Fernando’s School of Latch Assessment
March 29, 2015
“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!”
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
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.
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.
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.
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.
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
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.
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.
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.
Uniforms and Fairy Dust
January 30, 2015
Why do new parents seem so guarded or opinionated or defensive? Well, much of it is that they are protecting their new family.
Another thing I have noticed is that parents feel they have to subscribe to a specific style. In the years since I first became a new mom – over nineteen years ago, I have noticed that so much around parenting is trademarked. I believe that is all about marketing. I have written about how poor parents are the biggest target of marketing these days.
I remember when it was time to start feeding Phoebe solid food a mom at a La Leche League meeting suggested baby led weaning. This made sense to me – let her take food off the table – I would bite off a tiny piece of apple and let her chew it, I would continue to nurse her. Eventually I became a La Leche League Leader. A couple of years back at a meeting I was leading for toddlers a mom mentioned baby led weaning and I was thrilled to hear this concept being embraced until I heard about all the “rules around it. Rules? There is a book! Wow. I thought it was about being instinctive with a few guidelines about what foods to give and which foods to avoid so that they would not choke.
I also noticed how people would comment on how attached Phoebe and I were. Of course, I am her mom, we are together (the company I worked for closed while I was on maternity leave and I was a full time mom then.) Then I learned there is an organization called Attachment Parenting – which I love! But I hear moms asking, “Is it is AP to . . . “ Or “does it go against AP if I . . .”
Then there are the breast feeders and the bottle feeders and the co-sleepers and the baby never comes into my bed, and there are “Never let the baby cry” and the Cry It Outs.
I belong to way too many groups on Facebook and I hear so many new moms asking permission to go outside of the rules of whichever category they have chosen to join. I hear arguments about how you cannot do this or you should do that.
Titles: Tiger Mom, Hippie Mom, Crunchy Mom, Stay At Home Mom, Working Mom
Does one need only belong to one “club?” Does anyone only do things exactly as planned out in a book? Do breastfeeding moms never give their babies a bottle? Do most parents have their kids in their bed at least some of the time? Do the families that make their own baby food sometimes use a jar or sometimes eat convenient food? Do the touchy feely moms yell? Does the Tiger mom cuddle? Does the home-schooling mom want to send her kid away to boarding school? Does the mom with the most awesome and fulfilling career want to quit her job and stay home?
If you asked these questions to these parents you would get a resounding YES from time to time.
It seems like a new mom has to wear armor to defend herself and her choices. She has to seek permission to care for her baby. Whatever happened to instincts? Have we cultured intuition away by writing books and coining phrases and categorizing everything and everyone?
Maybe the extended family has done things differently so a new mom feels she needs to defend her choices. Perhaps she is faced with criticism and needs to wear a uniform.
Whatever it is I wish I could hug all new moms and blow some instinct like fairy dust at them and let them take it in, take in their babies. I want them to clear out the noise so they can hear. So they can hear that voice inside them that tells them: this is your baby, your child, do not strive to fit in, strive to find love, strive to find the wonder in your little person, strive to grow along with them.
In the meantime I will interject my thoughts in those groups when I have it in me to do so. I imagine fairy dust with each click of the keyboard.
Sweet Sleep and the Sleep Experts
November 19, 2014
This morning I attended a panel discussion of the Children’s Health Council at Cornell Weill Medical College on New York City’s upper east side. The topic was Tots to Teens: Sleep and Your Child.
The panelists were Vikash K. Modi, M.D., FAAP, Haviva Veler, M.D. and Mary J. Ward, Ph.D.
The topics they addressed are the things I discuss with my clients: routine, rhythm and consistency for good sleep hygiene. The topic of co-sleeping was mentioned but was never actually addressed during the panel discussion. It was great to hear these panelists discuss normal sleep behavior and when medical conditions get in the way.
