Tuesday’s Tips: Helpful Counseling Tips for Medications, Herbs & Galactagogues from Dr. Frank Nice


As a lactation specialist or one aspiring-to-be, you may find yourself getting asked questions regarding the safety of prescription and over-the-counter (OTC) drugs by your breastfeeding clients. Or maybe it’s not medications, but the safety of herbs or the use of Galactagogues.


As lactation professionals (and those aspiring to be), it’s essential we stay within the scope of our training and certification. Diagnosing and prescribing prescription and OTC medications, herbs and galactagogues are outside the scope of practice for IBCLCs (and other lactation specialists) – unless of course, you’re also a licensed health care provider who has the ability to diagnose and prescribe medication. What we CAN do as lactation specialists is to counsel our breastfeeding clients and provide them with evidence-based resources so that they can make an informed decision that is best for themselves and their family.


In the Middle East where I used to live and practice, it was not common practice to question your physician’s recommendations, ask questions, or even to begin an open dialogue about potential alternatives, risks and benefits, etc. To question your doctor was a big no-no and it was something that just wasn’t done.

But because my client’s (and their infant’s) health and well-being come first, I encouraged every single one to bring every single evidence-based resources to their health care provider – to ask questions, demand answers and to begin an open dialogue. Yes, I admit I probably committed a few cultural faux pas, but it was worth it.

I found this not only enabled those I worked with to make informed decisions that worked best for them and their families, but it EMPOWERED them as well. The cherry on top was that it also educated health care professionals on lactation issues, which was often desperately lacking. Due to this approach, I was able to establish working relationships with local health care providers and to network. It was a win-win.


Dr. Frank Nice, RPh, DPA, CPHP

You may be wondering where to start when counseling your breastfeeding families on prescription and OTC drugs, herbs and galactagogues. How do you go about it? What approach would you take? What questions should you be asking and answering? Well, thanks for Dr. Frank Nice over at Nice Breastfeeding, he’s got all of this covered.

He has shared a wealth of information in order to help you help your breastfeeding families. Best of all, it’s all FREE and immediately accessble – just click here for practical, relevant counseling tips that you can begin applying with soon as the situation arises.

This link is divided into 3 sections: 1) About Mom, 2) About Baby, 3) Useful PDFs (on several topics including but not limited to Domperidone, Galactalogues and Herbs, and Recreational Drugs). These are free, downloadable and are perfect resources to share with your breastfeeding families.

And don’t forget to encourage your clients to share these handouts with their health care providers – not only will this create an open dialogue of how to best approach their situation and meet their needs, but it will also help to educate health care providers as well.

There is also a helpful ‘Patient Resources’ section with  Useful Links that you can share with your expecting and breastfeeding clients. Again, these are free!


Dr. Frank Nice, RPh, DPA, CPHP,  founder of Nice Breastfeeding, has over 40+ experience specializing in medications and  breastfeeding. He has also authored 2 books: Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition (2011) and The Galactogogue Recipe Book (2017).


“Stretching Conference Dollars in 2019” (Bonus: a list of lactation conferences with links to registrations) by Christy Jo Hendricks

Happy-New-Year-Status-2019


Happy New Year! And who can think of a better way to ring in the New Year than by intellectually stimulating your mind (and your hearts because we all know pretty much anything lactation-related makes our hearts happy). You may be asking, how do I enrich my knowledge-base and make my heart happy?


Christy Jo Hendricks, IBCLC, RLC, CLE, CCCE, CD

Well, that’s simple and the credit goes to Christy Jo, IBCLC, RLC, CD (DONA) & CAPPA CLE Faculty, owner of Birthing, Bonding & Breastfeeding, and her new, exciting initiative already in the works – Lactation University.

For those of you who weren’t aware, Christy Jo has also just recently founded an award-winning IBCLC prep coursewhich has a 100% IBCLE exam pass rate from its first year of students. Incredible, awe-inspiring and just plain brilliant!


Are you ready to see the list of all of the upcoming lactation conferences in 2019? Then just scroll down to the bottom of this post and you’ll find it there – with links to registration and costs. Thanks Christy Jo for making this so easy for us.


Are you wondering how the heck to chose which lactation conference to attend? Christy Jo has some helpful advice:


“The main considerations when selecting which educational opportunity to attend include: cost, location, date, speaker line-up and networking opportunities. Many attendees also make decisions based on who the conference will benefit, or the reputation of the organization hosting the event. Audiences may also select a conference if it provides Continuing Education Units or CEUs to attendees. I usually attend several low-cost, high-quality, local conferences and one or two international conferences annually.”


