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. 
​

You took a class or a training.
Now what?

​What happens if you want to make another knitted item after knitting class? You likely need to read and perform a pattern that is entirely new to you. You need to evaluate if you have the skills to perform that pattern. If you can do it, that is fabulous, off you go knitting. If you don’t have the skills, you have to obtain them somehow. Or alternatively, you have to pass up the project. 
​
What happens if a new doula meets a situation she didn’t come across in doula training? She also has to evaluate if she has the skills to navigate the situation. If she does, she moves along supporting the family. If she doesn’t she will need to obtain them. Or refer to someone else. Sometimes neither happens and both the doula and the client are stuck. 
​
Potential knitting projects are unlimited, just as much so as the different kinds of births a doula will witness. To be honest, I feel a weekend of training or a few hours of knitting with a skilled instructor is not enough to prepare us for everything we might desire to knit or might see and need to support our client through as a doula. We need to understand our limitations of knitting skills just as much as a limitations to our doula capacity. 

Doula’ing also gets treated like a hobby, as knitting would be considered. I think there are a few reasons for this. If we were doing doula “right” then we wouldn't be churning over doulas like butter, because sometimes this is how it feels. We see many new doulas trained every year and very few  stay practicing year to year, and we lose just as many "old" ones in the next 2-3 years from when they trained. We really have no more doulas now than we did 7 years ago when I trained, we haven't changed anything in the community to enhance birth  & increase the desire to have a doula. It is treated like a hobby which does nothing to enhance our professionalism or create a bigger interest in doula to the larger community. There are many reasons why this is, but compare it to knitting again. In order to advance my skill to different projects outside the knitting class I took, I needed more support to continue growing my skills, and I had to seek that out after the class, sometimes in the middle of a project & sometimes before I started a new one. The reality is that many people in my knitting class set the needles down and never returned to knitting after the initial projects because they didn’t know how to get more skills, didn’t know who or where to turn to, or didn’t have the resources (time, money, etc) to do so. 

How to convert being a doula from a hobby to a business?

If people want to move from hobbyist doula to business doula there is also a huge amount of skills needed to be able to this, too. Again, some people come to those skills naturally, some have to learn it and others frankly pay someone to handle business stuff for them. But lots of what we need to do to move from hobbyist to business doula is looking at how we are "doing" doula, what skills we need to improve upon and how to get good client outcomes. Birth is unpredictable - that is the only sure thing about birth. But that doesn’t mean birth just happens to people and they should just roll with what may be. Birth can be a positive experience for everyone. It is time to doula differently. I am up for the challenge to connect to my clients, identify their needs & equip them with the tools they need to meet those needs because Your Birth Experience matters. Just like learning to knit more than basics by advancing my knitting skills and performing the same stitches over and over until I got the beautiful outcome I wanted consistently, I have advanced my doula skills to do similar steps and processes with clients to make sure I understand my clients needs, I am able to perform the necessary steps to meet those needs and consistently get good client outcomes. This isn't to say people and birth are processes and a systems, because I do not believe this is the case, I believe all people are births are unique. Rather what I am saying is that by using systems and processes, I can get to know people and their desires for their unique birth experience. 

If you would like to chat about your desires for your birth, consider booking a complimentary consult. 

                                      YOUR BIRTH, YOUR BABY, YOUR EXPERIENCE

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.

As I am sure you are finding, pregnancy is a busy time, and most of us already lead full busy lives. Trying to get to 6-12 weeks worth of classes can be a challenge, or simply put, undesirable to many people. Some people don't like large classes, don't have the attention span for hours and hours of lectures and videos. Some people like intimate groups where they already know or can get to know other people. 

I am pleased to offer Your Birth Experience, for all those reasons, and more. I am also happy to offer the program in a variety of formats based on individuals needs and desires. 

In group classes, set for 2 hours each over the span of 3 classes (can also be offered in a one day format). I also offer, 5 hour private classes, which can be scheduled in one or two sessions. These would take place in your home & can be scheduled when it works best for YOU! 

All of the options include: 

• your own copy of Your Birth Experience Parent Guide
• evidence based information on the process of childbirth and potential interventions
• envisioning your ideal birth experience and being provided the tools that you need to make that   happen
• labor comfort and relaxation techniques practice 
• discovery of your unique personality styles, how you tend to make  decisions & how this affects communication. This helps you create the best environment and birth team for your own unique birth experience
• Create a birth plan that effectively communicates your desires to your birth team

Your Birth Experience Class is $225 & includes the Your Birth Experience Parent Guide. 
Your Birth Experience Parent Guide is available book to work through on your own. $65 

For more information see Your Birth Experience. 
       

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. 

Canadian parents need some awareness about the health and future health of their children.

It is said about 98% of mothers “initiate” breastfeeding after birth, in home and in hospital. At six months about 26% are still breastfeeding. Stats can be seen here. One of the primary reasons women quit is perceived low milk supply. 

We are all familiar with the arguments of “But, some moms just don’t make enough”, “I will try to breastfeed but if I am one of those mothers that cannot produce than I guess I cannot breastfeed”. Correct, some moms do not produce milk, but certainly not 75% of women. When worded that way, hopefully more people say, “yes, that can’t be possible”.

Many women do have low supply. Low supply does not equal no supply. Low supply does not equal not having any ability to make milk. Low supply can very often be avoided, turned into full supply, or can be worked with in addition to supplementation. Low supply does not need to end all breastfeeding.

What is going on then? That is not an easy answer and cases are all unique and need to be assessed however, there can be underlying answers that are similar or related.  Some examples (the list could be much bigger)

·         Birth experience (trauma, separation, medications)
·         Supports (hospital staff, family, friends) or lack there of
·         Education (parents, grandparents, doctors, nurses, midwives) again, or lack there of
·         Returning back to school or work

We seem to be setting the aim for optimal starts for our babies and children but we are not often striving to reach them. If we become derailed why are we not getting back on track? Luckily, we can get back on track when we find ourselves off track. You need to know this.

We need to get serious about giving our babies the best start. Old arguments do not hold much weight anymore. “I was formula feed and I am ok (fine, survived)”. What is ok? What is fine? What is survived?

