1. Breastfeeding Advocate, Author, and Breast Cancer Survivor Kathleen Huggins (She is the author of The Nursing Mother’s Companion and The Expectant Parents’ Companion: Simplifying What to Do, Buy or Borrow for an Easy Life with Baby, and co-author of Nursing Mother, Working Mother and The Nursing Mother’s Guide to Weaning)

2. Dr. Jane Morton, Director of Breastfeeding Medicine at Lucile Packard Children’s Hospital and Clinical Professor at Stanford University School of Medicine (She also put together this free video on hand expression of breast milk)

3. Author Andi Silverman on Breastfeeding (She is the author of Mama Knows Breast: A Beginner’s Guide to Breastfeeding)

4. Registered Nurse, Lactation Consultant, La Leche League Leader, and Author Karen Kerkhoff Gromada (In addition to writing Mothering Multiples: Breastfeeding and Caring for Twins and More! she co-authored Keys to Parenting Twins, Keys to Parenting Multiples, and Care of the Multiple-Birth Family: Postpartum through Infancy)

5. Eight Things You Didn’t Know about This Breastfeeding Blogger (that’s me!)

Post from: Breastfeeding 1-2-3

B123: What are some of the significant changes and additions you made to this revised edition?

KKG: Hmm, there have been revisions to just about everything – every chapter includes some changes and updates. Amazing how the science of lactation and “standard” practices can change in a few years. And I’m always learning new things or new thinking from the mothers of twins and triplets (MOT/T) in our Cincinnati La Leche League (LLL) Multiples group and from MOT/T in online groups to which I belong. The section on preterm babies has been expanded as have chapters on nighttime mothering, partial breastfeeding, and fussy babies. The chapter on fussy babies includes more about GERD, lactose overload, sensory integration, etc. Finally, key points for each chapter have now been added at the end of the chapter, so the busy MOT/T can easily find the nitty-gritty when there is not enough time to read more!

B123: Tell us a little about your experience mothering multiples.

KKG: My monozygotic (identical) sons were our 3rd and 4th children. Their older sister was 5 and their older brother was 3 within a couple of weeks of their birth. My husband was a medical resident then, so I was on my own a lot. He was “on call,” meaning he was at the hospital from 7 a.m., through the night, to 5 p.m. the next evening every 3rd day; every 3rd weekend he’d leave Friday at 7 a.m. and return Monday evening.

I was lucky because I carried the boys to 40 weeks, 5 days gestation – almost unheard of today. A (Tony) weighed 6 lbs. 6 oz. and B (Joey) weighed 7 lbs. 11 oz. – 14 lbs. 1 oz. total. They roomed in from birth and were fully breastfed their first 6.5 months – usually gaining 2-3 pounds per month. Because of latching issues, it took 2-3 months before we got the hang of simultaneous nursing. But once we all figured it out, almost all daytime feeds were simultaneous because they usually wanted to eat at the same time. Lucky me – they usually woke on alternate hours during the night. We had a crib in our room and I played musical beds, rotating the one who woke to nurse with the sleeping one I’d drifted off with while breastfeeding an hour or so earlier.

Breastfeeding was the easiest part of mothering my twins! (I honestly cannot even imagine the work involved in feeding multiples any other way! Breastfeeding may take a bit longer for babies and mother to learn, but once learned it is sooo easy!) My sons were high-need babies, needing lots of contact. We lived in our rocking chair. But I felt lots of guilt about my older two children, whose lives changed so quickly, and about the babies because I couldn’t always meet one or the other’s needs as quickly as I had with my singletons….

I won’t even go into toddlerhood, which I thought was the most difficult period because of all they constantly got into – when they weren’t pushing, biting, or punching each other! But there’s a reason for the last few chapters in Mothering Multiples, and it isn’t because I’m the only MOT who found this a difficult phase!

B123: What bit of parenting or breastfeeding wisdom have you learned in your work with mothers of multiples that mothers of singletons might find helpful too?

