A heritage of breastfeeding

I believe that we stand on the shoulders of those that came before us. We learn from our parents and grandparents and that we owe a lot of our successes to their input and lives. I was interested in my family’s breastfeeding heritage, so I asked my grandmother and mom about their experiences and this is what my daughter’s breastfeeding heritage is.

My grandmother:

My mom was born 4th of five children. Formula was a relatively new invention and my gran was given the advice not to breastfeed but rather to give my mom formula. This she did do and within 2 weeks my mom was on her death bed. She was severely malnourished and extremely sleepy. At the time not much was known about lactose intolerance or Cow’s Milk Protein Allergy, which I suspect that my mother may have had. The doctors were ready to give up on her and then my gran says that the most wonderful midwife arrived at the farm and give my mom a soya-based formula. It was very new on the market and it made all the difference to my mother. My mom started to thrive and grow. Listening to my gran’s story I am not able to work out if she had lactose intolerance of Cow’s Milk Protein Allergy. What saddens me is that breastmilk would have been a lifesaver to my mother in both conditions. With lactose intolerance, breast milk has the lactase enzyme that helps the baby to digest the milk and help with the allergy. If my gran had followed a dairy-free diet my mom would have been able to drink her breast milk. This was not common knowledge then and my gran was not aware of it. The recommendation to start formula was downright crazy considering where my gran lived. It was on a farm and it made getting the formula milk and making up the bottle so much harder than breastfeeding.

My mother’s breastfeeding story:

Our story is so different, I an the 2nd born of 3 children. My older brother was a “difficult” baby who screamed for about 18 months. I, on the other hand, was an “easy” baby who slept and was easy to settle. My mother said she was a milk cow (a term I am not to fond of) and had plenty of milk. She breastfed all of us for 9 months. When the teeth started to show she believed it was time to stop breastfeeding. This was also mentioned to me many times when breastfeeding my 2 children. My mom also went back to work and did not know about expressing and leaving milk for her children. She also did not have access to a breast pump. She described breastfeeding as easy and enjoyable and always had positive messaging for me as a child.

My breastfeeding story:

My breastfeeding story is even more different as both of my children were born prematurely. My daughter is the second born. From my breastfeeding experiences of my son, I was a lot more prepared to have a baby in NICU. I also had 3 weeks of bedrest to prepare myself. I knew how important breast milk is in preventing NEC. NEC is when the intestines of an infant (generally a premature who is fed infant formula) start to rot and bloat. It is very dangerous and can result in parts of the intestine being removed or even death. With the help of my husband, we hand expressed colostrum the night and morning of my caesarian section. I knew that my baby would have milk while I was recovering from my operation. This settled me and I was able to relax and focus on her birth and how beautiful she was despite her being very early. I also had a hospital-grade breast pump ready for me. As soon as I could I started to stimulate my breasts. This was so that my body would make breast milk even though I was not able to hold and breastfeed my baby directly. I continued to express for the 6 weeks that she was in NICU and then longer as she needed it. Once she was back home I was able to teach her how to breastfeed directly. But to be honest I also needed a lactation consultant to help me with such a small baby.

Once we were over our hiccups we had a lovely breastfeeding relationship. I loved coming home and reconnecting with her through breastfeeding. She breastfed for almost 3 years, which did start many conversations as to when I SHOULD stop breastfeeding as this was getting a bit much. I really believe that the length of the breastfeeding relationship is made between the mother and the baby/child. Breastfeeding is a unique relationship that both parties need to be enjoying and benefiting from. They are the only two that can decide when to stop.

My Daughters breastfeeding story:

Well, she is currently only 7 years old but I think that she already has a breastfeeding story of her own. We often talk about breastfeeding. In fact, she is the one that asks me the questions. My goal is to help her gain confidence in herself so that when her time comes to breastfeed, she will know that she can believe in her body. She is learning about her breastfeeding heritage and knows that breastfeeding is a part of our family and culture. I will teach her not to be ashamed of her body and let her know that she can breastfeed when and where she needs to.

I will also respect her choice of how she wants to feed her children. I know that the feeding relationship is between a mother and her child, not the granny and grandchild. I will support her and help her with the correct information around infant feeding and answer her with honesty if she asks about breastfeeding difficulties. She will also know that I believe in her ability to breastfeed.