We have overcrowded health care systems. And we have normalized this situtaion. Surprising to some, breastfeeding, or lack thereof, can be linked back to the majority of the health conditions that patients have. We need to normalize breastfeeding to reduce the strain on our health and wellbeing. We cannot rely on the system of disease care to be the system that is going to help support our babies getting off on the right foot – being exclusively breastfeed for the first 6 months and continuing to 2 years or beyond as suggested to be optimal buy the authorities of children health. (AAP, CPA, UNICEF/WHO)

It is time to take charge of our own bodies and our children’s future. It is up to us to give our kids the best start that only we can give them.

We need to move past the idea that we have free health care. We simply do not have free health care. We have access to (some) free disease care. Healthcare should be disease and illness prevention. This certainly is not free. We need to start being accountable for our own healthcare. This lack of accountability is why we have maxed out healthcare facilities and resources. If we had more accountability we would make better choices. If the system wasn't so strained right now we could suggest that we start to put disease and illness prevention first, but right now that isn't a priority of the system, even though it is the priority of many citizens. 

With that awareness we need to start at the very beginning of an infant’s life and choose breastfeeding as a key to lifelong health.

There are lots of old arguments. It is time to let go of those. This is not about past choices, which were based on “what we knew then”. We know more/better now and when we know better we do better.

Ladies (& partners and support people), you need to know that there are resources out there to help you, when you need it, where you need it and that will consider YOUR goals. I can come to your home, I can come to see you at the hospital, you can come to my office. If you feel like you are not getting the support you need, when you need it, don't throw in the towel on breastfeeding. There are always options. 

Breastfeeding can take some time to get established. It is a learned behaviour by both mother and baby, and each baby a woman has is a new learning experience. With that said, time is also precious when trying to get breastfeeding established. Some things are normal learning curve experiences and some things are not normal and should be addressed as soon as possible. Mother's almost always know when something is not correct.

I spoke with a mother earlier this week who knew something wasn't right. She asked for a referral to a lactation consultant and was denied. She continued to ask as the days went on and was told repeatedly that what she was experiencing was normal and wasn't yet at the point of needing a lactation consultant. Her frustration was to the point that she was ready to throw in the towel on breastfeeding. She spoke to a friend who informed her that there are private IBCLC's who she could see and who would be able to see her sooner than later and that before she quit breastfeeding she should call me. 

This mother took the advice of the friend and gave me a call. I was able to listen to her breastfeeding story to date,  do an assessment on her and baby, figure out what her goals for breastfeeding were and prioritize the concerns she had about breastfeeding. Sometimes it is about addressing one big issue, like the amount of pain a mother is having, and then moving forward with other plans and goals. Breaking it down into manageable bits and pieces can make the big picture seem far less daunting. Let's not worry about breastfeeding until baby is one year, if we are not even sure we are going to make one week with the amount of pain we have. Maybe we should look at how to get rid of the pain, and see how week two goes…sounds far less scary than pain for a year. 

Tired of being tired? Look no further! We have a solution for you! Non-Sleep Training (not a registered trademark) is the LATEST solution to all that ails you. 

Step one of this innate process is to start considering even before you’ve started your path to parenting that your life may not be shrinkwrapped into a perfect and neat little package. You did it through the late years of high school and maybe even through college – studying into the night, slamming back coffee at 4am and cramming in three more hours of studying, writing the big exam, and then PARTYING because it’s done… followed by waking up in a tousled mess of blankets, books, and coffee cups and THEN going into work for the weekend and doing it again the next week. You made it. Even though, at your wedding or celebration of domestic partnership your grandmother whispered into your ear that having children would be this wonderful, golden, perfect start to your perfect white fence life and EVERYTHING hinged on routine, routine, routine. You thought you were set, right? Well, look no more – step one is ALL about breaking the rules of the grandparents and friends around you who are bragging about their perfect little bundle of joy who sleeps all day, all night, and even allows for time to Kon Marie your entire life! What’s the evil baby meme say? “You will never sleep again”. It’s partially correct.

Disclaimer: I am not a mental health care professional or provider. If you think you are suffering from any sort of mental illness I recommend seeking medical attention as needed. I will also add in that I do take mental health concerns seriously and this blog post in not intended to down play medical concerns. 




Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes. - William Gibson 

When I first came across this quote, I immediately identified to it as an adult, as an individual and as I related to other adults. More and more I have been thinking about this in the context of my work, my work with new families, young babies and children & different relationships forming in homes. 

The rate of postpartum mood disorders is on the rise. Baby blues, anxiety, depression and psychosis are a very real reality for many new mothers and fathers. We mostly see it in the context of mothers but more and more research shows our fathers are impacted by mood disorders as well. 

Let’s, however, just step back for a minute and think about the above quote. “Before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, just surrounded by assholes.” I don’t want to be rude but let’s face it, babies are assholes, toddlers are assholes and kids can remain like that as they grow up. They certainly don't mean to be but they are incompetent & demanding, they can be obnoxious and rude, they interrupt your every meal and all your sleep. You can’t even think about peeing without baby waking up and crying, let along move an inch to try to get up and pee.  They need to be fed constantly, hanging off your breast, YOUR breast no longer belongs to you. When they are not feeding, they need you to hold them or they will turn the reddest of red and blow horrible smoke from their ears. They pee and poop ALL.THE.TIME.  Rudely, they sometimes don't even wait for the new diaper to get on before they shit all over you or shower you in pee. You imagine stuffing that thing back inside you, because as awful as it was to have that watermelon come out the lemon, they are way easier to take care on the inside, right? Well, too bad, there is no turning back. There is only moving forward with this asshole in your life. 

By now you know I am not serious in calling babies assholes, but you can see my point. Life is HARD with a new little person to care for. The real assholes of the world are hard enough to put up with, but now you have to put up with the smallest of them all, ALL the time, because YOU created it after all, YOU wanted this. Now you have to do it when you have zero sleep, zero nutrition and probably zero clue how to actually take care of this baby - I can guarantee you it did not come with a manual. Add in some hormones and everyone’s opinion of what you should be doing and it is easy to see why one would end up with signs and symptoms of a mood disorder or postpartum depression. 

So, how about we get serious about what we can do about this baby and get through what will be one of the most challenging times of your life. 

Self-care is big. You don't want to lose yourself in this. Having a baby WILL change you, but doesn’t need to consume you. What do YOU need? What does your partner need? Make a plan to have that happen. 15 minutes in the shower, making two sandwiches instead of one when your partner leaves for work, tea out with friends.  Asking friends to bring you food when they come visit the baby. By the way, when they come visit, the asshole will switch personalities and put his nice guy face on.  Have someone come help with light house work and laundry once a week. It’s the small things that make a massive impact. 