KKG: Lots of bits. My LLL co-leader and I may do a presentation on this very topic this summer. Perhaps the most important thing is that some/partial breastfeeding truly is better than no breastfeeding – and that partial breastfeeding can work but it still has to work within principles of lactation physiology.

B123: What’s your top tip for breastfeeding multiples? What’s your favorite piece of mothering advice?

KKG: No fair asking for a “top tip” – but I guess it would be to hang in and keep breastfeeding (or pumping if both are preterm/near-term or either has difficulty). Unless a baby has an underlying physical problem, tincture of time, skin-to-skin mother-baby contact and a realistic method for supplementing that reinforces breastfeeding oral behaviors almost always leads to effective breastfeeding for all babies. It IS worth it – although it may be difficult to believe that when stuck in the middle of it!

B123: Is there a particular product (breast pump, nursing pillow) etc. that you routinely recommend to mothers of multiples?

KKG: LOL, mothers have been breastfeeding multiples for tens of thousands of years without today’s equipment. Today, everyone is convinced they need fancy-dancy equipment to breastfeed. I never pumped but occasionally hand expressed so I’d have “relief” milk in the fridge. Nursing pillows weren’t around 2-3 decades ago – yet we survived! So no, there isn’t a particular product I recommend. However, for babies who are preterm or near-term and not yet able to effectively breastfeed (remove milk from breast to GI system), I highly recommend an appropriate pump — an appropriate pump for this situation is a rental (let me repeat – rental), hospital-grade, electric, self-cycling breast pump that is used at least 8 times in 24 hours. If using a nursing pillow, a mother will get more for her money if she gets one that can be used for breastfeeding one or two at once. To breastfeed two most MOT/T suggest using a pillow with a wider and deeper “shelf” all the way around side-to-side, e.g. the EZ-2-Nurse.

B123: In your work as a La Leche League Leader and lactation consultant you’ve counseled thousands of mothers of multiples. What advice can you give to other breastfeeding counselors who have mothers of multiples come to them for help? Are there some key points to keep in mind when helping a mother of multiples?

KKG: Women breastfeeding twins or more deserve the best possible start, but they’re the least likely to get it. In addition to the increased likelihood of preterm/near-term birth, mothers are more likely to be affected by pregnancy or birth complications. Breastfeeding counselors of any kind often underestimate the impact of transitioning two or more preterm/near-term newborns to breast while still caring for them otherwise and recuperating from a more complicated pregnancy and birth. Helping strategies need to take into consideration the total situation. Strategies that make more sense for a woman with a single infant may overwhelm the mother with multiple newborns. Don’t lose long-term breastfeeding because of bias toward unrealistic (for MOT) interventions. (I’ve also found that strategies that work for MOT/T also tend to work for breastfeeding difficulties with singletons!)

B123: I’m assuming you’ve counseled some women who conceived multiples through advanced reproductive technology. I had a woman tell me that her reproductive specialist warned her she’d have trouble breastfeeding (why a doctor would sabotage a mother that way I don’t know). A recent study also indicated that mothers who conceived through IVF (whether or not they conceived multiples) need extra breastfeeding support. What are your thoughts on that? Are you aware of any data about assisted reproduction and breastfeeding success?

KKG: Probably most of the MOT/T I’m in contact with have been through fertility treatment. Most of these moms do great with pumping/breastfeeding IF pumping eight or more times in 24 hours, or babies are allowed to feed “on cue” vs. feed based on some ambiguous schedule. (Many organizations for parents of multiples seem to “push” more rigid scheduling instead of accepting that babies are babies no matter how many arrive at one time.) Inadequate milk removal, especially a concern in the first several weeks when lactation is being established, still leads as the top reason for insufficient production. There’s a perception that needing help to conceive means breastfeeding/lactation will be problematic, but that’s not necessarily so. The hormones that support conception are different than those that support lactation.

One condition that’s associated with fertility issues and insufficient lactation probably is polycystic ovarian syndrome (PCOS). Addressing some aspects of that condition often improves milk production. Thyroid conditions can also affect fertility and milk production.

