Something I hear often is: Breastfeeding is natural. I don’t understand why people struggle so much. If it was hard, the human race would have failed to exist”.  

​It's a natural process that has been practiced for thousands of years, and yet, it can be incredibly challenging for many new moms. Let's explore why this is the case and why it's important to approach this topic with compassion and understanding. Breastfeeding is undoubtedly a beautiful and intimate way to nourish and bond with our little ones. It provides numerous health benefits for both mom and baby, and it's a journey that can be incredibly rewarding. However, it's essential to acknowledge that it's not always a smooth sailing experience for everyone.
​
Throughout history, women have faced various obstacles when it comes to breastfeeding. From latch issues and low milk supply to painful nursing sessions, these challenges have always existed. In the past, when breastfeeding didn't work, babies sadly suffered, and infant mortality rates were higher. Thankfully, with advancements in medical knowledge and support systems, we have been able to decrease these rates significantly. This is a dark part of history we do not acknowledge. 

So, why is breastfeeding so hard if it's a natural process? Well, there are several factors at play. Firstly, every mother and baby dyad is unique, and what works for one may not work for another. It takes time for both mom and baby to learn and adjust to this new experience. Patience and support are crucial during this period. 
Additionally, societal pressures and unrealistic expectations can add to the difficulties. The pressure to exclusively breastfeed can be overwhelming, leading to feelings of guilt and inadequacy when faced with challenges. It's important to remember that every mother's journey is different, and there is no one-size-fits-all approach. What matters most is the well-being of both mom and baby. Did you know a large percentage of my clients are supplementing but many fear admitting this to me. 

Let's approach this topic with compassion and understanding. Instead of judging or shaming, let's offer support and empathy to those who may be struggling. 
To all the moms out there who have faced or are currently facing breastfeeding challenges, please know that you are not alone. Reach out for help, seek guidance from lactation consultants, and surround yourself with a supportive community. Remember, what matters most is the love and care you provide to your little one, regardless of how they are nourished.

Let's continue to educate ourselves and others about the realities of breastfeeding, celebrating the successes and supporting each other through the challenges. Together, we can create a more compassionate and understanding world for all moms and babies. 💗🤱

“Hey Kim! Is there a place in Regina that I can donate frozen breast milk. I have so much more than I need and don’t know what to do with it.” This is a common text or email that I receive. The short answer is “Yes”.  There is a formal route and an informal route. 
​
Northern Star Mothers Milk Bank in Calgary is the closest milk bank that we have to donate to in a formal manner. In Saskatchewan, we do have several depot drop points for approved donors. Approved donors; what are those?  Mothers have to be screened and approved before they can donate to the milk bank or take to the milk depots. You can see eligibility criteria here.  If you are eligible you can start the intake process. You do need to have 150 oz to donate to a milk bank. At the Northern Star Milk Bank donated milk is pooled, pasteurized and tested. This milk is then provided, at a cost, to sick babies in hospitals and homes around the country The costs are cover the expenses of the milk bank, not for profit. ​

Taking a breastfeeding class with an International Board Certified Lactation Consultant (IBCLC) could help prevent many of the problems that mothers experience early on. A class will highlight common concerns and give you solutions to implement right away. You can also have the opportunity to ask questions that are individual to you. It also helps you establish a relationship with an IBCLC so you can feel more confident calling for help at the first signs of trouble. You will also learn about unique hospital policies and procedures. ​

Have you ever expressed breastmilk? What does it look like? Have you expressed more than one time? Did your milk look the same each time? I suspect it varied from thin, watery and blue, to yellow and thick. Did you notice a difference with the time of the day you pumped? How about before a feed or after a feed?

What does the research say?  In point form the basics are: 
·   As the baby feeds the content of the milk the baby receives is higher in fat
·   Each feeding can vary in fat content over the course of the day
·  The fattiest part of one feed might actually contain the same fat content of the start of another feed
·  Milk is milk; no real need to differentiate foremilk and hindmilk. Some is more concentrated, some less so, but your baby needs it all.(Hindmilk would be better called "concentrated milk" and foremilk "dilute milk")
·   Babies all stay at the breast for different lengths of time and what satisfies them varies
·   The breast is not a reservoir. It is never “out” of milk. If babe hangs out nursing more milk will “let down”. If you switched breasts milk may flow faster because more milk is in that breast, but there is no rule to have to take a baby off one side to put him on the other because of foremilk and hindmilk. Yes, if we want "moremilk"

Is there a time when we might pay more attention to foremilk and hindmilk? 
·  Is there an issue with baby sleeping at the breast?
·  Is there an issue with baby being fussy at the breast?
·  Is there an issue with babes weight?
·  Is baby swallowing at breast?
·  Is baby relaxed, with wide open hands and content at the end of feeds or no? 

