Lactation Rooms – Your Right

Here is a link to a fantastic post from Mamas at Work.  Cynthia worked hard to research these letters for a friend of hers who was struggling with finding a place to pump at work.  The letters included here are fantastic and could help any mom who needs help talking to her employer about finding space to pump at work.  She also included a letter for childcare facilities that goes into detail about breastmilk and the USDA food program and babies older than 12 months.

Many thanks to Cynthia for putting this together.

 

Lactation Rooms – Your Right.

Non-Profit Milk Banking and How You Can Help

I received an email from Maryanne at the non-profit Mothers’ Milk Bank in San Jose who wondered if I would be interested in posting about non-profit milk banking, and I jumped at the chance!  I had a wonderful conversation with Executive Director Pauline Sakamoto about the work that Mothers’ Milk Bank does, and I’m glad to be able support this organization by sharing what I learned.

Mothers’ Milk Bank in San Jose, California is a non-profit, HMBANA (I am having a hard time saying “Hmmbana” for some reason) milk bank.  It’s one of many scattered across the US and Canada that collects breast milk from donors to provide to babies and children in need.  HMBANA banks set the standard for all milk banks in that they not only receive endorsements from health agencies, but they collect and distribute their milk in a way that adheres to a specific set of best practices.

Photo courtesy of Mothers' Milk Bank, San Jose, CA
Photo courtesy of Mothers’ Milk Bank, San Jose, CA

Pauline explained to me that one of the biggest things that sets HMBANA banks apart is the focus on the breastfeeding relationship.  The main goal is to get mom and baby breastfeeding, not ship out a certain volume of milk.  Many of the employees at Mothers’ Milk Bank are IBCLCs and RNs, and they work with moms to get them in touch with lactation support specialist in their own area.

I learned so much from speaking to Pauline.  I had always been under the impression that milk bank milk was almost impossible to get and that it was only for premies in the NICU.  I had assumed that, upon leaving the hospital, moms and babies would be left to fend for themselves.

I was amazed to learn about the diversity of the population that Mothers’ Milk Bank serves!  They provide milk to micropremies up to babies 2 and 3 years old!  They are even currently providing milk to a 7 year old suffering from spinal-muscular dystrophy.  Without his own mother’s milk and the milk provided by the milk bank, this little boy would not be alive today.  They also occasionally provide milk to adult cancer patients.

All a person needs to receive milk from the bank is a prescription from a doctor.  Many insurance policies cover the cost of the milk, and if not, often employees of the bank chip in to cover the cost of the milk.  And what is that cost?  Only enough to cover the costs of shipping and processing the milk, usually between $3 and $4.50.

It is often difficult for the bank, though, because demand almost always outpaces supply.  The bank focuses on situations where a mom is trying very hard to breastfeed but is not able to due to medical reasons like a double mastectomy or other situation.  In other cases, they support the mom’s attempts to breastfeed while providing the donor milk as a supplement to the mom’s actions.

I was also surprised at how easy it is to donate milk.  If you can give blood, chances are good that you can also donate milk.  Mothers’ Milk Bank covers that cost of shipping and for moms not living in a city with a milk bank, there are often depots set up to receive the milk and help transfer it to the bank.  This was surprising to me.  I always thought that you had to live in a city with a milk bank in order to donate to the bank.  They can even collect milk from Alaska and Hawaii and there are three banks in Canada!

Photo courtesy of Mothers' Milk Bank, San Jose, CA
Photo courtesy of Mothers’ Milk Bank, San Jose, CA

Once they receive the milk, they process it in very small batches.  Typically, they will combine milk from 2-4 donors, although sometimes they will note that there is a higher level of bacteria in a particular mom’s milk.  If they see that, they pasteurize her milk separately.  They work to make sure that the donors in the combined batches all have babies that are of similar age so that they can match the “age” of the milk to the age of the recipient baby.  They bottle the milk and treat it in a hot water bath using a method called Holder Pasteurization.  They heat the milk to 62.5 degrees C for 30 minutes.  Pauline told me that they have found that this method is most effective in killing off bacteria and viruses that may be in the milk while preserving as much of the benefits of the milk as possible.

Once the milk is processed, they ship it out to the patients.  It’s that simple.

According to Pauline, the biggest challenge they face is finding enough milk to meet the demand of patients.  Because they serve a larger population than just premies in the NICU, they often find that they have more patients than available milk.

When I asked Pauline about mother-to-mother milk sharing, my preferred method of milk sharing, she did not discourage this practice, but she said that no matter what you are doing with your milk, be sure you really know where it is going.  She has heard stories of professional atheletes soliciting for breast milk, and one advantage of going through a HMBANA bank is that it gives mom a layer of protection from liability in case a recipient baby does become ill.  This definitely made me pause and think.  The milk I have given has been to friends, but I wonder how comfortable I would have been donating milk in a more annonymous situation?