Communication is huge. Tell each other how you are feeling about the changes in life and the new demands. If you are reading this before having your baby, start that conversation now. Brainstorm the different ways to achieve self-care that will work after baby. Be open and flexible in changing those plans, if needed. Just talk to each other and others about what is happening in your new world. Just keep the conversations going. And find others who will listen to you both. Just someone who will let you get it out. I promise, they won't mind. 

Support. SUPPORT. SUPPORT.  This is a must. You need to build a team of support people. Before baby is ideal but may not have happened and you may now just be building a support team. Who are we talking about? Family, friends, community resources - your health care providers, doula’s, peer support groups. Everyone’s team is going to look different depending on the needs they have. What is important to know is that support is going to make one of the largest impacts in how you feel about everything and how stable your mood will be, how you will interpret your experiences and what the outcome of the situation is. It is important to identify your needs and equip yourself with the tools to get there. It is vital to know what your support options are because without options you have no choices. So, start now by identifying your needs and making a list of supports. If you get lost and have a need but don't know how to get the support you need to have that need met, please ask! I am here to help in this time of transition in your life.

The idea of Doula’s are based upon old, old history. Old birthing history has so many stories of women with women, supporting and uplifting, during birth. In today’s birthing world many things have changed from the past. Change is good, but can also lead to having good things getting lost in translation. Having solid support for the body & mind throughout birth is one of the things that was getting lost, but in recent years more and more women are choosing to hire a doula. 

“Doula” means “Woman servant" or “caregiving" and we adopted it from Ancient Greek language. “Doula” has now come to mean someone who provides emotional, physical and informational support. Doulas nurture a woman and her partner throughout the birthing process and afterwards. Doulas learn the desires and wishes of the expecting mother and partner and help them meet their goals. If the goals need to change a doula helps facilitate the unexpected changes.  

Doulas do not only attend home births - they attend all births. Doulas do not only attend water births - they attend to mothers wherever mother is comfortable. Doulas are still vital when a woman has a midwife - they are not the same, they are complimentary. Doulas do not replace the father or the support persons - they add an additional layer of support and help support the father and support persons.

What can you expect from a doula? 

You can expect they will help you prepare and educate yourself for the birth. 

You can expect they support your wishes for the birth. 

You can expect them to be with you for the whole of the birth process from the time you need them. 

You can expect them to listen to you and be compassionate to your emotional vulnerability. 

You can expect they will hold a safe and protected space for you. 

You can expect no judgement. 

You can expect they will hold you up. 

You can expect they will take your lead. 

You can expect they will lead you when you don't know where you should be headed. 

You can expect them to make your physical comfort priority. 

You can expect them to make your emotional health priority. 

What you can expect your doula NOT to do: 

• Doulas cannot do medical exams, tasks, diagnose conditions or deliver babies. Doulas are NOT medical professionals. 

The evidence for doulas show*

▪ 50% reduction in cesarean rate

▪ 25% shorter labor

▪ 60% reduction in epidural requests

▪ 30% reduction in pain medication use

▪ 40% reduction in forceps delivery

▪ 40% reduction in oxytocin (pitocin) use

*Stats from  “Mothering the Mother” by and Marshall Klaus, John Kennell & Phyllis Klaus.

Choosing a doula can seem to be a difficult task, but keep in mind there is a doula out there for everyone. 

We have come to a place in Canada where the previous less than mainstream idea of Midwifery care has come to a place of greater acceptance and desire and more understanding that Midwifery care should be the mainstream care a pregnant woman receives. But the acceptance and desire of this kind of care has increased much faster than the profession can handle and in some areas faster than the systems that insure and employ Midwives can handle. This is a Canadian problem, some would even say a Canadian crisis. 

In Saskatchewan, we have what some people would consider significant growth and what others would consider not enough growth, in the very recent years. Legislation came to be in 2008 but we didn’t see Midwives practicing until 2010, I believe. Many of the Midwives that practices pre-legislation could no longer practice due to legislative changes. Midwifery was left in limbo for a few years. Since then we have had 13 midwives in 3 health regions be employed. If you do the math, that is a big increase, but when you start at zero, anything is an increase. If you look at the number of pregnant woman and babies being born, it isn't going down. 

Here in Regina, we saw two midwives providing care for RQHR in 2011 and in 2012-2014 that increased to 5 positions, with 4 of those positions typically filled at a time. Those three new positions have seen a few changes over the years as we have had Midwives come in and out of those positions. RQHR has recently let clients and the public know that soon Regina will soon to down to only two Midwives. Likely within a month of this blog post, two of the 4 midwives we have will have moved on from Regina. So, what does this mean for midwifery in Regina & care that woman, babies & families receive? 

In short, it means a lot, but it can also mean very little. Women in Regina have tried everything they could to secure midwifery care. From calling the program as soon as they got a positive pregnancy test, to calling weekly to see if they have changed from a waitlist to a “yes”, and pleading for a home birth - something only midwives can provide on certain limited conditions. The waiting list is already rather large, 30+ women a month, and most women still end up in physician care currently so a plan B is needed. 

The biggest factor affecting potential midwifery clients is going to be that home birth component - or rather the CHOICE of birth location. Midwives can do home or hospital births but only midwives can attend home births. Within RQHR, there must be two midwives available and present in order to have a planned home birth. The choice of birth place is a huge benefit to women and families and one that I understand tremendously. But I want people to know, that births in the hospital setting can be wonderful, sometimes equally so to a home birth. Part of it is in the mindset of the family. Some of it is care providers. Some of it is support staff & some of it is the support people that the family choose. 

What else midwifery care offers is typically more time to get to know your care provider; (typically) care starts earlier, appointments are longer and there is more dialogue about options for care - like testing and other procedures that are offered. But what many people don't know is, you can have that dialogue with the care providers you do have and you always have choices and always a right to informed consent. So, yes, midwifery care “follows” that logic in nature but other care providers will meet you at that place when engaged. If your care provider is not willing to do so, then perhaps a new care provider might be a better fit for you and your family. You do have that choice. I will have it be known that I have had clients equally as happy with midwifery care, as they were GP care, and OB care. Often it comes down to simply being heard & being respected. Any good provider is capable of that, regardless of their title. Having a midwife isn't a guarantee of that. Not one care provider or support person can guarantee any sort of birth experience. 

