When do you need a breast pump?

By, Sara Steelman, MPH, CLEC

In accordance with the Women’s Health Preventive Guidelines in the Affordable Care Act, non-grandfathered health plans are required to provide breastfeeding support and supplies when needed.   There seems to be mass confusion of when a breast pump is “needed”. Breast pumps, when necessary, serve many purposes! They are especially useful when mother and baby need to be separated for an extended period of time. However, it seems there is a misconception that when you plan to breastfeed, you need a breast pump, end of story. That is simply not the case. Here are some reasons why a mother would need a breast pump:

• Mother and baby will be separated for more than a couple of hours. An example is when a mother goes back to work or school.
• A baby who isn’t nursing well (or at all). Examples include babies who are premature and unable to suck efficiently, babies with cleft palate, and babies with Down syndrome or other medical diagnosis which prevents them from nursing effectively – these infants may be able to nurse, and feeding at the breast should be attempted first.
• A mother who needs to increase her milk supply, or induce lactation for an adopted baby. Feeding frequently at the breast is always the best way to increase milk supply, but occasionally a pump will be needed in between feedings.
• A mother who makes an informed decision to feed her baby expressed milk. If this is the case, it is important to frequently hold your baby skin to skin (the unclothed baby lies on your bare chest). This will increase the mother/baby bond, and aid in the production of milk.

Please keep in mind, you should always consult with your healthcare provider or lactation consultant before deciding to pump your breast milk.

An alternative to a breast pump is hand expression. This method is good for the mother that will be with her baby the majority of the time, and may need to express milk for the occasional separation. This method also works great those first few days of life when small amounts of nutrient-rich colostrum need to be expressed to feed the baby, and for relief from engorgement.

© 2010 La Leche League International, The Womanly Art of Breastfeeding, Chapter 20.

Things to keep in mind while pumping:

1.  Proper storage is important. Follow these guidelines to store your milk: 

   

   Breastfeeding and Returning to Work or School. California Department of Public Health, California WIC Program

2. Nurse often when you are with your baby. This will prevent a drop in milk supply.
3. Talk to a lactation consultant to see if you need a pump, and how to use the pump. The lactation consultant can show you how to fit the flange for the pump, and set up a care plan for pumping and nursing. The hospitals will have lactation consultants to help you while you are in the hospital, and there are many community groups and organizations that can provide support once you leave the hospital. La Leche League and Baby Café Bakersfield are great community resources open to everyone. The Women, Infants, & Children (WIC) program also has lactation consultants, breastfeeding peer counselors, and trained nutrition counselors on staff to provide breastfeeding support.

For a detailed list of all the breastfeeding support available in Kern County, please refer to our resource directory: 

Reviewed and edited by Priya Khullar, RD, IBCLC 1/5/2016

Weaning is not something you do, weaning is something that happens!

By, Julie Huisjen, BS, IBCLC, RLC

How many times have we heard it?  “If you don’t wean your baby, he will never get off the breast!”  “He will be in kindergarten and STILL breastfeeding if you don’t wean him!”  Or maybe you’ve heard even worse: “you’re STILL breastfeeding?!”  “When they are old enough to ask for it, they are too old!”  Or worse still: “Ew!  Gross!”  These negative comments imply that a child is not capable of stopping breastfeeding on his own, it is something we must do to him.

We live in such a confusing culture.  There is so much pressure for new mothers to breastfeed, yet there is not enough support.  Mothers are criticized for not breastfeeding at all, yet if you do breastfeed, you are criticized for breastfeeding too long!  It can seem like you are never doing it right.

Having successfully breastfed and weaned all four of my children, I can assure you that they all do eventually wean.  They may not do it on your timetable or in the way you thought, but they all do outgrow the need and desire to breastfeed on their own. 

Humans are biologically programmed to breastfeed and do so for a time measured in years.  This can be surprising information in our culture, but it is supported by evidence-based information as well as thousands of years of human existence.  Rest assured, you are not doing anything wrong by continuing to meet your child’s needs at your breast into the toddler and preschool+ years.  So what does natural weaning look like?  Or better, what does normal/ biological breastfeeding look like?

Ask any mother who has breastfed past infancy why she does it, and she will likely tell you that it is a great way to calm a fussy toddler, fix a “boo boo,” reconnect at the end of the day, provide superior nutrition and antibodies, get some sleep.  The needs of the child change and breastfeeding remains a constant lighthouse in the stormy sea of life.  Study after study shows that children who have their needs met and have a strong connection to a primary caregiver are more independent later.  Breastfeeding is our primal way to connect with our children.  When allowed, our children are capable of deciding for themselves when their needs have been met, or not.  Learning to trust our children to make these decisions for themselves is one of the greatest gifts breastfeeding can give to us, as mothers. 