If there are any of these types of concerns, seek out an IBCLC to address the concerns. It may be somewhat related to the so called foremilk/hindmilk. It can sometimes be ONE factor to take into account for the whole picture when some of the above issues are seen. But it would not solely be a foremilk/hindmilk issue.
​

  
I don't want a mother to feel guilty, but I do want her to recognize her feelings about her situation. Feelings are not negative. Feelings are just feeling.  And we need to feel to work through the struggles. 

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. ​

Again, none of this is personal. 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! ​

What is a Lactation Consultant, LC, IBCLC?

The term lactation consultant or LC has become the known, accepted title for a professionals with expert knowledge in breastfeeding. They may work with moms and babies to address breastfeeding issues and concerns. They may also teach classes, assist with establishing breastfeeding one on one, and promote and protect breastfeeding through policy, procedure within health care and government.

Origin of the term “Lactation Consultant

The accepted term for “IBCLC” or International Board Certified Lactation Consultant in many geographical areas is "LC" or Lactation Consultant because, as you can see, that term is a mouthful. 

“LC” is not trademarked and does not hold the professional standard like “IBCLC” does, so one will occasionally find a practicing LC who is not an IBCLC. Consumers (mothers and families) and other professionals (doulas and doctors) need to be aware of this.
​
As well, not all those who work as “lactation consultants” in health centres or breastfeeding support centres are IBCLCs. Some employers encourage employees to pursue the credential but don’t mandate it for employment. Many times, nurses with some basic breastfeeding education fill these jobs. 

Why is this IBC part so important?
The International Board of Lactation Consultant Examiners (IBCLE) awards the title of International Board Certified Lactation Consultant to only the candidates who meet the comprehensive pathway requirements and pass an international exam. This allows IBLCE to establish the highest standards in lactation and breastfeeding care worldwide and to certify only the individuals who meet these standards. ​

This week husband of Florence Leung released an emotional statement about postpartum anxiety & depression after losing his wife two months ago. He also commented about the pressure to breastfeed in the same comments. I commend him for speaking up, being brave, being seen, wanting to improve other peoples situations & for encouraging all new moms experiencing low mood or anxiety or depression to seek help. He added that these mothers are not alone and that they are not bad mothers. I agree and know he is correct. I don't believe there are bad mothers. I know mothers feel alone and isolated. Too many mothers feel this way. They are alone but not alone at the same time. When we pull in the breastfeeding component it gets super confusing and conflicting and very, very emotional. There are so many versions of how breastfeeding plays into postpartum anxiety and depression. Part of it is emotional and the feeling part of our brains and body and some of it is biological and chemically controlled in our brains and bodies (hormones are so complex). Some of this is controllable, in the sense that we can just change our outlook and start to feel better, and much of it less controllable and sort it feels like it is happening TO the mother. It really feels like a loss of control. ​

​If the baby cannot function fully at the breast no amount of time at the breast is going to drive supply. At the same time, we also learnt the breast doesn’t function like we thought it did. The new science tells us we make more milk by emptying the breast more, NOT by letting it get full and empty every 4 hours. Hold on, what? But babies don’t like when the breast isn't full, they scream and protest or fall asleep. They are happy when it is full, let-downs come easy and milk leaks into their mouths. We now understand this all as a compensation for babies inability to function and realize that this routine of feeding can, in fact, cause (secondary) low milk supply down the weeks of feeding. If we address the babies issues, we can have proper feeding, proper demand and proper long term supply. We are starting to make progress with this and changing the idea of low supply. 