The main thing that Pauline wanted to get across is this:

HMBANA has been here for years and years.  We all service different people with different needs, and if we could work together and keep in concept that the mission is to help moms breastfeed it would be beneficial.  We do need milk. We do need moms to know about us.  There are babies behind who we serve and children who are failing to thrive that really need the support. If we had to close down because every mom was breastfeeding, we would do it!

We have excellent moms in the US that are breastfeeding in this country.  And bless them for having that extra milk and saying “Can anybody use it?”

Here is more information about donating to Mothers’ Milk Bank in San Jose.

Here is a link to the HMBANA site to help you find a non-profit milk bank near you.

I am grateful to Pauline for her time and for the hard work that she and other HMBANA bank employees do for breastfeeding moms and babies.

Photo courtesy of Mothers' Milk Bank, San Jose, CA
Photo courtesy of Mothers’ Milk Bank, San Jose, CA

Wild and Wonderful Toddler Nursing

I finally have to admit to myself that Cricket is a toddler.  She’s walking, starting to talk, getting more and more active, and starting to lose her baby rolls and chub.  I’ve been mourning this quite a bit.  She is my last baby, and while it’s amazing to see her grow, I have a lot of nostalgia for the cuddly baby stage.

These days, cuddles are short and to the point.  So is nursing for that matter.  Sometimes.  And then sometimes nursing takes hours and hours.

That’s right.  We’ve entered the land of…

Toddler Nursing

Anyone who has practiced full-term breastfeeding (also known as extended breastfeeding) is going to be able to empathize with me on this.

Toddler nursing can be exasperating.  Now is when the acrobatics start.  They nurse standing up, upside down, standing on one foot while balance on your leg (Cricket’s

personal favorite). They latch on and off as people walk past and daily activity happens around them.  Can you blame them?  The world is interesting!

They’ve learned to verbally (or with sign language) ask to nurse* and, like any new exciting skill, they like to practice.  A lot.  This means that they seem to constantly ask to nurse.

They are also learning to control their environments, which means that some babies (Cricket) may take to trying to open the shirt themselves.  Often in public.  Or in front of your male boss.

It is absolutely okay to teach nursing manners.  In fact, it is critical to do so at this time.  Teaching baby to show respect and kindness to Mama helps them to learn respect and kindness for themselves and others.  For shirt opening, I immediately either put her down or pass her to her dad. Consistency is key. She is gradually getting better.

Between the ages of 15 and 20 months, they seem to nurse like newborns!  Round the clock!  This is because they are in the middle of growth spurts, teething, and learning that they are independant people. Is it any wonder they need to come back to Mama so much for reassurance?

“I want to run and play, but I need to make sure you will still be here Mommy. You’re still here, right? That was a fun slide! Wait! Where’s Mommy? Oh, thank goodness. There you are! I still need you, Mommy. Don’t leave without me.”

Toddler nursing is just as wonderful as it is wild. Finally, they can thank us and show appreciation for our hard work. A kiss on the cheek, clapping, words of thanks, and hugs are just a few of the ways toddlers show us that they love us.  Those bedtime nursings are still the soft quiet times that they were in the beginning.  We still get to watch those big eyes slowly close in sleep.  The magic is still there.

Like everything else, toddler nursing is a stage.  The hard parts and easy parts and parts that you want to remember forever.

We are in the autumn of our breastfeeding relationship now, and every cuddle and every nursing is precious and fleeting.

*Let me be very clear for the “When they can ask for it, it’s time to stop” crowd: Babies ask to nurse from the moment they are born. We just don’t always understand their language. Believing that they should stop nursing when they finally learn our language is like telling an adult that he can’t have sushi anymore because he learned Japanese.

Guest Post: Misconceptions about Motherhood

P1040069_2Liz is taking a leave of absence from public education to care for her 18 month old and emotionally needy border collie. Before Liz stayed home, she taught every grade from Kindergarten to 8th, but loved middle school because that is where the real changes in life happen.  When she was working, her husband cared for their daughter and then he worked afternoons and nights. Being a mom to her daughter is the best job she has ever had.

I thought having a baby would be easy, like having another dog. I know, don’t laugh at me. I assumed I would feed it and it would sleep, or that I would be able to sit and write while my baby would play on the floor by my feet. Ha Ha Ha. Right now I have to decide if I take this moment of peace while she plays with her shoes to pee or start writing this blog. write while my baby would play on the floor by my feet. Ha Ha Ha.

Right now I have to decide if I take this moment of peace while she plays with her shoes to pee or start writing this blog. Keep in mind that I went back to work at 8 weeks, but I definitely did not have any idea of how much a baby would need me, it’s mother.

The purpose of this blog is not to scare people, but to tell the honest truth so people can have some idea of what they are getting into so they can schedule their lives. My husband always jokes, “You mean it’s not as simple as the new parenting videos make it out to be?”

