After I moved to California I quickly realized how easy it was to become mildly dehydrated in the hot summer months if I didn’t pay attention to getting enough water and other fluids to drink. However, it’s also all too easy for breastfeeding mothers to get dehydrated in the cold months with the dry indoor air from furnace heating. Mothers of newborns in particular need to watch out for early signs of dehydration simply because new mothers can get so busy caring for a newborn that they neglect their own needs.

Recommendations for Fluid Intake for Breastfeeding Mothers

When it comes to fluid intake for breastfeeding mothers, the mantra is “drink to thirst.” That means that a woman should drink enough water to stave off thirst, and not drink in excess of thirst in the mistaken belief that she needs the extra water or that more water will boost her milk supply. How do you know whether you are getting enough? If your urine is pale yellow, then you are getting enough fluids. If your urine is a dark, concentrated yellow, then up your fluid intake. In addition to water, fluids such as milk and juice also count, but keep in mind that fluids with caffeine (tea, coffee, certain colas) can actually have a dehydrating effect. So make sure to balance the types of fluids and get enough water to keep yourself adequately hydrated.

How and When Dehydration Might Affect Breastfeeding

The good news is that dehydration would have to reach severe levels before it would even affect milk supply at all. The Breastfeeding Mother’s Guide to Making More Milk says:

A pervasive myth in many cultures is that not drinking enough water causes low milk supply. While it’s true that life-threatening, severe dehydration may cause you body to cut back on milk production, the mild dehydration that most of us operate under does not. An old but still valid study from 1939 reported that nursing mothers who were given one liter less of water a day than was recommended continue to produce plenty of milk.

So what’s the danger in becoming mildly dehydrated? If the nursing mother (any mother!) gets dehydrated, it can affect her energy level, mood, and ability to care for her nursling. If you find yourself becoming particularly run-down and overwhelmed, it’s a good idea to sit down and have a glass of water and a snack. You might be surprised how that simple step boosts your mood! It can help to keep a glass of water by your bed and your other usual nursing locations. Have easy snacks at the ready too — carrot sticks, raisins, apple slices.

The Danger in Over-Hydrating

One study showed that consuming 25 percent more fluids than the “drink to thirst” recommendation led to a decrease in milk supply. I also learned from lactation consultant Linda Wieser at the LLL area conference that drinking more than 80 ounces of water per day can reduce a woman’s potassium levels and have a negative impact on milk supply. The Breastfeeding Mother’s Guide to Making More Milk explains:

The body’s reaction to excessive water intake (well beyond thirst) is to dump the excess fluid through the urine in order to maintain the proper electrolyte balance. Water is diverted away from the breast, and lower milk volume can result.

Your Experience

Have you noticed that your fluid intake affects your energy level and mood? Do you have any tips to share to help breastfeeding mothers get enough fluids?

Other Carnival Entries

Cave Mother: A Mother’s Christmas
Mama Knows Breast: A Breastfeeding Poem: Twas the Breastfeeder’s Nighttime
Chronicles of a Nursing Mom: Don’t Forget the Pump!

Post from: Breastfeeding 1-2-3

My cutie with a cucumber

Post from: Breastfeeding 1-2-3

Interesting to read all your experiences and to see what a common problem this is…I’m in a tough situation so your advice would be helpful.

I’ve co-slept with my son since he was 3 months old, and it has worked great for us. He wakes up to nurse, then falls right back asleep. Neither of us wake up fully, so I’ve been able to have great sleep from from about 12 mos until now (24 mos.)

But over the last 2 weeks his sleep has been terrible. He won’t go to bed until 10:30 (used to sleep easily at 8:30) and wakes up 3 times a night nursing voraciously (like, 30-40 minutes!). I’m pregnant (2 mos) and get so irritated with this! I take him off the breast but then he cries and cries. My husband then comes and tries to comfort him but he won’t go to him at all during the night, and gets really agitated.

I’m so worn out and am thinking of night weaning, but hate the thought of having him cry for long periods of time. Partly cuz I don’t want to cause him upset, but also cuz it is horrible to listen to during the night.

Any suggestions?

Rosemary, congratulations on your pregnancy! Breastfeeding while pregnant can be a challenge emotionally and physically. My guess is that your milk supply has started to diminish a bit (which is normal during pregnancy) and/or your milk has started to taste a little salty (also a normal change). Some nurslings (like my first daughter) continue on nursing as if nothing had changed, but others are affected by the changes.

Photo by Jessicafm

I highly recommend that you check out a copy of the book Adventures in Tandem Nursing: Breastfeeding During Pregnancy and Beyond by Hilary Flower. It describes the experience of breastfeeding while pregnant and the various emotions it triggers in both mother and nursling. You are not alone! Two other books that might be helpful are Mothering Your Nursing Toddler and How Weaning Happens.

