 By Dr. Kathleen F. McCue, FNP, IBCLC and Katie Ralls
As the customer service rep for Simple Wishes and Pumping Essentials, I wanted to share my story, in hopes of helping other mothers out there who might face similar challenges. My story begins with being diagnosed with Vasa-Previa (overlapping blood vessels next to the inside of the cervix) when I was 22 weeks pregnant, I was placed on hospital-based bedrest for the rest of my pregnancy. This story, however, has a happy ending. Baby Harper was born at 33-weeks gestation via C- Section when my liver function tests sky-rocked and I felt really sick. I intrinsically knew there was something wrong and am thankful my nurse listened to me and acted quickly. We have a voice within us that tells us what to do, but listening to that voice can be an art form, especially when we’re pregnant and everything is new. While on bedrest, I was given non-stress-tests twice a day with the plan of an eventual C- section. All in all, I spent a total of nine weeks in bed and was only able to get up twice a day for walks and brief trips to the bathroom. This was one of the most difficult times I ever could have imagined. Thankfully, with enough advanced planning, I had been given two rounds of injected steroids at 24 and 32 weeks; this helped mature my baby’s lungs in anticipation of her early delivery. I had no “Golden Hour,” where I could breastfeed my baby and be skin-to-skin, as she was whisked away to the Neonatal Intensive Care Unit so she could be given the best chance possible of survival outside of my womb. Harper was born weighting 3 lbs., 2oz. and was only 15.25 inches long. She spent her days in a NICU isolette being monitored 24 hours a day. My husband and I spent our days watching and worrying. On day three post-partum, I literally thought my breasts were going to explode. I woke up with breasts that were twice their normal size, tender and rock hard. Thanks to a class I had taken prior to delivering, I learned and remembered the method of hand-expression to relieve engorgement. Although I had access to a hospital grade pump, at this moment in time, this is what felt right to me. Hand expression. How could a hand be better than this super expensive breast pump? Am I a cow? I feel like I could fill a swimming pool but I only have little drops my first day. I think hand expression is the best thing to use, second only to the baby itself. Breast massage. Pull back, compress, release, repeat. You can use it anywhere at any time. You do not need a plug, battery, clean flanges. You always have your hands with you. It’s really interesting to know that my first experience performing hand expression involved two breasts that were NOT my own. Yep, I milked another woman. I had learned all about it in my classes with Evergreen Perinatal and at WIC where I worked for five years. How hard could it be? I had all the confidence on the outside and all the nervous shakes on the inside. My friend was in pain. She had forgotten her pump at home and we had just walked out of the Raider’s Stadium in Oakland, CA. We were making our way to the parking lot when she looked like she might cry. Can I help her?!?! Ok what did they say to do again? Massage around. Feel for lumps. Made a “C” hold. Why weren’t my hands bigger?! Ok now push back….. And compress. And again…. Push back and compress. Oh my gosh it is working! After spraying milk everywhere there was a sigh of relief. I had done it! Again, not too long after the previous incident another friend had forgotten her pump at a family party. Welp… looks like I am going to attempt this again. This time in a bathroom sink. Once again, It worked! Having said that, learning to hand express, hand expressing your friend and hand expressing yourself are not the same. When my own daughter was born at 34 weeks, I knew I needed to get my milk flowing right away. I was so hopped up on Magnesium, pain meds and morphine… … I was all thumbs…. So this is what it supposed to feel like? I was amazed that it worked. 2, maybe 3 droplets came out. Breakfast, lunch and dinner! Haha! I am joking. It didn’t feel great, to be honest as I had bruises all over my breasts which my husband got the stink eye for from a nurse later that day. Sorry about that. I knew the facts about hand expression. When using hand expression correctly you could express more milk than you could with any pump. You did not need a magic bra or a magic breast pump to express milk. My baby was too small and premature to latch and have milk transferred. It was up to me to get it going. The lactation staff at the hospital where I was admitted for observation had a video about what to expect in the first few weeks. How you could potentially go from syringe feeding (another technique rather than a bottle) to possibly breastfeeding directly when the baby was “ready”. Unfortunately, my baby was not cleared to breastfeed until she was 6 months old due to silent reflux (a danger for aspiration). Her