Support

Was that a diagnosis I heard?!

I’ve heard a few people getting quite hot under the collar because individuals are “diagnosing” conditions in mothers and babies who are just not qualified to do so.  But I can’t help wondering – are those people really making a diagnosis or are they just talking openly to parents about a variety of situations and conditions before suggesting that they visit a GP or other medical professional to get a diagnosis?

Imagine you are a stressed/tired/anxious (all of the above) parent of a baby and things are just not going well.  You visit your well-child provider, peer supporter, LLL group, breastfeeding counsellor, a n other person, and talk about what’s going on.  They listen well, they encourage you to explore how you are feeling, what’s happening now, what happened prior to the current situation, they show empathy and understanding of how you are feeling, they discuss things that could be going on with you and/or your baby, and suggest you go to your GP/other medical professional to find out one way or the other if a particular condition exists.

So, you go away feeling relieved that it’s not all in your head or because you are doing something wrong.  You visit your GP/medical professional and they say “oh yes, that thing you discussed with that person – yes, that’s what’s happening, we can fix that”.

Yay!  Someone who listened suggested a couple of things to you and that enabled you to have a discussion with a medical professional about the situation, who then pinpointed the problem and helped you fix it.  Thank goodness that lovely person who helped you first could tell you what was wrong… thank goodness they were able to diagnose the colic/reflux/thrush/vasospasm/tongue tie/lip tie/food intolerance etc….

But they didn’t actually diagnose anything.  They listened, they discussed options, they gave you some space to air your concerns and talked about the things that can sometimes happen.

I don’t know how many times I’ve heard a parent say “but they told me I have to do xxx, and it’s not working” or “she said that my baby should be sleeping xx hours/feeding xx times/putting on xx grams…”

We humans sometimes hear things in a way that wasn’t intended when it was said.  Sometimes that’s due to poor communication skills and sometimes because different words mean different things to different people.  Most people try to clarify understanding when they are working with parents, but even then there can still be misunderstanding.

Next time you hear or think someone diagnosed something when they shouldn’t have done – maybe they didn’t.  If, like me, you are working with mothers, remember that what you say isn’t always what is heard… and accept that sometimes you can’t do anything about that, but be aware and just keep trying… I try to remind myself often, but I bet I often get it wrong too 🙂

This is a fabulous article written by Diane Wiessinger in 1996.  It’s all about the language used in relation to breastfeeding – Watch Your Language

 

Tongue Ties – what’s it all about?

Tongue Ties – or ankyloglossia – just what are they and why do they cause problems for some mothers and babies, and not others?

As soon as you start to talk to people about tongue ties you realise that it’s a bit of a contentious topic; some people think they are over-diagnosed, others think they don’t exist, others have never heard of them.  So why the confusion?

What is a Tongue Tie?
Between the 4th and 7th weeks of development a baby’s oral cavity develops and tissue in the mouth (and other areas of the anatomy) goes through a process of growth and regression.  During this process the tongue forms and separates from the floor of the mouth leaving the frenulum – the piece of skin that attaches the tongue to the bottom of the mouth.  In some babies the frenulum doesn’t separate as much as it could do, causing a possible tongue tie.

If the frenulum is too tight  it impacts the baby’s ability to use his tongue to feed effectively – this can impact breastfeeding and and to some extent bottle feeding, as well potentially causing future problems with oral health and development, speech, digestive problems, and others.

Some babies have an obvious frenulum but it does not cause any problems – every baby and mother needs to be assessed on an individual basis.

Why do they occur?
There doesn’t seem to be a consensus of opinion on this.  There has been discussion about a gene that may be responsible, and whether or not folic acid has a role to play.  There does seem to be a higher chance of a baby having a tongue tie if there is a family history of tongue tie though, and often if one child in the family has a tongue tie, it’s not uncommon that their siblings do too.

