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Many mothers will be able to relate to this experience. The experience looks the same; a routine infant check up appointment, baby gets a weight check, the parents are asked some questions about development, etc. Upon looking at the weight, it is determined the infant is not gaining weight as expected. What does this mean? What is the cause? What should be done? It often is quite shocking to parents, especially mothers, to hear this news. They are perplexed because they thought feeding, usually breastfeeding, was going ok. How is it possible that baby isn’t gaining weight? How is it possible she didn’t know that baby wasn’t growing as expected? Can anything be done?  Common reasons provided for this phenomena is that mom has low milk supply, baby isn’t getting enough hind milk or baby is too sleepy and isn’t feeding often enough. I don’t think it is quite that simple.
What I find in these scenarios, because I get calls often after an experience like this, is that what is not communicated to the parents is why we do these checks, why they matter, what they mean and what should be done with the information. The simple answer is that we expect babes to maintain their own curve that they plotted on at birth (or more ideally 24 hours). When babies start to drop off that curve, this gives us a sign to look and assess what might be happening. This is a clue to ask some more questions and see if there are other pieces that can help tell us what might be happening. We want to know more about feeding behaviour, mood, output. Often what I hear is that there is no way baby needs to eat more. They are happy, content, sleep well, don’t really fuss. The opinion is that there is no way it is possible the baby isn't eating enough. People expect a hungry baby to cry, be irritable, to unsettled. I am going to say this is simply not true. I am sometimes more concerned about that “good baby” that sleeps well and always content. A very misunderstood piece of infant wellbeing is that weight gain influences appetite. What I mean by that, is that if a baby is gaining well, they demand to fed and show signs of being hungry regularly with easily identified feeding cues. What we think is a content baby because they have a calm mood, could be a baby who is content but not getting quite enough intake. A baby that is lower weight than expected, will have a lower appetite and will in fact cue less to be feed, will have subtle cues, likely won’t have a late hunger cueing & overall may make little fuss about it. If mother offers they will feed, but commonly have short feeding sessions. When they are being feed, their appetite is low so they do not do an efficient job, leading to milk being left in the breast and the body slowing down production. I give the example that if they are getting 70% of their intake requirement, they will eat at 70% efficiency (this will very baby to baby). This over time can cause a low supply, which influences their feeding because babies like flow...so low flow, means less interest in feeding and the cycle continues. If none of that concern is explained to a family, they leave these routine visits confused and bewildered as to why some one had a concern or what they could/should do about it and have no idea why it happened in the first place. There are lots of factors to consider to understand why this is happening & what the appropriate action for each case should be. If you are experiencing a difficult feeding situation where weight gain is a concern, booking a consult with an IBCLC is advisable. With a good assessment by an IBCLC, the root cause can often be determined and a solid plan can be put into place to get the baby fed, get weight gain concerns addressed, increase milk supply, maintain breastfeeding, etc. Other things to note in cases of lower than expected weight gain could be:
The first 6 weeks of breastfeeding really set the stage for how breastfeeding will be beyond 6 weeks. This is why it is so important for new mothers to seek help as soon as trouble arises, but even more so, knowing what trouble looks like. If someone has never breastfeed before, they may not to be well equipped to know what is normal & what is a sign of struggle. And even when everything goes "right" in that 6 weeks, breastfeeding is still challenging. Not only are mothers learning to breastfeed, along with their baby, they are also recovering from birth, coupled with lack of sleep and changes in hormones.  This is why I am now offering a 6 Weeks to Success Breastfeeding support package. This will take the guess work out of breastfeeding for new mothers. This package means new mothers are getting early, regular check in's with an International Board Certified Lactation Consultant. This package is designed to prevent breastfeeding stress and anxiety and rather build confidence and empowerment. Instead of waiting for problems to arise and then second guessing what to do and who to call for help, possible difficulties will be detected and strategies can be implemented early. If trouble starts to arise, new mothers will know someone is scheduled to come without having to decide they need help & begin to seek it. Sounds good right? So what are the details of the program?
Space is limited for this package offering. The estimated value of this package is over $900. From now until Dec 31, 2018 I am providing this package for an introductory cost of $500. This means 6 visits with an individual value of $75-150, for one price of $500. If you are expecting a baby after Dec 31, you can still take advantage of this price. You can book your spot now.
