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So your baby has a tongue tie…

Lots of parents are surprised to find out their baby has ankyloglossia (tongue tie) and that such a tiny piece of tight tissue under the tongue is causing so many feeding problems!

Luckily, it a simple procedure to release the tongue and get on our way to easier feeding!

In my experience providing care for babies with tongue tie, doing just “the snip” isn’t enough to get full results. If we think about how baby has never had full range of motion with the tongue it makes sense that they will need time and help to get to normal movement.

Of course, working with a tongue tie-saavy Lactation Consultant and your provider is key but there are also things you can do at home!

Top 5 At-Home Tongue Tie Care

  1. Tummy time

    You may already be doing this with your baby but there are some modifications which may improve outcomes for tongue tied babies. Try rolling up a blanket or using your nursing pillow under their chest. This can be more comfortable for some babies and make the whole process more enjoyable.

    My favorite recommendations come from the Tummy Time Method which has parent handouts and lots of suggestions for tongue tie specifically

  2. Guppy Hold

    The Guppy Hold is great for stretching tight neck muscles and it’s very easy to do! Babies love it.
    Check out this video for more info

  3. Play with baby’s mouth!

    Try running a clean finger from one side of their gums to the other. They will “chase” you with their tongue. This is a fun stretch which encourages good movement.

    You can also insert a clean pinky finger, nail side down, once baby starts sucking pull gently. You are just adding a little resistance for baby to help strengthen their suck.

    When I’m doing these games, I like to sing a little made up song to engage baby and reinforce that what we are doing is happy playtime!

  4. Give baby options

    Move around where you place baby during the day when they aren’t snuggling in your arms. Switch up how they are faced at bedtime. Baby will naturally turn their head toward you so by switching it up, they will take turns looking both ways.

    The same goes for feeding. Breastfeeding on both sides is great and bottle feeding on both sides is great, too!

  5. Massage

    Massage and gentle touch is beneficial for many conditions, tongue tie included. This video has a great demonstration of massage parents can do on their own.

The biggest thing, is to have patience and keep working with your experienced tongue tie-saavy Lactation Consultant for continued help.

❤ Megan Dunn, IBCLC

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Reasons you should feed your baby responsively

New parents are given lots of advice about how to feed their baby.  Where to feed, when to feed, how to hold baby, how long to feed, and so much more!

You may have been told to feed your baby at least 8 times a day or every 3 hours but feeding on a schedule doesn’t really meet baby’s needs.

Baby has a high need for frequent feeds to keep them alert and build their brains!  Research shows that with responsive feeding there is a high variability in how many times a day baby will feed but it’s much closer to 12 times per 24hours than 8.  

Preliminary research from Swansea University regarding how many times per 24hrs babies feed

Reasons you should feed your baby on cue:

Readiness – Feeding your baby when they cue means you are offering a meal when they feel hunger and are alert enough to communicate that to you.  Imagine being offered your favorite meals when you are super tired…would you feel ready to eat?  Or would you have just enough before falling into a deep sleep?

Meeting all baby’s needs – Baby wants to feed and be close to you for lots of reasons!  You are their home.  You smell like home, you sound like home, you taste like home.  Feeding our baby promotes bonding, reduction of stress hormones, brain development, and so much more than just calories and nutrients!

Milk supply – Your baby doesn’t feed on a regular schedule and your body doesn’t make the same kind of milk every 3 hours on the dot.  AM milk is different from PM milk.  Milk composition changes, too.  At different times of the day it will have higher fat or sleep hormones to help set your baby’s clock and meet their nutritional needs.  If we schedule all the feeds we miss the opportunity to give baby the perfect custom meal each time!

Feeding when baby asks also supports a robust milk supply! Frequent feeding communicates a need to your body to keep making lots of milk!

Capacity – Different breasts/chests hold different amounts of milk (no, this isn’t related to size).  Some people have smaller capacity and can make all the milk baby needs but they need to feed more often.  Scheduled feeds or expectation of only 8 feeds in the day can make parents feel like their milk supply is low – when it’s totally normal!