What i am not seeing is a change is how we see the idea of oversupply or overactive let down. If the idea of low supply is often being perceived incorrectly should we not consider the idea of overactive let down or oversupply isn't a true phenomena either? Could oversupply also point back to the baby? Is this another function consideration?  I certainly think so. I would like to ask that we consider the let down and supply as normal flow, but, too fast for that particular infant. The infant, for varying reasons (and an assessment would be needed to determine the reason) is having a hard time controlling the flow of the milk. They choke, cough, sputter, leak milk, etc. They might have fast feeds, gain well and seem to adapt to this "overactive let down". As time goes on, supply decreases (we respond saying milk supply is now regulated as nothing was wrong anyway) and soon, the same mom with overactive let down, is saying she has low supply. WHY? Because the baby could not feed correctly from the beginning. They had difficulty at the breast, relied on that fast letdown and now without correct feeding behaviours, just like the low supply moms I talk about above, the demand is not there and so the supply goes down. 

Something else we now know, that we used to say the opposite of, is that a hungry baby will cry and a content baby cannot be hungry, Regardless of weight gain plateauing on the curve, being slow gaining, so long as baby seemed content, no one worried. What we know how is that as milk supply goes down, appetite of the baby goes down. That appetite is the demand we need! So without the demand, we again will have no supply. This is quite a different tale than has been told in history! 

Let's keep chatting! If you think you need some hep navigating your breast-feeding I am happy to book a time to see you and your little one. 

One of the primary reasons women consider encapsulating their placentas is anecdotal information that it can aid in appropriate milk supply. As an IBCLC, of course, I think milk supply is very significant. One of the driving factors of good production is good breastfeeding, early and often. This helps lay the foundation for the days and weeks to come. Breastfeeding, in fact, is one of the reasons I became a doula. We know that better birth experiences also aid in better breastfeeding. I wanted to support as many families as i could through the whole experience, rather than coming in after the birth and trying to catch up. Being there right away at birth and returning within 18-24 hours to see how things are progressing really helps get things off to a good start. Early identification of any potential roadblocks and removing them as soon as possible can make a big improvement to how breast-feeding starts off. ​

 …stop ignoring the bigger issues when it comes to breastfeeding and babies. 

It is no secret I love essential oils. I really, really do. (I am a very committed doTERRA user) It is also no secret that I love helping moms breastfeed, to the point of making a living doing so. But, there are only a few people who know how much I dislike the use of essential oils for breastfeeding related concerns - like low milk supply or fussy, gassy, colicky babies. Surprisingly, it is not because I don’t think essential oils will help with those things. It is because there is almost always something more that needs addressing under those symptoms. 

I am a huge advocate for alternative wellness. I think there are so many options out there for people to maintain optimal wellness and I am accepting of all sorts of options. However, I am also an advocate of knowing what it is one is dealing with when it comes to being off track from ideal wellness and I am especially passionate about this when it comes to babies. The truth is, there are very few people who understand lactation and so even when a mother sees a doctor who tells the mother she has  “low milk” or “baby needs to be supplemented” they are not answering a very important question. That question is WHY? Why is the supply low? Why is baby not gaining as we expect? 

Breast-feeding is the biological expected way to feed an infant, but sometimes it isn’t as easy as one would expect for such a natural act. There are so many reasons why mothers and babies struggle with breast-feeding. We could make a large laundry list of reasons although the little list would be not enough milk or it is/was too painful - sometimes both. Moms should know that they can look into it further & babies deserve that, too!  

There are many reasons for complaints of low supply, weight gain issues, pain, and so many symptoms to tell us that breast-feeding is not working as smooth as it could be, or that baby is not feeling as well as a new baby should. I am thinking of things like sore nipples, low milk supply, low or no weight gain, a baby that is not seemingly full and happy, colicky, gassy, not pooping (YES, babies NEED to poop….disregard all the old opinions that breasted babies don’t poop frequently), not sleeping like a newborn (I don't mean to say babes sleep 8-12 hours a night and that is what you should be seeing. I am meaning naps and being able to be put down for little stints at a time vs a baby that is never settled & always falls asleep at the breast but startles as soon as he is set down).  

