Thrush – Yeast – Candida

Thrush is a common diagnosis when mom is experiencing nipple pain. Thrush is an overgrowth of a yeast that lives on the skin and in the gut of healthy humans. Thrush may also be referred to as candida albicans.

How Common is Nipple Thrush?

If you ask a group of moms, they’ll tell you thrush or yeast is very common. If you look at the research, a very different picture emerges. Mothers frequently complain of burning nipple pain, nipple damage, yellow or white discoloration in damaged areas of the nipple, sensations of heat or itching, and pain that radiates into the breast. These symptoms are then lumped together as thrush and treatment is prescribed often without a culture. Frequently, mom’s symptoms improve then return. Frequently, another round of anti-microbial treatment is begun.

The latest research on candida and breast yeast informs us that thrush is often the incorrect diagnosis. More women are shown to have staphylococcus aureus than candida, and not all women with one or both positive cultures have pain. In fact, only 15% of the study group experiencing nipple pain had yeast in the culture from swabbing the nipple. Even fewer, 9% had candida in the milk sample (Amir et al). Does ductal thrush even exist? Could it be something else?

Staph aureus has a white to golden color when present on the breast nipple. The common prescribed treatment for candida is miconazole or clotrimazole. Both of these drugs are effective in treating staph aureus as well as candida.

The largest common denominator in these studies on mothers experiencing nipple pain was nipple damage. Nipple damage is caused by a sub-optimal latch.

How Sub-optimal Latch is Misdiagnosed as Thrush

When a baby latches shallow to the breast and does not draw plenty of the areola into the mouth, the nipple is often exposed to inappropriate friction. The baby then must use the jaw and a clamping motion or bite to hold the nipple in the mouth. This can cause a very common condition called a vasospasm. The pressure from the poor latch causes an interruption of blood flow around the nipple. When blood flow returns to normal, a pain called a vasospam may occur. This pain can feel like shooting or burning pain in or around the nipple or deep into the breast. This pain can happen during, after, or between feeds. The solution for this pain is to fix the latch.

One contributing factor to shallow or clamp-down latch is a high arched palate in the nursing baby. These babies often have milk stains on the tongue because the tongue doesn’t rest against the hard palate and clear itself of milk. The milky tongue may look like thrush. Tongue-tie or ankyloglossia is another risk factor.

Sources:
Amir LH, Garland SM, Dennerstein L, Farish SJ: Candida albicans: is it associated
with nipple pain in lactating women? Gynecol ObstetInvest 41:30-34, 1995
Hale TW, Bateman TL, Finkelman MA, Berens PD. The absence of Candida albicans in milk samples of women with clinical symptoms of ductal candidiasis. Breastfeed Med 2009;4:57-61.
http://www.placerconferences.com/wp-content/uploads/2014/05/G.Why-Does-it-Hurt.pdf

What to Do if Your Culture Came Back Positive for Yeast

Medications: Your health care provider can prescribe medications for both you and your baby that are compatible with breastfeeding. Many mothers feel anxiety about medications and breastfeeding. Remember, your doctor prescribes medications because they have more benefits than risks. If you are interested in reading study data on breastfeeding and taking your prescriptions, contact the Infant Risk Center.
Pumping Guidelines: If your baby depends on pumped milk, keep feeding the pumped milk. If you engage in informal milk sharing, it is wise to take a break from donating until the yeast is cured. If you donate to a milk bank, contact the bank about the medications you are using to clear the infection. If you have an open system pump, be careful. Change the tubing completely. The tubing can’t be sterilized well and should be changed if there is thrush. If you have a closed system pump that is functioning properly, just sterilize the pump parts correctly after each time you pump.

Nursing Guidelines: It’s perfectly safe and beneficial to nurse through thrush. The direct mouth-to-breast nursing is a closed system and transfers antibodies and biochemicals back and forth. Infant saliva on the nipple actually helps change the make up of the milk to meet a babies unique immune needs. The living cells in the milk help fight the infection during the nursing process. The sucking also can help relieve some of the discomfort babies experience when baby also has thrush.