As for more immediate, practical advice, try offering your son a bedtime snack and some extra fluids (my suggestions would be water, milk or a cow’s milk alternative like almond milk). Does he drink from a cup, a sippy cup, or a cup and straw? Offer him his alternative drink in that cup. Have the same cup — this time filled with water only — available for drinking during the night. You can still nurse him for as long as you are willing, then offer the cup. I found that it helped to give my nursling some warning, either by offering to nurse for the length of the ABC song, or by counting down at the end of a nursing session (10-9-8-7-6-5-4-3-2-1-done!). Be sure to talk to him about the plan ahead of time, during the day and not just as you’re going to bed. “Mommy is extra tired and would like to get a good night’s sleep. We will nurse while I sing the ABC song, and then you can have your special cup! If you wake up in the night, your cup will be right there and I can sing you back to sleep.” Keep repeating your plan, whatever it might be, throughout the day and then remind him at night. “Remember how we talked about nursing to the ABC song?” He might still be upset, and you might have to keep working on a plan that suits you both. If he is verbal enough, you might even try asking him to help come up with a solution. “Mama’s mum-mums aren’t making as much milk, are they? What would you like to drink instead? Would you like your sippy cup or this special straw?” You never know, your son might surprise you! Different children have different temperaments, and you know what will work best with your son.

Does anyone else have advice for Rosemary? If you breastfed while pregnant, what was your experience like?

Post from: Breastfeeding 1-2-3

Post-It Image by Agata Urbaniak

Today I share a guest submission from a woman who does not have a blog but who felt strongly about sharing her breastfeeding wisdom in hindsight. At the end of her comment you can find the links to all the other carnival participants. First, Crystal offers the following insight:

What I wish I had known…to trust myself and my body to do what nature intended…which I am currently doing with breastfeeding my 7 week old twin boys!!!

I am currently a 27 year old mother of 3 beautiful boys. My first born son was breastfed for 18 months and weaned himself at that time. He breastfed with no problems and is as healthy as can be at the age of 4.5. Now I just recently had twin boys at 38 weeks gestation born on August 26th 2009 who are also breastfeeding on-demand. I had mixed feelings about my body making enough milk and having enough support for me to continue breastfeeding….etc. Many people said I wouldn’t be able to do it and even my boys’ pediatrician said I needed to supplement with formula because they were not gaining enough weight.

My twin boys are very healthy and are gaining weight through breastfeeding only. I am not and will not supplement with formula. My midwives said I am making enough milk for both my boys and that they are breastfeeding beautifully. Also they said that my body knows what it needs to do as long as I am eating and drinking enough. I am an experienced mother and I am experienced at breastfeeding. I must trust myself and my body to do what nature intended it to do:

To breastfeed my babies!!!!

I am happy to say that despite having my up and down days with breastfeeding two babies as it is difficult; I am never going to regret or give up on my decision to breastfeed my boys as they are worth it and much more.

Thank you to all the wonderful breastfeeding mothers who gave me advice, support, and encouragement in breastfeeding my singleton and then again in breastfeeding multiples. I believe in myself and in my body to continue breastfeeding my twin boys!!!

Congratulations Crystal and thanks for your submission!

Other Carnival Participants

Sarah Fancy Pancakes: Wish I’d Heard More Good Things
The Milk Mama: When breastfeeding begins badly, and what I should have done about it
Hobo Mama: What I wish I’d known when I started breastfeeding
My World Edenwild: What I Wish I’d Known Then: A Poem
Happy Bambino: I wish I had known then that it wasn’t up to me alone
Three Girl Pile-Up: 4 things I wish I’d known about breastfeeding
Birth Activist: What I Wish I Would Have Known About Breastfeeding
Breastfeeding Moms Unite!: You Don’t Have to Grin and Bear It
Momma’s Angel: What I Wish I’d Known Then: My List For Next Time
The Starr Family Blogg: I Wish I Would Have Known
Whozat: If I’d Known Then
Massachusetts Friends of Midwives: What I wish I’d known back then about breastfeeding
Fighting Frumpy: When Breastfeeding Feels Wrong
Breastfeeding Mums: 15 Breastfeeding Facts I Wish I’d Known as a First Time Breastfeeding Mum
Cave Mother: Nursing Wisdom
Blacktating: Breastfeeding Is Life-Changing
MumUnplugged: Six Things I Wish I’d Known

Post from: Breastfeeding 1-2-3

Photo by Leedman

As a reminder, here are the guidelines that will increase the chances a post will be selected for inclusion in the carnival:
– A well-written, grammatically correct post
– Thoughtful commentary directly on point for the carnival subject
– Overall quality of the rest of your blog and whether the general subject matter is something of interest to our readers (breastfeeding, parenting)

If your post is selected for inclusion, you will be asked on the day of the carnival to publish or re-publish your post with links back to each of the other participants in the carnival.

