10 Questions with a Homebirth Midwife

1) Moms planning a home birth are planning for a low intervention birth. Is the same true for their breastfeeding goals? Do women delivering at home plan to exclusively breastfeed and avoid formula intervention?

Yes. Most women who are planning natural birth also plan to exclusively breastfeed. However, there are situations where a mom chooses not to breastfeed. She may be a victim of sexual abuse or was unable to breastfeed a previous child. We ultimately want women to make the decisions they are most comfortable with after having been provided with as much education and support as possible.

2) What kind of support can a homebirth midwife provide to breastfeeding mothers that is different than a midwife in a hospital or birth center setting?

We offer a lending library that includes breastfeeding books. We offer a one hour prenatal visit so the mother has ample time to discuss her questions, goals, and fears about breastfeeding.

3) What role do you take in prenatal breastfeeding education?

In addition to the support and information provided prenatally, we also suggest the utilization of outside resources like breastfeeding classes, lactation consultants, and La Leche League meetings.

4) What aspects of homebirth uniquely facilitate breastfeeding initiation and establishment?

We are adamant about the necessity of skin to skin contact between mom and baby, with as minimal interruption as humanly possible.  Every aspect of the postpartum experience works better when you just leave them alone. Moms heal faster and babies want to nurse when they are not being poked, prodded, and taken away from mom for reasons that could, in most instances, wait.

5) Describe your breastfeeding-specific training. Does it differ from the training hospital midwives have?

I am not familiar enough to speak on the training of hospital midwives. My experience has grown through living and learning. I nursed all four of my babies at various lengths, based on my education and abilities at the time. I am learning all the time through my clients’ experiences ranging from no intervention to the necessity of an IBCLC or pediatric ENT. I also continue to learn through the support of my peers.

6) Describe the well baby care homebirth midwives give in the first 48 hours. How does this care screen for breastfeeding obstacles?

We usually stay with the mother after birth until baby has latched and is nursing well. If this doesn’t happen for some reason, we are in constant contact until it does. We listen to what moms are describing and make the call for further help based on what they are reporting. We may make another trip back to the house, or, if it seems like an issue that is out of our scope of knowledge, we will refer first to an in-home lactation consultant who is willing to assess mom and baby while maintaining the need for skin to skin contact in their own environment.

7) Do women with gestational diabetes, PCOS, or other endocrine disorders birth at home? What special feeding support do these dyads receive from a midwife?

Yes, and we don’t tend to do anything special unless we are finding it to be an issue. The premise is that it is normal and natural unless it’s not. We aren’t in the business of fixing things that aren’t broken. If we need to refer out for these things, we will.

8) Do Homebirth midwives facilitate informal milk sharing between clients? Why or why not?

Yes. However, not all moms are comfortable with that and we support that, too.

9) What signs or symptoms of feeding challenges do you refer out to an LC?

Baby not gaining weight, latch that just isn’t getting better despite our suggestions of different feeding positions,  mom in extreme pain with cracked, blistered, and bleeding nipples.

10) If a client chooses not to breastfeed, what alternative feeding do you recommend and why?

I usually don’t do much recommending of formula, but I suppose an organic formula of some type if they must. It is extremely rare that a client of ours comes to their six week postpartum visit and is not still exclusively breastfeeding. If they are supplementing with formula, they have already been working with a lactation specialist and have made those decisions together.

Bonus question 11) Share your favorite nursing memory.

I remember a moment nursing my last baby. I nursed all four, but I think I was in a hurry for a lot of that time. Hurry up and quit nursing. Hurry up and walk. Hurry up and potty train. With number four, I knew she was my last and I was thankfully in a place in my life where I didn’t want to hurry anymore. I wanted everything to slow down. I am grateful that I was able to have the awareness to enjoy every single stage with her. I squeezed every last drop. Nursing her one afternoon, she was holding my finger and resting her hand on my chest, while staring into my eyes. I felt in the depths of my being, at that very moment, what an amazing gift to be given the ability to nurse my baby, and I wasn’t going to hurry.

 

Rachel Hart I am a traditional midwife and CPM. I moved to Atlanta from Las Vegas with my husband and four children in 2008. I am a graduate of the University of Nevada, Las Vegas with a Bachelor’s degree in English. I began my midwifery journey through an apprenticeship training program in 2005 and began my own practice in 2007.  All four of my children were born at home, the last birth unassisted. I joined Beth at Birthing Way in 2010.

Helping women realize their true power and potential as a woman and mother through the birthing process has been a privilege. I have really enjoyed attending births with the lovely families here in Georgia. I also support the birth community as Secretary of the Georgia Midwifery Association and as Membership Director of the Georgia Birth Network.

 

www.birthingway.com
rachel@birthingway.com
770-597-4478

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.

