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Breast Changes During Pregnancy
Your belly isn’t the only thing that grows during your pregnancy. Your entire body changes—especially your breasts. Here’s a tour through the next three trimesters and how each one will affect your breasts.
While pregnant, your tummy expands to accommodate your growing baby. But many women may not realize that their entire bodies are transformed by the brand new lives inside them—and no other area changes more than the breasts.
Thought of as an adornment until now, the breasts experience dramatic changes during pregnancy as they prepare for their role in providing nourishment for a little one. Here’s what you can expect from your breasts during pregnancy and in the postpartpum stage.
First Trimester
You may notice it before you find out you’re pregnant: tenderness. The breasts can become very tender to the touch during the first three months of pregnancy, says Sue Huml, International Board Certified Lactation Consultant (IBCLC) and member of the Lansinoh Breastfeeding Advisory Board. They may become fuller as well, which is the primary reason for the increased sensitivity.
Second Trimester
The fun has only just begun! As your pregnancy progresses, so does the expansion of your breasts. The extreme sensitivity usually diminishes by now, says Huml, but expect quite a gain in the bust area. “It is not unusual to increase breast size by four to six inches and one to three cup sizes,” says Huml. Get ready to change your bra often!
The middle months of pregnancy also bring a change to the nipples. The nipple and areola can double in size and may actually stay that way after delivery. The typically pinkish-brown skin will darken and continue to do so for the remainder of the pregnancy. This is due to the increased blood circulation to the breasts, says Dawne Kirkwood, mother of five and author of Giving Birth to Me, The Guide to Birthing Your Dreams.
Third Trimester
As you near your due date, your breasts will continue to expand with your belly. They will feel much heavier, says Kirkwood, especially once they begin to produce colostrum. This yellowish fluid is rich in antibodies and filled with nutrients to provide your newborn with the vital minerals needed to make a healthy start in life.
You will also notice tiny bumps around the areola called Montgomery’s tubercles. These glands produce an oil that will help make breastfeeding more comfortable when the time comes. The nipples will become much more elastic, too, says Huml, which will be a lifesaver once you’re breasts are called for active duty.
Though the changes your breasts encounter during pregnancy are completely normal, there are a few things you should be aware of in case there is a problem.
Inverted Nipples: Sometimes, the nipples can turn inside, says Kirkwood, and this can lead to trouble once you begin breastfeeding. If you notice flattened or inverted nipples, make sure the baby takes much of the areola into her mouth. This makes for a good latch and will help to encourage the nipple to express milk.
Engorgement: This filling of the breasts can be extremely painful for a new mother. Your body is producing milk like crazy, and you may not be nursing enough to relieve the pressure. “Apply chilled ice packs to breasts between feedings and try a warm shower right before nursing,” says Huml. This will slow down the milk production and minimize the pain for you.
Clogged Duct: When a milk duct gets clogged, it can become painful and make it difficult to nurse. Speaking from personal experience, Kirkwood says, “Warm compresses were helpful but the best thing was to have the baby nurse and massage the duct.” It’s important to nurse often in this situation, as a clogged duct can lead to mastitis.
Mastitis: This painful condition can develop during pregnancy and after delivery says Dr. Robert Atlas, MD, chairman of Obstetrics and Gynecology at Mercy Medical Center. Whether spurned on by a clogged duct or a cracked nipple, mastitis occurs when one area of the breast is hard or sore. This is an infection that can be treated with antibiotics. Since cracked nipples are usually the cause, it’s important to treat them with lanolin or another cream to ensure they heal properly.
Breastfeeding Tips
So your breasts have just been on the proverbial rollercoaster, expanding and changing to accommodate their new role as nourishment providers for your newborn. Breastfeeding is a very natural process, but that doesn’t mean you’ll know all of the tips and tricks for successful feeding right away. Here are a few tips to help feed your baby as painlessly as possible.
Nurse Often: You’ll be glad that you did. This ensures your baby is getting all of the nutrients he needs and that your breasts will not become engorged.
Ice Packs: If engorgement should occur, ice packs will be your friend. Coldness slows down milk production and helps to ease the pain of tight breasts.
Warm Showers: Conversely, a warm shower will encourage milk production and help it flow more freely when it comes time to nurse.