Another factor that really makes a difference in how people feel about their birth experiences is whether or not they felt supported along the way. What many people don't know is that this is exactly what doulas do and is the primary goal of doulas. To support the family - emotionally & physically and with information. Your doula, much like a midwife, would have longer appointments with you, they would get to know your desires and wishes and would help you make a plan to get your desires and wishes. They support you regardless of birth location & care provider, they support you regardless of change in plans, they support you during those changes, so that you can still feel good about them. They help you find your voice and find it again if you have lost it and need to make sure your wishes are respected. They work for you, and with you, to get you to your goals. 

At the end of it all, with physician care, and sometimes midwifery care, and the support staff, you do not know who is going to be attending your birth, and you may see different people come and go as the shifts change. With a doula you can count on at least one consistent person who knows you, is there for you, understands what you want and won’t leave your side. 

Care providers are very important in pregnancy and birth but it isn't something I think people should get too hung up on during the pregnancy and focus too much attention and energy into. I think that energy is better spent cherishing the pregnancy, making sure mom is staying healthy by good self care, that baby knows that s/he is loved and welcomed to the world, that good plans are being made for the birth and someone is there supporting and encouraging this experience and the family. In an ideal world we would all have the choice of care providers and who receives our babies into the world, but when we do not have that option, we cannot dwell on that loss, but should instead focus our attention and energies where we do have control. Getting a doula can allow all that goodness to happen and you always have control over who your doula is. 

I asked this question of my Facebook friends earlier this week. What do dentists, midwifes and chiropractors all have in common? I received a wide variety of answers and all were very points. Let us have a look at some of the answers. 

"You totally dismiss their existence or possible usefulness until it turns out you need one?" This one had the most likes, and for good reason. I don't know what it is like in other places in the world specifically but I know in Saskatchewan what these practitioners are able to do for health and wellness and care is not well understood. Dentists would be the most commonly accepted practitioner of the three but they still are not fully understood as far as their role in things beyond healthy teeth; more to come on that later. Midwives are growing in popularity but again until you need one you probably wouldn't have paid much attention to them and all the benefits they serve in a community and why we so desperately want more of them. I think everyone needs to care about increasing our midwifery numbers and access to them in all communities, not just our currently pregnant moms. And chiropractors; they are a hidden secret in health and wellness. Most commonly known for snapping necks and popping bones back into place even though that is rarely what they do & definitely not what they want to be doing. They really want to help your body be sound structurally since the basis of function comes down to structure. If a structure isn't 100%, it isn't going to function at 100%. The scope and importance of these practitioners cannot go underestimated. 

"I would guess that they aren't considered necessary to medical care (by the powers that be…)" This was one of my favourite answers, because it some days it really feels that way. There are jokes by doctors that I have heard before such as "What do you call a doctor that failed out of medical school" - "A dentist". Chiropractors and midwives are not easily accepted into western medical practice, either. Both would be considered "alternative" even though as far as practice goes as ancient times. They fell out of medicine for quite some time and in the late 20th century started to become a popular choice again. Having said all this, that wasn't the point I was trying to make.  

"You refer to them? Or they refer to you?" Next on the list of answers was about my referrals to these allied practitioners & referrals to me. Yes, this happens, both ways. It happens for many different reasons. Depending on where a mother is prenatally or postnatally would depend on the referrals and why, but the point is we can all work closely togther. This leads into the next answer.

"All can play a vital role in supporting a healthy breastfeeding relationship, along with lactation consultants create the circle of support for breastfeeding moms and babies with tongue and lip ties."  Now, I love this answer. We are getting somewhere on where I was going with the question. I would say that we could have simply said, "all can play a vital role in supporting a healthy breastfeeding relationship, along with lactation consultants create the circle of support for breastfeeding moms and babies" and we could have had I not mentioned the dentists.  My reasoning for that is because tongue and lip ties are part of why I posed the original question and because it was in the answer. However, there can be lots of issues aside from tongue and lip ties that a midwife and chiropractor could help with. Add in the tongue and lip ties and, yes,  then we need a dentist. But now look at the other person mentioned in this answer and mentioned in the circle; lactation consultants. This was the answer I was looking for. They are all knowledgable professionals, but they are not IBCLC's. 


Lactation Consultants are at the hub of it all. Some people would actually suggest it isn't really a circle that would be formed but rather think of an IBCLC more as a project coordinator, like a general contractor. The general contractor is a manager. An IBCLC must first assess the breast-feeding relationship. A consult is required to get a better understanding of the breastfeeding dynamics . The IBCLC than can recommend specialized “subcontractors"  to perform tasks that are needed to meet the goals of the breast-feeding mother and help resolve some of the challenges. Then the IBCLC as the specialist in breastfeeding can do another consult to fine tune the work of all the “subcontractors”.  This is really important as many of the symptoms of tongue and lip ties can be because of many other things. We need someone to assess that all. That needs to be an IBCLC. While the other practitioners have knowledge of breastfeeding and how it all works, they are not specialists in all things lactation. Some of the practitioners are going to assume that moms and babies are working with a lactation consultant and some are going to be a little more forward in making sure that moms and babies are indeed working with an IBCLC. Sometimes we need to plan how and when to fix tongue ties based on what all is happening with mom and baby. An example would be needing to resolve moms milk supply so that after baby has his tongue and lip tie fixed, he is rewarded easily with a good supply. It can be challenging for mom to do this while caring for a baby after the procedure. Another example is oral exercises for baby. You can think about this as rehabilitation. We cannot make a change to a babies physical structures without helping that baby adapt to the changes - again, this comes down to what an IBCLC is going to teach and assist parents and babies with. The IBCLC will further assess for improvements and make recommendations as needed. Keep in mind, these are only two examples of what an IBCLC is going to do. 

It is really hard to skip over some of the practitioners. Sometimes things will not resolve at all or much more slowly than needed unless we have a solid team trying to resolve the issues at hand. I think it is incredibly important before we go ahead and perform any procedure on any baby, that this idea is well explained, understood & accepted so that ultimate, ideal care is provided to families, especially the baby who needs the most support. 

