Breastfeeding

Introducing Your Breastfed Baby to the Bottle

Baby Feeding on Bottle

Whether you will be returning to work after your maternity leave or would like to get your partner more involved in feeding your new babe, introducing a bottle to your breastfed baby can be a helpful, and sometimes tricky, endeavor. Many women like to have the option to have pumped milk available that a family member or caregiver can give the baby should they need a break, some extra sleep or happen to be away for more than a couple hours. Here are 5 helpful tips to introducing your breastfed baby to the bottle so that it’s a smooth and gentle transition for you both.

5 Tips to Introduce Your Breastfed Baby to the Bottle

  1. Timing is everything: Your midwife or lactation consultant will likely tell you that introducing any sort of bottle or artificial soother must be well-timed. Too early, and you run the risk of disrupting your newly established breastfeeding routine and too late, your babe may reject the bottle all together. The ideal time to introduce a bottle is between 4-6 weeks. That way, you will have already found your groove with breastfeeding and your baby will likely not experience any nipple confusion. 
  2. Choose a slow flow nipple: When picking out a bottle and nipple for your baby, choose one that most closely mimics the breast and allows for a slow flow of milk. Sucking from a bottle requires a different latch and tongue movement than suckling from the breast. A slow flow nipple will most closely replicate the experience of breastfeeding and allow baby to take his time eating. 
  3. Have your partner give the bottle: Getting a bottle from mom who usually breastfeeds can be confusing and frustrating for a little one. If possible, have your partner be the bottle aficionado. Even better yet, take the time that your partner is learning to bottle feed your baby and do something for yourself. Take a shower, take a nap, go for a walk or run an errand. Your baby is more likely to have a successful bottle feeding experience if they can’t smell mom and her milk nearby. 
  4. Take baby steps: Rather than having your partner or family member offer the bottle when your baby is hungry, try introducing it after they have breastfed. This way, they will not be frustrated as easily with the process and can explore the feel of the bottle without the pressure of needing to satiate their appetite. You don’t need to put a lot of breastmilk in the bottle, even starting with a half an ounce should suffice. If the milk is not freshly pumped, place the bottle in warm water to heat it prior to feeding. Baby may be more likely to accept a warm bottle versus milk that is directly from the refrigerator. 
  5. Encourage paced feeding: One of the challenges with bottle feeding is that we decide how much baby should drink rather than baby deciding. To most closely simulate the experience of breastfeeding, never force the nipple into baby’s mouth and simply allow him to decide how much he wishes to drink. Give baby breaks for burping and rest and switch sides from which you feed him as he would when breastfeeding. It’s also important to make sure your partner or the caregiver is able to recognize baby’s hungers cues so that he or she can feed baby when he’s hungry versus on a set schedule. 

Introducing bottle feeding does not have to be a stressful process if approached slowly, gently and with plenty of time for practice. If you have questions about the process of introducing a bottle to your breastfed baby or are pregnant and considering a natural birth in a homelike setting, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center. We are here to support you throughout your journey of motherhood.

What You Need to Know About Breastfeeding During Pregnancy

Breastfeeding While Pregnant

If you are pregnant with your second (or third or fourth) or are considering becoming pregnant, you may be wondering about the safety of continuing to breastfeed your baby or toddler throughout your pregnancy. There’s a lot of misinformation about the risks associated with breastfeeding during pregnancy and we want you to have the necessary information to make an informed decision for you, your child and your baby-to-be. Here are the most commonly asked questions about breastfeeding during pregnancy. 

Is it safe for my baby-to-be?

In most normal, healthy pregnancies there is no risk to your unborn baby if you choose to continue breastfeeding your toddler (or baby). A common misconception is that breastfeeding during pregnancy will lead to preterm labor or miscarriage. In actuality, the uterine contractions caused by the release of the hormone oxytocin from breastfeeding are quite mild and no different than the contractions you might experience following sexual intercourse. If you have not been placed on pelvic rest and have a normal, healthy pregnancy, there is no reason why you cannot continue to safely breastfeed as there should be no harm to your developing fetus.

Under what circumstances is it not safe to continue breastfeeding during pregnancy?

It may be advisable to wean your current nursling if you have a high-risk pregnancy for any of the following reasons:

  • You are carrying multiples
  • You have a history of, or are at risk for, preterm labor
  • You have bleeding or pain in your uterus
  • You have been placed on pelvic rest
  • You have been identified as high-risk for any other reason that may make breastfeeding dangerous for you or your developing baby

These reasons alone do not mean you must stop breastfeeding at once but it is important that you discuss it with your healthcare provider who may advise that weaning is the safest option for you and your baby.

Are there any risks to my current nursling if I continue to breastfeed during pregnancy?

Fortunately, the amount of pregnancy hormones released into your milk is minimal and pose no risk to your current breastfeeding child. You toddler may find that you milk supply begins to decrease by the fourth or fifth month of your pregnancy or that the taste of the milk begins to change. Because of this, some toddlers and babies who are nursing while mom is pregnant will naturally self-wean. It is important to ensure that your current nursling is receiving adequate nutrition once you experience a drop in your milk supply. Particularly if your baby is under six months and has not begun eating solids or if they are over six months and breastmilk is still their primary source of nutrition, you will want to make sure they are receiving sufficient daily caloric intake.

What will breastfeeding while pregnant be like for me?

While many women go on to successfully breastfeed their baby or toddler through subsequent pregnancies and beyond, there can be some discomfort due to your rising pregnancy hormones. Up to 75 percent of women report having sore nipples during pregnancy which can consequently make breastfeeding painful at times. Some women also report feeling some nausea when their milk lets down but keeping light snacks on hand while nursing can help prevent this discomfort. In addition to making sure your nursling is getting adequate nutrition, it is vital to make sure you are also getting plenty of nutritive calories per day. During the second trimester of pregnancy, the average woman needs to consume an additional 350 calories per day. By the third trimester, it is recommended that you consume an additional 450 calories per day. When you are breastfeeding during pregnancy, in addition to those extra calories, you need to add an additional 500 calories per day for a nursing baby over six months and an additional 650 calories for a nursling under six months of age. A nutritious diet is important during any pregnancy but even more imperative while also breastfeeding your baby or toddler. Aside from a healthy diet, you’ll want to make sure you drink plenty of water and get as much rest as possible. Try laying on your side to nurse your toddler for naps and you may even be able to catch a few zzz’s yourself.

Deciding whether or not to continue breastfeeding during pregnancy is a personal decision that you should make based on your own comfort level and your toddler’s current nursing habits and physical and emotional needs. It also doesn’t have to be an all or nothing decision and you can decide to cut back the number of nursing sessions per day or to limit the amount of time your toddler spends at the breast during each feeding. This may be a good option if you want to continue nursing but are experiencing any discomfort such as sore nipples or nausea.

For questions about breastfeeding during pregnancy, prenatal care, natural birth, and other women’s services, contact Health Foundations for a free consultation with a midwife or for a tour of our Birth Center. We are here to help you make decisions that work for you and your baby.

Infant Hunger Cues - A Simple Guide to Baby's Hunger

Infant Hunger Cues

Wouldn’t it be nice if newborns came with an instruction manual? One of the more challenging feats as a new parent is learning your baby’s various hunger cues and how to catch them before tummy rumbles turn to tears. Initial signs that your baby is hungry may be subtle and easy to miss if you don’t know what you are looking for. Here’s a simple guide to breaking down the stages of baby’s hunger cues and what to do if baby becomes upset before you notice them.