A natural weaning will typically occur after two years of age.  The child will gradually reduce breastfeeding, sometimes holding onto the last breastfeeding of the day, or the first one in the morning for quite some time.  Children can continue to nurse once or twice a day, sometimes skipping a day or two, for many weeks or months.  “Don’t offer, don’t refuse” is wonderful advice from La Leche League and allows the child to take the lead.  This is a great time to communicate your desires to your child.  An older child can understand that “we don’t nurse at the park anymore” or “I am busy right now, but we can nurse in five minutes.”  A toddler’s need to breastfeed is not usually as urgent as an infant’s. 

There are two books that I often recommend to mother’s seeking information on weaning.  One is “How Weaning  Happens” by Diane Bengson and the other is “Mothering Your Nursing Toddler” by Norma Jane Bumgarner.  There are great support groups online, and La Leche League meetings are wonderful places to get support in person (and sometimes the only place a mother can feel supported for breastfeeding past our cultural “norm.”)  I have talked to thousands of mothers over the years, including grandmothers.  I have never heard from a grandmother who wishes she wouldn’t have breastfed, but most of them say that they wish they would have breastfed longer.  I tell new mothers, “you can’t breastfeed too much” and this applies to all children, whether they are newborns or toddlers.  If you are a mother who is breastfeeding your child and are conflicted about weaning, seek out support, follow your heart, and trust your child.  It will happen!

Why Exclusively Breastfeed for 6 Months?

By, 
Rochelle Lukehart RNC, IBCLC (San Joaquin Community Hospital)

There has been a resurgence of public awareness in the past 15 years of the benefits of exclusive breastfeeding for 6 months.  The American Academy of Pediatrics recommends it in their policy statement from 2012. They state in the policy that exclusive breastfeeding is the normal standard of infant feeding and nutrition.  They state that there is documentation of the long and short term health and development benefits for the infant.  It is also stated that breastfeeding should be considered a public health issue and recommend exclusive breastfeeding for 6 months and continuing breastfeeding with complementary foods for 1 year and beyond.

A recent La Leche League publication on the “Gold Standard” of infant feeding restates the AAP recommendation,

Babies grow and develop best when exclusively breastfed for six months. Continued breastfeeding with complementary feeding after six months is also important to infant and toddler health. The American Academy of Pediatrics encourages breastfeeding until at least a year with complementary foods after six months, and thereafter, as long as mutually desired. The World Health Organization and UNICEF recommend that breastfeeding should continue after six months with appropriate complementary foods up to two years or beyond.

Interestingly the awareness of benefits of breastfeeding has a long history. In the eighteen century it was viewed differently. The following is an excerpt from Nature's Body: Gender in the Making of Modern Science by Londa Schiebinger,

Mother's milk was considered a miracle fluid which could cure people and give wisdom. The mythical figure Philosophia-Sapientia, the personification of wisdom, suckled philosophers at her breast and by this way they absorbed wisdom and moral virtue.

Pictured below is the “Ten Reasons Why A Mother Should Nurse Her Baby” as written by the New York Bureau of Child Hygiene in 1914. The modern ten reasons may differ from the ones written in 1914 in many ways, however, reason #4 on the list should be considered as a fact today as well.  Reason #5 is also true though the food safety now may be better, artificial baby milk is now and never will be equal to breast milk. There is a misconception in today’s society that breast milk is equal to infant formula, but that is simply not the case. We knew it in 1914, and that has not changed. Breast milk is still far superior to artificial formula. 

Breastfeeding is not always simple and easy at the beginning; many moms need to have assistance.  Help for breastfeeding in Kern County can be found in many ways; here are a few: 

La Leche League: lllofbakersfield@gmail.com

International Lactation Consultant Association: Ilca.org  

Baby Café:  babycafebakersfield@yahoo.com

San Joaquin Community Hospital: (661)869-6438

Clinica Sierra Vista WIC: (661) 862-5422

CAPK WIC: (661) 327-3074

References:

Schiebinger, Londa (1993). Nature's Body. Gender in the Making of Modern Science. Boston: Beacon Press. page 60

AAP policy: Breastfeeding and the Use of Human Milk

La Leche League Media release 2004: Exclusive Breastfeeding: The Gold Standard to be the Theme of World Breastfeeding Week

