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|Posted on December 13, 2018 at 4:34 PM||comments (68)|
What is normal nipple pain?
Normal is, not painful on day one, a little soreness on day two, with no cracking or bruising, pain beginning to subside by day three.
Severe pain with latch, cracking or bruising on day 1 maybe a sign of a problem. Quickly identifying what is causing the problem is crucial to reducing pain, preventing bruising and cracking, as well as improving milk transfer. Think about it, if latch is painful on day one, it will only get worse by day two.
(Bleeding not associated with cracking that comes from inside both breast while pumping or breastfeeding in the first few days is considered normal and the milk is safe for the baby to drink).
Painful latch can be caused by the baby not being ready therefore not opening the mouth wide enough. The baby’s tongue maybe up blocking the breast from going deep into the baby’s mouth. Perhaps the shape of the breast or the nipple are making it difficult for the breast to get in deep enough to prevent pain and trigger suck.
Possibly the positioning of the baby may be unstable causing the baby to slide down to the nipple after being latched on or the baby’s mouth maybe latched onto the nipple only and not the areola. Often times a finger maybe in the way of the baby getting passed the nipple or a finger is being used to pull the breast away from the baby’s nose for breathing room causing the baby to again slide down to the nipple. Some babies may have a slight oral cavity issue like a tongue tie or a bubbled palate.
The goal of latch is still the same! Open mouth, tongue down, deep latch. Identifying an issue a can be very helpful to improve technique. However when the oral cavity issue is mild or moderate it maybe be difficult to identify. In the case of a mild tongue tie or a bubbled or high palate for instance, there isn’t a fix available clinically, therefore you need to learn how to accommodate what cannot be fixed at this time. Therefore understanding what is happening and what needs to happen to get a good latch can really be helpful in working through it. Tweaking your hold, yours and your baby’s position, using tools like; pillows and foot stools to find a good effective, comfortable latch. It is extremely important to wait for a baby to root and open his mouth wide with the tongue down, so that the breast goes in above the tongue and deep into the baby’s mouth.
The baby should not be sucking on the nipple itself. The lips should be wrapped around the areola passed the nipple, so that the nipple is actually deep inside to where the hard and soft palate meet. In order for the breast to trigger suck it must get in deep and up near the palate.
Pain is often caused because the baby has not yet opened wide and the tongue is up, pointing to the roof of the mouth, blocking the breast from going in deep enough
In order to get the baby to root and open the mouth, you must tickle the lips to trigger the rooting reflex, but back away a bit until the baby actually says Ahh. If the baby doesn’t open wide tickle and back away again. If after a few attempts the baby doesn’t open wide. Wait a few minutes. The baby may not be ready.
When attempting to latch and the baby is not ready and not rooting, the baby will move around and often pull away from the breast and get fussy. This may seem as if the baby does not want to breastfeed.
Sometimes babies will want to be close to the breast but not actually eat. Trying to feed at this time can cause confusion. Since the baby is not ready, the baby will respond but not open wide enough to get a deep latch. Constantly trying to latch will cause the baby to get fussy and even go to sleep to conserve energy.
So take a moment calm the baby and let the baby regroup.
When an infant is ready to eat, touching around the baby’s mouth will cause the baby to root: turn to the breast and open the mouth. But, it is important to wait for the right open mouth to latch.
I use what I call the tickle back away technique with an anatomical latch. Which is also known as chin to breast, nose to nipple. First, place the baby’s chin to the breast, hold the breast in a C or U shape with fingers away from the nipple, and rub with the nipple downward from the nose to the chin rolling out the bottom lip. Back away slightly so the baby can open for you. Repeat a few times until the baby opens wide and allows the breast to land deep inside the mouth above the tongue. Again if the baby doesn’t open wide or gets fussy, stop to calm before attempting latch again.
Lay the baby’s cheek against the breast and cuddle a moment to see if the baby wants to eat or just cuddle skin to skin. On a side note some baby’s won’t eat when they have a wet diaper so if you feel you are getting the breast deep into the mouth but the baby is still fussy, check the diaper.
