Cribsheet

by Kathy Moren RN, BSN, IBCLC

One of the greatest things about having adult children is that every once in a while, you learn something from them. This happens often with my oldest son, who is intricately involved in my business. He is often suggesting podcasts he thinks I might be interested in. He has turned me on to Tim Ferriss for business and life advice, and Vox, a media group known for explanatory journalism. One day, I listened to a Vox podcast that actually intersected with my passion: dissecting the conflicting advice that my patients, all new parents, get bombarded with.

Ezra Klien had a fascinating conversation with an economist that was promoting a new book. The anxiety in Ezra’s voice was apparent as he discussed his exhaustion and concern about sleep training his new baby (another passion of mine!) The book was Cribsheet, A Data Driven Guide to Better, More Relaxed Parenting, From Birth to Preschool. The economist’s name is Emily Oster. Imagine my surprise to find out she teaches at Brown! She also wrote a book Expecting Better: Why Conventional Pregnancy Wisdom is Wrong-And What You Really Need to Know. Coincidentally, one of my patients recommended that book to me a few days ago. I just returned from vacation, and happily devoured Cribsheet while away. I would like to encourage all new/expecting parents to read both of them.

Dr. Oster’s premise is that data doesn’t always support the common mandates provided to parents regarding what is best for their children. And what I most found most refreshing, is her proclamation that you have a choice in how you parent, which of course, you do. She confesses to being a new Mommy, going down the internet rabbit hole looking for advice about a multitude of subjects, only to be more confused and worried. Haven’t we all done that? And doesn’t the conflicting advice only leave us more stressed out?

The book starts by addressing all the things that no one talks about after having a baby. I vividly remember my three younger sisters, who all gave birth to their first child weeks from each other, looking at me and saying “Why doesn’t anyone tell you about this?” I don’t know, but now someone has! Anticipatory guidance is a beautiful thing, and I try to provide it all the time. Everything is much easier to deal with when you have an idea of what to expect and understand what is normal.

Dr. Oster then tackles the most important parenting topics and addresses the data relevant to each one. My favorites of course are breastfeeding, the current SIDs recommendations, sleep training and vaccinations. But every topic you are concerned about is in there, with a deep dive on the data, analyzed by someone who knows how to do it, and is not currently sleep deprived and emotional. I am looking forward to incorporating her data and recommendations into my presentations. I want to validate what I have been professing all along, but anecdotally, and without the data to prove it.

Some of her key assessments: Breastfeeding support in the home after birth increases breastfeeding success. And of course, breastfeeding is not always easy and/or the right choice for everyone. This is blasphemy when acknowledged by me, I know! But some of you have looked at me with profound relief when I have asked you to consider that it might not be the best option for your family. I consider it an important part of my work to give you options based on my honest assessment of your entire situation and I strive to do that daily.

Other gems are that sleep training and crying it out work, with both parents and babies much happier while sleeping longer. Vaccines don’t cause autism. And my all time favorite realization, that parents need to “put the sleep risks (relative to SIDS) in the context of the risks that we are implicitly accepting every day.” And to realize that “sleep choices have real quality of life impacts.”

I would like to encourage all new families to use this book to make educated decisions about how to parent. My hope is that it will be liberating for you, decrease your stress and give you the confidence you need to be the best parent you can be. And if you are local, consider hearing Dr. Oster speak at the Providence Children’s Museum on July 19th at noon. I will be there and am looking forward to what she has to say!

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Our Family's Story - Infant Tongue-Tie

By Sarah Berns

Like most pregnant people, I found hundreds of things to worry about while I was carrying our daughter: labor, how our lives would change, the possibility of her becoming sick or getting injured. Though I worried about breastfeeding challenges, I didn’t worry about the possibility of a tongue-tie or the difficulty of diagnosing and deciding whether and how to treat one, probably because I’d never heard about it before! When my wife and I found ourselves facing these choices with a two-month old baby, overwhelmed with the stress of feeding difficulties and exhausted, I wanted to hear from people who’d faced similar issues and decisions. I’m glad to be able to share our family’s experience with the HBHM community.