How the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Supports Breastfeeding Mothers

By, Sara Steelman, MPH, CLEC (WIC Regional Breastfeeding Liaison)
 

In response to the growing issue of malnutrition amongst low income families in the 1960’s, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) was authorized on September 26, 1972. The program was originally created to provide supplemental foods to pregnant women, and pre-school aged children. In 1978, the program evolved to include not only supplemental foods, but also nutrition education and referrals to health services. Concern over the extremely low breastfeeding rates in the late 1980’s lead to a shift in the services WIC provided. New food packages were offered to mothers who exclusively breastfed their infants to incentivize the decision to breastfeed. WIC began to recognize how important breastfeeding is to the health and nutrition of both the mother and the baby, and began providing lactation education and support to participants (Full history obtained from Oliveira, Racine, Olmsted, & Ghelfi, 2002).

 
Flash forward to 2015, WIC has implemented a variety of programs that promote and support breastfeeding in the community. With an emphasis on health and nutrition, WIC understands the importance of breastfeeding, and the positive impact it has on maternal and child health.

In order to support breastfeeding mothers, WIC offers:

Ø “Food Packages” that incentivize breastfeeding

Ø Prenatal Breastfeeding Education

Ø Peer to peer support in the form of the “Peer Counseling Program” and “Breastfeeding Support Groups”

Ø Individual breastfeeding support by lactation professionals including Certified Lactation Educators/Counselors (CLE/CLC), and Internationally Board Certified Lactation Consultants (IBCLCs)

Ø Breast pumps (manual, electric, and hospital grade) for mothers returning to work or school, and for mothers whose baby requires intensive care in a hospital NICU

In addition, the WIC program has more recently adopted the “Regional Breastfeeding Liaison” program. Regional Breastfeeding Liaisons work in the community to promote breastfeeding and assist all organizations that work with breastfeeding mothers in being able to better support their clients/patients.

WIC’s strong support of breastfeeding has often filled in where other facets of support are lacking in our society. In our current culture, we have the lost the breastfeeding “Sisterhood”, and women may not have family or friends who can provide breastfeeding help. Laura Jason, an Internationally Board Certified Lactation Consultant (IBCLC) for the WIC program, states, “The prenatal education WIC provides counteracts the lack of breastfeeding knowledge in the community. At WIC, each mother learns the impact of breastfeeding on both her health and her baby’s health. She is encouraged to set a personal goal, and to assess her family and friends’ abilities to help her achieve that goal. In the postpartum period, we help her understand normal newborn behavior and how to know her baby is getting enough to eat while she is exclusively breastfeeding. Sometimes, there are concerns about breastfeeding or barriers to achieving her goal. At WIC, we offer new options and extra tools to allow her to continue to work toward her breastfeeding goal.” Margaret Jegede, a WIC Nutrition Educator/Certified Lactation Specialist, talks about the importance of WIC led breastfeeding support groups. She states, “The breastfeeding support group is like a small village where breastfeeding moms of different ages and cultural backgrounds share ideas, and help encourage those who do not have support or have the confidence to be successful in nursing their babies. Pregnant woman attend to prepare for baby’s arrival. The support group serves as an open forum to express concerns and troubleshoot obstacles in breastfeeding. Ongoing support is very crucial in assuring breastfeeding success. As a result, WIC is seeing an increase in breastfeeding rates among women from all ethnic and cultural backgrounds.”

It is currently estimated that half of all babies born in California participate in the WIC program; a large subset of the population. Until our whole culture shifts to one that accommodates breastfeeding because it is the best source of nutrition for babies, WIC will be there providing support and advocating for change along the way!


Reference:

Oliveira, V., Racine, E., Olmsted, J., and Ghelfi, L.M. (2002). The WIC Program: Background, Trends, and Issues. Chapter 2. Food Assistance and Nutrition Research Report No. (FANRR-27) 44,  pp 7-12. Retrieved from http://www.ers.usda.gov/media/327914/fanrr27c_1_.pdf

World Breastfeeding Week/National Breastfeeding Month Events in Kern County

By, Sara Steelman, MPH, CLEC


The first week of August is World Breastfeeding Week as declared by the World Alliance for Breastfeeding Action, and the entire month of August is National Breastfeeding Month as declared by the United States Breastfeeding Committee. Breastfeeding has been identified as an important contributor to overall public health. There have been links between breastfeeding and a reduction in the risk of obesity and cardiovascular disease, cancer, diabetes, asthma, childhood infections, and sudden infant death syndrome (SIDS) in children and a decrease in the risk of breast, ovarian, and uterine cancers in mothers. Studies also show an increase in intelligence in children who are exclusively breastfed.