Nipple Care: Your health care provider will probably provide a nipple ointment that is anti-fungal. There are many on the market that are perfectly safe for your baby’s mouth. You may want to consider saline nipple soaks to ease the discomfort and facilitate healing any damage. Using disposable breast pads can reduce staining in your nursing bras and clothing from the ointment.

Laundry and Dishes: Many moms are worried their bras, cloth breast pads, and cloth diapers are harboring yeast. Contact your cloth diaper manufacturer for instructions on how to strip your diapers. Other fabrics can be soaked in vinegar for 24 hours then laundered normally. Pacifiers and bottle nipples can be sterilized daily.

This blog post is informational only and does not serve to diagnose or treat any condition. See your healthcare provider if you suspect a nipple infection.

 

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10 Questions with a Doula

1) What is a doula?
         A doula, also known as a birth companion, is a nonmedical person who is trained to assist women before, during, and/or after childbirth as well as her spouse and/or family, by   providing physical assistance and emotional support.
2) Why hire a doula?
        There have been numerous studies that show the benefits of hiring a doula include a decrease in the chance of C-section, decrease in the amount of time a woman spends in labor, decrease in the use of interventions like forceps and vacuum, decrease in the use of epidurals or need for pain medication, decrease the chance of postpartum depression, and increase the satisfaction a woman feels about her birth experience.
 
3) How does having a doula impact initiation of breastfeeding at birth?
        All doulas should be equipped to assist moms with the initiation of breastfeeding after birth. Often times in a hospital setting, nurses might have to leave to attend to another patient leaving the new mom to figure it out on her own. Some hospitals do not have on-site lactation consultants on call around the clock. Having a doula ensures that a knowledgeable person will be there to help if/when needed. 
4) What barriers to breastfeeding does a doula help reduce or eliminate?
    1. Educational barriers: misinformation about breastfeeding, milk production/supply
        2. Emotional barriers: lack of confidence in ability to breastfeed, embarrassment of feeding in public. A doula provides support if the mom is lacking support from family/friends.
        3. Physical barriers: learning how to prepare for breastfeeding, postioning mom and baby for comfortable and sufficient nursing/bonding time.
        4. Medical barriers: Breastfeeding while recovering from c-section, helping to identify potential medical issues such as tongue ties and lip ties and refer to specialists
5) Does a doula come in handy after birth?
        Yes. Doulas routinely remain in close proximity to moms immediately after the birth of their baby. This is to help facilitate the mother’s wishes for skin-to-skin care, breastfeeding initiation as soon as possible, and to answer any questions about newborn care and postpartum care. Many moms also benefit from the services of postpartum doulas. Postpartum doulas contract with the mother and her family for a specified amount of time (hours/weeks) once the family is settled at home after the birth. Postpartum doulas assist with baby care, sibling care, light household chores, and meal prep to help parents acclimate to having a new baby in the home. It can be a great help to have someone onsite those first days/weeks after birth to help with breastfeeding issues among other things, when needed.
6) What do you think are the 3 biggest factors in a birth that impact breastfeeding?
        1. Medications administered during labor and their effects on the mother and the newborn.
        2. Type of birth. If mom has interventions such as forceps, vacuum, or caesarean and baby has a medical issue due to this and they must be separated for an extended amount of time after birth.
        3. The length of the birth. A mom who has a lengthy labor may be extremely fatigued and unable to breastfeed right away.
7) How can moms find a doula friendly care provider?
        1. Moms can ask their care providers how they feel about having a doula in attendance at the birth. Most providers will have a definite opinion one way or the other.
        2. ICAN of Atlanta has a provider review section on their website. Anyone can join ICAN. You do not have to have experienced a c-section. The forums provide excellent information for all expectant moms.
        3. Word of mouth. Ask your friends,  who have used a doula, who their provider was and what the experience was like. If you have already hired a doula, most can tell you of the more popular doula-friendly practices in the area.
8) How can moms find a doula in their area?
        Resources for finding a doula in your area include www.doulamatch.net, www.gabirthnetwork.com, (or local birth networks) asking your provider if they have a list of doulas that they work with, websites of doula certifying organizations such as DONA, CAPPA, and ProDoula, and again referrals from friends/family/mom’s group members who have used a doula’s services before.
9) What skills does a doula have to help with long term breastfeeding success?
       Many doulas have taken breastfeeding classes to assist their clients in the early stages of breastfeeding. For long term breastfeeding success, doulas assist moms through emotional support and encouragement. Many moms give up just because they do not have the support needed to continue. Doulas provide practical information and solutions to assist with challenges associated with breastfeeding. We are knowledgeable about common problems like engorgement, symptoms of clogged milk ducts, mastitis and can refer you back to your care provider or a lactation consultant for added assistance.
10) Do moms need a doula for birth center or home births?
         I believe all moms could benefit from the support of a doula no matter where they choose to give birth. Birth is a very beautiful, but physically and emotionally draining experience. Having a person who has walked the journey before can make it easier by helping to reduce or eliminate the obstacles of fear, anxiety, lack of information, and more because they are a trusted, trained and experienced individual who is there just for the mom.
Bonus Question! 11) Share your favorite nursing moment?

