MILC Moment: The Truth About Pumping & Dumping

By Rebecca Costello, IBCLC

Pumping and dumping: not being able to nurse, and pouring your milk down the drain, is NOT a fun experience! Mothers are often told to stop breastfeeding and/or "pump and dump" because they are on medications, or needed to have a scan or test (like an MRI). This seems to be widespread - we hear about this advice being given by everyone from dentists to urgent care doctors to pediatricians. And yet so often, when we look up the medication or test, it is perfectly safe for breastfeeding to continue. You poured your milk down the drain for nothing! Moms may pump and dump for hours or days before finding out they could have breastfed all along. Why does this happen?

Which book or website your health care provider uses to look up medication or test safety can make a big difference. One study used a list of 14 drugs that were commonly prescribed to breastfeeding mothers, and looked how many were considered safe in frequently consulted resources. Several resources said NONE of the medications were safe. Others said about 50% were. It turns out, 85% were fine! Many health care providers don’t get any education about which resources are most accurate.

So where should you turn for advice about medication safety and breastfeeding? One option, of course, is WBWC! We often take calls with questions like “I had a CT scan today – they told me I couldn’t breastfeed for 24 hours, is that true?” or “I’m having a dental procedure next week – which pain meds are safe?” Our most frequently used accurate resource is the book Medications & Mother’s Milk, one of the “bibles” of breastfeeding and medication safety. It’s on the shelf in almost every office!

An even more accessible reference we sometimes use – and that you can use from anywhere with an internet connection – is Lactmed, a free website from the National Library of Medicine. They provide information on thousands of medications, herbal supplements, contrast used for scans (try typing “CT contrast” into the search box), and even specific procedures (try “MRI” or “X-ray”). Often the information makes it very clear that it’s safe to keep breastfeeding. If you have questions or concerns about what you read, please give us a call; we are happy to help you sort through it. We want you to continue nursing or pumping with confidence, knowing that you’re continuing to provide the best you can for your baby!

MILC Moment: Breast Massage for Plugged Ducts and Mastitis

 When you get a plugged duct, it may start as a little lump in the breast. It may feel a little tender, and the skin over it might look more pink or red. If it doesn’t get better, it may get bigger and the congestion may start to spread to other areas of your breast. More of the skin might look red. You might feel body aches or chills, or get a low grade fever. If the congestion still doesn’t go away, you might start feeling worse – like you have the flu, with a high fever. At that point, you should definitely be calling WBWC (or your OB care provider) – “Help! I think I have mastitis!”

A round of antibiotics will usually clear up mastitis pretty quickly. But we like to avoid antibiotics if we can, and of course we like to avoid you getting sick! Could we prevent a bad case of mastitis? Plugged ducts, engorgement, and mastitis can sometimes be treated with just our hands - just by clearing out those congested areas before your breasts get really inflamed. A lot of the suggestions you read online suggest getting behind the plug and forcing it forward. We used to do this too, until we learned new techniques from an IBCLC named Maya Bolman, who teaches LCs about traditional Russian breast massage and hand expression, which can work much better than pumping for a plugged duct.

If you’re getting a plugged duct, or if you feel like your plugged duct is getting worse, check out this video for techniques from Maya on how to massage and hand express to help clear your breasts: https://vimeo.com/65196007

All the WBWC LCs, and many of the midwives and nurses, have been trained on how to do breast massage to help clear plugged ducts and breast congestion. If you feel like a plugged duct is getting worse, and you’re not able to clear it yourself, you can call for an appointment to get some hands-on help. If you believe you are getting mastitis, or have mastitis, you should always call WBWC (or your OB care provider) for care. Do not delay in getting care for mastitis, as it can become more serious if it is not treated. Some cases of mastitis require the use of antibiotics for treatment.

We hope that you never have to deal with plugged ducts, engorgement, or mastitis, but if you do it’s good to know that you have some very good tools to deal with them – your own two hands!