These are all symptoms of a mother and baby that could use some help with breastfeeding. And yes, oils could help alleviate some of the stress and reduce the symptoms. I won’t say that they won’t help. But wouldn’t it be nice to figure out WHY this is occurring so that one doesn’t run into more troubles down the road? Using oils to help alleviate symptoms a little bit can make things seem better for a short time but in the long run can delay mothers and babies getting help they need and ultimately can end the breast-feeding relationship sooner than baby would like, and you better believe it, even sooner than a mother may like. When I work with moms and babies that are struggling to keep breastfeeding going and I do a history intake the dyads, so many times there are red flags in the early days. Most moms are told these are “normal” and not to worry, so they do not. We need to start paying attention to the first few days and weeks to make sure mothers are able to meet their goals of months and years of breastfeeding. Don’t just hand out some samples of myrrh for those sore nipples, or some fennel for that low supply or upset baby tummy. Get moms some samples in hand and do mom a favour and give her a  recommendation for a solid lactation consultant (IBCLC) in their area to make sure that 1) the oils would be the right oil for what is going on and 2) help mom figure out why things are not working as smooth as they should be. In the end things are cause breast-feeding issues can also be affecting other areas of life for mothers and babies.  Breastfeeding issues are not isolated to breastfeeding. 

Birth preparation is important! However, you do not need to become a birth expert to give birth. What I mean is, you do not need to commit weeks and weeks and a large number of hours to a prenatal class in order to have a baby. 

What if I told you could attend a 5 hour childbirth class? Yes, simply FIVE hours. There will be some homework, but I believe you are capable of doing this all on your own time. You will get from the homework what you put into the homework! I am there to help you with the homework, too. 

Your Birth Experience is designed to connect YOU with all your childbirth options in a unique way. You won’t find a program like this anywhere else. It is comprehensive yet personalized to you. 

In Your Birth Experience, there is CONNECTION to each expecting family, IDENTIFICATION of their individual needs, resulting in families being EQUIPPED to achieve their unique birth experience.

Everyone receives a copy of the YBE parent guide, complete with colouring pages. Yes, colouring pages. Colouring is a great activity in pregnancy & labour. 

You will learn evidence based information on the process of childbirth and potential interventions. 

You will envision your ideal birth experience and be provided with the tools that you need to make that happen. Note, that it is YOUR ideal birth experience, not mine, or anyone else’s. 

You will learn labor comfort measures & relaxation techniques and we will practice them. 

You will explore and discover your unique personality styles, how you tend to make decisions & how this affects communication.​Communication  is very important in labour and birth. You will be able to create a birth plan that effectively communicates your desires to your birth team. This helps you create the best environment for you and your birth team for your own unique birth experience. 

We will also begin our entrance into the world of breastfeeding in this class. I say begin because there is a more in-depth breastfeeding class that is available. I have them broken into separate classes for a couple reasons - to help make more breastfeeding classes accessible to people taking other childbirth classes & your time commitment, you can break up learning sessions. 

What won’t you find in this class? Videos of women giving birth. You are saying, “What? No videos? Why not?” I can tell you, that as a birthing woman, you will NOT be seeing or feeling birth from the angle or perspective that you will see in the video, so it might not be of any value. Another big reason is most of the support people we bring to classes with us do not want to watch birth, and also, may not be experiencing birth from that angle of perspective either. They are uncomfortable watching videos in a group setting and to be fair and honest, do not digest the content because they are distracted by the discomfort. Birth is a right brained activity, meaning we don't need to see birth to give birth. And another big reason, YouTube is full of birth videos. If you feel birth videos are important to watch, you have hundreds and hundreds available to you. You don't need me to facilitate viewings. We do, however, watch a video about breastfeeding. Breastfeeding is also a right brained activity however does have a left brained component to it, so it is helpful to see breastfeeding when preparing to breastfed. 

You also will not hear about all the complications of pregnancy and/or birth. This is important for a few reasons. 1) I don't want to scare you. We will talk about fear in the class and how fear inhibits labour. 2) If you do have a unique concern in your pregnancy or birth, that is where your trusted care providers are your best resource, not your childbirth educator. I am a resource for you, for sure, but we do not need to discuss ALL the possible concerns, in order to understand the one or two you might be having. 3) Back to the communication I mentioned earlier in this post. I will help you to be able to communicate with your care provider so that you have all the info about your unique concerns. That is important. 4) There is info in the YBE Parent's Guide about possible complications and interventions, so you do have information. We just do not spend lots of time in the class because it doesn't universally apply to all.    

I invite you to the next session of this class and am excited to help you prepare for Your Birth Experience. This class can also be done in your own home, one-on-one, if you prefer that option. Simply contact me to set that up! 

​Do you know what can mimic a tongue tie? Terrible breastfeeding technique can. The number one cause of many breastfeeding concerns or issues is positioning and latch. A good latch is vital to milk transfer. Good supply is dependent on milk transfer. Weight gain, pees and poops are dependent on supply. Swing back full circle to latch and latch is dependant on good positioning. This is true in the majority of cases. Add in that good positioning and latch should also make things easy, comfortable and pain free for mother. It should also make things easy, comfortable and effective for baby. 