In the beginning:
A few months before my baby was born, a friend told me that nursing was a part time job. I didn’t really believe it. But no, she is right. A new baby needs to nurse every two to three hours, and sometimes will want more, especially during growth spurts, every four, six and eight weeks. A new baby nurses 10-12 times a day; this is important because it establishes milk supply. During this time I watched a lot of Gilmore Girls. Some people read. Learning to sideways nurse helped a lot because then I could sort of sleep.

The first eight weeks are hard, very hard for someone who isn’t used to sitting down. I had to tell myself that the time would pass and it sure did. It seems like only yesterday I was holding her on a breastfeeding pillow.

A new baby wants to be held, a lot. I assumed that I would nurse the baby and put it to sleep in it’s bed. I learned that that moment between sleep and awake is a fragile moment to a baby, and that they cry. A lot.

I also learned that the best way to maintain my sanity was to wear her on me in either a sling or a wrap; my Moby Wrap and I became great friends because I could have my hands free.

We also danced a lot and bounced on a yoga ball because babies have gas, lots of it. The first eight weeks we nursed, I burped her after each feeding, sometimes we nursed again, we went for walks with her in the Moby, I tried to nap during the day as I was used to getting more than five hours of sleep at a time (a record for new moms actually), she would fall asleep on me or in the Moby and I would have a few moments to relax before it all started up again.

Motherhood is hard. No one tells you that. Sometimes we assume that they will be like little dolls that we can just give a bottle or pacifier and all will be alright. That’s certainly a fantasy world. My child had no interest in a pacifier, which turned out to be a good thing because now I don’t have to figure out how to take it away from her.

Now I went back to work at 8 weeks and I pumped at work. When I came home I still had all the usual chores like shopping, laundry, pulling weeds, cooking and cleaning etc. For getting these things done, I found my Ergo and sling to be indispensable because I could wear her and be close to her and not feel like I was away from her too much. Every day when I got home if it was still light out, I either put her in the Moby or Ergo and we walked, my favorite part of the day. She was happiest when she was involved and up close by me because I could talk to her, sing to her, and she could look at me and feel me.

When she got older and could sit up on her own, I put her in our Bob stroller and we went for longer walks. Of course I also brought a carrier and kept it underneath after learning that pushing a stroller and holding a sad baby is not a fun thing to do.

When she was nine months old I took some time off work, but that month my baby, who crawled at six months, started walking. Before she was born, I assumed there would be so much down time, time to do other things like I used to always. I didn’t count on all the time it takes to dress a baby, comfort and nurse a baby, bathe a baby, and then when baby was eating food, clean up the food that ended up on the ground and in baby’s hair etc. What I’m getting at is that life is different. So different. But so good! I wouldn’t trade a moment of this because watching her grow is the most fascinating thing I have ever seen.

The great thing about babies is that they are portable and travel well. When she was 4 months, we took her to Washington DC and the Smithsonian. From 10 days to 9 months, she spent quite a lot of time traveling to San Diego to visit family and also went camping a few times. At 10-11 months, we took a three week road trip up to Washington. A few weeks shy of her first birthday, we went to Hawaii. Since then she has been camping in Sequoia and has also flown to Michigan. Having a baby changes life, but she’s just a little person who can enjoy the adventure, too.

In the time that I wrote this blog (a little over an hour), I have also stopped my now 18 month old from taking my books off the shelf, have read her a book about South African animals (she picked it!), taken out the ice packs from the freezer because she wanted them (I don’t know why), watched her climb in and out of our Bob stroller and play with the buckle while putting on and off a hat and putting a hat on a ratty dog toy. She has worked on a puzzle, gotten frustrated with the puzzle and crawled on my lap because she wanted to type. I have taken her to sit on the potty and we read her farm book four times. I just left her in her room after we played with her farm animals for a minute, but now I hear her taking out her books. Things change a lot between 8 weeks and 18 months. Now excuse me, I’m being handed a Dr. Seuss book. Time for me to exercise my oscar winning actress skills on my rendition of Oh the Things You Can Think.

Links: Pumping at work: http://kellymom.com/bf/pumpingmoms/pumping/what-to-expect-when-pumping/

The first week: http://kellymom.com/bf/normal/newborn-nursing/

Nursing: http://kellymom.com/ages/newborn/bf-basics/latch-resources/

breastfriend pillow: http://www.mybrestfriend.com

carriers: http://www.thebabywearer.com

Handling Breastfeeding Criticism

With the holidays coming up, many of us are on our way to visit friends and family.  Those visits can be full of joy, but they can also be stressful. I am so fortunate to have supportive friends and family, but not everyone is so lucky in that regard. So many times, moms and dads find themselves receiving criticism for the parenting choices they made, particularly if those parenting choices don’t exactly line up with the way grandparents, uncles, aunts, and friends view child-rearing.

