them to pump while their baby is being supplemented with formula. In some of these cases this compromises their milk supply. The bottom line is that the baby must be fed. But if your baby is being supplemented and you want your body to make milk then it is important to pump. Milk is made by removing milk form the breasts – this can be with a baby who has a good latch, by hand expressing or by using a good breast pump.

 

Let’s now talk pumps. Pumps are not all created equally and not everyone responds to pumps the same. I have worked with people who pump using their hands – hand expressing – here is a cool video:

hand expressing

 

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There are hospital grade pumps, electric single user pumps , and hand pumps.

 

When should you pump?

  • If your baby is separated from you
  • If your baby is not gaining enough weight
  • If your baby causing you so much pain you cannot tolerate nursing
  • If your baby takes a bottle
  • If you are donating milk
  • If you are working away from your baby

There is no need to fill your freezer! Pumping is not an Olympic sport!

How many people compare their milk stash to those they see on Instagram?!

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You really only need enough milk to feed your baby.

If you want to pump that is cool but if you do not want to pump and do not need to then don’t pump.

People can bond with a baby without a bottle. If you want your baby to have a bottle of breastmilk, then pump.

Each situation is unique and blanket statements do not help new parents. For help call an IBCLC (International Board Certified Lactation Consultant) Find a Lactation Consultant or a La Leche League Leader.La Leche League International

 

 

 

 

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.

Everly & Me

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

 

Tandem Nursing

August 10, 2016

classic tandem

 

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 »

Weaning

June 23, 2016

I remember when all three of my children weaned.

My plan for Phoebe was to nurse for one year.

I figured I could avoid formula and bottles if I nursed her for twelve months.

At my baby shower for her I received 36 bottles! I had not registered for anything and told people I would be breastfeeding. We did not have a dishwasher. The thought of washing bottles overwhelmed me and made me want to breastfeed even more.

Laziness was a motivating factor initially in some of my parenting choices. Breastfeeding and co-sleeping were the bomb!

Though we struggled together initially, nursing became an extension of my mothering Phoebe.

As her first birthday approached I got anxious about the weaning process. How would I do it? Who would it benefit? How would I calm a tantrum or get her to sleep?

photo 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.

“It is better to look good than to feel good.”

Many mothers tell me that their breasts are painful and they want to know why.

“It could be the latch,” I offer.

“No, it is not the latch, the nurse/doctor/lactation consultant/my mother . . . (fill in the blank) said the latch looks great.”

The problem is that the mouth and tongue are complex and the movements are complex and can be effected by various outside factors.

Do you remember Billy Crystal as Fernando? His mantra was:

“Dahling, you look mahvelous! It is better to look good than to feel good and, Dahling, you look mahvelous!

snl billy crystal

I believe that many health care professionals were trained to assess latch at Fernando’s Hideaway.

The latch is NOT marvelous if the mom is in pain. It is NOT marvelous if her nipples hurt, if the baby is not gaining weight, if the baby cannot maintain the latch for a feeding.

What can cause this poor latch?

There are a number of things that can make the latch un-marvelous. They can include:

  • poor positioning
  • birth trauma
  • tongue-tie
  • weak suck

What are the consequences of poor latch?

  • breast infection
  • low milk supply
  • early weaning
  • gassiness in baby
  • fussy baby
  • poor weight gain for baby
  • engorgement

What can be done?

Understanding what makes a good latch. When there is a good latch both mom and baby comfortable and the baby moving milk appropriately.

Different remedies can help different challenges.

Positioning the baby close to mom is essential – the closer the baby the deeper the latch

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If the baby is tongue-tied, this is where the frenulum that attaches the tongue to the floor of the mouth is too restricted, this small piece of skin can be released by surgical scissors or by laser.

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This procedure is quick and can prevent a host of problems both immediately and down the road including poor weight gain, the need for orthodontia, digestive issues, premature weaning to name a few. Often when the tongue-tie is present there is also a thickened frenulum under the upper lip. This, too, should be evaluated.

