Assignment 7 - Part B

Frequently Asked Questions regarding

1. When should I use a hakka or breast shell? Breast shells are used for inverted, sore, or leaky nipples. The shell can help take out the nipple right before you are going to nurse your baby if your nipple is inverted. You do not breastfeed with the breast shell on (this is not the same as a nipple shield). So, you should remove the breast shell right before you breastfeed. You can also use a breast shell if your nipples are very leaky and don't want to wet your clothes when you’re out and about. The breast shell catches all the milk that is leaked out, and when you remove the shell you dump out the milk. Also, if you have sore, dry, cracked nipples, breast shells are amazing for preventing your nipples from chafing against your or clothes. This helps heal your nipples quicker. A hakka is a plastic device that you suction onto the breast to also help pull out the nipple through the vacuum technique if you have inverted nipples. But, more importantly, it is a pumping tool that is inexpensive and not electric! Lots of women when breastfeeding their baby will use the hakka on the other breast to pump out milk and store it (as well as even out the breasts and prevent engorgement). This is less irritating on the breast and nipple, unlike electric breast bumps.

2. Is it true that breastfeeding can act as a natural contraceptive? Yes! Frequently breastfeeding will prevent your menstrual cycle from starting again, which means no ovulation. There is a ton of science behind this, but in layman’s terms, this process is called lactational amenorrhea. Lactational amenorrhea is the lack of periods due to breastfeeding. Your menstrual cycle, and ovulation occurs because of the high amounts of estrogen and progesterone throughout your cycle. These two hormones help with ovulation, implantation, and maintaining . When your baby is born, progesterone levels decrease drastically (because it doesn’t need to maintain pregnancy anymore), and estrogen also decreases. Then your body knows it’s ready to lactate and breastfeed your baby, so prolactin levels increase. Prolactin is the milk producing hormone. The longer you are breastfeeding, the longer prolactin will be released and make milk. Now, how does progesterone/estrogen, and prolactin tie in together? Basically, if prolactin is being released by a small part in the brain (called the pituitary gland), then progesterone and estrogen are not being released. You can think of prolactin as being released by a tiny tunnel from the pituitary gland, which blocks other Assignment 7 - Part B hormones like progesterone and estrogen from being released too. These two different types of hormones with separate functions, can’t work at the same time. So, what happens when you stop breastfeeding? Prolactin levels decrease, and make space in that tiny tunnel for other hormones to come in and produce estrogen and progesterone. These other hormones are called luteinizing hormone, and follicle stimulating hormone, and they are essential to producing estrogen and progesterone. Then you will start ovulating and getting your period again! How does lactational amenorrhea work? There are three things you must continue and consider for it to be 98% effective as contraception (which has been studied and concluded)! You must: 1) be breastfeeding on demand, around the clock non-stop; 2) be breastfeeding your baby who is 6 months old or younger; and 3) not have a period at all (not even spotting) since .

3. Can I breastfeed with breast implants? Yes, you definitely can! Do not be discouraged by any fear mongering, or rumour you've heard that breast implants completely take away your chance to breastfeed your baby. It all really depends on a few questions like: where your incision was to place the implants?; do you feel sensation in your nipples?; did you have them done cosmetically, or because medically necessary? There may be some difficulties when it comes to breastfeeding if you have tissue/nerve damage and required surgery. If any milk ducts, or glands were damaged during surgery or previously due to medical reasons, this could affect the way milk is produced and released. If you had breast augmentation due to underdeveloped breasts, there could be a chance your breast tissues and milk ducts did not develop enough or properly, and this could affect breastfeeding. If you were incised for the breast implants on your nipples, there could be damage to the nippes pores, milk ducts, and Montgomery glands which will affect breastfeeding. Usually, the incisions are underneath the breast or at the armpits, and this won’t affect breastfeeding. Sensation of your nipples is a great sign that the nerves are working properly, but even if you don’t, breastfeeding can still be done! Be positive, and focus on methods that help your breastfeeding journey be more successful! Every ’s journey is different and has their own challenges.