I look forward to seeing where her breastfeeding heritage leads her and her children.

Why Preemie Awareness month is important to me! My story of my firstborn

Martin in NICU

September is Preemie Awareness month

September is NICU awareness month, this is were we acknowledge the parents of children that have been in NICU and the amazing staff that work in the NICU. I am a mom of two children that were born early and had to go to NICU and then High care before they could come home to me. Both experiences have changed me and made me realize that NICU parents need that little bit extra help and support. If you are a NICU mom, you need to realise that you did not have the “perfect” birth story that you dreamed of and to then make peace with how your unique birth story unfolded. My first birth was an absolute horror story that still at times, can knock my confidence and belief that I am a good mother. It is my horror story filled with fear, confusion, love, worry and relief that my baby came home. This is my story of my first born.

The holiday turns in to a nightmare

I was on holiday, and stated to retain a lot of water, which I thought was “normal” but then my urine changed colour and I was not feeling so well anymore. We came home a day early and I slept the entire trip, which is unlike me. Have you ever tried to sleep in a landrover? It is almost impossible with the bouncing around but somehow, I slept like the world had faded away.  I felt like there was something wrong, but I had been checked the week before by my gynae and had been given the all clear. I was only 33 weeks pregnant and needed the holiday before we finalized all the baby things we needed to do. I did not think anything major was wrong, I was in denial, but something told me I should just check. As soon as we got home, I phoned my mom to take me to the hospital, something was just not right. I left my husband to unpack the car I just wanted to make sure still not believing fully that something was wrong.

Safe at the hospital?

The nursing staff at the maternity ward were not happy to see me, they did not really want to do a urine test, but something in me insisted. Out of protest, they phoned my Dr to let him know that he had a “difficult” patient. I was feeling unsure and very unwelcome at this time. My doctor took me seriously. He asked them to do a full blood because I had been near the Kruger park and he was worried that I may have got Malaria. Malaria is a serious complication for a pregnant women. I remember waiting for my results in the coffee shop and saying to my mom: “That I really hoped that something was wrong with me otherwise it was all in my head”. As it turned out, my blood results told a very scary story.  I was very sick, in fact I needed to deliver my baby asap, not because of malaria but I had HELP syndrome.  There was just no time, I could not bath, my father was called and no one told me how serious my condition was. My parents and husband knew that they would most likely not see me again but the baby would live. As a parent now, I can’t imagine how that must have felt like seeing your daughter going into surgery and not knowing……..

My Baby was born……way to early

Anyway, fast forward to 2 hours later I was in recovery room totally confused not remembering what had happened. I will never forget waking up, my husband’s and paeds faces were right in front of me. The Paed said you have a healthy baby boy and I responded “What baby, why do I have a baby? I was all of a sudden, a mom of a 33 weeker, 1.76kg little boy. It was too soon. My husband was ecstatic, and I was numb. I was so worried for my son, the one that I had not seen yet and the pain was unbearable. My emotions and understanding of what had happened was not at all computing. I went to ICU and there I stayed. I wanted to breastfeed, NO I NEEDED to breast feed, I wanted to help my boy as much as I could even though I was so far away from him. My husband helped me to hand express. I was too weak to do it by my self but I knew how to and taught him how to. There is no real privacy in ICU, just a flimsy curtain that protects your dignity from one side but the rest is all open. With pride and after much effort we sent a tiny syringe with about 2ml of breastmilk down to NICU for my son. I was so proud of my “love letter” going to my boy- the one that I had not seen yet. I got a message from my paed that he was so happy to get breast milk that I started to hand express again and the stress about making enough breast milk became real. The worry about having enough milk is a feeling that never left me while my son was in hospital. I remember one ICU Doctor not caring that I was pumping and insisted on doing an examination while I was expressing, causing me to mess all my milk. You need to pause here and understand how devastating that was for me. I just wanted to get out of ICU. I don’t remember the first time that I saw my son, but I do remember that he did not look like my boy. There was a big disconnect, you need to understand that I was not awake when he was born. I remember once I had been sent home and was visiting him, he made a specific movement: his little arm swept above his head while simultaneously kicking the opposite leg. When I saw him do that, I KNEW he was MY SON. He had made the same movement inside of me. Finally, I had my connect to my boy.