My favorite nursing moment was probably the first time my daughter latched properly. I was unable to successfully breastfeed my older son due to lack of education and support. I became engorged and had painful, cracked, and bleeding nipples. After 3 days of crying (both of us) I gave up. After I had my daughter, I was able to get help from the buses at the hospital. They explained what a good latch looked like and should feel like. They gave me tips for sore nipples, too. So once at home, when she latched with little help from me and with no pain to me, I was very excited. I went on to breastfeed her for 14 months.

Elysia Douglas is a wife, mother of 4, and a professional, certified birth doula in the Metro Atlanta area. In her first 3 years as a doula, she has assisted over 50 families as they prepared for and welcomed their little ones into the world.  She offers attentive, nurturing, and compassionate support during pregnancy, labor, birth, and beyond. Elysia is passionate about equipping, encouraging, and empowering women to achieve their birth goals by providing unbiased, evidence-based information, emotional, and physical support throughout their pregnancy journey. She fully believes in your right to know your options and make decisions that are best for you and your baby. When Elysia is not at prenatal visits, facilitating a childbirth education class, or attending a birth, she enjoys sewing, painting, volunteering in children’s ministry at her church, and spending time with her family and friends.

www.mother2motherlaborsupport.com
http://doulamatch.net/profile/6020/elysia-douglas
www.facebook.com/mother2motherlss
www.instagram.com/mother2motherdoula

Are My Breasts Empty?

Our lactation counselors are frequently told that the mother feels her breasts are empty or not full any more. This anxiety often causes mothers to end exclusive breastfeeding prematurely or begin supplementing with formula when it is not needed. One of the most common misconceptions about breastfeeding is that breasts, like tanks or bladders, fill and empty. Here are some facts about the way human lactation works to help nursing mothers understand what is going on in there.

Fact: Breasts contain glands, not bladders. Milk production is continuous.
Human milk is made by specialized cells called myoepithelial cells. Blood is supplied to these cells, and they turn blood into milk, drop by drop. The milk is continuously being produced by these cell as well as continuously reabsorbed into the blood stream. During periods of engorgement, the body tries to reabsorb the milk faster and slow down the production. When the baby is actively nursing or mom is actively pumping, the reabsorption is slower and production is faster. Breasts can never be empty until after the baby is fully weaned off breastfeeding.

Fact: Babies don’t take all of the available milk during nursing.
Using ultrasound, science has determined that babies take about 65% of the available milk in the breast during a feeding session. This is why pumping milk after feedings is recommended for mothers who are pumping and storing milk for future separations.

