Kim Smith, International Board Certified Lactation Consultant Regina
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October 08th, 2024

10/8/2024

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Let’s get the milk flowing on some hot topics regarding breastfeeding and tongue ties!

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People are getting on the Tongue Tie Bandwagon.

Excellent. 

For years, I advocated for tongue tie releases, enduring ridicule, hostility, and receiving countless letters and emails expressing peoples opinions on what I was pursuing. 
I was actively seeking out dentists for assistance, literally flipping through the Yellow Pages. Some of you may not even be familiar with what the Yellow Pages are. I certainly knew them well as I marked off “NOs,” “maybes,” and arranged face-to-face meetings with those who said “YES.”
I was dismissed as someone who knew little about breastfeeding. “She just thinks everything is a tongue tie now”. 
I was accused of receiving kickbacks from dentists.

Critics claimed I shouldn't be in business, with some even urging families to cancel appointments with me.
Now, multiple offices in our town are performing revisions. We officially have more dentists in this city doing revisions than I know of IBCLC’s in private practice. 
We have people who are flipping lips but overlooking tongue ties.
Babies are undergoing revisions without a comprehensive assessment of their overall needs.
People are not asking what additional issues require attention. 
Is the baby truly prepared for a release? Is the FAMILY ready for it?
Timing is crucial.
Preparation is essential.
Aftercare is important.
Infant oral autonomy is significant.
Lactation Consultants play a vital role in ensuring that families receive the support they need before and after a tongue tie release. It's important that they work closely with families to create a holistic plan that addresses not just the physical procedure but also the emotional and practical aspects of the procedure. There are activities and exercises we can do with infants to support their success post release. And if breastfeeding has been a symptom, we need to address the breastfeeding concerns post revision. 
Education about the potential benefits and limitations of tongue tie releases is key. 
Furthermore, a multidisciplinary approach is beneficial. This team approach helps in making informed decisions that are in the best interest of the child and family at this particular time of their lives. 
Some offices that do releases in other cities will not even allow a family to book an appointment without vetted IBCLC referrals because they see the big picture. I am not saying I want access gate kept, however, it is crucial to ensure that families receive the highest standard of care and support. By requiring vetted referrals, these offices aim to connect families with qualified professionals who can provide expert guidance and assistance. This approach helps ensure that families are not only receiving accurate information but are also empowered to make informed decisions regarding their care.
The goal is to foster a supportive and nurturing environment where families feel confident and well-informed. While access should be as seamless as possible, maintaining a level of quality and trust is equally important in delivering effective and compassionate support to those in need.
Ultimately, the focus should remain on the well-being of the infant and supporting the family through informed choices, compassionate care, and thorough follow-up. By prioritizing these aspects, we can ensure that tongue tie releases are performed thoughtfully and effectively, with the best possible outcomes for everyone involved. 

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September 27th, 2023

9/27/2023

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​Understanding Tongue Tie: More Than Meets the Eye

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On my intake form I often receive a comment such as: "My midwife said my baby has a slight tongue tie” or “the pediatrician said there is small tongue tie but it nothing to worry about.” 
Let's explore why tongue tie is more than just a visual examination of the tongue and why it requires proper attention.
What do we mean when we say Tongue Tie? This is where the tissue connecting the tongue to the floor of the mouth (lingual frenulum) is shorter or tighter than usual. This can restrict the movement of the tongue, potentially causing difficulties with breastfeeding and other oral functions. It can restrict motion in more than one direction - not just out. 
Some babies may have a tongue tie where the frenulum restricts the tongue's movement significantly and it is very obvious visually. Others may have a tongue tie where the restriction is less pronounced. This is likely why people say “slight tongue tie.”
When it comes to breastfeeding we need to do a functional assessment. While a visual examination of the tongue can provide some initial insights, it's not the sole determining factor. The impact of tongue tie on breastfeeding can vary from baby to baby, and it's essential to consider other factors such as latch, milk transfer, and maternal comfort. 

If you suspect that your baby's tongue tie is affecting breastfeeding, it's crucial to seek guidance from a lactation consultant experienced in assessing and treating tongue tie. They will evaluate your baby's feeding patterns, observe the latch, and consider other factors to determine the best course of action.
The goal of an assessment is to identify concerns that are presenting and/or being created. From there a plan to improve those aspects of breastfeeding and ensure both mom and baby are comfortable and thriving can be created.  This plan can range from actions to improve intake and heal any trauma the breast/nipple has sustained and treatment. Not doing so results in babies who are not growing as expected, low milk supply and maternal pain amongst other concerns. 
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If you've been told that your baby is "just a little tongue tied," it means that there may be some degree of restriction in tongue movement, but it may not be severe enough to cause significant breastfeeding challenges or it may not be presenting concerns YET. However, it's always worth seeking professional guidance to ensure optimal breastfeeding success. This also helps to understand why I say no concerns YET. Breastfeeding changes so much in the early days & weeks that it is not uncommon to see a tongue tie that was not causing any issues at 2 days does cause issues at 2 weeks. 