Has someone suggested to you that your baby isn't gaining weight as expected and the solution is to get baby to ingest more hindmilk? It has become common knowledge that fat content of milk changes throughout breastfeeding. This is true. Milk doesn't change in each feeding session in the same way...it changes over the course of the day and feeding patterns. The anxiety about whether or not baby is feeding "long enough" to get to the hind milk is not necessary.  Something else that is true is that the longer a baby feeds, the more letdowns occur and more fat is released into the milk from the milk making glands, however...there are some things that need to be pointed out and kept in mind.
Foremilk and hindmilk are not two different kinds of milk. Women do not produce a low fat milk and a high fat milk. It is simply that the first milk a baby receives at the start of a feed is foremilk and the milk after that is hindmilk. The change is gradual It is not based on a percertange of fat content, like skim, 1%, 2% or whole milk that we are used to thinking of. There is no magic time in a feed that changes the fat content or we can see a switch of kind of milk. There is no percentage of fat a baby needs to be able to gain wright. On this note, all the foremilk is not always lower fat than all the hindmilk. Foremilk from one feed might have a higher fat content than hindmilk from the next feed, previous feed or other feeds in the day. With this all in mind, when there is a weight gain concern, the focus needs to be on increasing intake of milk and looking at the factors that might be impacting intake & not trying to avoid foremilk. Strategies to avoid formal and increase hindmilk consumption are ideas like pumping foremilk before a nursing session, so baby can only access hindmilk or keeping baby on one breast for 15 or 20 or 40 minutes, depending on who is giving the instructions. In fact, sometimes these strategies means the baby is getting even less milk than before. It is the total daily milk intake that determines successful weight gain. We cannot look at one feed as the way it is for all feeds. We need to look at each day and all the breastfeeding sessions combined and then address ways to increase milk intake overall. If you find yourself in the situation of having an infant that is not gaining as expected, not gaining at all, slowly gaining or losing weight, I suggest a full evaluation with an IBCLC. Let's talk about breastfeeding pain. I have a theory. Some others might share this theory. Some might think I am crazy. Pain in the body tells us to pay attention. Pain isn't always bad, but its a way the body signals to the brain to pay attention. It can be *pay attention* because something is wrong, or *pay attention* because this needs your focus. Pain is not always a bad thing, per say. Like birth, for example. Birth can hurt (it doesn't always, believe it or not). Birth is a great thing, not like illness or injury that make you feel pain, but that first contraction will kick you in the @ss as a way to say "Something BIG is about it happen. Pay attention. Cancel all unnecessary things. Put down your phone. Tune into your body. Get your people here."Birth pain doesn't necessarily need attention or anything done to stop it once we are paying attention to the process. Sometimes, it does. I think breastfeeding pain is similar. Either something is needing attention, like baby isn't latching well, position is off, baby isn't getting enough milk, baby is losing weight or maybe it is a message we just need to connect with baby, release some emotions, get hormones flowing, get on the same page, figure some things out, get a groove going. But breastfeeding pain shouldn't be ignored, or accepted as the way it is, in my opinion.  Breastfeeding pain I love talking breastfeeding and I really like talking the history of breastfeeding. When people find out I am an International Board Certified Lactation Consultant, they often respond with, “you’re a what?”. As I continue to explain what I do they say “seriously? People have trouble with breastfeeding? How is it that the human race has made it this far if it weren’t for breastfeeding?” Oh, goodness, what era do you want to talk about? I mean there is so much history about how breastfeeding can fail and what resolutions people had for that, depending on the era and the region. We are part of another era and in the middle of history. I call the time before where we are right now “Before Tongue Tie”. Really, as an IBCLC of just shy of a decade, I had MINIMAL education on tongue ties and their impact on breastfeeding. Like a dismel amount. Then several years ago, I attended a few conferences, online, in person, different geographical locations. Everyone was talking about tongue ties. I said to myself and to others: “Can we not talk about anything else?” “There is no way there are this many tongue ties” “Did we even know anything about breastfeeding until now then, if tongue ties are to blame for everything?”
They had different potential solutions. I come into all of this ready to learn and see if we can address some of the challenges that faced breastfeeding families that didn’t seem to have resolve. Much of what I was learning was that there was hope for these ongoing struggles that my previous education and training didn’t teach about.
