August 10, 2016
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.
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
- 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.
How does one manage tandem nursing babies of different ages?
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
- 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
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.
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!
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?