Tongue ties undoubtably have an impact on breastfeeding and it is important to seek proper evaluation and support. By doing so you can be empowered to navigate breastfeeding with confidence. 

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September 26th, 2023

9/26/2023

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The Beauty and Challenges of Breastfeeding:
​A Compassionate Perspective 

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

​It's a natural process that has been practiced for thousands of years, and yet, it can be incredibly challenging for many new moms. Let's explore why this is the case and why it's important to approach this topic with compassion and understanding. Breastfeeding is undoubtedly a beautiful and intimate way to nourish and bond with our little ones. It provides numerous health benefits for both mom and baby, and it's a journey that can be incredibly rewarding. However, it's essential to acknowledge that it's not always a smooth sailing experience for everyone.
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Throughout history, women have faced various obstacles when it comes to breastfeeding. From latch issues and low milk supply to painful nursing sessions, these challenges have always existed. In the past, when breastfeeding didn't work, babies sadly suffered, and infant mortality rates were higher. Thankfully, with advancements in medical knowledge and support systems, we have been able to decrease these rates significantly. This is a dark part of history we do not acknowledge. 
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So, why is breastfeeding so hard if it's a natural process? Well, there are several factors at play. Firstly, every mother and baby dyad is unique, and what works for one may not work for another. It takes time for both mom and baby to learn and adjust to this new experience. Patience and support are crucial during this period. 
Additionally, societal pressures and unrealistic expectations can add to the difficulties. The pressure to exclusively breastfeed can be overwhelming, leading to feelings of guilt and inadequacy when faced with challenges. It's important to remember that every mother's journey is different, and there is no one-size-fits-all approach. What matters most is the well-being of both mom and baby. Did you know a large percentage of my clients are supplementing but many fear admitting this to me. 

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

Let's continue to educate ourselves and others about the realities of breastfeeding, celebrating the successes and supporting each other through the challenges. Together, we can create a more compassionate and understanding world for all moms and babies. 💗🤱
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Growth Charts - Do they mean anything or a waste of time?

5/13/2022

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​Growth charts! They are a huge topic, partly because of many opinions on them.  There are good reasons why there are so many opinions on them. One thing to keep in mind, believe it or not, is that they are not all the same. The growth chart I use vs the one some doctors use vs public health vs all the apps is that some use older versions that were made and provided by formula companies, some use the CDC, some use the WHO, and some maybe even have their own. 
Once upon a time, I was trained to not really consider what growth charts said because the ones we had were made in the 1970s/1980s with a group of all American Caucasian formula fed babies and they were distributed to health care providers by formula companies. Because of this, it was believed they had no relevance to breastfed babies. This isn't entirely wrong, but this is also no longer the case.  
The growth charts available today have since been redesigned.  The WHO one is now based on breastfed, world wide babies with much more detailed analysis. I will point out there are many growth chart versions available - so please look to see what  is being referenced. With proper understanding they can be a very useful tool and tell *part* of the story of growth. The WHO developed standards of growth of the breastfed infant as the norm for growth.  The WHO charts reflect growth patterns among children who were predominantly breastfed for at least 4 months and still breastfeeding at 12 months. In contrast, the CDC growth charts are references. They identified how typical children in the US DID grow during a specific time period. Typical growth patterns may not be ideal growth patterns. I often say "just because something is common, does not mean it is normal." The WHO growth charts are standards; they identify how children should grow when provided optimal conditions. The WHO standards are based on a high-quality study designed specifically for creating these growth charts. For the CDC growth charts, weight data were not available between birth and 3 months of age and the sample sizes were small for sex and age groups during the first 6 months of age. There are lots of gaps in these charts! Some infant apps actually use their own version! 
It is still common to hear statements like “don’t worry about it”  but sometimes this is secret code for “I don’t know how to help you” or “I don’t know how to read the data” or “I don’t understand what the chart is telling me”.
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Donating breastmilk in Saskatchewan

9/25/2021

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“Hey Kim! Is there a place in Regina that I can donate frozen breast milk. I have so much more than I need and don’t know what to do with it.” This is a common text or email that I receive. The short answer is “Yes”.  There is a formal route and an informal route. 
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Northern Star Mothers Milk Bank in Calgary is the closest milk bank that we have to donate to in a formal manner. In Saskatchewan, we do have several depot drop points for approved donors. Approved donors; what are those?  Mothers have to be screened and approved before they can donate to the milk bank or take to the milk depots. You can see eligibility criteria here.  If you are eligible you can start the intake process. You do need to have 150 oz to donate to a milk bank. At the Northern Star Milk Bank donated milk is pooled, pasteurized and tested. This milk is then provided, at a cost, to sick babies in hospitals and homes around the country The costs are cover the expenses of the milk bank, not for profit. ​
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​The informal way is mom-to-mom milk sharing. This can be facilitated within mom support groups or online with social media pages like Human Milk for Human Babies Saskatchewan or Eats on Feets Saskatchewan. This kind of sharing leaves the need of asking questions up to the recipients. Recipients might ask questions about their health history, recent tests, the age of the baby/milk, diet, lifestyle, etc.  The people that usually use this informal route of milk donation typically do not quality for pasteurized human donor milk from the milk bank. 