We had significant doubts throughout the process, but perhaps especially when trying to discern if our daughter might have a tongue tie. Though she was slow to gain weight, she had no other common signs or symptoms: she nursed happily, was not fussy or gassy, caused no nipple pain or damage. When we began to research the possible causes of slow weight gain in breastfed infants, tongue tie and lip tie came up, but the sources we trusted, including the AAP, were somewhat skeptical. Tongue ties are overdiagnosed and under researched, they suggested, and correction might not resolve feeding issues.

At this point, as our daughter approached her two-month checkup, we were trying everything we could to help her eat well and gain weight more quickly. With the help of her pediatrician and Kathy Moren of HBHM, we’d set up an intensive routine: I would breastfeed our daughter for up to an hour and then pump while my wife offered her a bottle of expressed milk or formula. Like many breastfeeding parents, my supply diminished due to inefficient milk removal, and I pumped 10-12 times daily on top of regular nursing in an effort to produce enough milk for all of the supplementation. Though I got closer each day, I never totally caught up to her demand.

We have multiple friends who’d attempted similar routines and ultimately decided to stop nursing, finding bottle feeding easier on the whole family. This wasn’t our story largely because bottlefeeding wasn’t easier for us: it would often take the baby an hour or more to finish a two ounce bottle of milk. Eventually, she would crash, exhausted, and sleep for only a short time before we had to wake her to begin the process again. The whole cycle was exhausting, and truly only possible because both parents were on parental leave and we were also lucky to be supported by a wonderful postpartum doula, Jacquie Procopio, who offered endless encouragement as well as the logistical help we needed to focus on feeding full-time.

Both Kathy and Jacquie suggested that it might be worth having our daughter evaluated for a posterior tongue tie, a type of tie that is both less researched and more difficult to diagnose visually than an anterior tie. We made appointments with an ENT and a pediatric dentist, and continued to do our own research. The appointments were starkly different. The ENT inspected her mouth and quickly and confidently confirmed the absence of an anterior tie or a tie in the upper lip, suggesting that she’d likely grow out of her slow eating. The dentist, Dr. Carolyn Lubrano, focused more on function in her assessment, feeling our daughter’s suck with her finger (“disorganized,” she noted), asking about her eating speed and patterns, noting the development of her palate. She diagnosed a posterior tie and an upper lip tie, showing us how inability to fully lift her tongue or flange her lips showed in our baby’s sucking blister, the thick, white coat of milk on her tongue, and the high, narrow roof of her mouth. She recommended laser revision and a course of cranio-sacral therapy.

We struggled deeply with the decision, as I’m sure any parents considering a frenectomy or other medical procedure for their infant do. As professional researchers, we both had doubts about the lack of peer-reviewed literature, particularly controlled studies, evaluating the efficacy of posterior tongue tie revision. We worried that it would hurt her, that it wouldn’t work, that she might scar badly. We knew her insurance would not cover treatment, and worried about the high cost if it was ineffective. As the breastfeeding mom, I felt guilty that part of my motivation was a desire to more easily nurse my baby: after all, many moms I respected deeply had decided to exclusively pump or formula feed in similar situations. Was I being selfish?

We sat with our options. I spoke to other families who’d had revisions and all reported positive changes. We watched our growing baby become more frustrated both nursing and bottle-feeding, and began to worry about the emotional and psychological costs of her difficulty eating. We thought about returning to work, and doubted whether any childcare facility would be able to feed her all day long. Eventually, after many reassurances that the revision was quick and only slightly painful, that complications were extremely rare, we decided it was worth the risk of failure. Lucky to be able to afford treatment, we felt that the cost and anxiety were worth any possibility of improvement.

About a week later, we went in for the revision. It took less than ten minutes, and our daughter was easily soothed with her pacifier and cuddles. It was much, much less scary than I’d imagined. She nursed immediately afterward and fell deeply asleep. Some differences were immediately apparent: her jaw moved more dramatically, and, for the first time, I could see the suck-swallow-breathe sequence. Other aspects seemed unchanged: I still needed to manually flange or flip her upper lip at every feed, she often fell asleep nursing, and was not much faster. As planned, we added cranio-sacral therapy, a gentle manipulation of the mouth, skull, and spine, at Bayside Chiropractic. Over a few weeks, with patience and regular nursing, chiropractic care, and home exercises, the difference grew. She ate more fully and quickly, and we increasingly found ourselves with time when she was neither eating nor sleeping. We began to play and rest. She was often too full for the offered bottles. At a weighed feed, she transferred twice the volume she had previously. For the first time, she could keep a pacifier in her own mouth. As my expressed milk began accumulating in the fridge and freezer, I dropped pumping sessions, realizing only in retrospect that we’d last needed to supplement with formula the night before the revision. The impact on my supply had been immediate.

