Dealing with Unwanted Criticism

An interesting article on dealing with those lovely well meaning comments from friends and family members that are something akin to having someone kick you in the back of the knees.

http://www.breastfeeding.asn.au/bfinfo/dealing.html

Bottles after the first month = Probably not a bad idea (Yes I know this will raise lots of eyebrows but hear me out)

I started out my career as a lactation consultant as a breastfeeding purist.  I felt that if it wasn't the boob then it was unnatural and somewhat wrong.  Over the years my pragmatic streak combined with the stories mothers were telling me made me change my position.

Mums who had exclusively breastfed their babies for 5 months were running in to challenges because the baby refused to be fed any other way than from the breast.  400 years ago not really a problem, because there was usually an aunty or someone who could help out if mum needed to be away.  But fast forward to modern times.  Sometimes mums get sick and have to go to hospital, sometimes they have to go to a wedding, sometimes they just want to go on a date with their partner that doesn't require they squeeze it in between feeds.  Breastfeeding Aunties with clean bills of health just aren't as plentiful as they used to be so reality often requires adaptation.  Enter the bottle.  Once a baby figures out how to feed effectively from the breast add about two to four weeks.  Then after baby has had a good morning feed express off what is left in your breasts. Stick in the fridge and then in the evening it can be giving to a partner or given by yourself before baby goes to bed.  Now this is cool for two reasons.  It is mostly hindmilk (fatty sleep inducing milk) because it was pulled off at the end of a feed.  So now baby will learn to take a bottle, will get full on your own milk, and will hopefully give you a bit extra sleep in the night.

What sort of bottle to get:
Bottle marketers and formula marketers are both excellent at what they do and will try to tell you that their bottles are the best because of this or that reason.  The reality is that it only matters if your baby has a facial issue such as a cleft, or palsey.  If your baby can breastfeed and doesn't have palatal or neurological issues then any bottle will do.  Just stay away from dodgy plastics, and if it it comes from a dollar store I would avoid it.   Medela, and Ameda, are my safe bets but there are hundreds of bottle manufacturers that are making excellent bottles out there.  Just keep them clean during the day and sterilize them once a day and you should be all good.   Dr. Sears has put out a good guideline on selecting and cleaning your bottles located here.

First Month: Bottles and Breastfed Babies

Bottles in the Beginning = Bad Idea

Simply put:  When a baby is learning to breastfeed don't mess with their head.  Suckling on a breast and sucking on a bottle require two totally different skills. If the breast is low on milk (as can occasionally happen), and a doctor or midwife has prescribed a top up.....please whatever you do...avoid a bottle.  It flows fast and if the baby has been hungry up until this point they will most likely decide that your breast is frustrating and just too much hard work, and many then just say forget it and will start refusing to go to the breast.  Plus some studies have shown that at least in premature babies their temperature can drop and they can have more frequent episodes of their oxygen level dropping.

First give baby a fighting chance:

So how do you provide supplementary feeds to a baby if not in a bottle in the beginning.  First get the baby naked down to a nappy and skin to skin with mother.  Often this is all you need to do to stimulate the baby's natural feeding instincts, and has the added benefit of stimulating your milk supply.  I am not kidding about this.  Clothes between you and your baby in the first few weeks can be the natural enemy of breastfeeding success.  So give them the best chance and get naked together and warm (hat on baby, open front shirt or sweater on you, blanket over babies back, or just a warm room.)

Tube to the Breast

 My preferred method if baby is attempting to suckle well is to try tube to the breast.  This is a smallest gauge nasogastric tube (can usually get from the special care unit of the hospital) attached to a syringe with the tip cut off with sterile scissors.  The syringe is filled with either pasteurized breast milk from another mother or artificial baby formula.  The tube is placed so that it will end up with the tip at the nipple tip and angled so that it will protrude from the corner of the babies mouth.  (pictures are soon to follow).  You can also use a commercially available set up from Medela called a supplemental nursing system.

The reason we suggest this is it still requires that the baby is fed from the breast, they mentally process that the breast is a comfortable rewarding place to get food and then when your own milk comes flowing then you just subtract the tube. 

It is akward and can take a couple of people to get it sorted in the beginning but soon becomes easier.  I have a lady whom I worked with who was eventually able to tandem feed her twins using this set up.

This is by far my first choice when a top up needs to be delivered, plus usually there is less spillage. 

Variation: You can try and see if you can jump start a baby to suckle at the breast by trying a nipple shield over the breast with a tube under neath.  This will often tickle the babies vagal nerve and then will encourage a reluctant feeder to feed. You can then provided them with the extra milk via the tube underneath the shield.  