Post from: Breastfeeding 1-2-3

Last week I reviewed the set of “Laugh and Learn” DVDs on childbirth, newborn baby care, and breastfeeding. Now is your chance to win these four helpful DVDs!

The Products

You can win this 4-DVD set of three classes: Laugh and Learn About Childbirth, Laugh and Learn About Newborn Baby Care, and Laugh and Learn About Breastfeeding. The whole DVD set currently sells for $79.95 on the Laugh and Learn site. I see that if you want to watch the classes online they are offered that way at a discount too!

How to Enter

The contest is open to entrants with a mailing address in the United States. You have three chances to win! For your first entry, simply leave a comment on this post using a valid email address before the end of the day Friday, October 16, 2009 Pacific Coast Time. For a second chance to win, mention this contest on your blog with a link back to this post, and — this is the key part to get a second entry number — leave a second comment letting me know about your post! For a third chance to win, mention this contest on Twitter @Breastfeed123 and come back to leave another comment. The winning comment number will be picked at random using Random.org. I will notify the winner on Saturday, October 17 both at Blisstree.com/Breastfeeding123/ and by email. The winner will have until Tuesday, October 20, 2009, to get back to me with a postal mailing address for shipping within the United States, or another winner will be selected. Good luck!

Leave a comment below!

Post from: Breastfeeding 1-2-3

Today she talks about how breastfeeding success begins in the hospital:

Five Hospital Practices that Extend Your Duration of Breastfeeding

Photo by Vedrana Bosnjak

Your hospital experience — brief as it may be — can have a powerful impact on your long-term breastfeeding success. Making hospital changes in maternity care practices has been shown to significantly increase breastfeeding initiation and duration rates. The Baby-Friendly Hospital Initiative (BFHI) — launched in 1991– is a worldwide campaign to encourage hospitals and birthing centers to adopt maternity practices supportive of breastfeeding. (See www.babyfriendlyusa.org.) Hospitals that commit to improving their support for breastfeeding mothers by successfully implementing the BFHI’s Ten Steps to Successful Breastfeeding can apply for and receive the designation as a “Baby-Friendly Hospital.” While only 83 maternity facilities in the U.S. (among more than 3200 hospitals and birthing centers) have chosen to comply with all Ten Steps and be awarded “Baby-Friendly” status, a recent large study in Colorado1 has identified five of the BFHI supportive practices (dubbed the “Can Do 5!”) that have a significant impact on breastfeeding duration among mothers of healthy newborns. The following “Can Do 5!” successful maternity practices can help extend your duration of breastfeeding after you are discharged from the hospital:

1. Baby is breastfed in the first hour after birth. The AAP recommends that healthy infants be placed skin-to-skin with their mothers immediately after birth and remain with their mothers until the first feeding occurs. Immediate skin-to-skin contact not only eases your baby’s adaptation to the world, it allows the two of you to get to know one another, and promotes early breastfeeding. A baby who nurses well shortly after birth is more likely to continue breastfeeding effectively, and a successful early first breastfeeding experience promotes a mother’s confidence. Ask to have your baby placed tummy down on your bare chest immediately after delivery, and watch how her inborn reflexes help her achieve a successful early feeding. You may want to limit your visitors during this intimate bonding time.

2. Baby is fed only breast milk in the hospital. Many studies show that giving supplements to breastfed infants is linked with a shorter duration of breastfeeding. Supplemental milk should be offered only for a valid medical reason. When babies are supplemented with formula, they breastfeed less often, since formula takes longer to digest than breast milk. Infrequent breastfeeding may interfere with establishing an abundant milk supply. Furthermore, giving unnecessary supplements undermines a mother’s confidence in her ability to produce sufficient milk. Ordinarily, frequent, round-the-clock breastfeeding will provide all the milk your baby needs.

3. Baby stays in the same room with mother. By keeping your baby in your room throughout your hospital stay, you will learn to recognize her earliest feeding cues and be able to offer your breast whenever your baby is ready to nurse. Furthermore, studies show that babies are less stressed and do not cry as much when they are cared for in their mother’s room. Rooming-in is a great confidence builder. When you provide most of your baby’s care yourself in the hospital, you leave knowing that you will be able to meet your baby’s needs at home. To make the most of your rooming-in experience, ask your partner to help limit your visitors at the hospital and monitor their length of stay.