 

Breastfeeding and Maternal Diet

There are thousands of myths about what mothers should or shouldn’t eat when breastfeeding. The current recommendation is that the mother should eat a varied diet of healthy foods that are typical for her geographic region or culture and not limit or include any special foods without medical indication.

To understand why maternal diet should not be restricted, it’s best to examine how milk is made. Milk is made inside glands from the blood stream. Breast milk is NOT made from the mother’s stomach contents. The foods mom eats are broken down in the digestive system. Blood reaches the milk glands where it delivers carbohydrates, nutrients, white blood cells, enzymes, pro- and pre-biotics water, fat, and proteins into the gland.

The foods that mom eats have a long trip to the milk. Not every food is able to pass a whole protein or fat or carbohydrate out of the GI and into the blood stream. Most of the proteins moms eat are broken down substantially in the digestive system. Insoluble fiber is a component of mom’s diet that never leaves the GI and never reaches the milk.

When considering foods to include or avoid when breastfeeding, we must remember that the whole food does not enter the milk. Here is a list of common food myths for nursing mothers and the facts:

MYTH: Broccoli, cabbage, beans, and cucumber give the baby gas.
FACT: Vegetables cause gas because of insoluble fiber mixing with gut bacteria. Insoluble fiber does not leave the GI tract and cannot reach the milk.

MYTH: Spicy food will make the breastmilk spicy.
FACT: Human milk is very sweet. No evidence has been found of capsaicin in human milk. Many moms taste-test their own milk after eating well seasoned food.

MYTH: Strong flavors a like garlic or onions will give the baby colic.
FACT: In a garlic breastmilk study, the babies in the garlic group spent more time at the breast and took more milk. Garlic might be helpful for moms who need to nurse more.

MYTH: If the baby is fussy or has colic, cut dairy.
FACT: Cow milk protein allergy is only in 2-7% of the population. Fussiness is not a symptom for diagnosing cow milk protein allergy.

MYTH: If the baby is gassy or has colic, switch to lactose-free milk
FACT: Lactose is the primary carbohydrate in human milk. It does not come from lactose in mom’s diet. The breast glands make lactose. Lactose intolerance in a newborn is a serious metabolic issue that needs to be addressed by a medical doctor.

MYTH: Mom should avoid soda because it gives the baby gas.
FACT: Carbonated drinks don’t carbonate the blood. The bubbles can’t reach the milk.

MYTH: Peppermint (tea, candy, essential oil) will dry up your milk.
FACT: Some folklore and historic herbal texts list peppermint as a lactogenic herb. There is no science to support either claim. Peppermint is one of the herbal teas listed as compatible with breastfeeding by The Academy of Lactation Policy and Practice.

MYTH: You have to drink milk to make milk.
FACT: Plenty of dairy-free women make milk.

 

Have your own favorite dietary myth to add? Leave us a comment! Breastfeeding myths are a favorite topic at our regular free mother to mother support group.

 

7 Things You Can Do Right Now with a Fussy Baby

When you have a fussy baby, the minutes feel like hours and it’s easy to panic. Don’t panic! Take control of the situation and help your baby adjust to life outside the womb. Set aside worries about allergies, diet restriction, and milk production. Get the baby calm, help mama get calm, and then call your lactation consultant.

Hop in the Bath
Babies love baths. Mommies often need one too. Co-bathing can calm and focus your baby. Babies who are frustrated at the breast often respond well to nursing in the bath. Bath tub nursing can halt a nursing strike, help a baby with a shallow latch relax and open wide, and help a mom who is having let down trouble. Safety tip: have another adult present to pass the baby in and out of the tub to mom to avoid slip and fall risk.

Magic Baby Hold
It’s magic. Hold the baby like this. Magic Baby Hold with Bill

This is a variation of the common tummy massages like bicycling legs, rubbing the tummy clockwise, or burping. This can help pass gas or ease a baby who seems constipated. Remember: constipation is hard dry stool, not infrequent stool.

Swing and Sway
Not just the baby swing. Babies calm faster in arms. Swing with your baby on your lap on your porch swing or glider. Wrap your baby in a sling or carrier and walk through the house. Babies like to be near a heart beat. Being skin to skin while swaying through the house is extremely soothing.

Nurse in a Carrier
Nursing in a carrier allows the baby to be upright and compressed. This helps with reflux symptoms and gas. Upright feeding can also ease the stress of fast milk flow or over-active let down. Babies with tongue or lip ties can often open wider because of the firm back support carriers provide while the head can move more freely. Sucking also helps relax babies and their GI muscles. More nursing helps them poop.

Play with Temperature
Take some frozen milk out and spoon feed it to your baby or put it in a mesh feeder. The cold is exciting and different for older babies, especially teething babies. Older babies may like to hold a frozen teething toy or a warm teething toy.

Get Outside
Even if the weather is crummy, just standing on the porch may change things. If you’re able to carry your baby for a walk, this is usually better than a stroller. The upright position and being near an adult care giver are more relaxing than a stroller.