The one thing that never changed was the concern that had started the whole process: her slow weight gain. She never had a sudden jump in size, nor even a slow increase in growth rate. Seeing her happy and satiated, achieving developmental milestones and finding delight and comfort from breastfeeding, though, we began to worry less. She’s four months old now and we’re nursing 95% of the time, with bottles of expressed breast milk when it’s more convenient. Soon, she’ll begin eating solid foods—maybe then we’ll see a weight jump. Or maybe not until she’s big enough for clam cakes and Del’s, or after-school sports. Maybe she’ll always be small.

In the end, perhaps this was the most important benefit of treating the tie: we were able, as a family, to move from an acute focus on numbers—pounds, fluid ounces, hours—to the rhythm and trust of breastfeeding on demand. We know that our daughter will let us know when she’s hungry, that she can eat until she is full, and we’re able to fill the time between those states with all the other things babies and moms need: books and walks, games and friends.

This is, of course, just one story. I’d still love to see more research on tongue ties and their treatment. Even more, I’d love to see all of these remedies and supports—chiropractic, revision, lactation consultants, doula care, supportive pediatricians—more widely available and affordable. We are so lucky to have been able to choose this path. If you’ve been struggling with similar choices, I hope our story provides a little more information and makes your path easier.

What You May Not Expect After Expecting

By Melissa Nassaney, MS, PT, DPT, Women’s Health & Pelvic Health Clinical Specialist

Having a baby, for many expectant women, begins with the maternal journey of self-discovery centered around various changes that are happening to their body while it accommodates the physical demands of growing a tiny human. Often moms-to-be find more enjoyment in tracking their baby’s changes as they grow from a raspberry to a watermelon throughout the 42 weeks of gestation. Eventually, the focus tends to shift towards the preparation for birth and the arrival of the little one. Life after pregnancy and delivery may present its own unique set of changes and challenges. With shifts in hormones, crazy sleep cycles and postpartum fatigue, it’s no wonder that a woman could become a little skeptical about the changing relationship between her and her body.

In the first 6 weeks after delivery, a variety of unfamiliar symptoms may be experienced while recovering from the birth. Common and treatable conditions such as back pain and pelvic girdle pain can present during and/or after pregnancy, however pelvic floor issues can arise. This can be an extra nuisance and unwanted surprise. For some of us, it is during pregnancy that we may experience our first problem with urinary control, whether it’s with a frequent urge to urinate or accidental leakage (incontinence). This may also be the first time we learn about or start to do ‘Kegel’ exercises (pelvic floor muscle exercises) to manage these symptoms. The 2 most common conditions a mom can experience early on are incontinence and pelvic organ prolapse. These conditions are often due to muscle injury or strain, temporary nerve injury from the pregnancy or delivery, or perineal laceration from childbirth.

Incontinence is accidental leakage of urine or stool that may occur with coughing, sneezing or exercise or may be associated with a strong urge to “go” or going to the bathroom frequently. Urinary and fecal urgency is very common right after delivery. Urinating “just in case “or going with the first sensation of urge may lead to symptoms that feel like an overactive bladder and ultimately interrupt your normal daily activities or even sleep. More than 89% of women experience some form of incontinence after childbirth. This includes both cesarean and vaginal births.

Pelvic organ prolapse (POP) is a drop or descent of pelvic organs into the vaginal canal or out of the vaginal opening. It could be one or more structures such as the uterus/cervix, the bladder, urethra and the vagina itself or the rectum. POP can be asymptomatic for many however some women will first notice a bulge in the vagina or perineum or feel a heaviness or pulling in the lower abdomen, low back or perineum. Symptoms may feel worse after exercising, lifting or straining to have a bowel movement.

Pelvic floor issues are very treatable and can be done so conservatively. To prevent these during pregnancy, it can be helpful to perform pelvic floor muscle exercises several times a week. Maintaining a healthy weight during pregnancy and avoiding prolonged sitting and straining during bowel movements also help. Kegels are exercises will strengthen your muscles and in turn may help to reduce incontinence, restore control and improve the support to your pelvic organs. Kegels are typically safe to do in most situations except if you are experiencing pelvic pain including vaginal or rectal pain, abdominal pain or back pain, all of which would necessitate further medical evaluation from your obstetric provider. Both during pregnancy and postpartum, efforts should be made to avoid constipation and stool straining in order to minimize additional stresses on the pelvic floor muscles and pelvic organs.