4. Baby does not use a pacifier in the hospital. Several studies have found an increased risk of early weaning when a pacifier is introduced to breastfed infants in the first weeks of life. During this sensitive time, all your baby’s sucking efforts should provide her with the milk she needs and stimulate your breasts to produce a generous milk supply. Sucking on an artificial nipple can interfere with learning to nurse, and frequent use of a pacifier may limit how often your baby breastfeeds. Once breastfeeding is going well and your baby is thriving, you can introduce a pacifier if you desire. To reduce the risk of SIDS, the AAP recommends that babies use a pacifier when falling asleep. Mothers of breastfed infants can wait about a month to offer a pacifier.

5. The hospital gives mother a phone number to call for breastfeeding help after hospital discharge. These days, most new mothers are discharged before your milk has come in and before your baby has become proficient at breastfeeding. Even when breastfeeding seems to be going well in the hospital, problems commonly arise in the early days at home. Knowing where to turn for help can allow you to overcome early breastfeeding glitches before you get discouraged. There’s no need to struggle on your own. All breastfeeding questions are important, and expert help is available. Ask your hospital nurse or lactation consultant who you can call for breastfeeding help after you go home.

Each of these five hospital practices was found to have a significant positive impact on breastfeeding duration. More importantly, breastfeeding continued longest among mothers who received all five supportive hospital practices. Nearly two-thirds of mothers who reported all five breastfeeding-friendly practices (versus half of mothers who did not) were still nursing their babies at four months after hospital discharge.

Clearly, what happens in the hospital in the first day or two after birth powerfully impacts a woman’s breastfeeding experience after discharge. Expectant moms can take heart in knowing that requesting five simple steps while you are in the hospital can boost your chances of long-term breastfeeding success.

Additional Hospital Practices That Promote Successful Breastfeeding

Other supportive breastfeeding practices that help lay the foundation for success include:

* Nurse as Often as Your Baby Gives Feeding Cues. Many new parents expect their baby to cry when she is hungry. But crying is the last sign of readiness to feed. Instead of waiting for your baby to cry, look for earlier, more subtle clues that she wants to nurse. Babies signal their readiness to feed by rapid eye movements, arousal from sleep, increased alertness, flexing their arms and legs, squirming, wrinkling the forehead, bringing a hand to their mouth, turning their head, or moving their mouth or tongue. One of more of these signs will be evident before your baby cries out loud.

* Nurse as Long as Your Baby Desires. In the past, new mothers often were advised to keep breastfeeding sessions brief until their milk came in. This dictum was based on the mistaken belief that sore nipples could be prevented by slowly building up an infant’s sucking time. Actually, the most important cause of sore nipples is improper infant latch-on, not lengthy breastfeeding sessions. If your newborn is latched on well, she should be allowed to nurse at least 15 minutes at each breast. Strictly limiting how long your baby nurses can prevent her from getting all the milk she needs and keep you from establishing an abundant milk supply.

* Forego Gift Packs Containing F*ormula. As a marketing strategy, infant-f*ormula companies routinely supply hospital nurseries with free f*ormula and giveaways for new mothers. However, some studies show a link between receiving a f*ormula gift-pack and a shorter duration of breastfeeding. To avoid an implied endorsement of f*ormula-feeding, some hospitals have stopped giving f*ormula-company gift packs to nursing mothers. If you receive a gift pack with f*ormula, make sure you understand when, and when not, to use it. Giving your baby f*ormula without a valid medical reason can undermine successful breastfeeding.

1 Erin Murray, Sue Ricketts, and Jennifer Dellaport. Hospital Practices that Increase Breastfeeding Duration: Results from a Population-Based Study. BIRTH 2007; 34 (3):202-211 (September)

©2009 Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding

For more information please visit http://www.dr-mom.com/

Post from: Breastfeeding 1-2-3

Before Going Back to Work

“Read up on what other women do because you never know what will apply to you in your situation. Get a book on nursing, I like the The Nursing Mother’s Companion guide, so that you can troubleshoot any nursing issues. Your baby will have growth spurts and nursing patterns will change, don’t panic, it’s normal, just nurse on demand whenever you’re with your baby.” ~ Azucar at The Jet Set

“If you are a breastfeeding mom preparing to work outside the home, I’ve found a couple good resources. The first, Nursing Mother, Working Mother, is a book I have flipped through but haven’t read. And I just came across another called The Milk Memos that I would love to read. . . someday. When I have more time.” ~ Christina at The Milk Mama

[Editor: I second all these book recommendations!]