Multiples are two, three, more times the usual number of babies no matter how they were conceived, but parents who were “blessed” with multiples via fertility treatment often believe they aren’t “allowed” to feel overwhelmed, negative, etc. when babies’ care is 24/7.

B123: Thanks for taking the time to speak with Breastfeeding 1-2-3! Is there anything else you’d like to share?

KKG: Breastfeeding multiples is not always easy but it’s always worthwhile. And once you’ve hung in and breastfed multiples, you know you can do anything (if you want and put your mind to it)!

I try to always be available to MOT/T via phone, email (kgromada@fuse.net), etc. and I’m a member of the Yahoo group AP Multiples as well as check LLLI’s mother-to-mother forums for mothers breastfeeding multiples. There are links to these groups in addition to FAQ, photos, articles, etc. via my web site: www.karengromada.com.

Beyond that there’s tons to share – so many tidbits, so little time or space! Heck, I can talk on this topic for hours – and probably days! Speaking of speaking, I love to do so! Info is available on my page at the LactSpeak site: http://lactspeak.com/speakers/KarenGromada/.

Thanks for having me here!

B123: Thanks again Karen! For more discussion of breastfeeding multiples, click here.

Post from: Breastfeeding 1-2-3

KH: Four years ago, in addition to directing the breastfeeding clinic, I opened a maternity/nursing boutique in downtown San Luis Obispo. After just a couple of weeks, one morning I found a lump in my left breast. Being very familiar with both of my breasts, I knew what this meant. After two surgeries, six months of chemo and two months of radiation, I returned to the clinic. Only weeks later, the Board of Supervisors closed my beloved county hospital, promising to keep all of the county clinics open. Just a few weeks later, they gave all of the clinics to another entity including my breastfeeding clinic. Very soon, I was notified by the new owners that my services at the clinic would no longer be needed. Although disappointed, I still had my store and periodically got to work with nursing mothers and babies.

B123: You co-authored The Nursing Mother’s Guide to Weaning with Linda Ziedrich and Nursing Mother, Working Mother with Gale Pryor. How did your collaboration with these women come into being and what has your experience working with co-authors been like?

KH: Linda Ziedrich and I, as well as the publisher, decided to update Weaning a couple of years ago. Every 4-5 years I like to refresh what ever I write. I was also asked to join Gale Pryor, daughter of Karen Pryor (famous author of Nursing Your Baby) in updating Nursing Mother, Working Mother. She is a wonderful writer and I thought I could be helpful in updating information on pumps and pumping. So a new team was born! Linda Ziedrich is my editor on everything I have ever written. She is so very thoughtful, a great writer and weaned three babies. I simply felt Linda would be a great co-author and she has been. I think we worked on both of these books for about six months or so.

B123: In your work at the breastfeeding clinic, what are some of the concerns that come up most often for nursing mothers and babies? What do you wish more women knew before they started breastfeeding?

KH: In the breastfeeding clinic, I worked with mothers who suffered with latch on problems, insufficient milk production, and colicky babies. Interesting you should ask about what I wish more women knew before they started breastfeeding. That is my next book, “Twenty Five Things Every Breastfeeding Mother Should Know.” I will be writing this book with a friend and Lactation Consultant, Jan Ellen Brown. For now, all I will say is that breastfeeding is one of the most important things that can a mother can do for her baby.

B123: What’s the most rewarding thing about helping nursing mothers and babies?

KH: Perhaps I manage mothers and their struggles with nursing differently than others. I am committed to making a difficult situation with a mother easier until the mother-baby pair have worked things out. I don’t send mothers home with a strenuous plan. I simplify things. They typically go home with just one goal and then I see them again very soon. My reward is that they leave happier than when they came and they feel hopeful that they can work issues out with their babies.

B123: You are one busy woman! How do you find the time to juggle all of your responsibilities?

