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:

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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.

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

 

My Brilliant Career(s)

February 12, 2017

I have had many jobs in my life, some career worthy and others just a way to make some extra cash. Some have truly fed my soul while others ate away at my soul. Some were ordinary and others quite fascinating. Here is a list of most of my jobs.

Babysitter – a common first job for preteens – I started when I was eleven years old – when I think about that family leaving me with their toddlers – that was insane but they were expecting their third baby and they had two boys under the age of three – they probably didn’t care who watched their kids – they just needed to get out! They also knew my mom was across the street. I called her when the youngest boy peed everywhere and the older boy spilled milk all over the place

Sales clerk – I loved the discounts I got at Thalheimer’s – I was a “flyer”, this meant I worked in most of the departments, great for me to one day work in men’s cologne, another in children’s clothing and then another in housewares.

Waitress – Annabelle’s was a pub like restaurant at the Cross Creek Mall – I was terribly disorganized so it was good that I was in an Army town and I was cute – the soldiers tipped well and were not too picky

Starmount Forest Country Club – this was a different clientele and there was one cranky old man who always wrote in 10% for tips no matter who served him – the standard was to just sign the bill and the club added 15% – there were a few who wrote in 20% – it was good money to work an event like a wedding or bar mitzvah – there were always extra tips

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Dorm receptionist – I got to know who was dating whom, whose parents came to visit the most and who stayed out all night

Bouncer – OK, the Fifth Season was at the Four Seasons Hotel in Greensboro and I worked the door checking IDs and making sure the guests honored the dress code. Since Daddy was a soldier I knew soldiers were not allowed to drink in public in uniform – I loved telling the soldier to go back to his room and change into street clothes and not disrespect the uniform and our country!

Fragrance model – at major department stores I would demonstrate the free gift or the latest product for beauty companies – I promise I never squirted anyone who did not want to smell of cinnamon or lemon or gardenia or whatever the latest scent was but some people looked at me and ran – one woman actually jumped back three feet in fear of me dousing her in Estee Lauder

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Epilady lady – this contraption had a spinning spring system that literally ripped hair out of your body. At Bloomingdales one day I turned my back away from the Epilady stand for a moment. When I turned back to show the product line to a curious customer I saw a woman wincing as she swept the device across her chin and ripped out the chin hairs! We were trained to never use it on the face but I let that woman have a go at it as I saw her whiskers from ten feet away and I figured I would want to eliminate that extra hair growth if I had it on my chin. I moved my new customer to the teeth whitening EpiSmile!

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Model – I modeled jewelry for private parties for a jewelry designer – I once wore a necklace that cost more than my parents’ lifetime income!

Receptionist – this was my first NYC job! I moved to NY, well, I stayed in NJ with my close friend’s family, I arrived on a Wednesday, bought the Village Voice on Thursday and set up interviews for Friday and accepted the job offer that started on Monday and paid the highest. My office skills were limited because I had goofed off in typing class but I could talk and be pleasant and I had college debt and a total of $174 to my name, I needed that job immediately!

Office temp – again, I was a good receptionist but that did not pay as much as people who could type fast so,

Paralegal temp – I was smart despite my inability to process words quickly on a machine, paralegal temping required decent amount of intelligence and paid better than other temp jobs. And it was amazing to hear about frolicking going on between the attorneys and the paralegals and other scandals.

Location Scout – I worked in a location scouting office, mostly representing short term rentals for photo shoots and TV commercials but I liked to be out and about so I always volunteered when an odd request came up or the need to photograph a new spot for our catalogs.

Hair stylist – OK, my location scouting office shared space with a private hair salon, the stylists were top notch but they never learned to French braid. A woman from the pub around the corner popped in because she knew there was a salon in the back and wanted a French braid for a wedding she was attending. John and Terry were at a loss. I told her to sit at my desk and wove her hair into a lovely braid.