“The week before I went back to work, I started pumping during “work hours” and feeding him by bottle. I thought it may ease the transition to bottle feeding for him if it was me still giving it too him. Also, it would give me a chance to gauge how much milk he was drinking, and if there would be any issues (hello sore nipples!). I’m glad we did this week long “trial run”. I was able to toughen up a little to the new way my breasts were being sucked on, and we also learned that our bottle nipples were too slow flow for him to be satisfied. These were two things we didn’t have to worry about during my first days back.” ~ Victoria

“I think that to be successful breastfeeding and working, it needs to be a very strong commitment. Despite thinking that it’s so hard, I still think it was worth it and would do it again in a heartbeat.” ~ Amber Shah at Project Super Mom

Choosing a Breast Pump

There are lots of options for renting or buying a pump. Working mothers generally find they need a good double electric breast pump.

Medela Freestyle Breast Pump

“I purchased an Ameda double electric. I absolutely love my Ameda and I’ve used it for both babies.” ~ Azucar

Storing Breast Milk

“Freeze your milk in smaller portions, 2-3 ounces. It’s tempting to put 4-6 ounces in a bag, and you can occasionally, but try to keep smaller portions so that you only pull out what you’ll need. Sometimes I’d label the time of day on the bag, or the type of milk (more foremilk, more hindmilk, evening, morning, etc.) to make it easier to mix and match bags.”

“You don’t have to freeze all your pumped milk. You can keep expressed milk in your fridge for a week, so you can combine milk from sessions to make one bottle or for one package. Just use the date of the oldest milk.” ~ Azucar

Dealing with Your Employer

“I spoke with my employer about pumping times and a spot to pump early on, I made it clear to her that this was a priority and in my mind there was no other option but to have the time and place to pump.” ~ Sara

“Really, everything went really smoothly. I work for a very large consumer goods company, who provides a Medela Pump in Style double electric pump to any breastfeeding mom for a small co-pay. I also was offered free lactation counseling, and had the sweetest old lady checking in with me before and after the birth to make sure everything was working smoothly, and to answer any questions I had. She also made a special call just to discuss pumping at work. I work in California, so my employer is required to provide a non-bathroom place to pump. Our campus has two “Nurture Rooms” with a hospital grade pump, a couch and a fridge. Work also provided spare parts for the multi-user pumps (the Medela Lactina, I think). I was pleased that the bottles and horns worked with my Pump-in-Style. There is a small employee lounge right by the restroom closest to my desk which is where I usually pump. I started out pumping three times a day for a few weeks, then moved to twice a day when I realized I could get roughly the same volume of milk in two vs. three pumps. I always pumped way more than I needed, because I was so worried about losing my supply. Fortunately, my milk was abundant, and I have donated over 1000 oz of milk to a family and a milk bank. Once solids were firmly established, around 8 months, I cut back to one pump a day.” ~ Victoria

“Both of my employers were incredibly supportive. My first employer allowed me to bring the baby to work for half days until he was about 3 months old. There was never an issue with taking the time I needed to pump. There was a mother’s lounge type room that was inside the women’s rest room. The lounge had a long, wide chaise and a door that closed and locked. It was marvelous. The only challenge was that there were three or four of us pumping and working. We just emailed each other to coordinate times to use the room if we knew we might want to go about the same time. We usually budgeted about 30 minutes each, just for a little leeway and clean up time.” ~ Azucar

Making It Work

“I dreaded the return from maternity leave to part-time work. I thought of how much I would miss my baby, wondered how I would manage to get myself ready and out the door on time in the morning. I imagined breaking down crying in front of my coworkers from the stress of it all, and I worried that my milk supply would diminish.

But it wasn’t bad. I found some ways to juggle my time, continue to provide breast milk, and spend quality time with my son. I’ve gotten used to this, and I like my part time schedule. I pump 3 times during a full work day to maintain my milk supply and provide milk for the bottles.” ~ Christina

“Pumping can be both a grind and a time to relax during the work day. I had to almost go to another place while pumping, taking deep breaths, thinking of my baby, it’s kind of like meditating at first. It can be a challenge to find that kind of relaxation if you’re stressed from working. And you have to relax, otherwise your milk won’t let down. Pumping just becomes another thing that you do everyday, and you commit to it for your baby. You have to trust that your body will make the milk your baby needs. It’s surprising that working and breastfeeding becomes even more about trusting your body.