Responsiveness = communication, trust, and independence – What do all these words have in common? They are what happens when we are responsive feeders.   When we respond to baby’s needs and pay attention to their body language (rooting, sucking, wiggling, lip smacking) we tell them they are heard.  When we respond to our babies they build trust and know their communication will be heard and they will get their needs met.  And that’s how we get independence!  Studies show that responding to our children and meeting their needs results in more independence in toddlerhood and beyond.

❤ Megan

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Not pumping enough?

  1. Is your pump new?  Your insurance will provide you a new pump with each baby.  The motor wears out with use!

  2. Are you using the right size flange/shield?  It should be just big enough to comfortably fit your nipple.

  3. Have you tried other settings?  Many pumps have a “letdown” mode with stronger and faster cycles to start MER.  When your milk slows turn this mode back on.

  4. Visualization makes milk flow! Sit in a comfortable place, take some deep breaths, and imagine your milk flowing easily.  Cover up the bottle so you can relax and not worry about how much you are pumping.


  5. Membranes, valves, and tubing need replacing regularly (between 3 weeks and 6 months depending on how often you pump).

This is also a good time to explore what “enough” is. Some bottles are really huge! And other parents on social media share huge pumping session successes which may not reflect what is average or achievable.

On average, exclusively pumping parents can express 3-4oz (90-120mL) with each session. Whereas, parents pumping after feeding baby will express about 1.5oz (45mL).
This is a reflection of what baby’s stomach can hold. Around 4-6 weeks most babies reach their maximum intake and can hold up to 5oz at a time. This doesn’t mean they need all 5oz (I don’t want to feel Thanksgiving dinner full after every meal!).

Over the course of a day, baby will take 27-30oz and this does not increase with age for breastfeeding babies!

So….how are you doing? Are you expressing 3-4oz when you exclusively pump?

If not, try some of the tips above and if that doesn’t work, check in with your IBCLC for a full evaluation and support!

❤ Megan

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Should I get the vaccine if I’m breastfeeding?

Yes!

The vaccine is safe for breastfeeding people and effective at preventing infection. The vaccine cannot give you or your baby a Covid infection.

Here’s where to find out where you can get vaccinated

Here is more information from the CDC about getting the vaccine when you are breastfeeding

Recent research has shown that out milk contains anti-bodies in response to the vaccine that we then are passing onto baby. This may help protect baby from infection!

Antibodies and T-cells stimulated by the vaccine may passively transfer into milk. Following vaccination against other viruses, IgA antibodies are detectable in milk within 5 to 7 days. Antibodies transferred into milk may therefore protect the infant from infection with SARS-CoV-2
-Academy of Breastfeeding Medicine

Currently the Covid vaccine is available for people aged 12 and up. There are clinical trials in place for ages 6 months to 12 years to determine safety. Experts think that we may have expanded use for younger children available this Fall.

If you do become infected with Covid-19 while breastfeeding the CDC has guidance for you.

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What I Wish I Knew About Breastfeeding

Parents who have breastfed their babies have great advice. Here are some of their suggestions.

Take a breastfeeding class during pregnancy

Breastfeeding is a natural thing to do, but parents need to learn how. Parents who take a breastfeeding class during pregnancy are less likely to have problems or pain.
 

Start breastfeeding right away

Spend an hour skin-to-skin with your baby. This is called the Golden Hour and it’s when they are most alert and ready to get started feeding

Babies cry more on their second day of life

This can be upsetting and you might not know how to calm your baby. Hold baby skin to skin and offer the breast frequently. This is called “Second Night Syndrome” though it can also happen during the daytime.


Feed throughout the night  You do need to feed around the clock in the beginning. This brings in an excellent supply of milk and takes advantage of baby’s alert time which is during the night, at first. “Cat nap” during the day when your baby is sleeping.

Attend a breastfeeding support group
Meeting and connecting with other moms can bring a lot of reassurance. The facilitator is a peer counselor who breastfed her own children and can answer questions and help you troubleshoot problems.