I believe that criticism, particularly breastfeeding criticism comes from two major places, ignorance and pain, and if you can identify the root of your critic’s feelings, it can make it easier to move past their hurtful words.  To be clear, when I say “ignorance,” I don’t mean stupidity.  Ignorance is simply a lack on knowledge on a subject.  Because breastfeeding wasn’t the norm in the US for an entire generation, much of the tribal knowledge surrounding it has been lost.

Is it any wonder Aunt Edith worries your baby might need to switch to formula if her doctor told her that milk turns to water at six months?  Is it any wonder that Great-Grandma Cathy worries you are overfeeding your baby if her doctor instructed her to space out feedings to every four hours?  Is it any wonder your young, childless friends think you might be spoiling your child by nursing her down for naps if all they see on TV and in movies are peacefully sleeping babies that never, ever seem to need to eat (or poop for that matter)?

I’d like to go through a few scenarios, and by the end of this article, I hope you will have some tools added to your belt to help you through these situations.

Scenario 1: The Opportunity to Educate

Your Aunt Edith approaches you while you are breastfeeding your 8 month old and says something along the lines of, “When are you going to get that baby off the boob? Your milk isn’t enough for her anymore.  She is starving!”

This is a great opportunity to help educate Aunt Edith (and other family members who may be listening in).  Tiny ripples can cause big changes, but it’s important to educate in a way that is sensitive and loving.  Getting angry at your Aunt and giving her a piece of your mind will only leave her feeling hurt and defensive, and while it may get her off your back, it won’t help other family members who may be in a similar situation.

Here’s how I have gently educated my friends and family members when in a similar situation (I’ll highlight the key “gentling” phrases):

“You know, that is a really interesting point that you make.  Did you know that new research shows us that breastmilk grows and changes as the baby grows?  Nowadays, doctors tell us that breastmilk should be a baby’s main source of nutrition until they are a year old and that we should continue nursing until the baby is two!  It’s really amazing how recommendations change over time, isn’t it?

Sure, it’s not brand new research, but it’s new research to her.  And framing it that way can sometimes feel less aggressive and patronizing than saying, “Actually, that’s wrong.  Here is the right information.”

I would encourage you to take every chance you can to educate your friends.  Taking the time to educate Aunt Edith, even though she isn’t nursing anymore, may mean that in the future, when Aunt Edith’s daughter-in-law has a baby, Aunt Edith will be better able to support her.

Scenario 2: The Opportunity to Connect

Sometimes, people’s own breastfeeding-related experiences may have been emotionally painful.  They may feel guilty for not breastfeeding and the fact that you do breastfeed may make them feel defensive.  That defensiveness can manifest in that person being hypercritical of you.  It seems counter-intuitive that a person would want to bring another person down like that, but it’s human nature.  It doesn’t make them a bad person, it makes them a person in pain.

If you run into a situation like this, and if the friend or relative mentions that, well, they couldn’t breastfeed at all because of [whatever reason], you can take the opportunity to reach out and connect to that mom and honor her pain.  No, that doesn’t mean that you grill her on why and tell her why she probably would have been just fine if she had just stuck it out or gotten in touch with a proper IBCLC.  That doesn’t help.  What happened happened.  What you can do, though, is offer her sisterhood and say something along the lines of, “I am so sorry that you didn’t have the support you deserve. I wish I could have been there to hug you and cry with you and tell you that it was going to be okay.”

My dear friend Paris at Mother Revolution is way better at this than I am.  You should definitely read her blog.

Scenario 3: The Jerk Factor

It’s all well and good to talk about the above two opportunities to connect and grow closer to your family.  However, it would be naive to believe that there aren’t people out there who are just plain mean.  I’ve had friends who have dealt with friends and family members who try to cut them down for a variety of destructive reasons, and there are times when your parenting choices simply need to be off-limits for conversation.

The best way to shut a conversation down politely is by using the Bean Dip Method.  I honestly don’t know where this term was coined.  It was something we talked about over on the Kellymom.com forums.  If you know where this came from, please let me know so I can properly attribute this. Update: Many thanks to Amanda down in the comments for pointing me to the source of this, Joanne Ketch. Read more about it here: Parenting Choices – Boundaries.

The Bean Dip Method (or in light of the upcoming holidays, the Cranberry Sauce Method) is a polite way to redirect a conversation.  It’s not about changing someone’s mind.  It’s about setting a boundary and enforcing it.  Here’s how it works:

Cousin Jill has been harping on you all weekend and will not leave you alone about breastfeeding.  She thinks that it is high time you wean your toddler, and despite the fact that you have told her the WHO recommendations and attempted to connect with her in a loving way, she will just not stop.  Cousin Jill has an axe to grind, and you are her current target.

Cousin Jill: Ugh, breastfeeding again?  You’re turning him into a sissy.
You: That’s interesting.  Can you please pass the cranberry sauce?
Cousin Jill: Seriously, when they’re old enough to ask for it, it’s time to quit.
You: Okay.  Can you pass the gravy?
Cousin Jill: Seriously, that’s just gross.
You: I know you love the baby.  We’ve researched and made our parenting decisions, and they aren’t open for discussion.