It has been well established in medical literature, that pregnancy and childbirth are associated with decreased pelvic floor muscle strength and endurance. Other risk factors that can contribute to incontinence and prolapse are forceps assisted delivery, trauma to the pelvic floor muscles and obesity. Regardless of whether your birth experience occurred vaginally or by cesarean, after delivery, your pelvic floor muscle strength and function may continue to be impaired for a short time and for some, pelvic floor issues may persist months or even years after the birth of your baby. If you notice changes in your bladder or bowel control, or experience symptoms of prolapse be sure to tell your doctor, especially if it has been > 3 months after delivery with little to no improvement with typical Kegels. However, mild to moderate prolapses may take 3-6 months to resolve. Ultimately, it is best to get checked out sooner rather than later.

For most women, pelvic floor muscle strength should return within 2 months after delivery. While it may be common for women to experience incontinence or prolapse symptoms early post-partum, it is not normal for it to persist longer than the 4th trimester. Committing now to supporting your pelvic floor during pregnancy and after birth can optimize your recovery over the next several months but more importantly, impact your future pelvic health. Ideally, you should be able to look forward to the obvious; sleeping on your belly, seeing your toes again, and not peeing your pants…

If you would like an evaluation and assistance strengthening your pelvic floor, during or after your pregnancy, please contact me at Performance Physical Therapy.


Shining a Light on Mental Illness

In January of this year, we were very fortunate to have Beth Collins join our team after leaving a long and wonderful career as a hospital lactation consultant. She brings a wealth of clinical knowledge and a fresh perspective to our work and is already responsible for several great improvements in the way we do things. But most of all, she brings compassion and empathy to every patient encounter she has. She has become an inspiration in the lactation community, not only because of her skill as a RN/IBCLC, but because of her grace and strength while facing challenges that no mother should have to face.

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Beth, and her husband Mark, are shining a light on mental illness through education and activism in their community and across the state of Rhode Island. They launched The Chris Collins Foundation in 2018 after their 20-year-old son Chris died by suicide after an almost 3-year battle with depression and anxiety. Chris was studying math and music at Amherst College in Massachusetts and was also a member of their baseball team. He loved learning and being outdoors. He was an avid musician who loved playing the guitar, piano, and ukulele as well as singing, writing and composing music. Chris was known most for his kindness, bright smile and deep love for family and friends. He was open about his mental health struggles, which began in his freshman year of college, and helped many of his friends with their own struggles. His ability to give so much of himself, even while struggling, inspired the creation of the foundation.

The Chris Collins Foundation raises awareness and advances education about mental illness, especially in schools, with a student-led Peer-to-Peer program. The program was created by the University of Michigan Depression Center in 2009 and is built on the premise that teens are more likely to listen to their friends than to well-meaning adults. The program works to raise awareness and eliminate the stigma of mental illness and increase the likelihood of early detection and help-seeking. A small group of students in each school are trained in September and then build an awareness campaign to spread their knowledge and understanding to others in the school. The peer-leaders serve as positive role models that help shape social norms and attitudes regarding mental illness in their schools and communities.

Many mental health problems, including depression, emerge during the middle and high school years. According to 2017 RI Youth Behavior Survey, 27 % of high school students reported sad feelings, 14 % considered suicide and 10.5 % attempted suicide. Additionally, 18% of middle school students seriously thought about attempting suicide, 11.6 % made a plan to attempt suicide and 6.5 % attempted suicide. The Peer-to-Peer program will have a positive effect on these troubling numbers. Data collected from participating schools show that students are:

• More confident in their ability to identify someone who is showing common signs of depression and to help them to access mental health support services

• More likely to seek help if they were experiencing symptoms of depression themselves

• Less likely to keep it a secret if a friend is thinking about suicide

• More comfortable discussing mental health issues with their peers

• Reported lower stigma in their school environment related to students with mental health challenges

The Foundation launched the P2P program in South Kingstown and Narragansett high schools this past school year. It has partnered with the University of Michigan Depression Center and the Rhode Island Student Assistant Services (RISAS) to bring the program to 8-10 more schools each year. Personnel from Brown University and the RI Department of Health are part of the program’s scientific advisory board.