There are several kinds of nipples; flat, everted, inverted, retractable, etc., a mother’s breast can be firm, taught, pliable, round, tubular, triangular, there are so many variations no one hold or position will work for everyone. So, don’t focus on the nipple! The milk is behind the nipple. Focus on getting the breast itself deep into the baby’s mouth.
I often find that some mothers really are hard on themselves and when latch is difficult they blame themselves. When often there is something unforeseen or simply unexplained. Remember Rome was not built in a day. Take your time with latching. Mom needs to be in charge of when the baby latches, slow it down look into the mouth if possible to make sure the tongue is down.
Reattaching is painful! So it is better to slow down and get a good deep latch the first time. Then don’t be stiff, but don’t move a lot once the baby is latched. Readjusting your position will cause the baby’s mouth to slide down.
|Posted on December 13, 2018 at 4:24 PM||comments (32)|
When you talk about positioning there are actually a lot of things to consider. I always say positions are a guide you have to tweak a position to make it work for yourself rather than trying to perfectly mimic a position that you saw someone else do or that you read in a book or something you saw on the Internet. It's very important that you actually tweak the position to work for you specifically you and your baby. People have often said to me " oh the cradle is my favorite position or the cross cradle or football is my favorite position". But I have found over the years that there are many things to consider when positioning a baby.
1. The position and comfort of the mother. Did mom have a c-section and she is laying on her back. Does she have a 3rd degree tear, an episiotomy or hemorrhoids that prevent her from sitting straight up.
2.The size of the baby. Large , Small, Long?
3.The size and shape of the breast. Round, Tubular, Triangular?
4. The type of nipple and its location. Does it point downward? Does it retract?
5. What side you are breastfeeding on. Oftentimes you may even have to use a different position on one breast than the other.
6. There may be an oral cavity issue like a tongue tied or bubble palate.
7.Where you're sitting or laying. What type of furniture you are using. Does your chair have arms?
8.You may need to consider the comfort of the baby in a special way, for example if the baby has a fractured shoulder or a twisted neck or clubbed feet or a circumcision.
9. The size of mom's fingers. The distance from her thumb to her index finger determines how well she's able to hold her breast during breastfeeding and how well she's able to position her baby. The amount of space from the wrist to the elbow makes a big difference, because if she has very large breasts she will not be able to use a cradle position, because she'll lose the stability of the baby's head as it moves further towards the wrist area.
10. Does Mom have a very long torso or is Mom obese and her breast lean to the side. Does Mom have a large tummy therefore eliminating the lap space that a pillow would have sat on.
My advice is be open-minded. Be comfortable, start with basic positioning and tweak it according to where you are and what works for you. The baby should always be tummy to tummy with Mommy no matter what position. You should start positioning with Mom's comfort. Once mom is comfortable and in a secure position, then you start to secure a position for the baby. But what you don't want to do is put Mom in a position or Mom get yourself into a position and then once you position the baby readjust your own position. You want to stay in the position that you start with during a latch so get comfortable. Get the baby into a good position right in front of the breast. Don't hold the baby by the neck. Support the baby's head. Don't lay the baby on the pillow, hold the baby and use the pillow for support. Don't hold the baby's arms behind them, no one wants to eat with their hand twisted behind them. Try to get the hands around the breast as if giving the breast a hug if possible. Some people like to swaddle the baby. But swaddles usually work more when babies are younger. And some babies just don't like being covered up. Try to give the baby a little skin. Skin-to-skin is always great and has continuous benefits for mom and baby. Once mom and baby are in a comfortable position. Hold the breast in a C or U shaped hold with fingers away from the nipple and areola complex, therefore not blocking the baby from getting a deep latch. Use an anatomical latch technique by positioning the baby chin to breast nose to nipple. Use the nipple to tickle from the nose downwards rolling out the bottom lip therefore causing the breast to land above the tongue and deep into the oral cavity.
