Many medications are totally fine to take during lactation. Many meds won’t affect milk production and they won’t harm your baby!
Medications, prescription and over the counter, are processed through several steps which determine how much makes it into your milk and determines if it will affect your baby or the milk production process.
Let’s take a look at this process!
As you can see oral medications need to be digested, metabolized through the liver, processed through the target organs, before they can make it into the mammary tissue of the breast and into the milk.
If they make it that far the remaining molecules still have to be small enough and attracted to water, fat, or both to make it into the milk.
If it makes it into the milk it still needs to be digested and processed through baby’s liver before it will possibly affect baby!
Most medications are diluted to 0.5-10% of the parent’s dose before they even make it to baby! That’s very small!
There’s a lot that goes into determining if a medication is safe for you and baby during lactation. You can discuss the medications, supplements, and herbal remedies you are considering with your IBCLC who will provide you with resources to talk with your doctor.
Often there are alternatives if the medication you want to take is not compatible.
Since it’s cold and flu season you can check here for information about common medications you may be thinking of taking if you get symptoms.
The flu vaccine is safe to take while breastfeeding and gives your baby extra protection!
Life with a new baby is exciting and full of new experiences! But the holidays also bring chaos, lots of visits, travel, and stress. Which are the last things that new parents and babies need. When the holiday season rolls around, your family and friends will no doubt be thrilled to include your little one. How do you protect the peace and keep the boundaries for your family?
Here’s some ideas:
- Tell your family what to expect in advance. The earlier the better so they can set their expectations.
- Put yourself and your baby first. The holiday season is about giving and connection, but baby’s needs top the wish list. You know your baby best and what routine works best for them. Your family and friends will understand that you and your baby’s comfort needs to come first.
- It’s always okay to say “no”. It can take some getting used to so you can recruit your partner and closest friends/family to help you have these conversations. This goes back to putting your needs and those of your infant first. You are likely feeling exhausted, overwhelmed, and emotionally sensitive. Postpartum recovery isn’t the time to stretch your ability. If in doubt, say “no”.
- Keep it simple. Let someone else host the events. Then you can drop in and leave as your schedule allows Do your shopping online and focus on group gifts. There’s nothing wrong with a gift certificate, a nice card, or just skipping the gift giving all together! You can even keep the holiday itself just to your own household. This is a time for recovery and connecting with your new child. There will always be future holidays with the whole group!
These conversations can be tough! Ask your partner and close friends to step in and help you navigate.
As many as 1 in 7 parents experience chronic low milk supply.
An estimated 5-15% of lactating parents experience CLMS (chronic low milk supply).
CLMS is associated with many common metabolic and endocrine conditions like:
- thyroid disorders
- metabolic syndrome
- hormonal imbalances
- nutrient deficiencies
- insulin resistance
- IGT (insufficient glandular tissue)
Up to 20% of lactating parents may have PCOS
Many parents don’t know why they experience CLMS. There are significant Mental Health impacts from CLMS.
Experiencing CLMS may compound trauma and feelings of inadequacy from infertility, pregnancy, or birth challenges.
Connecting with other parents who have similar experiences and working with your IBCLC to make feeding comfortable and enjoyable can help.
Resources for support:
Wellmama http://www.wellmama.net 541-231-4343
Hope for Mothers Albany 541-812-4475 Lebanon 541-451-7872
Low Milk Supply Foundation https://lowmilksupply.org/
It can be confusing to figure out because some symptoms of food allergies/intolerance are also found with other types of feeding problems.
So how do you know for sure if your baby has an allergy?
Some symptoms are clearly associated with allergies and intolerance, not just a feeding problem. Babies will generally have more than one of these symptoms.
- Wheezing or asthma
- Eczema or Hives
- Diaper rash
- Red eyes
- Rash around the mouth
- Unexplained stooling issues
- Persistent mucous
- Diarrhea (without illness)
Food allergies mostly start after baby has started solids in addition to your milk.
While food intolerances, can start at any time. Dairy is the most common in infants.
You only need to remove it from your diet for about 3 days to see a difference. You do need to remove all milk products though. Check this list so you can spot the dairy in the ingredients list.
Other symptoms can go along with food allergies and intolerance but they can also be a sign of another feeding problem.
Colic or discomfort
Poor night time sleep
Fussiness after feeds
Temporary green stool
Spit up or reflux
Blood in stool when you have nipple damage
How do you figure out the difference?
Schedule a consult with your IBCLC and they can do a full feeding assessment then refer you to a dietitian and an allergy specialist if a food allergy or intolerance is suspected.
We’ve talked about how PCOS and insulin resistance can affect lactation and milk production before but let’s explore this a bit more.
There is a disproportionate incidence of diabetes among ethnic groups.
Prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%).
This, of course, is not the only disparity found in lactation among different ethnic groups.
However, insulin resistance plays an important role in the physiological barriers to successful feeding as well as the perception or expectation of failure.
PCOS is a syndrome and the combination of symptoms is unique in each case, making identification more challenging. Many people never receive a formal diagnosis.
Symptoms can include:
•Raised levels of insulin (that can lead to excessive weight gain)
•Raised levels of androgens hormones (that can lead to acne and growth of unwanted hair)
•Irregular menses, ovarian cysts
•Increased risk of developing diabetes
•Underdevelopment of breast glandular tissue – not size
Medical conditions related to insulin resistance create additional challenges to lactation. Insulin resistance may delay Lactogenesis II – which is the milk transition from colostrum to mature milk and copious volume increase – this may be delayed by up to a week.