Early Hunger Cues:

Your newborn is not likely to raise his hand and ask for the breast or bottle when he is feeling hungry. There are, however, some early indicators to look for that may suggest he needs to be fed. Early hunger cues include waking from sleep, stirring, turning of the head, lip smacking, opening and closing the mouth and rooting or seeking the breast. The rooting reflex, for the new parents out there, is a baby’s automatic tendency to turn his head toward the stimulus and make sucking motions with his mouth when the lips or cheeks are touched. This is a natural reflex that helps with the process of breastfeeding. If you see baby displaying any of these cues, offer the breast or a bottle.

Mid Hunger Cues:

If you miss the first set of cues (which can easily happen when you are just learning), the second set of more active cues may be more noticeable. Babies who are beginning to feel frustrated and hungry may display increased physical movement such as fidgeting, stretching, rooting around the chest of whoever is holding them, positioning themselves for nursing, fussing, fast-paced breathing or putting their hand, toy, clothes or just about anything in their mouth. If your baby has reached this stage of hunger, offer a bottle or the breast as soon as possible.

Late Hunger Cues:

Responding to late hunger cues is when it gets a little trickier. Every new parent has missed the early and mid-cues at least once and found themselves having to soothe an inconsolable baby. If your baby has reached this point of frustration and hunger they will begin to cry, move their head frantically from side to side, turn red and display signs that they are agitated and distressed. At this point, you will need to comfort your baby before feeding them in order to have a successful nursing or bottle feeding. 

Try calming your baby by cuddling him, having skin-to-skin contact, wearing him, singing to him, rocking, bouncing or even taking a warm bath together. Once your baby has calmed down, offer the breast or bottle. Although it will likely happen to even the most attentive parent from time to time, you want to avoid reaching this stage of hunger to the best of your ability. Once baby has reached this stage of agitation, he is more likely to have a poor latch, feel overly tired, eat less and wake sooner for the next feeding. Routinely letting your baby reach this stage of hunger and distress can result in feeding problems and poor attachment.

A good rule of thumb in the early days is-- when in doubt, feed baby. For breastfed babies offering the breast frequently and for comfort in addition to hunger will only help increase your milk supply and develop a strong and lasting bond with your baby. For bottle fed babies, feeding with love and attentiveness is also a great way to strengthen your attachment and nurture your bond with baby. If you have questions about hunger cues, nursing your baby or any and all things related to pregnancy, birth and the postpartum period, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center

*Special note for bottle feeders*

With bottle feeding, it is also important to look for signs that your baby has had enough. These signs include turning the head away, refusing to suck and becoming fidgety or frustrated. Just as it is important to be aware of hunger cues, it is also important to respect signs that your baby is full and let him take the lead on how much he eats. This will help prevent overfeeding baby.

Is Breastfeeding An Effective Form of Birth Control?

Breastfeeding Baby

If you’re a new mommy and have passed your postpartum period of pelvic rest, you may be wondering how effective breastfeeding is as birth control. While you and your partner may be eager to be intimate once again, you are likely not looking to add another baby to the family anytime soon. Fortunately, exclusive breastfeeding is actually a highly effective method of birth control during the first six months postpartum and sometimes even beyond. Here’s how to make the most of your lactational amenorrhea.

What is the Lactational Amenorrhea Method?

Lactational amenorrhea is the term used to refer to the natural period of infertility that occurs after giving birth when a woman is breastfeeding her baby and is not menstruating. This period of infertility occurs because the hormones necessary for milk production actually suppress the hormones necessary for ovulation. Consequently, the Lactational Amenorrhea Method refers to when a couple uses exclusive breastfeeding as a form of birth control. You may be wondering just how effective simply breastfeeding your baby can possibly be at preventing pregnancy. The answer to that question is very effective, if a few important criteria are met. 

In order for the Lactational Amenorrhea Method to be as much as 98-99.5 percent effective, the following factors must be present:

  • Your baby must be 6 months or younger
  • You must be breastfeeding on demand during both day and nighttime
  • Your menstrual cycle has not yet returned
  • Your baby must be exclusively breastfed with no formula supplementation or introduction of solid foods to his diet

Even after six months of age, moms who frequently breastfeed their babies and who have not had the return of their menstrual cycle are only 6 percent likely to become pregnant.

What Factors will Affect the Return of My Fertility?

Although the average time for nursing mothers to experience a return of their menses is 14.6 months, there are a number of factors that may cause you to become fertile before then. These factors known to impact fertility include:

  • The introduction of solids to baby’s diet
  • A reduction in the number or duration of nursing sessions per day
  • Your baby beginning to sleep through the night
  • Regularly pumping in lieu of breastfeeding

Every woman is different and experiences sensitivity to hormones to varying degrees. Overall, the amount of time your baby spends at the breast each day will be the biggest factor contributing to the duration of your lactational amenorrhea. If your period has returned, breastfeeding is no longer impacting your fertility and you should not rely on this method for birth control. 

Can I Increase the Length of my Lactational Amenorrhea to Prevent Pregnancy?

Yes! There are several simple ways that you can attempt to maximize your lactational amenorrhea while breastfeeding. These include:

  • Continuing to breastfeed on demand past six months. Aim to put your baby to the breast at least every 4-6 hours, day and night.
  • Cosleeping to increase night nursing. Fertility hormone production is highest during the nighttime hours making night nursing a primary factor in preventing the return of fertility.
  • Delaying solids until 6 months and offering the breast before each meal.
  • Using nursing to comfort your baby.
  • Offering breastmilk exclusively. Do not supplement with formula.
  • Skipping pacifiers and postponing the introduction of bottles until necessary.
  • Keeping your baby close to encourage frequent nursing by babywearing.
  • Nursing lying down for naps and at night.

Using breastfeeding as birth control is a safe and effective way to prevent pregnancy during the first six months postpartum and even beyond under certain circumstances. Most importantly, your baby will enjoy the limitless health and emotional benefits of exclusive breastfeeding during this critical time in her development. For questions about lactational amenorrhea or for anything related to pregnancy and natural birth, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center. 

15 Ways Breastfeeding Boosts Baby’s Immune System

Baby and Mom

Breastfeeding offers an unparalleled way to protect your baby from illness and disease. Because it is perfectly formulated to meet the needs of your child, breastmilk offers the perfect combination of nutrients, antibodies, enzymes and immune factors to keep your baby healthy and thriving. Here are 15 ways that breastfeeding boosts your baby’s immune system and protects your little one from harmful illnesses.

  1. Breastfed babies are less likely to develop diarrheal disease. Statistics suggest that formula fed babies are 3-4 times more likely to suffer from gastrointestinal problems like diarrhea and vomiting. This is because breastmilk stimulates the growth of good bacteria and prebiotics in the digestive tract impeding the growth of bad bacteria and preventing it from attaching to the intestines. 
  2. Breastfed babies are less likely to develop ear infections.
  3. Breastfed babies are less likely to be hospitalized with a respiratory infection. Research suggests that formula-fed babies may be as much as 3 times more likely to suffer from severe respiratory illnesses like bronchitis, croup and pneumonia.
  4. Breastfed babies are 34 % less likely to develop juvenile diabetes.
  5. Breastfed babies are less likely to develop childhood cancer. Formula-fed infants may be as much as 8 times more likely to develop childhood onset cancer than babies who are breastfed for at least six months.
  6. Breastfed babies are less likely to develop urinary tract infections.
  7. Breastfed babies have fewer cavities than formula fed babies.
  8. Breastfed babies are significantly less likely to develop certain types of spinal meningitis.
  9. Breastfed babies typically have lower blood pressure than formula fed babies and are less likely to develop heart disease.
  10. Breastfed babies have a lower risk of obesity. Some studies suggest that formula fed babies are 20-30 percent more likely to struggle with obesity.
  11. Breastfed babies born into families with allergies are less likely to develop a milk allergy and less likely to develop problems with eczema.
  12. Babies who are breastfed for six or more months are less likely to get leukemia and lymphoma.
  13. Breastfed babies have been found to have a 36-50 percent reduced risk of Sudden Infant Death Syndrome.
  14. Breastfed babies typically have fewer cavities than formula fed babies.
  15. Breastfed babies may be less likely to develop psychological and behavioral problems.