Then they talked about the importance of letting babies learn to sleep on their own. They even encouraged Cry It Out. What was especially compelling was the fact that the two moms on the panel confessed their own discomfort with letting their own babies Cry It Out. I was relieved to hear this because it confirmed I was listening to real people with real life experience. But I wonder why. Why they have expectations that others should “do as they say, not as they do?”
They discussed the problems of electronics and irregular schedules. They discussed how light disrupts the excretion of melatonin.
They never discussed diet. They touched on allergies, mostly airborne allergies causing inflamed adenoids and obstructing airways. But they did not discuss what and how babies are fed. I wonder if they considered this in their research.
They talked about sleep associations like music, blankets and parents. They insist these “objects” need to not be there when the baby falls asleep or they will need these associations when they wake in the middle of the night. They did not discuss breastmilk or the melatonin levels that change throughout the day to help babies to sleep more. They discussed circadian rhythms.
I learned the two factors that determine the need for sleep are 1)circadian rhythms and 2)how much time has elapsed between sleep sessions.
During the Question & Answer period there were many parents asking about their own children’s sleep issues. Luckily I got a chance to ask my question. Into the microphone, I spoke, “I am a Private Practice Lactation Consultant and one of my favorite things to show new families is how to SAFELY lay down and nurse their babies and to know how to SAFELY fall asleep if that were to happen. Why then when families pass into the borders of the United States do their bodies suddenly become dangerous?”
Dr. Ward admitted that she may be biased toward Western philosophy and mentioned a study that showed most parents do not like sleeping with their babies or children.
It made me wonder if the participants in that study answered that they don’t like it because they are conditioned to think it is bad? Are they conditioned culturally to think that babies are not supposed to cross the border of the marriage bed? Maybe I am reading too much into it. Maybe my personal bias towards wanting more sleep and wanting to breastfeed comfortably colors my thoughts on this controversy.
Gerald M. Laughlin, M.D. suggested that in this country the mattresses on adult beds as so soft as to cause suffocation as opposed to the hard mattresses in Asia where co-sleeping is the norm. I am not an anthropologist but I do sit on a lot of beds and very few I have examined are soft enough to cause a risk for babies.
Dr. Veler stated that there is research that states that there is an increase in SIDS when sleeping with parents. I told her I have research that negates that untruth.
I brought along two copies of Sweet Sleep – Nightime and Naptime Strategies for the Breastfeeding Family, the new book by Diane Wiessinger, Diana West, Linda J. Smith and Teresa Pitman published by La Leche League International. This book debunks many myths around sleep. The authors really went through many studies with a fine tooth comb and proved that in specific circumstances co-sleeping is the safest for babies.
They talk about the Safe Sleep Seven. For this to work a mom needs to be:
1) a non-smoker
2) sober
3) breastfeeding
the baby needs to be:
4) full-term and healthy
5) kept on his back when he is not nursing
6) unswaddled, in a onesie or light pajamas
and they both need to be
7) on a safe surface.
This is nearly a five-hundred-page book so if you are really interested I recommend you check it out – many of those pages notes with citation of studies and research.
I gave one to Dr. Veler and the other to Dr. Loughlin.
It is my hope that these doctors will really look at them, take in the research and consider their words when they are asking parents to do what goes against their instincts.
I did take away some good information about my own older children. I learned how sleep works. My knowledge of the technology interfering with sleep is a real thing. I learned that it is absolutely normal for my thirteen year old to not want to wake up early in the morning.
I also learned that by trusting my instincts and paying attention to my children’s sleep I know what works against them getting good sleep and what helps. As babies we all slept better together. I did not mind being their sleep association “object.” It reminds me of the time when Phoebe was a toddler and she was holding onto her little red Elmo and another mom asked me, “Is Elmo her security object?” I was stunned then I realized what she was asking. “No.” I replied. “Well, what is,” she needed to know. “Um.” A beat, then “I am,” I beamed.