Beth and Mark also sit on the Washington County Zero Suicide Leadership Board. The Zero Suicide Initiative, to be implemented over the next 5 years, is a collaboration of health care partners to address mental health needs in Washington County. South County Health, Yale New Haven Health/Westerly Hospital, Thundermist Health Center, Wood River Health Services, URI Health Services, WellOne Health Services, Block Island Health Services and Gateway Healthcare will establish systems to identify and assess suicide risk among all patients receiving care and provide referrals and follow up to ensure behavioral health patients receive the care they need.

Someone aged 25 or older dies of suicide every 3 days in RI. In addition, someone under the age of 25 dies every 20 days in RI. The Zero Suicide initiative is evidence based, has been used around the country and in 13 nations, and has been demonstrated to decrease the rates of suicide by significant amounts. The ultimate goal is zero suicides. Other hopes are that as routine depression screening becomes part of health care, medical staff and patients will become more confident and comfortable talking about mental health while eliminating the stigma surrounding the disease.

Beth is bringing her knowledge and experience with mental health issues to HBHM and is an excellent resource for our moms and new families. She has plans to update our mental health screening survey that is part of our patient medical history questionnaire, and to educate staff about perinatal mental health awareness. She will be starting a support group in the future for moms who are suffering from perinatal mental health adjustments and illnesses. We have been truly blessed to have her as a resource and advocate for our mothers. We are looking forward to implementing her ideas and supporting her and Mark in their very important mission. Anyone needing more information about this impactful work can email her at beth@healthybabieshappymoms.com.

Paced Bottle Feeding

I recently met with a family in my office that was practicing “paced bottle feeding” with their 5 month old daughter.  Mom had returned to work and had been exclusively breastfeeding until then, with bottles given only occasionally. Now however, bottle feeding was becoming difficult. The baby was mostly unhappy with the feeding taking an hour. I am embarrassed to say it took me a good hour to figure out what the problem was with bottle feeding, as Mom and baby nursed happily throughout our consult.  So often the answer is in the questions I ask, and if I don’t ask the right ones, I don’t get the answer. I am always learning!

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I finally found out that to this family, paced bottle feeding meant letting the baby have a few sucks, and then pulling the bottle out of her mouth.  At that point the baby would get hysterical, as they made her wait a minute or two, and then offered the bottle again with that process repeated over and over.  In addition, this 5 month old was drinking from a bottle with a newborn nipple, even though she could have handled a bigger flow at her age. It would take the baby an hour to finish the bottle and be satisfied.  It was not a pleasant experience for anyone.

When I asked why they were doing this, when it was clearly distressing for everyone involved, it was because they didn’t want to do anything to disrupt the breastfeeding relationship, which of course I wholeheartedly agree with. However, what they were doing was developmentally appropriate for a newborn, not a 5 month old!  This poor baby was terribly frustrated. She was hungry, given a taste of milk, and then had the feeding stopped abruptly, albeit temporarily. In addition, the strength of her suck on a newborn nipple would collapse it, making it difficult for any milk to come out at all.

I encouraged Mom to get wide based nipples that are appropriate for a 5 month old, have her held upright when bottle feeding, and stop her for a burp after an ounce or two.  This is what paced bottle feeding means to me with an older baby, but there's not much on the internet about it. Most everything online is geared toward a feeding a newborn.  Once the family made these changes, bottle feeding took about 20 minutes, there was no crying and the baby was satisfied. In addition, she nursed eagerly and happily whenever with her Mom.

A great resource for families who want to use paced bottle feeding is this article on KellyMom, one of my favorite evidenced based breastfeeding websites. She references a video that I also like, although I wish a wide based nipple was used, which is the recommendation for breastfed babies.   It think it very helpful to see someone else do it, especially for people who have never fed a baby a bottle before.