Good Latch: It can be quite painful and ineffective for the baby to only take your nipple into his mouth. Ensure that he is taking the areola into his mouth as well. This makes for a good latch, meaning the maximum amount of milk is expressed and will help to minimize the risk of cracked nipples.
Use Lanolin: Nothing will be kinder to your breasts as you breastfeed than lanolin. This cream will soothe sore nipples, making it easier for you to continue to breastfeed and reducing your risk of a clogged duct or mastitis.
The breasts go through a lot as your pregnancy progresses, but rest assured, they are equipped for the process. Heed your body’s signals and visit the doctor if you think something may be wrong. Otherwise, enjoy the changes your breasts make as your due date approaches. They are one more sign of your impending motherhood and of the joy that’s about to enter your life.
How to Breastfeed Twins
How to breastfeed twins and multiples
Many moms are tentatively nervous about the prospect of nursing. For expectant moms of twins, it’s double the anxiety, particularly in the face of naysayers who can’t imagine how a woman could breastfeed twins and not wither away. A mom who’s been there shares some tips for successfully breastfeeding twins.
Two babies.
Two breasts.
Enough said.
Well, not exactly . . .
We’ve all heard the recommendations from the American Academy of Pediatrics urging new moms to breastfeed their babies for at least a year. In reality, most moms try for a few weeks, but only about 30 percent make it to six months.
And that’s with just one hungry baby.
Many moms are tentatively nervous about the prospect of nursing. For expectant moms of twins it’s double the anxiety, particularly in the face of naysayers who can’t imagine how a woman could breastfeed twins and not wither away into a shell of a human being. But with a little advance planning, a lot of patience and a supportive friend or two, nursing twins won’t seem like an impossible fantasy. Here are a few tips:
Take a class. OK, so this sounds counter-intuitive, taking a class to learn how to do something that’s supposed to come naturally. But believe me, taking a breastfeeding class will not only leave you feeling empowered, but it will provide you with helpful tips you might not have thought of on your own. Check with local hospitals to see if they offer breastfeeding classes, or, even better, if there are courses on having multiples.
Buy a pillow. We’re not talkin’ a regular, run-of-the-mill nursing pillow. We’re talkin’ a specially made twins nursing pillow. They’re thicker, sturdier and can simultaneously hold two newborns. In the early days of my twins’ lives—when I felt like my entire life was consumed by mammaries, spit-up, and diapers—the twins’ nursing pillow was a life-saver. I was able to breastfeed the babies at the same time and cut my nursing time in half. Because the pillow was so thick, it brought both babies up to my breasts, rather than having me hunch over to reach them, and spared me backaches.
It took a while to get coordinated and arrange the teeny preemies on the pillow without having one baby’s head flop around while the other kid rolled onto the floor. But once I got the hang of it—and got over feeling bizarrely exposed by nursing from both breasts at the same time—it worked amazingly well. By the time the twins grew too tall to simultaneously nurse on my lap, I was much more confident in my breastfeeding skills.
Learn the positions. The “football hold” and the “crossover” aren’t sports plays, at least, not in this context. The position that worked well for me and my two babies was the “football hold.” In this position, you wrap your babies’ legs around your sides so that the infants’ heads nearly touch in the middle of your belly. The football carry was effective, even once my babies started to squirm and kick their legs. This way they were only kicking me, not each other.
The crossover position—which works for younger, less mobile twins—is when you cross the babies’ legs over each other in front of you while they breastfeed.
Switch sides. When breastfeeding twins, keep in mind that each baby has a different style of nursing. To avoid getting blocked ducts and failing to drain all the milk from your breasts because one kid nurses in a particular way, try to remember, if you can, to put a different child on each breast every time. If you simply can’t remember which side little Gracie and little Georgie nursed on last time, don’t worry about it. As long as you don’t have one dedicated breast per kid, you’ll be fine.
Wake them up. Despite the time-tested adage about never waking a sleeping baby, in this case, the kiddo is getting up. Our twins were on a four-hour feeding schedule. Overnight, one baby would typically awaken at about the four-hour mark, while the other slept soundly. I would nurse the one who’d just woken up, followed by the other baby, even if the second baby wasn’t really interested in eating. Usually, the child who had been asleep would get hungry and be up first the next time around. This helped us get through the night with a modicum of sleep.