Keep a few extra pairs of nursing pads (love Lansinoh in the purple box) in your office or your car. You may think your time for leaking is past, but one day, you may be sitting at your desk and spring a leak.” ~ Azucar

Reverse Cycling (Nursing more at night to make up for the separation during the day)

“My second baby was a reverse cycler. In fact, he would often refuse a bottle until I got home, sometimes not eating for 6 hours. Don’t panic, babies know when they’re hungry. He’d make up for it by nursing while I slept.” ~ Azucar

“Jack started reverse cycling when he was a few months old, waking every 2 hours to nurse. He’s 20 months old now and still has the same night nursing schedule. Some habits are hard to break…” ~ Amber Shah

“This was really hard. From four months to eight or nine months he was feeding at least three times through the night. We eventually started co-sleeping, which helped, but caused other issues for our family that made me have to force the issue of him sleeping in his crib. People have asked me how I handled all the night feedings and going to work in the morning. All I can say is that you just do what you have to do, rise to the occasion, and remember that it’s not forever. I figured that if I couldn’t be with him during that day, then it was good that we got extra time together through the night. It’s a compliment, really, that the baby prefers getting his milk directly from the source…” ~ Victoria

“Knowing that it was likely to happen did help me when it actually happened.” ~ Amber at Strocel.com

Overcoming Challenges

“I made the commitment to myself when I went back that my baby and breastfeeding take priority over my job. This means that if I have to pump, I do, even if it makes me late to a meeting. When I had a clogged duct, I took a sick day to work it out before it got worse. I encourage other moms to keep it up, even when it’s hard. Pumping at work is a big commitment, but if you have to be away from your baby, your milk is the best thing you can leave behind for him. I know pumping can be much more difficult than it was for me, but if you can only bring home 4 ounces a day, it still counts! If your having trouble, get help! Connect with other moms at work who have done the same thing, and don’t give up!” ~ Victoria

“Your baby will go through growth spurts when they want to nurse or eat more often to increase your supply –DO NOT PANIC– simply try to sneak in an extra pumping session or two, even if it’s short like 5-10 minutes, it will help. You can also try to pump after your baby is down for the night, just for a couple days. Your supply will increase and they’ll settle down again into more manageable times.”

“Babymoons are wonderful. If you can spend an occasional day skin to skin with your baby, with free access to nursing, it really helps keep your supply.” ~ Azucar

“I have an oversupply problem so I had to be careful in the beginning not to pump too much or my sensitive supply would go crazy.” ~ Sara

General Tips

“Try something called tandem pumping: when the baby nurses on one side and you pump the other. I did this with the first session of the day, often on Saturdays as well (an extra day or two of pumping on the weekend will sometimes help you get a little supply built up in the freezer. It’s a cushion that keeps your mind at ease.) Get the pump set up at night before you go to bed so you can just roll out and pump/nurse the baby. It’s a little tricky to get the hang of latching the baby and then the pump, but you can figure it out–a nursing pillow, like a Boppy, helped.” ~ Azucar

“By the way, at some point you will leak on your clothes at work. Through the pad. Also – at some point you will spill breastmilk on your clothes during your pumping session. So it would be smart to have a change of clothes packed in the car (no, I’m not that smart).” ~ Amber Shah

“I feel that in order to pump and continue to EBF while working, you need to be completely, 100% committed to breastfeeding. Otherwise it is too easy to start to drop pumping sessions and as a result have a decrease in supply. I also feel so fortunate to be able to be home with my son more days than I am at work…the more days that we breastfeed at home, the better for my supply. If you have any flexibility with your job and finances, work part time. I love my job and the socializing at work and I feel like I have the best of both worlds.” ~ Sara

Things I Wish I’d Known

“I didn’t figure out sleeping with my baby until my second came along. It’s SO MUCH better if you can co-sleep. I got a lot more sleep and my supply never suffered. Co-sleeping is specially helpful when your baby goes through growth spurts and tries to up your milk supply by nursing constantly.” ~ Azucar

“I wish that I hadn’t worried so much about leaving my son. He is with a friend, my mother in law and my husband…I couldn’t have had a better situation and still, I worried. That being said, I know it is completely normal. I had been pumping for about 2 months prior to returning to work and my son was not a bottle lover, so it took a while for him to take to one (Adiri).” ~ Sara

“I would say that one thing I wasn’t prepared for was how time-consuming work-pumping can be. I used to be able to use break time to get things done, go for a walk, and build relationships with my coworkers. Pumping fills all that time. It’s important, and of course it’s worth it for my baby. I just didn’t realize how full my day would feel!” ~ Christina

“I was surprised how normal I felt being back at work. (Of course I would stay home in a second if we could figure out how). I was pretty easily able to slip pumping breaks between meetings. The worst part of working and pumping is washing all the bottles and equipment every night. I really hate doing that.” ~ Victoria

“I went back to work way too early (5 weeks). I think this in large part due to my own insecurity and also PPD. I plan on taking a longer leave next time and would encourage everyone to do the same.” ~ Amber Shah