He was only in the hospital for 3 weeks but they were the longest 3 weeks I have lived through. I was lonely at home and longed for him when we were apart. I was torn because I knew he was in the best place for him and that he was receiving the best care, but it did not stop me from disliking being in the NICU. I felt so unempowered, I felt like I was in the way, I was not able to hold him to touch him and I was constantly trying to make more milk. One of the nurses even told me in front of everyone in the ward that I don’t have enough milk. I was devastated because I had 7 bottles of frozen milk in the NICU freezer at the time.

We survived

Our beginning was a tough one, we had lots to learn and I think I battled for a long time with the shock of almost dying: what it would have meant to my son and husband and then learning about the needs of a prem baby. Now, we still, like with all children have our own struggles, but he is so worth it. He has taught me so much about myself, about others and how to show love. The other day he said to me; “You know mom you are the best mom I could have had” and you know what, I believe him because he is the best son I could have ever had.

Some days I don’t remember his birth as scary and lonely as I have written here. I remember the better parts, but I decided to write about my “scared” emotions on this post because I have realized that moms don’t talk about how they really feel. I would like to encourage any mom that if they are feeling overwhelmed that they talk about it. NICU can be a scary place and no parent is ever prepared for what they see and hear or how they feel. I also know of parents that have completely different experiences in NICU, that they were comforted and felt welcome in NICU. I think that it depends on how you respond to your child’s birth and the support that you receive from health care professionals, family and friends. If you are a parent that has experience having a child in NICU, this month is all about hearing your story and acknowledging your journey.

Can Herbs help make more milk?

Galactagogues

by Carey Haupt RD(SA) SACLC

As a lactation consultant, one of the most common questions that I get asked is “how do I make more milk?” Mothers want to know that they are providing enough milk for their baby to grow and to grow well. When faced with images from Facebook about how much milk other mother can express it can feel a bit daunting when comparing the images to yourself.

Increase Milk supply: First steps

My first suggestions are:

  • Check the latch. The reason for this is if you have good milk transfer you will improve our milk supply
  • Feed your baby often. Demand feeding helps you to make the correct amount of milk for your baby’s needs.
  • Expressing breast milk can be used to help increase your supply. This is very necessary if you are separated from your baby by hospitalization or work.
  • Skin to skin. Spending time holding your baby with her skin toughing your chest with no barriers.
  • Improve your let down:
    • Message your breast before you your start feeding or expressing
    • Use warmth on your breasts before you start feeding
    • Watch a video of your baby or smell his blanket

Moms often want to include a super food in their diets to increase their milk production or use jungle juice. This can be problematic as there is not clinical data that shows that jungle juice has any effect on your milk production. Jungle juice has so many different recipes that it is impossible to know which one is the original and why the ingredients have changed so much. Importantly most recipes are high in sugar which ads to your calorie intake. Eating massive amount of a single food (or superfood) for me also is not idea as it decreases the variety that you have in your diet which can affect your micronutrient and macronutrient intake, or it will increase your total calorie intake. The higher the calorie intake the harder it will be to lose weight after pregnancy.  

What effects your milk production?

The most basic answer is your hormones are responsible for increasing or decreasing your milk production. The two hormones that increase your milk production is Prolactin and Oxytocin. Prolactin helps your body to make more milk while the oxytocin helps to move the milk through your milk duct towards your nipple. When your breasts are constantly full and not being emptied you have hormones that inhibit your milk production. This is so that you don’t become to uncomfortable or full. Therefore, demand feeding, a good latch (transfer of milk), expressing and improving your let down all help to increase your milk supply.

What are herbal galactagogues?

What if you are a “just enougher”?

Is there any thing else you can do to improve your milk supply if you have tried all the suggestions above? Well yes there is, Galactagogues. They are herbs that have been used traditionally to help mothers with their milk supply. They are a complementary medicine and you need to be careful to use them appropriately if you do choice to use them. Before you take a galactagogues you need to find out what they are used for and why the contraindications are.

Why would I say be careful if they have been used for years and are considered natural?