Those Eyes
November 13, 2014
Looking through old photos of Phoebe I was taken back to the moments she was born. The thing I remember more than the pushing, the pain, the fear of what was going on with my body, more than thinking about our apartment move as I was in labor, more than thinking about moving out of Manhattan, more than thinking of whether she would be a boy or a girl, about what we would name her, I remember those eyes. Those eyes saw right into me. More than thinking if I would be a good enough mother, more than thinking about breastfeeding I remember those eyes.
She is a young adult now and I am still taken with her eyes. Looking at this photo when she was about two years old, the image is a bit blurry but look at those eyes.
I would wonder what was going on behind those eyes, what she was thinking.
There are certain moments in mothering that leave indelible images in my mind. There was when Chloe, at three weeks of age told me she did not like the light in her eyes while she was nursing – she pulled off my breast, turned her head toward the lamp beside the bed and fake cried then turned back toward me and stopped – she repeated this action until I figured out to turn off the light. She then happily latched on and nursed herself to sleep in the dimmed room.
There was the moment when two year old Finn looked up at me, a stressed moody mama trying to get out the door and get three children to school on time on a rainy day – you know that level of stress – I began to raise my voice, speak angrily. Instead of heading my demands to get into the stroller he stopped, crossed his little arms across his chest and proclaimed, “you have to be patient, Mama.” A tear rolled down his check. I listened.
There are many stories like this but there is nothing like a first. Phoebe’s first look into my soul made me the mom I am. Never forget to look into your child’s eyes. Never forget to watch your baby’s actions. Never forget to listen to the wisdom of a two year old.
Change and Magic
June 26, 2014
Yesterday was my birthday. Today was the last day of school for NYC Public School children. This weekend all three of my children will begin their summer at camp in the Berkshires and Rob and I will be alone for four weeks.
My oldest child has one year of college under her belt. My second child will be researching high schools in the fall. My youngest will begin fourth grade.
This summer many friends are leaving New York. They are going to Portugal, Massachusetts, Portland (both East and West) Israel, and Phoenix. The list goes on.
Change is hard. I have trouble with change. I have a hard time packing. I am challenged to move things around like furniture and art on my walls. I am a creature of habit.
But I also have change envy. I am envious of all those friends starting out on new adventures. I feel a little left behind.
Working with breastfeeding moms and babies I get to relive those early challenges of motherhood, the dramatic changes in the body and the heart. As someone who advises about weaning I get to relive the emotions of that milestone.
I was talking to Finn on the way to school this morning and he told me he wishes he could perform magic. The first thing I imagined I would do if I was magic would be to bring back my mother. This year in October it will be ten years since she died.
If I was magic . . .
Oh, the possibilities.
For now, I will remain in New York. I will continue to mother my children through all of the changes they experience. I will nurture my relationship with Rob. And I shall seek change that is positive. I will embrace each day, each challenge, each wrinkle and gray hair.
You see, this is about getting older. Yesterday was my 49th birthday and I am thinking deeply about 50. It is such a milestone. When I was a kid I used to imagine a grownup being 35 years old. I am past that quite a bit. I have to consider what this means.
I walk down the street and I look at other women. I try to figure out how old they are. I try to analyze their state of mind. I try to figure out if they are happy and healthy.
I will take in this final year of my forties. I am happy and I am healthy. And I know deep down I do possess some magic!
As an active member of the breastfeeding community for nearly two decades I have seen so much marketing of formula from a personal place and for new parents. The marketing gets more and more clever and nefarious each day.
I was once helping a mom and baby in an apartment building in New York City where one has to be buzzed in. I was with this family for about an hour and a half. The buzzer never buzzed and the doorbell never rang. Upon my departure I nearly fell over a box of formula. The mom had not ordered this.
Currently infant formula manufacturers make formula specifically for breastfeeding moms. Why? Is it really different? Breastfeeding is the biggest market competitor for formula companies.
It was very exciting for me when, in 2012, Mayor Bloomberg took the marketing of formula out of New York City hospitals. Many people were upset by this action. They claimed that they were being bullied into breastfeeding. They were angry that they were not getting their “free” gift from the hospital. This was not the case at all.
