Dear New Mom: Put Down That Cookie!

Dear New Mom,

I get it. I’ve been there. It’s exhausting. Your baby is days (weeks, months?) old and all you can think is “oh my gosh, why is he eating again? I can’t have enough milk! That’s it!” So you turn to the internet. There you are bombarded by all sorts of suggestions to help get milk in: Cookies, smoothies, breads, drinks, teas, herbs, the list never ends! AHA! You rush out to the grocery store, stock your cart filled with goodies, and return home knowing this will solve your problems.

The truth is new mom, you don’t need the cookies. I promise. While sure, they taste awesome (because really who doesn't love a cookie!) in most cases your milk supply is just fine. The fact of the matter is babies nurse a lot. They nurse all night long and sometimes all day long too. Sometimes they get fussy at the breast and act like there is no milk there. I can assure you, there probably is. The biggest reason for the fussing is a growth spurt. There is no set time for this to happen, and they happen ALL the time. Look at how much growing your baby is doing in the first year of life! And how much they change! If your baby is a bit older, supply regulation is happening. This doesn't mean you don’t have enough milk, it means your body now is producing exactly what your baby needs. Sometimes they can get a bit frustrated when the milk slows down a bit and they have to work harder, but it’s all totally normal.

If you are struggling with weight gain or not pumping enough at work, find a good IBCLC to work with. You need to figure out the underlying problem. With weight gain often times its a transfer issue, and more milk isn't going to help your baby transfer better.  Remember: your pump is not as efficient as your baby. Its normal to pump .5 – 2oz combined when you pump after nursing, and 2 – 4oz combined is normal when you pump at work. Often times the struggles with pumping at work are actually related to overfeeding at daycare or not pumping enough. We can help you find a solution!

So new mom enjoy that cookie, but please know that the best thing you can do for your supply is to nurse frequently and watch your babies ques. The first year of life is exhausting for everyone, but this too shall pass, and in the blink of an eye you will have a toddler running around keeping you on your toes.

POSTPARTUM MOOD DISORDER

Women-One in five.  Men-One in ten.   These are the numbers of new mothers and fathers who experience Post Partum Mood Disorder.  No longer described solely in terms of depression or anxiety, Post Partum Mood Disorder is a disorder that describes women and men who are not only depressed or anxious but also moms that experience scary, intrusive and obsessive thoughts and obsessive behaviors (Postpartum OCD), as well as moms that experience frequent panic attacks (Postpartum Panic Disorder).  Some moms experience difficulty managing their anger and feel intense feelings of rage.  Postpartum Mood Disorder also includes moms that experience symptoms in pregnancy  (Antenatal Mood Disorder) and moms that experience mood and anxiety problems related to traumatic births (Postpartum Post Traumatic Stress Disorder).  For a very small number of women, this illness can progress to Postpartum Psychosis which needs immediate medical and psychiatric attention.  The symptoms of PPMD can develop anytime in the first year after birth or after weaning from the breast.

There are many symptoms of Postpartum Mood Disorder and the website, Postpartum Progress, outlines these symptoms quite well.  http://www.postpartumprogress.com/the-symptoms-of-postpartum-depression-anxiety-in-plain-mama-english 

Many moms wonder how Postpartum Mood Disorder and breastfeeding interact with each other.   There is evidence to suggest that breastfeeding protects and/or lowers the risk of postpartum mood symptoms and that weaning early may not be in the mother’s best interests and may not reduce or clear her symptoms. http://www.sscnet.ucla.edu/comm/haselton/unify_uploads/files/Hahn-Holbrook,%20Haselton,%20Dunkel%20Schetter,%20Glynn%20Does%20breastfeeding%20offer%20protection%20against%20postpartum%20depression.pdf  However, early weaning due to PPMD is a personal decision and for some moms due to certain medications or conditions (such as complications from psychosis and medications to treat psychosis or suicidal ideation or behavior), it may be in the interest of her health and safety to wean.  Weaning early should not be taken lightly and should always be discussed with a doctor or IBCLC.

