Supplementation

Many pediatricians write for supplementation for reasons like poor weight gain, more than 7% weight loss or for jaundice. If your pediatrician has requested supplementation for your new baby there are ways to do so while still supporting breastfeeding.

So many people immediately think of formula as a supplement which is wrong, and many pediatricians easily hand over formula for supplementation.And some pediatric health care providers don't specify the type of supplement because we are so quick to think of formula as a supplement. Using formula instead of your breast milk can drastically affect your milk supply which is the main reason I am writing about this subject. I want mothers to know that you don't have to supplement with formula, but you can express your milk and feed it to your baby instead.

One thing to understand when supplementing formula is how ever much you are giving your baby is every bit that isnt being removed from your breast, and every bit that will not be made. The more milk you take out and the quicker you take it out, the more milk you will make. So be cautious of when you supplement. If you are unable to get any milk out by using an double electric pump, try to hand express. In the first few days before you milk comes in it can be very difficult to remove your milk, but after your milk comes in you should start seeing volume. Pumping is recommended every time after your baby feeds even if there was a feeding at the breast first and then followed up with supplementation. It is recommended you pump for 15-20 minutes after each feeding.
So remember, expressed breastmilk CAN be used as a supplementation if needed!
: )

Nipple Shields

A nipple shield can be a helpful device when troubles arise in the early stages of breastfeeding. Many women are first introduced to a nipple shield in the hospital at the first signs of trouble by either a nurse or a lactation consultant. But I feel that sometimes important information is lost, or forgot to be given to the mother using the nipple shield.

Why was I given a nipple shield?
Women are given nipple shields for multiple reasons like
-preterm infants
-late preterm infants
-flat or inverted nipples
-nipple pain
-baby who is having trouble latching or not sucking rhythmically
-babies who have been given bottles or pacifiers and have trouble maintaining a latch

For preterm and late preterm infants nipple shields can be magic. It has been proven that they can actually remove more milk with a shield than being at the bare breast. But healthy term babies can remove more milk from the bare breast. The thought behind this the early babies are too weak to create the strong vacuum they need to breastfeed. With the shield, it actually creates a little extra vacuum for the baby. There is still research coming out regarding the use of nipple shields and preterm infants.

Things to know if you are using shield
-if you are using a shield in the first two weeks of your breastfeeding venture you MUST pump after every feeding. The first two weeks for your milk supply is the most crucial, because it the first two weeks sets your supply from the long term. So with that being said you want to nurse as much as you can in order to maximize your supply for the future. It is also important because there is lack of stimulation of the nipple itself and because milk removal for healthy term babies is lower with shields, so there could be required complementary feeding (either with your expressed breast milk from your pumping session, or if nothing can be pumped you can use formula.
-If you are passed the two week mark and still using a shield, you can slowly stop the pumping and monitor your milk supply.
-always tickle your baby's lips with your nipple/tip of the nipple shield to elicit the rooting reflex so they gape (open really wide) to practice good breastfeeding habits.
-you don't always have to use the shield, there are stress free ways to wean from the shield.
-if you were given one please follow up with a lactation consultant to assess intake, weight, milk supply and help getting your baby latched on without the nipple shield
-sometimes it was a last resort for your nurse to use one because you were having nipple pain or your baby wasn't latching as well as he or she could. It is an "easy" route to get your baby on the breast and sometimes information was not given to you that needed to be.
-use breast compression while feeding with the nipple shield to increase the volume your baby gets per feed, to avoid having to do complementary feedings.
-make sure your baby is on deep, not latched on the middle or tip of the shield. Sometime baby will slide off of the shield which can cause nipple pain and not enough milk transfer.

Ways to Wean from the Shield
-try to latch your baby to your breast in between feedings for some "non nutritive" sucking. Sometimes you will have a let down and your baby will get the reward from nursing from the bare breast.
-remove the nipple shield half way through a feeding and try to latch your baby on that way
-or just try to latch on at the beginning of a feeding, depending on if your baby goes zero to sixty (calm to hysterically crying).
-use breast compression
-always tickle baby's lips with your nipple to elicit the rooting reflex and get baby to open WIDE before trying to latch, don't just let your baby nibble themselves on.

--Remember to follow up with your lactation consultant if you are using a nipple shield

Please contact me with any questions regarding nipple shields
johnson.sarahliz@gmail.com

Back to Work

Going back to Work
Going back to work can be a super stressful time for you and your baby! But there are ways to make the transition easier for you both.
If you know you are going back to work sooner than later I would recommend introducing the bottle to your baby once nursing is completely established (this means your baby is latching properly and gaining proper weight, you don't have nipple pain, and don't have supply issues). I recommend giving your baby a bottle once a day so he or she can get used to drinking from both.
The bottle is much different from the breast and im sure you have heard that a hundred times already. Your baby has to create that negative pressure in order to draw the milk form your breast whereas the bottle, you don't really have to have negative pressure in order for the milk to come out, it just flows when you tip it. So having that in the back of your mind, makes you think okay, if I am giving my baby a bottle, like many formula fed babies are given (in the laying down position) the milk is literally flowing fast down into their mouth and they have to keep swallowing and swallowing because they don't have a choice to stop and take a break. This is not ideal for any baby to drink like this (hence the over eating ie: obesity). So there are two options you can do.

The Calma bottle by Medela offers your baby to use the negative pressure in order to draw the milk out just like he or she would do at the breast OR you can use the paced bottle feeding method. These methods will reinforce your babies breastfeeding habits, by allowing them to use more of their sucking abilities to draw the milk out and also by not overfeeding.There is a great video that shows you how it actually works here: www.medela.com/IW/en/breastfeeding/products/breastmilk-feeding/calma-feeding-device/calma-video.html. The Calma bottle is great because if your baby is going to be fed by a child care provider, they will not need any instruction other than how to store the milk whereas paced bottle feeding requires more instruction and practice.