It shouldn’t hurt

How your baby attaches (latches) to your nipple and areola is the key to comfortable breastfeeding. Make sure the mouth is opened wide and baby gets a big mouthful.

Hold baby frequently

Skin-to-skin reduces crying, facilitates bonding, and improves breastfeeding. Use a safe baby carrier when baby is big enough for hands-free snuggling!

It gets easier
Just like any new skill it gets easier with time and the more practice you have. Ask for help when you need it.

There are lots of sources of community help Check out the resources section for Lactation Consultants and Support Groups near you.

Anytime you are unsure if breastfeeding is going well, contact a Lactation Consultant.

Signs of poor feedings

✓Feeling pain during feedings
✓Sleepy baby
✓Difficulty latching-on and staying on
✓Clicking or popping sounds in your baby’s mouth
✓Prolonged nursing (more than 20-25 minutes on each side)
✓Infrequent nursing (baby does not wake to feed at least every 3 hours)
✓Baby is not satisfied at the end of the feeding
✓Inadequate wet diapers and stools
✓Rapid or excessive weight loss (more than 7- 10%) during the first few days
✓Has not regained birth weight by 2 weeks
✓Slow weight gain thereafter (less than 2/3-1 oz per day in the first few months)

Megan Dunn, IBCLC

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Do I have enough milk???

Up to 80% of breastfeeding parents believe they have low milk supply. And while people do truly struggle with milk supply issues, it’s also true that only about 5% or less suffer from primary lactation insufficiency or a physiological inability to produce enough milk (usually because a health condition).

Milk supply issues can happen due to a secondary cause like a premature or complicated birth.  These situations can make it harder to establish a full milk supply right away. This doesn’t mean your breasts can’t make enough milk ever. It just means that they aren’t making enough milk right now—often we can fix these issues!

After many years as a Lactation Consultant, the majority of low milk supply concerns I see are actually non-issues.  That’s to say, parents feel like their milk supply is low but there’s no evidence that’s the case.  Often this occurs because we haven’t fully learned what our babies are communicating to us.  We think if our babies cry or fuss there might be something wrong with our milk! And it has a lot to do with how we feel about our bodies and how much we trust things to go well.

Perceived low milk supply is the number one reason breastfeeding parents give for why they stopped breastfeeding.  Figuring out what’s really going on can be tricky because it’s not just you but also your baby in the picture.  So milk supply has to match up with baby’s ability to eat well.

My baby cries and fusses often so my supply must be low…

Babies cry for lots of reasons!  As parents we are quick to blame ourselves and worry that we don’t have enough milk or that something in our milk is bothering our baby.  Most babies who aren’t getting enough are actually very sleepy.  They are difficult to wake and have a hard time staying awake for a whole feeding.  They are quiet, “good” babies.

Babies often have periods of fussiness related to gassiness, overstimulation, or just common evening crying.  Snuggling your baby close, skin to skin can help soothe some of these discomforts. Alternately, hold your baby in a carrier or sling and go for a walk.  The motion and change of scenery may help!

My baby wants to eat more often than every 2-3 hours…

Newborns who are fed responsively will feed on average 12-14 times in a 24hr period.  Older babies and bottle fed babies do this sometimes, too!  It’s normal to have increased feeding times at 4-6 weeks and 16-18 weeks.  It’s also normal that your baby will cue to feed for soothing and snuggles.  Touch and suckling are strong needs for baby and they are satisfied by breastfeeding.

My baby will take a bottle after breastfeeds so they must still be hungry

In the early weeks, suckling is a reflex.  A bottle nipple stimulates the right spot on the top of baby’s mouth and they suck reflexively.  The bottle nipple also drips which causes baby to swallow.  When they swallow the nipple releases more milk…and then you are in a cycle!
Babies also love to suck for comfort.  So they are willing to take more if it’s offered.  This can cause overfeeding which results in spit up and gas and that can cause more fussing!