I also teach what I call tickle back away which is; tickling the lip or nose area of the baby with the nipple to trigger rooting, yet, slightly backing away, and coming back to allow the baby to open wide. Once the baby actually gives you a nice wide open mouth with the tongue down allow the breast to land deep into the mouth above the tongue and get up to the pallet to trigger the suck reflex.
|Posted on April 29, 2017 at 2:54 PM||comments (29)|
|Posted on December 16, 2016 at 11:53 PM||comments (23)|
Shirley Morales who used a blue bicycle horn manual breast pump in Copenhagen in 1973 and such got such a surplus of milk that she sold it to the Childrens Hospital for premature and sick infants. A Milkman who come 4 mornings a week and pick up the milk. She would sell the milk in 1/2 liter bottles and she was paid $2.50 per bottle. Now Human milk is sold in milk banks all over the world for $3.85 per ounce.
Its mothers like Shirley who set the pace for the future of Human Milk Banking
|Posted on November 7, 2016 at 4:44 PM||comments (60)|
Hello everyone time for an update. I am still doing home visits for one on one help with breastfeeding all over long beach and surrounding areas. I still teach BSN students mostly from West Coast University. I am also the full time Lactation Consultant for Hollywood Presbyterian Hospital, Interestingly I am the only Lactation Consultant we have and we deliver about 300 babies a month. So needless to say I am really busy. I am constantly studying because the field of Lactation is growing at a very rapid rate and research is finding new information every day. Plus I don’t want to become a quack, so I need to stay updated. That’s one of the reasons I came to the hospital is to learn breastfeeding from a clinical perspective and to have a chance to work with all sorts of situations. Doing home visits for the last 6 years along with my years at WIC has taught me a lot I did not learn in a book.
Everyone has their own views and values and you would be amazed at how different breastfeeding challenges can be from one person to the next. I have worked with all nationalities, in various atmospheres at varying intervals of lactation ranging from one hour old infants, to two year old toddlers, from young poor teen parents, to wealthy middle-aged couples in their homes. I have helped Caucasian, African American, Hispanic, Pilipino, Korean, Armenian, and Indian, Turkish and Russians, even some refugees whose visit was more nodding and sign language than actual conversation.
I have been blessed to work with babies who are premature, have Down syndrome, cleft palates, trisomy 13, hematomas, broken clavicles and pelvis bones, torticolis and clubbed feet. Babies exposed to drugs like heroin and methamphetamines. I have worked with babies who didn’t make it through the hospital stay, but were able to spend a precious few days breastfeeding before going to heaven. I have learned so much but daily it is apparent that there is so much more to learn. Working in the hospital has given me an opportunity to see firsthand many of the challenges mothers and professionals face postpartum.
When I come to work every day the nurses are always happy to see me, they say “yah Sandra’s here” then they give me a list of people to see in mother baby unit, Peds and NICU. It’s really nice to be needed. See before I came people told the nurses not to give formula but no one taught them how not to give it. I teach them how to listen to the patients concern, help with breastfeeding and I give them tools they can use to prevent or delay supplementing during the hospital stay, with empathy and compassion. Also in the hospital you have to deal with numbers. There are goals and measure sets, like Baby Friendly’s exclusive breastfeeding rates and Perinatal Core measures by the Joint Commission and CDC that determine how well a hospital is functioning.
On top of that some doctors don’t mild a little supplement in the early days and they really don’t like us using alternative feeding methods like syringes to feed newborns. Now I know that sounds crazy right? Why would a doctor not push for exclusive breastfeeding? But here’s the deal. First of all exclusive breastfeeding when it is not going well can pose a risk if the infant is not being well hydrated and taking in enough calories. Even though any Lactation Consultant will tell you 99% of mothers produce breastmilk, colostrum comes in small amounts and can be temporarily delayed based on several factors. Match that with sore nipples and Peer Review and you have a doctor who says just give a little formula with a nipple and follow up with a Lactation Consultant. When a patient is readmitted after recently being discharged a doctor has to go before a board of his peers to determine if he handled the patient correctly before discharging. As far as alternative feeding methods they are afraid someone will choke and they feel babies eat more when given by artificial nipple.
Now with respect to delays just think when a mother has a cesarean she is laid on her back for the first 12-24 hours, not given any water or food and is instead given liquids through her I.V. So day one she is very uncomfortable, dehydrated and in pain. On day two she can finally start to move but she has a lot of swelling form the fluids. Colostrum is now temporarily delayed from the edema, even though she did see colostrum on day one. By this time the nurse is encouraging mom to get up and walk. Mom has sore nipples, she is trying to pass gas, have a bowel movement and start eating regular food. The baby is in second day syndrome is fussy wants to curl up with mom and eat frequently.