To learn more about the great benefits of breastfeeding or for questions about having a natural birth, contact Health Foundations for a free consultation with a midwife and for a tour of our Birth Center.

Read More About the Benefits of Breastfeeding:

Lactation Services at Health Foundations

Breastfeeding Mama

If you’re expecting your first baby and are planning to breastfeed, you likely have images in your head of lovingly nursing your newborn in your new cushy glider as he drifts off to sleep and you gaze down in awe of your little miracle. You probably have these images because that’s how we often see breastfeeding portrayed in photos and movies. Breastfeeding is a beautiful, natural way to nourish your baby while creating a lasting bond. But it’s unfortunately not always as easy as you expect. Problems such as a poor latch and lip and tongue ties can leave both you and your baby in tears as you struggle to overcome the learning curve on your way to nursing bliss. That’s why, at Health Foundations, we offer comprehensive lactation services to get you on your way to building a successful breastfeeding relationship with your new baby.

Crying Baby.jpg

Lactation consultation can begin as soon as your baby is born with guidance and instruction from our team on how to get baby latched on properly and receiving the vital colostrum that precedes your milk coming in. But it doesn’t end there. During your postpartum visit, our registered nurse Jan Kaste will answer any questions you have about breastfeeding, address any difficulties that have arisen, and troubleshoot any problems to ensure that you and baby can get back on track. 

“Nursing is a learned skill that often benefits from time spent with a lactation consultant. We offer lactation education on a one to one basis to get new moms through those first challenging weeks. Reassurance and individualized problem solving create the best chance for each mom to successfully reach her breastfeeding goals.” –Jan Kaste, RN, Nurse Practitioner.

If you’re breastfeeding challenges are not resolved during your postpartum visit, you are welcome to schedule a one on one consultation at the Birth Center. During a lactation consultation, we will assess your concerns and give you the individualized attention, support and guidance needed to help you achieve your breastfeeding goals. It is not uncommon for it to take a month or even two to get in a comfortable groove with your baby as you both learn to navigate the rewarding and nutritive relationship of breastfeeding. 

In addition to private consultations, we also offer a number of classes and groups to support you in your breastfeeding journey. These options include:

Breastfeeding Class (First Wednesday and Third Tuesday of Every Month, 6:00-7:00 PM): This class focuses on getting off to a great start with a comfortable latch as well as understanding nursing positions and infant feeding cues. The class also covers nutrition for breastfeeding, breastfeeding supplies, and common concerns such as infant growth spurts.

Mama’s Milk Hour (Thursdays from 2:30-3:30 PM): This group is a wonderful way to gain support in breastfeeding in those early weeks.  Come weigh your baby, practice breastfeeding in public, ask questions and connect with other mamas. Free and open to the public.

Pump Talk 101 (First Thursday of Every Month from 3:30pm - 4:30pm): If you’re returning to work soon, this class will help you learn how to make the transition by teaching the ins and outs of pumping and storing milk after you return to your job.

To learn more about the lactation services, classes and groups at Health Foundations, contact us to speak to a lactation consultant. We are dedicated to helping you achieve your breastfeeding goals and supporting you on the way.

How To Boost Your Milk Supply

breastfeeding mom

For many new moms, milk supply is a common worry. You wonder if your baby is getting enough to eat, if she is gaining the appropriate amount of weight and if your body could possibly be producing enough milk to nourish your growing baby. The reality is that most women make exactly what their baby needs. A very small percentage of women are unable to produce enough milk and require supplementation as the only option. The body has an amazing way of knowing exactly what your baby needs and adjusting its milk production accordingly. However, if you have been told that you may have a low supply or are concerned for any reason, there are several healthy ways you can give your supply a boost and ensure that your body is producing to its maximum potential.

1) Nurse, nurse and nurse some more: Our bodies produce based on demand. The more your baby nurses, the more your body will be signaled that it needs to produce more milk. If your baby is having trouble gaining weight, be sure to feed at least every 1.5-2 hours during the day and every 3 hours at night. Otherwise, it’s best to nurse your baby on demand especially as your supply is being established and you and baby are developing a healthy nursing relationship.

2) Use proper positioning and make sure baby has a good latch: How efficiently your baby breastfeeds is dependent upon an optimal position and a latch that allows for the maximum transfer of milk. Be sure to position baby close to you with his mouth and nose facing the breast and his hips turned towards you so that he does not need to turn his head. A baby who has a proper latch will have his tongue extended over his gums, lips flanged outward and will be covering your nipple and most of your areola with his mouth. If your baby is having a difficult time latching on and is unable to transfer sufficient milk, have a professional check for a tongue or lip tie. This is a common cause of a poor latch. A proper latch should not hurt.

proper latching technique

3) Pump in between feedings: Particularly if you feel your baby is not emptying the breast, pumping in between nursing sessions can be a great way to increase your supply and also to store up some extra milk on reserve. To further signal your body to produce more milk, continue pumping 2-5 minutes after the last drop of milk is released and use a high pump setting if your nipples aren’t too sore.

4) Offer both breasts at every feeding: Although baby may favor one side or the other, be sure to offer both sides at each feeding to ensure that both breasts are signaled to produce more milk. Switch baby to the opposite breast if you notice him dosing off, losing interest or ‘comfort sucking’. You can even offer both sides several times per feeding to ensure maximum milk transfer and production.

5) Steer clear of pacifiers and bottles at least until your supply is established: To avoid nipple confusion and allow your body to establish its supply, avoid the use of bottles and pacifiers until at least 3.5 weeks of age. During the first 3 weeks postpartum, your milk supply is under endocrine control and is being established by the baby spending time at the breast. Studies have shown that a minimum of 140 minutes of active nursing per day is needed to achieve your maximum supply. Artificial nipples can interfere with this process. In the event that you must be separated from your baby during this period, be sure to pump when you would have nursed. 

6) Take a ‘nursing vacation’: If you’re struggling with your supply, plan to spend a couple days in bed doing nothing but nursing your baby and resting. Not only will this allow baby to nurse often and trigger your body to produce more milk, it will also provide quality bonding and resting time for you and your babe.  

7) Take care of yourself: Giving birth, whether naturally or via C-section, takes a toll on your body. Not only are you in need of time to recover physically but you are also adjusting to caring for another human being around the clock. Getting rest, sleeping when you are able, staying hydrated and eating a nutritious, balanced diet are all important factors in maintaining your milk supply. Breastfeeding women require an additional 300-500 calories and at least 8-10 glasses of water per day. As with most all things related to parenting, if you don’t take care of yourself, you won’t be at your best for your baby.  

8) Limit alcohol intake: Although you may have been waiting nine months to enjoy that glass of wine, it’s best to do so sparingly while nursing. One study that examined women after drinking 1-2 glasses of wine found that they had a slower let down and produced less milk overall following the alcohol intake.  

9) When necessary, try a natural galactagogue: A galactagogue is any substance that promotes lactation. Some of the most common natural galactagogues used to increase milk production include fenugreek, Blessed Thistle, Red Raspberry leaf, brewer’s yeast and steel cut oatmeal. As with any medicine or herbal supplement, speak to your healthcare provider before trying any galactagogues to determine if that is the best decision for you and your baby.

10) Give baby only breast milk: When possible, avoid supplementation with formula. Breast milk is perfectly composed to meet the needs of your baby. When formula is used for supplementation, your body is not receiving the signal from baby to produce more milk. This is particularly important during a growth spurt when your baby is cluster feeding. Although it may seem like baby is not being satisfied because they are nursing so frequently, they are actually doing their part to boost your milk supply to meet their growing needs.