Best,

Your MILC LCs: Rebecca, Ellen, Elley, Nancy, and Deborah

MILC at the Women’s Birth and Wellness Center: Mother’s and Infant’s Lactation Care

     We are so proud of the community we have through Women’s Birth and Wellness Center! We recently completed a survey of some of you to see how our community was doing with breastfeeding over the long term. Thank you to all the families who participated in the survey, and our apologies to those who might have gotten the survey in error. It was our first breastfeeding survey, and we learned some extra steps we will use when doing future surveys. We knew there was a lot of breastfeeding going on, but this survey helped us understand just how much there was!

     The results we got were astounding! We knew that our community was special, but this survey quantifies one aspect of what makes it so remarkable.

     We emailed our survey to 416 WBWC families who had babies between 6 months and 18 months of age to ask a short series of questions about their breastfeeding experience. Out of the email surveys we sent, 215 were completed, which was about a 52% response rate. Most of our respondents (95%) intended to exclusively breastfeed for the first six months of their babies’ lives; 28% of those intended to nurse just at the breast, while 72% planned to mix breast feeding at the breast and using pumped breast milk. Five percent of our mothers were planning on breast milk and formula feeding in the first 6 months. No one planned to formula feed exclusively.

     Sometimes, despite the best of intentions, women who plan to breastfeed are not able to continue to breastfeed because of problems, or lack of support. For instance, in one group of about 900 women, when asked prenatally (different from our survey, which asked women to remember what their intentions were), about 75% of the original group of women wanted to exclusively breastfeed. By the end of the first month, 15% of them were still exclusively breastfeeding; the rest had introduced formula or were fully formula feeding. While women who choose to give birth in an out of hospital birth center are different from the general population in many ways, this is one example of what things might look like in other settings.

     In our community, almost everyone who responded to the survey wanted to exclusively breastfeed for the first 6 months. At six months, almost everyone had met their goals. At 3 months, 91.5% were still exclusively breastfeeding; 97% were still breastfeeding but also using some formula. At six months, 85% of women were still exclusively breastfeeding and another 10% were breastfeeding and also using some formula. This means that at 6 months, while some women who hoped to be exclusively breastfeeding were not, we still had a 95% breastfeeding rate. See how different this is?

     Here’s another way to look at it. Let’s compare our rates of exclusive breastfeeding to rates in the United States and North Carolina. ¹ Overall, North Carolina and the United States have better rates of ‘any breastfeeding’ than exclusive breastfeeding. In this category, we have over twice as many women breastfeeding as in the United States, and not quite three times as many women breastfeeding as in our own state. When you look at exclusive breastfeeding, by six months, we are about eight times above the average for North Carolina, and over four times the average for the United States. Pretty good!

Why Are Our Rates So High?

     We don’t know exactly what makes our breastfeeding rates so high, but there are some things that we have built into our care that certainly help. There is a lot of research about how important support is for breastfeeding mothers.  That includes support from other mothers and from health care providers both prenatally and after the baby is born. In our community, most women who responded to the survey (80%) answered that they had received some kind of support. Most of that support was from a lactation consultant (73%), followed by a breastfeeding class (43%), and La Leche League (27%). Some women may have responded ‘yes’ in more than one of these categories. Another is giving birth in a Baby Friendly² facility. Our birth center received Baby Friendly status in 2010 and UNC Hospitals received Baby Friendly status this year. Twenty-nine percent of our respondents gave birth at UNC, and 71% gave birth at WBWC. While UNC wasn’t Baby Friendly at the time that our survey respondents would have given birth there, it was working toward that status, and many of the recommended practices would already have been in place.  Additionally, we know that all of us at Women’s Birth and Wellness Center love breastfeeding, and are knowledgeable and supportive of our mamas when they need help. Whether the birth took place at the WBWC or at the hospital, that love and support was there.

     So there are many things that make breastfeeding at Women’s Birth and Wellness Center work. One is the commitment of the women who choose our center as a place to give birth and the support those women seek on their own. But we also hope that our care is a part of the picture. Most of our survey respondents saw a lactation consultant. Although we don’t know whether that was through the WBWC or through the hospital or community LCs, we hope that many took advantage of MILC (Mother’s and Infant’s Lactation Care), the breastfeeding support network of classes, full clinic hours available for visits with an International Board Certified Lactation Consultant (IBCLC), and support programs that we offer at WBWC.