What does a tongue tie have to do with breastfeeding?
When a baby breastfeeds he needs to be able to keep his tongue forward over the bottom gum, use the tongue to cup and grasp the breast, bringing the breast tissue far enough back in the baby’s mouth to ensure that the nipple is not squashed between the tongue and hard palate, and create the vacuum in the babies mouth that results in the milk flow from the breast.  If the movement of the tongue is compromised in any way then some or all of these activities can be more difficult.  The baby’s tongue should be able to work in a rippling type of movement that carries the milk from the front of the baby’s mouth to the throat for swallowing.

If a baby is tongue tied some mothers experience pain that cannot be managed by improved positioning and latching, the nipple may be squashed or grazed by the tongue causing bruising and/or bleeding, cracked nipples; the baby may not gain weight well as he is unable to remove milk efficiently from the breast, leading to low weight gain, or a sleepy baby due to insufficient calorie intake.  Sometimes the baby may not gain weight well, but the mother may not experience any pain.  In some cases all seems well for the first few weeks.  The mother naturally has an abundant milk supply and the baby is gaining weight well.  However, as supply becomes dependent on the baby removing milk from the breast well (rather than hormonally driven as in the first few weeks), the baby’s weight gain starts to drop and the mother notices a decrease in milk supply.  All of these things COULD be an indication that the baby has a tongue tie.

How do you know if there is a tongue tie?
If a mother is having problems with painful breastfeeding, or the baby is not gaining weight sufficiently, then the first thing to do is check that the baby is positioned well at the breast and is latching well.  Many painful breastfeeds can be rectified by improved position and/or latch.  However, if things cannot be resolved this way, then the possibility of tongue tie should be investigated.   Tongue ties are generally deemed to fall into one of four classifications:  I, II, III and IV.  The first two tend to be easier to see and involve the tip of the babies tongue being restricted.  These are often called anterior tongue ties.  However, tongue ties are diagnosed by both appearance and function – some tongue ties just don’t cause problems for feeding and can be left alone.  Many practitioners use the Hazelbaker Assessment Tool as a consistent and reliable method of checking both appearance and functionality of the tongue in a breastfeeding baby.

Why are tongue ties more common these days?
It’s not clear why tongue ties seem to be occurring more often, or even if they really are more common – it could be that we are just hearing more about them than we used to.  You may have heard stories about midwives in the past keeping a finger nail long to cut them as soon as the baby was born.  As formula became more of the “norm” for babies and, for a while was believed to be scientifically superior, it was easier to switch babies to bottle feeding and the tongue tie was less of an issue.  It is likely that due to more mothers wanting to breastfeed again, and generally having access to better and more easily available breastfeeding help, tongue ties are again being recognised and dealt with.

How do you fix a tongue tie?
The procedure of dividing a tongue tie is called “frenotomy”.   There are a number of ways of carrying out a frenotomy – laser, scalpel, diathermy.  Laser is expensive and is deemed by some as unsuitable for use in babies.  Some midwives and lactation consultants perform frenotomies, in other areas GPs who carry out minor surgeries will do them.  A frenotomy involves the tight frenulum being cut in one or two places to relieve the tongue and allow normal movement.  There is usually very little bleeding – the risk of excessive bleeding and infection is deemed to be very low.  Usually a small piece of gauze will be placed against the cut area for a few seconds and then the mother encourage to feed the baby.  The baby is often not upset by the procedure itself, but often doesn’t enjoy adult sized fingers being poked in the mouth and under the tongue during the process.  Most of the time, mothers report immediate improvement, however some babies have got used to using their tongue in an inefficient manner and take more time to get used to the new mobility of their tongue.  In these cases tongue exercises may help:  http://vimeo.com/55658345

Some mothers find that these tongue exercises can help the baby use their tongue better while waiting for a tongue tie to be checked, along with using nipple shields (to prevent further damage to the nipples), or expressing and bottle feeding until the tongue tie can be divided.

Once the tongue tie has been divided, it’s always worth going back to your breastfeeding support person to ensure positioning and latching is optimal.

References/further reading:

Is my baby getting enough milk?