You are a new breastfeeding mother. It has been about ten days and your cracked bleeding nipples aren't healing & you have started to have a burning sensation with deep throbbing pain in your breast. It sometimes lasts for a few minutes, but sometimes hours. The beginning of feeds are terrible and even between feeds you are getting electrical shock like feelings in the breast. If this is you, you are like many other mothers and like many other mothers you may have been told you have thrush. You are given a prescription for nystatin for you and baby. You treat for two weeks and symptoms get mildly better, but it isn't going away. Baby has no symptoms but your pain just won't knock it off. You get Nystatin for a couple more weeks, cut out all sugars, start washing your nipples with grape seed extract and the pain in still persistent. Maybe you have had APNO cream & some Diflucan in there, as well. Still no success. 

How about I suggest to you that if you have thrown every thrush treatment at your nipples and you're not seeing results, that it isn't really thrush you are trying to treat? 

Thrush is very commonly diagnosed, rather misdiagnosed. I do not think that it is as common as we are being led to believe it is. I know you are asking me, "if it isn't thrush than what is it?"

I would say in more likelihood than not, it is vasospasms. Vado-Whats? What are those? The simple answer is that the blood vessels in the are contracting and becoming smaller in diameter - called vasospasms. This can happen for a variety of reason and for some people it can be very painful and occur in various parts of the body, including the nipple in breastfeeding mothers. 

There are risk factors for vasospasms including but not
limited to : 

• Poor latch, position or clenching during feeds
• Nipple cracks or trauma, especially severe or reoccurring trauma 
• Exposure to cold temperatures
• Periods of severe emotional stress
• Cigarette smoking or second-hand smoke
• Caffeine intake 

What are some more symptoms and how would you suspect you have vasospasms? 

• Nipple/breast pain
• This pain might be a burning sensation, throbbing, pins & needle-like, deep into the breast, and/or numbing.
• The pain can last from seconds to hours, and come during or in between feeds.
• The pain may get worse when the nipples are exposed to cold, i.e. when you step outside in cold weather, or when you get out of a hot shower.

• When you are having the pain, your nipples will usually change color to pale/white, blue/purple, or dark red. These color changes are a sign that your blood vessels are contracting or spasming. 

What can you do about vasospasms? 

1. Most importantly, make sure your baby has a good latch and you are pain free during feeds. If you are in pain or are unsure about the latch, get help as soon as you can. I suggest booking an appointment with an IBCLC. Getting the latch and pain resolved is key to stopping and healing your vasospasms. 
2. Use heat! Stay warm and keep your nipples warm. During episodes of pain and after feeds, use a warm compresses or your own arm or hand to warm the nipple. Always have heat on the nipple while wet. 
3. Avoid smoking and second hand smoke.
4. Decrease caffeine intake. 

It is important to seek professional help as soon as possible if this problem is persistent. They can help assess the cause and come up with some remedies for you. They can also explain the use of vitamins, minerals and omega fatty acids (important for healing). There are also prescription medications available, if warranted, and your IBCLC and physician can help accommodate that. 

You do not need to suffer through the pain or end breastfeeding for this to resolve. If you would like to keep breastfeeding, without pain, book an appointment and we can get you back on track. 

There is a holiday guide for everything - why not have one for breastfeeding? From holiday clothing to preparations to unsolicited family advice, here are some tips for the holidays. 

Lets start with the easy stuff; wardrobe. If you are going to find yourself breastfeeding at a holiday event, you might find it easier to wear separates, a shirt and skirt, or pants, something that opens from the top down like a zipper or buttons. If you want to be a little more discreet, consider a shawl or scarf you can place along your breast but not have babies face and head covered (many babies don't like that, making it less than discreet).  And you can also make your baby an accessory! Get a ring sling or other handy carrier. They can be easy to nurse in, keeps baby close, helps reduce stimulation, less people to handle baby, gives you both hands and provides a comforting spot for baby to sleep while you enjoy festivities. 

Engorgement, plugged ducts and mastitis are not holiday visitors anyone wants, but the holidays does see a rise in these sometimes easily avoidable issues. The easiest way to prevent these are to nurse often, take breaks from the busy times, preparation, long travel, & shopping. Nurse often and regularly. The bonus is that the oxytocin flow will help keep you relaxed in what can often be a hectic time. 

If you are hosting a holiday event, don't over plan and over do it. Ask for people to help. Maybe have a potluck dinner, less decorations and don't be afraid to have a quite place that you can sneak away to if you need. 

Lots of unsolicited advice seems to come up when we get together with our closest family and friends. They all do mean well, so don't be offended. To help them to also not be offended, practice a polite response, such as, “Thank you for your perspective. We have decided that this is best for our family” or “That’s an interesting idea. We might consider that at a later point”. You might not be telling the truth, but thats ok. Simply ignore what you can. 

Many hands make light work, but those same hands often want to feed the baby. Try to delegate those hands to change diapers, play, or just cuddle baby between feeds. 

Most of the time, what mothers eat doesn’t cause too much concern for the breastfed baby, but sometimes we indulge beyond moderation and then it can be concerning. Too much chocolate for example can cause fussiness. Peppermint and sage can have a negative effect on supply, so just be cautious with how many candy canes you have. Also, going to note that it is safe to consume some alcohol when breastfeeding, without the need to pump and bump. General rule of thumb - your breastmilk alcohol content is the same as your blood alcohol content. Generally, a drink or two would be 0.02-0.04% - you can see its not enough to worry about. 


Enjoy your holidays with your precious little ones! May they bring you the magic of the season. 

Multiple times today my attention was called to this article posted by Nancy Mohrbacher that brought an idea that tongue and lip ties are an epidemic. I would suggest reading that article first and then looking at my post. 

Nancy refers to a study just recently released that was trying to prove that the prevalence of tongue tie is higher than the literature suggests of 0.3%-12% of the population. 

After seeing the responses on social media I am not convinced that that people are looking at the study for themselves and are drawing conclusions from the title alone. Here is the conclusions of the study. 

"All but one infant (n=199) had an observable or palpable lingual frenulum that was Coryllos type 1 (n=5), type 2 or 3 (n=147), or type 4 (n=47). 

Although our study was not powered enough to test for any correlation between the cessation of breastfeeding and the type of frenulum, we found no statistical correlation between the Coryllos type of lingual frenulum and the presence of breastfeeding difficulties.