KH: Well, it’s not that hard for me. I have loved, secure children that have been little trouble! I have helped them discover their passions and they grew up to be successful. My husband Brad takes care of me! And, I must admit I have housekeeper once a week!

B123: Can you tell us some of your personal history of being a nursing mother/working mother and about weaning?

KH: I never ever considered doing anything else but nursing my babies! But who knew what a life altering experience that would turn out to be. With my first child, Kate, I suffered with severely damaged nipples, most likely from poor technique. Soon after, I developed mastitis, and a large abcess that required hospitalization with an incision and drainage. I remained very committed and continued nursing during a period (1970’s) when we were less knowledgeable about breastfeeding management. At four months post partum, I returned part time to graduate school. I did not pump during our separations and I am certain that my milk supply faltered and Kate’s weight gain slowed to a rate that concerned her pediatrician. Still I continued and Kate weighed only 17 pounds at one year. On the other hand, her father and his family were small people. Soon after, I decided to end my marriage. In a last ditch effort to work on the marriage, a counselor suggested that perhaps things would improve if I weaned. Out of guilt, over the course of a month or so I weaned Kate by her 18th month. Of course, nursing had nothing to do with a failing marriage and to this day I regret being pressured into weaning prematurely, that is before either of us was ready.

When my son was born, nine years later, I was reluctant to seek out help even though he was severely tongue-tied and could not remove any milk from my breast. My goodness, I could not admit to anyone that Kathleen Huggins was struggling. After several days of being home, a new Lactation Consultant dropped by to see me. She held John and said, “My goodness, your nipples must be killing you! The next day, my pedi-dentist clipped his frenulum and my initial troubles were over. Soon, he developed severe colic with bloody stools. He nursed every 30-45 minutes for comfort. I adjusted my diet until I was down to nothing! Driving down the street with a screaming baby, I said aloud, “What can this be? All I am eating is bread and water! Well, dummy, maybe it’s the bread.” Within 24 hours my miserable baby was cured as he was in fact allergic to wheat. I was committed to nursing John until he weaned. When he was three he spoke of weaning, but he continued nursing to sleep until his fifth birthday. I am convinced his normal nursing period is the reason he is such a kind and generous young man.

B123: You spoke of your extensive treatment for breast cancer in 2003. Is there anything you’d like to share about your experience with breast cancer?

KH: I remember a few key things. I do know that one day the tumor was not palpable and the next day it was. I do remember being a bit angry that after yearly mammograms, this rather large tumor never showed up. Now there are new digital mammograms and I hope that women seek these out in addition to soaping up their breasts EVERY day and getting a good feel. I am certain that is why my tumor was stopped at stage two.

I was never afraid for some reason. I knew I would be fine. I sought out the best breast cancer center in Northern California. I reassured my children and crying friends that I would be fine. I remember a study that I was told in Nursing School (196?) about women who had a positive attitude. They did well. I did well.

B123: What do you think are the greatest challenges or opportunities in the breastfeeding community today? What would you like to see happen with breastfeeding legislation and breastfeeding research in the coming years?

KH: One of the reasons that our county has the second highest breastfeeding rate in California is that a few of us dedicated our lives to this. It starts out with great prenatal classes, teaching moms what they need to know including when they need to get help. The hospitals are the next link–great breastfeeding assistance as well as identifying mothers and babies who may be at risk for difficulties. They need to go home with who to call for help. We have had a Breastfeeding Warmline for the past 25+ years. If needed, moms who call can get hands on help from a local, affordable clinic. Also, the pediatricians need to be breastfeeding supporters.

Legislation is very difficult. I took part in an attempt to rid hospitals of formula “gift” bags. We lost and that was a hard pill to swallow.

B123: Thank you so much for taking the time to talk with me. Any last thoughts you’d like to share?

KH: Well, I still see mothers in my store on weekends when the clinic is closed and a mother is in crisis, but my work is not as much as it once was. But I will tell you this: rarely a night goes by that I don’t dream of being in my clinic supporting a new mother. Yes, I miss it.