Assignment 7 - Part B

4. What are the best positions for my newborn to have the best latch? There are five optimal positions you must try that can easily be found on the internet if you need photos or videos for extra guidance, they are: cradle, cross-cradle, football, laid back, and side lying. The cradle position requires you to basically put your whole arm (let’s say right arm) underneath your baby's ​ head and body for support, with their head on the bend of your elbow. Both of your hands should be near your baby's bum. The cross cradle is similar, but you are holding your baby's head with your hand (and ​ ​ opposite arm, so let's say the left arm) instead of the bend of your elbow. Your entire left arm will be under the baby supporting them. Next is the football hold, where your baby won't apply as much pressure ​ ​ to your belly. Place a comfortable pillow beside and under your breast and lie your baby on top of the pillow (or you can just hold the baby). Your baby’s head should be directly facing your breast, and their body will wrap around your ribs and towards your armpit. Your hand in this position is supporting their back or head. The laid back position is you laying down in a semi-reclined position with your baby ​ ​ tummy to tummy with you. You can guide them to your breast. Finally, the side lying position is when ​ ​ you lie on your side facing your baby with one pillow behind you supporting your back and one underneath your head. Your baby will be on their side facing you, with your nipple aligned to their mouth. Pull their feet and lower body close to yours and you can place a blanket behind her for support as well, or she can be lying down, or you can support her up with your arm/hand.

5. Can medications pass through my breastmilk? Yes, medications can pass through your breastmilk, but it is in extremely tiny quantities. These amounts are not enough to affect your baby, compared to when your baby is in the womb and medications are passed on through the bloodstream. There is a significant difference between drugs being passed through the blood and through breast milk. Most medications are safe to take while breastfeeding, and most of the time it is safe to breastfeed your baby while taking medication. It is important to weigh the risks and benefits of taking a certain medication that would cause you to stop breastfeeding for a few days to weeks. Not breastfeeding for this amount of time can make it difficult for your baby to nurse again. They can have trouble latching on, or start weaning off the breast. So, if there is a medication that prevents you from nursing, ask your doctor if there are alternative medications that allow you to nurse. If a drug is safe to take during pregnancy, it is usually safe to take while breastfeeding as well. This is a good indicator. Also, if the drug can be prescribed to , it also works. A few common drugs that you can take while breastfeeding are: ibuprofen, acetaminophen, aspirin, antidepressants, zoloft, and paxil. Remember to always ask your doctor before taking medications that were not prescribed. You can also use the following websites for more evidence-based research on which drugs you can and cannot Assignment 7 - Part B take: https://www.ncbi.nlm.nih.gov/books/NBK501922/, and ​ ​ https://www.infantrisk.com/category/breastfeeding. ​

6. What do I do if I'm not producing enough milk? Many breastfeeding women don’t realize that breastfeeding is all about supply and demand. The more you breastfeed, the more milk is released, the emptier your milk lobules are, and the more your body begins to produce milk again. If you are constantly feeding your baby on demand, 8-12 times a day (in the first few months), there shouldn’t be a problem with producing milk. Now, if you are only breastfeeding a few times a day, and then supplementing with formula (so you don’t pump and feed your baby pumped milk), this can cause your breasts to engorge, and stop milk production. This is how milk supply decreases. The longer you go without breastfeeding, the more “dried up” your milk supply gets. It is crucial to begin breastfeeding within the first 24 hours after your baby is born. The sooner you get them latched on in those first 24 hours the better! The first few days to a week are crucial for the outcome of your breastfeeding journey and milk production. You should also make sure that your baby is getting enough milk and not just nibbling at the breast. If you feel like you are engorged, breastfeed your baby more often, and if this doesn’t work, hand express the milk out and spoon or finger feed it to your baby. If hand expressing does not work, then pump it out and store this milk. Make sure to do these three things every 2-3 hours! The more milk coming out, the more milk is being produced. Increasing your milk supply all starts with frequent feedings, which means releasing milk in those 3 ways, every 2-3 hours! Another tip is “power pumping,” or “power hand expressing” (not as catchy). This is when you hand express, or pump for 5 minutes after each feed on each breast. This way you store more milk if it is needed for your partner to nurse the baby, or whatever reason. While you are pumping, make sure to massage the breast at the same time. Another form of power pumping is to dedicate one hour of the day to pumping. You pump for 20 minutes (while massaging the breast), and then take a 10 minutes break, and do it again for another 20 minutes. This can be done everyday until you feel your milk supply has increased. For some women it takes a few days, for others it takes a week. This type of power pumping simulates cluster feeding, which is what happens when your baby is going through a growth spurt, when they’re newborns, or when they're sick. This also stimulates the breast to make more milk and you can make sure enough milk is coming out to demand the body to produce more. Make sure your baby has a good latch, and that they don’t have a tongue or lip tie. Seek a doctor about this. Are you also eating and drinking enough, and supplying your body with the fuel and calories you need to make milk? Dehydration is a cause of decreased milk supply, so make sure to drink enough water. There are also lactation cookies and foods you can eat to boost your milk supply! Assignment 7 - Part B