Thank You

     So thank you again to our community. We appreciate the time you took to communicate with us. Breastfeeding, while it is often natural and normal and completely carefree, can also sometimes be difficult. As lactation consultants, we stand witness to how very hard women sometimes work to achieve their breastfeeding goals. We see families push themselves to the outer edges of their ability to cope in order to maintain breastfeeding as much as possible. It is an honor and a gift to stand with families and witness their bravery and commitment. This is what we see when we, as lactation consultants, see this many women exclusively breastfeeding at 6 months. We see this, and a fabulous community of wonderful families brought together in a setting in which we are proud to participate.

Ellen Chetwynd

Nancy Albrecht

Elley Schopler

WBWC Lactation Consultants

Thank you to the volunteers who worked on this project: Kathy Parry, Meribeth Harlow, and Katie Mills.

1. http://www.cdc.gov/breastfeeding/data/NIS_data/, 2007 data

2. http://www.babyfriendlyusa.org/eng/index.html

What's New at the Boutique

WakeMed Mother's Milk Bank in Need of Donors

      If you are a healthy, lactating mother who doesn’t drink, smoke, or use certain medications, please consider donating your extra milk to the WakeMed Mother’s Milk Bank.  This milk bank, which is one of only 2 serving the entire east coast, is running critically low on milk due to increased demand.  The milk bank is an invaluable resource to our community. They supply donor milk to WBWC, and many of our moms depend on this donated breastmilk for infants who have difficulty latching or gaining weight, or are jaundiced or premature.

      According to WakeMed’s press release, “Most donor mothers find they can begin pumping extra milk (typically four ounces each day) to donate once their own children are a few weeks old and are regularly gaining weight. Donors store the milk in their home freezer, then deliver the milk to WakeMed.”

If you are interested in becoming a donor or have more questions, contact the milk bank  (919-350-8599) or email the program coordinator at suevans@wakemed.org . You can also contact Kerra Bolton at WakeMed Health & Hospitals (919-350-5695) or kbolton@wakemed.org.

We hope our generous community of WBWC families will take this opportunity to help out other moms and babies in need!

Express Yourself!

     Our WBWC lactation consultants have put together a new monthly breast pumping class called Express Yourself! This class will take place on the 4th Thursday evening of each month. The first one will be held April 26th at 7 PM at the WBWC Boutique. The cost is $10. Breastfeeding Basics is a prerequisite.  For more information, or to register for the class, stop by the front desk or call us at (919) 933-3301.

All I Really Need to Know I Learned from Breastfeeding

by Claire C. McKiernan

I was sitting on a futon in a back room of the WBWC boutique on a particularly busy afternoon. Nancy Albrecht, the lactation nurse, had squeezed us (my husband, baby, and me) into her busy schedule for a nursing consultation. I was holding back tears as I tried unsuccessfully to get my newborn daughter to nurse.  She latched on eagerly, but after 20 minutes of “nursing”, she wasn’t gaining an ounce and my breast had not softened. This simply couldn’t be happening. I knew how to nurse; after all, Rosemary was not my first baby: she was my fourth! 

Nancy looked at me reassuringly and stated matter-of-factly: “Every baby has something new to teach you.”

I suppose it was a magical combination of her tone, my mental/emotional state, having my concerned and loving husband by my side, and the innocent sweetness of my newborn nuzzled against me, but Nancy’s words had an immediate relaxing effect. Those words wafted past me like a warm, gentle breeze.

 It was exactly what I needed to hear at that moment and helped me to look past my emotional state and tune into the methods we would need to correct Rosie’s tongue-thrusting habit.  This included tongue exercises, and lacing a tube through a nipple guard to squirt expressed breast milk or formula into the baby’s mouth while she was latched on. The latter would ensure she received enough milk while she was still learning to nurse properly.  I can’t say I wasn’t in tears over this awkward and unnatural set up, but the problem was corrected within two weeks. Rosie and I soon became the relaxed nursing duo that I hoped, and ultimately knew, we would be.

Nancy’s words, however, stayed curiously and contemplatively in my mind. It was true: each of my nursing experiences had been different, yet with time, effort, and faith in my baby and myself, they had all been successful and enjoyable.