Post from: Breastfeeding 1-2-3

Tell us a little about yourself and your three children!
I am 23 years old and active duty Navy. I’ve been in the Navy for three years. I’ve been married for four years, and my husband just graduated from college in December. We were told we were expecting twins when I was seven weeks pregnant, and were ecstatic and surprised and a little scared. I experienced some bleeding a few days later, and it continued on and off for the next two weeks, so I had an ultrasound done during my first OBGYN visit, even though it was not anticipated. It was at this appointment that they told us we weren’t expecting twins, we were having TRIPLETS! The ultrasound technician told us that two babies were sharing a placenta (likely identical, although fraternal twins/triplets can have fused placentas that look like one, and only upon delivery is the fusion discovered) and the other was on his/her own. Later in the pregnancy we discovered we were having two identical boys and a little girl. My triplet pregnancy was fairly uneventful, a few trips to the ER early on, a few trips to L&D later on and many many many perinatologist appointments in between.

The babies were born at 32 weeks and 4 days, after five days of active but dysfunctional labor. Yes, I did break down and beg them to deliver these babies. And when it was clear to the doctor that the best decision was to deliver them my husband raced down I-5 to get to the hospital in time for the c-section. He made it by three minutes.

Tristan was born first, followed by Cassandra and then Ryland. Tristan and Cassandra spent 18 days in the NICU and Ryland spent 19 days there. They are now almost six months old and are very well adjusted babies for being 7+ weeks early. Tristan and Ryland weigh over 15 lbs and Cassandra is a petite little one at 12 lbs. They are so much fun and are rolling over, mimicking us, laughing at anything and everything, and I swear I heard Tristan say “addie” (daddy) the other day.

When you were pregnant, did you research the benefits of breastfeeding multiples?
Yes I did. I found the most useful resource to be the internet chat groups, where you can interact regarding your curiosities and ask questions specific to your situation. I found both a local group of moms of multiples, and a regional one for triplets and more.

What did you do to prepare yourself to get off to a good start?
I had some time to research breastfeeding while I was on modified bedrest with the babies. I found a lot of support with my local “moms of multiples” group that has an online support group/chat group. I also found a lot of support on The Triplet Connection website, which is a support group for triplets or more. There were a lot of positive and successful breastfeeding stories, as well as personal responses to questions I posted about the pumping verses feeding at the breast.

Were you and each of the babies able to breastfeed shortly after the babies’ births?
I was not able to feed the babies until five days after their birth due to the fact that I was put on magnesium sulfate to stop my contractions. I was on the magnesium sulfate for an extended period of time and the babies had very high magnesium levels. Therefore they had to wait a few days to feed them. And then they were given my expressed breast milk via gavage feeding (a tube into their noses), and then a bottle with my milk, and then about a week after their birth I was able to try and put them at the breast. I had a lot of support from the lactation department at the hospital where I delivered.

I know you are currently pumping a majority of the time. Did you pump right from the beginning to establish supply and to prepare bottles of expressed breast milk for your children?
Yes, I was very lucky to have a mother very involved in the aftercare of my delivery. Within two hours after the c-section, she had me in bed pumping. She describes me as being “three sheets to the wind” and was actually holding the pump flanges to my breasts as I was lying down on my side in bed. Then again two hours later, I was a bit more alert but still exhausted and in pain. Nevertheless, she had me roll to the side of the bed and she held the flanges and worked the machine. From there on out, for the next week, I was pumping every 1-2 hours, NEVER going more than two hours in between pumping sessions. A nurse in the NICU explained to me about pumping as much and as often as I can in the first 1-2 weeks after delivery to “lay down” as many milk producing cells as I can. I’m not sure how medically backed that theory is, but I can say that her support, encouragement, advice, and the support of my mother and husband were amazing.