There are several natural ways a mother can help herself with her mood and anxiety symptoms.  A nutritious diet high in protein and sleep as well as any type of physical activity are important first steps.  Disrupted sleep is one of the biggest triggers for PPMD so it’s even more important to rest and find ways to get good sleep with a new baby.  The housework can wait, nap and cuddle with your baby.  Even a walk outside with or without your baby for 30 minutes a day can make a difference.  Deep breathing is the number one way to manage anxiety and progressive muscle relaxation and guided meditation are also very effective ways to treat depression and anxiety.  Practice these techniques before bedtime for 10-20 minutes.  Not only will you gain the practice to be able to use these techniques when you are feeling low but it will also help you fall asleep.  You can find several different scripts and ways to practice these techniques online and guided meditations are available online as well to download to your preferred media.  Journaling, asking for help for household chores and childcare, reducing your caffeine and sugar intake, a daily hot shower, taking care of your hair and body, reading, sex and masturbation (when you’re up to it, of course), yoga and other restorative exercises, and enjoying your interests and pleasurable activities are all great ways to help manage your feelings.   Take a break from childcare and put yourself in timeout.  It’s so important for your well-being and for the well-being of your children.  If you’re feeling overwhelmed or having a particularly bad day or, just pick one to do and it will make a difference.

Some mothers may need further assistance from their primary care physician to address their symptoms, especially if they are worsening or not improving with good lifestyle changes addressed above.  There are several medications that are considered safe for breastfeeding mothers.  Download Lactmed to your phone or call Infantrisk or Mother Risk with your doctor to find a safe option for you.  Medications take time to work (about 4-6 weeks for antidepressants) and sometimes it takes multiple trials of different medications for a mother to get relief because not all medications work for all people.  Some mothers also benefit from seeing a professional counsellor to talk about their feelings and find solutions.

As for dads, they can get postpartum mood disorder too.  Many dads have symptoms related to depression, anger management issues, feel an increase in stress about money or providing for the family, stress in supporting their partner with PPMD, difficulty or refusal to bond with the baby and low sex drive.  Sometimes when mom gets help and feels better, dad starts to suffer.  Look out for each other and keep communicating your needs and encourage dad to get help too.

Finally, remember you are not alone.   Postpartum Mood Disorder can be treated and managed.  You deserve the help and to feel well.   It is a brave mother to admit and seek help.  Check out the links below for further information and Google your state or city for local resources.

www.postpartumprogress.com

www.lifewithanewbaby.ca

http://www.postpartummen.com/

www.motherisk.org

www.infantrisk.com

http://www.ppdsupportpage.com/document.html

www.postpartumresource.com

http://postpartum.net/Default.aspx

www.meditainment.com  (to download guided meditations)

The Breastfeeding Competition

It happens. You see a woman share a photo of her first pump of the day, 12oz. You suddenly look at your own bottle filled with a measly 4oz and think “what am I doing wrong?!” A mom shares that her baby is “off the charts chunky” at 3 months all thanks to moms milk while your baby is hovering around the 5% each time. You start to wonder if something is wrong with your milk and how can you help your child catch up.

Breastfeeding today has turned into a competition. Moms who don’t have a huge freezer filled with milk, a massive pump output, and a huge chunky baby feel like they are doing something wrong. They beg for the tricks of the trade from other mothers, trying to determine how they can catch up. While the moms sharing these impressive outputs are not trying to brag, our society today has put such a pressure on moms they can feel inadequate in comparison. So what is a new mom to do?
The first thing you should do is remind yourself that breastfeeding is NOT a competition. There is no prize to the woman who produces the most milk or has the biggest baby. Just like every person is different, every baby is different. Your body will produce the perfect milk for your child in the quantity your child needs. If you had a room filled with 100 women you would discover a huge difference in eating habits and weight. One would swear she was hungry all the time and eating constantly while another could easily only eat 2 meals a day and be happy. One woman may be tall and lean and another short and muscular. Variety is all around us. 

So what is important to remember?

When you see a picture of a huge pump output, remember there is a story behind it. Maybe the mom has twins, maybe this is the first time a mom has successfully pumped well, or maybe it’s a working mom who has been struggling to pump enough. The normal pump output when you are pumping in addition to nursing on demand is only .5 – 2oz combined from both breasts. When you pump away from your baby it is 1 – 3oz combined from both breasts. http://kellymom.com/bf/pumpingmoms/pumping/what-to-expect-when-pumping/

When you see a picture of a huge freezer stash of milk again remind yourself, there is a story. Most moms do not need a large supply of milk in the freezer. The mom who is sharing may have a preemie or is exclusively pumping. If you are a stay at home mom with no regular need for frozen milk, considering having about 20 – 30oz on hand. This is a good amount in case of an emergency. If you are a working mom concerned about not producing enough at work, aim for closer to 60oz on hand. Working moms especially tend to feel a pressure to have hundreds of oz in the freezer before they even return to work! The reality is that you will be feeding your baby the pumped milk from the previous day, so you don’t need a huge stash from the freezer with 500+ oz before returning to work. For new moms the extra pressure of pumping to build up “the stash” can easily make those newborn days more exhausting. It is hard enough having a newborn! 