For more information on how Christy Jo stretches her hard-earned pennies to be able to take advantage (and afford) these incredible, enriching opportunities? Simply click here to find out.


Are you interested in what else Christy Jo is up to? My question is, how does she sleep?! She has so much to offer – so it’s definitely worth checking her out. You can find her on Facebook, Twitter, her professional blog, professional lactation website and more, including, but not limited to helpful and practical lactation education items that are perfect for home and hospital visits, trainings and breastfeeding classes and a picture book portraying real families breastfeeding, which goes a long way in normalizing breastfeeding titled, “Mommy Feeds Baby.”


And don’t forget to sign up for Birthing, Bonding and Breastfeeding’s (BBB) FREE newsletter here


Free Drug Safety & Lactation Resource List

Free Drug Safety & Lactation Resource List


Author’s Note:  This post used to be a static page. I turned it into a blog post to make it more accessible and easier to search. Providing lactation support is hard enough, it’s my goal to make whatever I can easier and simplified for lactation specialists and those aspiring-to-be.


Do your clients ever call you wondering if a particular medication is compatible with breastfeeding? Many times nursing mothers are told to “pump and dump” or wean by their physicians when in fact, it’s unnecessary. Other times, it’s assumed if a medication is over-the-counter or an herb, it’s completely safe. This is not always the case.


Check below for the most widely used evidence-based resources in order to evaluate drug risk and safety during lactation. This list is arranged by alphabetical order and is by no means exhaustive, so if you’ve found another database or resource helpful, let me know so I can add it.


Questions for lactation professionals and nursing mothers to consider when evaluating risk levels of drugs, herbs, chemicals, etc. during lactation:

1) Will the drug, etc. affect my baby?
2) Will the drug, etc. affect lactation?
3) What are the risks of weaning?
4) What are the options?

For tips on how to counsel your breastfeeding clients on medications, galactagogues and herbs, see these tips by Dr. Frank J. Nice, RPh, DPA, CPHP.


Electronic Databases 


Breastfeeding Network –  Provides FREE Fact Sheets on a wide array of drugs, medical procedures and health conditions and compatibility with breastfeeding available here. These are great to share with your clients (and to encourage them to print them out and discuss safety concerns or potential alternatives with their health care provider). Also provides a detailed description of an ‘Introduction to the Safety of Drugs Passing Through Breastmilk’ here. For common FAQs concerning breastfeeding and generic medications, see here. Also contains general ‘Information on Breastfeeding’here, ‘Thinking about Breastfeeding’ here, ‘Breastfeeding and Perinatal Mental Health’ here and common ‘Questions about your Baby’here.

TIP: when using drug search databases: Since drug names can differ by country and even more so if it’s a generic vs. name brand drug, if the drug you are searching does not show up in the database search engine, then google that particular drug for the active ingredient and search by that instead.

e-lactancia – Compiled by pediatricians affiliated with APILAM. Uses risk levels 0 (no risk) -3 (very high risk). Covers “medical prescriptions, phytotherapy (plants), homeopathy and other alternative products, cosmetic and medical procedures, contaminants, maternal and infant diseases and more.” For common FAQs concerning lactation and medications, see here. Very easy to use and understand. A great resource to share with families so they can look up their own medications. Available in English and Spanish.

Infant Risk Center – Researched and compiled by Dr. Thomas Hale, PhD and author of the renowned and widely used medical lactation risk and reference guide, ‘Hale’s Medications and Mothers’ Milk.’ This reference guide is updated every 2 years, with the most recent edition published in 2017 and a new edition coming out in 2019). This resource uses lactation risk categories 1 (safest) – 5 (contraindicated). It covers prescription medications, chemicals, herbals, vitamins and radioisotopes/radiocontrast agents. This reference guide is also affiliated with the Infant Risk Center at Texas Tech University Health Sciences Center. A detailed description of ‘Drug Entry Into Human Milk’ is available here. If you have a question regarding a particular drug, you can call a free helpline at (806) 352 – 2519.

Medications & Mother’s Milk is an electronic database also established by Dr. Hale. Annual subscriptions are available at varied prices for individuals and groups/institutions. Mobile apps are also available for both androids and iOS – one is for healthcare professionals ($9.99) and the other is a simplified version for parents ($3.99). You can view options here.