When we see concerns with breastfeeding we must start with full maternal and infant assessment. This cannot be skipped. This includes a history on the birth and the start of breastfeeding, how feeding has been going, any know medical issues that contribute to breastfeeding concerns with mom and baby, a feeding assessment including positioning and latch, and structural exams of both mom and baby.

​Sometimes we have breastfeeding issues and concerns that are easy resolved by refining breastfeeding techniques. It can be that simple. Sometimes you will get breast-feeding technique (position and latch) perfect but there is still lots of trouble. We have pain, we have inadequate transfer, we have low weight, low pees and poops, etc. These are times we need to look further. There can be lots of reasons for this but today I am going to highlight tongue ties. 

Tongue tie or poor breastfeeding technique? 

I am all for fixing tongue ties. If they are a problem they are better resolved than to be “pushed on through”. However,  I am more if favour of through assessment of breastfeeding & comprehensive follow up if a procedure is deemed warranted which is why I am drawing attention to this point today. 

Assessment of breastfeeding MUST include watching a feed amongst structurally examination of mothers and babies. And we have to address position and latch. The sooner we do this, the better. Why? Because if we have position and latch causing pain and damage, it is hard to tell if position changes are helping the pain or not. If we have damage and trauma, even a good latch will hurt until that is healed. So, then if look at a baby and see what visually looks like a tongue tie, we start to get blurred lines. The simple presence of a frenum is not a tongue tie. Diagnosing a tongue tie requires more than just looking. It is an assessment of function. Now when we are dealing with breastfeeding infants that function includes transfer of milk, weight gain, position needs, maternal comfort, visual of babies like folds in the lips, blanching of the frenum, blisters in the lips, etc. The people that can assist us in revision of ties are doctors and dentists and I am grateful to have them as part of our team. 

But, let me ask you how many doctors and dentists are watching feeds? How many would know how to throughly assess a breastfeeding session? How many know what to look for structurally in a mother? And throughly for an infant? 

Doctors and dentists that we rely on in resolution of breastfeeding concerns by revising tongue ties are typically only looking for a tongue tie as the reason to why you are presenting themselves to them. Their brains are actually wired to look for a possible intervention to try and resolve the issues based upon their skill level, experience and ability to help. 

Have you heard this quote before? “If you hear hooves behind you, don’t expect to see a zebra when you turn around. Chances are it’s a horse.” 

This means, first look for the simplest, common explanation to the problem presenting first. Once we have done this, then yes, we should go ahead and look for rarer & more problematic causes. In the medical community this is know as differential diagnosis.

How do you know what is causing your breastfeeding issues? 

The most important key is to telling the difference between the horses and zebras. You cannot do this without a through evaluation, by a skilled practitioner. In the case of breastfeeding, these practitioners are International Board Certified Lactation Consultants. We have to be cautious of not assigning more importance to one element of breastfeeding than another, just because we think it is important or because we think the title of a certain practitioner is important or because that person thinks they are so important. There is another term for this which is “availability heuristic”. It is a bias towards things which you deem as more important because you readily recall it so deem it more probable. So, as someone looking at tongue ties most of the time this is front and centre in their minds. So, it is likely a dentist or doctor would go to tongue ties as a common cause of breastfeeding issues.  As IBCLC’s we start at the basics, with the most common explanation of position and latch and move from there. The differential diagnosis mentioned about is what an IBCLC would do. This is why an IBCLC should be a first stop and why I think referrals for revisions of tongue ties should not be done without an IBCLC assessment. 

I bring this up because I am seeing moms & babies after tongue tie revisions who I didn’t see before. I don't know what the baby looked like before but more importantly what I am seeing a little more frequently than what I would like is bad breastfeeding technique. I cannot help but wonder, if we had just corrected positioning, would that have been enough. Did we have a true tie or did we have symptoms of bad technique that are also symptoms of tongue tie. Looking back at the information presented above about assessments, evaluations, horses and zebras & availability heuristic people you can see where my concern is warranted. 

Where do you go from here for support in resolving breastfeeding concerns?
 