CONCLUSIONS:
A lingual frenulum is a normal anatomical finding whose insertion point and Coryllos classification are not correlated with breastfeeding difficulties. We suggest that the term "lingual frenulum" should be used for anatomical description and that the term "tongue-tie" be reserved for a lingual frenulum associated with breastfeeding difficulties in newborns."

A valid point - A frenum present/observed is not a tie. And there is no correlation between type of "grading" and breastfeeding concerns. In fact, this is why some of us professionals skilled in tethered oral tissues want to eliminate the terms and grading and why I, in my practice, do not use a grading system. (I do have tools and assessments) Moms ask me a lot what class it is - they get this idea from the internet. It is easy to understand a range of 1-4, or anterior or posterior. I will not attempt to grade it because implies one type of restriction is more problematic than another and this might not be the case. It is a little bit harder to comprehend structure and function, central nervous system and how it all plays into feeding. So, I don't blame moms for wanting a simplified tool. The truth is we don't have that. It also seems like grading can validate decisions, to treat or not, based on a grade. "The IBCLC said it is a severe tie and I had to fix it" or "it was just mild so I didn't need to fix it" are examples of what we might hear from most given a grade. Part of the grading is simply for documentation purpose if a revision is done. It is like taking a before picture without the picture. The surgeons preforming frenecomies need a way to document what they see and what they performed. 

This study looked at infants at days 0-3 and then a follow up  at two weeks, by telephone. 

The lingual frenula of 200 healthy infants were evaluated by visual examination and palpation within the first 3 days after delivery. The frenulum was categorized according to the four Coryllos classifications. Each infant's mother responded, immediately after the examination, to a structured questionnaire on the quality and type of feeding. An additional structured telephone interview with the 179 breastfeeding mothers was conducted 2 weeks later.

This raises some questions for me: 
Is day 0-3 too early to show concerns? Yes, in many cases it is. What we know from the study is 3-4% of the babies had issues they considered to be from ties. But we don't know if all the others were completely asymptomatic after the 3 days or after the two weeks. 
Are we considering any infants that did have breastfeeding problems to be something other than restricted tissues? This is an unknown. 
Is breastfeeding established in the first two weeks? No, it is not. 
What about later onset of issues?  So, revisiting the earlier question, we don't know beyond the 3-4% that has issues in the early days if others had issues. There are quite a few symptoms of tongue ties that show up later, like secondary low milk supply, reoccurring mastitis, weight gain concerns, inability to swallow solids foods. There are many symptoms. Too many to list in this blog post. 
Is two weeks normal term breastfeeding and the optimal goal?  No, World Health Organization and the Canadian Paediatric Society recommended breastfeeding for two years. Many undiagnosed tongue tie babies are reported to self wean between 6 & 9 months. 
Do they intend to follow up longer? This is an unknown. 
There were 200 assessments done, but only 179 telephone calls made at 2 weeks; what happened with the other 21 dyads? Did they stop breastfeeding (perhaps due to issues)? Again, another unknown. 

While on the subject of tongue and lip ties on social media in response to this treatment came up, multiple times, and Nancy discusses it in her post as well. We need to be very through in evaluation and looking at the root causes of the problems. We need to seek out the people knowledgeable to do such an evaluation. Depending on where moms live these resources might be abundant or they might be scarce. 
 
There is so much to consider when it comes to breastfeeding that we cannot latch on to one specific if things are not going ok. It is often a cascade of things. Sometimes it is partly mom, sometimes partly baby…it is a little like detective work at times. Breastfeeding is fluid and holistic. There are many considerations and options before revision & revisions are not a quick end to the concerns dyads have. One example of what I mean is considering moms anatomy/function when looking at ties. It is a bit like puzzle pieces. A tongue tied baby might not have any issues with a mother with one sort of breast and might with another (think about wet nursing, or even babies who do well on one side and not on another). 

My clients get presented all kinds of options. We start with what can we do today, right now, to make this better and manageable and tolerable so we can even get to a place of discussing long lasting breastfeeding. Often by the times I see moms I am getting told is "YOU have to fix this or else I QUIT". No pressure. But when a mom is looking quitting in the face, I need to give her some right now options, but also get her as far away as quitting as I can before I leave her because it I don't she is right back at looking quitting in the face. That is why consults are so through and a big plan is made - a right now, a week from now and longer term. 

So, when I see restricted oral tissues, do I let clients know? Yes! Even when I'm not 100% sure that is the issue, I mention it because moms don't always come back for follow up so I cannot assume that after they try tricks 1, 2 and 3 for a week, and come back so we can reassess. If I don't tell them they might never be told or if the tricks don't work and nothing resolves they are left feeling like it was a failure and give up. If they know that there are things that could work, BUT, if they don't we need to consider the restrictions to having an impact, they are informed. If I see moms early in the process (like day 0-3 when issues might not be noticeable yet) and I can see some red flags I also mention things to just watch for, just as an FYI, because it could become a larger issue. There is also a lot of myths that need to be busted, such as breastfeeding just hurts for the first few weeks, that can be related to ties, so they get overlooked and the problem spirals. Does it mean sometimes moms latch on to that idea and run with it? Yes, sometimes it does. I try to limit that by being very upfront and through in the discussions. I don't get much done in 15 minutes - this is why consults take as much time as they do. History, assessments, evaluations and then discussion takes time. 

Mentioning it doesn't make me a poor clinician & tongue tie happy (trust me, I dislike them, a lot, and my work would be far easier without them). It does make me through and ensure that my clients are getting a full assessment, not just get a superficial look and a pat on the back that things will get better, that breastfeeding just takes 6-8 weeks to get used to and if they just stick it out it will be worth it. How many times have you heard a mom be told to take some herbs, eat some cookies and drink some beer? That would be fantastic if that is all it took to make breastfeeding easier. But that isn't the truth. 

Keep in mind, before we had providers who could release ties longer term, we had strategies to deal with breastfeeding concerns. The ability to now release ties doesn't negate or remove these strategies. Why are we not simply just sticking the golden oldies? Because they don't work for everyone, they don't always get people to normal term breastfeeding before they become too overwhelming or exhausting. Because babies are highly adaptable and will compensate and these compensations are not necessarily good for babies and can cause longer term life and health issues. Breastfeeding is linked to so much health wise and it seems like it is acceptable to mention that breastfeeding lowers the rates of commonly known health issues, such as diabetes and asthma, but isn't yet acceptable to say the same things that can cause breastfeeding issues can also cause issues with dental, speech or breathing. 