This situation illustrates a couple of common issues I run into daily. I know I have written about it before, but it is worth repeating.  The first is that if what you are doing is not working, regardless of who told you to do it, even if it was me, stop doing it! Try something else. Trust your instincts. Get help from someone whose opinion you respect. The second is to change what you are doing so that it is developmentally appropriate for your baby. Often I meet with families at 6 weeks who are still doing as they were instructed in the hospital, in spite of the fact that everyone in their house is unhappy.  And lastly, remember that advice online is very general and may not be appropriate for your particular situation. If things are really not going well, please see someone who can help you sort it. Sometimes a fresh set of eyes on the situation makes all the difference!

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The Gift of an Ordinary Day: A Mother's Memoir

As Thanksgiving approaches, I am reminded of a great book that I think all new mothers should read.  I had commented to my youngest sister that I would give anything to go back to the days of teaching a preschool boy to drown Cheerios in the toilet. She was lamenting a stubborn three year old completely uninterested in potty training. I was dealing with an obstinate, ungrateful 18 year old man/child. Two days later she brought over a book that she declared a must read for me, given where I am in my life right now. After sailing through it, I want to suggest that it is a must read for all mothers. Whether we are at home raising tiny little people, or getting ready to launch young adults off to college, the message is relevant.

“The Gift of an Ordinary Day” ~ A Mother’s Memoir by Katrina Kenison, starts with a family’s move from suburban Boston to rural New Hampshire. The author’s mid life crisis was the impetus for the move. Her desire to live in a slower-paced environment and have her family more grounded, starts the family on a house building adventure that doesn’t end until the oldest is off to college. Her family consists of her husband and two sons, one of whom is getting ready to start high school, the other just on the cusp of puberty. During this transition, she reflects on all the moments long passed that caused her so much anxiety, as she worried about whether her boys would turn out alright. She notices her parents’ calm demeanor and relaxed attitude toward her sons and their increasingly independent behavior. She remembers all the moments with her boys when they were little that were priceless and mostly unappreciated at the time. Mostly, she tries to live in the present, and be truly aware of those ordinary moments with her family, cognizant of the fact that in 4 short years, these moments will be increasingly few and far between.

For me, the struggle that she writes of – the fine mingling of letting go and holding on – hits very close to home. I cannot make it through a single chapter without shedding a tear, all while trying to hide it from my husband. Each chapter offers up multiple quotes that resonate so strongly with my life, I feel like I could have written this book, although not nearly as eloquently. The description of the entire college application process, the pressure this age group is under and the reality that no kid can just be ordinary anymore, is something I am living daily. The uncertainty of how this will all end, and the desire to slow down the whole process, so I can have this delightful boy with me just a little longer, is ever present.

I also found it reassuring that another mother, and famous author at that, feels the way I do about so many things. The anxiety she experiences is something that I struggled with since I became a mother, but it did dissipate with time. My confidence in my ability to parent these boys to adulthood and in their ability to make good choices grew tremendously. Now, I am overwhelmed at times by all the struggles people in my age group are dealing with: divorce, illness, financial crisis, wayward teenagers and aging parents. My best friend’s mother always says “Little people, little problems; big people, big problems.” And she is so right! But this is the stage of life that I am in, and it will pass. And in so many ways, it is easier. I have time to myself. I get a good night’s sleep. I can go for a run when I want to. I can talk and reason with my kids. My husband and I can sneak out for a drink if we want to! I am lucky to have a job that I am as passionate about as I was about staying home and raising my boys. Really, even when it’s hard, it’s good. And this book reminded me of that on every page!

So, I am going to re-read this book while on an upcoming vacation. I am going to cherish every moment with my sons, even the difficult ones. I am going to revel in the times the six of us are all together, no matter what we are doing. I will create opportunities for them to have good memories of this phase in their life. And I am going to try hard to let go with grace, and trust that they will all wind up where they are supposed to be, with faith that I have done the best I can with the most rewarding, but hardest job in the world.

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Breast Pump Hacks

I have recently been amazed by all the items, applications, shortcuts and “hacks” I have come across that have simplified my life and saved me money. I am currently learning tons about nutrition by viewing videos when and where I have the time to do it. Amazon Prime has saved me time and money on several occasions. Applications on my phone keep me up to date with my finances, help me track workouts, call an Uber, listen to a Podcast, and order a lunch pick up at the nearest Panera. All good things as far as I am concerned!