Lastly, remember all babies come in all shapes and sizes. Even in a family no two siblings are alike. You may have one child who is long and lean while another who is a chunky monkey. Both are fine and normal. The key for infants and weight is that they should continue to gain weight on their growth curve. A growth curve is NOT a competition. It is a way for doctors to make sure your child is gaining weight appropriately. A child in the 5% who stays in the 5% is perfectly healthy. There is no need to fear something is wrong with your milk. 

So next time you see a photo of a massive pump output, freezer stash, or chubby baby smile to yourself, say “Awesome job!” and remember that you are also doing an awesome job feeding your baby.

Building a stash to go back to work

"Help! I go back to work soon and need to build a stash! What should I do?"

A few weeks before you know your maternity break is done, you should begin pumping regularly to not only get used to your pump, but to get a stash of milk together. 

I would suggest to pump once a day. The morning tends to yield the most. But keep in mind that you are right now feeding your little one full time, so an output of 0.5-2 ounces is totally normal. 

"Should I take any supply boosters?" 
Be warned, supplements come with their own side effects (fenugreek is bad for diabetics as an example). You really should research them before taking. Also, know that they will not help unless you remove more milk from your breasts. Lastly, you really don't want to boost your supply too much as the amount of milk being removed from your breasts during a work day should roughly be the same as what your little one will be nursing. Oversupply sounds nice, but it definitely comes with its own set of problems.

"How big should my stash be?"
If you think about it, you really only need enough for the first day. That's an average of 12 ounces. It is nice to have a little more, but really not much more is needed. Each day you work you should pump what you need for tomorrow. If you have a large stash, you may feel less pressure to get the amount right because you can just dip into your stash. And sabotage your supply. If you aren't pumping enough at work, you should immediately begin troubleshooting why. Is your pump not working properly? Do you have the wrong size horns? Is your daycare provider over feeding? Do you need to pump more often?

Unfortunately many times mamas that have huge stashes don't do this until months have passed and their stash is cashed and their supply has regulated down. That will be much harder to rebound from. 

If I were starting fresh today, I'd aim for a stash of 30 ounces. Enough for 2 days and an emergency bottle or two for date night. But remember, anytime you dip into your stash, you should be pumping to replace that milk.

Breastfeeding In The Early Weeks: What To Expect

Congratulations! You just welcomed your baby into the world. It may be your first child, your second, or even your fourth! This may be your first time breastfeeding or you may consider yourself an “old pro”. Every mom finds themselves at a point in those first 6 weeks questioning themselves. Even the most experienced mom hits a point of “wait, maybe something is off here!” So what can you expect in the first 6 weeks? What is normal? What are red flags something is wrong??

What is normal:

Nursing, and lots of it. Newborns cluster nurse and they do this frequently! Many time a mom feels like they can not possibly have enough milk or their child wouldn’t be nursing all the time. The fact is that cluster nursing is normal and is telling your body to produce more milk! Remember breastmilk digests quickly and babies have small stomachs. This means frequent nursing!http://kellymom.com/parenting/parenting-faq/fussy-evening/

Wanting to be held 24/7. Remember, your baby was inside the womb for 9 months. All it knows is that warm secure environment. The world is a big new place! Babies want to be held, snuggled and feel secure. You may feel like the only time your baby is happy is when they are on you, and that’s normal. 

Gas and grumbling stomachs. Your baby’s digestive system is still maturing and this means, gas. It is very normal for babies to have excess gas, especially around growth spurts. Bicycle legs and stomach massaging can help. Gas can also be caused by many supply boosting herbs so you may want to consider cutting those out. http://kellymom.com/parenting/parenting-faq/gassybaby/

Spit up. Moms often freak out over spit up, but 9/10 times it is harmless. Babies are happy spitters most of the time and the amount of liquid they spit up is often much less than what you believe. Spit up is only a problem if your baby screams in pain or is loosing weight. http://kellymom.com/health/baby-health/reflux/

Not sleeping. At this age most babies nurse every 2 - 3 hours around the clock. That can be very exhausting for a new mom, but also very very normal. Remember especially during growth spurts babies nurse frequently. Typically by about 6 to 10 weeks babies will go a 3 - 5 hour stretch at night. Remember: for a baby sleeping through the night is sleeping more than 5 hours in a row! 