If it continues, be prepared to quietly remove yourself from the situation.  There’s no need for you to subject yourself to that kind of thing.

 

Family gatherings can be fun, but they can also be stressful.  Have you had to deal with criticism over your parenting choices?  How did you handle it?

Infant Sleep Strikes, Sisterhood, and Surrender

It’s been a long time since I have slept due to baby night wakings so I am not sure how coherent I will be.  But I wanted to reach out to all the families out there that might be going through something similar and offer empathy, sisterhood, and the promise of better days.

We, as a culture, seem to have this Hollywood-esque notion of baby sleep. The phrase “sleeping like a baby” immediately comes to mind.  And I know I am not the only person who has been asked, “Oh, is she a good baby? Is she sleeping through the night yet?”

We seem to have lost sight of the fact that infant and toddler sleep is meant to be light.  They’re meant to wake often at night for food and reassurance.  This is what kept them alive in more primitive times.  Of course, now we don’t have to worry about being eaten by sabre tooth cats, but that doesn’t change the fact that babies are hard-wired by their very biology to need to wake at night.  Learning to sleep through the night is a developmental milestone that all babies reach at different times.  Just like walking and talking, you cannot “train” a baby to sleep through the night before he or she is developmentally ready to do so.

That doesn’t change the fact that waking with a baby through the night can be exhausting.  Believe me, I know.  We are on day 5 of the current sleep strike.  Cricket is waking up every hour and staying up.  She is nurse, nurse, nursing.  Crawling around.  Exploring my face with her little fingers.  And just generally not sleeping.  Thank God we bed-share.  I can’t even imagine how hard it would be if I had to hike my butt down the hall to put her to sleep, stagger back to bed, only to have to hike down the hall again just as my eyes were closing.

She’s not waking to be mean or difficult or because she is a “bad” baby.  She is waking because she has a need, and for babies these needs are real and immediate.  Babies wake for all kinds of reasons:

  • Teething
  • Learning new skills
  • Because they miss us and love us
  • Hunger
  • Thirst
  • Growth spurts
  • Feeling sick
  • Baby is realizing that he or she is a separate person from Mama

Just to name a few.

And I’ve noticed with both girls and in talking to other parents that sleep definitely comes in cycles.  There are often ways to predict it.  There are several periods of wakefulness that we see pretty much across the board:

  • The 4 month sleep regression
  • The 6 month growth spurt
  • The 8 month sleep regression
  • The 15 month old period of nursing like a newborn

Cricket is right at 13 months.  We’re a little early for the 15 month period, but she is teething, growing, and coming down with a cold.  Plus, she misses me.  She is so busy playing in the mornings and evenings that she often doesn’t want to nurse or only wants to take the time for a little snack.  Note: This isn’t self-weaning. This is also really normal baby behavior and will pass with time.

Getting up every morning for work when I haven’t slept at night is hard.  Really hard.  I feel like hell right now and the horrible cold I caught isn’t helping.  This is so hard.  But I know it will pass.  I am here, waving my white flag.  I am surrendering to her needs.  She will only be a baby for a little while longer.  Every day with her is precious, every night waking is a chance to remind her that Mama will be here for her no matter what.

So if you’re like me, or if you find yourself in the future in a similar situation, I’m here with you, wide awake in solidarity and sisterhood.  Dig deep and find that white flag.  Surrender to it.  Don’t get caught in the moment.  Remember that the days are fleeting right now.  It will get easier and, as my dear friend Paris says, “Just because something is hard, doesn’t mean you suck at it.”

Chronic Plugged Ducts and How I’m Fighting Them

I think it’s finally time to admit to myself that I’m having an issue with plugged ducts. A plugged duct is when one of the milk ducts becomes blocked and milk can’t exit the breast.  A hard, painful lump can form as the milk backs up.  If the milk isn’t removed, a plug has the potential to develop into mastitis, which is an infection of the breast.  Think fever, chills, nausea, etc.  Plugged ducts are not fun.

I’ve had six instances of plugged ducts in the last month and a half, which is more than I had the entire three and a half years of nursing the Grasshopper.  Twice now, the plugs have been especially exciting because I’ve gotten a bleb along with them.  A bleb is a hardened bit of milk that forms a blister right at the nipple. Once, I got a mild case of mastitis and ended up missing work because of it.  Obviously, there’s something going on.

I brought it up the last La Leche League meeting, and I got some great help.  We really thought together about what kinds of things I notice before a plug occurs.  Here’s what I came up with.  My plugged ducts coincide with:

  • My husband travelling for work
  • Eating fast food
  • Especially wakeful periods for Cricket
  • Missed pumping sessions at work
  • Feelings of stress, anger, and disconnect
  • Allowing Cricket to roll her lips in for a lazy latch

In doing some online reading, it seems like these items play into the risk factors for developing plugged ducts: sleep deprivation, stress, poor diet, bad latch, failure to remove milk.