Play with Texture
Let your baby touch something interesting and new. A tooth brush or cotton ball or sand or salt. Watch that these things stay away from the mouth. Novel sensory experiences can change your baby’s outlook pretty rapidly.

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.

What to Expect When Pumping

Expressing milk for your baby can be one of the most affirming or daunting tasks. Filling your pumping bottles to the max can be a real boost of confidence, but is that normal or optimal?

General recommendations for how to pump milk

1. A double electric pump is ideal for mothers who will be expressing milk frequently. (For more information on how to choose a pump, see Finding Your Perfect Pump)
2. A properly fitting flange (the horn or bell shaped piece that presses to the the breast) will be the most comfortable and ensure optimal milk expression
3. Pump both breast simultaneously for about 20 minutes.
4. Normal pump output is 2-4 ounces total from both breasts from one 20 minutes double pumping session.
5. Pump output is not an accurate gauge of milk production. Pumping is a developed skill that improves over time.

Getting a Good Fit

Fitting your pump flange can be a tricky process. Breasts change over time. It is completely normal for a mother to need to change flange sizes over the course of breastfeeding. Many pumps now come with a range of flange options or additional flanges that you can purchase separately. The best fitting flange at week 1 may not be as comfortable or effective at week 28. Human bodies are not symmetrical. It is normal to use different flange sizes for each breast.

Most women use trial and error for testing their flange fit. Learning to hand express milk can also help determine where on the areola the flange should rest for optimal pumping. The flange should be in contact with the same areas of the areola that a woman stimulates to hand express her milk. The flange should not rub the nipple. It should provide even pressure to the areola.

Tips for Double Pumping

Some women find it difficult to hold the pump flanges simultaneously. Pumping bras are easy to find at most baby product stores. They hold the pump flanges for you. This hands-free option means that working mothers may be able to do other tasks while pumping. A sports bra with holes cut in the cups can work in a pinch if you don’t have a pumping bra. Simply feed the flanges through small holes in the bra.

Normal Pump Output

The general understanding of pumped milk output is that 2-4 ounces is normal for both breasts combined. You may notice that one breast expresses significantly more milk than the other. You may notice that time of day influences how much milk you collect. It’s important to remember that pumping milk is not a predictable process, just like all things with parenting. Here is a list of common pumping experiences that cause mothers to worry about their milk supply though they are usually perfectly normal:

–  higher pump output in the mornings, lower pump output in the afternoons

– pump output that decreases over time as the baby ages (most women begin with oversupply that noramlizes between 6-12 weeks postpartum)

– one breast pumping a high volume, one breast pumping a low volume

– pump output decreases during menstruation and/or ovulation

– inability to pump the breast “empty,” milk continues to flow after the standard 20 minutes of pumping

– need for new flange sizes over time

– change in nipple shape over time

Blame the Pump First

Some women notice sudden changes in pump output. Always blame the machine before your breasts. Pumps have parts that are designed to be replaced during the course of time. Membranes and tubing are susceptible to small holes and degradation. If these parts are not at top shape, the pump will not work properly. Assembly errors (user errors) are also common. If your pump is not functioning, check  the pump first. Chances are mom is perfectly lactating and the pump needs a tune up. A good rule of thumb for open system breast pumps is to change the tubing every 2-3 months to avoid contamination and improve pump performance. The membranes on open systems pumps often function best when replaced monthly.

Top Tips for Improved Pump Output

1. Make sure the pump is in good working order, properly assembled, and properly fit to the breast

2. Pump in a relaxing environment to facilitate the strongest letdown response. Some mothers look at photos of their babies or watch films on their smart phone. Smelling an relaxing aromatherapy candle or even a “dirty” baby blanket can help some mothers.

3. Heat and massage the breasts before a pumping session. A microwave rice sock is easy to transport and can be tucked in your bra a few minutes before pumping. Rub the breasts all over in firm circular strokes.

4. Stimulate the nerves to the breasts. The thoracic spinal nerves that correspond to the breasts are T3, 4, and 5. They can be stimulated by rubbing your back against a door jamb. Think “bear scratching back on tree.” Or ask your partner to rub your spine a bit while you pump.

5. Drink a glass of water while you pump. It may help relax you and feel more in control of the process.

6. Hand express for about 5 minutes after pumping. Some women are able to express 50% more milk by hand after they pump. Remember, the breast is never truly empty until full weaning happens.

7. Make sure your baby is being fed appropriate amounts while you are away. 1-1.25 ounces is per hour of separation is the recommended amount. Many moms find their pump output is normal but the baby is being overfed. (more information see Bottle Feeding Human Milk)

8. Contact an LC to develop a pump routine that matches your pump output needs. Some mothers need an individualized plan because of workplace constraints or parenting demands.

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