Some people with IR may never make enough milk to meet all the needs of their infant because of the role insulin plays in milk production and glandular growth during pregnancy, however, we do not know in advance that a person with diabetes will have insufficient supply.
Our focus should be on best practices to support these parents in the optimal outcomes for milk production and healthy infant feeding. We can do this by supporting nutrition which does not focus on weight alone, through offering medication therapy if indicated during pregnancy, by increasing access to lactation care both in-patient and after discharge, and increasing access to human donor milk for supplementation.
As providers we can also learn more about non-medication supports for managing milk supply which can include:
• Frequent milk removal using hands-on techniques
• Learning about which herbs to use or avoid
• Avoiding pacifiers and bottles, instead focusing on skin-to-skin and using at breast supplement tools
• The use of donor milk until milk production is established
• Frequent visits with an IBCLC in the first week after delivery
• Supporting in-home care
• Using Peer Support programs to encourage parents and monitor the need for medical intervention
With support, education, and provider support parents with PCOS can chestfeed successfully!
Manual therapies like chiropractic, osteopathic manipulation (these first 2 are most likely to be covered by your insurance), cranial sacral therapy (focuses on the head/neck/shoulders only), physiotherapy, and many more!
The practitioner and their skill set is an important factor in deciding which type to go with along with the areas your baby needs treated, your IBCLC or pediatrician should help you determine which will be right for your baby.
2. Oral motor exercises
These gentle exercises are meant to address compensations and work toward function. They are done in the mouth and on the face and may include other body movements. Unlike bodywork, these exercises are done daily by the parents as directed by your IBCLC. Some providers call this Suck Training.
3. Managing the feeding plan
This is evaluated and organized by your IBCLC. The feeding plan balances the need of the infant and parent and works toward feeding goals.
Your IBCLC will manage your feeding plan according to your goals and to get the bet outcomes for you. This can include counseling on pumping, feeding positions and techniques, supporting milk supply, and referring to other providers.
*these first 3 components are part of your pre and post release plan*
4. An effective release
Scissors or laser …it doesn’t matter as long as your provider is skilled and performs a full release to allow the tongue and/or other tissue to move normally. The release allows for movement while bodywork, oral motor training, and feeding plan management work together to get to normal function.
5. Wound care
Sometimes called stretches or exercises these are targeted on the site which was released (the diamond shape under the tongue). Wound care is necessary for posterior releases to prevent reattachment and aid in the tissue healing correctly.
Sometimes your provider will suggest oral motor exercises along with the wound care. Your IBCLC will suggest additional, customized oral motor training in addition to these.
Without all 5 components your baby may not achieve full functionality. Your IBCLC should be able to guide you through this process and make referrals to skilled providers as needed.
What to Expect After a Tongue Tie Release (Frenotomy)
- When appropriate anesthetic is used, the procedure is generally not painful but it is irritating to be swaddled and have the mouth held open for the procedure. Your baby may be a little fussy after but can be soothed with skin-to-skin and a feeding.
- Baby may initially feed very well but about 5-6 hours later they may be quite fussy and difficult to console. When adults get the procedure done, they report that they experience muscle fatigue which is quite uncomfortable. Try not to use a pacifier and instead to offer skin-to-skin and other forms of soothing. Smaller, closer spaced feeds may work better temporarily.
- Work with baby’s skills and abilities. We aren’t trying to challenge their feeding during healing. Latch and hold your baby the way that works best for them.
- Feeding starts to improve over time as the tongue strengthens and other muscles which have been compensating start to relax.
The suck training exercises (oral motor work) recommended are very important in this process of “teaching” your baby how to use their newly released tongue and to address areas of tightness and weakness.
- After about 4-5 days the wound will start to contract and feel tight again. Many parents worry that this is reattachment. Continuing your gentle wound care is important to keep these tissues soft.
- Stretches should be done quickly and gently. I don’t recommend doing them before feeds to avoid associations with feeding. If you practice the stretches on yourself and your baby before the procedure it will increase your confidence and skill.
- Effective and comfortable feeding requires a lot more than just a tongue which can fully move and function. It also requires that baby isn’t experiencing pain or discomfort anywhere else. Bodywork helps baby find full function through gentle manipulations. This can include pediatric chiropractic, osteopathic manipulation, cranial sacral therapy, or other types of bodywork. Ask your provider or IBCLC for referrals to providers who are experienced working with infants.
- At home, you can support your baby with movement, massage, and at-home care like Tummy Time.
- A visit with your IBCLC about 2-5 days after the procedure is important to check on the wound healing and to adjust your suck training and bodywork instructions.
August 15-21 is Asian American Native Hawaiian and Pacific Islander Breastfeeding Week! This year’s theme is Telling Our Own Stories. Elevating Our Voices. Organized by the Asian & Pacific Islander Breastfeeding Task Force, the week is a great time to listen and learn from AANHPI families, community members, and lactation support providers; and celebrate and share resources.
August 16, at 1 p.m. E.T. join 1,000 Days and the National WIC Association for the next live panel discussion. This week’s topic is AANHPI Breastfeeding, moderated by Darlena Birch, with presenters Wendy Fung and Pauline Sakamoto.
Wow! It was so amazing to see you all and celebrate the special relationship we share with our babies and community!