11) Massage the breasts: Massaging your breasts while baby is nursing or while you are pumping can increase the flow of milk. Start at the top of the breast massaging the milk producing glands firmly with your fingers in a downward circular motion. Gradually move closer to the areola as you massage, spending time focusing on each area of the breast. A warm compress can also help this process. 

12) Seek support: The help of a lactation consultant can be invaluable as you build a breastfeeding relationship with your baby. A lactation consultant can help with troubleshooting to determine if there’s a problem with latch, position or a ties and can also be a source of comfort and reassurance that your baby is getting exactly what she needs. Other great forms of support for nursing moms include breastfeeding support groups, mom groups, and friends and family who have breastfed their babies. It is so important that you feel supported during this special and often challenging time in your life.  Surround yourself with people who share your values and can help you uphold your wishes to breastfeed your baby.  

Even if you can't nail all of these tips, remember that most women do produce enough breast milk for their babies. The perception that their bodies are not producing enough milk is one of the most commonly cited reasons by mothers who decide to wean or introduce solids early. Unlike bottles, which you are able to measure, it can be difficult to determine exactly how much milk your little one is drinking. Rest assured though that as long as they are wetting and soiling their diapers regularly, they are probably getting exactly the right amount of milk from you. Also, breast milk is digested more quickly than formula which leaves breastfed babies needing and wanting to nurse more often. This is perfectly normal and healthy! 

At Health Foundations, our lactation consultants and postpartum nurses are here to assist you with any and all questions you have related to breastfeeding your new baby. If you are pregnant and just beginning your search for prenatal care, contact Health Foundations to schedule a free consultation with a midwife and a tour of our beautiful Birth Center. We are here to serve you at every stage.

 

Breastfeeding and Going Back to Work

Breastfeeding Career Mom

Returning to work after having a baby can be one of the most challenging transitions for a new mom. You may be feeling anxious about being away from your little one and wondering how he will fare in your absence. One gift you can give to your baby as you return to work is to continue to provide him with the incomparable nutritional and emotional benefits of breastfeeding. This may seem like an extraordinarily daunting task, to continue to provide milk for your baby while at work, but many women do so successfully and with great reward to both baby and themselves. Here are a few tips to ease the transition back to work and help you and your baby continue to have a thriving nursing relationship.

1. Get a good pump and get to know it well

While a hand pump may be fine for occasional pumping needs, if you are planning to return to work and will be pumping regularly, you want something that works efficiently and effectively. The best option would be to get a double electric or a hospital grade pump. There are several ways to obtain a breast pump including purchasing one yourself, renting one from a hospital or going through your insurance company. Many insurance companies today provide full coverage for a breast pump with no out of pocket cost to you. Once you receive your pump, review the directions, learn how to use and clean the parts and start practicing using it before you return to the office. Don’t be discouraged if you are not producing much milk at first. A baby’s sucking is the most effective means of extracting milk but your body will become accustomed to regular pump use and begin to produce more consistently.

2. Get a hands-free pumping bra

A hands-free pumping bra is an invaluable investment when it comes to comfort and convenience while pumping. This will allow you to continue to do work if you wish, make phone calls, eat your lunch, read a book or any number of other activities while pumping that you cannot do if you are stuck holding the flanges.  

3. Introduce your baby to bottles BEFORE you return to work

While you should wait until you’ve established a good breastfeeding relationship with your baby before giving a bottle, it is important to introduce bottle feeding before you return to work.  Some babies will easily adapt to the bottle while others may be less accepting of the change.  Don’t worry if your baby does not take to it right away, keep trying and know that they will eat if they are hungry. Consider having the caregiver who will be watching your baby while you are at work practice giving the bottle as well. Your baby may actually be more willing to take a bottle from someone other than you as it can be less confusing.

4. Discuss your plans to continue breastfeeding with your boss

In accordance with an amendment made to the Fair Labor Standards Act of 1938, you have the right to a reasonable break time to express milk for your baby for up to 12 months in a private place that is not a restroom. Although this law only applies to companies with over 50 people, all employers should be respectful of this right. Let your boss know when and how often you will need to take breaks and find out what accommodations they have available both for pumping and your milk storage.  

5. Establish a pumping schedule and routine

If you are returning to work when your baby is only a couple months old, you will want to pump every time you would have fed your baby. This is because you want to maintain your milk supply and let your body know that you still need to produce at the same frequency. Once your supply is more established, you may be able reduce the number of pumping sessions per day. Pre-schedule your pumping sessions and put a reminder on your phone or in your Outlook calendar to prevent missed sessions, engorgement and leaks. Be sure to allow yourself 20-30 minutes per pumping session as you will need time to clean the parts and store your milk after you finish. If you struggle to letdown with your pump, have pictures or videos of your baby on hand to help ease the process. It’s also smart to have snacks and water available to stay hydrated and nourished.

6. Choose a breastfeeding supportive caregiver

Finding a caregiver who understands and values the importance of breastfeeding and breast milk is an important part of returning to work. Be sure to educate your caregiver on how to handle, thaw and warm breast milk and what safety precautions to take in terms of making sure the milk stays fresh. Share the importance of holding your baby and lovingly offering a bottle in your absence to ease the transition of not being around mom. Consider storing your milk in small amounts (approximately 2-4 ounces) that can be thawed individually to minimize having extra that is wasted. Any milk that has been thawed and placed in the refrigerator should be used within a 24 hour period or discarded. It may be helpful to build a small stockpile of milk in your freezer for the caregiver so that there is always back-up on hand.  

For tips on storing human breast milk, see "Storing Human Breast Milk"

7. Maximize your time together with baby by breastfeeding often

When possible, nurse your baby right before you leave for work and right when you return to continue nurturing the breastfeeding bond. Consider sleeping near your baby at night so that you can nurse comfortably if needed. Often babies who are separated from their moms during the day will nurse more frequently at night. This is called reverse cycling.  Consequently, you may find that your baby actually eats less during the day with the caregiver than he does at night with you.  Any amount of breast milk you can continue to give your baby when you return to work is better than no breast milk. Make a commitment to yourself and your baby to try to continue exclusively breastfeeding for the first 30 days and if you find you are unable to produce adequate supply, you can always choose to supplement with formula. If you find yourself feeling discouraged or overwhelmed by the process of continuing to nurse your baby when returning to work, remind yourself of the tremendous physical and emotional benefits of breastfeeding. And always, as with everything in motherhood, find other moms to connect with who are on a similar journey. Sharing tips and support for one another during your transition back to work can be a saving grace during this stressful time. For questions about breastfeeding or other pregnancy and infant related topics, contact Health Foundations to schedule a free consultation with a midwife and tour of the Birthing Center.

A Brief (and Fascinating) History of Breastfeeding and its Alternatives

Madonna-Child Breastfeeding has never been without cultural commentary. Breast milk is arguably one of the most provocative of bodily fluids—we do not feel as passionate about urine, sweat, snot, or tears—and yet breast milk is a biggie. Since the beginning of time, breast milk has been revered…and has been a substance of great contention. The history of breastfeeding is fascinating, especially seen in the context of our current culture about breastfeeding.

Breastmilk has been revered since ancient times. In Classic Greece, the milk of a Greek goddess was thought to confer immortality to those who drank it. It was Hera’s breastmilk that made Hercules invincible. It was Hera’s breastmilk that formed the Milky Way itself (so the story goes). The Mother Mary was exempt from sex, pain in childbirth, and perhaps many bodily functions (at least as the story goes)—and yet she breastfed. Baby Jesus at the breast of Mary has been one of the most popular and powerful artistic images for millennia.

Painting by Leonardo DaVinci

In ancient Egypt, wet nurses were exalted, despite their station as servants. They were invited to royal events. The children of royal wet nurses were considered kin to the king. In the great tale of Odysseus, only two individuals recognized the protagonist after his long absence from home—his loyal dog and his wet nurse. History has long recognized and exalted the special nature of the breastfeeding relationship.