Did any of you face any medical complications that affected breastfeeding?
When my babies were three weeks old, the day before two of them came home from the NICU I was in my OB’s office with a bad mastitis infection, fever of 102.5, body aches, chills, headache. I was put on an oral antibiotic and then went up to the NICU to visit the babies. Two days later, when we went back to get the third baby from the NICU and bring him home, I ended up in the ER due to the mastitis infection. It was very painful, and the pain was worse with pumping/feeding but is very necessary to promote the healing of a mastitis infection. I ended up on IV antibiotics in the ER, and was sent home on a different type of oral antibiotic than I had been given the day before. The infection cleared up in about a weak, and then pain lessened each day, but it was a very painful experience.

About a month later I ended up with another mastitis infection that required oral antibiotics and cleared up within a few days and then I experienced a third infection that landed me back in the ER. It probably would have only required oral antibiotics, but when I felt it coming on, we had been snowed in and I wasn’t able to get out of my neighborhood until 24 hours later. At that point, the only thing open was the ER and I was in enough pain that I was confident it couldn’t wait until the following morning. I was given antibiotics via an intramuscular shot and sent home to rest for a day. The worst part of the mastitis is most definitely continuing to pump/breastfeed through the infection. It was extremely painful for me for about 4-5 days each time I had an infection.

Mothers of singletons often worry–many times unnecessarily–about their milk supply. We know milk supply increases based on demand and that it’s possible (and wonderful) to breastfeed multiple babies, but I know many mothers are wondering, how is your milk supply??
Initially, my milk supply was pretty large. I am thoroughly convinced that it had to do with the pumping within hours after delivery though. And then continuing to pump every 1-2 hours for the next 1-2 weeks. I don’t have any singleton breastfeeding stories to compare it to, but I really think that’s what made my experience so successful and my supply so large. There were times, especially after I returned to work, that my supply dropped significantly. Enough that we had to pull some extras we had stored in the freezer, out for daily use. But once I relaxed in my work environment and got over the initial change of returning to work, things got better. My pumping time was also different at work than what I had been doing at home, so I just had to adjust and talk to my superiors about the importance of my pumping and the amount of time I needed to do so.

How do you manage feedings?
All weekday feedings are done with a bottle. On a few occasions, to console one of the babies, I would and still do feed at the breast. But due to working full time and having three infants to feed at once, it’s not very likely on the weekdays after an 8- or sometimes 12-hour day. On the weekends, I do my best to feed each baby at least once on the breast, just to have that bonding time. But there are weekends where that doesn’t happen. At first, I would feel really guilty about it and miss that bonding time. But as time passes, I realize there’s no sense in beating myself up over it and I can only do what I can do. Now that the babies are getting older, they are more interested in looking around and playing, so sometimes breastfeeding isn’t even on their daily agenda.

What sort of support have you received for breastfeeding? Did you attend a support group? Do you have any favorite books on breastfeeding, pumping and/or multiples?
I guess you could say that I had breastfeeding support, but I didn’t attend an actual in-person or online “breastfeeding support” session. I did however find a lot of support in chatting with other mothers on INCIID’s “babies born in October” forum (my babies were due in October) as well as my local moms of multiples club and the Triplet Connection. (INCIID’s website is www.inciid.org and is a WONDERFUL resource). (I agree!)

I didn’t do much reading about breastfeeding, so I cannot recommend any books. For me, I preferred to interact and be able to ask questions about personal situations and share my curiosities and get answers to them, which my online groups were able to provide me with.

What advice to you have for mothers of multiples?
I had many people tell me breastfeeding triplets would be impossible. For me, that just fueled my desire and determination TO breastfeed them. I would encourage mothers of multiples to talk to other women on support websites about their fears, concerns and questions. Breastfeeding was very different than I had imagined it would be. But it is so very fulfilling. Plan in advance to be pumping as well. In the end, some mothers of multiples are very successful at feeding at the breast. For other mothers, a combination of feeding at the breast and pumping is the choice that works for them. And still other moms choose to be pump only moms. Either way, your child/children are receiving that irreplaceable breast milk. I would also encourage moms to rent a hospital grade breast pump instead of buying one. I have not personally used both, but other moms have highly encouraged me to go with the hospital grade. Additionally, many insurance companies WILL pay for a breast pump or rental for a premature baby. I would recommend looking into that before the baby(s) arrive so that you have it all planned and there is no last minute running around to find what you need.