LactMed – Sponsored by the National Institute for Health (NIH)’s US National Library of Medicine TOXNET Toxicology Data Network. It provides peer-reviewed, fully referenced, evidence-based resources. Users can look up lactation risk of both drugs and chemicals. This site is highly medicalized and may be too versed in “medical speak” for the average consumer to fully understand. LactMed also offers a mobile free app for both android and iOS.

MotherRisk – Sponsored by The Hospital for Sick Children in Toronto. It provides evidence-based information about the compatibility of prescription and over-the-counter medications, herbal products, chemicals, radiation, chronic diseases, infections, occupational, environmental, and other exposures during pregnancy and lactation. Also covers general FAQs about medications and lactation. Various brochures are available here. Offers a FREE MotherRisk Hotline: 1-877-439-2744, which is open Monday – Friday 9 a.m. to 12pm and 1 to 5 p.m. Eastern Standard Time.


Additional Drug Safety & Lactation Resources


Breastfeeding &  Human Lactation Study Center (which is a part of the Division of Neonatology at University of Rochester Medical Center’s Golisano Children’s Hospital) under the direction of Ruth A. Lawrence, M.D. Healthcare professionals can call (585) 275-0088 at no cost for information on drug risk and compatibility and to consult on difficult breastfeeding issues. Note: This hotline is for healthcare professionals ONLY, not for parents or your breastfeeding clients. For more information, see here. See here for a breastfeeding site geared specifically toward your breastfeeding clients and families.

Cindy Curtis, RNC, IBCLC, CCE, CD of Breastfeeding Online has compiled a comprehensive and beautifully organized list of lactation risk and compatibility with direct links to articles on breastfeeding and alcohol, herbals, epidurals, antidepressants, social drugs, cigarettes, prescription and non-prescription drugs and more. This is an accessible and quite handy resource to share with your breastfeeding clients or lactation specialists-in-training.

Frank J. Nice, RPH, DPA, CPHP of Nice Breastfeeding has written several books on medications and compatibility with breastfeeding: ‘Nonprescription Drugs for the Breastfeeding Mother’ (2017) here. ‘Recreational Drugs and Drugs Used to Treat Addicted Mothers: Impact on Pregnancy and Breastfeeding’ (2016) available here. ‘The Galactagogue Recipe Book’ (2017) which discusses dosage, uses, and cautions of galactogogues here. There are free downloadable pdfs on a wide array of lactation and drug risk categories including herbs and galactagogues, recreational drug use and Domperidone are available hereFree patient resources with helpful links are available here. You can find information for healthcare providers on how to counsel breastfeeding mothers who have drug-related questions here.

International Breastfeeding Centre established by Dr. Jack Newman, MD, IBCLC provides a general overview of maternal medications and breastfeeding in a Q&A blog post format, addressing general FAQs, whether or not to continue breastfeeding, how drugs get into breast milk and lactation compatibility with specific medications here. If you have a question about a particular drug’s compatibility with breastfeeding (or you’re dealing with a difficult breastfeeding case in general and would like some guidance and feedback), Dr. Newman answers emails from Lactation Specialists at no charge here. Information sheets on a wide array of lactation topics are available here, many of which are translated into different languages here.

Kelly Bonyata, BS, IBCLC of Kellymom has compiled lists of lactation risk databases in English and other languages, common FAQs on specific drugs, treatments and medical procedures, lactation risk resources and a detailed list of reference links here.This is an accessible, easy to understand resource to share with your breastfeeding clients.

La Leche League International (LLLI) has also published some articles and FAQ fact sheets on medications and breastfeeding. It also has a comprehensive resource of hyperlinked articles addressing breastfeeding with maternal illness, conditions, diseases and  if medications/treatments are compatible. LLLI’s site, including it’s articles (typically written  for mothers and parents by mothers (who are also breastfeeding counselors), are fantastic reat resources to share with nursing mothers and families as they are easily accessible, usually short and sweet, and written for an audience without a medical background. Just click on the title(s) below:

Wendy Jones, BSc, MSc, PhD, MRPharmS of Breastfeeding and Medication.This comprehensive site includes free downloadable Fact Sheets, evidence-based useful links on medication and breastfeeding, E-Learning Packages/Training Packs, aimed at GPs (latest cost was £40.00), which can be purchased here. She has also authored the books, “Breastfeeding and Medication.” (2018) and “Why Mothers’ Medication Matters” (2017).


Herbs & Breastfeeding


Kelly Bonyata, BS, IBCLC of kellymom.com has created a simple, accessible resource list of specific herbals and natural treatment and compatibility with lactation here. For information on marijuana and breastfeeding, see here. These are both fantastic, easy to read and understand resources to share with your breastfeeding clients.