My first baby, Christina, had been a natural, nursing before her umbilical cord was even cut. Her latch-on was perfect and she nursed fully and contentedly. I was not prepared, however, for the colic that would soon keep her screaming in seeming distress for hours every evening. The only time she stopped was when she was nursing. I recruited my husband and parents whenever possible to walk her around and give me a 10-20 minute break before her cries pierced my heart so that I would nurse her again. This, somewhat predictably, led to dry, cracked, sore, and bleeding nipples. I dubbed her the vampire baby and sheer determination drove me on. When the colic subsided within a couple of months, the two of us were left with breastfeeding times that were blissfully quiet and precious. She nursed for a total of 14 months, giving us far more happy times than stressful ones.

Christina taught me that the true beauty of a rainbow can only be appreciated after a storm.

Nearly three years later, Thomas was born, and he, too, took to the breast easily and well. The nurse who came for the home visit after his birth weighed him before and after he nursed and was shocked to find that at two days old, he took in a full 7 oz of milk in a single feeding! His eagerness to nurse came at a price. Tom had the delightful habit of reliably spitting up some milk after nursing.  It didn’t cause him any distress but led to lots and lots of wet cloth diapers, bibs, clothes, and sheets. Additionally, he nursed in bed with me from 10pm until 5am every hour on the hour for 20 minutes at a clip for the entire first month of his life! In his second month he gave me a break by nursing every two hours. This time I was more prepared for sore nipples, though I was sleep-deprived beyond expectation. Fortunately, during the day he was a content little boy and he began sleeping through the night by four months. I had nothing to complain about.

Tommy nursed for 11 months, which was half-way through my third pregnancy.  I especially cherished those quiet evenings of nursing and singing to him before bedtime, feeling the closeness of the three of us, the youngest of whom we had yet to meet.

Thomas taught me that there may be hiccups (or spit-ups and wake-ups, as the case may be) along the way, but time is precious and you should soak up every relaxing moment you have.  

When my third child, Peter, arrived, he didn’t have colic or spit-up issues, and “only” nursed three times per night, on average. Life with three kids all born within four years was…exciting. The relaxing moments were far and few between, and I didn’t take the time to air out my nipples after feedings as I had in the past. The outcome of a rushed and hectic life was an excruciating infection, for which the midwives prescribed a nipple cream. Nursing that week had me wincing and literally brought me to tears at times. But again, we survived it. I had no fears that I would need to stop nursing entirely, I just desperately needed to get past this.

 I remember remarking to my husband that I couldn’t wait for Pete to be three-months-old. I knew that, right around three months nursing, would be less around-the-clock, have a more predictable, settled-in sort of feel to it, and that’s when it would become a truly enjoyable and relaxing series of breaks in the day. I had read that more American women were opting to breastfeed, but I wondered how many give up just when they were about to turn that crucial corner? Pete also nursed for 11 months.

Peter taught me to slow down, prioritize, and look forward to the future.  

          Rosemary came along three years later. Within a week of her birth I was visiting Nancy with nursing issues that I never thought I’d have.

          “Every baby has something new to teach you,” Nancy said.

Weeks and then months passed and I found those words continuing to settle comfortably and deeply in my heart.  I doubt she realized at the time the meaning I would attribute to those words. It is true of every baby, every child, at every stage. It is a very freeing reminder to any responsible and dedicated parent to occasionally sit back and instead of being the teacher, be the student.

So, what did Rosemary teach me through breastfeeding? Well, she just turned two-years-old this month and she’s still nursing before bedtime. She taught me that the more kids you have, the more you realize you don’t know as much as you thought. 

Breastfeeding, as with life, can be unpredictable, uncontrollable, and ever-changing, but if you hang in there it can also be vastly rewarding, edifying, and very, very sweet.

Like Your Lactation Consultants!

 by Ellen Chetwynd, RN, BSN, MPH, IBCLC

Breastfeeding usually works beautifully, but when there are difficulties, it’s nice to know that you have lactation consultants available who can help. WBWC has three IBCLCs (International Board Certified Lactation Consultants) on staff, available five days a week. They see women who gave birth at the WBWC and women from the surrounding community.

 North Carolina has a very active Breastfeeding Coalition. “Like” ‘North Carolina Breastfeeding Coalition’ on Facebook to stay informed about breastfeeding and IBCLCs in North Carolina!