7. I’ve heard pumping is bad and should be avoided. Is this true? If so, what is an alternative? Pumping is not the end of the world! If you are producing a ton of milk, or just don’t have time to hand express, then pumping is a fine alternative. But, it is best to hand express first before trying out the pump. Babies have a natural instinct to grab your breast and squeeze it while they are nursing. Why? Because this is them trying to squeeze more milk out of you. When you hand express, it will take longer than using a pump, but there are more benefits. Hand expressing is free, will not cause sore nipples, still allows your body to have skin to skin and continue its natural reaction to releasing milk, and stimulates milk letdown better, and faster. The hakka is a great alternative for a pumping device over an electric pump. One of the bad things about pumping is that if you do it wrong, it can cause sore nipples. It is expensive, and takes more work to clean and sterilize the materials. Also, there is a chance that pumping leads to exclusive bottle feeding over time. This can make latching for your baby difficult once they have tried the bottle nipple. Every baby is different, and if you have the time, it’s a great alternative to hand express, and spoon feed if you can not breastfeed for any reason over putting the milk in a bottle and bottle feeding. But of course, if you are pumping at work or somewhere that requires less time, then pump away! You’re still feeding your baby that liquid gold.

8. Should I breastfeed if I have my mastitis? Yes! If you’re thinking you will pass the infection on to your baby, that is not true. If anything, it is best to breastfeed if you have mastitis. Mastitis is due to a couple of reasons, one of them being a plugged duct, which is due to engorgement. This is just a cascade of events that started because of too much milk being produced and stored in the breast. It is important to release the milk you have, especially when you feel a larger amount of pressure in your breasts than usual. Breastfeeding is a supply and demand process, which means the more you release and feed your baby, the more milk that will be made. If you are breastfeeding constantly, and suddenly stop (skipping a few breastfeeding sessions), then this will lead to engorgement, which can lead to a plugged duct, which can lead to mastitis. So, it is best to solve the entire issue at once! Let your baby nurse on the breast with mastitis to release as much milk as possible, and help heal the breast. This can help release the plugged duct, and reduce swelling as well. Also, it’s better to start nursing your baby on the infected breast, because when babies start their feeding session they tend to suck harder, removing more milk! If it becomes too painful, make sure to stop, and nurse the baby on the other breast.

Assignment 7 - Part B

9. How do I use potatoes and cabbage leaves to help with breastfeeding complications? Which complications do they treat? Cabbage leaves are used on engorged breasts as a cold compress, or to reduce the overfilling feeling in her breasts. They are also used to wean away milk! So, if you wanted to stop breastfeeding and reduce the milk in your breasts, using this method more often can “dry up” your milk supply. So, if this is only to prevent engorgement, make sure not to do it too often. To start, rinse off two cabbage leaves and dry them thoroughly. Make a slit in the middle of the leaf to leave an opening for your nipple, and wrap them on your breasts. Leave them on for about 20 minutes, or until they become warm. If you have not felt any relief by this first session, repeat this process again until you do. You can hold the cabbage leaves in place with your hands, or with a bra. It is best to do it just twice daily or after each feed. Do not continue this method once you start feeling more relief and engorgement is starting to go away. You don’t want to risk losing your milk supply! Potatoes are said to reduce pain, swelling and redness of mastitis! You have to cut 6-8 raw potatoes lengthwise and into thin slices (about a centimeter or less thick). Place them in a large bowl of room temperature water for about 15-20 minutes. Apply the wet potato slices to the affected area of the breast, and leave the potatoes for 15-20 minutes. After, remove and discard the potatoes. Repeat this session two more times, so it’s done three times in one hour. This can be done before or after breastfeeding your baby.

10. What food should I avoid while breastfeeding? There are four main foods and drinks to avoid while breastfeeding: processed, sugary foods, alcohol, caffeine, and fish. Of course, you can totally eat and drink all of this in moderation! You don’t have to cut this out of your diet. It should be moderated, and monitored. Alcohol, no matter what level, is never safe for a baby to consume. Breast-feeding shouldn’t stop you from drinking your occasional wine during dinner. You must monitor how much alcohol you consume, what time you finished drinking it, and how long it takes to leave your system. For instance, if you drink a 12 ounce beer that contains 5% alcohol, it is said it takes 2-3 hours to leave your system. So, if you finished drinking the beer at 7:45 pm, then the beer will leave your system by 9:45-10:45 pm, and you can breastfeed then. Assignment 7 - Part B

Caffeine should be limited to 2-3 cups per day, maximum. Too much caffeine can affect your baby's sleep and agitate them! While processed, sugary foods can increase weight gain, and affect your breastmilk to not be as nutritious as can be. Large predatory fish contain high levels of mercury that could affect your baby's developing nervous system. But, small fish have a great amount of omega-3 fatty acids and proteins. Everything is okay in moderation. Still, it is best to seek your doctors advice and see what fits best for your and your baby's health, depending on your medical history.