This year, the World Breastfeeding Week theme is “Breastfeeding and Work: Let’s Make it Work”. Several celebrations and activities will be held throughout Kern County during the month of August.

The Kern County Breastfeeding Coalition will be holding their Annual Breastfeeding Resource Fair at Valley Plaza Mall (Bakersfield, CA) on Saturday, August 1, 2015. This event is open to the public, and coalition members will be providing valuable breastfeeding resource

s and increasing awareness on how to make breastfeeding “work” in the workplace. The coalition will also be obtaining countywide proclamation from the Kern County Board of Supervisors on Tuesday, August 4, 2015. Lastly, the Kern County Breastfeeding Coalition will be visiting local Obstetricians’ offices throughout the month of August to distribute breastfeeding posters/resources that will increase access to prenatal breastfeeding education.

The Central Valley Lactation Association will be hosting a FREE viewing of “The Milky Way Movie”, an exposé documentary on breastfeeding in the U.S, at Homewood Suites on Mill Rock Way Sunday, August 2, 2015 at 2:00 PM. Individuals can register at http://bit.ly/1GO32tW. 

Community Action Partnership of Kern’s WIC Program will be creating a breastfeeding awareness display to be placed in the Beale Library (Bakersfield, CA) for the month of August. Certificates of appreciation will also be awarded to businesses that are supporting their breastfeeding participants.

 
Clinica Sierra Vista’s WIC Program will be raising awareness to their staff by showing “The Milky Way Movie” at their regular staff meeting.
 
Local hospitals will be having their own celebrations. Ridgecrest Regional Hospital will be handing out gift bags full of fun items to their breastfeeding patients (and their families) the entire month of August! San Joaquin Community Hospital will be holding FREE breastfeeding classes on Thursday, August 6, 2015 and Thursday, August 20, 2015. Space is limited and individuals can reserve a seat at https://www.adventisthealth.org/sjch/event/breast-feeding-basics. Kern Medical Center will be holding their annual bake sale on Tuesday, August 4, 2015 and Thursday, August 6, 2015 from 11:30 AM to 1:30 PM. Proceeds will go towards improving lactation care and support in the hospital.

If you have questions regarding any of these events/celebrations, please feel free to email us at kcbc.breastfeedingmatters@gmail.com.

Happy World Breastfeeding Week and National Breastfeeding Month!!

 

What to Expect in the First Week of Breastfeeding

By, Priya Khullar RD, IBCLC

The first week of breastfeeding for a mother and baby is often a learning experience. This period is when the mother and baby are becoming more familiar with each other, but it is also crucial to the production of copious milk supply. There are several tips that a pregnant woman should be informed of prenatally, and they should be reiterated immediately following birth in order to ensure breastfeeding success.
All prospective/breastfeeding mothers should be informed of the following tips for the first week post-delivery:

·       Breastfeed your baby as soon as possible after birth.

·       Putting baby skin to skin helps babies breastfeed and gain weight faster.

·       Your first milk, colostrum, is thick and yellowish. Even a very small amount has everything your baby needs!

·       New born babies have small stomachs and need to breastfeed often: about 8-12 times in 24 hours.

·       You should see baby swallow after several sucks.

·       Your nipples will be slightly tender.

·       You may experience uterine cramps in the first week when you breastfeed; this is actually a good thing. This means that the hormone, oxytocin, is being released which aids in milk production. 

·       Your breasts will feel fuller around days 2-5 and then feel less full around day 7.

·       Breastfeeding takes practice! Stay confident in your body’s ability to provide the best food for your baby.