Finger Feeding

For a baby who is less coordinated and really cannot yet get their head around suckling at the breast (due to birth trauma usually) I recommend trying finger feeding. Before you move to finger feeding though the baby must first prove that they cannot latch onto a breast.  So undress them down to their nappy and put the baby skin to skin between mum's breasts and see if the baby will bounce down and try to latch on on their own.  If they can latch on, then use the tube to the breast technique.  If they just sniff and mutter at the breast then try this technique instead.

This is where babies are placed in the crook of your arm and the tube with the milk is taped on their finger and the finger is placed in the babies mouth.  By wiggling your finger with the pad side facing toward the roof of their mouth you are often able to stimulate their sucking reflex by tickling their vagus nerve.  Then when they are sucking on your finger you release a bit of the milk from the syringe.  Repeat until they have finished the required amount of milk and then return them skin to skin to their mother.  This is a very important part.  Please do not wrap up a baby that has had birth trauma and leave them to sleep all day in a  bassinette away from the perfectly designed healing space of their mothers chest.  If mum is not available or needs a break then this baby needs another warm body from the family if possible to help them to heal the fastest way possible. 

Cup Feeding or Spoon Feeding

Spoons are our friends in the first few days.  When a mum is expressing those precious drops of colostrum I don't want one drop missed so I  use a clean teaspoon.  They get every last drop nothing is wasted and they can be used by a mum by herself as opposed to using a syringe which usually requires three hands. Milk is expressed into the spoon then when there is a small pool fed to the baby you place it in the baby's mouth and they tend to lap it right up. If you need to measure volumes carefully then you can do this by filling it with water and then drawing it up in a syringe to measure volume the spoon can hold (do not feed the water to your baby this is just for measuring).  Then you have an idea how much the spoon can hold.  I have yet to find a baby that I couldn't spoon feed.  And there is no wastage of the milk.

 

Once the volume is over 5 mls then a cup, like a small medicine cup can be used to feed the baby. However be careful for spillage.  One study showed that over 38% of the milk could be lost during cup feeding, fine if it is formula but not fine if it is expensive or hard won breastmilk. And not fine if the baby needs volume.

For more information please feel free to have a look at the following:

Protocol from the Academy of Breastfeeding Medicine on Supplementation of Breastfed Infants

Stateside breastfeeding observations

I have been back in the states for 5 days now and have yet to see a baby being breastfed.  Or many babies for that matter, nor pregnant women.  I have seen two pregnant women all up since arriving.  Babies seem to live in front packs, which is encouraging but was quite saddened by the obvious sale of breast feeding capes, next to bottles that were so cute that even the bottle hesitant me was tempted to buy one.  So maybe babies are being breastfed they are just being hidden as if they are too shocking to be seen by the general public.  I must explore this.  It must just be that I am not in the right locations but it reminds me of my friend Sophia's quest to find a squirrel while she was Stateside and he subsequent failure to find one.  Will a confident breastfeeding mother be as elusive to find?  Have I just become so used to Kiwi mothers relaxed feeding style that I have forgotten after 10 years what the breastfeeding culture is like in the States?  I am in San Francisco so I expected a degree of openness here.  Now mind you it is winter so that could definitely be a factor.  But I am intrigued by this.  Stay tuned...I will look harder.

very cool Kangaroo care Article

Here is the New York times article

Oversupply Reflux in a Breastfed Baby

Many medical professionals believe that you cannot over feed a breast fed baby....Hogwash.  When I used to hold open clinics I could almost draw a line down the room of fussy babies.  Half would be skinny, grumpy looking old man bubbies and half would be gynormous Buddha babies.  The skinny ones were crying because they were not getting enough milk.  The Buddha's were crying because there guts were full to bursting and they had sequential Christmas dinners for the past 4-8 weeks.  There is only so much a newborn esophageal sphincter can take (the muscle ring that keeps the food inside....quite undeveloped in most newborns...which is why they spill a lot).  Some theories also believe that the mums who have too much milk also have high amounts of foremilk which is high in lactose.  The baby only has so much Lactase the enzyme which breaks down the lactose and so the excess undigested lactose then causes gastric cramping as it shoots through the gut.   Basically a recipe for a really grumpy little bubby.

Symptoms of Oversupply Reflux:

In Baby:

Treatment
First thing is get help from a professional that has experience in dealing with Oversupply Reflux, Lactation Consultants usually have experience with treating this challenge and when working in conjunction with a supportive GP or Paediatrician usually can fix the issue in a week or two.

Some things that have worked for my clients in the past are as follows:

• The primary treatment is aimed at reducing the speed and amount of milk the baby takes in.
• Expressing off the first let down into a cloth and then latching baby after the lactose rich foremilk has passed can sometimes help.