Do you have any tips for other pumping and/or working mothers?
Initially I cared about what people thought of me taking time to pump. And I realized that it was stressing me out and affecting my milk supply, and also making the whole process less than enjoyable. I realized that I am providing my children with the best nutrition possible and that as a mother, working or not, I have a right to do that. I would plan my pumping times at home so it would fit into a convenient schedule at work. For me, I’d rather be a bit engorged and uncomfortable at home while taking care of my babies and doing what I LOVE, than being in that same predicament at work and “sour” about the fact that I’m leaking and in pain and “should” be pumping but can’t. I had set in stone times that I pumped everyday, and that made it easier for my co-workers so that they could plan to have coverage for me while I pumped. Giving that schedule knowledge to everyone assisted so that I was rarely ever told that I couldn’t pump at that time. Working in a medical field, there have been unexpected situations and I can’t just drop what I am doing to pump. But at the next earliest opportunity, everyone understood (although not always happy about it), that I needed a break to pump.

If you were to do it all over again, would you do anything differently? Are you happy with your decision to breastfeed?
I would feel less guilty about taking breaks at work to pump. It’s a temporary situation and isn’t going to last forever, even the frequency and amount of time of pumping has decreased as my babies are getting older and are demanding less and eating more solids.

I am very happy with my decision to breastfeed. There were times, like my first few weeks back to work and the mastitis infections that I really wondered how long I could do this and if it was really worth it. But, I have yet to have sick children, and that’s pretty impressive for babies that were eight weeks early. And, I can’t imagine the cost associated with feeding formula to my three babies when I have breasts that produce enough milk to feed them.

How long to you plan to continue breastfeeding and pumping?
My plan is to continue until they are 9-10 months (7-8 months adjusted), and then wean down, and I imagine with my milk supply the weaning process will take a month or so. The babies are getting more active now and want to be played with together and individually, so the hardest pumping times are at home when I’d rather be playing with them than pumping. But I feel that 9-10 months will be a good time to start weaning, both for them and for me.

Thanks Julie! Congratulations on your wonderful babies and your success in breastfeeding and pumping!

If you’d like to share your breastfeeding story, click here. To read more breastfeeding stories, click here.

Post from: Breastfeeding 1-2-3

Dr. Morton assured me that medications are covered in the model breastfeeding curriculum. She also directed me to her favorite tool on the subject, an NIH website put together by the United States National Library of Medicine. She likes it even better than the Thomas W. Hale, Ph.D. book Medications and Mothers’ Milk because the site is free, easily accessible to medical professionals as well as parents, it’s peer-reviewed and very up-to-date. It’s the LactMed database available at www.toxnet.nlm.nih.gov (click on the link for the full web address). The site description reads:

Drugs and Lactation Database (LactMed) – A peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed. Among the data included are maternal and infant levels of drugs, possible effects on breastfed infants and on lactation, and alternate drugs to consider.

I tested the site by looking up a few medications including the anti-thyroid medication one doctor told me I could not take while nursing. I was very impressed by this resource. I particularly like the feature that suggests alternate drugs to consider. I also like that PubMed links are provided for any studies cited.

Readers, please pass this reference on to any and all of your doctors — your child’s pediatrician, your obstetrician/gynecologist, your family or general practitioner and any other doctor advising you on medications and lactation. Let’s get the word out about this fantastic free resource!

Post from: Breastfeeding 1-2-3

When I told her that I was interested in looking at the fact that breastfeeding instruction is lacking in medical schools across the country, she replied:

I couldn’t agree more and the American Academy of Pediatrics also agrees completely. That’s why the American Academy of Pediatrics and the Health Resources and Services Administration’s Maternal and Child Health federal bureau have put together a multi-specialty breastfeeding curriculum that is in its first pilot year at seven pilot sites and seven control sites across the country. The seven pilot sites are Duke University Medical Center, Harbor-UCLA Medical Center, Jacobi Medical Center in New York, Medical University of South Carolina, MetroHealth Medical Center in Ohio and Texas Tech [University Health Sciences Center at Amarillo]. Out of 70 applicants we chose ones that had a good number of residents in both obstetrics and pediatrics and in family practice and also were located in underserved communities. There are over 400 different residents participating.