However, I am increasingly seeing hacks that Moms are using related to breastfeeding that are having detrimental effects on their milk supply. Often, I get involved too late and am unable to reverse the situation, much to the dismay of the women I care for. The first hack is demonstrated in the many YouTube videos showing Moms how to use their Medela breast pump parts with their new Spectra pump. Eager to have more than one set of pumps parts to use, Moms are reconfiguring their old parts to work with the pump of a different manufacturer. And it does “work.” You will get suction and probably some milk too. But it doesn’t work as it is intended to. Each pump manufacturer has created their pump and its parts with a considerable amount of biomedically engineered research and development. Manufacturers then go through a strict FDA approval process. When the pump is used as intended, the results are great.

However, when the pump isn’t used as intended, it often has very detrimental results for women intent on giving their babies breastmilk. Women using these parts incorrectly at a time when they are trying to establish their supply, or increase it, are often crushed when it just doesn’t happen in the way that they had hoped. And rather than questioning the pump or the set up they are using, they assume it is the fault of their body. Convinced something is wrong with them, they give up. But, they saved themselves $50 in new pump parts.

Another new hack are the Freemie Collection Cups that can be used to allow you to pump discreetly and hands free with any compatible pump. These cups connect to your pump and advertise the convenience afforded with hands free pumping. You can now leave Women and Infants Hospital with both your pump and this device. Because it was given to Moms at the hospital, many assume it means they should use it immediately. I am seeing women using this when they are unable to nurse and are trying to establish their supply. In this situation, Moms should be using a hospital grade rental pump, and when they don’t, the results are not good. When I teach them how to use their pump without the Freemies, Moms are amazed at the difference in the strength of suction and the increase in the amount of milk they obtain. Again, the manufacturers don’t engineer pumps to be used with an additional product and it decreases the effectiveness of the pump. And at the most critical time of establishing your milk supply, you are not giving your body the best option to get things going.

Lastly, I need to say a word (or several) about pumping with an individual patient pump that has been used by another woman. The pumps are all warrantied for a year and intended to be used by one woman. This is both for sanitary reasons, and the effectiveness of the pump. Eventually, these pumps will die and you will notice a decrease in suction, unless of course the suction was low when you started using it. I have had patients that have 3 pumps: one upstairs, one downstairs and one at the office. The one upstairs is new. Downstairs is the one her sister used for two kids, but is in “great shape.” The one at the office is her girlfriend’s, who is done with babies and doesn’t need it anymore. She gets different amounts of milk with each, and attributes that to a defect in her body’s ability to produce milk, rather than the age and past use of the pumps. Ultimately, her supply has been affected, which is why she is calling me.

One of the greatest things about the Affordable Care Act is the insurance coverage of a new breast pump for each mother with each pregnancy. If you will need to pump, please take advantage of that. Get a new pump for yourself. Use it as it was intended to be used. Insist that the Durable Medical Equipment Provider that gives it to you, shows you how to use it. If they can’t teach you how to use it, they shouldn’t be providing it for you. Be sceptical of the need to purchase any additional attachments to make pumping “better”. Order your pump before you have your baby and know how to use it before you need it. This way you are not making decisions or purchases at the last minute when engorged, hormonal or overwhelmed in the hospital. And if you have questions about what pump is best for you, ask them. Don’t let anyone tell you that you only have one option. It often means you are getting the pump that is most profitable for the provider, and not necessarily the best option for you.

But most importantly, know that you don’t have to pump. As great as the ACA is, this pump coverage has made women think that pumping is the most important part of breastfeeding, and somehow essential to success. Nothing could be further from the truth. The best way to get breastfeeding off to a great start is to nurse, and not to pump. In fact, early pumping can cause a host of problems and get you in a situation where you have to pump. Best case scenario, pumping can come in later, in preparation for your return to work, if necessary. Have confidence in yourself and trust your body.

Please advocate for yourself, and find someone that can help you with nursing, and pumping if necessary. As always, we are happy to assist you with this. I never leave a home visit without making sure my patient knows how to use her pump correctly. I always determine if what she is using is appropriate for her situation. And lastly, spend the money to get what you need-whether it is lactation support, or an appropriate pump. It will pay off in a excellent supply, a beautiful nursing experience, decreased (or no!) formula costs, and a healthy baby. Your family deserves it!