But history has also complicated the breastfeeding relationship by adding cultural and ethical baggage to what is a biological function. We all know the current conditions around which our babies are fed—the importance given to breast milk, the push for formula by some and the rejection of it by others, the judgments that are made about women who want or don’t want to breast feed, women who can and cannot breastfeed, women who love and women who loathe breastfeeding, women who breastfeed a short while and those who nurse for years. It all comes highly charged.

And this high charge is nothing new. Formula vs breastmilk may be the contemporary dichotomy of choice (with a long list of subtler but equally divisive nursing nuances), but there have long been alternatives to a baby nursing at his or her mother’s breast.

We think of formula as a relatively new invention, but seeking breastmilk substitutes has long been a human enterprise (however unsuccessful many of those attempts). Breast-shaped clay bottles have been found in ancient sites in Europe that date back to 3500BC. Some historians believe that cows and goats were actually domesticated for the reason of providing a human breast milk substitute to infants. Babies may have suckled directly from these animals or been given human-fashioned devices very roughly akin to our modern baby bottles. Cow and goat milk substitutes largely fell out of favor when people learned that babies do not thrive on these human milk alternatives. Records from 18th century Europe, for example, show that babies given milk from these animals early on suffered greater rates of diarrhea and death compared to those fed human breast milk.

Animal shaped ceramic feeding bottle from Regensburg, Germany, ca. 1350–800 BCE

In addition to the long search for human milk substitutes, history shows us a long storied use of proxy milk givers—the practice of a woman other than the child’s mother nursing the child. This practice—called wet-nursing—is ancient and was one of the few ancient professions open exclusively to women. While not a common or accepted practice in the West today, wet nurses were once so popular that they had to advertise their services and compete for business. In 16th century England, how-to books were published for new parents about how to hire a wet nurse and what attributes she should possess. In Renaissance Florence, wet nurses gathered in public squares to sing songs in promotion and celebration of their services.

The use of wet nurses began in the upper classes; but, like many elite trends, it trickled down to the masses. (Formula use followed a similar trend.) By the 1600s in Europe, over half of all women were sending their babies off to be nursed by other women paid for such a service. In 1780, less than 10 percent of all Paris-born babes were nursed by their mothers, according to one historian. Expensive wet nurses even sent their babies off to be nursed by cheaper wet nurses so they could keep their supply for paying customers.

The Wet Nurse, c.1802, by Marguerite Gerard

Why such popularity in wet nurses? Historians postulate many reasons for the rave. Some argue that men did not wish for their wives to breast feed for a gamut of reasons. One, it “ruined their maidenly bosoms.” Two, it took women and their affections away from men. Three, nursing was understood to compromise a woman’s fertility—the more a woman lactated the fewer babies she made. Men seeking progeny and heirs became great critics of lactating wives. There were also superstitions that intercourse somehow tainted breastmilk, another reason for a lack of support for breastfeeding.

As with so many popular trends, there came a backlash against the use of wet nurses. Come the late 1700s/early 1800s—as part of the reform movements that swept across the social landscape of Europe and the United States—many women and men were calling for a return to in-home breastfeeding of babies by their own mothers. It was even billed as a feminist issue, though women still bore the brunt of this new creed—where once you were not a “good enough woman” if you DID breastfeed; now, you were not “good enough” if you DIDN’T nurse your babes. (Sound familiar?)

In 1793, the French declared that women who did not breastfeed were ineligible for welfare. In 1794, the Germans took it a step further and made it a legal requirement that all healthy women breastfeed their babes. By the early 1800s, elite women were bragging about their commitment to breastfeeding. Ah how the tides do change.

Victoria Era breastfeeding

Though wet nursing has never regained popularity, similar themes have risen and met their demise in times since. The 20th century equivalent came with the advent of infant formula. Elite men and women again led the charge. Formula has historically been both hailed and rejected. At one time, formula was considered superior to breast milk in purity and nutrition. Later it was condemned as a harmful substitute for human milk. Other arguments swirl around these, many of which we know well for we still swim in these cultural waters.

porch nursing

The sway between breastfeeding and formula use has been striking in the United States in the last hundred years or so. Prior to 1930, most all mothers nursed their babies. By the early 1970s, only 22 percent of mamas breastfed, and most only for the first few weeks of life. Today, breastfeeding rates are on the rise. In 2011, 79 percent of newborn infants were breastfeed. Though the World Health Organization currently recommends babies breastfeed for 2 years, many nursing pairs do not breastfeed that long. Of infants born in 2011, 49 percent were breastfeeding at 6 months and 27 percent at 12 months.

WPA PSA

Women throughout all of history have been subject to the cultural ideals and mores of the current day. All women throughout time have done their best, given the constraints of work, responsibility, familial and social expectations, desire, health, and ability.

Florence Owens Thompson (mother), taken in 1930s in Nipomo, California

Please note that this article does not attempt to be exhaustive in covering of breastfeeding's history, which is certainly a topic that could be covered in MUCH greater detail. This article does not cover historic breastfeeding trends worldwide, but rather, primarily focuses on Western culture, and even within this sphere of focus, much is surely uncovered.  We invite you to delve further into this rich history should you so desire and share with us your interesting findings!

The information in this article is largely based on a chapter from Natalie Angier’s phenomenal book “Woman: An Intimate Geography.” For all those who love and care for the female body, this book is an incredibly insightful and valuable read.

Breast Feeding after Breast Reduction (BFAR)-- One mama's journey through the first 6 months

BFAR - My Journey through 6 Months

Photo credit: Render PhotographyWhen I became pregnant with my son, George, I knew I wanted to breastfeed him.  There were a lot of reasons that this was important to me: nursing him would be better for his health, for my health, and it just felt like it was the natural thing to do.  Every time I learned another thing about breastfeeding, I was amazed.  
 
I read so many horror stories on the internet, from bleeding nipples, to low milk supply, to oversupply.  In fact, my mom hadn't been able to nurse me due to recurring mastitis, and she never even tried with my brother.  I knew that nursing could be really hard - it could be impossible.  And that was from women who had never had breast surgery.  
 
When I was 17, I had a breast reduction.  It was not a tough decision to make.  I was told that there was a chance I wouldn't be able to breastfeed, but I was 17 and not thinking that far down the line.  I had the surgery the summer I graduated from high school, and I felt so much more confident.  Although I had the scars to remind me, it became a distant memory.
 
Fourteen years later as I prepared to give birth, I started researching as much about breastfeeding after breast reduction as possible.  I read Diana West's book, Defining Your Own Success: Breastfeeding after Breast Reduction Surgery.  In it were many stories about women who had varied amount of success with breastfeeding.  I felt like the book prepared me to fail, to be mentally OK with the idea that exclusive breastfeeding was not the only option.  
 
I called my plastic surgeon to ask his office which type of surgery I'd had (inferior pedicle).  That method was known to have the best success rate for nursing because it leaves the nipple intact.  I was relieved.
 
I read and read and googled everything I could on the internet.  I think I found one success story on a blog but for the most part success stories were few and far between, especially for first time moms.
 
Perhaps the best thing I did was read Ina May's Guide to Childbirth.  Her book helped shape my whole birth plan.  Instead of giving birth in a hospital, I chose to have my baby in a freestanding birth center.  Although her book did not directly discuss breastfeeding after a breast reduction, it did offer many suggestions applicable to all women attempting to breastfeed - skin to skin contact immediately after the birth of the baby, rooming in with the baby, initiating breastfeeding as soon as possible after the birth, limiting the use of drugs and other modern interventions so that baby is wide eyed and awake after birth, no pacifiers, bottles, supplementing, etc.  I felt that having a natural birth, without any medical intervention (no pitocin, no pain medications, etc) would set me up for the best breastfeeding journey.  Additionally, the birth center released its patients just 5 hours after the birth of the baby.  I'd recover in my own bed, with my husband and mom caring for me, instead of nurses I didn't know, which was one of my biggest fears about a hospital setting.
 