I always say day one doesn’t tell the story days two does. Due to the delay the baby will stop pooping and possibly becomes a little jaundice or stop peeing and get a little dehydrated. This is when the mom and the doctor start demanding formula.
When breastfeeding is going well it’s wonderful but when it is not going well it can be very challenging. Some babies make me sweat and really work for my money. Each time I walk into a room or a new home, I don’t know what I will see until that door swings open. There are no blanket answers I give people. I take all of my knowledge and all of my experience and when I get there, I throw it all out and deal with the person right in front of me. Each family has to be assessed separately and individual care plans will vary based on each person, the current situation, the efficacy of the mother and infant and the milk supply.
|Posted on August 20, 2014 at 5:10 PM||comments (48)|
When using or recommending the use of a nipple shield, it is important to remember not become too dependent on the shield. A nipple shield is a wonderful tool for a mother when she is experiencing difficulties with Breastfeeding. However, it was always intended for temporary or occasional use. It is not a permanent solution. The long term use of a nipple shield will not only reduce your milk supply, and reduce milk transfer during nursing, but it can mask the true problem, create the need for supplementation and lead to premature weaning. I worked with a mom who was told she had flat nipples and was given a nipple shield. When I met her, her infant was 71/2 weeks old and she did not breastfeed without a shield. During our first home visit, I noticed her nipples were not flat. I also noticed her babies frenulum was a little short. But clipping it was not an option. I recommended we try latching without the shield and mom said " nope, I'm fine to just use it forever" On our second visit I offered again "she said no". I explained extensively how to properly latch without it. I also suggested to her that she try it when ever she felt good and her infant wasn't too hungry and she felt like it was a good time for her. I also suggested she get herself mentally ready to let it go. By our third home visit, mom had not used it for two days. nipples did start to get a little sore by the third day. We worked on latching without it to improve technique a little more. Shortly after that visit, she no longer uses the shield, her milk supply has improved and she is even breastfeeding in public.
I also met a mom who was given a nipple shield due to pain with latch. Her baby was already 7 months old when I met her and she had never breastfed without a shield, not even at night or away from home. Her complaint today was that her infant will not latch to her breast without a shield. It was not about pain anymore. This infant has gotten a custom to the shield. He has never used a bottle and even uses a sippy cup for water, but won't breastfeed without a shield.
Before using a shield, seek clear answers as to why the problem exist. Look for and plan for resolve. Most problems related to latch can be improved with better technique. For example: better positioning, that offers comfort and a good vantage point. A calm mother who is aware and patiently looking for an open mouth with the tongue down.
Cracked nipples can be painful and a nipple shield can help for a few days to allow some healing to take place. however, if technique is not improved the problem will just reoccur.
Of course, some issues are not fixable today. For example: an infant who has a tongue or lip tie ( see blog post the uncuttable frenulum ). With these moms the problem can go on for many months. Initially a nipple shield can be used to allow healing and give mom time to gain confidence and perfect her techniques. She will really need some tips on latching with a tongue tied baby. She will need to learn to adapt to what cannot be immediately fixed. She needs to Always work to get a deep latch and may still get a little sore from time to time. When latching the tip of the shield still needs to get up over the tongue and deep into the center of the mouth or the infant will fuss with it but not suck.
When things improve she can choose to use a shield occasionally but should work to not need it anymore. For some moms it still hurts even with the shield on. It is important to give instructions on how to use it. If it is not on properly and it's sliding around, it will limit the amount of milk the infant gets based on the the lack of negative pressure created by the sucking. Make sure the size of the shield is accommodating also, some women use two size shields one that is more comfortable and one that gets more milk. Even with a shield an infant needs to learn and be reminded to open wide and put its tongue down to achieve a deep latch. If not, the infant will only be on the nipple. If just on the nipple, he will be gassy and fussy and he will get considerably less milk.
|Posted on January 14, 2014 at 1:37 PM||comments (38)|
|Posted on May 20, 2013 at 7:37 PM||comments (64)|
I have been noticing that severalcases of thrush (Candida) are going undiagnosed. I truly believe that this isaffecting the success and duration of breastfeeding for many mothers. Because the symptoms can so easily go without being recognized, they are often misjudged as some other problem or mistaken as a normal part of a different issue. Even when it is noticed, some feel it is common and harmless so they just let it run it's course. Other people clean the infant’s mouth with a solution like hydrogen peroxide, baking soda or thieves’ oil so it looks better. Often times they have recently seen a doctor so they feel that the infant has already been checked for it. The problem is so many mothers and babies suffer through preventable symptoms and often time’s breastfeeding is stopped or its planned duration is greatly reduced.