This is a question that many mothers ask themselves at some point during the time they are breastfeeding their baby.

Often the frequency of a baby’s feeding habits can be a surprise for new parents and without the right support and information it’s easy for a mother to feel she hasn’t got enough milk for her young baby’s growing needs.  Many women I speak to worry about not having enough milk, and I often hear that well-meaning friends and relatives have commented on how the baby should be made to wait for 3 hours, or sometimes longer, or to top up with a bottle of milk after a breastfeed.  Unfortunately this advice, if followed, actually has the opposite effect on the mother’s milk supply, and therefore the baby’s growth too.

On average, a baby born at around 40 weeks of pregnancy can only fit around 5mls (a teaspoon) of milk into his or her tummy in the first 24 hours of life.  This increases to around 25/30ml by about day 3, and 60/80ml by about day 10.  Even though a baby only drinks small quantities of milk, it can still take them 20 minutes or more to finish feeding.  Just like adults, each baby is unique and some eat more quickly than others, so it’s important to let the baby decide when he or she has finished; that way babies will drink until they are full, ensuring they get enough calories to grow well, and stimulate the mother’s milk supply adequately.

Every time milk is removed from the breast, more is made.  However, if milk is left in the breast then a protein called FIL (Feedback Inhibitor of Lactation) increases, which slows milk production.  Therefore, the more often a baby feeds at the breast, the more milk a mother is able to make.  Most people are not symmetrical and this applies to breasts too.  A lot of women have breasts that vary slightly in size, this is quite normal.  The size of a woman’s breasts bears no relation to the quantity of milk she will make.  Large breasts may contain a small amount of glandular tissue and vice versa.  It is not possible to tell!  By allowing a baby to feed as often, and for as long, as he or she needs to, most women’s breasts will make enough milk for their baby.  If you think of the breast as a glass, it doesn’t matter how big the glass is – you can still drink lots of water in a day from a small glass, you just need to drink more often.

So even if you feed your baby for as long and as often as he or she wants, how do you know it’s all working?  Weight gain and growth is something that can be measured, and certainly in the first couple of weeks your baby will be checked to ensure that by around day 10 your baby is at least still at birth weight.  Many babies lose a little weight in the first few days and this is completely normal.  If the mother has had IV fluids during labour then the baby’s weight can be slightly inflated at birth and this can mean the baby loses a little more weight than otherwise as they lose the excess fluids taken on during birth.  On average, a baby will gain anything between around 110g-220g a week in the first four months.  As you can see there is a wide range of “average” and at different times babies put on different amounts of weight.  It can be important not to weigh a baby too often as some weeks babies won’t put on much weight which can cause unnecessary worry.  It’s better to look at the overall pattern of growth, taking into account growth in head circumference and body length as well as weight gain, and to ensure that the overall trend is upwards on the growth chart, and that the baby is staying more or less on their percentile line on the chart.

However, in between your baby being weighed you’ll want to feel confident that things are going well.  One of the easiest ways to do this is to check what’s coming out the other end 🙂  If milk is going in at the top, then something will be coming out the other end.  It’s amazing how important the contents of your baby’s nappy becomes!  When your baby is born his bowel contains meconium.  This is the first poo you baby will pass and breastmilk helps your baby’s digestive system start to work; the colostrum works a little like a laxative helping your baby pass meconium – a sticky, black/dark green bowel motion.  In the first 2 days your baby should produce one or more poos a day, and two or more wees a day.  On days 3 and 4, your baby will produce three or more poos a day, which will become more green coloured and possibly a little softer, and three or more wees a day.  On days 5 and 6, your baby will produce three or more soft yellow poos.  The poos change to yellow as all the meconium has been passed and your baby starts to drink and digest more milk.  By now you will notice that you are producing more milk.  From day 7 onwards, your baby will produce at least two soft yellow poos, possibly a lot more, which is quite normal.  They may also look a little “seedy”, which is fine.  Your baby should also be producing six or more heavy wet nappies a day.