Sheila Humphrey, BSc, RN, IBCLC has written the ‘The Nursing Mother’s Herbal’ (2003) available here, which discusses the effects of a wide array of herbs, dietary supplements and natural remedies on lactation and lactation-related maladies such as mastitis, plugged ducts, thrush and more. Her book is organized into Herb Safety Categories A (no contraindications) – E (Avoid. Toxic plant with no justifiable medical use). See here for a more thorough description of the Herb Safety Categories and see here for a review of her book from LLLI.


This list is by no means exhaustive. If you have a evidence-based resource on drug safety and lactation that you recommend and it’s not included in the list, then please, send me a message with a description and relevant info so that I can include it. Thanks a bunch, xx

Guest Post: “Supporting Women Through Relactation” by Lucy Ruddle, IBCLC

Supporting Women Through Relactation

by Lucy Ruddle, IBCLC

Lucy Ruddle, IBCLC

Editor’s Introduction: Lucy Ruddle is an International Board Certified Lactation Consultant (IBCLC) who resides in the United Kingdom (UK). She’s a mother who has successfully relactated herself and runs a UK-based relactation Facebook group. She specializes in relactation and breastfeeding grief (which we all know often go hand-in-hand). If you’d like to learn more about Lucy, you can find her on Facebook here. She also has a fantastic blog where she’s published a wide array of lactation-related posts and resources.


Author’s note on language: Throughout this article, I refer to “Breastfeeding” however, I am aware that not everyone who lactates identifies with this specific term. The term “Chestfeeding” may be preferred – please do use whichever language you feel most comfortable with. I have used a broad range of terms such as Mother, Mum, she, they, person, parent etc. throughout this article. It is my aim to embody the diversity of language individuals relate to in the field of lactation.


It’s a bit of a mythical beast, relactation. It’s talked about across the parenting forums and Facebook groups around the world. It seems that barely an “I’ve stopped breastfeeding and I feel awful” post goes by without someone saying, “You know you can relactate, right?” And yet even in the field of lactation, practitioners aren’t always sure how to support parents asking them if it’s really possible to bring their milk back.


Let me start by saying a clear “YES”, relactation absolutely is possible. If humans can induce lactation, then, of course, they can produce milk after doing so once before. There are anecdotal reports of Grandmothers relactating to feed their grandchildren, and many of us are aware of the outstanding work currently happening to support refuges to rebuild milk supply so they can safely feed their babies.


However, what I often hear is women being told to “Just put baby to the breast.” Which seems very logical to be fair, so this may come as a surprise… “Just put baby to the breast” rarely works. I run a relactation group on Facebook and have relactated myself. Over the last 5 years, I have lost count of how many women I have supported through this process. I have also lost count of how many babies simply will not latch to an empty breast. These babies have been taking a bottle for at least a couple of weeks, and usually, they were exposed to one before mum stopped breastfeeding altogether. They are used to a silicone teat dripping or pouring a steady flow of milk straight down their throats. They rarely have the patience to play around with a breast which isn’t giving up the goods.

Of course, we should encourage mum to find out if baby will latch. Let’s be honest, a willing baby makes rebuilding milk supply a lot easier. BUT if baby won’t attach, and the adult keeps pushing the matter, then we are on a fast track to breast aversion. Let’s take this thing, breastfeeding, which is supposed to be connecting and lovely, and turn it into a battlefield, shall we? No. If baby doesn’t want to latch, then we drop the rope, as it were.

Lucy demonstrating her suggestion of bottle feeding near the breast.

Instead, parents can work on building in skin-to-skin contact. This may be through co-bathing, babywearing, baby massage etc. A lovely and easy way to get in regular and prolonged skin to skin is while feeding with the bottle. Mum can hold the bottle close to her breast and snuggle baby in close. This starts to rebuild the association that milk and breasts are related, and helps the parent to feel close and bonded to baby. When parents are feeling relaxed and close to their babies relactation tends to go a lot better. In fact, this is really important.

Here’s what tends to happen when someone wants to relactate: They are overwhelmed with guilt, shame, anger, confusion and grief for their experience of breastfeeding. The need to erase those feelings is so strong that they throw themselves into pumping, taking herbs, and demanding their GP prescribes Domperidone. And then, when things don’t happen quickly – they burn out and stop. They tell themselves they really can’t breastfeed, they have failed not once, but twice. That is potentially deeply damaging and we need to support families to avoid this happening.

When we instead focus on what parents actually miss about breastfeeding, we often learn that it boils down to the closeness.