Fact: The more rapidly milk is removed from the breast, the more rapidly new milk is made.
When milk is being removed from the breast, the milk making hormone prolactin is highest. Frequency of nursing and pumping is key to making more milk. Women who “save up” or try to wait for the breast to feel full before nursing are actually lowering their prolactin levels. This is why supply and demand is the law for breastfeeding and making more milk. Moms who remove milk the most frequently will make the most breastmilk.

Fact: Even a hospital grade double electric breast pump cannot empty the breast.
Because milk making hormones peak during milk removal (nursing, pumping, or hand expression), the body will always rush to make more milk every time mom is pumping.

The Take Away

Continuous breastfeeding or breast milk removal is the key to high levels of milk production. If a mother is doubting her milk production capabilities, milk production is easily assessed by an LC at a home visit or office visit. LCs employ techniques like weighed feeds and latch assessments to determine how well the baby is “transferring” or getting enough milk. When in doubt, it is always better to nurse more and pump more. Supply and demand is the ruling principle of lactation. Feelings of fullness do not happen for all women who make a full milk supply. Feelings of fullness may come and go but do not indicate milk production levels or how well the baby is eating.

 

Finding Your Perfect Lactation Counselor: Meet Meredith

meredithfall2013It helps to work with someone who has been where you are when mothering is hard. Meet Meredith and read her success story that includes a cesarean birth, lip tie, tongue tie, and over supply.

Meredith Jacobsen has been helping individuals and couples transition into parenthood for over a decade. Working first as a nanny, newborn specialist, postpartum doula, and then labor doula before finally serving as a lactation counselor, she has assisted with every step along the way of this transformative time.

Meredith provides home visits for Oasis Lactation Services. She enjoys working with families, one on one, in their home to give them the information and confidence they need to reach their breastfeeding goals. This personalized assistance can help with troubleshooting breastfeeding issues like latch or milk supply difficulties as well as addressing questions about normal newborn behavior and parenting, such as sleep patterns or pumping and preparing to return to work. She also enjoys supporting growing families by teaching prenatal breastfeeding and baby care classes in a group setting.

On a personal level, Meredith understands the challenges that can come with breastfeeding after a difficult birth. Surgical deliveries can often lead to physical challenges with breastfeeding as well as emotional challenges, especially when the mother was preparing for a natural birth. Luckily, these can be minimized by preparing during pregnancy by taking classes, getting involved in support groups, and knowing who to call if you need help after the birth.

After spending years working as a labor doula and preparing for a natural water birth, Meredith was crestfallen when she needed a cesarean. Exhausted and emotionally drained from a long labor and recovering from surgery, she also found herself struggling with the ability latch thanks to her daughter’s lip and tongue ties and her own issues with oversupply.

Thankfully, she had a support system in place to assist with these difficulties. She was able to overcome all of these challenges and breastfeed her daughter without any supplementation. They have met the World Health Organization’s recommended six months of exclusive breastfeeding and continue to have an enjoyable nursing relationship while adding complementary solids. This healthy, happy nursing relationship has been a healing experience after a disappointing birth. And because of that, Meredith is especially passionate about helping other mothers who have struggled with births that did not go as planned.

My breast feels hot and hard. Is this mastitis?

It could be. Many cases of mastitis begin with a hard knot in the breast. Often this hard spot is caused by a clogged milk duct.

What is a clogged duct?      Breast milk contains a variety of fats and proteins so that it is complete nutrition for your baby. The fats and proteins are different shapes and sizes. Sometimes they get tangled and get stuck in the milk duct. Most clogs release from the breast with frequent nursing and/or pumping. If your baby releases the clog while nursing, it is perfectly safe. Your baby will not have digestive upset from nursing out a clog.