It can be hard to feel confident of something that we haven’t done before, and having a baby that seems unsettled or unhappy is enough to make any mother concerned.  If you are worried about your baby’s behaviour, development, or health then you should always seek advice.  A mother’s instincts are often right and sometimes it can take a while to get to the root of the issue, so keep asking and talking to people who have been well trained and have good experience until you are satisfied.

You can find some great information here about how milk production works, and on this page for what to expect in the early days of breastfeeding.  If you are worried about how often your baby is feeding, you might feel reassured after reading the information on this page.

Please feel free to comment on this post, or ask questions.  You can also contact me directly vie email:  bfc.denise@gmail.com

Holidays interrupting breastfeeding?

As the holidays start and visitors arrive many people find their normal “routine” goes out the window and you seem to spend time rushing around after everyone else more than usual.  It’s easy with all the festivities and visitors to attend to, to find that you just don’t have as much time to sit down with your baby/child to cuddle and breastfeed as you would normally.  It’s often a time when children don’t behave in the way the would do at any other time of year and older babies especially, get very distracted by all the interesting activity around them.

Most babies will breastfeed beyond a year old; if a baby suddenly stops breastfeeding before a year old it is quite likely to be a “nursing strike”.  A nursing strike doesn’t mean your baby necessarily wants to stop breastfeeding but it does mean something has got in the way of, or made him want to stop breastfeeding right now.  Sometimes it’s not possible to ever find out exactly what caused it, but time and patience will often solve it.  It might be a sore ear, stuffy nose or something else physical that is making breastfeeding uncomfortable, or it might just be that there are so many distractions and delays in breastfeeding for a couple of days that your baby just stops asking.

So what can you do if it happens?  Well, as this most often happens to babies from 7 months upwards, there is no rush to replace the lack of breastfeeding with lots of other drinks and foods – your baby is probably quite a strong little thing by now and eating some solids.  You can express your milk and give it to him in a cup if he wants it – expressing will also help to maintain your milk supply and prevent engorgement, blocked ducts etc.  Avoid bottles and pacifiers though as these will just satisfy the urge to suck with something other than your breast.  Some mother’s find that trying to feed when their baby is sleepy or drowsy works, others find feeding in the bath, while standing or rocking, trying a totally different position than your baby is used to, and sometimes just leaving it for a day or two so there is less tension and anxiety around breastfeeding.  Usually after a few days, but sometimes as long as a couple of weeks, things return to normal for no apparent reason.

Young babies don’t enjoy being passed around from one person to another but it can be difficult to deter excited family and friends.  Using a wrap or sling is an easy way to keep your baby close and calm during these times, and means that your baby can remain peaceful and relaxed… feeding in a room where there are less people can be useful too.  You might feel more relaxed and your baby is less likely to be distracted.  Young babies are so beautiful that people just can’t resist touching them but it is very distracting for a baby to have his or her head touched – especially when they are feeding.

There is very little food that is banned now your baby has been born, but if you have concerns over your supply it might be best to avoid too much sage or peppermint as both are reported to reduce supply in some women.  Alcohol can suppress the milk letdown reflex and make baby’s sleepy so best avoided if possible.

Finding time out for peace and quiet with your little one can be hard though at this time of year, and can lead to frustration and worry.  Over the holidays most organisations are closed so don’t forget to check out where your local La Leche League leaders are.  You can also check whether there are Peer Counsellors in your area, national breastfeeding helplines and lactation consultants.  There’s nothing worse than feeling you are on your own with a problem and there is no one available to listen or help… and sometimes the “help” and “advice” from visiting relatives and friends is, well, unhelpful :-)

The Breast Room specialists are available all through Christmas and the new year holidays.  You can find their details on Facebook https://www.facebook.com/TheBreastRoom.  You can contact them on breastroom@gmail.com or 027 476 1339.