We can recreate this with skin-to-skin contact and we can help Mum to learn that she is good and wise, and tuned into her Babe’s needs even without breastmilk. Once her healing here begins, the pumping won’t feel so desperate. She won’t be in such a hurry, won’t need quick results. She can think more clearly, be open to the idea that this might take many weeks, and that perhaps she will only be able to partially breastfeed until solids are introduced.

Once the hurt and grief are subsiding we can also begin to talk with the family about how breastfeeding is only a tiny bit about nutrition, and perhaps the breast/chest can become a lovely safe, relaxing space for reassurance, sleep and pain relief. Skin-to-skin – it’s my number one recommendation for relactation.

While Mum is rediscovering close, physical connection with her baby she can begin to rebuild her supply. A good breast pump isn’t essential, but if it’s an option then it will most likely make the process quicker. Mum needs to be pumping as close to 8x a day as she can manage, never going longer than 6 hours between pumping sessions. 15-20 minutes each breast is about right in the early days, finishing up with 5 minutes of hand expression. Generally, drops are seen quite quickly – days rather than weeks. The key here is consistency though. The breasts must be stimulated often to keep prolactin high and to keep the growing milk supply flowing so the breasts replace what’s been removed plus a bit more.

I firmly believe that our role as breastfeeding practitioners here isn’t to pressure the parent into expressing a certain number of times each day but to support them to find ways to pump as often as they feel able.

We can talk about putting baby in a bouncy chair which can be rocked with a foot while pumping, we can suggest roping in friends and family to hold baby, bring meals, run through a load of laundry, look after older siblings. We can encourage pumping to be seen as a chance for the parent to put their feet up with a favourite TV show or audio book. The list of creative ways to help pumping feel sustainable and less of a chore is endless.

Telling someone to pump every 2 – 3 hours for potentially several weeks, and then not helping that person find ways to achieve that goal is, in my opinion, unkind and only carrying out half a job.

The transition from bottle to breast needs to be carefully managed. As supply increases, the breast should be offered at regular intervals (no more than once every few days until baby is willing to latch, and once baby is happy at the breast, it can be offered before and after bottle feeds, or any time that just feels good) and pump afterward. Paced bottle feeding may give baby opportunity to show satiety cues and avoid overfeeding as they take more from the breast, but evidence to support this is woefully lacking. Frequent weight checks with a breastfeeding-friendly provider are very important and responding to any drop in centiles with an increase in supplements and pumping will protect Mother and baby as they work through this tricky part of their journey.

This is the point parents often begin to worry they can’t make enough milk, so they need a lot of emotional support as well as education around normal feeding behaviour and signs that baby is getting enough to help them transition to full breastfeeding and maintain it long term.

Gentle, empathic, positive care, focusing on how incredible mum is, how well her baby is growing, how dedicated she is, how connected to her baby she is etc., will all help bolster confidence in herself, her baby, and her body.

I can’t emphasize enough the importance of counseling and listening skills when dealing with a family wanting to relactate. These parents are often hurting intensely and are vulnerable to PND and low self-esteem. Relactation can be a powerful way to empower a family, and the correct support can genuinely facilitate that and change lives.


Are you a lactation specialist or one who is aspiring-to-be who has a special interest in a lactation-related topic? Perhaps you’d like to share your experience in the lactation field– tips, helpful resources, lessons learned, do’s and don’ts, challenges, etc. Or maybe you just have a lot to say! And that’s ok. Galactablog welcomes guest posts on a wide array of lactation-related topics. Contact us here or at galactablog{at}gmail{dot}com to share your ideas or for more information. 

FREEBIE FRIDAY: “Nutritional Support of the VLBW Infant” Free Toolkit

Do you help support Very Low Birthweight (VLBW) Infants in your lactation work? Or maybe you are just starting out and want to learn more about working with and how to better support premature and VLBW infants. If so, then you’ll enjoy this FREE toolkit. I can’t take credit for this find myself – it was shared in a private lactation group by Liz Brooks, JD, IBCLC, FILCA.

The California Perinatal Quality Care Collaborative explains what’s included (and what’s new) in the 2018 version:

“The 2018 update of the Nutritional Support of the VLBW Infant Toolkit was developed to provide rapid assessment of current nutritional practices, outline evidence-based best practices, and enable rapid multidisciplinary improvement cycles to improve nutritional outcomes for premature newborns. We have added important new references, streamlined recommendations, and targeted the best resources.”

Aren’t you excited to download it and check it out? If so, click here for your free toolkit. And don’t forget to check out all of the FREE Additional pdfs located on the same site on your lower righthand side.