BabyGeorgeI'm not sure if I would have been as successful breastfeeding had my birth story been different, but I am so thankful that I had an uncomplicated labor and delivery, and I was home in my own bed the night that George was born, snuggling with my sweet baby.  
 
My milk came in within 48 hours of having George.  George was born 2 weeks late at 9 lbs, 6.5 oz.  I think he got down to about 8 lbs 12 oz, and was back to 9 lbs 1 oz by day 6.  He nursed like a champ!  He was hungry ALL the time and those first couple of weeks my nipples were SO sore, but no one, myself included, ever asked if he was getting enough milk.  There was never a doubt in my mind.
 
I wanted to wait we had really settled into a routine to write about my experience.  It was so wonderful, I didn't want to jinx it.  
 
RockingchairI exclusively nursed George until he was just 5 days shy of 6 months old.  We then started introducing solid foods via baby led weaning.
 
I think that there are a couple of things that really helped us to have a successful nursing relationship.  One: a birth team and husband who knew a lot about breastfeeding and who were 100% supportive.  Two: a ton of education while pregnant.  The birth center offered a one on one consultation with a lactation consultant during one of the last visits; one of the Bradley Method classes was dedicated to breastfeeding; in addition, I had the chance to do lots of research on sites like kellymom.com, which I bookmarked for questions that arose after George was born.
 
milkdrunkgeorgeNursing my son might be the coolest thing I've ever done.  It's definitely the most beautiful thing my body has ever done, in addition to growing this tiny, perfect human.  I hope and pray that every woman who wants to breastfeed has the opportunity to do so, and that my story can help offer some hope to women who have chosen breast reduction surgery.
 
UPDATE:
George is now 9 months old are we are still enjoying nursing - maybe more than ever!  It calms him if he's upset, it helps him sleep if he's tired, and it's so easy now that he can more actively participate.  I'm planning to let George self-wean, and I definitely don't see that happening anytime soon.
TracyGeorge

Herbs and Breastfeeding

herbs and breastfeedingA particular herb can be a powerful source of medicine or it can pose significant risks or unwanted effects, depending on who is consuming it and when.  In pregnancy, some herbs are incredibly beneficial, while others should be avoided entirely.  The same is true when breastfeeding.  In particular, some herbs are known to help increase the supply of breast milk, while others deplete or stop the supply. What is considered safe and ideal depends on the woman’s aim, among various other factors.  If she is trying to build her supply, galactagogues are ideal.  If she is trying to wean or needs to dry up her milk (perhaps because of infant loss), she may want to use a different set of herbs.

Or it may be that she is considering the use of an herb for a reason unrelated to breastfeeding and wants to know if and how those herbs may affect her supply.

Below is a partial list of common herbs that can build or deplete breast milk supply.   It is always good to speak with your health care provider before beginning any new herb or medication when pregnant or breastfeeding.

Galactagogues: Herbs that promote breast milk production

Some of the most commonly used herbal galactagogues are:

  • Fenugreek
  • Blessed thistle (a bitter herb known to help liver and digestive problems as well)
  • Alfalfa
  • Anise seed (also considered good for colic and gas pains)
  • Chaste Berry
  • Fennel seed
  • Hops
  • Milk Thistle seed
  • Nettle Leaf

It is important to note, however, that most women do not need to take such herbs or take any other medications or foods to increase or maintain their supply.

Cases where such herbs may be useful include:

  • Working mothers may use these herbs to increase their pumping output (since pumps are typically less effective at milk removal than babies are).  This may be true even if their supply is adequate when baby nurses.
  • Moms who adopt children may use galactagogues to increase the amount of milk they provide their babies.
  • Some moms who have a genuinely low milk supply may use these herbs in combination with increased nursing and pumping.

If you suspect a low supply, you should speak with a lactation consultant and/or a La Leche League leader first.

Herbs that can deplete breast milk supply

These are herbs that most breastfeeding women will want to avoid, unless they are weaning or needing to abruptly stop breastfeeding with good cause.  The ability of these herbs to deplete milk supply is dependent on how frequently and how much of the herb is consumed.  Consuming a small amount of the culinary herbs below generally will not affect supply.

  • Sage
  • Jasmine flowers
  • Peppermint (especially peppermint oil)
  • Thyme
  • Spearmint,
  • Parsley
  • Chickweed
  • Black Walnut
  • Stinging nettles (not nettle – that increases milk supply)
  • Yarrow
  • Lemon Balm
  • Oregano
  • Periwinkle Herb
  • Sorrel

 Word to the wise

When considering any herbal remedies while breastfeeding, it can help to follow these precautions:

  • Avoid pharmacologically active herbal teas. Drink herbal teas in moderation.
  • Limit herbal preparations that combines several active ingredients.
  • Always check the label. Even vitamins and echinacea may contain herbs that should not be used by breastfeeding mothers.
  • Use only reputable brands that have ingredients, concentrations expiration date and name of the manufacturer and distributor clearly marked on the label
  • Be sure to check with your health care provider before taking any natural remedy, since it could interact with other medications.

Sources:

www.kellymom.com (multiple pages)

http://www.mobimotherhood.org/MM/article-herbalgal.aspx

Oxytocin in Childbirth: A Labor of Love

Last week, we talked about the role of endorphins in natural childbirth and today we turn our focus to oxytocin, another crucial hormone in the symphony of chemicals created naturally in the body to help mom and baby through childbirth. There are four major hormonal systems active during labor: endorphins, oxytocin, adrenaline and noradrenaline, and prolactin.

What is oxytocin?

pregnancy oxytocin

Oxytocin, known as the “love hormone,” is a hormone and neuropeptide that causes both physiological and behavioral effects when produced in the body.  It is produced in the hypothalamus of the brain and is released into the bloodstream via the pituitary gland.

Our bodies produce oxytocin when we are attracted to a mate, during lovemaking (it assists with arousal, fosters bonding and may facilitate sperm and egg transport), following positive social interactions (it can even potentially improve wound healing following such positive interactions, say experts), and with other positive experiences.  It is thought to enhance our capacity to love ourselves and others.

Oxytocin is produced in pregnancy, levels increase significantly during active labor and childbirth, and both mom and baby produce oxytocin after birth and as long as baby breastfeeds.

Oxytocin evokes feelings of contentment, trust, empathy, calmness and security and reduces anxiety and fear. Under certain circumstances, oxytocin can hinder the release of cortisol, or stress hormones.

What are the functions and roles of oxytocin in childbirth?

Oxytocin plays a major role in the following:

  • Uterine contractions that help facilitate dilation in labor
  • Facilitating the milk let-down reflex
  • Fostering the mother-baby bond
  • Encouraging maternal behavior in the first hour after birth
  • Released during breastfeeding, oxytocin causes mild uterine contractions after birth to expel the placenta and close of many blood vessels to prevent bleeding
  • Assisting the uterus in clotting the placental attachment point postpartum

What helps to facilitate the production of oxytocin naturally during labor?

Unhindered production of oxytocin is important in labor because oxytocin is responsible in large part for uterine contractions.  Oxytocin initiates labor and helps it keep going strong.

