breastfeeding, chestfeeding, Diabetes

September is PCOS Awareness Month

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!

❤ Megan

breastfeeding, chestfeeding

Tongue Tie Release and Recovery

1. Bodywork

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.

❤ Megan

breastfeeding, chestfeeding, WBW

Asian and Pacific Islander Breastfeeding Week!

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.

Register here!

❤ Megan

breastfeeding, chestfeeding

Necrotizing Enterocolitis

Even the name is foreboding and for good reason! (NEC) is a serious gastrointestinal problem that mostly affects the intestines premature babies. This inflammatory condition can happen when infants are not receiving only human milk or have received antibiotics which can cause damage in the digestive tract.

May is Necrotizing Enterocolitis Awareness Month

There is a ton of research which looks at the connection between human milk feeding and significantly reducing the risk of developing NEC.

To learn more check out NEC Society

breastfeeding, chestfeeding, Diabetes, mastitis, Nipple concerns

Is it thrush?

“Nipple thrush pain is often described as burning, itching, or stinging and may be mild to severe. The pain is usually ongoing and doesn’t go away with improved positioning and attachment of your baby to the breast.”

“When you have nipple thrush, your nipple appearance may change to being shiny in appearance, sometimes chapped, blistered with white patches but may also look completely normal. You may also experience itchy, flaky and red nipples or areola.”

Picture of oral thrush in an infant

Thrush is an overgrowth of candida or yeast. It mostly commonly causes an infection and overgrowth in people who are immunocompromised.  It can overgrow in areas with skin folds which are moist and warm, like armpits, the vagina, etc.  It’s very rare to have yeast/candida/thrush in highly vascularized areas like the breasts and nipples.

Research has shown that in cases of suspected thrush the parent is most likely experiencing mastitis 
“microbiological analysis of milk samples provided by 529 women with symptoms compatible with “mammary candidiasis”. Nipple swabs and nipple biopsy samples were also collected… Results showed that the role played by yeasts in breast and nipple pain is, if any, marginal…our results strongly support that coagulase-negative staphylococci and streptococci are the agents responsible for such cases.

When providers visually assess for thrush, they may be seeing dermatitis rather than a yeast overgrowth on the nipples.  Dermatitis is an allergic reaction or irritation caused by something the parent is sensitive to on their skin.  This can include creams, ointments, and medications.

Here are some pictures of parents who thought they had thrush but actually had dermatitis!

Below, is what yeast on the skin actually looks like

So what you should you do if you think you have thrush?

Talk to your Lactation Consultant for a full feeding and breast evaluation. They can make referrals to providers for treatment, if needed, and can help figure out what’s actually going on!

❤ Megan

breastfeeding, chestfeeding

It’s Doula Appreciation Week!

March 22-28 is a time to be grateful for all that doulas provide to us during pregnancy, birth, and beyond!

A doula is a professional labor assistant who provides physical and emotional support to you and your partner during pregnancy, childbirth and the postpartum period.


Did you have a doula?
How was your experience supported by your doula?

Doulas can support breastfeeding in lots of ways!
By teaching basic hold and latch techniques.
By discussing your feeding options and helping you sort out what’s right for you.
By helping you to have a healthy and safe birth so you can get started with the Golden Hour right away!
By providing education, encouragement, and resources to help you keep breastfeeding if you run into any bumps.
By connecting you to other knowledgeable providers who can assist and support you.

Thank your doula today!

breastfeeding, chestfeeding, reflux

Plagiocephaly and Torticollis

March marks Plagiocephaly and Torticollis Awareness Month.

Plagiocephaly is when a baby develops a flat spot on one side or the back of the head. It happens when a baby sleeps in the same position most of the time or because of problems with the neck muscles that result in a head-turning preference.

In babies, torticollis happens when the muscles that connect the breastbone and collarbone to the skull (sternocleidomastoid muscle) are shortened.

There are many reasons that babies can develop these conditions and none of them are your fault! In fact, plagiocephaly and torticollis are becoming increasingly common.

Here are some reasons your baby may have one or both of these conditions:

  • Being malpositioned in the uterus. A smaller parent may not have as much room for a larger baby which can put baby in the same position for days or even weeks before birth. This can occur with pelvic floor issues or with parents that have differing anatomy
  • Babies who sleep on their back for long stretches. While sleeping on the back is safest overall, if baby doesn’t move around a lot and sleeps looooong stretches it can increase flattening of the back of the head. These babies need lots of tummy time when awake!
  • Babies with reflux or torticollis may develop plagiocephaly on the side of the head. When we turn our head, it helps close off the esophagus during refluxing.
  • A baby who is best soothed in a swing or other baby-holding device. If your baby spends a lot of time in a swing, bouncy chair, or car seat it’s much more likely they will develop plagiocephaly.