Do you have an idea for FREEBIE FRIDAY? Don’t be shy! Please do share – I promise to give you full credit. If you’re a company, private practice, NGO, etc. and have a FREE opportunity or item to offer to Galactablog readers, let me know. As long as you are WHO Code Compliant, you’ll be given full consideration. You can contact me here or email me at: galactablog@gmail.com. I look forward to hearing from you.

Tuesday’s Tips & Tricks: How to use grapes to illustrate lactating breast anatomy & milk production

It’s Tuesday! That means it’s time for some tips and tricks. Do you ever struggle in explaining lactating breast anatomy and how milk production works to your clients? Perhaps you have the definitions and explanations down pat, but you can see their tired eyes glossing over and it’s obvious they are losing interest. I’ve learned that fun, visual props not only make great conversation and keep attention, but they work as visual aids much better than words alone. Bonus points if the prop is completely unrelated to breastfeeding. Come on, who wouldn’t want to pay attention when you pull a bunch of grapes out of your lactation bag. Yup, you heard that right – GRAPES!

You may be scratching your head and wondering, what the heck to grapes have to do with breastfeeding or lactation? Not everyone has the money or access to fancy breast models (and some clients may not be able to read or understand complicated breast diagrams), so I’ve learned that keeping it basic and simple, along with using something that you probably already have laying around, is cheaper, easier, quite effective, practical and oh so fun. So let’s get to it. If you live in an area where grapes aren’t expensive and they are available, hurry and go get some. They serve as fantastic visual props to illustrate breast anatomy and how milk production works. Bear with me here. Take a quick look at this very basic diagram of a lactating breast (on  different topic, I was surprised at how many breast diagrams still existed that contained lactiferous sinus) and then the grapes. Do it a few times.

 

Are you starting to see the resemblance? Can you see how if you look closely (and use your imagination), that in a bunch of grapes, you can point out the ducts, alveoli (clusters of glandular tissue that look like small, grape-like sacs), lobules (cluster of alveoli), a lobe (cluster of lobules), ductules, adipose (fatty) tissue and so on? Get creative and have fun with it – I guarantee they’ll pay attention. Now if you happen to come up with a simple, basic, quick script, please do share – mine is still kinda rambly and dense, it’s something I’m constantly evolving.

If you want to have fun with it, bring different colors of grapes – just as all breasts come in different sizes, shapes and colors – so do grapes! Don’t forget to share, after all, a breastfeeding mother needs to eat.

Do you have a tip or trick for Tuesday’s Tips & Tricks series? If so, don’t be shy! FREEBIE Please do share – I promise to give you full credit.  You can contact me here or email me at: galactablog@gmail.com. I look forward to hearing from you.

 

Tuesdays Tips & Tricks: Knitted Breastfed Baby Poop Diaper (a.k.a. ‘Happy Knappy’) as a Teaching Tool

Photo courtesy of Philippa Pearson-Glaze, IBCLC (2017) from the website: breastfeeding.support

Do you knit? If not, perhaps you have a friend, neighbor, relative or co-worker that knits? It is definitely worth asking around (and being willing to bribe) if you do not – or perhaps using this as a perfect excuse to learn yourself – because this adorable knitted diaper demonstrating what normal breastfed baby poop looks like for the first 5 days (and in weeks 1-6 postpartum) is a great, effective teaching tool – not only for prenatal breastfeeding classes but also for home and hospital consultations you may be doing soon after birth.

I’m sure many of you have received frantic phone calls from scared, worried parents telling you their baby’s poop is black, green and/or yellow. A visual teaching aid like the ‘Happy Knappy’ not only teaches parents what to expect (and what’s normal) with regards to the color, consistency and size of an exclusively breastfed baby’s poop, but it also is an indicator if babe is getting enough milk or not, babe’s general health and how breastfeeding is going.  See Philippa Pearson-Glaze’s article, “Breastfed Baby Poop” for more detail on what exclusively breastfed baby poop should look like and how to use the ‘Happy Knappy’ as a teaching tool.

Wondering how to knit the ‘Happy Knappy’? La Leche League International has a FREE pattern here.

(courtesy of Alison Blenkinsop, 2014)

Don’t knit yourself? And you don’t know anyone who knits? Have no fear – next Tuesday’s ‘Tips & Tricks’ will feature DIY options that do NOT require any knitting whatsoever. Stay tuned.