If there is birth trauma healing can happen by bodywork by a practitioner skilled at working with babies.

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This can include a chiropractor, a craniosacral therapist, an osteopath or a physical therapist. These folks are trained to help relieve muscle tension and to release the fascia. With birth trauma there can be misalignment in the babies oral structures. Sometimes the roof of the mouth is highly arched which can make the latch very uncomfortable as the breast tissue can be pressed into this area by the baby’s tongue. If this is the case often the baby feels tension and this makes his sucking more “chompy.”

Releasing the tension can help alleviate this pain and help to reorganize the baby.

If the baby has a weak suck there can also be therapies to help as well as suck training.

If there is a breast infection the mom can continue to nurse but she must be treated.

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No matter what it is important to get the baby fed. It is also important to protect the milk supply.

When there is engorgement the mom can hand express, pump and/or nurse the baby.

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When needing help with breastfeeding please do not accept that if it looks good then it is good. It should feel good and it should function appropriately.

If someone says “It looks good,” this is time to seek help by someone trained to assess the latch, inside and out.

In most cases that someone is an IBCLC – International Board Certified Lactation Consultant.

The Lactivist

February 4, 2015

Lactivist

Chloe nursing at the World Walk for Breastfeeding NYC 2002

The word was accusatory. I felt her anger over the internet.

What had I done to her? I did not say anything about formula feeding. I did make the case against the unethical marketing of formula. That is distinctly different from condemning moms who formula feed.

There is a formula campaign going around social media under the guise of making the “Mommy Wars” go away. In actuality most of the conflict of motherhood, parenthood really, is sparked by media and advertising.

The line between marketing and entertainment is becoming more and more murky. I have learned for the most part to discern what is being sold to me as opposed to what is there to entertain me.

This is the comment I made:

This is not about breastfeeding vs formula feeding, it is about the nefarious marketing of the pharmaceutical industry that undermines all families. Formula has its place. This is about using guilt to promote their product and to make us divisive – are we really? At the heart of it on the playground I can say that most moms get along. The images in the media create fear and defensiveness. I work professionally to support all mothers, I know when formula is needed and wanted. People are not always given the opportunity to make an informed choice.

Why was she angry with me? Why did she think I was attacking her?

I started thinking about it. She was directing her anger at me because I am safe. She does not know me – I am just that breastfeeding advocate. What had happened to her? Was she really experiencing grief and anger over her baby feeding experience?

I have many friends who did not breastfeed and they are not angry at me. They made informed decisions or at least dealt with what they were handed and they have made peace with it.

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I thought about the times I get angry at people. I moved to New York for many reasons but one of the big ones was for an acting career. I am not a Broadway or TV or movie star. I could list all of the obstacles that prevented me from becoming famous but it doesn’t matter. I still get jealous and angry sometimes when I see actors my age who have made it. I also wrote and performed stand-up comedy. I loved watching the Golden Globes but I felt little jolts of envy watching Tina and Amy up there.

These feelings are far overshadowed by my happy life. I have a loving husband whom I love hanging out with – he really is my best friend and I am looking forward to growing old with him. We have three awesome children who are smart, healthy and beautiful.

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I have moved on. (Casting directors – I can still provide a resume!)

I am also a bit envious of the moms who have had babies at home. Complications prevented that from happening with my babies and me. Still, I ache a bit about some of the birth experiences my babies and I went through. In the end they are all healthy and we made it through.

I have worked out the things in my life that got in the way of some of my goals. I have accomplished many of my goals and I am a happy woman.

So, going back to the name caller, I think she is angry and sad that she is not breastfeeding. I do not know if her birth interfered with her plans. I do not know if her family gave her a hard time about breastfeeding. I do not know if she is taking a medication that is incompatible with breastfeeding. I do not know if her body never made milk. I do not know what experiences she may have had in her past that makes it uncomfortable for her to have anyone touch her breasts.

I sure as hell bet she loves her baby immensely. I hope she can find some peace. I will be the brunt of many a new mom’s anger and frustration.

That is a role I can play.