What is not normal:

Bleeding cracked nipples. There can be some initial nipple tenderness when nursing, but anything more than that is a sign something is wrong. It could simply be a baby not getting a deep enough latch or it could be an indicator of a lip or tongue tie. If you are in that much pain you should seek out an IBCLC as soon as possible. 

Low weight gain. Poor weight gain is a sign something isn’t right. While most moms jump to the conclusion of low supply, a poor transfer can also be the issue. If your baby is not gaining weight well a visit with an IBCLC should be your first stop. http://kellymom.com/bf/normal/weight-gain/

Remember, those first 6 – 12 weeks of breastfeeding can be exhausting. Babies go through a ton of growth spurts and it seems like just when you have things figured out, something else changes. It’s very normal for them to have a period of fussing at night, or a witching hour. It’s very normal for them to want to be held all the time and cry when put down. It’s perfectly normal for them to want to eat every 1 – 3 hours around the clock. It is exhausting, but all normal!http://kellymom.com/bf/normal/newborn-nursing/

Preparing to Breastfeed!

Congratulations, you're about to have a new baby! You plan to breastfeed, right? Piece of cake! It is what we were built to do! So no need to prepare, right? Wrong! Most of the cultural knowledge that women had about breastfeeding has been lost over the last 100 or so years, and many modern obstetricians and hospitals unintentionally (or intentionally?) set you up to fail at breastfeeding before your baby is even born! It's important that you prepare yourself and understand how to support this beautiful biological process from the beginning.

Step one: build your network!
-Talk to your family and friends and find out who has successfully breastfed. Get their tips and tricks. (Ignore the rest... You'll always find a nay-sayer in every bunch and you need positive influences right now. We will do another tip on how to deal with those negative nancies.)
-If you know where you plan to deliver, see if they have a LC on staff and if they have any support group meetings. (if not, you may want to reconsider delivering there...)
-find a local La LecheLeague meeting and attend! Pregnant moms are always welcome. www.llli.org
-find a local Breastfeeding USA chapter, and make contacts www.breastfeedinusa.org
-find a local IBCLC (internationally board certified lactation consultant) and meet with her one on one. http://www.ilca.org

Step two: educate yourself.
While most birth classes have a breastfeeding section, many are limited. Ask your network what course options are available and recommended, take it. Bring your spouse. Take notes. Ask questions...even the "stupid" ones.

Step three: write a detailed birth plan and make sure it includes clear direction on how to support your breastfeeding goals, along with your other birth instructions. Make sure you have multiple printed copies of this and that all of your support team (spouse, doula, OB, midwife, nurse, visiting friends, parents, janitor, etc) are familiar with it. Below are some suggestions of instructions that can set you up for success:

IMMEDIATELY AFTER BIRTH
• Place my baby directly to my stomach/chest immediately after delivery, putting off ALL procedures that are not medically necessary for at least 1-2 hours.
• Mother directed breastfeeding please. If we need assistance, we will ask.

BABY CARE / BREAST FEEDING
• SKIN TO SKIN contact. I would prefer to hold the baby and use kangaroo care as opposed to using the warmer.
• If the baby is not in distress, we would like to start bonding immediately with baby by me or spouse immediately after birth. I request that the baby stay with me for at least two hours or as long as possible for bonding & nursing.
• We request the evaluation of the baby be done with the baby on my abdomen, with both of us covered by a warm blanket, unless there is an unusual situation.
• If the baby must be taken from me to receive medical treatment, my spouse will accompany the baby.
• I plan to breastfeed the baby and would like to begin nursing very shortly after birth (even in recovery room if c-section is required).
• Do not offer my baby the following without my consent:
o formula, pacifiers, any artificial nipples, sugar water, etc.
• If baby’s blood sugar is low, we will be self-expressing colostrum in lieu of sugar water

BABY'S HEALTH:
If my baby's health is in jeopardy, I would like:
• To be transported with my baby if possible, if I am unable to have father go with our baby
• to breastfeed or express my milk for my baby
• to have as much bodily contact with my baby as possible
• to be offered a room at the hospital for the duration of my baby's stay (within reason)

Written By Erin Bigalke