The 111 Benefits Of Breastfeeding – For Babies, Moms & Everyone Else

Learn more about the incredible benefits of breastfeeding your baby at Mom Loves Best

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In Defense of Demand Feeding

I have had several heartbroken Moms in the last month whose situations have prompted me to write this newsletter. Most have come to me for a lactation or sleep consult around 3 months, exclusively nursing, with a very unhappy baby who is not sleeping.   The baby’s great weight gain is starting to dip on the growth curve, and Mom is exhausting herself trying to make it all work. After asking all my pointed questions, I usually find out one of two things.  Either Mom is following a very strict EAT-PLAY-SLEEP schedule, and limiting feedings to every 3 or 4 hours during the day, or she is limiting the baby’s total intake to 32 ounces daily. 

The first scenario is a very popular child rearing theory popularized by the book BABY WISE.  This book advocates a schedule in which the baby is fed at certain intervals throughout the day, and not sooner, regardless of feeding cues.  In addition, if he happens to be asleep at the designated feeding time, he is woken to feed.  He then plays for a predetermined amount of time, and then is put to sleep, which he often doesn’t want to do, because he is hungry.   While this may work for younger babies, I am paid well for sleep consults around 3 months because suddenly (usually around the growth spurt) this isn’t working and the entire family is miserable.  Unfortunately, BABY WISE, is the beginning of the end of breastfeeding, as limiting feedings limits your supply.  I had two exclusively breastfeeding Moms come to me in this situation at this age this past month.  Despite their best efforts to increase their supply, they weren’t able to.  Both babies now get a significant amount of formula, while still nursing.  Everyone is happier, and the babies are thriving, but it isn’t what either of these women wanted.

The other scenario of limiting babies to 32 ounces daily, regardless of their weight, is out there on the internet. I have also been told that some pediatricians tell their patients this as well.  Confused, as it is contrary to what I have been taught, I finally Googled it myself.   Much to my surprise, I found it on a page about formula feeding on the AAP Healthychildren.org website!  I wrote them last night, let know about my experience with my patients, and asked them to remove it. The page has not been updated since 2009.  On that same page, it states that a baby should have 2-2.5 times their weight in ounces daily.  So a 16 pound baby should have 32-40 ounces daily. And it makes sense if you really think about it.  A baby’s calorie needs grow as he does.  And if you are nursing on demand, your supply will grow with him.

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What is a new mother to make of all this easily accessed inaccurate information?  Please remember that if this week is worse than last, and either you or your baby are unhappy, with no one getting sleep, what you are doing isn’t working. It doesn’t matter who told you to do it, even if it was me!  Babies change. Change with them. Trust your instincts.  You know your baby better than anyone. Do what makes sense to you.  Feed your baby when he is hungry.  Let him sleep when he is tired.   Hold him and rock him when he is out of sorts.  Nothing you do today is going to screw him up for the rest of his life.  I promise.

And if you can’t figure it out, please call us.  We are happy to help. Sometimes an objective person assessing the whole situation helps you see what isn’t working.  Often, when you are so tired, you just can’t see it for yourself.  Everyone needs a little help sometimes.  Seek it out.  You and your baby will be glad you did!

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World Health Organization (WHO) Breastfeeding Resolution

I woke up this morning to an email from some physician friends of mine letting me know about the United State’s opposition to the international breastfeeding resolution proposed at the recent World Health Organization assembly.   Irate, I closed my computer and put it out of my mind in light of my husband’s 53rd birthday and my hope to honor him by forgoing work for today.  I was mostly successful.  Fast forward to this evening, when we met two of our four sons at our favorite restaurant to celebrate the birthday. After our drinks arrived, my oldest, the 26 year old responsible for my beautiful website and all things tech at HBHM Inc, turns to all of us and says, “Did you hear about the US’s response to the WHO breastfeeding resolution?”  To which my 16 year old son and then my husband, chimed in about how they were well aware of it, and expressed their dismay at our country’s response. Imagine my surprise: that they knew about it, (and not from me!) had an opinion, and were as disappointed as I was. I was stunned. While they joked that it was in their best interests to know what is going on in the breastfeeding world in light of the “family business”, I could not have been prouder. As disappointing as this is, I really don’t think this generation is going to put up with policy changes that support business at the expense of public health or civil rights. I am going to continue to do what I can to advocate so that those who want to breastfeed can do so with the support they need. I will also continue to support those that need to or choose to use formula. And I will encourage my sons, who will hopefully be fathers one day, to do the same.

 You can read more about this disappointing act HERE 

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