Be wise in your selection of care providers when you are struggling with breastfeeding. Step #1 should be an assessment with a skilled IBCLC. From there we will make all appropriate referrals to other members of our team that assist with getting breastfeeding back on track. If you are in Regina or in the Regina area, I would be happy to help you navigate your breast-feeding challenges. You can give me a call or easily book online.

Nipples sore? 


Sore nipples can be one of the more common breast-feeding challenges. You certainly are not alone in this, however, you don't need to remain sore, or worse yet, in pain. Pain at any point is your bodies way of telling you something is wrong and you need to pay attention to yourself. 


What causes soreness and pain? 


Most commonly it is because of trouble with positioning and latch, creating friction, and proceeding them to soreness, cracks, blisters, bleeding and sometimes infections and even lose of skin. 


What can be done? Here are a few quick ideas. 


Most importantly, check your position and your comfort. One of my rules is to make sure mom is comfortable first. Ideally, mothers are slightly reclined, arms and shoulders lose and down, and her neck has the ability to be relaxed. With this, mothers can then bring baby to them. You don't want to try to take your breast to baby. Baby can be front-to-front with mom, being supported by mother’s arms, and mother’s arms can be supported with pillows. Use gravity to help baby get on the breast deeper, rather than sitting upright and having gravity pull baby down or away from the breast. 


If we still have discomfort, we need to check baby’s latch. A good latch is vital to comfort but also to long term duration of breastfeeding. A good latch is key to effective feeding which is essential for adequate milk supply. You might need to ask someone for help with checking the latch. If someone tells you it looks good, but you have pain during or after a feed, you need to ask someone else. 


If position changes do not help with latching issues and soreness and pain are still prevailing sometimes we need to look farther into reasons and makes plans. Sometimes we can use a nipple shield to help protect the nipple and help baby to latch. It is important to get good help if needing a shield. There are important things to watch for such as fitting, proper placement, adequate milk transfer, babies output and weight gain. This is very important to know and recognize however; nipple shields are a Band-aid solution. They are not an answer, they are simply a tool to help keep the baby breastfeeding, at the breast, rather than quitting breast-feeding or going to pumping and feeding another way. It is a short term tool that needs a bigger plan. 


Throw away the lanolin! For years we were told Lanolin was fabulous and all new mothers needed it. But the new research shows us, doing nothing is actually more effective than lanolin and in fact lanolin can delay healing, making things even worse for a longer period of time. Mor effectively you can apply breastmilk to the nipple or coconut oil or calendula if you want to try something else. 


Do not let you nipples be wet and cold at the same time. Again, we were told for years that we should let the nipples air dry. But for mother’s with very sore, damaged nipples, the cool air can cause more harm. It is a good idea to apply heat while the nipple dries. Something like a rice sock or heating pad after baby unlatches, or even when getting out of the shower or bath, can help. This helps bring blood flow to the nipple that previously was restricted. 


Soreness and pain are not considered normal for breastfeeding at any time or for any length of time. If basic positioning and latch changes do not help, it is worth having someone skilled come and have a look. They can help assess and evaluate what might be happening and help you make a plan to further overcome the struggles. 
​

Very few days of my previous career stick with me like the one I am about to share. At the time, I didn’t realize to what extent that day would change my opinion and outlook on many things. 
 
A couple brought their very ill young infant to the emergency room. I was called down to do blood work which was standard procedure. After having a difficult time drawing the blood I returned to the lab to run the tests & analyze the results, hoping to shed some light on why this infant was so ill. 

Some of the initial tests gave results that led to further testing. One of these further tests was a “blood smear”, where we smear blood onto a slide and look at it under a microscope. As I was looking at the smear, I started to think that something was wrong with my equipment or my reagents; something was greatly wrong. My blood smear looked like something I had never seen before. I made a new slide and the same thing happened. I changed all the reagents that could be contributing to the bizarre results. each test gave the same outcome. I needed to accept that this was how this child's smear was. This told me why he was so ill. The baby’s treatment continued. Testing continued. My shift ended. 

I returned the next evening still thinking about this infant and wondering if we had any more answers. I wasn’t prepared for what I heard and couldn’t believe it when I heard it; the infant has passed away, and the cause of death was malnutrition. He had been fed Coffee Mate and water in place of infant formula. I asked myself, as you may be asking yourself, how does this happen? 
 