Priority number one with all of this is to clear the plug and remove the milk.  Easier said than done.  My old stand-by trick is to lay the baby on her back on bed, turn myself around so that her chin points at the plug, and nurse over her so that her suction and gravity can clear the plug.  Trouble is, that hasn’t worked the last two times.  The resulting let-downs from the nursing just seemed to make the plug worse.

At this point, hand expression seems to work best.  I express most of the milk out (or have her nurse for a while).  Then I start hand expressing very gently over the area.  If you don’t know how to hand express, here’s a YouTube video.  This is an incredibly valuable skill.

Once I get to the point where I can look really closely and see the pore that is clogged (I typically see a bit of white that just isn’t coming out), I gently squeeze on the nipple to work that bit out.  A warm wet washcloth or even getting into a warm bath really helps with this.  Typically, that bit will come out with a POW! and I’ll be able to very easily hand express the backed up milk out.  Massaging at the front of the plug, instead of trying to push it from the back), can also help loosen things up and get it moving.

If you have a clog that you just can’t get out, get help!  Find a lactation consultant.  Ask for help from (dare I say?) your husband.  Don’t let it sit around.  Having a plug long-term is not only really painful, but it can lead to mastitis.

At this point, I’ve got my plug clearing routine down.  But how do I keep from getting them in the first place?

Here’s what I’m doing to try to prevent plugs from forming:

  • Removing milk often (as in, no more skipping pumping sessions)
  • Taking a lecithin supplement
  • Trying to eat healthier, whole foods
  • Paying careful attention to Cricket’s latch
  • Taking a few minutes each day to relax and have some time for myself

So far, this seems to be helping, but I think to a certain extent, the occasional plug may just be part of my landscape right now with my oversupply.  I’m okay with it happening once every few months, but I’m looking forward to a few plug-free weeks.

Here are some more resources that I found on plugged ducts.

Have you had plugged ducts?  How did you deal with them?  Do you have any tricks for getting rid of them?

Keeping up your supply while you’re pumping and working

I mentioned in my post about maintaining my stash that I have seen both sides of the supply coin.  With the Grasshopper, I struggled to keep up my supply.  Now with Cricket I have an oversupply.  My friend over at gratimood (check her out, she’s a fantastic writer), emailed me and asked me how I keep up my supply while I work.

I remember when I had to go back to work with the Grasshopper.  I had so many questions as a first time mom, but my biggest concern was this: How much milk would she need and how would I keep up?  She was a pretty big baby after all.  How could I pump enough milk?

Imagine my joy when I learned that breast milk isn’t based on Baby’s age and weight!  Not even a little bit!  The breast milk grows and changes with your baby, so you don’t increase the bottle size as baby grows.  So forget those complicated weight-based formulas.  Let them leave your mind forever like lost kites in the wind.

Replace that idea with this:

Breastfed babies take in, on average, 25 oz per day.  That’s roughly 1 oz per hour.  So all you need to do is figure out how many hours you will be away from your baby at daycare, and that’s how many ounces you send!  I kid you not.  It really is that simple.  For more help with this, check out this article from Kellymom.com that includes a nifty breast milk calculator.  The idea is this: Baby’s stomach is small.  Big bottles (over 4 oz) stretch out the stomach.  Smaller, more frequent bottles are better.

Here’s how that played out with the Grasshopper:  She was in daycare from 7:30 AM to 5:30 PM.  That’s about 10 hours.  I would send three 3 oz bottles and then I would feed her when I picked her up at the school at 5:30.  I only needed to get 9 oz.  So when I pumped for her, I would typically get 4 oz at the first pumping session, 3 oz at the lunchtime session, and 2 oz in the afternoon.  Those 9 oz were enough for her at school and whatever she didn’t get at school she would make up for at home.

Here’s how it’s working with Cricket: She is also at school from 7:30 AM to 5:30 PM.  With her, though, I am able to go at lunchtime to nurse her, and she wakes often in the night.  I nurse her at around 6:30 AM, pump at 9:00 AM (she takes about 1 oz at school at the same time), nurse her at 11 AM, pump at 3 PM (she takes 3-4 oz at school around this time), and nurse her again at school at 5:15 PM or so.  So I don’t need that much milk for Cricket at school either.  Just 5 oz each day.

That said, I remember with the Grasshopper that it was a real struggle to get those 9 ounces.  We had some pretty serious nursing issues during the first few weeks and she was not able to set up my supply early on.  This is why it’s so, so critical to bring baby to breast as often as possible during the early weeks.  Do not space out feeding.  A newborn eating every hour is letting your body know that it’s time to produce milk.  If you let your baby nurse as often as he or she wants, you’re setting yourself up to have great supply later on.

This brings up another important point:

What you pump is absolutely not an indicator of what your supply is.

