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Choline

Choline is an essential nutrient during pregnancy and lactation but only 15% of us are getting the recommended daily amount.
So what is it and why do we need it?

Choline is one of the many B Vitamins we need. B4, to be exact.

Choline is a key nutrient for fetal brain development and protection. Choline supports brain development, memory, and learning —and protects us from infections. When we think about brain development during fetal growth we often think about folate (which is also very important!) but choline plays an important role in neural tube development.

During pregnancy choline protects us from serious complications.

Choline is required for maintaining normal levels of homocysteine: 

Elevated homocysteine levels during pregnancy have been associated with complications like: preeclampsia, miscarriage, placental abruption, intrauterine growth restrictions (IUGR) , venous thrombosis, and cardiovascular related complications.  

Adequate choline during pregnancy can also protect us from cholestasis which is a common complicating during pregnancy and postpartum.

Choline can also be used to reduce risks and prevent mastitis. It is one of the components of lecithin.

Choline RDA During pregnancy 450 mg/day During lactation 550 mg/day

Choline is a naturally occurring amino acid found in egg yolks, liver, animal meat, beans, milk, some vegetables, as well as in human breast milk. 

Amount of Choline Per Serving of Food: 

  • Beef Liver (3 oz): 356 mg 
  • Egg, hard boiled: 147 mg 
  • Beef top round (3 oz) : 117 mg 
  • Soybeans, roasted (½ cup): 107 mg 
  • Chicken breasts (3 oz)  72 mg
  • Beef, ground (3 oz): 72 mg 
  • Fish, cod and salmon (3 oz): 71 mg 
  • Broccoli (1 cup): 63 mg 
  • Green Peas (1 cup): 47.5 mg 
  • Navy Beans (½ cup): 41 mg
  • Milk (8 oz): 40 mg

If you are considering supplementing your diet with choline look for products containing phosphatidylcholine.

❤ Megan

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American Academy of Pediatrics Recommendations

“The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for about the first six months. We support continued breastfeeding after solid foods are introduced as long as you and your baby desire, for 2 years or beyond.”

The new recommendations bring the AAP in line with the World Health Organization, UNICEF, The American Academy of Family Physicians, and so many more health organizations!

This article from Healthy Children explains the recommendations and highlights the need for skilled lactation support. It also addresses the structural barriers to meeting these feeding goals.

You can read the official statement titled “Breastfeeding and the Use of Human Milkhere.

❤ Megan

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LGBTQIA+ Resources

The Basics of Inducing Lactation — Breastfeeding Without Birthing (Alyssa Schnell, IBCLC)

Milk Junkies — Breastfeeding and parenting from a transgender perspective (Trevor MacDonald)

Using an At-Chest Supplement Device

Trans Breastfeeding FAQ – Diana West

Find an LGBTQ Care Provider — Breastfeeding Network  (Jaye Simpson, IBCLC)

Professional Organizations on LGBT Parenting — Human Rights Council

Two Women and a Baby: LGBTQ and Breastfeeding

❤ Megan

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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