Get support. Try to find at least one personal cheerleader to motivate you. It could be anyone from a lactation consultant, a doula or a close friend, to La Leche League members or folks from your local mothers of twins club chapter. It’s hard enough to breastfeed one baby when so many people are still squeamish about the topic, but when you announce plans to breastfeed two babies, be prepared to hear discouraging comments from people who can’t imagine how this is humanly possible.
Try a bottle. (This one may rattle some folks who believe that it is a recipe for absolute disaster to introduce a bottle to a breastfed baby. Only try this if you are comfortable with your nursing, and your lactation consultant and/or pediatrician are on board.)
I bought a top-of-the-line, dual breast pump and pumped enough milk daily for one feeding for both infants. I’d sleep through one feeding time in the evening while my husband got some bonding time and bottle fed the twins. The fact that the kids would take a bottle afforded me opportunities later on to get out of the house without the babies and take a well-earned break. It helped keep me on track and quasi-sane during the year I nursed my twins.
FDA Warning: Infant Overdose Risk With Liquid Vitamin D
Pediatricians recommend vitamin D supplementation for infants who are fully or partially breastfed. But are parents unknowingly giving their babies too much? In an alert issued by June 15, 2010, the Food and Drug Administration (FDA) warned parents and caregivers that some liquid vitamin D supplement products on the market come with droppers that could allow parents and caregivers to accidentally give harmful amounts of the vitamin to an infant. Some droppers may be poorly marked or hold a greater amount of liquid vitamin D than an infant should receive.
“It is important that infants not get more than the recommended daily amount of vitamin D,” says Dr. Linda M. Katz, interim chief medical officer in FDA’s Center for Food Safety and Applied Nutrition. Currently, the American Academy of Pediatrics recommends fully or partially breastfed babies receive a daily supplement of 400 IU of vitamin D.
As the FDA explained in its warning, vitamin D promotes calcium absorption in the gut and plays a key role in the development of strong bones. Vitamin D supplements are recommended for some infants—especially those that are breastfed—because deficiency of this vitamin can lead to bone problems such as thinning, soft, and misshaped bones, as is seen with the condition known as rickets.
However, too much vitamin D can cause nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion, and fatigue, as well as more serious consequences like kidney damage.
To make sure Baby is getting the right amount of vitamin D, the FDA recommends parents take the following steps:
Keep the vitamin D supplement product with its original package so that you and other caregivers can follow the instructions. Follow these instructions carefully so that you use the dropper correctly and give the right dose.
Use only the dropper that comes with the product—it is manufactured specifically for that product. Do not use a dropper from another product.
Ensure the dropper is marked so that the units of measure are clear and easy to understand. Also make sure that the units of measure correspond to those mentioned in the instructions.
If you cannot clearly determine the dose of vitamin D delivered by the dropper, talk to a healthcare professional before giving the supplement to the infant.
Additionally, if your infant is being fully or partially fed with infant formula, check with your pediatrician before giving the child vitamin D supplements. Depending on the amount of vitamin D already in the formula (and Baby’s intake), vitamin D supplementation may not be needed.
Secrets to Breast Pump Success
The conventional wisdom about how to pump enough breast milk doesn’t work for everyone. Three thousand ounces of milk later, one working mother shares the advice no one gave her. Hear her breast pump success.
If women logged hours on a breast pump the way pilots log hours in airplanes, I’d be doing long-haul flights to Beijing by now. Seriously. By my rough estimates, at this point in my nine-month-old’s life (and this is not math I recommend doing), I have pumped at least 3,000 ounces of breast milk for her and her older sister, neither of whom have been given formula. That’s a whole lot of hours hooked up to the milk machine.
From hour one, I loved nursing—the closeness, the convenience, the feeling of being able to provide exactly what my baby needed, whenever she needed it. I also loved my job, and the benefits it provided—like, you know, food to eat and a roof over my head. So, like most over-educated mothers who waited probably until they should have known better to have babies, I spent a lot of time reading everything I could about how to pump milk for my baby once I went back to work.