I pump a lot of milk these days.  I’m not going to tell you how much.  It’s completely abnormal.  Instead, please read this article about what is normal: http://www.kellymom.com/bf/pumping/pumping_decrease.html#normal

Pumping is a funny thing.  With the Grasshopper, I struggled and struggled to pump enough.  I know that if I could have been with her and allowed her to just nurse, I would have had zero supply issues, but when it came down to it, I just didn’t respond all that well to the pump.  Totally normal.

But still,I needed to get those 9 ounces for her for daycare.  So here are some things that I did:

  • Drank Mother’s Milk Tea every morning instead of my regular green tea.  But really, don’t rely on tea alone if you’re dealing with pumping supply. You’d have to drink gallons of it to really have that strong of an effect. I think the effect of this was mostly psychological, which is okay because with breastfeeding psychology is half the battle.
  • Took herbal supplements.  Sometimes I did a combo of Fenugreek and Blessed Thistle (3 tablets of each 3x/day), and sometimes when I was feeling extravagant, I took the MotherLove herbal More Milk Special blend.  I found the Goat’s Rue to be very helpful.  The tincture seemed to work better than the pill. Don’t do this if you don’t need to. There are a lot of problems that come with oversupply and all of these “natural” supplements have side effects.
  • Took a Calcium/Magnesium supplement from the day I ovulated until a few days after my period started.  I got my period back with the Grasshopper early on, and something they don’t tell you is that getting your period can cause a supply dip between ovulation and when your period starts due to calcium loss.  The Cal/Mag helps with that. This was important.
  • Never, ever skip a pumping session.  This was the most critical thing. Milk production is supply and demand. Skipping sessions gave me more milk the next session, but much, much less milk the next day.  The short-term gain was absolutely not worth the long-term loss.

All of those things really seemed to help.

Below are a few more tips that I compiled for the corporate lactation program that I helped to found within my company.  I’m cross-publishing here because I and other moms within the corporate support group have found them to be pretty tried and true.

Pumping Quick Tips

  • Come up with a pumping plan(when, where, what you do, etc.) and stick to it. Set your times in your outlook calendar so you won’t get too busy and forget to go pump.
  • Pump at around the same time your baby would be nursing or taking a bottle.
  • Pump for a full 15-20 minutes even if no milk is flowing. Remember, milk is a supply and demand system. You have to demand it so that it will be there for the next time.  Please be aware that pumping for longer than 20 minutes at a time can cause breast tissue damage.
  • Typical output is 2-3 oz, so if you aren’t getting 8 oz like some people talk about, don’t worry! It’s normal!  Those 8 oz ladies just respond really, really well to the pump.
  • Feed only what you can pump. Remember, it doesn’t take as much breast milk as formula, so don’t let a formula fed baby’s 6 oz bottle make you feel inadequate. Breast milk grows with your baby, so you don’t need to increase your bottle size.  1 oz per hour is the rule of thumb, so if you’re away for 9 hours, three 3 oz bottles should cover you!
  • RELAX! Kick back, read a good book, don’t try too hard to multi-task if you find it interferes with the flow. Just take the time to relax and think about your baby.
  • Keep up with your pump maintenance. Medela users, don’t forget to change those white membranes regularly. I change mine every 10 days.
  • Don’t shake the milk! Mix the fat back into the milk by swirling it gently and warming it. Human milk is full of live white blood cells that carry your immunity to your baby. Shaking the milk breaks those cells open and “bruises” the milk. It’s precious gold. Treat it with respect.
  • Use slow flow bottle nipples. A breastfed child never needs a faster flow than a newborn nipple. Slow flow, wide mouth nipples more closely mimic the flow from the breast.
  • Go hands free!  Using an Easy Expressions Bustier or a homemade hands-free system gives you the flexibility to do other things while you’re pumping.

Do you have any tried and true tips that help you pump?

How I Manage My Milk Stash

A friend recently had her first baby and asked me about how I store my milk.  As I spoke to her, I realized that I really do have a system that I’ve perfected through my years of pumping.  And yes.  It has been years of pumping.  I pumped for 20 months for the Grasshopper and I’ll likely pump just as long for Cricket.

Before we go one, it’s critical to tell you that you don’t have to have a stash. Most moms pump just enough for their baby for the next day, and that is perfect. I have an oversupply, and I’m struggling with this. It has caused me problems like plugged ducts and mastitis. Having this much milk is just another symptom of that. No one ever has to have a stash. You never have to have this much extra, or any extra at all. Feed the baby, not the fridge.

Pumping takes time.  It takes effort.  Every drop of that milk is precious, precious gold.  I’ve had a few instances where I’ve lost milk, and the guy who came up with the saying, “Don’t cry over spilt milk,” was clearly a dude who had never lactated before.  I take my stash really seriously.