The good news is that you can treat both of these conditions! Working with a pediatric PT is very helpful!

At home you can do fun activities with your baby to help them develop and improve.

  • Tummy time and the Guppy
  • Encourage baby to turn their head both directions by offering stimulation on the non-preferred side. Talk to them and sing songs to get baby to turn their head. Position baby for sleeping so they will turn to the non-preferred side toward you.
  • Superbabies!
  • Torticollis therapy
  • Babywearing is a great way to soothe baby and keep your hands free!
  • Cranial sacral therapy, OMT, and chiropractic can all be great options. Look for a provider that specializes in infants and ask your Pediatrician for recommendations.

With help and time, it will get better and you are likely to see big improvements in your baby’s feeding, too!

❤ Megan

breastfeeding, chestfeeding, milk supply

Overactive Letdown?

Does your baby gag, choke, and cough during feeding? Are they sputtering and tugging on your breast? Ever notice them clicking or leaking milk? What about gas…do they seem to have an awful of it?

There could be a number of things causing baby to struggle with feeding.

  1. It could be a strong letdown (or as we call it in healthcare Milk Ejection Reflex – MER)
  2. I could be an oversupply
  3. It could be ineffective latch.

Let’s learn about the differences.

Strong MER
Inside your breast are milk making cells that form a sphere. These spheres are clustered together so I like to think of them as bunches of grapes with the stems representing the ducts that carry milk to the nipple.
Each grape is wrapped with muscle fibers. When your baby is feeding (or sometimes just when you think about your baby!) your oxytocin rises. Oxytocin is a hormone which plays a role in bonding, pleasure, and MER. It’s the same hormone that kicks starts uterine contractions during birth. The muscle fibers respond to oxytocin and squeeze milk down the ducts and out the nipple.
To have strong MER you need strong muscle contractions. Over the first 3 months, MER starts to chill out because those little squeezing muscles become less sensitive to it.

Oversupply
We actually just talked about oversupply. If you have an oversupply, when the muscles contract the milk making “grapes” are soo full that milk flows very quickly.

Ineffective Latch
Latch, or attachment to the breast, can be ineffective due to positioning, other medical conditions, tongue tie, or due to something else.

Hmmm, I think I know what’s going on. What do I do about it?

Make an appointment with your Lactation Consultant so they can give you personalized instruction and make a plan which will work for you!

All too often, the difficulty is with your baby and not with you. Your IBCLC can direct you to care which can include changing your feeding plan, adjusting your position, suck training exercises, working with a physical/occupational therapist, or SLP.

We are here to help!

❤ Megan

breastfeeding, chestfeeding, milk supply

Plugged Ducts

Many people think a plugged duct is caused by a backup of thickened milk but the plugging comes from outside the duct.

Our milk ducts carry milk from the milk making cells which are grouped together in alveoli.  The alveoli are like little clusters of grapes which connect to the ducts.  The ducts carry milk to the nipple openings.

A breast “plug” represents an area of swelling in the breast and more accurately reflects lymphatic fluid congestion and dilated capillaries than a “plug of milk.”  The plugging is caused by engorgement and congestion of fluid and blood vessels pressing in on the duct from outside which narrows the pathway. 
Exclusive or excessive pumping, nipple shield use, oversupply, unresolved engorgement, inflammation, or subacute mastitis increases plugging.

To treat plugging, try the following:

  1. Warmth before feeding.  A warm shower or warm pack applied to the breast.
  2. Ibuprofen and/or Tylenol as needed along with a cool pack applied after feeding/pumping.
  3. Avoid massage and excessive pumping (remember it’s not milk that’s plugged).
  4. 5-10 grams daily oral sunflower lecithin supplementation

This should resolve in 24hrs.  If it does not, contact your provider and lactation consultant for guidance.  Therapeutic ultrasound is very effective.  Your doctor may prescribe a single dose of 10-30mg of Pseudoephedrine (Sudafed) which acts as a vasoconstricting agent (i.e. decreases blood flow) and may help with any pain.

Any plug or mass persisting for several days and not resolving with conservative interventions requires referral to a medical provider, who may obtain breast imaging to rule out galactocele and/or other mass.