  1. Firstly, you need to know what each plant or herb helps can hinder you with. For example Alfalfa is related to legume and the peanut family and thus should not be consumed by some one that has those allergies. Fenugreek is not considered safe in Diabetics.
  2. Look for a reputable company that has done research on their product and has good quality control measure to ensure that you are consuming what is on the label.

List of herbal galactagogues

Here is a list of herbs that can be used to help improve your milk supply

Herb Possible action Possible
complication
When to use
Alfalfa Increase milk supply
Stimulate mammary gland growth
Increase milk fat content
Improve water retention for moms with postpartum edema.
Avoid using it if you have lupus or another autoimmune disorder. Related to the legume and peanut families Can be taken both during pregnancy and after birth
Anise Improve the flow of milk Soothe colic or gassiness in babies Do not use if you are allergic to anethole or plants in the Apiaceae/Carrot family.  Not safe for use in pregnancy.
Use after birth
Black Seed Rich source of fatty acids and protein
Has insulin- sensitizing and anti-inflammatory properties.
It can lower blood sugar – if you’re diabetic or hypoglycemic, consult your doctor. Not safe for use in pregnancy
Use after birth
Fenel Milk production
It may have anoxytocic effect (may assist with milk let- downs)
Do not use if you are allergicto anethole or plants of the Apiaceae/Carrot family.  Not safe for use in pregnancy Use after birth
Goat’s rue Increase milk production 
Stimulate mammary gland growth
  Can lower blood sugar – if you’re diabetic or hypoglycemic, consult your doctor.
Ixbut Milk production    Use after birth
Milk Thistle Milk production Don’t use it if you are allergic to daisies, artichokes, kiwi or ragweed Use after birth
Moringa Increase milk production It can lower blood sugar – if you’re diabetic or hypoglycemic, consult your doctor. Use after birth
Shatavari Stimulate mammary gland growth Increase milk production   Not for use during pregnancy
Use after birth
Torbangun Stimulate lactation It can lower blood sugar – if you’re diabetic or hypoglycemic, consult your doctor. Not for use during pregnancy After birth

The information on herbs and their uses and contraindications can be found on the Legendairy milk page.

If you are very concerned about your milk supply, please monitor your baby’s weight and see a lactation consultant. Weight monitoring can show you if your baby is growing well or if you need extra support with your breast feeding. Knowing that you baby is growing well will help you to trust in your body. However if your baby is not growing well you can get the necessary assistance that you need by seeking help with a qualified lactation consultant who will be bale to assist you with making sure that your infant gets enough milk to grow well.

The Magic of Skin to Skin: How to increase your milk supply

Mother doing skin to skin

After scrolling through Facebook and reading a few breastfeeding and other parenting blogs, I realized that there are many mothers that are desperate to increase their milk supply. Moms are either unsure that they have enough milk for their baby, want to start storing milk for when they go back to work or their baby is not gaining weight sufficiently and they need to increase their milk supply. This is made even more obvious by the increase in milk increasing products on the market. There are special teas and mixtures, cookies, snack bars and herbal supplements. Many of the product have not really been tested to see how effective they are but they are still very popular.

I am sure you have heard of supply and demand. Which means that the more you breastfeed, stimulate, express or empty your breasts, the more milk you will make. For example, when Mothers need to increase their milk supply while pumping some Mothers use power pumping. This is based on the principle of emptying the breast often in 60 minutes and repeating the process for 3 days. This method imitates a baby going through a growth spurt which helps the Mom to increase her milk supply. 

Skin to skin is also a wonderful way to increase your milk supply. It is when you place your baby with just a nappy onto your bare chest. Depending on the room temperature you can cover your baby with a warm blanket or a thin muslin cloth. While on your bare chest your baby can fall asleep, listen to your heart and breathing, while you also rest or read a book. It really is amazing that when a baby’s placed in this position your hormones respond and start to increase your breast milk. Some mothers can feel the tinging as soon as the baby is placed onto their chest. (Don’t worry if you don’t feel the tingling some mothers don’t feel it).

When should I do skin to skin?

Skin to skin is fantastic and should always happen directly after birth. This allows your baby to catch her breath, rest and connect with you before she starts to breast feed. This time is called the golden hour where Mommy and Daddy can get to spend time with their baby.