11. What are the steps for my baby to latch properly? You should try the following steps to get your baby to latch properly: 1) Get your baby in one of the five well-known breastfeeding positions. 2) Lightly tickle/run your nipple, pointing to the roof of the baby's mouth, along the upper lip (not lower), from one corner of their lip to the other. 3) Once the baby opens their mouth, bring them toward the beast, and only their chin should touch your breast. Your nipple should at least still be pointing up and towards the roof of their mouth, if it's not touching it. Having only the chin touch the breast helps guarantee this nipple position. Also remember that it is extremely important that your baby is not only latched to the nipple, but the areola as well. Your entire areola (or most of it if yours are large) should be in your baby's mouth. Your milk ducts and lobules are not directly behind or in your nipple, they are farther back and around the nipple. So, when your baby mouth is wide and covering your areola, this gives them the opportunity to massage, and suck the milk ducts to release milk into their mouths. Your baby's mouth should also be at a 120 degree angle, not at a 90 degree angle! 4) If your baby can’t breath, they will pull away from the breast, meaning they were not latched properly. Breathing is possible when their chin is touching the breast and their nose is not (leaving space to breath). It’s best to adjust the latching positions while the nipple is still in their mouth. Do not remove the nipple from their mouth over and over again trying to get the perfect latch on the first try. This will only hurt your nipples more.

12. What should I do if my baby is only nibbling and pacifying instead of eating?

Assignment 7 - Part B

Well, this depends on a few factors. Has your baby been doing this since they first started breastfeeding? Did they just start doing this randomly? Sometimes babies will nibble just to do so when they are not hungry. If you know that it could be a possibility that they aren’t hungry, and they are just nibbling, remove your breast from their mouth and try again in 15-20 minutes or so. If you know they are hungry, and have been randomly nibbling, check that your nipples are erect enough and that they are not flat or inverted. Your baby may not be getting the roof of their mouth stimulated by your nipple, and they are trying to latch on. They could be distracted, or bored, so you can try breastfeeding again later, or in a darker room with less distractions. Your baby could also be teething, and the nibbling helps soothe their gums. Is your baby nibbling right before they open their mouth to suck in milk, or when they are waiting for milk to flow? If so, you can try to hand express while they are nursing so the milk flows constantly, and they don’t feel an urge to bite. This could also prevent behavioral issues of associating biting with more milk flow. If you have trouble releasing milk while nursing, try hand expressing, or pumping right before the session so the flow is faster and easier by the time your baby latches. If they are pacifying themselves to sleep or relax, I wouldn't say this is a bad thing (if it is towards the end of their feeding session). If they have eaten a whole meal, and now are latched to sleep, then this is great and creates a stronger bond between the two of you, and relaxes your baby more. But, if they wake up in the middle of the night and require breastfeeding (without the feeding) to go to sleep, then this could lead to behavioral problems that affect your and your baby’s sleep. Try using another tool like a rocking bed, or transition to only carrying and rocking them when they wake up and not feeding them. Make sure if the baby is nibbling too hard, too often, to remove your breast from their mouth to prevent sore nipples. Sometimes, when the baby is not properly latched, and they only suck/nibble the nipple, this will cause irritation in your nipples, along with cracking, and dryness. It is also a great idea to seek a lactation counselor or consultant.

13. Where can I find additional sources for breastfeeding support and information? You can find additional support and sources by lactation professionals first, along with groups, and online websites! There are different types of lactation professionals. Most doulas have basic lactation training, and if they have plenty of experience this could be enough for you. Assignment 7 - Part B

If you need additional help (which is usually what women seek), there are lactation counselors, and consultants. A lactation counselor or specialist has about 16-20 hours of classroom education. An international board certified lactation consultant (IBCLC) is the highest ranking lactation support and has about 45 hours of classroom education, specialized hands on training, and more. They must take an exam as well. An IBCLC can help you with difficult, abnormal, and complex breastfeeding issues like recurring mastitis, properly latching, and more. They are not medical professionals and can not prescribe medications, but many have more breastfeeding experience and knowledge than doctors, because this is what they specialize in. Remember, that if you need basic help with breastfeeding, and doula, or even just a nurse, or friend can help with this! Peer support is so important and often disregarded. Community help is essential, and can put your mind and body at ease. Seeking help from women in your family, or other friends who are can be enough to help you! Don’t forget there are breastfeeding classes you can take, and lactation support groups (ask your hospital if they have a support group they can recommend). Sites that are professional, evidence-based, and accurate to help you are: https://lllusa.org/, and https://ibconline.ca/. ​ ​ ​ ​