Dr. Morton went on to describe the unique model breastfeeding curriculum put together by a group of academicians in the field. There are two prongs to the curriculum for the residents: Advocacy – how to support breastfeeding in what you do and say — and Clinical Management. With respect to Clinical Management, Dr. Morton states:

There are three clear things that every single resident needs to be able to teach every single mother: (1) four nutritional parameters, (2) hand expression, and (3) positioning and latch.

She elaborated on the four nutritional parameters: (1) it’s normal for the baby to lose weight in the first few days, (2) the baby should regain that weight within 10 days, (3) the baby only takes in a teaspoon – 5 milliliters – of breast milk at a feed in the first day (about an ounce total), and (4) the baby should have bright yellow mustard-like poop by day 5. The parameters can be summarized easily for tired residents and overwhelmed new mothers as 10-5-5: regain any lost weight in 10 days, take in 5 ml of milk per feed in the first day, and have yellow breast milk poop by day 5.

I found very interesting what Dr. Morton had to say about the second element: hand expression. She firmly believes that most mothers should not need to rent a breast pump when they leave the hospital to get their milk supply up. Instead, they can be taught the art of hand expression, which is free and more gentle than a pump. Hand expression can help relieve engorgement, gently express milk when a mother is in pain or having trouble getting the baby to latch on, and stimulate the breasts to produce more milk. Dr. Morton hinted at new research that suggests that hand expression used in conjunction with pumping in the first three days is much more effective in promoting subsequent milk production than pumping alone. If women were taught to hand express in the first three days after giving birth, their milk production could be boosted significantly and fewer women would experience problems (or unnecessary worries) over low milk supply. Look for that research to be presented at the international conference of the Pediatric Academic Societies in Toronto, Canada in May. Dr. Morton will also help get out the word through a new video entitled “Making Milk.”

Personally I gave up my manual pump and switched to hand expression long ago. It’s simple, sanitary (no equipment to sterilize), and it worked the best to clear the plugged ducts I experienced early on when breastfeeding my first daughter. I’m very encouraged by the thought that women, regardless of their income, could be empowered with the knowledge of how to hand express their milk and boost their milk supply.

Back to the third element of the Clinical Management portion of the curriculum: positioning and latch. The residents are learning how to demonstrate the cross-chest or cross-cradle hold for the baby and the sandwich hold or “C-hold” on the breast to get the most effective latch. The cross-cradle hold allows for a deep latch with the lower jaw and tongue massaging the breast tissue below the nipple and allows the mother to see the baby’s jaw.

These techniques are being taught to residents in the pilot program regardless of each resident’s gender. Dr. Morton reports that the pilot year is being very well received. She says that doctors in the past may have been reluctant to support breastfeeding because they were never trained in it.

They never had a “see one, do one, teach one” in breastfeeding. That is where you watch a procedure, have someone watch you, and teach someone else how to do it. Residents enjoy being able to help at a mother’s bedside. It’s all part of taking breastfeeding out of the closet and making it a norm and making it a comfortable process to ask for help.

The pilot program will be analyzed to compare breastfeeding rates among women helped before the residents received the training and after they started the training, and that data will also be compared to information from the seven control sites. Results should start coming in by the end of summer 2007. The program has already generated a tremendous amount of interest from other schools.

The program sounds fantastic and it’s wonderful progress forward in breastfeeding instruction. I want to thank Dr. Morton for taking the time to speak with me and share her inside knowledge of the model breastfeeding curriculum. You can read more about Dr. Jane Morton at her biography on the Breastfeeding.com site.

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