It turns out it happened, because the family became dependent on the food bank for food, including infant formula. When there was a shortage of infant formula, the parents decided to substitute with Coffee Mate and water. Some will say that it was because they were illiterate and didn’t know the difference. Some would say it was because it resembled infant formula. Some will say it’s because a milk-like product equals milk-like product. 
 
This experience stays with me, and I reflect on and react to the action of infant formula being distributed at the food bank. Food security is a basic need, and, for an infant, it’s one of the few things they need and they need often. 
 
How does formula get to the food bank? Often the samples that are sent to new parents end up there. Women who choose to -and successfully- breastfeed then have these cans and bottles of formula sitting in their homes in dark cupboards, on top of the fridge, and other out of the way places. They know they will never use it, but the idea of letting it go to waste or ending up in the garbage isn’t something they want. They think about all the moms who have less than they do, less support to breastfed and use the food bank - and think that if they take it there, they can help a mom. Moms who need the food bank go there, they say that formula is available, and they take it. That helps the family budget. Formula is expensive and is likely a large part of the financial stress of the family. What’s wrong with that? The samples don’t come consistently and frequently enough to sustain the food bank supply.  There will be times when the food bank doesn’t have a supply of formula but the mothers are assuming it will be available so the income gets budgeted to other items. Now, the food bank has no formula, and the family has no money. They still need to feed the baby. 
 
In my ideal dream world, the supports these families would receive would be breastfeeding support  as well as prenatal and postnatal education. Breastmilk is virtually free. With even suboptimal nutrition, mothers still produce a perfect, free food for their infants. Infants can be sustained for a significant amount of time on just breastmilk.. The recommendation from WHO and CPA is 6 months exclusively and then continued to two years or beyond, with the introduction of solids at around 6 months. In the event of a food crisis, a mother could sustain her infant for the better part of its first year through breastfeeding alone.

The support aspect would be important for that to happen. These mothers also need the education. Many of them believe that without an optimal diet, their breastmilk isn’t good for their baby and that formula is better. All mothers want the best for their babies. They need to be taught that they’re what’s best for their babies. They also need to be taught what normal infant behaviour is. If they don’t understand normal infant behaviour , they  may feel like they’re starving their baby. Without access to infant formula, they would likely plug along and make it work. With formula being free and on the shelf at the food bank, however, they may grab it and feed that to the baby. Many of us know, when we start supplementing, we can quickly lose that breastfeeding relationship. The food bank may continue to have formula or they may not and we end up in situation like the above. How do we feed the baby in this situation? 

The staff at the food bank could use some education on breastfeeding and formula feeding. Many of them may still hold the belief that mothers with a low-quality diet shouldn't breastfeed, that it isn’t good for them or their baby. When formula is available, they may encourage that to a mother who’s breastfeeding because of this belief. 
 
Don't get me wrong here; the issue isn’t the people donating the formula to the food bank. They have good intentions and likely don’t realize the damage that can be done. The issue here is that this is exactly one of the things the formula companies want to happen. They want their products in the hands of the vulnerable new mother and father. This is why they send packages out, and they do it in the manner of “Breastfeeding is best; however when the time comes, introduce formula”. If the time comes to introduce it and continue with it, you will buy the kind that was free and came with coupons and other swag items like a backpack or change mat. It’s all marketing. How free do you think all that stuff was to produce and mail out? Not free at all; in fact, it’s in the high price of the formula. Let’s look at what formula is and why it costs so much. Those sending it out are a business and they need to make a profit.  After all the free packages they give away, they need to increase the cost of formula drastically to make a profit.  They’re so profitable, in fact, that not only are they giving parents free stuff, they buy the names and contact info of  parents from the likes of maternity stores and giving all kinds of free stuff to hospitals and doctors’ offices. When a family legitimately needs formula, it’s so drastically overpriced that it creates hardships for them.  
 
What do I suggest we do with the free samples? I suggest they be returned to the stores where they came from with a note explaining why it’s being returned. Imagine if just a small percentage of moms did this. Would the stores start to think twice about their partnerships if they had a large number of packages to deal with? 
 
Another option is return to sender. I don't think this would have near the impact as the above option, but it would show them that you don’t want their products. 

As far as the moms who need the additional supports and are at higher risk of needing to use formula, there’s a better way to help those mothers feed their babies safely and reliably. 