I can’t pump as much as my friend so I think I’ve got low supply

On average, a pumping session without prior breastfeeding will yield 3-4oz (or about 1-1.5 oz if you’ve just breastfed).  More than that can be normal but it’s not necessary.  Baby’s stomach can only hold about 4oz. 
Also remember that milk flow comes from oxytocin (that lovey, warm hormone you get with skin to skin) and oxytocin isn’t as high with pumping as it is with your sweet, cute baby. 

Your Lactation Consultant can help you find the right pump for you and make sure you have a good fit and a pumping plan that works for your needs.

My breasts don’t feel full anymore.  I think I lost my supply.

In the early days our breasts can feel *very* full and heavy.  Lots of that is from milk but even more of it is from fluid retention (which can also cause our hands and feet to swell).  As that extra fluid is passed, our breasts get softer.  They also start to respond to what your baby needs so they tend not to get overfull after a few weeks.

For many people, anywhere from 1.5-3 months is when they notice these changes.  It can often coincide with returning to work and increased pumping sessions (see above). 

The best indicator for a sufficient milk supply is to look at your baby. 

Is your baby happy most of the time? 
Do they have some alert times during the day? 
Are they making daily bowel movements and lots of wet diapers? 
What about weight gain?  If they are gaining 5-7oz per week in the first few months then they are doing great!

If you ever have concerns, drop in for a weight check at your local breastfeeding group or schedule a visit with a Lactation Consultant.

Here is a list of local providers and breastfeeding support groups:

Resources – Linn Benton Lincoln Breastfeeding Coalition

Megan Dunn, IBCLC

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Debbie Alba – Breastfeeding Advocate of the Year

On January 14th from 3-5pm at the Corvallis Birth and Women’s Health Center, the Linn Benton Lincoln County Breastfeeding Coalition honored Debbie Alba, CNM, IBCLC with the coalition’s fourth annual “Breastfeeding Advocate of the Year” award.

Debbie Alba, Breastfeeding Advocate of the Year

Debbie currently works as a Certified Nurse Midwife and lactation consultant for the Corvallis Birth Center and as a lactation consultant for Samaritan Health Services in Corvallis. Her passion is to support women and babies through the birth experience and beyond.

She started working as an advocate for women and children in 1995 in San Francisco, where she first learned of the power of a positive birth and breastfeeding experience. Debbie has worked in the local area as a public health RN for Benton County, and for Samaritan Health in the home health, inpatient, and outpatient environments as an RN and lactation consultant.

Debbie holds a Bachelor of Science degree from Santa Clara University and a Bachelor’s in Nursing with honors from Oregon Health Sciences University. She has been an International Board-Certified Lactation Consultant since 2002 and more recently graduated Summa Cum Laude from Frontier Nursing University with a Masters in Nursing in nurse midwifery. 

She has served on the board of directors for the Oregon Washington Lactation Association, the Breastfeeding Coalition of Benton County, the Linn Benton Lincoln Breastfeeding Coalition, and the Breastfeeding Coalition of Oregon. She works to engage in and inspire innovative projects around the state of Oregon. This has included her role in Good Samaritan Regional Medical Center’s path to becoming a Baby Friendly Hospital.  

This adds up to an impressive 25 years of helping breastfeeding families!

She is the mother of three children; and she and her husband live on a small farm outside of Philomath. She gardens and takes care of their herd of dairy goats, makes cheese, and runs on the hills around Corvallis with her two dogs.

To sum up Debbie’s passion for her work, here is a quote Debbie’s bio from the Birth Center website:

“I am committed to supporting women through evidence-based practice and informed choice throughout their personal journey towards health, and am particularly interested in providing a bridge from pregnancy care to overall health care, including mental health.  I believe that empowerment of women in their life journey and optimum health and well-being of both women and children lays the foundation for a healthier, more sustainable society.”

Thank you, Debbie, for your valuable and impactful work and congratulations, on being this year’s Breastfeeding Advocate of the Year.