What they did not realize is that by giving these “free” gift bags the citizens and patients were actually paying for these goodies.
When a hospital gives away promotional items they are endorsing this product and they are using human power to handle these items. These “free” gift bags are taking up precious real estate in our already crowded hospitals. This is FREE advertising for the pharmaceutical industry. FREE advertising. Those guys have plenty of cash to buy advertising but why spend it when the hospital will do it for free?
In May of 1980 the 27th World Health Assembly endorsed the WHO/UNICEF recommendation that “There should be an international code of marketing of infant formula and other products used as breast-milk substitutes.”
This is important because we know that breastfeeding rates decline where formula is marketed.
This is not an anti-formula campaign rather it is a recommendation to support healthy outcomes both long term and short term. The campaign is designed to take an ethical approach to promote breastfeeding as the normal way to feed babies.
Unfortunately the United States has not agreed to this recommendation.
On this anniversary the Public Citizen’s campaign to End Infant Formula Marketing in Healthcare Facilities is firing up to bring awareness to the continued marketing of formula in the US.
They are encouraging participants to use social media to get the message across by making signs that say “No Formula Ads in Hospitals” or “Follow the WHO Code.”
As an advocate for breastfeeding families I will join this day of action. What will you do to promote breastfeeding?
My Review of Breastmilk – the movie
May 16, 2014
I have seen the documentary Breastmilk twice.
The first time around I was happy to see the diversity of the subjects, the inclusion of gay families and the normalization of milk sharing.
I came away knowing that Dana Ben-Ari is a true documentarian in that the viewer is brought into the scenes unobtrusively. We observed real life situations and outcomes.
The second time around I was sitting next to woman who nursed her child a decade earlier. She squirmed in her seat and whispered to me, “If I had seen this before having my son I would’ve been afraid because it seems so hard to nurse.”
Certain elements were left out that I believe only a seasoned eye would catch. Missing from the film: physicians trained to support breastfeeding, pre-natal education, support for the mom and baby and extended work leave. Were with these elements missing from the film because they are missing in real life?
There were a handful of subjects followed from pregnancy through the first birthday of the baby. In the end only one of those babies was nursing.
The moms who experienced premature weaning talked extensively about how was “really okay”, that “the doctors were right”, they “had their baby’s health in their best interest” and “thanked goodness that their baby was healthy.” What I saw behind those words was grief, defeat and lots of justification for their unplanned weaning.
The producers, Ricki Lake and Abby Epstein, say the outcomes of the subjects of their film align statistically in the United States with breastfeeding rates.
I believe documentaries are made not only to show real life but to affect a change or to educate or to inform.
There were experts talking about the cultural anthropological aspects of breast-feeding in the Western world but there was no real information on how to make breast-feeding easier or even pointing out what got in the way. We did see a bit on how our culture gets in the way: the boyfriend who not wanting to be patient as his baby nursed, the nurse not wanting to be patient as the parents wanted to baby to self attach, the moms who had to go to work and could not keep up making milk. Once again women, these new mothers, are at the mercy of the system, a system that does not support women or children.
In my documentary I would show women all of the world breastfeeding. I would show statistics on breastfeeding rates in different countries. I would show how birth practices impact breastfeeding, how working outside of the home impacts breastfeeding, how education and lack of education affect breastfeeding.
But I am not a filmmaker. I am a lactation consultant, a La Leche League Leader, a mom, a friend. I am working in the field daily to support mothers and babies one by one.
The longer I work in this field the more obstacles I see. What do you think? How do you see breastfeeding? Do you see it as easy? Do you see it as a privilege? Do you see it as impossible? How does a baby see breastfeeding? What if we asked babies? Would that change our outcomes? Would that change our culture?
Boxes
April 7, 2014
Computers are boxes that hold information. They are solid, finite. Computers rely on an algorithm of complete ideas. Computers categorize our lives, our files, our ideas.