I dove in. I recruited other professionals as supports. We networked. We shared experiences. We re-evaluated. We want the best for families. My job as an IBCLC is not the same as those other supports and professionals but I want to share some of my learnings and reflections. I know tongue ties cause a lot of issues. I will not deny that, but I will say that just “getting it snipped” or getting into a dentist for a laser revision isn’t a guarantee things are going to be resolved. A really key piece I have acknowledged is how much better babies that are at an appropriate weight recover and catch on to breastfeeding post-revision compared to babies that are underweight or slow gaining, maybe gaining weight a little faster than what is called a slow gainer and who maybe is not getting much concern from anyone but still not growing on “their curve”. Doing a revision on these babies is something I really hesitate to do now and I won’t make a recommendation for revision until resolution has occurred in the weight department. This to me a really good reason to be working with an IBCLC before hand. Another really important part to working with an IBCLC is to assessing milk supply. Babies respond to flow and without that flow, they just won’t want to try and improve anything. Add in a tongue tie and they just don’t care to breastfeed nicely or at all. If supply is low, again even with a revision, they just are not happy breastfeeders. Both this scenario and the above one make people say “the tongue tie wasn’t the issue” and sometimes add in that “they did the procedure for nothing”. Being able to get moms working on supply, which in turn can help the weight gain issue, if it exists, helps ensure that once they get those two factors sorted out, they are ready for revision and have a good foundation to make the revision successful. The pieces fall into place nicely and almost predictably. It also helps me be able to tell a mom a timeline for “when will this all be better”. I can help them set up a plan so they can see a means to an end, rather than “just keep trying, it will click soon”. There is also maternal pain that is often a concern and should be addressed INDEPENDENTLY of a revision. Sometimes tongue ties cause pain, damage & trauma to mothers breasts and can be resolved with a revision, but ideally more should be done to address this instead of just waiting for things to get better. When we deal with the breast/nipple independently, it makes the revision seem significantly more effective. Babies can have other factors/stresses affecting and influencing breastfeeding that are often identified by IBCLC’s or professionals who assess physical factors, like Chiropractors or Osteopaths. I also find when we resolve these issues first, or at least start working on them, that things get back on track faster post-revision. Sometimes I am not consulted until after a procedure for a tongue tie has been performed. When I get called after, I can most certainly still help and we can get past these remaining pieces, it just is in reverse. What I find though, is it is all a lot more stressful for moms and families because they also have a cranky baby and after care exercises to get in, as well as possible pumping & supplementing, and perhaps appointments with the other professionals we work with. I personally think It is better when I can set up a plan in steps with one focus at a time. Once supply and weight is up, it is one less stress, so the family can handle the stress of the aftercare and extra needs of the baby. I am also aware that some parents would rather not go through a revision at all and this is where my “Before Tongue Tie” experience and knowledge comes in. I say to the parents and myself, “what would we have done BTT?” Are there strategies that would be useful and address the concerns? Sometimes there are solutions that the parents are 100% ok with and will get the baby fed and minimize concerns. Sometimes all of those are tried and the revision conversation might have to happen again. This is where knowing the risks to the situation and knowing what else to watch for is important. Tongue ties are a topic that people get really excited about from many different perspectives and I don't see that changing for awhile, but I wanted to raise the thought that we are in a place of breastfeeding right now that in the years to come will be a historical recollection. It might be known as something more eloquent than BTT but until then we can recall what it was like BTT. Canadian Pediatric Society no longer recommends this practice from the late 1800's (it is now 2017)9/6/2017 What is that eye ointment babies get after birth and why do they get it? It is erythromycin and it is for prevention of severe eye infections in newborn babies. This routine practice has become outdated and no longer recommended. This might be a topic you would like to have a conversation with your care provider about. Neonatal ophthalmia (NO) is a relatively common infant illness & is defined as conjunctivitis occurring within the first four weeks of life. This term originated from cases caused by N gonorrhoea, but the term now currently refers to any conjunctivitis in this age group. In most instances, neonatal ophthalmia is a mild illness and can easily be treated case by case once infectious conjunctivitis is determined & distinguished from eye discharge secondary to blocked tear ducts and from conjunctivitis due to exposure to some kind of irritants or chemicals. The exception to this is ophthalmia due to infection with N gonorrhoea. Those cases are quite dangerous for infants.  Historically, the purpose of prophylaxis treatment with Silver Nitrate at birth was for neonatal ophthalmia eye infections due to N gonorrhoea. But when I say historically, I mean the late 1800's!