Do you have musical talent? Want to make your clients giggle and give them a fun way to remember what normal breastfed baby poop looks like? Try singing the song, “The Five Days of Feeding” while you are demonstrating your ‘Happy Knappy.’

“The Five Days of Feeding” Song

Sung to the tune of “The Twelve Days of Christmas”

On the first day of feeding, your babe will give to you a wee and a sticky black poo.

On the second day of feeding, 
your babe will give to you
two little wees and a less sticky, thinner dark poo.

On the third day of feeding, 
your babe will give to you
three little wees, two little burpsand a big greeny-browny soft poo.

On the fourth day of feeding, 
your babe will give to you four little wees, three little farts, two little burps and a nice runny toffee-brown poo.

On the fifth day of feeding, 
your babe will give to you five bi-ig wees;
four little farts, three big burps, two overflows, and a large golden mustard-seed poo!

(Song from Alison Blenkinsop’s 2008 book Fit to Bust: A Comic Treasure Chest, chapter 5.)

Do you have a tip or trick that you think should be featured on Galactablog? If so, don’t be shy. Please share with me! You can contact me here.

Babies and the Art of Sucking

While completing an online lecture via Lactation Education Resources (LER), Jane Bradshaw, RN, BSN, IBCLC stated something so eloquently in one of her lectures that I couldn’t help but share it with my fellow lacties.

One of the most common questions (and concerns and fears) new mothers consistently have is, “Do I have enough milk? Why does my baby want to suck all of the time? This MUST mean I don’t have enough milk!” This quote not only sums up a baby’s biological need and desire to suckle simply and beautifully but it also empowers a breastfeeding mother to know that yes, she can make enough milk to meet her infant’s needs.

final sucking instinct quote

Photo used with permission. Copyright © 2016 Galactablog and Tamara Drenttel Brand.

 

 

How a Simple Candy Dispenser Can Help Teach a Wide, Deep Latch

A shallow latch is more often than not the cause of sore nipples and nipple damage. The importance of a wide, deep latch (mouth open at a 160 degree angle) and chin touching breast first is an important concept to portray to breastfeeding families (and those intending to breastfeed). I am always on the hunt for new and innovative ways to describe this image, particularly when I am trying to troubleshoot over the telephone or working with a mother who speaks English as a Second Language.

Fortunately, Angela Love-Zaranka, BA, IBCLC, RLC, in her “latching and positioning” pez 3lecture for the Baby Friendly Hospital Initiative (BFHI) Nurse, Physician and Staff Training offered by Lactation Education Resources (LER), has provided yet another fantastic tool I can add to my repertoire. It’s simple, brilliant and cheap (and chances are, if you have a little kid at home, it’s free). What is this magic tool you say? It’s a Pez Candy Dispenser. Yes, you read that right!

Angela explains, the “baby’s head looks like a Pez Dispenser coming to the breast helps parents understand the concept of bringing baby’s chin to breast first.” Thanks Angela! Now the fun and most difficult part – picking out which Pez Dispenser you want to use for demonstrations.800px-Hello_Kitty_PEZ_dispenser_open_II

Do you have a nifty trick that makes your life as a lactation specialist (or one aspiring to be) easier? Well, please don’t be shy! Please share it with Galactablog and we’ll share it with all of our loyal followers. Of course, we promise you full credit for your brilliancy. Contact us here or at galactablog{at}gmail{dot}com.

 

How Can Lactation Professionals Help Make Child Care Centers Breastfeeding-Friendly?

edited stormy cover pic

Guest Post by Stormy Miller, CLC

February 27, 2015

Why should daycares, nurseries and child care centers support their breastfeeding families and create a breastfeeding-friendly site?

In short, the payoff is significant.

Child Care Centers can see savings and benefits from breastfeeding in areas like:

  • Better daily attendancebreastfeeding_welcome_here_stickers
  • Less spit-up, reflux and GERD
  • Less offensive diaper smell
  • Healthier newborns, infants and children
  • Public image boost for center
  • Builds trust and communication with parents
  • Encourages centers and its employees to be up-to-date on current breastfeeding information and practices related to child care and development
  • Centers under the USDA Child Nutrition Program (or similar programs) may get reimbursed if parents do not use the provided food (as they are instead using expressed breast milk)

Having a breastfeeding-friendly daycare, nursery or child care center will not only help support the mother in reaching her breastfeeding goals, but it will also increase breastfeeding rates and lead to healthier people. Hopefully, this in turn will help reach the Healthy People 2020 goals.

How do we create a breastfeeding-friendly center?