What is mastitis?      Mastitis is inflammation of the breast tissue. It may or may not be caused by a bacterial infection. Mastitis is a relatively common condition. Women who suspect mastitis should keep nursing and seek treatment. Mastitis that is caused by infection is in the breast tissue, not in the milk. The milk is safe for the baby.

Common first aid recommendations for mothers experiencing the symptoms of clogged ducts or mastitis:

1. Keep nursing the baby. Frequent nursing is the best treatment. The milk is perfectly safe for the baby.
2. Rest. Mastitis tends to escalate more frequently in mothers who are over stressed. Staying in bed with your nursling has amazing benefits.
3. Drink plenty of clear fluids, just as you would with a cold or flu.
4. Apply heat to the affected area. Heat helps increase blood flow to the area and open the milk ducts so clogs can pass. A hot shower is a great place to hand express. Nursing directly after applying heat is beneficial as well.
5. Ibuprofen is a known anti-inflammatory that is compatible with breastfeeding. Contact your health care provider to discuss appropriate dosing.

Some mothers explore home remedies and traditional medicines. lavender

– essential oils massage oil: blend 1 part eucalyptus, 2 parts lavender, and 3 parts chamomile. Apply oil over skin, avoiding areola and nipple. Massage in. Cover with moist heat for 20 minutes. Repeat 3-5 times per day or until clog releases.

– herbal compress: chamomile is a known anti inflammatory. A chamomile tea bag can be used as a hot wet compress over the affected area.

– potatoes: grated raw white potato is said to draw out infection when placed over infected area

garlic– garlic: Garlic is considered naturally antibiotic and anti inflammatory. One study showed that babies nurse more when moms are taking a garlic supplement.

-lecithin: lecithin is a dietary supplement that is purported to keep fats smooth and flowing in the milk. A dose of 4000 mg is commonly recommended. Lecithin is derived from either soy or sunflower.
What to avoid

1. Cold. Ice or cool packs cause constricting.
2. Tight fitting bras or clothing.
3. Doing too much
4. Alcohol

Antibiotics are very effective in treating bacterial mastitis. Drugs from the penicillin family are commonly given to treat this condition. Amoxicillin and many others are very safe for breastfeeding. There is no need to wean to treat this condition, and evidence shows weaning during mastitis exacerbates the condition.

The information provided on this blog is not intended to diagnose, treat, or cure. Always contact your health care provider and LC to work as a team during illnesses while breastfeeding.

Do I Need a Lactation Consult?

Plenty of moms have “just a quick question” about breastfeeding that really seems simple enough. Internet forums are an easy way to get quick answers or find links to published information. But what happens when that information is contradictory? Or what if your question has many layers that the forum didn’t consider? Or what if you just didn’t like the answers that you got?

It’s probably time to call the LC.

Most of the time, a breastfeeding question does not have a simple answer. Each mother-baby pair is unique and has unique needs. The solutions that may work for one family might be inaccessible to yours, culturally inappropriate, or medically inadvisable. Most breastfeeding “rules” describe feeding patterns for healthy, full-term infants. If your baby came early, was low birth weight, or has a health issue that is uncommon, those “rules” may not apply. A lactation counselor can walk you through the twists and turns of meeting your breastfeeding goals with your individual needs in mind.

The modern age allows people to share information more rapidly than ever before. Finding outdated information is one risk a family takes when researching breastfeeding answers. If you’re finding inconsistent information or solutions that just don’t seem right, trust your gut and call in the professional. An LC can help you sort through the studies to find the most current information and explain why certain recommendations have changed.

Many new moms worry that a phone call will end in another appointment with the doctor. Fortunately, many breastfeeding challenges can begin to disappear from a simple phone call. Many LCs make home visits as well, eliminating the struggle of leaving the house with a brand new hungry baby. If your baby’s needs are great, the LC will give you an action plan to feed your baby and protect your supply until you can be seen in person.

Just like your pediatrician says, “Just call us if you have questions,” LCs are pretty much the same way. Your family’s health matters.

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