A lot has changed in Canada since then and the Canadian Pediatric Society is no longer recommending routine prophylaxis for neonatal ophthalmia. The primary reason is that N. gonorrhoea strains isolated in Canada are showing considerable resistance to the treatments routinely used and there are no recent studies of the efficacy of ophthalmia prophylaxis with these treatments. You can see the position statement, complete recommendations from the CPS and the history of NO, risk factors & legal considerations depending on where in Canada you live on the Canadian Paediatric Society website. Doulas have become increasingly popular over the years. The popularity has grown in Regina due to the benefits of expectants parents having a doula and that more people becoming doulas, making more doulas available for families. Doulas benefit anyone who feels they would like to receive additional support, regardless of how or where they choose to give birth and with whom they choose to do so with. Looking for a doula can be an overwhelming task. How can you know when you have found the doula for you? Have you identified factors that are important to you or maybe you don't know where to start with that? I am going to highlight a few things that might be important factors.  During prenatal visits your doula should be able to help you figure out what is important to you. You, and your experience, should be the doulas priority. My goal as a doula is to provide comprehensive care, along with the team you have put in place, to cover your own birthing needs. In order to do that, we figure out what is important to you we spend time prenatally discussing many things - things you might not think impact your birth experience, but things I know from my experience as a doula, that do make a difference. I have developed consistency in my communication with each client that helps me to connect with you and then equip you with the tools and information to meet those goals. I can help you navigate through the many different childbirth education options, provide informational and evidenced-based resources to add to your confidence and empower your decision-making. I have exceptional relationships with local resources for whatever you may need during pregnancy and parenting that is beyond my scope as a doula or an IBCLC. Prenatal appointments occur as needed, giving you that vital one-on-one support. Typically you would meet 2 times for about 2 hours each time. Telephone and email communication is encouraged between appointments and after care provider appointments. I go on call immediately for you and am available to you from the minute you hire me. I do not wait until 38 weeks to go on call for you and I remain on call past 42 weeks, if needed. Babies are unpredictable and so well I do book other clients based on the average woman delivering between 38-42 weeks, I am on call before and beyond those weeks. Once you are in labour my role is to empower you & encourage confidence in communication with your birthing team. Remember, I will have provided information & tools to help you make your decisions in your pregnancy for the time of birth, so you are confident in your ability to do this. I will provide emotional reassurance, physical comfort and informational support from the beginning of your labour. I will stand by your side during active labor and stay with you while you greet your baby into the world, providing reassurance. I am a support for partners, as well. Partners are the primary support & I will continue to support the partner in that role. This is your experience and a doula is simply a secondary support person for your whole birth team. If there is no primary support person, or your support team does not want to be the primary support, or simply needs a break, a doula will step into that role. I will stay with you during your first breastfeeding experience to provide assistance and encouragement. I will then come see you again to check in and how things are going and provide additional support where needed 24-48 hours after the birth or sooner if requested. I can provide additional hours of postpartum care and exceptional breastfeeding support, if requested. I do have a variety of packages available to ensure you are getting what you need. Don't wait to get the support you desire for yourself and your family & get the best care possible during this time. Contact me to book a one hour complimentary consult to learn more about how I will do my very best to ensure the most positive of experiences you can have. You can fill in the form below or just give me a call at 306-550-6143.
Earlier this week you might have seen my Facebook Live discussing what I am calling a guise for breastfeeding support. What is really happening when the sponsorship of events is by pump companies or formula companies/pharmaceutical companies.
I want to be *explicitly clear* that this is NOT about individuals. This is not about the idea or execution of such events. This is not about women supporting or not supporting women. This is not about businesses who chose to plan events. This is not about businesses who participate in events. This is fully about the sponsorship by the companies covered by the WHO Code. (and I promise you they all know about the WHO Code and how that impacts their relationships). So, what is the WHO Code?
The WHO Code is the common wording used to refer to the International Code of Marketing of Breastmilk Substitutes. The Code was adopted by World Health Assembly and UNICEF in 1981. Since that time, a number changes have been made with the Code.
The purpose of the Code is to protect breastfeeding, to protect all mothers and babies, regardless of their desired feeding methods, and to prevent aggressive marketing practices that often interfere with mothers meeting their own breastfeeding goals. Infant formula, feeding bottles, and artificial nipples are the main products that fall within the scope of the Code. Breast pumps are not under the scope of the Code BUT some pump companies violate the code because they market bottles and artificial nipples. Again, the Code only applies to the marketing of these items–it does not affect whether they are sold or used. Confusing, right? What did I have to say?Confused? Of course you are!