• Feed on one side only  for a 3-6 hour block, this enables the baby to get less volume and higher fat content.
• Feed until baby begins to pop off or fight at the breast, then pick up and cuddle on shoulder for about 5-20 minutes.  You can offer small top ups after this on the same side only (this seems to settle babies and may be related to washing down a burning silent reflux)
• Nipple shields can help baby control the flow.
• Feed baby in an upright position with his bottom much lower than his head.
• These babies tend to do better being held by a family member while they are in pain.  Holding the baby upright and gently moving tends to help baby cope with the discomfort.
• Raise the head of the babies sleeping area by 40 degrees.
• Reflux medication can help in many cases where baby is in a lot of pain.
• Most parents seem to prefer Ranitidine to Gaviscon for ease of use and effectiveness with a baby.
• You can express your breast only to comfort not to empty, as that would stimulate more milk production..
• Leaving a baby to cry it out that is in pain is not developmentally appropriate.  They do not yet have the ability to soothe themselves and need help.  So lots and lots of cuddles for baby as well as parents until baby comes right.  
• Cabbage leaves can help with engorgement and help reduce supply in heavy breasts (cut the hard stem out and roll the leaves with a rolling pin then place them on the breasts in the bra, when they wilt replace them with fresh ones.  I would recommend using an organic cabbage so as not to potentially).   put pesticides near the breasts).  Use in moderation because these can be more powerful than you would suspect.
• If the milk supply is just over the top and will not be tamed by the above measures then you can try using an herbal tincture called Galactagone (try healthfood stores).  But be very careful as it will kill a large supply almost overnight.  I only use in extreme circumstances.

Little Noah is not so Little

Georgia came along to the Boobs in the Berries course but I didn't get to meet her boys until this photoshoot. They were both absolutely Gorgeous!  Noah is huge, cruising the 97% tile on everything.  A future All Black if I have ever seen one!  And speaking of Cruisy.  My goodness this kid is mellow!  Wouldn't stop smiling.  I love photographing them when they are 8 weeks.  They still look sparkly new but they can grin at you....Too much!

Killing Off Supermom | ModernMom.com

Killing Off Supermom | ModernMom.com

I thoroughly enjoyed this, a bit off topic, but not really. Enjoy

Bubby A'La Mode

Boobs in the Berries is now  Bubby A'La Mode.
Big changes are afoot and Boobs in the Berries has moved from its setting in the Tipi on the Blueberry Farm to the more convenient space at 115 Jackson Street Petone, home of A'La Mode Photographic Boutique.  Our classes are smaller and more intimate and more regular and timed for working familes as they are held on Wednesdays at 6:30pm.   Looking forward to seeing you there.
Still working on a logo for it....so watch this space.
Cheers,
Mandi

Very straight shooting video from Hollywood

Course Feedback and PDF

I hope my new friends in the south are weathering the storm okay. Here is your chance to tell me what you thought of the course and you can do that by logging on here and letting it rip.  It is great for me to get the feedback so I can improve the course for future classes, and if you enjoyed it, let me know so I can let others know what your experience was like and we can take this information on the road so more babies will get to receive the sort of care that we talked about.

If you would like a copy of the lecture notes in a PDF you can follow this link to receive it .
Thanks again for taking the time to attend and I hope to visit you again.....Stay warm.
Cheers,
Mandi

Boobs in the Berries are heading south

I am tickled pink that a group of Midwives from the South Island have invited me down to do a speaking tour and share what we are doing up here in our little valley.  I will be doing a whirlwind tour to Queenstown, Invercargil, and then Dunedin.  This tour piggy backs onto the New Zealand Institute of Professional Photography conference in Queenstown the week before, so I will be filling my brain with all kinds of photography wisdom then hopefully delivering a smattering of Breastfeeding support inspiration in exchange.
The best thing about the speaking tour is it is forcing me to take the time to write down all of the stuff that I speak about in the course.  I will put the PDF's up online so that class participants will reap the benefits. And hopefully one day soon i will be able to shape it into the book I have had sitting in my head but not out on to paper.  

Cambell Live clip on Kangaroo Care

Advocates call for kangaroo care to be more supported

This was a lovely little news piece that I unearthed and thought it was worth sharing

Professional Photography of Breastfeeding Babies

SALMA HAYEK Breast Feeds A Hungry African Child | Actress Act Of Love !

Mandi Lynn Photography: The Big Latch On 2010 | Mamalicious

Mandi Lynn Photography: The Big Latch On 2010 | Mamalicious: "You could get high from all of the Oxytocin flowing at the Big Latch On held last Friday at the Wellington Town Hall. Mamalicious put on ..."