Because the production of oxytocin is so connected to our emotions, it is paramount that a laboring mama feel calm, secure, and uninhibited in her environment and that she trust those around her.  A dim room without too much excitement or distraction is an environment conducive to the unhindered production of oxytocin.

happy birth

Natural ways to stimulate oxytocin production in labor include:

  • Caring, non-medical touch
  • Nipple stimulation (this can be helpful in getting labor started in some cases, or to increase strength and frequency of contractions)
  • Laughter and humor
  • Kissing (Ina May, a famous midwife, touts “smooching” as a great way to keep labor going)
  • Gentle exercise, dancing and rhythmic movement
  • Feeling grateful and loving (a partner’s words and actions can be so instrumental in helping mama create oxytocin and so help her labor along)
  • The repetitive use of mantras, prayer or sounds
  • Meditation, positive visualization and hypnosis
  • Relaxation
  • Warm bath

What can diminish oxytocin levels in labor?

Again, because of the emotional connection, any experience of fear, anxiety, stress, tension, discomfort, or distrust can negatively effect oxytocin production during labor.  A feeling of being watched can also hinder oxytocin release.  The use of synthetic oxytocin (Pitocin)—which also stimulates contractions and is used to induce labor—can also slow the body’s own production of oxytocin.

Oxytocin in Breastfeeding

oxytocin breastfeedingOxytocin, also called the cuddle hormone, is released by both mama and baby during breastfeeding.  It can cause slight sleepiness, mild euphoria, a higher pain threshold, and increased love for one another.  It also helps build the attraction and strengthen the bond between mama and baby.

As you can see, oxytocin is an amazing gift and tool our bodies make to help us through childbirth and postpartum.

Interview: Welcome Baby Care's Carey Lindeman

wbcWe had the pleasure of speaking with Carey Lindeman, founder of Welcome Baby Care to discuss postpartum care and her pioneering postpartum doula service in the Twin Cities.  Many people don’t know what a postpartum doula is or how they can help.  Hopefully, this interview will shed some light on this invaluable and unique type of postpartum support and what amazing doulas, like those at Welcome Baby Care, can offer.

What is a postpartum doula?

While a lot of people have heard what a birth doula is, not everyone has heard of or understands what a postpartum doula is.  Essentially, what a postpartum doula does is come into a family’s home after the birth. Our first priority is taking care of the mother and making sure that she is healing properly and bonding with her baby.  So our goal is to relieve her of the things that would normally be overwhelming her.  Whether that be laundry, changing the sheets, keeping the bathroom clean, cooking, maybe running errands.

So there is that piece and there is also the education piece where we educate on taking care of baby—you know, best practices, what’s normal, what’s not, as well as what is normal and what is not in her own recovery.  So a lot of the questions she may call the doctor about or wonder about, we are able to help with and so help her with the transition into a more confident parent and navigating all of the unknowns.

Having this support can speed up the process of becoming a more confident parent and bonding with your family, staying connected with your husband, all those things you are negotiating during this tremendous transition.

What does a typical doula visit look like? 

ppdoula

It could be two different things depending on whether it’s a day shift or an overnight shift.  A daytime shift is usually a minimum of 4 hours.  When the doula arrives at a family’s home she is going to assess what is going on—she may walk into a sink full of dishes,

piles of unfolded laundry, or mom may need some hands on help with the baby or with breastfeeding).  She is not going to ask, “what can I do” but instead will assess and do what needs to be done.  She may ask things like “Have you had anything to eat today?” to mom.  Usually what a doula will do is prepare snacks for the day for when mom is feeding, she’ll prepare food for later, she’ll clean up, and essentially her goal is to create a very stress-free environment.

And, you know many times a doula is walking into chaos, there may be multiples or other challenging situations.  A doula’s role is to put a “calm” on the situation.

She may be managing other people as well—maybe there are grandmas involved or aunts, cousins—she may have to say to them “This is where you can be most helpful right now.”

 What about if there are older children there, how does that look with a postpartum doula? 

With other children, what a doula will do is find a way to entertain and manage them while mom needs to be breastfeeding or napping or whatever she needs.  But she also finds ways to incorporate the family together.  So it isn’t just a separation of mom from partner and other children.  Sometimes, for example, the doula will make a snack and ask dad or an older child to take it to mom and sit with her.  We are always trying to foster family bonding.

Great, and what about that overnight postpartum doula service you mentioned?

Yes, going back to our overnight care, this looks a little different.  This is a separate service and definitely our most popular.  A typical overnight shift will begin at about 9 or 10 at night. Mom and partner are off to bed immediately and we take over from there.  We are with the baby.  Mom may choose to pump and have us feed the baby or maybe she wants to breastfeed.  In that case, we would console baby for as long as possible, then bring the baby into her, she can breastfeed, and then we will change the baby and put him or her back to bed.  So we are with the baby all night long while the parents sleep.  The doula will stay as long as the family wants them in the morning but a typical shift ends about 6 am or so.  A lot of times we leave when everyone is sleeping.  And mom can get up with baby whenever that is.

What does service typically look like for a new or growing family—how often do people need care, is it different for everybody? 

You know it is different for each family, depending on if there are multiples or not, if it is a first child, etc.  We do have packages offered on our website that give some examples.  And I would say that most people buy one of our packages.  Probably in the next few weeks people will be able to purchase these right from the website (as well as our classes).

twins

What does the training look like for a postpartum doula? 

We have our own postpartum doula training and certification program.  We have an excellent trainer formerly from Fairview and she has developed a certification program.  We felt that a lot of postpartum doulas coming to us as DONA-trained doulas (birth doulas with a piece of postpartum education) had great training but that it didn’t go far enough.  We wanted more extensive training.  So we developed our own specific postpartum training program.

People can go through it and not necessarily work for us, though there is always the option to interview with us, while other people will work independently or just want to learn this information for their own benefit.  We give people a max of 6 months to go through the program and there are 4 components: reading, classroom training, shadowing a doula, and pro bono work for moms in the community that need help.  The details of the classroom training content can be found on our website.

How did Welcome Baby Care come to be? 

One of the unique things about our service is that we also do senior care—so we are kind of a full spectrum in-home care provider.   How Welcome Baby Care started was with this senior business.  When my stepdaughter was having her first baby—and I have raised four children myself—I was there as a grandmother I thought, “I’m really rusty—I don’t really have all the answers to help out.” So what occurred to me at that time was, just like seniors, new moms need support, everybody needs a doula.  And its just one of those things, you know it’s the same type of care, the difference is the type of caregiver.  But it is still that turbulent time in people’s lives where they don’t know what they are getting into.  It’s so new.

So that is when we decided to have these two ends of the care spectrum (we split these into two sister companies).  And that’s how it came about.  Then I discovered that a doula with her expertise, the sixth sense they have…those were the kind of people that I wanted to do this care.  They are just so loving and caring and have such a heart.

Can you tell me more about the doulas you work with? 

The doulas are hand picked and multi-talented.  They all have their own gifts; they are all different in so many ways.  They are all doulas but they all have special additional gifts that they can offer.  So when we are interviewing with families, what’s great is that we have this whole team to pick from, not just one person.  So we can really assess what the family needs and hand pick the doula or doulas that are going to be the best fit.

Another great thing about having a doula team—and all of our doulas are our employees, none of them are contract—is that we have ongoing monthly training. So we may have speakers come in, and there is always a discussion session.  If there is ever something with a family that they maybe have a question or concern about, it’s all confidential, but they also have this team to talk with and get support from.  So they are not trying to figure things out all on their own.  And what’s really important is this ongoing training component.

When they go into a home, we always want that continuity of care.  So when you hire our doulas, you are not going to get someone different every time.  You are going to get the doula or two that are the best fit for you (# of doulas per family depends on # of hours needed).

What other services does Welcome Baby Care offer?

Through in-home care, lactation support, and classes, we offer:

  • Information for bonding techniques for new families (including adoption)
  • Breastfeeding support and counseling
  • Special care for preemies and multiples
  • Expertise in postpartum depression
  • Overnight care
  • Household care
  • Bedrest support
  • In-Home infant CPR

As far as our classes go, we offer a gamut of breastfeeding classes.  We have Breastfeeding 101, which is “the basics”.  The 201 class is not just breastfeeding or bottle feeding but also weaning, starting solids, and those types of things.