The Code itself can be confusing, but then try to figure of which companies are WHO code Compliant and which are not is a whole other task. Companies come in and out of compliance all the time. Something that commonly happens is large companies merge, or enter into marketing relationships with each other and they also acquire departments from other companies with buying, selling and trading.
Then we have to consider who are the "kid" companies and who are the "parents"? Companies who are owned by Code violators are considered the same as their parent company. You really have to dig deep to find out a lot of this info, but if you start goggling different brands of formula, medications, infant supplies, etc you start to see that there are a lot of kid companies and just a few parents. The parent companies, of course, want to keep their smaller companies WHO Code violating record clean so that health care workers who have to adhere to the WHO Code can still have relationships with these companies, while the parent company gains benefits. They can also give items and samples not covered by the WHO Code and maintain compliance. But in the end, they are still violators. As an IBCLC, I need to educate people about the WHO Code and marketing. What I am encouraging people to do, all across Canada, is to just keep their eyes open a little bit to who is hosting events, who is sponsoring events, what is that relationship like, who is providing the educational piece & decide if the information being given is evidence based and helping mothers meet their breastfeeding goals or if the information might be slanted. You will see a large variety of how these events take place and some will be absolutely ok and some are going to have questionable practices. 
This is not about you and it is not about me.
Again, none of this is personal. None of the individuals involved did anything "wrong". It is not an individual issue. This is a nation wide issue. If one baby store is approached to host an event, any baby store could be being asked. If any doula is asked to be at an event, it could've been any doula they approached. If any nurse is involved, it could be any nurse approached, It happens to doctors, chiropractors, pharmacists, or even IBCLC's. It is anybody who is nice and kind and is buying into the idea of hosting an events for moms to offer support and companionship and education. That in itself is a fabulous idea and needs to happen! I will say people are ALLOWED to do this. As an IBCLC, I choose to adhere to the Code so I will not participate I do let people know that if that is breastfeeding matters to someone else in their profession, they can choose to adopt to follow the WHO Code. I am not here to tell anybody how to run their own business. They CAN participate and have relationships like this if they chose to. But I will always protect breastfeeding in my community. True breastfeeding support does not come from WHO Code Violators.
I want this to be heard by everyone because if the doula/nurse/doctor/pharmacist or IBCLC, asked to participate this time walked away, the companies will just go to find another one. This also applies to educational events for professionals so not only do we look down, we have to look up. I want parents to hear this so if they go to an event they can also see who is providing the funding for the event and the information. Eyes open! Do you remember that time I told you to throw away the Lanolin? (You’re welcome) I am here again suggesting you keep again breastfeeding old faithful on the shelf! At bare minimum before taking fenugreek to help an unsteady to low supply keep that bottle of fenugreek sealed until some further investigation as to why you might need something to boost supply is started.  Should I use fenugreek to post my breastmilk supply? We are starting to learn that fenugreek may not actually help a supply but also can be quite harmful for many mothers who are struggling with a low supply, depending on why the supply is low. The very reason supply is low can be a contraindication for use of fenugreek. For your own safety, you need to know the reason for the low supply, before taking fenugreek. Of particular awareness would be mothers with thyroid concerns, PCOS, IGT, diabetes, insulin resistant type health concerns. Women who has just had babies may not aware of or have an official diagnosis because until that time they have been mostly healthy. Sometimes it is not until the stress of a pregnancy and birth and early postpartum has an impact on the body that women start to feel unwell. And they might not even feel unwell, but just not be making a full supply. Producing milk is not a necessary part of living, so if the body has stressors, often production is suppressed. Breastfeeding truly is a time in life where a mother needs to take care of herself in order to be able to take care of the baby.
I think “breastfeeding issues” are sometimes breastfeeding issues but I also think that often time struggling with breastfeeding is just a symptom of something else. Paying attention to your supply as an indiction of something else, might actually help you understand more about your body and its personal needs. This is not to say there are not good herbal options for supply, because there are. It is matter of knowing what is happening with your supply and body and having a health history taken or worked up, so that the right herbal for each individual can be chosen/suggested. It might just be fenugreek for you. But, there is a good chance there is something better. |
Kim Smith
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