This should go without saying, but the need to say it is always there. This isn’t about formula vs breast milk, nor about a mother’s choice to breastfeed or not. This is about an infant’s right to quality nutrition and food security, one of the basic hierarchical needs of the human race and a primary building block of children's futures. Breastfeeding can almost always guarantee an infant and child can be sustained.

This is a question the Pasqua South Medical Centre office staff often get asked when they make the recommendation to book an appointment with me. I am going to try and answer that question for you, and them.  The centre staff may actually not know all the benefits of seeing me either. I am "new" to their space, they are getting used to me and gathering experience. They can see the improvements mom and babies are having, but they really do not know much about my services vs the free services. I bet it is safe to say that most people don't know the differences. 

I am going to highlight a few. If you think of others that could be added, by all means leave a comment and I will add them in! 

1) We, the client and myself,  have a mutually agreed upon, prescheduled time. Free clinics often have you come in, take a number & sit and wait for your turn. They won’t likely know how many moms are going to show up, meaning mothers & babies (maybe fathers and other children,, too) could wait for quite some time and then be feeling rushed. They see all the other moms & babies waiting for their turns. At the centre we have a scheduled time, hopefully to your convenience and we allow enough time to avoid feeling rushed. Home visits provide a scheduled time AND the privacy and convenience of your own home. 

2) I simply have more availability and flexibility. Not only is the timing better but you get more options as to when. Again, free clinics might only happen once a week. What happens if your struggles start on the evening the free clinic was being held and you missed it? Or sometimes you may benefit from two appointments only 2 or 3 days apart. A week can seem like an eternity when you are struggling.  

3) I am an Internationally Board Certified Lactation Consultant  (IBCLC). Not all the staff at the free clinics may be an IBCLC. The free clinics are staffed by Public Health Nurses (PHN's). Some PHN’s are IBCLC’s but not all are. I am an IBCLC dedicated solely to breastfeeding, with 10 years of experience helping moms and babies, 5 years as an IBCLC. (By the way, if you use the free clinic, don't hesitate to ask if the person helping you is an IBCLC. If you really wanted to, you could consult the IBCLC directory.)

4) Education is a high priority to me. I mean MY education and I mean YOUR education. I have attended, and continue to attend, a wide variety of additional & extended trainings and conferences. I have a strong ethical background to practice evidence based lactation “science”. I also want to give you enough information about what is going on with you and will answer all the questions you have. We book enough time to be able to do this. 

5) In all my years of experience I have had access to ranges of breastfeeding from normal to extreme difficulties. My initial exposure to breastfeeding help was a peer-to-peer support group where our scope of practice was to help mothers by providing emotional support & information within “normal” breastfeeding. I got to know normal really well and be introduced to some not so "normal".  I was super curious about those not-so-normal cases and pursued my IBCLC. Now I have much more training with the outliers of normal. I am also able to follow my own client cases much more closely to monitor outcomes and refine the plans along the way. This gives me the advantage to know whether the information and care plans I am sharing with clients really work. Often in a free/public setting you will be exposed to different staff member every visit and they do not have that same luxury. They might tell all the moms to do the same “thing” thinking it is best practice and not realize that is not useful for moms to do and they are not getting the desired outcome. 

6) I have direct access to centre physicians if something is outside my scope of practice or comfort zone and we want or need a physician involved on some level. This is especially useful for further diagnostic testing or prescriptions we might want to consider. We have developed some great protocols together and collaboration like this is unique, yet so beneficial and much more efficient for resolutions of concerns. 

7) It is my standard practice to do a through history of mother and baby. We need to make sure that we have all aspects and contributing factors considered when we are determining why there might be struggles. There are more factors to lactation than most people are aware of. I go much further beyond getting a better latch and a better position. We make sure to look at the situation from a few lenses. We pull out the puzzle pieces that might be problematic and piece by piece get the whole puzzle fitting together into a nice picture. 

You should hopefully be able to see what we are offering is completely different from what is being offered for free.  You can count on focused, one-on-one care with a plan to approach the issues that brought you to me. You have the opportunity for follow up with the same person you saw originally and someone that can dialogue or report back to your physician and other care providers. I can help you address the specific concerns you have and reassure you what is the normal course of breastfeeding and give you my expertise with the more challenging aspects, with references and resources from the latest research. I can also make referrals and recommendations easily to a variety of other health care practitioners who may be of value to your specific concerns. 

I look forward to seeing all of you and your darling little ones. Please feel free to book an appointment at your convenience.