“I am a very proud breastfeeding mother. Everyone knows that I breastfeed and pump twice daily at work. I am so pleased at the dialogues that have opened up with other women regarding breastfeeding and our children in general. I was amazed at how pumping just becomes a part of what you do during the day. That being said, I can’t say I particularly enjoy pumping and some days I downright hate it! The most difficult part of working and BFing for me is that my son will only fall asleep easily if he is nursed. This has made it difficult at times for others to get him to nap during the day.” ~ Sara

“Something happened that surprised me. I worked Monday / Wednesday / Friday from the office. The other days I was working at home with my daughter. My work days were long – we were apart for 9-10 hours at a stretch. On days when we were together, my daughter nursed frequently. And on days when were apart, my body just adjusted. It was amazing to me how it just seemed to ‘know’ whether it needed to make milk or not, especially because it alternated days. The human body is a truly amazing machine!” ~ Amber

When to Stop Pumping

Many women find that around their baby’s first birthday they no longer need to pump at work and can simply continue to offer the breast when they are at home.

“I pumped until they were both about 13 months, then we kept nursing, just not pumping. It’s kind of crazy to stop pumping after a year of the routine, but one day you just hang up the horns!” ~ Azucar

“I returned to work when my daughter was one year old, since I’m Canadian and we have long maternity leaves. I didn’t do any particular preparation, and I didn’t pump. At that age my daughter wasn’t willing to take a bottle of my milk, and my research suggested that most moms stop pumping around that time anyway.” ~ Amber

“Breastfeeding while working is a commitment, but if you’re planning on extended nursing, you don’t have to feel daunted about the prospect of years of pumping. It’s pretty reasonable to stop pumping when your child turns 1 and can just eat solids during the day, and nurse in the evening and on the weekend.” ~ Amber Shah

Other Carnival Participants

~ Strocel.com: Working and Breastfeeding a Toddler
~ Breastfeeding Moms Unite!: Breastfeeding at My Family Daycare
~ The Milk Mama: A Job Where Everyone Breastfeeds
~ Momnesia the Book: Sorry, Facilities Guy
~ Marshins: Taking Your Working Boobs to Work
~ The Marketing Mama: Working and Pumping
~ Motherwear Breastfeeding Blog: Breastfeeding and Working Is Possible, and You Can Make It Work
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Post from: Breastfeeding 1-2-3

Just a Few Weeks Early
Breastfeeding Challenges in Late-Preterm Infants

Marianne Neifert, M.D.

Until recently, babies born a few weeks early — between 34 and 36 weeks gestation — were referred to as near term infants. However, the designation, near term, implies that an infant is almost term or almost fully mature, and the misnomer has often caused health professionals and parents to underestimate the medical risks in this large, vulnerable population of infants. Recently, the American Academy of Pediatrics has recommended that infants born at 34, 35, or 36 weeks gestation be referred to as late-preterm infants to emphasize that these babies are physiologically immature and have special health care needs compared to full term infants (born between 37 to 41 weeks). In addition, the mothers of late-preterm infants are more likely to have medical complications themselves, such as gestational diabetes, high blood pressure, or C-section delivery.

The Rising Incidence of Late-Preterm Births

The proportion of all U.S. births that are late preterm has increased over the past 15 years. Late-preterm infants now comprise over 9% of all births, and account for more than 70% of all preterm births (<37 weeks gestation), representing nearly 400,000 babies each year. Although the reason for the increase in late-preterm deliveries is not well understood, one explanation is the increased use of fertility treatments, which has lead to a rise in pregnancies with twins and higher multiples. Half of all twins and 90% of all triplets are born preterm. Other possible contributors to the rise in late-preterm births include the rise in cesarean section births (now 30% of all deliveries), the need to deliver some infants early due to medical complications, and more pregnancies occurring among women at an older age. In addition, performing elective labor inductions or elective cesarean sections for no clear medical or obstetrical reason sometimes leads to the unintentional delivery of a late-preterm infant. Both expectant mothers and obstetricians need to know the importance of avoiding late-preterm delivery unless it is medically necessary.

Medical Complications among Late-Preterm Infants

Because many late-preterm babies are the size of infants born at full term, health care professionals may not always give these at-risk infants the special treatment and careful screening they deserve. Instead, hospital personnel and parents tend to treat these apparently healthy infants as if they were developmentally mature. Late-preterm infants have been called imposter babies because many of these “slightly early” newborns masquerade as full-term infants, appearing to need no special care after birth and being discharged as early as term babies. Yet, babies born even a few weeks early have an increased risk of medical complications after birth and may require a longer hospital stay than full-term infants. Late-preterm infants are more likely to develop low blood sugar, severe jaundice, breathing difficulties, and infections; to have difficulty maintaining their body temperature; and to experience feeding problems and excessive weight loss after birth. Late-preterm infants also are more likely to be re-admitted to the hospital in the early weeks of life for medical complications, including newborn jaundice, breastfeeding difficulties, dehydration, and possible infections.