·       The best way to tell if your baby is “getting enough” is by recording their wet/dirty diapers. The following chart, provided by the California WIC Program, is very helpful:

 

 Reviewed and edited by Sara Steelman 6/8/2015

Skin to Skin Care in the Hospital

By, Lindsay Sims, BSN, RN-C 

At one hour old, life outside the womb is a special time when a baby meets his or her parents for the first time, and a family is formed. The manner in which a new baby is welcomed into the world during the first hours after birth may have both short-term and long-term consequences. There is good evidence that newborns who are placed skin-to-skin (s2s) with their mothers immediately after birth make the transition from fetal to newborn life at greater strides than not being placed on their mother’s bare chest.  One of the main benefits seen fairly quickly after s2s is initiated is the process of breastfeeding. Babies are born with the instinctive skill and motivation to breastfeed and are able to find the breast and self-attach without assistance when s2s with their mothers. When the newborn is placed s2s with the mother, nine observable behaviors can be seen that lead to the first breastfeeding, usually within the first hour after birth. Evidenced based practice shows that a baby placed s2s immediately after birth will succeed with breastfeeding at a higher rate and for a longer period of time compared to those who go to the radiant warmer after birth. In 2012, researchers pooled the results from 34 randomized, controlled trials in a meta-analysis (Moore, Anderson et al. 2012). The researchers found that babies who were randomly assigned to receive early s2s (initial or before 2 hours of age) were 2 times more likely to be exclusively breastfeeding at 3-6 months, compared to babies who received routine hospital care. This is a "sacred" time that should be honored, cherished and protected whenever possible.

S2s is a trend that more and more U.S. hospitals are embracing. Hospital protocols can be modified to support uninterrupted s2s contact immediately after birth for both vaginal and cesarean births. In the sections below we will cover how the baby and mother benefit from s2s, what the patient should request, and the barriers seen by the nursing/medical staff in regards to s2s.  

Skin-to skin is recommended by the American Academy of Pediatrics (AAP), the U.S. Department of Health and Human Services (HHS), the World Health Organization (WHO) and many other health organizations. One of the AAP's recommendations is that “nurses will encourage moms and dads alike to continue skin-to-skin contact throughout their hospital stay.” The Baby Friendly Hospital Initiative states that all mothers must have the opportunity for s2s contact for at least one hour or until after the first breastfeed, whichever is sooner.

As nurses/medical staff we are faced with many hurdles during this intimate/important time of s2s and breastfeeding. Some of the s2s challenges faced in hospital include the need for immediate documentation (weight/length for MD, delivery record; assessing mom & baby); family disturbances; staffing/time constraints; unstable baby; C/S baby; patient's level of pain, being tired or cold; and patient/family being uneducated on s2s and breastfeeding. An important fact to keep in mind is that the rate of Cesarean births has increased significantly in the U.S., and currently averages around 32% - or 1.4 million American babies born by Cesarean per year. The low rates of skin-to-skin care provided to this population means that there are a significant number of mothers and babies who are not receiving skin-to-skin care.

Nurses, physicians, childbirth educators, and lactation consultants have unique opportunities to develop relationships with mothers prior to birth providing education on wellness and health promotion including s2s and breastfeeding. We must take advantage of this role! With this role in hand we can customize our plan of care and interventions to allow this one hour of uninterrupted s2s, with a little adjustments of charting and caring for the patient(s).

Patients should be educated on the importance and benefits of practicing skin to skin care with their newborn baby.  They should tell the nurses/medical staff they want immediate s2s and Golden Hour when they arrive to the hospital and throughout their stay. They are in control of their stay and the staff should do everything in their power to make sure they grant their wishes towards s2s and breastfeeding.

Benefits of s2s care in the newborn:

1. Accelerates BRAIN DEVELOPMENT

2. Reduces Crying/Stress (negative effects of separation)

3. Regulates BODY TEMPERATURE

4. Improves QUALITY OF SLEEP

5. Enhances IMMUNE SYSTEM

6. Stimulates DIGESTION & WEIGHT GAIN

7. Synchronizes HEART RATE & BREATHING

8. Encourages BREASTFEEDING BEHAVIOR (aids in attachment)

 

Benefits to the mother:
1. Reduces risk of POSTPARTUM DEPRESSION

2. Increases MILK PRODUCTION

3. Speeds RECOVERY TIME

4. Promotes PSYCHOLOGICAL WELL BEING

Skin to skin contact and breastfeeding are hot topics at this time in the hospital with The Joint Commission Perinatal Care Core Measures and Baby Friendly Hospital Initiative goals all aligning to promote the practice. As a nurse in Labor and Delivery, I want to stress that we must be educated and adjust our plan of care and interventions to allow for this. This process change from what we are used to will only show positive outcomes, as we all know! For the mother (parents), please come educated on your rights as a patient and be ready to let the hospital know your specific wishes. Do not allow your medical team to adjust the plan unless deemed necessary! You deserve to have this special time with your newborn, as you will never get that one hour of skin to skin directly after birth ever again! Enjoy every second!

Edited by Sara Steelman, MPH (2/25/2015)