Humans are not boxes. We are fluid forms, soft, curvy. Our ideas are amorphous and infinite. I worry that the coming generations are going to be trapped in these boxes, these categories.
I am a woman. I am in my forties. I am married. I am a mother. I am college educated.
These are categories in which I fit but this is not all of me.
I think of the challenges of checking off answers. The other day I called the United States Post Office. I needed to find out where a package was that my oldest daughter accidentally had shipped to our home address instead of her dorm. I needed to know if I could pick up her package even though it was not in my name.
There was a recording asking me various questions including the tracking number. This number was illegible as I imagine author of said numbers was in the habit of checking off boxes and not actually used to writing. The tracking number option was not an option. In fact, none of the boxes the recorded voice wanted me to choose was of any help to my situation so I said “Operator.”
She responded in confusion. So I said “customer service.”
She still wanted me to choose: send a package or repeat previous options.
I then said “Human.”
Her reply: I am sorry, I do not understand, do you want me . . .”
“FUCKING HUMAN!!” I screamed in to my phone. She didn’t flinch. I hung up.
Another recent situation with computer options was a package ordered form Target. My eight-year-old son has a new position: General of the Spy Club in his third grade class. For this position he needs to wear a jacket and tie. My husband ordered a crisp white shirt and sharp navy jacket. It was supposed to be delivered on Wednesday the 26th. On Thursday the 27th I tracked the package from an email with all of the ordering details. I tracked the package through UPS. They handed it off the USPS. On Friday March 28 I called and checked and tracked. According to USPS it was on time for delivery on Wednesday the 26th – remember I am calling on Friday the 28th. I placed several calls. The only human I talked with was from Target and every word uttered was from a script which I imagine had little check marks for each situation.
“I am sorry you feel this way. Your package is scheduled for delivery on Wednesday the 26th.”
“Do you know what today is? It is the 28th.”
There was not a way for anyone to help me because computers do not have arms, eyes or hearts. They cannot call and speak to UPS or the USPS and ask where my son’s General suit is.
My worst box checking experience was when I was sitting in the pre-op for a D & C at St. Vincent’s Hospital. I had been 17 weeks pregnant and a Doppler could not pick up my baby’s heartbeat so I went for a sonogram. The baby inside me had died. My body still felt pregnant and I did not physically miscarry. We decided on a D & C.
The Physicians Assistant asked me a series of questions before the procedure. Then this one:
“Are you pregnant?”
“Do you know why I am here?”
“I just need to know if you are pregnant.”
“I don’t know,” my eyes filled with tears for the thirtieth time that day. I didn’t think I could produce another drop.
“I need to check off a box.”
“How about: yes, I am pregnant, with a dead baby? Do you have a box for that?”
When people are trained to check off boxes they should get sensitivity training. There should always be an “other” box with a line for explanation. And that line should be endless.
I worry about so many new mothers these days. It must be so hard to be instinctive. They are encouraged to follow a set of rules that they can track. They have apps for everything: feeding, diapers, pee and poo.
When I had my babies and I was nursing them in the early days I was trying to keep my breasts balanced. When it was time to nurse I would gently squeeze my breasts to see which felt fuller so I could start with that breast. Ask many moms today and she may say, “hold on, let me look, I have it on an app.”
Technology has a its place but not at the price of humanity. We are culturing the instincts out of ourselves. New mothers are following all these concepts:
Are you any of the following?
- Attachment Parenting
- Co-sleeping
- Ferber
- Sleep training
- Home birth
- Planned Caesarean
- Home school
- Public school
- Private school
- Breastfeed
- Bottle feed
- Homemade food
- Prepackaged food
- Baby led weaning
- Blonde
- Brunette
- Bald
- Young
- Old
- Friendly
- Shy
- Silly
- Frustrated
It is my hope that we can learn to live in harmony with computers, that we not let them do our thinking.
Step outside of the box. Look into someone’s eyes. Think for yourself.
mamamilkandme 