There’s no shortage of advice about what works, and that’s great—get all the advice you can. But having been through this a couple of times now, I’ve learned several things that are the opposite of everything I read about successfully giving a baby breast milk without the breast. Here’s the advice that no one gave me.
Baby’s First Bottle
You might actually be the first person to get Baby to take a bottle.
When my older daughter, Charlotte, was born, we paid close attention to all the recommendations about how to introduce a bottle to a breast-fed baby. Rule No. 1: Make sure that Mommy is somewhere far away, because Baby will turn up her nose at a bottle if the original café is around. And so one day, once breast-feeding was well-established, I waited until she was starting to get hungry—but not too hungry—and pumped some milk in the other room. Then I sneaked out, leaving a nice warm bottle on the kitchen table for my husband to give her.
It was a complete and abysmal failure. Tears would be shed—and not only Charlotte’s, either. My husband tried several times, on several days, over several weeks, to get her to take a bottle. My sister tried. The neighbor tried. Then one day I put Charlotte in the sling and went out for a walk, and on a whim grabbed the bottle my husband had been trying to give her. She loved to nurse in the sling, so once she was outside and relaxed, I stuck the bottle in her mouth. Before I knew it, she’d sucked down the entire thing. We had a similar experience with Leah, my younger daughter. My theory is that both girls were used to my being around at feeding time, so they ate. Maybe I was more relaxed about it, too. After all, I had two secret weapons as backup—underneath my shirt.
Let-Down at the Pump
You might get a better let-down if you don’t think of the baby while you pump.
The way most experts tell it, you practically need to meditate your way into a good let-down at the pump. Visualize the baby, they say. Look at a picture of the baby. Smell something that smells like the baby. Call your care provider and check on the baby. Baby baby baby. Here’s me, back at work my first week. Baby is at nursery school, and I miss her something fierce. I have 2,700 unread e-mails. I’m hooked up to the pump, looking at a picture of the baby, clutching her kitty-cat PJs and imagining her three miles away, playing with toys I didn’t pick out, snuggling someone else. This is supposed to make me feel relaxed? The milk dribbled out. Maybe I wasn’t smelling hard enough. I inhaled deeply, thinking milky thoughts, rivers of milk, fountains of milk, waterfalls of milk. Nothing.
Well, I figured, might as well just enjoy the next 10 minutes. I picked up The New Yorker magazine and started reading. I completely forgot about the baby, forgot about the 2,700 unread emails, and just got immersed in reading. The next time I looked down at the pump? Geysers of milk. It must work for some women to think about their babies while they pump, but for me, what works best is to think about whatever I normally think about while I’m nursing the baby. Maybe this makes me an inattentive mom. But it makes me an inattentive mom holding four more ounces of white gold.
Milk Production Schedule
Your milk production might actually go up, not down, during the work week.
Mondays are terrible days for me at the pump. This used to really stress me out, because the experts always warn that your milk production will diminish over the work week. The theory is that your body gets used to making lots of milk when your baby is around. Then, when you start pumping, because the breast pump is less efficient than your baby, your body makes less milk. By Friday, the theory goes, your body makes a lot less milk, which means you pull out even less.
At some point I quit worrying about Mondays, because I realized that my milk production actually increased during the work week, peaking around Wednesday. I think my body gets acclimated to the pump, to the mwah-mwah sound, to the fabric of the chair where I sit, to the hour I take the break. Mondays are sad days for me, too. The days without my baby stretch ahead; piles of work loom. By Wednesday, I’m in the groove.
Which Pump to Use
A “better” pump is not always preferable.
The first time I pumped was a few days after my first daughter was born. She had been readmitted into the hospital for jaundice, and I didn’t want her getting formula. But the nurses in the NICU got all twitchy when I took her out from under the bilirubin-busting ultraviolet lights, so they told me to pump instead. I holed up in what I remember as a broom closet and attached my breasts to a hospital-grade pump. After 20 minutes, I had maybe half an ounce, and sore nipples.