14. Is it safe for my baby to drink donor milk?If so, where do I buy it? Of course! If you cannot breastfeed at all, and have tried your best, the next best alternative is to feed your baby donor milk. If you cannot get your hands on donor milk, then formula should be the last supplemental option. Avoid buying donor milk through the internet, because you are not 100% sure where it is coming from, or the mothers medical history, and diet. It has been shown that milk sold from milk-sharing sites has been contaminated with bacteria. It is best to do your own research on this. Milk banks are much safer since the donor must provide a self-reported health information sheet, and her doctor, and her doctor must both sign a health statement. The donated milk is extensively tested, and prepared and stored safely. There can be less of a chance of finding donor milk from milk banks since it is first offered to fragile, hospitalized infants. To find a human milk bank you can search on https://www.hmbana.org/. If you know of a friend or ​ ​ family member who is breastfeeding, and trust in them, you can also ask for their milk donation as well. This, https://www.momspumphere.com/community/groups/viewbulletin ​ Assignment 7 - Part B

/3-list-of-donor-milk-banks-in-the-united-states, is a list of other local milks banks across the ​ U.S.

15. Why is breast milk better than formula milk? To begin, formula is made mainly from cow’s milk, but can also be derived from goat’s milk and soy milk. These then are manufactured and altered to resemble breastmilk more, by having more vitamins, minerals, proteins, carbs, and fats added. Cow’s milk has more casein proteins than whey proteins, and this can cause your baby to have an upset stomach, diarrhea, constipation, or spit up. Casein is a protein that is in smaller quantities in breastmilk, which makes it softer for the baby’s digestive tract to handle. Casein when it hits your baby's stomach, turns into solid balls, while whey is in liquid form (traveling through the stomach and intestines easier). The solid protein balls are much harder to digest. Breast Milk has more linoleic acid (a type of fat that helps boost your baby's immune system) than formula milk. In fact, linoleic acid accounts for 10% of your breast milk’s total fat content. While in cow’s milk (formula) it is only 2%. Breast milk also has twice as much lactose as cow’s milk! Lactose is basically milk sugar and it boosts your baby's energy, and helps their stomach absorb calcium, magnesium, and other minerals. The most important reason of all is that breast milk has leukocytes, which are living cells that help fight infections and can not be found at all in formula milk. It has antibodies, living cells, enzymes, and hormones that can not be replaced in a lab, because they come directly from you and your immune system! You fight off infections, viruses, and bacteria, and the antibodies made to fight this pass on to your baby through your breastmilk! This helps give your baby an immune fighting boost, because they don’t have to make it themselves from scratch. They have your living cells to help protect them. Breastfeeding also helps you prevent breast cancer, stop postpartum hemorrhage, lose weight, decrease your chance of postpartum depression, osteoporosis, type 2 diabetes, high blood pressure, ovarian cancer, and so much more! Formula milk does not give you these benefits.

Assignment 7 - Part B

Sources / Additional Information

Colleen, D. B. (2020, July 29). Breastfeeding With Breast Implants. What to Expect. ​ ​ https://www.whattoexpect.com/first-year/breastfeeding-with-implants

International BreastFeeding Centre | Mother’s medications while breastfeeding. (2017, ​ July). Ibconline.Ca.

https://ibconline.ca/information-sheets/breastfeeding-and-medications/

Ramgopal, S. (2021, January 11). Normal Progesterone Levels During Breastfeeding. ​ ​ Healthfully.

https://healthfully.com/normal-progesterone-levels-during-breastfeeding-8080951

.html

Shkodzik, K. S. (2020, April 14). Breastfeeding As a Contraception Method: Does It ​ Really Work? Flo.Health. ​ https://flo.health/being-a-mom/adjusting-to-motherhood/contraception/breastfeedi

ng-as-a-contraception-method

Stephens, C. S. (2020, March 18). What To Know About Biting During Breastfeed - and ​ How to Cope. Healthline.Com. ​ https://www.healthline.com/health/breastfeeding/nipple-biting#how-to-stop-biting