epiglottis was under-developed which caused her to inhale thinner liquids. This was heartbreaking. As the months went on I used hand expression in many different circumstances. If I forgot my pump, if an outlet was not available, in the shower for comfort, to release plugged ducts, to express milk into my baby’s eye if it had discharge (it happens). I will be forever grateful for the knowledge I had and the confidence that was built by my experiences and training. I believe every mother should learn how to hand express for these very reasons. I remember using a video clip that was on the Standford.edu website to encourage many moms to use this technique over the breast pump. The method is to start with clean hands and sit down in a place where you can relax and get comfortable. By the way, this should be the case whether you’re nursing, pumping, hand- expressing, or simply holding your baby. You need to build a nest of sorts. Gather a container to catch your milk, then gently massage the breast your expressing in a circular motion from chest wall down to the nipple. Heat can also be an added benefit. In order to stimulate your let-down (a reflex that starts the milk squirting out of the nipples), you’re going to need some rolling of the nipple between your thumb and index finger. You will then place your thumb on the top of the areola (the edge where the darker color ends and your breast begins) and your index finger at the bottom (same placement). Spread the skin back toward the chest wall, squeeze in and gently but firmly pull, aiming the nipple into the collection container. There is a sweet spot that you will have to find. Some moms find that the area needing compression is either closer to the nipple or further back on the areola. It will take practice. Remember, they’re not faucets! You will get faster with practice and yield more milk as you gain confidence.  Breastmilk production relies on supply and demand. Every baby is different, but between the ages of 2-4 months, and again around 6 months, you may notice a change in your baby's sleeping patterns. As your baby begins to sleep longer stretches at night, you may find yourself questioning how to best keep up your milk supply. Most parents are thrilled at the idea of getting more sleep, however, if you decide to skip that night feeding, your body will notice there is less demand for breastmilk and will begin producing smaller volumes.
You may be thinking... why do I need to keep up my supply if my baby's demand is less than before? Well, sleep patterns are not linear. As your baby grows and develops you may notice that there are some challenging sleep regressions along the way. Most commonly, these regressions occur at 4 months, 8 months, 12 months, 18 months, and 2 years. Thanks to growth spurts, teething, and other normal developmental milestones, your baby may wake more frequently at night again. Keeping a healthy supply will allow you to keep up with fluctuating demands and provide baby with exactly what they need to get through it. This is where a breastpump comes in handy! Pumping at night during what would have been a nursing session will help send signals to your body to keep that liquid gold coming. If you are not already using a breastpump, now may be a good time to consult with a lactation consultant about your options and needs. At Metropolitan Breastfeeding, we offer hospital-grade pump rentals (is a hospital-grade pump is right for me?). Stay Focused on Your Breastfeeding Goals: -Commit to replacing a missed nighttime feedings with a pumping session. -Why is breastfeeding important to you? Keep a list handy of all the benefits of breastfeeding to help remind you of your why. -Keep a journal. Write down things your baby does when you are feeding them. Did they giggle? Smile? Caress you? How is your baby changing day to day and what sweet things did you notice? Look back on your entries whenever you lack motivation. -Get an app to keep track of feedings. Patterns will emerge and this can help you adjust your schedule as your baby's sleep patterns change. Build Your Support System: -Work with a Board-Certified Lactation Consultant. A lactation consultant is a health professional who specializes in the clinical management of breastfeeding and can help you and your baby overcome breastfeeding challenges. -Work with a Certified Gentle Sleep Coach to work through those sleep regressions. -Work with a Postpartum Doula. A doula isn't only for birth support! A postpartum doula can provide you with support, motivation, confidence, and education while you embark on your parenting journey. -Friends, Family, and Community. Don't be afraid to ask for help with daily tasks so you can get quality rest and have more time to stay focused on meeting your breastfeeding challenges head-on. Lastly, BE GENTLE WITH YOURSELF. You're doing great!  Today our expert owner Dr. Kathleen F. McCue is sharing her thoughts on low milk supply and some of the underlying reasons.