Later, as I was researching breast-pumps to buy, I learned that hospital-grade pumps were the most effective type. I was horrified. Hoping for the best, I bought a luggable electric pump—the strongest one you can buy at the baby-supply store. And you know what? It was fine; it was plenty. Patience, experience (and loads of fluids) are much more important than the kind of pump you use. You know what else? To this day, I still use a cheap-o little hand pump for my first pumping session of the day. It’s quiet, I’m in control, and it’s just so nice to be unplugged.
Learn from Experience
You’ll have to learn everything again with No. 2.
Although I worried about pumping with my older daughter, when Leah was born, I didn’t give it a second thought. I figured, I worked it out last time, so it’ll be no problem this time. But … no. It took several weeks before my body adjusted and I was able to settle into a reliable routine. Even then, though, I was only able to get about two-thirds of what I needed, so I had to add an extra daily session while Baby was home. What’s more, I was consistently getting a half-ounce less milk on one side than the other—something I was certain hadn’t been the case before.
Strange, right? Wrong. My husband insists that both things were true the last time as well; I’d just forgotten. I tend to believe him. Like so much of babyhood, pumping breast-milk is all a blur. So pour yourself a glass of water, sit back, and relax. It will be over before you know it.
When It Comes to Infant Weight Gain, Not All Baby Formula is Alike
Can formula make your baby fat? According to a study from researchers at Monell Chemical Senses Center in Philadelphia, babies fed cow’s milk formula put on more weight than other babies and continued to gain weight faster than their counterparts during the first 7.5 months of life.
In the study, published online December 27, 2010, in the journal Pediatrics, a group of 2-week-old infants whose parents had already decided to bottle feed were randomly assigned either a cow’s milk-based formula or a protein hydrolysate formula (PHF), a type of formula that contains pre-digested proteins (PHFs are typically fed to infants who cannot tolerate the intact proteins in other formulas). Both formulas contained the same calorie content.
Infants were weighed once a month for the next seven months. When researchers compared growth data to national norms for breastfed babies, the rate of weight gain for PHF-fed infants was comparable to the breast-milk standards—in contrast, infants fed cow’s milk formula gained weight at a greater rate than the same breast-milk standards. Researchers found that after only two and a half months, babies who received cow’s-milk formula had significantly higher weight-per-length than the babies on PHF formula. By three and a half months, the cow’s-milk formula babies also had significantly higher weight-per-age than the PHF babies, whose weight (per length and per age) matched those of breastfed babies. Higher weight gains among cow’s milk formula feeders persisted even after all babies started solid foods.
Researchers aren’t sure why the cow’s milk formula led to more weight gain, but they have a leading theory. Certain compounds in PHF called free amino acids appear to stimulate receptors in the mouth and gut that signal to the brain that the stomach is full and it’s time to stop eating. As proof of this, researchers note that though babies in both groups spent about the same amount of time eating at each feeding (between 11 and 12 minutes), babies on the PHF formula drank less during that time before pushing the bottle away.
“One of the reasons the protein hydrolysate infants had similar growth patterns to breastfed infants, who are the gold standard, is that they consumed less formula during a feed as compared to infants fed cow’s milk formula,” says study lead author Dr. Julie Mennella. “The next question to ask is: Why do infants on cow’s milk formula overfeed?”
Induced Lactation
Infants have been nursed by surrogate mothers throughout human history. Even a woman not already lactating can induce lactation enough to create the special closeness fostered by breastfeeding. Here’s how:
Introduction
Breastfeeding of infants by someone not their mother has commonly happened because of death or illness of the birth-mother, or when the birth-mother gave over or shared the care of her baby with another woman. Sometimes, the surrogate was already breastfeeding another baby, and her milk supply simply increased due to additional demand to meet the growth needs of two (or more) babies.
But anthropological reports from all over the world describe efforts by non-lactating woman to bring on lactation by putting the baby to breast, if no already-nursing mother was available, according to D.B. Jelliffe and E.F. Patrice Jelliffe in Human Milk in the Modern World: Psychosocial, Nutritional, and Economic Significance. Such infants were probably helped along with teas or gruels until sufficient milk appeared. While there must have been a high mortality rate in orphaned or abandoned babies, induced lactation evolved as a solution to their plight long before the development of artificial milk formulas.