I take my stash so seriously that when we moved cross-country from St. Louis out to California, I packed the entire thing in dry ice, FedExed it priority overnight to my dad up in San Francisco who transferred it immediately into a deep freeze.  He then packed it a second time in dry ice and drove it to our new house in California.  I won’t tell you how much time it took me to research airline regulations for dry ice shipments and how much it cost to get the special vented cooler and the cost of the air shipment out to the west coast.  But I will assure you that it was worth every penny, and if you ever need to ship your milk, drop me a line.

So yeah.  I do not mess around with my stash.

Right now, I am blessed with an oversupply.  This means I am fortunate enough to feed Cricket fresh milk every day and freeze the excess.  With the Grasshopper, I was not so blessed.  I had to fight for every ounce, but the same principles still applied.  So whether you’re pumping an oversupply or freezing what you can, this method can work for you.

Here are a few of the factors I have had to consider:

  • The stash must be compact
  • The stash must be easy to cycle through so that no milk goes bad
  • The stash must be protected so that not an ounce is lost

Before you read further, it you should familiarize yourself with some basic milk storage guidelines from Kellymom.com.

My stashing supplies are simple:

  • An empty milk bottle
  • Lansinoh Freezer bags (I get these in bulk via subscription from Amazon.com)
  • A pen
  • A tray
  • A narrow plastic box that is wide enough to hold the bags of milk (an old veggie stick crisper from Tupperware is what I had laying around)

Freezing the Milk

During the week, I keep the milk I plan to freeze in the fridge at the back. By the end of the week, I usually have between 20 and 30 oz saved up and ready to go in the freezer.  Since milk is good in the fridge for about a week, it makes more sense for me to do my freezing all at once on the weekend.  On milk-freezing day, I get out my bags, a pen, and my milk and start measuring.

The milk storage bags have measurements on the sides.  Don’t use these.  Depending on how you squeeze the bag, the milk level changes making it impossible to tell how much milk is actually in the bag.  Think of these measures simply as milk-themed decorations.  I measure my milk into Ameda bottles.  I happen to have them around and the volume markers are easy to read.

  1. Before pouring the milk into the measuring bottle, you will want to swirl all the fat back into the liquid.  Don’t shake the milk!  Swirl gently until all the fat has come away from the sides of the bottle. This takes some patience so feel free to get a little Zen about it. Relax, swirl, and meditate on the wonderful gift your baby is going to receive.
  2. Pour the milk into the measuring bottle in small quantities.  I measure off no more than 4 oz at a time, and I prefer even smaller quantities (1 – 2 oz).  This is important for a couple of reasons: If the baby doesn’t happen to finish the entire bag of milk in 24 hours, you have to toss it, and overfilled bags can burst when you freeze them.

    Here you can see that I’ve measured out 2 oz. See how easy it is to read the measures on this bottle?
  3. Label the top of the bag with the quantity of milk in the measuring bottle and the date you expressed the milk.
  4.  Pour in the milk and seal the bag.  To get the air out of the bag, try using the edge of a counter or table to squeeze it out.
  5. Lay the bag flat on the tray, tucking the bottom so it lays completely flat.
  6. Continue the process and simply stack the bags as you go alternating top to bottom to help them lay flatter.

    Freezing flat means the milk doesn’t take up as much space.
  7. Pop the tray in the freezer.

Freezing the milk flat keeps the stash compact and easy to organize. I found that when I was just letting the bags freeze in any old shape I wound up with a pile of milk. This meant that I had to dig through the milk pile to find the older milk, and there were a few occasions where bags got lost.  Rattling through the bags repeatedly also meant that I was bumping the edges and increasing the risk of the bags springing leaks. Milk storage bags are fragile and need to be handled with gently.

Once the milk is frozen, I arrange them in order by date by filing them with the oldest dates in front and the date/volume tabs sticking up so they’re easy to read. Yes. I have a filing system for my milk.  How cool is that?  And because the milk has been frozen flat and dated in a way that is easy to see, the bags are only handled three times: filling, filing, and thawing.  Thus we have maximized storage space and efficiency while minimizing milk waste!

Managing the Stash

Milk stays good in the freezer for a while, but after a few months it’s important to cycle through the milk to make sure that the stash stays fresh.  Remember, you worked hard for every single precious drop and you don’t want to neglect it and allow it to go bad.

I prefer to cycle through my milk slowly and continuously.  I want my baby to get at least one bottle per daycare day of fresh milk because the fresh has the antibodies that are current for whatever bug might be floating through the school.  So we cycle through one bag per day until the stash is up to date.  Because I filed the milk by date, keeping it current is easy.

Right now I’ve got 110 oz in my freezer!  Can you believe it?  That’s almost a gallon!  I feel like I should moo. I will be donating some of it very soon!

110 compact ounces. Easy to organize and easy to cycle through.

Do you have a milk stash?  If so, how do you manage it?  Do you get all wild and free with it and pile it up in the freezer or do you organize it obsessively like I do?