Dr. McCue: It’s fair to say that I make a living regulating milk supply. The number one complaint we hear from clients is, “I don’t have enough milk!” Sometimes I’m in agreement and other times, expectations are totally unrealistic. There are so many things that come into play; storage capacity of the breasts (meaning amount of glandular tissue and milk-making alveoli within the breast itself); adequate nipple stimulation to help produce prolactin (a hormone that promotes milk production); suckling ability of the baby (big strong baby or jaundiced baby with a low birth weight); frequency of stimulation by either baby or breastpump. Here are some of the issues I look for, and as always, a consultation with an International Board Certified Lactation Consultant (IBCLC) will help determine what’s happening and how to assist:
 Traveling with Milk
It’s summer and that can mean vacations and traveling! For the pumping mom, the question of how to get breastmilk from one destination to another can be a difficult one. We usually recommend packing breastmilk in a cooler with lots of ice, taping it up, and checking it to your destination. But what about times when that method won’t work (or the flight is too long?) Recently, the Milk Stork service gave us a great overview of their services. We’ve included this information below. Tell us, how have you gotten your milk from one place to another? Milk Stork Services, Here is an overview of our services: Milk Stork provides the following breastfeeding travel solutions: Pump & Ships Pre-addressed and pre-labeled with FedEx Priority Overnight Shipping labels (for delivery anywhere in the US), Pump & Ships provide at least 72 hours of refrigeration and enable moms to overnight milk home as needed. Pump & Ships are available in two sizes: * 34 oz (a day’s supply of breast milk) at $139/delivery plus shipping and handling to the destination. This is a great option for moms with newborns who need to send home a daily supply of milk. * 72 oz (over two days’ supply) at $159/delivery, plus shipping and handling to the destination. This is a great option for moms who want to send more milk home less often, nurse more than one baby or who have a larger milk supplies. Pump & Totes Compliant with domestic TSA carry-on regulations and complete with an easy-to-activate, push-button cooler and free tote—Pump & Totes provide 60 hours of refrigeration and offer moms a convenient way to carry their milk home with them on a long flight or road trip. They’re also great for weekend and Sunday travel, when a mom might otherwise arrive home before a cooler shipped separately. Pump & Totes are available in two sizes: * 34 oz (a day’s supply of breast milk) at $79/tote plus shipping and handling to the destination. * 72 oz (over two days’ supply) at $89/tote plus shipping and handling to the destination. There is shipping and handling charge to cover the cost of getting the kit(s) to your travel destination which varies based on order lead-time, quantity, and destination. You will have visibility to the shipping and handling cost before you complete your order. How do you get your breastmilk from one place to the other? Share your tips and tricks with us on Facebook! (photo courtesy: http://www.freedomforgepress.com/2012/12/30/udderly-ridiculous/)  What is it?
Have you ever had someone recommend you use a nipple shield? It’s exactly what it sounds like: a thin, flexible silicone shield that fits over your nipple and some of your areola. Nipple shields are one tool in a lactation consultant’s toolbox for a baby with latching issues, among other things! Mary Unangst wrote a great post discussing the use of nipple shields. Why would you use them? Nipple shields are helpful for the baby with a tongue or lip tie (until revision) as they allow the baby to grasp the breast and actively remove milk. They are also helpful for the late preterm infant. These early babies have difficulty coordinating their suck, swallow, breathe reflexes and the shield can allow for an easier latch and therefore removal of milk. In conjunction with adjusting holds and maturation of the breastfeeding relationship while following your lactation support’s guidance, the shield can bridge the gap between challenging feed scenarios and a normalized breastfeeding process. An IBCLC might also recommend the use of a nipple shield when an improper latch has painfully damaged the nipple(s). When I hear a mom say “I just can’t imagine putting her on the breast one more time, it hurts so bad”, then (following a comprehensive assessment) I may very well pull out a shield. Nipple shields can allow just enough relief for mom to go on breastfeeding as she simultaneously works on correcting her baby’s latch. It’s also important to note that you should definitely consult a lactation consultant if you are using a nipple shield. Making sure that you are followed is key: An IBCLC (local or virtual) can also follow up frequently to monitor your baby’s weight gain while using the shield. Most importantly, an IBCLC will work with you to resolve the underlying issue so you can eventually (and hopefully quickly) go on to breastfeeding without it! Have you ever used a nipple shield? What was your experience? Tell us in the comment section below! And thank you Mary for sharing your great words of wisdom! |