Personal assistant – a former boss married a millionaire and needed a bit of help with little things – I was happy to shop for her, to return items after a shopping spree or buy gifts for family and friends, ride around in her town car with Carlos, her driver.

Baker – I have always found peace in creating cakes and cookies so I decided to make it a career while parenting two young children, I baked cakes and pies and cookies in my kitchen and delivered them to cafes or to birthday parties or events – I still love to bake. I was often challenged to go outside of my comfort zone and bake something unusual or important like a wedding cake!photo 2

Caterer – this was an extension of my baking business – my most popular was a menu of friend chicken, potato salad and red velvet cake!

Producer – I produced stand up comedy shows and a full-length off-off Broadway play – sometimes you gotta cast yourself to get the parts you want! We did a two-week run of Crimes of the Heart at the Producers Club on West 44th Street!

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Actor and Comedian – see above and I continue to dabble a bit here and there – I recently did a show called Moms Cracking up!

Writer – I write for parenting – Bundoo.com, BreastfeedingToday.com and contribute to articles and books

Lactation consultant – this has been my longest career so far. I love helping, educating and empowering families. It is not always easy but it is important and it fills my soul to be in the presence of babies and their families. I see so many emotions bundled up and flying out. I have learned so many cultural traditions and learned to see how much people are different and how much they are the same.

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Life is full of interesting adventures and the career you pick when you are eighteen or thirty-five or any age does not have to define you but it sure can inform your life and enhance your worldview!

 

 

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!

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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.

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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?

 

 

I love baking. It relaxes me. It chills me out.

I tried knitting. I would go to conferences and see the Zen aura haloing the knitting needled goddesses as the sticks gently clacked together as soft sweaters and scarves emerged. I tried it. It totally freaked me out! I wanted to scream. I wanted to impale those needles into the eyes of those sweater-making freaks. I could not sit still and make sure I counted those stitches and the rows. What if I fell short a stitch. I could not go back. If I unrolled it I would cry. Eventually my daughter finished the scarf I started years ago. She wrapped it up in beautiful Christmas wrap and placed it under the tree.

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So, I went back to the kitchen. Baking is honest, straightforward.  There are rules but they are bendable. There is creativity. Before I was a lactation consultant I had a little baking business called Leigh Anne’s Southern Sweet Tooth. I baked for a local café and I baked for a restaurant in SoHo. I also baked for private events including a couple of weddings.

About three years ago I discovered I was allergic to wheat! Yikes! I have toyed with gluten-free flours and flour-free baking. Some has been great while some has turned out disastrous.

Nonetheless I still bake with beautiful, silky, binding flour. Nothing holds a cake or cookies together the same as good old-fashioned wheat flour – not whole wheat, just regular flour. Go get some, run your hands through it. It is dreamy.

One of my popular cakes is my lemon cake. No one makes the way I do – until now. I am going to share this recipe. This is a dense, moist, sweet and tart cake.

Enjoy!

 

Leigh Anne’s Luscious Lemon Cake

 

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1 ½ cups sugar

4 eggs

1 cup vegetable oil

1 cup of fresh squeezed lemon juice (6-8 lemons)

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Zest of 2 lemons (some will be used for the frosting)

2 ½ cups flour

½ teaspoon salt

2 ¼ teaspoons baking powder

2 teaspoons vanilla extract

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Preheat oven to 350. I like to put wax paper on my pans and use butter to prep the cake pans. I use two eight-inch pans.

 

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Beat together the eggs and sugar for 30 seconds.

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Add the remaining ingredients and beat on high for a minute and a half. Pour into the baking pans. Bake for about 20 minutes. Use a cake tester, knife or fork to test for doneness.

Let cool.

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Frosting:

1 box of confectioners sugar

1 block of cream cheese

1 stick of unsalted butter

Zest of one lemon

1 teaspoon vanilla

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Let the cream cheese reach room temperature, combine all the ingredients until smooth.

Frost the cake and enjoy!