In the United States, especially among La Leche League members, induced lactation has been embraced as a way to provide an enhanced bonding experience for women adopting babies. The special closeness fostered by breastfeeding can be profoundly comforting for both mother and child. Many women who have struggled with fertility problems value the experience of breastfeeding, even if the volume of milk they produce is small.
The amount of milk produced varies considerably from woman to woman, and it’s difficult to predict the results of induced lactation. It is unusual in the United States to find women who bring in a full supply of milk, but also rare to find women who make no milk. If a mother understands that the young infant will need supplementation with formula, she can relax, enjoy the experience, and nurse her infant without fear of compromising growth. While any amount of human milk is valuable to infants, La Leche League and most lactation consultants counsel that the emphasis be kept on the positive aspects of nurturing and closeness, rather than on volume of milk actually produced.
How Does Induced Lactation Work?
It is important to remember that prolactin and oxytocin, the hormones that govern lactation, are pituitary, not ovarian hormones. Therefore, even if a woman has had a hysterectomy, she may lactate, providing her overall health is good. (Estrogen, in the form of birth control pills or for replacement therapy, is a lactation suppressant.) Both prolactin, the milk-making hormone, and oxytocin, the milk-releasing hormone, are produced in response to nipple stimulation.
While there are now several regimens that use hormone therapy to assist in bringing in milk, many women have induced lactation with only mechanical stimulation. This consists of breast massage, nipple manipulation, and sucking—either by a baby or a hospital grade electric breast pump. Some adopting mothers rent a breast pump in anticipation of the infant; other mothers simply put the adopted infant to breast.
Hormone therapy to induce lactation generally consists of taking estrogen to simulate the high-estrogen state of pregnancy. The estrogen is then abruptly stopped to mimic the rapid hormonal changes following delivery. A course of a prolactin-enhancing drug such as metaclopromide (Reglan) is then instituted. Sucking stimulation (with a pump or by baby) is begun at this point.
Milk production typically begins between one to four weeks after initiating mechanical stimulation. A 1994 study of induced lactation using medications, published in The Journal of Tropical Pediatrics, describes onset of milk production between five and 13 days. (See abstract at the end of this article.) This is similar to cases of inductions using only nipple stimulation. At first, the mother may see only drops. During the time that milk production is building, she may notice changes in the color of the nipples and areolar tissue. Breasts may become tender and fuller. Some women report increased thirst and changes in their menstrual cycles or libidos.
Is Induced Milk Adequate for Infant Growth?
Is human milk produced this way adequate for infant growth? The same 1994 study observed babies of mothers inducing lactation in New Guinea, and 89 percent were found to be well nourished at follow-up.
Another study, “Protein Values of Milk Samples from Mothers without Biological Pregnancies,” done in 1980 by R. Kleinman and reported in The Journal of Pediatrics, looked at the chemical composition of milk produced by non-biological mothers. Two of the studied women had previously delivered babies; three had never been pregnant. Milk samples were collected from five women with adopted infants who had induced lactation by infant sucking. Milk production (at various levels) was established within 11 days without medication.
Milk samples were collected during the first five days of milk production and compared with samples of milk from five biological mothers. The mean protein concentration in the induced lactating women was identical to that of transitional milk of post-partum donors. There were differences in the concentration of albumin, the antibody immunoglobulin A, and lactalbumin concentrations in the milk produced during the days immediately following birth. Levels of these constituents were higher in the colostrum of the biological mothers. Sucking alone is apparently not sufficient to produce colostrum; other hormonal influences associated with pregnancy seem to be involved. The milk brought in by non-biological mothers, in other words, skips the colostral phase and more closely resembles transitional and mature breast milk. Kleinman’s study does not look at other nutritional characteristics (such as fats, carbohydrates, or micronutrients).
Since induced lactation produces low volumes of milk at first, and no colostrum, how is the baby’s nutritional status guaranteed in the early days of the process? Many women use a feeding tube device. This is a bag or bottle which is worn suspended on the mother’s chest. These devices have thin, silicone feeding tubes which are taped to the nipple with hypoallergenic surgical tape. The baby sucks the breast, and milk flows through the tubes as through a straw, delivering donor milk or formula directly at the breast. This is one way to avoid conditioning a baby to expect the quicker flow and more formed nipple of bottle teats (thought to be the reason for the condition called “nipple confusion”).
