Monday, March 21, 2016

But I should be happy....

By,
Stacie Bingham, CD(DONA), LCCE 

These are my sad stones. I found them at the beach one day, when I felt the need to venture away from my home and my problems and spend time collecting my thoughts and just feeling free for a while. I had been crying daily, hit by a sadness I couldn’t even explain. It was a terrible time for me, and while I knew I should reach out to a professional for help, everything just felt too overwhelming. With a family of busy children, a nursing baby, and all that was expected of me, I couldn’t fathom finding someone to call from a random list of names, figuring out if my insurance would cover expenses, and taking the time to travel and sit with a therapist, pouring out my sadness…which I already didn’t have the energy to engage. There was just too much I already had to do, and I didn’t have the resources within me to do this for myself.

When I trained as a doula, many years before I ever experienced a perinatal mood disorder, I learned depression in pregnancy is more common than postpartum depression. This surprised me, and it took many years before I heard Birdie Gunyon Meyer, RN, MA, CLC, give the exact numbers: one in five women experience depression while pregnant, and one in seven experience postpartum depression. Dads can be affected as well – one in ten will experience depression before or after their child is born.

In my childbirth classes I often share we have ideas about how life will be after our baby is born. I liken it to a wall of decorative boxes where we have our existing activities and priorities. We expect to contain our new baby in the space we have carved out for him or her. The reality sets in, though, and suddenly we see that “baby space” has exploded, baby puke all over the other boxes – everything smells faintly of sour milk, and we wonder, “Could this be right?”

Up to 80% of women experience Baby Blues. This is a week of very strong emotions, tears, frustration, as we move into the role of being mothers. It is not supposed to last longer than two weeks – at that point, it is possible we have moved into a postpartum mood disorder. What can be confusing, though, is we often tell women to watch out for “depression,” for crying all the time, sadness, not getting out of bed, etc. We don’t often warn women there are other signs of something going on inside, and it may not look anything like depression.

Pregnancy and birth is a time when hormones affect almost everything related to growing, having, and feeding a baby. Hormones affect our bodies, and they can also affect our minds. It makes sense to have emotional changes related to becoming a parent – as our bodies are prepared to grow, birth, and feed our new ones, emotional changes can help us prepare in other ways. There is a saying – worry is the work of pregnancy. Indeed, worrying can move us to action. If we are worried about birth, we can take a childbirth class or hire a doula. If we worry about how our babies will stay warm, we can gather clothes, blankets, a safe place for sleep, etc. Worry can help us be ready.

Many mood disorders are normal feelings that are working overtime. This is where anxiety, panic, or obsessive-compulsive thoughts and actions can appear. That doesn’t always come with crying all day or feeling sad. This can look like worrying something is wrong with your baby; needing to check on your baby while he or she is sleeping, counting baby’s breaths or heartrate, taking baby’s temperature; feeling overwhelmed about all the baby gear you must bring with you to leave the house and choosing, instead, to stay home. When these habits or behaviors interfere with the pastimes you used to enjoy, activities with friends and family, or needed tasks such as grocery shopping, it may be time to let your doctor know and ask for support.

Recently, because this is such a tender topic for me, I have set up a Postpartum Support International chapter for Kern County. PSI is an organization that provides resources for families dealing with mood disorders related to pregnancy and having a baby. Families can call for resources – therapists and groups that can help. They can call for information about mood disorders. They can also call just to talk to someone when they are feeling they need immediate support. If you are a professional who works with mothers and families dealing with perinatal mood disorders, please connect with me so you can be listed within the resource network of PSI of Kern County.

On PSI’s website it says this: “You are not alone. You are not to blame. With help, you will be well.” Reading this statement continues to bring tears to my eyes. It is valuable! We aren’t alone in this. We are not to be blamed. And we can, with help, be well.

I keep my sad stones in my kitchen window, to remember that time. As I picked each one up off the sand, they felt like heavy weights adding to my emotional burden. I held them, wet and cold, and wondered, how will I ever get past the thick fog of confusion that has settled around my brain? I did, though, with help and with patience, to emerge feeling healthy and well on the other side.

I can look at them now for what they are – rocks. They are smooth to the touch, with tiny holes bored in them by sea creatures. Just rocks – nothing more, nothing less. But I remember, also, I was dealing with a real illness, and I don’t want to face that again. They remind me that if I end up there again, there is hope and there is help. And I don’t have to suffer alone.


PSI FAQ: http://www.postpartum.net/learn-more/frequently-asked-questions/

Monday, February 1, 2016

Postpartum Fitness

By, Janelle Webb, MBA, CLE

Getting back to pre-pregnancy weight does not happen right after birth, but it does not need to take the same nine months that the baby was in the womb.  The American Council on Exercise advises the first few weeks after birth should be focused on bonding with the baby and getting the necessary rest that allows mom’s body to heal properly.  As mom chooses to begin exercising during the postpartum period, she should speak with her doctor regarding any medical precautions that she should consider.  The goal of the exercise program should be relaxation and stress management, focusing on adding exercise into the daily routine for physical and mental health benefits other than weight loss. Breastfeeding moms are already burning calories due to the nature of breastfeeding and may need to keep track of their rate of weight loss to ensure they do not lose faster than a pound a week.  Postpartum exercise, like any new exercise program, should be started slowly and with realistic expectations.  Special attention needs to be given to warming up, cooling down, and avoiding pain and excessive fatigue.      

While high-intensity exercise may produce a sour tasting breastmilk because of the lactic acid your body produces, moderate exercise that results in a slightly increased pulse rate and faster breathing but still leaves mom able to talk in short sentences does not affect the quality or taste of the breastmilk.  Breastfeeding before working out will relieve the fullness of the breasts and lessen any soreness that may be felt by mom as she moves. A supportive sports bra will reduce “bounce”, and nursing pads will absorb any leaking breastmilk.  The breasts may taste saltier after exercise which can be reduced by washing with a warm washcloth before the next nursing session or taking a shower.  As with any exercise program, it is important to drink water, especially for nursing moms; drink enough water to avoid feeling thirsty. 


Since babies’ schedules are unpredictable, use “stolen moments” to exercise.  This can include marching in place while holding the baby, taking stroller walks around the block, or walking up and down a flight of stairs for ten minutes at a time.  Even small spurts of exercise can kick start your metabolism, burn calories, and relieve stress.  Get moving with your baby and have fun!

Tuesday, January 5, 2016

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

Thursday, December 10, 2015

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!



Thursday, October 29, 2015

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  
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

Wednesday, August 12, 2015

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

Monday, July 20, 2015

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!!