The brain and nervous system are among the last systems to mature during fetal development, and some studies show that late-preterm infants have a higher risk of developmental and behavioral problems compared to full-term babies. Late-preterm infants also have a higher rate of birth defects and an increased risk of sudden infant death syndrome. For all these reasons, late-preterm infants require close monitoring, evaluation, and follow-up after birth.

Breastfeeding Challenges among Late-Preterm Infants

The initiation of successful breastfeeding can be especially challenging for smaller, developmentally immature, late-preterm infants. These babies often have trouble latching on to the breast correctly and may be unable to breastfeed effectively at first because of their lower muscle tone and tendency to tire easily. Inadequate breastfeeding increases a newborn’s risk for severe jaundice and excessive weight loss.

Providing your baby with skin-to-skin contact immediately after birth and as often as possible while you are rooming-in will help promote infant feeding behaviors and successful breastfeeding. Your hospital lactation consultant can offer valuable assistance with your breastfeeding technique during your hospital stay. Sometimes, using an ultra-thin, soft silicone nipple shield can help your late-preterm baby latch on and stay attached to your breast. Ask to be referred for extra help with breastfeeding after discharge, since it often takes several weeks for a late-preterm infant to be able to breastfeed effectively.

Late-preterm infants seldom are able to drain their mother’s breasts well at first. Ineffective breastfeeding not only increases a baby’s risk of medical complications, a mother’s milk supply can rapidly decrease if her baby removes little milk. If you deliver a late-preterm infant, you can help assure that you bring in and maintain an abundant milk supply by using an effective electric breast pump to express the extra milk your infant leaves behind after breastfeeding. Removing the milk remaining after your baby nurses is known as “insurance pumping” or “prevention pumping” because it helps keep your milk supply generous until your infant is big enough and mature enough to drain your breasts well on her own. Having an abundant milk supply also helps your immature, smaller, less-vigorous baby obtain more milk when she attempts to breastfeed because she can “drink from a fire hydrant” instead of having to work hard to get enough milk. Furthermore, the extra milk you remove with the pump makes the ideal supplement if your baby temporarily requires supplemental feedings. Your surplus pumped milk can be stored for later use (in the refrigerator for 3-5 days; in a separate door freezer for at least 3 months; in a deep freezer for at least 6 months).

After you go home from the hospital, arrange to have your baby followed closely and weighed often to monitor her progress with breastfeeding. Her first pediatric visit should occur 24-48 hours after discharge. A lactation consultant or your baby’s doctor periodically can weigh your baby (identically clothed) before and after breastfeeding to measure how much milk she drinks and monitor her progress with breastfeeding. As your baby matures and gains weight rapidly and becomes able to breastfeed effectively, you gradually can decrease your pumping regimen. Your extra investment of time and effort to safeguard breastfeeding in the early weeks after your baby’s birth will pay off in a thriving infant and a plentiful milk supply that will set the stage for a long-term successful breastfeeding experience.

©2009 Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding

Marianne Neifert, M.D., author of Great Expectations: The Essential Guide to Breastfeeding, also known as Dr. Mom®, is a popular pediatrician, nationally recognized expert in breastfeeding management, and celebrated author of child-rearing books and magazine articles. In 1985, Dr. Neifert co-founded the Lactation Program in Denver — one of the very first community breastfeeding centers in the nation, sponsored by the Colorado Health Foundation. She is also clinical professor of pediatrics at the University of Colorado Denver School of Medicine. A long-time leader in the field of breastfeeding medicine, Dr. Neifert is a co-founder of the Denver Mothers’ Milk Bank, founding member of the American Academy of Pediatrics Section on Breastfeeding, the International Lactation Consultant Association, and the Health Advisory Council of La Leche League International. Dr Neifert has addressed audiences in forty-six states and has been a guest on countless radio shows and national television programs, including Today, Good Morning America, The Early Show, 20/20 and CNN. She has written for numerous publications, including Parenting, BabyTalk, American Baby, and ParentLife.

For more information please visit http://www.dr-mom.com/

Post from: Breastfeeding 1-2-3

Photo by David Owen

What a darling little flower girl! I suspect that toddler nursing break was just the thing she needed to re-charge and re-connect during the excitement of the wedding and reception! Her mother looked gorgeous too and I think it’s great she didn’t have to retreat to another room to hike up a dress in order to nurse.

Post from: Breastfeeding 1-2-3