  • Education is key! Staff and employees not only need to know the benefits of breast milk but also how to bottle feed breastfed babies (called paced bottle feeding) and how to store and handle breast milk (more on this below). They also need to know that from 1 – 6 months of age, breastfed babies do not need increased quantities of milk because breast milk changes composition to meet infants’ needs – so unlike formula, volume does not increase. Many assume that as babies grow, they need greater quantities of milk and this is not true in the case of breastfed babies.
  • Paced Bottle Feeding – This is a method of bottle feeding that mimics breastfeeding. The baby controls the feeding, just like at the breast, which is not only healthier for the infant’s digestive tract, but it helps protect the breastfeeding relationship. See here for videos on how to do Paced Bottle Feeding.

  • Feed on demand – Watch for hunger cues instead of scheduled feedings. In fact, most infants will begin to put themselves on a general schedule (e.g. 3 oz every 3 hours).
  • Develop a communication plan with parents – What should be done if breast milk is gone? Does mom want to bring in an emergency freezer stash that is clearly labeled for cases like this? When should this freezer bag be de-thawed and does mom want to be contacted in this case? What does mom want done if baby is acting hungry and she will not arrive for another hour? Have a clear plan and be aware of both parties’ expectations.
  • Do not give any bottle within 1 hour of mom’s arrival if possible– This way baby will be ready for mom (as long as this is outlined in communication plan).
  • Know proper breast milk storage and handing guidelines, including  how to properly thaw and warm up breast milk.– see here and here and here.
    • Guideline charts are great to print and put on all of the refrigerators!
  • milk labelsEstablish proper and correct labeling procedures in place for breast milk. Ensure  all staff understand protocol and labeling techniques and that parents are educated on labeling protocol as well.
  • Ask the mother to bring her milk in small amounts (2-3oz. in each bag) to avoid unnecessary wastage – especially if regulations require throwing out bottles that are not finished within 1 hour.
  • Offer to keep breast milk in the mother’s cooler, if her baby has not finished it within the 1 hour rule.
  • Baby-wear – wear infants in wraps, slings, etc. Studies show baby-wearing keeps babies calmer, less colicky, promotes physical development, increases trust and attachment and promotes breastfeeding; in addition to helping employees multi-task with multiple children. See here and here and here. Some cities, counties and or state regulating agencies do not allow baby-wearing, so always check with your regulatory agency first to ensure you are abiding by current regulations.
  • Have free breastfeeding materials and how-to guides available for caregivers here and breastfeeding families here (hard copy), here (electronic) and here readily available and accessible. These are just some examples of what’s available.
  • Create a community breastfeeding resource guide – let parents and caregivers know what type of help is available in their own communities. This can include local breastfeeding support groups, WIC offices, lactation consultants, breastfeeding peer counselors, breastfeeding classes, Baby Cafés, etc.

    Click on book!

  • Normalize breast feeding for all – infants, children, parents, employees, etc. Have children’s books that discuss breastfeeding or show illustrations of breastfeeding. This demonstrates that nursing is the natural and healthiest way of feeding. Some examples available: Mama’s Milk, Nursies When the Sun Shines, The Mystery of the Breast, We Like to Nurse, We Like to Nurse Too, Mommy Breastfeeds My Baby BrotherMichele: The Nursing Toddler – A Story about Sharing Love

 Last but not least, provide a comfortable, practical space for pumping and nursing – for both nursing mothers, staff and employees. Many mothers will nurse at drop-off and, if their work allows, will pop in during the day to nurse their baby. What can be included in a pumping/nursing space? Here are some ideas: 

ACES Lactation Room, Peoria, AZ http://austincenters.com/

Lactation Room at Austin Centers for Exceptional Students (ACES) Peoria, AZ http://austincenters.com/

  • A room with a locking door, a comfortable chair – perhaps with a footstool, outlet for the pump, table to set the pump on, a mini fridge or fridge access, a sink (or access to one), a CD player or I-pod dock for relaxing music and mini heater for cold rooms can also be beneficial.
  • If possible, a microwave for sanitizing (with the microwave bags). Hand sanitizer and/or sanitizing wipes.
  • Even better – providing extra storage bags and bottles for milk collection in case the mother forgets hers at home.
  • If a workplace has multiple pumpers, they could consider investing in and supplying a hospital-grade multi-user pump. This will enable mothers and staff to pump efficiently and effectively – thus saving time and ensuring they maintain their milk supply. A win-win for all!


If you would like to write a guest post or collaborate on a post for Galactablog, please contact me with your ideas! I am open, flexible and very interested in helping you publish anything lactation-related.