Skin to skin is not just for a birth, it can and should be repeated as often as you can with your baby. It helps you to increase your milk, allows your infant to find your breasts easily, calms your baby if she is distressed and allows you to have some down time. It is so effective at calming a crying baby is has become known as the reboot position. Skin to skin can be practiced with your infant when ever they are not well need additional comfort and you can continue to practice skin to skin for as long as you feel comfortable. You may even find that your child responds to settling in your arms with a hug when they are school going age. The recommendation is to do skin to skin for an uninterrupted 60 minutes a day for at least 12 weeks. There is no limitation on how long you practice skin to skin.

Mothers are not the only ones that can do skin to skin with their baby. Fathers can also be encouraged have skin to skin with their baby. It won’t help them with any milk supply but it does help them to bond and calm their baby. A nice time for fathers to practice skin to skin, is afterbirth if the Mother has had a C-section and is needing extra time for recovery. A baby will know the voice of his Dad and respond to him and also feel comforted by his Father’s touch.

“Skin to Skin is for all babies.

Prem, Full term & Older”

What else does skin to skin do?

Not only can skin to skin help you with your milk supply but it can also help to regulate your baby’s temperature. Your breasts can increase or decrease their temperature according to your baby’s needs. Through research it has been confirmed that if a Mother of twin babies has a cold and a warm baby and she does skin to skin with both babies at the same time. Her one breast will warm the cold baby while her other breast will cool the warner baby. It really is amazing how in tuned our bodies are with our babies without us even knowing it.

How does skin to skin work?

So how does skin to skin increase your milk supply? It just does not sound possible? In practice when you hold your baby, smell your baby, see and hear your baby and your body responds by making oxytocin. This is why Mothers may leak when they hear another baby cry at the shops. Oxytocin is the love and bonding hormone that is responsible for your milk let down. So by holding your baby as close as you can with both your skins touching you are maximizing the response from your body and the amount of oxytocin in your body and thus making more milk. I would also imagine the quiet time, being still and just enjoying your baby by getting out of the hustle and bustle of daily life with a new born baby also helps you to relax and replenish yourself. This too is good for breast feeding and milk supply.

I think the part that I like the most about skin to skin is that there is no monetary cost. You don’t have to go to the shops to buy it or wait for an online delivery. You can start with skin to skin immediately and use the time to bond with your baby. I know how important time is to a Mother of a new born. There are so many things that need to be done. With skin to skin you know you are helping to increase your milk supply while taking care, loving, bonding with your baby and while also practicing some self-care that is so needed during this time.

Breast feeding & Work Balance

AMeda breast pumps supports working moms

by Carey Haupt RD(SA) SACLC

Breastfeeding and work is a delicate balance, with a bit of practice it can be done. So you don’t need to stop breast feeding just be prepared. Being away for your baby does not mean that you can’t keep your supply up and continue to breastfeed. Did you know that under South Africa Law you are entitled to two 30-minute breast feeding breaks in the first 6 months of your baby’s life? These breastfeeding breaks are paid for time. The law that allows for these breast-feeding breaks is called the Code of Good Practice on the Protection of Employees during pregnancy and after birth of a child.

Unfortunately, some companies may not have the correct policies in place to support the code. In order to benefit the most from this law approach your HR manager while you are pregnant and inform them that you are intending to continue to breastfeed when you return to work and would like to have the facilities available so that you can safely express your breast milk. This allows the company the additional time to find a space that is suitable for you and to amend any policies if needed. If your HR manager is not aware of the Code of good practice you can down load it here.

A main concern for some moms is that their milk supply will run dry or that they will not be able to make enough milk for their baby once they return to work. Luckily breast milk is made continually over a 24-hour period and your body adapts to your cycle of milk production. Your two 30-minute breast feeding breaks can be used to support this cycle and to supply milk for your baby while she is away from you. Most moms can express a full feed in 15-20 minutes. The additional time can be used for preparing to express and cleaning up afterwards.