How to Paced Bottle Feed The purpose is to mimic breastfeeding as much as you can. So it is recommended you do some skin to skin with the baby, or feeding baby as close to the breast as possible. When choosing a bottle it is better to get a wider based bottle with a short nipple if possible, like the Tommee Tippee bottle.This way they are able to get a "wider latch" with this bottle. When you go to give your baby milk sit her/him up to an almost upright sitting position. When offering the bottle nipple tickle your babys lips with the nipple to elicit their rooting reflex, and then let them have the nipple. This ensures them from not adapting bad breastfeeding habits. When holding the bottle, you want the milk to be about half way in the nipple, this should always make the bottle being nose level with them. The milk being half way in the nipple is better for them because they are able to take the milk in slower, and "pace" themselves. About every half ounce I recommend burping them because they will have a lot more burping occur in comparison with the breast because they are taking in a lot more air. Let your baby take the milk at his or her own pace and dont force them to take anymore than they want.

Who are you ?

Who am I? Im Sarah Johnson,mother of a beautiful girl named Annabelle and the wife of my handsome husband Michael!

I believe in breastfeeding, in spending time with family, loving everyday, and giving it all you have!
I am currently doing my Lactation Consultant Internship with a local hospital, and proudly almost independent! I love working with new families and helping them discover the magic of Mommas milk! I have some projects I will be working on like setting up a breastfeeding support group for Moms with babies six months and under, setting up an outpatient home office for lactation visits and doing question and answer via emails! Currently I am taking questions from new Mothers, and am not charging until the first of the year, so get it while its hot! Please see my contact information at the end of this page!
After my internship is done, which will be at the first of the year I am hoping to have the support group up and running, and aiming for 2-3 times a month. I will be taking my boards in June (cross your fingers) and will be an Internationally Board Certified Lactation Consultant!

If you have a question or concern please feel free to contact me at johnson.sarahliz@gmail.com

Why breastmilk anyways?

Why choose breastmilk over formula anyways?
Breastmilk is unique in so many ways that are incomparable to formula. If Mom's and Dad's knew the benefits human milk has over formula they would choose it in a heart beat. If you want to optimize the health of your child than keep reading.

So what is what in breastmilk??
Anti-infective properties:
Phagocytes-Engulf and absorb pathogens and release IgA
Lymphocytes-Have T and B cells which are essential for cell mediated immunity, antiviral activity
Anti-inflammatory factors
- prostaglandins are cytoprotective which basically means they protect cells against harmful agents.
- cytokines which activate the immune system
- growth factors which promote gut maturation and epithelia cell growth
Enzymes
-amylase- facilitates infant digestion of polysaccharides
-lipase- break down fats and kills bacteria
Growth Factors/Hormones
-human growth factors- stimulates growth of intestinal mucosa and epithelium( cells that line the insides of cavities- like the inside of your intestines)
-cortisol, insulin and CCK- promotes the maturing of intestines and the host-defense process inside the intestines. Protects against hypothyroidism and enhances digestion
-prolactin- enhances development of B and T lymphocytes ( which are components of the adaptive immune system)
Fats
-long chain polyunsaturated fatty acids- DHA ad AA (amino acids) are associated with higher visual acuity and cognitive ability and breast milk.
-free fatty acids- anti infective effects
triglycerides- large source of calories for infant which are broken down to free fatty acids and glycerol by lipase
Lactose- is a carbohydrate which is a major source of energy and breaks down into galactose and glucose and enhances the absorption of Ca, Mn and Mg.
Oligosaccharides- is a microbial and viral ligand
Glycoconjugates- microbial and viral ligand
Minerals- regulate normal body functions
Protein
-whey- contains lactoferrin, lysozyme and immunoglobulins
-immunoglobulins (SIgA, IgM, IgG)- immunity response to specfic antigens in the environment
-lactoferrin- an antibacterial agianst ecoli and is an iron carrier
-lysozyme- is a bacteriocidal and anti inflammatory
-taurine- an amino acid which is associated with early brain maturation and retinal development
-casein- inhibits microbial adhesion to mucosal membranes
Vitamins A, C and E- anti inflammatory action
Water- which constitutes 87.5% of human milk volume which provides adequate hydration

What else is in breastmilk?
fat, dha, amino acids, lactose, probiotic, prebiotic, protein, nucleotides, vitamin a, d, e, k, b12, b6, sodium, zinc, iron, calcium, magnesium copper, selenium, aluminum, iodine, chromium, fluorine, manganese.

-My Thoughts-
So lets summarize what breastmilk really does. Breastmilk is pretty much like taking medicine to boost your immune system to protect you from not getting sick and from getting certain diseases. It also is so gentle and easy to digest. Do you really think formula has active living cells in it to fight infection? Not a chance..

Before I had Annabelle (who is now 17 months) I looked into what was really in breastmilk I was blown away and won over by breatmilk. Why wouldnt I want her to have the best start she could have? Why would I want her to take the chance of being sick all the time, or getting a disease? Thats the main reason I chose breastmilk.

It wasnt about the conveinence, money, bonding or anything else that goes along with it. It was hands down for the health of my child.
I sacrificed my nights out, going back to work full time, going on vacation. Honestly who the hell cares.
I knew I was sacrificing my social time for the health and well being of my child, it has been well worth it! It was the best decision I have ever made for my child so far.
Resources: Breatfeeding and Human Lactation by Riordan and Wambach 4th Edition