I think there are good points to be taken but I think there are gaps in this study and article. Balance needs to be strived for. 

If I asked myself if pumping was being used as a magic fix for common, yet easily managed, breastfeeding concerns I would have to say "yes, it is". The idea to pump instead of, or in conjunction with, breastfeeding is often suggested to mothers by their support people. These support people include other new mothers and experienced mothers at places like Mommy and Baby Yoga, Mommy and Me time, Kinder Music, Baby Signs, the museum, StarBucks, any place mom's and babies hang out together; you all know where mommy's go. Other support people are their mothers and mother-in-laws, sisters, sisters-in-laws, aunts, grandma's, that old family friend; again, you know who these people are. Of course, other new mother's support people include Health Care Providers like doctors, nurses, midwives and the complementary support people like doula's and childbirth educators. And, in case you are not aware, these people include many that did not breastfeed themselves or were not successful in their attempts to breastfeed. 

Most moms new moms have the intention of breastfeeding, as so as expected, it comes up in conversation. People feel the need to ask new moms how breastfeeding is going, new moms feel compelled to seek out support in these early weeks or health care providers are following up mom and baby. When moms are asked about breastfeeding they share the concerns they have with breastfeeding in hopes that someone can help them. Here is the list of common complaints and one likely answer they will receive to alleviate that concern. 

Sore Nipples -> Pump and bottle feed
Baby not effectively sucking -> Pump and bottle feed
Thrush -> Pump and bottle feed
Engorged -> Pump between feeds
Plugged Duct -> Pump between feeds or pump and bottle feed
Needing to feed in public -> Pump and bottle feed
Over Active Let Down -> Pump before feeding
Low supply -> Pump between feeds or after feeds
Baby not sleeping -> Pump and bottle feed or have someone else feed
Colic -> Pump and have someone else feed
Foremilk/Hindmilk concerns -> Pump before feeding 

It appears that pumping can be a common suggestion to alleviate the most probable breastfeeding issues. We need to be aware it is not a magic fix, it is most likely to be a band-aid, and it does not "fix" anything. We also need to be aware that pumping can create more issues. 

These are just a few ways this pumping band-aid could create more issues for mom and baby. 

With sore, bleeding, cracked nipples, generally the most common concern, generally easy to fix, pumping only results in double the work. Why would a new mother want to add in all the extra work of pumping and bottle feeding when getting some assistance with position and latch could make the problem go away, in even the very next feed? Often long term pumping is not going to sustain a babies needs and milk supply like breastfeeding directly from the breast would. Often breastfeeding relationships end far sooner than mother's intended due to supply issues because it leads to supplementation or another feeding method all together. This might not be the case all the time, as some mothers, do exclusively pump, but there is unique difference between a mother who makes the decision to exclusively pump compared to one who is trying to get baby nursing pain free at the breast and needing to pump in addition to.  

How about that baby that just is not sucking effectively or will not latch? Let's see, how do people learn? We learn by doing. If we take baby away from the breast, how does he learn? Again, we need to support moms and babies in positioning and latch and innate instincts that babies have to feed and let them learn together. If habitual placement is still not getting baby latching and sucking, we need to further evaluate what might be going on with that baby. Ignoring the difficulty baby is having and turning solely to the pump does not make the original issue baby was having go away. 

Thrush is no reason to stop feeding at the breast. The reality with pumping with thrush is that mothers now have more parts and equipment to treat or throw away. Thrush can sometimes take time to clear up but it spreads so easily, we need to restrict what comes into contact with the thrush to stop the spread of it, not add more to it. There are medication and alternatives that we can use to treat thrush and the discomfort of thrush as we are trying to eliminate the nasty little bug it is. 

Milk supply works on supply and demand so as well as pumping to relieve engorgement seems like a good idea right now, later on the fullness comes back and generally more full then the previous time, as a mother's body thinks that is milk that baby needed. If moms are engorged because a baby is not eating or draining the breast, then the answer is to get the baby eating and draining the breast, not pumping. The more baby is at the breast the less engorged mother's will be, assuming baby is eating well. Again, back up to latch and sucking. If baby is not waking to feed and mom is starting to fill up, mom can put baby to breast and encourage that baby to eat, to play his role in this breastfeeding relationship. Another concern with engorgement is that as much as it may seem logical that when mothers are engorged, it means they have a good, healthy milk supply, in fact the opposite can occur. The more often a women is engorged, the faster her milk supply will start to decreased. When breasts are full it sends a signal to the part of moms brain responsible for milk supply to slow production down and milk making cells start to shut down, resulting in less milk in the days ahead. Pumping when engorged can also pull more fluid, and not just milk, into the breast, resulting in edema. Often that fullness is confused for milk and "good supply". 

Plugged ducts are uncomfortable, in fact down right painful, and yes moms want them out, but pumping is not the most effective way to unplug a plugged duct. In fact it can lead mom right back to the engorgement stage and create the spiral onwards from there, when the easiest way to get rid of that plug is by using baby, again. 

I am starting to see a larger amount of women pumping so they can feed their baby while out and about. First, people that want to go out in public just need to accept that mothers and babies go out in public, too, and mothers and babies use breasts to feed. Secondly, mothers need to be informed about how this "solution" really is only one that is feasible for a small time. Each feed mom misses at the breast impacts that supply and demand mechanism again. If mom is out and is not feeding baby or replacing a feeding session without pumping again her body and brain communicate this to each other and the process of milk supply slows down. This again goes back to what I mention early about keeping up supply, supplementing and ending the relationship early than expected. 

Over Active Let Down is a problem that some moms struggle with but again pumping can just aggravate this problem. It is an easy problem to aggravate as it can lead to the engorgement issue and when baby is ready to feed, mom is ready to burst with milk and when the let down occurs it is like opening up a dam. Baby gets flooded with milk, has trouble managing flow, staying latched, becomes upset and this all causes frustration in mom and baby. Positioning, latch and frequent feeds are the easy fix here. On the other side of it, some babies have a hard time handling a normal let down, but it mimics and over-active let down. We need to be sure that we know if we have a baby that is struggling with a normal flow or a true over active let down. 