We also have a Grandmothers class, which is really popular.  This is where the expectant mom and her mother and/or mother-in-law come to class together.  And they talk about the differences between when grandma had the babies versus now.  A lot of new things that are happening, such as back to sleep and feeding and equipment, and all those things that may be new that grandma may not know about.

Kind of breaking down the barrier of her knowing what is important, and what mom feels is important, because often grandmas play a large role in raising the new child.  So with the help of this class, they are not going into it with preconceived ideas, barriers, and walls and not really discussing it.  And it’s learning on both ends—both the new mom and the grandma.  It’s a combination of education and facilitating communication between the generations.

gma

What if you are not sure during pregnancy whether you want or need a postpartum doula? 

I would suggest pursuing it.  We are here to answer all questions without any strings attached.  And maybe its not even postpartum services she may have questions about.  We also have a separate lactation service so maybe if she is feeling uncomfortable about breastfeeding and has questions, you know she can ask without being locked into in-home services.

I think that it’s worth attending one of our classes. We help provide a postpartum plan.  You know a lot of people make a birth plan, but not always a postpartum plan.  And we help you develop a plan, which covers things you should be aware of postpartum.

And again, consider calling and asking questions or even interviewing someone just in case, because again no strings attached ever.  People don’t always realize the importance of having that care.  You know, in other countries, people have their families and they have people helping them and we just don’t have that in this country.  The lesson is from second world nations that really know how important extended family care is.

What if you are sitting at home one week postpartum and you realize you need some help.  Is it too late to call a doula? 

It’s never too late.  We answer our phone 24/7.  I get calls during the night.  Calls come in when people are in the hospital or are feeling like they need to go back to the hospital.  You know, I got a call from a mom recently, I couldn’t even understand her.  She was so tired and so overwhelmed—it was four in the morning—and I was trying to get information and finally I just asked: “Do you need help right now?”  She asked if we could call her back in the morning at nine.  So we called her back and she was so overwhelmed.  But we were able to help her.

So anytime, we are available for new moms.  We want you to call us.

What advice might you have for pregnant mamas?

No expectations.  I mean, plan, but have an open plan for how the postpartum is going to look.  I think one of the most damaging things about our social world and the media is they put such high expectations on new moms and I think that is a mistake.  To buy into that and listen to too many people ahead of time and have all these expectations and lofty goals is a mistake.

You know, take things a day at a time and realize that, more than anything, you just want to have time for that baby, and give them everything they need.  But don’t have this idea of what its going to look like—like you’re going to lose weight, you’re going to look like this, you are going to have all the perfect equipment and clothes, and everything is going to look perfect and composed, and then buying into what all your friends are saying.

You know make sure you know who your support people are: get the support.  But don’t surround yourself with people who tell you how you need to be—just get that loving non-judgmental support.  And know, too, that we come in with NO judgments—mom can decide and parent the way she feels is right.  You know, we will guide and support but we will not judge.  That’s the biggest thing—you do not want judgment around you because it is just toxic.

What advice do you have for new mamas, who are maybe going through the postpartum period right now?

For them, I would say, the same information applies.  You need the support of other people.  Do not isolate.  Get the support.  Find those people that don’t have expectations for you.  Because you are the parent and you know your baby better than anybody and you need to be the one to make decisions.  You know, 10 or 20 years from now, it is going to be your decisions that matter, not anyone else’s.  So I think you need to really look at your own “mama guts” because you know.  And don’t think you don’t know because you DO know what is best.

And also, there are so many good resources out there, so take advantage of these great resources.

And plenty of rest and relaxation, and try not to put too many expectations on yourself.

You can contact Welcome Baby Care on their website or by calling 952-942-5676. 

 

Insurance Coverage for Breastfeeding Support: Pumps and Lactation Services

Breastfeeding_a_baby

The Good News:

Under the federal Affordable Care Act (ACA) of 2010, insurance companies are now required to cover the costs associated with breastfeeding, such as breastfeeding pumps and lactation services, without a copayment or co-insurance to meet your deductible so long as the services are “in-network.”*

The Bad News:

The language of the act is a bit vague and so insurance companies are setting their own specific policies about what is covered and how to go about procuring the breastfeeding support services and supplies you need.

This has created much confusion about the law and what it means to mamas.  We are here to help you understand your rights and advocate for the benefits to which you are entitled by law.

Call your Insurance Company First

Contacting your insurance provider is the first step in understanding what breastfeeding-related coverage and benefits you are eligible for.  Generally speaking, lactation consultants typically fall under preventative care, while breast pumps are considered medical supplies.

We’ve seen mamas get lots of different answers from their insurance providers about what is covered.  Some will cover hospital-grade pumps, while others only cover hand pumps.  Some have specific brands of pumps they will cover, and many require that you purchase such pumps at specific medical supply locations. This is due to their “in-network” requirements.

It’s best to call your insurance company before your baby is born (but, of course, its not too late once they’ve arrived).  Your insurance card should have the company’s toll-free member services number on the back.

Questions to Ask about Breast Pumps:

  • What type of pump can I get? (hospital-grade rental pump, double or single electric personal-use, battery or manual pump)
  • Do I have brand options?
  • Do I have to get the “recommended” pump or can I choose to purchase one (aka “out-of-network”) and submit the receipt for reimbursement?
    • If yes, what amount will I be reimbursed? Is there a dollar limit on coverage for breast pumps?
    • If I have already obtained a breast pump, can I submit a claim for reimbursement?
    • Do I have to get the breast pump approved first?
    • When can I get my breast pump? Before giving birth? After the birth of my child(ren)?
    • Where can I get my breast pump? Does it have to be from a designated place (aka “in-network” provider) or can I choose where to get it?
    • Do I have a rental pump option? Do I need a prescription for proof of medical necessity?

 Questions to Ask About Lactation Consultations:

  • Is there a limit on the number of visits with a lactation consultant?
  • Do I have to get the lactation visits approved first?
  • Where can I receive lactation counseling services? Are there approved in-network providers? Can I get reimbursed if I use a lactation counselor out-of-network?

Medela has great tips on talking to your insurance provider, especially if you encounter difficulty getting the coverage provided by law.

Contact the Medical Supply Providers or Lactation Consultant

Once you have obtained a list of “in-network” providers, it’s a good idea to contact the medical supply providers your insurance company gave you.  Ask them about what types and brands of breast pumps they carry and if there are any specific requirements related to obtaining your desired pump as covered by insurance.  For example, some medical suppliers will not allow you to obtain a pump prior to birth.  Some will let you pick up the pump, while others will deliver it to your home.

Same goes for lactation consultants—be sure to call the ones your provider gave you to get details about the services they offer.

Breast Pumps and Minnesota Care

If you are receiving Minnesota Care you may also be eligible for coverage.  The same recommendations apply: call your insurance company first and then call the medical supply providers.  (You may also have to contact your Minnesota Care caseworker.)  Make sure the medical supply provider is aware that you are covered under Minnesota Care, as this can affect the type of pump you are eligible to receive.

Getting Help Getting Covered

If your insurance representative doesn’t give you the answer you’re looking for, ask to speak to a supervisor. If that doesn’t work, tell them your going to file a request for assistance with the Department of Insurance.  Often, this is enough to prompt action.  If not, the Department of Insurance can be of assistance.  They can be reached with questions at 1-800-657-3602 or 651-296-2488.  Select the Insurance option (choice #1) on message menu to speak with an insurance investigator who can assist you.

Wishing you a smooth and easy experience obtaining the breastfeeding support services and equipment you need!

*Note: This federal law covers private and commercial insurance carriers but does not cover Medicaid or WIC.