There are a few ways in which you can use your breastfeeding breaks, discuss the different options with your HR and see which one best suit you:

  • Use the two breast feeding breaks during the day. One in the morning and one in the afternoon to express milk while you work.
  • Combine the breaks and have a longer 1-hour breastfeeding/ expressing session. This can be useful if your child is close to your work so that you can direct feed.
  • Use the 60-minutes to shorten your work day and direct feed your baby at home/ creche before or after work

In the Code of Good Practice, it says that “where possible provision should be made for the establishment of facilities for breastfeeding under adequate hygienic conditions at or near the work place”. This in common terms means that your employer should provide you with a clean space where you are able to sit down in, that gives you privacy and access to clean water and secure storage for your breast milk. Some employers are very accommodating and can provide fridges and microwaves with a special allocated room while other employers are not able to. What the code protects you from is the use of a toilet to express or breastfeed you baby in and having to express in front of other work collages.

How to practically keep your milk supply up for your baby.

Step 1: Build a stash

You only really need to start to store up a supply of breast milk about 2 weeks before you go back to work. Some moms start very early with collecting milk and that can cause them to have to buy a new freezer, which should not be necessary.

How much milk to expect when expressing:

If you are expressing in between feeds while direct feeding expect to express about half a feed.
If you are expressing to replace a direct feed expect to express a full feed
Women have different storage capacities so some women will be able to express more than what is expected. All women are different and try not to compare yourself with others.

Step 2: Find your work expression spot

As discussed earlier you are entitled to a safe clean space where you can sit and express your breast milk. Make it as comfortable as possible for you. If you need a pillow to make the chair more comfortable bring one from home. Check to see if you can lock the door, or bring a sign for the door that indicates that you are expressing and that you should not be disturbed

Step 3: Make the place clean and hygienic as possible

If needed clean the surfaces. Wash your hands before your start expressing. Bring sterilized equipment to the office. This way you can avoid the need to sterilise at work. If you sterilize your equipment at home, you can bring it to work in a clean container like a Tupperware or Ziplock bag. If you have access to a microwave at work and you would like to sterilize your equipment use a closed container or a microwave sterilization bag so that you can keep your equipment clean. Work microwaves might not be cleaned as regularly as needed.

Step 4: Prepare for expressing

Use a few minutes to disconnect from the hustle and stress of work. Focus on your baby, you can even watch a short video or look at pictures of your child. You can use heat pads and/or massage your breast to help with the let-down.

Step 5: Express your milk

Every mom should know how to hand express. This can be very important if you forget a pump part at home. A double electric breast pump is most often the fasted ways to express breast milk.

Step 6: Store your milk safely

Once you have finished, store your breast milk into the contain that you will be freezing it in. Make sure it is closed tightly and will not leak during transportation. Depending on the facilities that you have at your workplace. You can store your milk in a fridge or cooler bag with ice packs for the rest of the day. Once you are home you can freeze or get the milk ready for the next day.

It is important to take into consideration the different cultures at work. Some people may find it offensive to keep expressed breast milk in the fridge (we hope that that will change soon). If this is the case, you can keep you bottle of milk in a non-see though container and your work colleague most likely will not even know it is there. Remember to label the bottle with baby’s name and date of expression so that you can identify your milk and how old it is.

Step 7: Clean up

Make sure that you leave the area clean and ready for the next mom to use.

If you are going to express again later in the day, you can either wash and sterilise your flange (not always possible) or you can store the flanges as they are (used) in a clean container and use them again later at the next breastfeeding break. The breast milk should not spoil in this time and if possible, you should keep the flanges cool in a cooler bag or the fridge.

It is always idea to wash and sterilise your breast pump equipment after every expression session, however this is not always possible. Try to wash and sterilize your breast pump equipment at least once a day when you get home. That way you know that you are starting out with sterilized equipment and you can control where it is kept during the day.

Step 8: Prepare for the next day

Once you are home wash and sterilise your equipment. Once your equipment is dry pack it away ready for you to take to work. This way you are less likely to forget it in the morning.

Step 9: Decide how you will feed the expressed milk to your baby

There are different ways to feed the breast milk to your baby. The World Health Organisation recommends cup feeding. However, many mothers find that bottles are more culturally accepted. If you do decide to use a bottle consider using PACE feeding method, which allows for the baby to show you when they are full, protects their airway form choking and can also prevent overfeeding.