Medela Inc. manufactures a device called the Supplemental Nutrition System (SNS)* and Lact-Aid International manufactures the Lact-Aid Nursing Trainer.
Mothers who are attempting to induce lactation can get help and support from informed sources. Local La Leche League Leaders will be able to help women find information on the subject and may be able to connect an adopting mother with other women who have induced lactation. Lactation consultants provide equipment (feeding tube devices, electric breast pumps), networking with other similar clients, and expertise to help the adopting mother get started.
The lactation consultant may also be able to refer physicians in the community who are supportive of the process. Many U.S. doctors do not know that induced lactation is feasible. Ideally, adopting families interested in induced lactation will seek open dialog and information sharing with the baby’s doctor, both for growth-monitoring purposes and to help make this a learning experience for everyone!
Dealing with Thrush
Battling thrush is no fun for you or your baby. Learn what causes this unpleasant and sometimes painful infection and how you can get rid of it safely.
When you hear the phrase “yeast infection,” you likely don’t associate it with breastfeeding. Yet as many moms know, breastfeeding and yeast can combine to cause an unpleasant, painful infection in both Mom and Baby called thrush.
What is Thrush?
“Thrush is a yeast infection in the mouth,” says Dr. Deborah Lehman, a pediatric disease specialist at Cedars-Sinai Medical Center in Los Angeles. Yeast fungus, also known as Candida albicans, thrives in moist, dark areas—so an infant’s mouth is an ideal place for thrush to take up residence.
Babies can get thrush in several ways. Exposure to antibiotics (either by the child or a breastfeeding mother) can cause thrush since the antibiotics kill the friendly flora, or bacteria, found naturally in the human body, allowing the yeast to thrive. Some babies become infected when they make the trip down the birth canal, while others contract thrush from pacifiers and bottle nipples. Babies are susceptible to thrush because “their immune systems are weak and are not fully matured,” explains Dr. Leo Galland, co-author of Superimmunity for Kids).
Detecting Thrush
“Infants can’t tell you what they’re feeling, so [go by] what you see,” recommends Dr. Galland. White patches on the gums and tongue that cannot be scraped off are a telltale sign of thrush (if it’s milk, it can be scraped or wiped off). Other symptoms include fussiness, irritability, and discomfort when eating.
According to Dr. Cathryn Tobin, pediatrician and author of The Parent’s Problem Solver, “A mother who has been breastfeeding without pain and develops sore nipples should be treated for thrush. Symptoms include burning nipple pain and shooting pain in the breast with or without nipple pain. This can occur without any signs of thrush in the baby’s mouth or diaper area.
Additionally, the La Leche League (LLLI) reports that nursing mothers may be at increased risk of developing thrush if their nipples are cracked or damaged, or if they are taking oral contraceptives or steroids (such as for asthma).
Treating Thrush
Many parents receive conflicting information about whether or not to treat thrush. According to Dr. Galland, the decision should depend on your child’s symptoms. If your baby is not eating due to the pain, treatment should begin immediately. If there are only white patches in the child’s mouth and no other symptoms, the baby’s immune system may take care of the thrush on its own.
“Theoretically, thrush doesn’t need to be treated unless it’s bothering Mom or Baby,” says Dr. Tobin. “However, on a practical note, I find it generally spreads and then begins to become bothersome until it’s finally treated.” She reminds parents to be patient. “Thrush is hardy and it can take time to get rid of it.”
There are many ways to eliminate thrush. Nystatin is a common prescription for thrush. A cream containing Nystatin is generally applied topically to the nipples, and baby may be prescribed a liquid form of Nystatin that is swabbed on the white patches in her mouth. Dr. Lehman says it’s important to use the medication the baby is prescribed on everything baby puts in her mouth, such as pacifiers and bottle nipples.
Gentian Violet is an antifungal agent that can also be applied to thrush. Dr. Tobin recommends applying a one-percent solution once a day for three days using a cotton swab (allow your baby to suck on the tip of the cotton swab). It should also be applied to mom’s breasts, bottle nipples, and pacifiers. What about the colorful reputation of this purple remedy? “Gentian Violet is messy but highly effective,” says Dr. Tobin. “While it stains clothing, it does not stain skin … the color disappears in a few days.”