Thrush is basically a yeast infection in the baby’s mouth. We all have yeast naturally on our bodies, but when there is an overgrowth it becomes and infection.
Why is it so easily mistaken or over looked? Let’s take a look at the basic symptoms:
For the Mom:
· White patches on mom’s nipple and areola area
· Nipple pain not improved with better latch and positioning
· Sharp shooting pains deep within the breast
For the Infant:
· White patches – may appear on the tongue, cheeks and lips
· Latch difficulty
· Short frequent feedings
· Diaper Rash
The white patches characteristics of Thrush often occur only inside the buccal pads (cheeks) of an infant’s mouth so they go unnoticed. These white patches are easily seen on the infant’s tongue but are often mistaken for leftover milk. A mother’s nipples and areola may take on a shiny appearance which can be overlooked, unless a mom knows to look for it. Especially if she is using a nipple cream, she may think the shine is from the cream or the Lanolin she is applying. Latching can become difficult, the infant’s mouth may be sore therefore he may nurse only when hungry and desire short frequent feedings. He may be fussy while trying to nurse or suck on a pacifier. This behavior is often mistaken as bottle nipple confusion, breast refusal or even a desire ofthe infant’s to no longer want to breastfeed. This is especially a hint if the infant has been nursing with no problems for several weeks or months and all of a sudden latch becomes difficult.
The mother may experience burning pain on the nipples during and after nursing. If a mother is not aware of thrush being present she may think it is a latch problem or that her infant is a really aggressive sucker and she has to decide to take the pain or give up nursing. Some mother’s will choose to stop latching and pump only for the duration of their breastfeeding experience to avoid the pain. This mother didn’t know that the situation was temporary and that even without treatment the pain would have most likely subsided as soon as the thrush improved. Even though pumping only and offering breastmilk in a bottle is still breastfeeding, pumping only does tend to decrease the milk supply and again reduce breastfeeding duration. Not to mention it’s a big commitment and a lot of work.
The sharp shooting pains in mom’s breast are often confused with a strong milk ejection reflex (letdown). In the later stage of thrush, an infant’s diaper area may get a raised patchy bright or dark red diaper rash with distinct borders. However, especially depending onthe age of infant, the origin of the rash may be assumed to be related to urine or feces left on the skin too long, an allergic reaction to the brand of diapers being used or maybe mistaken as an allergic reaction to a new food or askin care product. Thrush is contagious and often time’s thrush is shared back and forth between a mother and baby. That is why it is important to treat them both simultaneously.
It is important to not diagnose yourself or take remedies you get off the internet or from other people.Contact your physician for diagnosis and treatment. Replace or sterilize everything that touches your infant’s mouth, nipples, pacifiers, toys, breastpump parts, bras and nightgowns. Change nursing pads often. Wash hands frequently.
Be on the lookout for symptoms of thrush if;
· Mom has had a yeast infection during pregnancy or in the postpartum period
· If a mother is given antibiotics after surgery
· If the infant has been given antibiotics
· If you suddenly get an onset of nipple pain after several weeks or months of pain free breastfeeding
Sandra Davis-Hathaway, IBCLC
The Breastfeeding Specialist
|Posted on December 2, 2012 at 4:47 PM||comments (258)|
A shortfrenulum or a tied tongue can present true challenges for a nursing mother;sore nipples, low milk supply, a fussy gassy baby and even mastitis. Somefrenulum’s can be so short that they are immediately noticeable almost at birth.The tongue never really comes out past the lips and it curves into a U or Vshape whenever the infant cries. For this family the answer is obvious, thedoctor says “this infant needs a frenotomy.” A very simple procedure where thefrenulum is clipped to give the tongue more mobility. Unfortunately, someinfants have a frenulum that is not so short that it needs to be cut, but notso long that it allows for comfortable breastfeeding. It is not just importanthow short the frenulum is but also where it attaches to the bottom of thetongue, close to the base of the tongue or closer to the tip. The problem with this is that a doctor doesnot cut frenulums just because it hurts to breastfeed. Frenulums are cut toprevent speech & dental problems later in life. Therefore this family is ina difficult situation. Though this is not considered a medical emergency, itwill present special implications for breastfeeding. For some they end up pumpingonly, supplementing or they stop breastfeeding altogether.