Happy Holidays every one!  🙂

Breastfeeding… it takes time

The other day a mother said to me that she wished someone had told her that it would take time to get breastfeeding “right”.  She’d done lots of research prior to having her baby – read books, spent time on google, talked to people – but she didn’t recall anyone telling her that it would take time.

The thing is, for some people it doesn’t feel as though it takes very long for breastfeeding to feel natural, and “right”.  Others feel that it takes them ages to get to the point where it all feels ok.  Just because breastfeeding is what our bodies are designed to do, doesn’t mean it will just work straight away.  There are a lot of things we do, that are “normal” or “natural” for humans… walking and talking for example.  However, these things that we take for granted have to be learned before they are automatic or natural, and take a fair bit of time to master.  Breastfeeding is just the same.

People learn a lot by watching others, so surround yourself with people who do, or have, breastfed.  Find out where you can go to talk to women who breastfeed, women who are having the same experiences as you, or have already been through the stage you are at.  Stay in touch with the women you meet at antenatal classes – it’s amazing how much moral support you can get from these people, and sometimes they become life long friends 🙂

But just as important, give yourself and your baby time.  Be kind to yourself.  It can take a few weeks before you feel completely comfortable about breastfeeding – and that’s just fine.  Sometimes babies need a bit of time to get the hang of it all too!  If you don’t feel that things are improving, or working the way they should, then ask your midwife, a lacatation consultant, or other breastfeeding specialist or supporter for some information.  They can talk to you, find out what’s happening, and often share information and ideas that will help.  If you don’t want to talk to someone face to face, there is lots of support online;  Facebook has some great groups too – look out for Breastfeeding NZ, The Breast Room in the House, LLL NZ, and Kelly Mom to name a few!

 

 

The Breast Room in the House

The Breast Room in the House was an idea I had about a year ago.

World Breastfeeding Week (WBW) takes place the first week of August each year.  Early in June 2011, during a discussion about WBW,  I was asked what I would do if I could do anything locally to help women who want to breastfeed.  Having been involved in breastfeeding drop-in groups in England, I was keen to start something similar in Dunedin.  There are many groups around that support breastfeeding, and places women can go to get help (eg. Lactation Consultants, Plunket, LLL, etc), but I wanted to create something that was less “official” and had no links to any specific organisation.

That year, I’d also been training women to volunteer as Breastfeeding Peer Supporters and so I was also conscious that these women needed somewhere to volunteer and use their new skills.  Some of them were happy to make contact with mothers they met during their day to day lives, but others were keen to do something more structured.

So, when I was asked what I might do, the idea of The Breast Room in the House began to grow.  The Methodist Mission had recenly opened The Hub in South Dunedin, a community centre for groups offering support/information/education for local families – the perfect place for me to start 🙂

And so now, one year on, The Breast Room in the House is well on it’s way to being very successful!  There is an ever growing team of volunteers, with myself and Jill providing support, ongoing education, and an escalation point for the peer supporters.  The feedback from the mothers who have visited us has been great – and they keep coming back too!

The Breast Room in the House is a place to come for information and support about breastfeeding; it’s for pregnant women, mothers who are trying to make breastfeeding work, mothers who just want to have somewhere to go for a cup of tea or coffee on Thursday mornings, somewhere for a chat about why breastfeeding didn’t work… a comfortable, welcoming place where women can meet other mothers, and talk in confidence about their situation.  We can provide information sheets, books, breast pump hire and a listening ear 🙂

The theme for World Breastfeeding Week 2012 is Understanding the Past – Planning the Future.  The past year alone has been interesting, and the future is exciting!  I hope that The Breast Room in the House will continue to grow.  We are already able to offer more than we could when we started a year ago, I expect us to get busier in the next year, perhaps we’ll even open up on another day of the week too.  We move to bigger premises in the next month or so and I’ll be relocating the antenatal breastfeeding classes for parents to our new venue too; I’m even considering starting a nursing bra fitting service  – The Breast Room in the House will be a center for everything to do with breastfeeding!

Who knows where we will be in another year!