According to Dr. Shari Lieberman, author of The Real Vitamin and Mineral Book, an excellent way to treat thrush is to restore the friendly flora. The most important way to achieve this is to continue breastfeeding, because breast milk contains a friendly flora known as bifidobacteria.
Moms may also take acidophilus, garlic, and/or oil of oregano—all three help to kill yeast (these three also work well for non-breastfeeding moms who have thrush). Baby will inherently gain the benefits of this treatment via Mom’s breast milk.
Dr. Lieberman says other measures to help prevent and treat thrush include taking a quality prenatal vitamin; disinfecting (boiling) all pacifiers, toys, and bottle nipples; and avoiding alcohol and sugar.
Dr. Galland recommends a healthy diet, taking flaxseed oil supplements, and eating plenty of green, leafy vegetables. He also suggests talking to your doctor about taking extra vitamin supplements.
Pumping Milk for Baby
Mom can continue to pump breast milk, even while experiencing thrush, unless it’s just too painful to do so. According to Dr. Lieberman, “You’re basically pumping food and you should treat it the same way you treat food.” Sterilize and disinfect tools as instructed on the breast pump.
Mary Talbot came face to face with thrush after her son Connor was born. Connor developed thrush in his digestive tract after being prescribed antibiotics as a pneumonia precaution. “He’d suck once, then cry because he was hungry,” says Talbot. “We are now more hesitant to put him on any kind of antibiotics.” Talbot says The Nursing Mother’s Companion by Kathleen Huggins was very helpful in treating her son’s thrush. “The one thing we did find when he got really bad [was that] he could drink from a bottle easier [than nursing].” Talbot would pump, then bottlefeed Connor her breast milk. Because the thrush wasn’t causing Talbot much discomfort, it didn’t hurt her to breastfeed or pump.
Thrush is not a pleasant experience, but it can be treated. Just like colic and sleep deprivation, it will soon become a memory!
As Selling Breast Milk Becomes More Popular, the FDA Issues Safety Warning
Breast milk for sale? As more and more moms are sharing breast milk, concerns over safety are being addressed by the Food and Drug Administration.
As an increasing number of parents seek out milk banks and informal milk sharing groups as a way to make sure their infants have access to breast milk, the Food and Drug Administration (FDA) has voiced concern over the safety and risks of milk sharing, especially when human milk is obtained directly from individuals or Internet-based milk sharing groups.
According to a warning released November 30, 2010, the FDA cautions parents who seek out donor milk that feeding a baby with human milk from a source other than the baby’s mother may raise possible health and safety risks for the baby, including exposure to infectious diseases, chemical contaminants, and to a limited number of prescription drugs that might be in the human milk, if the donor has not been adequately screened. The FDA also warns that if human milk is not handled and stored properly, it could, like any type of milk, become contaminated and unsafe to drink.
A special FDA panel met on December 6, 2010, to discuss regulation of breast milk sharing, but decided to take no action at this time beyond this warning.
For parents who are considering using donor milk, the FDA recommends the following guidelines:
Consult a healthcare provider first: Making the choice to feed a baby donor milk should be made in consultation with the baby’s healthcare provider, because the nutritional needs of each baby depend on many factors including the baby’s age and health.
Don’t use milk from unscreened donors: When breast milk is obtained directly from individuals, the donor is unlikely to have been adequately screened for infectious disease or contamination risk. In addition, it is not likely that the human milk has been collected, processed, tested, or stored in a way that reduces possible safety risks to the baby.
Research milk banks: Milk banks (such as those run by hospitals) are the safest route for obtaining donated milk, but still make sure the bank has procedures in place to screen milk donors, and safely collect, process, handle, test, and store the milk.
In a few states, there are required safety standards for milk banks, but most still rely on self-regulation. You can contact your state’s department of health to find out if it has information on milk banks in your area. The FDA also recommends contacting the Human Milk Banking Association of North America (HMBANA), a voluntary professional association for human milk banks. HMBANA issues voluntary safety guidelines for member banks on screening donors, and collecting, processing, handling, testing, and storing milk.