The 1step is recognizing that the frenulum is a little short. A mother may not knowthat the frenulum is short and she believes that she is doing something wrong.Especially since the doctor may have already told her that the frenulum wasn‘tshort. It is usually a little later when these moms figure out something justisn’t right. All the pillows and positioning are still not working and their breastare still sore. Nipple shields can helpbut are a temporary solution, they reduce milk transfer and for some mothers,it still hurts even with a nipple shield on. Once the determination is madethat the frenulum is a little short, she can turn her efforts to accommodatingit, instead of thinking it’s her fault or that the baby doesn’t want it. Thiscan reduce a lot of pressure on mom and point her in the right direction. Thedegree of breastfeeding difficulty maybe proportionate to the tightness of the frenulum.
It is commonto find that with a short frenulum one breast is sorer than the other. Thatbreastfeeding is more difficult on that one side. Positioning can be a key toolto finding comfort. Mom’s position as well as the infant’s position is really important.I find that the traditional cradle position and cross cradle positions are notalways the most comfortable for that sore side. Football, lying down, laid backbreastfeeding and a sitting up facing the breast position seemed to offer themost comfort. These infants work really hard to latch and often fall off thebreast frequently. Sucking is harder so they are more likely to nurse longer, fallasleep at the breast and wake still hungry. Therefore scheduling is really notrecommended.
It isimportant to target the middle of the tongue when latching, be very patient andremember, touching the lips will promotethe rooting reflex which says open your mouth, but, to operate the sucklingreflex, the infant needs to have the nipple at least into the mouth about tothe middle of the tongue before he will suck. Think about it, if you put yourfinger in your mouth, you will have to stick it an inch or two in before you triggeryour brain to suck. I also find that thetongue is often in the way instead of lying down, so remember to look for andwait for that target in the middle of the tongue. It is better to take the timeto get a good deep latch the first time instead of having to keep re-latching. Re-latchingfrustrates the infant and promotes nipple soreness. These infants also tend to bitedown a little on the nipple in an effort to hold on to it and not slide off thebreast. Again positioning, pillows, foot stools are all useful tools.
I wouldrecommend if breastfeeding is not going as well as planned for now pump to helpmaintain your supply. It is also important to help your breast heal. So continueto use your lanolin when needed. Expose the breast to fresh air to promote healing.When really sore a nipple shield can provide a barrier to reduce healing time.
The frenulummay give a little as the infant grows making breastfeeding more comfortable inthe later months.
|Posted on August 12, 2012 at 6:45 PM||comments (69)|
Be an advocate for your own healthcare. Be an educated informed participant in all areas related to the health and welfare of you and your baby. Be an active key decision maker, but don’t diagnose yourself or your baby. Self-assessment can be dangerous. Collect the facts open-mindedly. Don’t look for something that’s not there. Ask questions and do your research. Narrow down possibilities using obvious facts, not what ifs. Then take all the information to an expert. Don’t take remedies you find on the internet, always seek a doctor’s advice. Talking to people, searching the internet, books, chats, are all great tools that are essential for seeking information, researching, and getting an idea of what might be going on. You can find out what remedies have worked for other people and make some comparisons, eliminate options and narrow down possibilities. But ultimately you need a professional doctor to determine the correct steps to take. Stick to your doctors recommendations. Don’t take remedies, medicines, herbs, or homeopathic supplements unless approved or prescribed by your doctor. Always let your doctors know what you are taking or when your routine’s change in regards to your health care practices. It takes a village to raise a child and it takes a health care team to live healthy.