For the healthy, full-term infant pumping for perceived low supply should be the last resort. Babies truly are the best solution here again; baby to breast = more milk in breast. Secondary low milk supply is a different issue and does not fall into the category of common yet easily managed breastfeeding concerns., which is what I am addressing here. I am also not addressing primary low milk supply which are maternal factors in less than 5% of mothers who do not make enough milk. These conditions should be determined with through evaluation with an IBCLC and primary health care providers. I am talking about common breastfeeding concerns that most mothers face. 

Pumping to top up or to force more milk into that non-sleeping baby:. Fuller tummy does not equal more sleep in babies. Babies have very small tummies, breastmilk is readily absorbed and digested so babies feed frequently. The issue here is not the amount of milk the baby takes, but rather unrealistic expectations and misunderstandings babies. If babies are really struggling with sleep, it is worthwhile seeking out a feeding assessment to ensure all the things above are not an issue. 

Colicky babies are much better soothed at the breast than any other way, pumping to feed another way removes that comfort source from this already high needs baby and can make the baby even more upset. There is no real understanding behind colic and why some babies are colicky and some are not but there is good understanding that skin-to-skin and mothering at the breast calms these babies best. Again, all things above should be ruled out before we just assume we have a colicky baby. 

Foremilk/hindmilk imbalance or what is being perceived as such seems to be rampant these days. It seems like a viral condition that has spread. So many moms seem to feel they have this issue, when in fact it is very rare. However, if a mother thinks this is an issue she has and pumps to get to the hindmilk, we go back to the engorgement cycle where mom has too much milk, can have a forceful let-down and then babies do get more foremilk than hindmilk, they are upset by the flow of milk and we end up in a vicious cycle. Worst case scenario, in fact, this could create that colicky baby we all fear. Foremilk/ hindmilk is best controlled by frequent feeds and proper positioning. 

I am pleased to see fewer mom's grabbing for a formula can when breastfeeding challenges arise but I am not thrilled to see more mom's grabbing for the pumps.

Mom's please seek out appropriate, knowledgeable, support when you encounter these easily managed breastfeeding concerns.

I would really like to see the documentary Breastmilk vs reading an article about it, however I have not been able to see it yet. So far I have only really seen this article, "Eat It, Drink It, Pump It, Freak Out Over It". 

Sounds like there are some extreme scenes, but it is media. Media is made to grab attention. Breastfeeding is not extreme, at least I do not see breastfeeding as extreme or work in extremes with my mothers. 

The naked breasts in the documentary likely are not intended to grab attention but rather normalize breasts, in a non-sexual manner. The more we see them in a different manner the more comfortable we will be with them as non-sexual objects. 

I am understanding that the film does not sensationalize breastfeeding. Thank you. You are not a super-star if you breastfeed. You are a woman with a child. It should be an ordinary experience. Again, it should be an ordinary experience. If you live in North America, it likely is not an ordinary experience. 

In other parts of the world we have toddlers nursing at the playground, entire groups of them. In Canada we don't see that often at all because most of our toddlers didn’t get breastfed must past a few weeks. Toddlers are nursing in Canada, I reassure you of that, but how often does any see this? How often are these mothers comfortable to tell anyone this? And why is it that she is uncomfortable sharing this, when in reality it is recommended in Canada that we breastfeed our children until the age of two and beyond. Shouldn't she be proud she made it to the recommendation? 

I am also understanding the film to avoid the formula vs breastmilk debate. Again, I say thank you. Not all of the discussions around breastfeeding need to have formula involved. They just do not. Most mother’s who have decided they would like to breastfeed, want to breastfeed. That doesn’t mean it is going to be easy, without struggle, doesn’t need support. That would be silly. It is an aspect of motherhood and motherhood is hard, there are struggles and we need support. We need this regardless of how our babies are fed.   If a mother has chosen to breastfeed, it is not a debate. (If a mother makes an informed decision to choose formula, so be it. It is also not a debate.) If a mother choose to breastfeed, she should be encouraged to breastfeed that baby then, and given the supports to do so. Supporting breastfeeding is not to offer formula when it becomes hard.  We are culture 3 generations into formula feeding as the ordinary experience, and in culture we look for sameness. This is not a mommy-war, this is how humans function. We look for sameness to find where we fit. Another example is if your mother formula fed you and your are struggling, she doesn't know how to help until she makes your experience more like her own, which is to suggest that you try a bottle. Could this looking for sameness for the reason that the mothers that do breastfeed toddlers are not sharing? In our culture sharing that information does not bring a lot of sameness amongst our community. In small pockets, yes, and those are safer places to share, but our overall culture is still not there. 

New mothers should not be under pressure to breastfeed. It should be an ordinary experience, with the supports to do so. The weight of the world shall not be on the mother’s shoulders. In fact, I want those shoulders relaxed with arms gently crosses and a baby in those arms. 

There is a gap in the current health care. You see big decisions about public policy are made at meetings with CEO’s and upper management sort people & doctors looking at research etc. They decide that they are going to have a position that breastfeeding should be recommended and all the reasons why and the hospital and public health offices need to encourage breastfeeding and be on board with the policies. Sounds great. Until you realize the people working directly with the new moms and babies have an even harder job than those making the decisions. They need to actually make it so that moms and babies can breastfeed and they simply do not have the skill set and time to do so. There lies the difference between the 95% that start and the 33% that might still be breastfeeding after several weeks. That weight again is not on the mother’s shoulders. That is society’s responsibilities. The front line workers and their employer's also don't seem to know what they don't know so they share misinformation. Mother’s take that misinformation as truth because these are the people who we trust to do right by us. Or they do not have the time needed for each dyad. Pumping and supplementing or formula supplementation is a faster means to get to the goal, which might be weight gain, mother's to be pain free,  etc.

Mother's grieve the loss of what they expected. They expected breast-feeding to be easy. Maybe they are succeeding but it is still much harder than they expected. They might not have expected to make a formula choice (which they probably did not make but had to succumb to because the support needed was not there). And so they grieve a loss. We think mother’s feel that as guilt. It is not always guilt mothers feel, it is grief. And it is not always judgement other feel, it is sympathy. I sympathize with the majority of mothers, my clients or not, because it is hard, hard work. And mothers ask for help, identify needs, but those needs often go unmet. They go with mothering let down & disappointed. They feel they failed and are disappointed in themselves. The truth is, they are failed. Mothers do not fail at breastfeeding. They are failed to be able to succeed.