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Keto Diet + Breastfeeding = ?

Over the years I have had many mothers ask me if low carb diets are safe while breastfeeding and recently several mothers have asked me if the keto diet is compatible. Many people find that a low carb or keto diet helps them to lose weight rapidly without being hungry all the time or experiencing cravings, and of course after having a baby, many women are looking for some kind of diet plan. A few weeks ago the IABLE came out with a parent handout about the keto diet in relation to breastfeeding, as well as making it the subject of their weekly #LACTFACT question.

They discuss a risk of low carb and keto diets called ketoacidosis. This can occur when the body is burning fat and produces an excess of blood ketones which causes the blood to become too acidic. This rare but life threatening illness is more likely to occur during breastfeeding because of the extra calories the body requires to make milk. This condition is fairly common among dairy cows during early lactation because the energy required to make large quantities of milk is often much more than the cow is physically able to eat. Cows suffering from this condition have to be given large quantities of intravenous glucose and steroids to save their lives.

In addition to the low but real risk of ketoacidosis (Google: lactating women ketoacidosis), a woman who starts on a low carb or keto diet is often restricting her daily calorie intake very rapidly and this can result in a decrease in milk production. Experts who study “blue zones” – areas of the world where populations live longer and are generally very healthy – have found that the typical diets in these areas consist of legumes, grains and vegetables and generally relatively low amounts of dairy, meat, and fat. Long term, these “blue zone” diets are probably more sustainable and balanced than low carb dieting.

The authors of the keto diet and breastfeeding handout recommend that women considering a low carb or keto diet while breastfeeding use caution. They suggest consultation with a dietician or physician before strictly eliminating carbohydrates or dramatically reducing calories. A diet with increased protein and fewer carbohydrates may be helpful for lessening hunger and cravings while losing weight, but completely eliminating carbohydrates while breastfeeding is probably not wise, particularly during exclusive breastfeeding.

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Parallel Pumping Technique for Breastfeeding

Many breastfeeding mothers need to or choose to express breastmilk at some point during their breastfeeding journey. Many use breastpumps, though some prefer hand expression or milk collection devices to collect leaked milk. Many women pump while they are away from their babies for work or school, while others pump to increase their milk supply. Some choose to pump their milk and donate it to babies whose mothers can’t produce enough. Some mothers with babies who are born somewhat early, often called late preterm babies, use a technique called triple feeding to make sure their babies take in enough breastmilk while they wait for them to mature enough to be able to breastfeed exclusively. The three steps of triple feeding are: 1. Feed the baby at the breast. 2. Simultaneously pump both breasts with a double electric breastpump. 3. Feed some of this expressed breastmilk to baby via bottle. This cycle is generally repeated every 3 hours. Triple feeding is a lot of work and many women find it cumbersome or overwhelming.

Parallel pumping is a technique described in an article called Maternal Satisfaction With Parallel Pumping Technique by Kathleen McCue and Michelle Stulberger in a recent issue of Clinical Lactation. This technique aims to make triple feeding more manageable by combining two of the steps. The technique involves using a breastpump to pump one breast while simultaneously breastfeeding baby on the other. They recommend using a pumping bra to hold the pump in place, then latching baby to the other breast. Because the women in their study were pumping to maintain or increase milk supply for late preterm babies, they recommended using a hospital grade multi user breastpump. For mothers who want to use this technique for donating or for having some extra milk in the freezer, the regular double electric pump issued by insurance may be adequate.

Mothers who are triple feeding may want to use the parallel pumping technique every feeding. Others may only want to do this a few times a day, or only when they happen to need some extra milk. A blog post at The Leaky Boob.com explains the technique and has a few pictures.

According to the article Clinical Lactation, many mothers found this technique easier to manage and more efficient than triple feeding. In theory it may also increase milk production since women may experience a stronger let down reflex for the pump while they are also breastfeeding than they do when pumping alone. I hope that this technique will become more widely known and accepted as an alternative to triple feeding, and also for mothers who are pumping for other reasons.