Slings - Questions and Answers

At Boobs in the Berries this past Sunday there was a question relating to the safety of slings.  Here is the information that I have been able to dig up from the sources I most trust on these matters, the Academy of Breastfeeding Medicine:



CPSC warning on slings misses the mark New Rochelle, NY, March 19, 2010 — The Consumer Products Safety Commission's warning on baby slings provides vague and misleading information for parents. The popularity of slings has increased tremendously in recent years, as more and more mothers report that slings facilitate parenting and breastfeeding on demand. "All slings are not created equal," says Arthur Eidelman, MD, vice president of the Academy of Breastfeeding Medicine. "Unfortunately, however, the CPSC issued a blanket warning about all types of sling carriers." Ring slings, which carry infants in an upright position snug with the parent's chest, protect the infant's airway. By contrast, the illustrations of "unsafe" slings in the CPSC warning appear to be bag or duffle slings. In bag slings, the infant is carried near the parent's hips. In this position, the infant may be curled up and the neck may be bent, making breathing more difficult. The CPSC's advice on safe baby carrying is also misleading. The agency recommends positioning infants so "the baby's head is facing up and is clear of the sling and the mother's body." "The face out position they say is correct could be risky with a premature infant, because of the baby's unsupported neck," Eidelman says. "A baby whose face is sideways with cheek against the chest, head slightly extended and body and shoulders and yes, face, snug so that the baby can't move, is secured in a safe position." In the warning, the CPSC reported 14 deaths associated with sling use in the past 20 years, including 3 in 2009. The agency provided no information on the types or brands of sling involved, nor did they account for the rapid increase in sling use among parents in the US. This stands in contrast with the hundreds of recalls of other juvenile products issued by the CPSC that specify the precise brand and model number involved in adverse outcomes. "Last month, when the CPSC recalled a crib model associated with 3 infant deaths, they did not issue a blanket warning that cribs can be deadly," Eidelman notes. "Parents deserve the same precise, accountable information when it comes to baby-carrying." The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation through education,
research, and advocacy. An independent, self-sustaining, international physician organization and the only organization of its kind, ABM's mission is to unite members of various medical specialties through physician education, expansion of knowledge in breastfeeding science and human lactation, facilitation of optimal breastfeeding practices, and encouragement of the exchange of information among organizations. Breastfeeding Medicine is the official journal of the Academy of Breastfeeding Medicine. It is an authoritative, peer-reviewed, multidisciplinary journal published quarterly. The journal publishes original scientific papers, reviews, and case studies on a broad spectrum of topics in lactation medicine. It presents evidence-based research advances and explores the immediate and long-term outcomes of breastfeeding, including the epidemiologic, physiologic, and psychological benefits of breastfeeding.
The Academy of Breastfeeding Medicine, 140 Huguenot St., 3rd floor, New Rochelle, NY 10801-5215 (800) 990.4ABM (914) 740.2115 Fax: (914) 740.2101 abm@bfmed.org



http://www.bfmed.org/Media/Files/Documents/ABM%20PR%20CPSC%20wasning%20on%20slings%20misses%20the%20mark%20(3-18-10).pdf

Boobs in the Berries Autumn Edition

Hello lovely pregnant families. The Boobs in the Berries is approaching its first Autumn and classes are booking up fast. I will continue to try to hold it in the Tipi but may have to start a fire to keep it warm enough for the class but just to be safe bring layers. If it gets too cold we may relocate to the photography studio but irregardless you will learn heaps and have fun.

Sign up for the Classes here

Dominion Post features Boobs in the Berries

---

The Dominion Post
17 Feb 2010, pp. 56 - 57

Feedback from the Boobs in the Berries Class

"What was the best part of the class?  Mandi! I found Mandi to be so approachable, straight forward and relaxed.

"We left feeling so positive and the 'fear' of something not going right with breastfeeding has been eliminated. We are so confident now of what we are going into and how it will work for us. What seemed so hard before we got there (thanks to all those old wives' tales) now seems like it will be a total breeze, and so beneficial to the baby. 


"My hubby and I aren't really 'class' people so are always a bit reluctant about attending things such as this, but we left so informed and so positive about everything that I will not be able to recommend you enough.  (I know that I have already told all my pregnant friends!)"

- Jessica & Hamish

"I enjoyed the relaxed environment, friendly teacher and the wealth of information. I feel more confident with breastfeeding when my little bub is born." 

- Rachael Bolland

"Lots of great information and lots of laughs -- fun and very informative. I like the informal atmosphere. And I want my own teepee." 

- Aaron Compton

"I liked:  Having someone give clear and sensible justifications for not putting the baby in a basinet. Discussing the 'sidecar' solution as a practical and safe (given the normal guidelines) way of sleeping with the baby. Loved the balloons to show the latch. Great idea.


"All in all, I wish that the other antenatal classes covered this rather than seeming to stop at the birth. I feel better prepared after this course." 

- Andrew Hood

"I liked the ability to ask questions in a relaxed, non-judgemental arena. The balloons gave a very graphic demonstration of the effect of a good latch. This was very useful in understanding the effect of a good vs. poor latch. Appreciated the discussion of breastfeeding in relation to the rest of baby care - taking a holistic view of breast feeding made a lot of sense, but doesn't seem to normally be mentioned."

- Annemarie Hood