The important part of all donating and receiving donated milk, is to do your research, gather an understanding of the processes, benefits and risks, feeding goals and sustainability of using or donating donor milk. 
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​I consider donating of human milk to be such as amazing gift. It is such a valuable substance and is in limited amounts, yet widely needed. It is just as limited in the time frame that women are able give so much of themselves to help someone else. 
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Tips to getting breastfeeding off to a good start

7/13/2021

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Learn about how birth impacts breastfeeding. Breastfeeding complications can be linked to the birth experience, birth choices, interventions and care providers. If you can avoid unnecessary interventions, it is recommended, so you reduce the risk of complications associated with interventions. If you cannot (because birth is unpredictable) then it is good to have an understanding of the interventions and how they impact breastfeeding so you can take necessary precautions or measures to help protect breastfeeding still. If interventions are suggested it is ok to ask more questions, gain more information and make your own decision. It is also important to understand how medications in labour will affect breastfeeding. Again, if you can minimize risk of medication exposure by having a drug free birth it is recommended. This is not alway feasible so understanding the impacts, means you can know what to do to counteract the medication effects.  
 
Skin-to-skin immediately after birth. You want to welcome your baby into your arms and on to your tummy or chest immediately after delivery. This step has so much incredible impact that the first hour after birth is known as the Magical Hour. There is very little of more importance that needs to happen more in this hour, than mom and baby being skin-to-skin. Any infant procedures can be delayed until the first breastfeeding experience has occurred. During this hour baby will start to move towards the breast, without anyone doing anything, and go through a series of steps that come before they instinctively begin breastfeeding. This might take 30-50 minutes. Be patient. Enjoy watching your amazing baby. Take in your baby's smell and look. Talk to your baby. Sing to your baby. Connect with your baby.  

Once baby locates the breast and latches on, they may feed and rest on and off for an hour or two. This is now three hours post delivery. It will feel like just moments in time for you. Continuing to be uninterrupted during this time is impactful to your hormones, specifically prolactin & oxytocin, which in turn is responsible for your milk production and milk release. Avoiding separation and things like showering & bathing, is recommended. Baby will be receiving colostrum during this stage of feeding. Frequent feeding helps change the colostrum to transitional milk and starts the increase in milk volume. The oxytocin also helps your body with contracting the uterus, preventing against postpartum hemorrhage.  

Limit visitors after birth and the immediate hours following the birth. I know you want to show off your baby & I know others want to meet your baby. Or maybe you do not want visitors but you are being pressured. This is the perfect excuse to not have everyone visit right away. Your partner is one exception from the handing off of the baby. Having too many people handle the baby interrupts this physiological process that needs to happen in order for long term breastfeeding success. If you would like to have visits, prepare them that baby will likely be skin-to-skin or breastfeeding. They are welcome to come see YOU but may not get to snuggle baby quite yet. 

​REST. So after the first breastfeeding session your baby will likely want to sleep. And you will want to rest, too. Once baby has had some rest, it will be the start of frequent feeding sessions.

The first 3 days are hard. You might feel a little like your baby must not be getting anything and that is why they won't stop feeding. This is not the case. Babies are incredibly smart and are setting the stage of their future milk supply but nursing frequently in the first few days. Switching sides often is important; start feeds on opposite breasts at each feed. Babies might have a short nap between sides and then have a longer nap after that second side.  Napping when baby naps is critical. Get help with easy nutrition and meals for yourself. 

​Get help early! If you have pain, trauma, a sleepy baby, baby is not latching or baby is not peeing and pooping as expected, you need assistance. These are red flags and not expected and acting fast will make a big impact on your success.

Take a breastfeeding class. This will help you learn more in-depth about breastfeeding, prepare for breastfeeding and learn as much as possible and how breastfeeding works, positions and strategies for challenges that come up. 
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Baby not pooping? 3 days? 10 days? Is this normal?

2/21/2020

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I get asked about infants stooling patterns quite a lot, typically from worried mothers who have an infant who has slowed down on stooling, maybe 1-2 days, sometimes 7-10 days. The baby might also be gassy, not sleeping or fussy. Moms often will ask various sources if this is normal or expected. I was certainly taught to believe this with a variety of reasons as to why. As an IBCLC  I don’t consider this to be normal, anymore, and I will list some of the reasons as to why later. In my opinion, the information I had been provided over a decade ago is still how health professionals and peer support are being taught in their education and orientation to units and job positions that support infants and mothers is also teaching this way. 

The number one reason I hear is that breastmilk is just highly digestible & there is nothing left to dispose of. My common sense response to those who say ‘it’s just absorbed’, is why then when babies finally do have a bowel movement is it always reported as “a huge blow out” or why do babies have “poop days”. The days are described as days where, once the stooling starts, it does not stop for several diaper hours. If it was readily absorbed, it wouldn’t be an explosion or take hours to clear out the bowels. In recent years more information has come out to tell us that, in fact, there are known constituents in breastmilk that are not digestible. One specific component is human milk sugars that are attached to the lactose molecule in breastmilk. They can make up to 20% of the content of milk. So, to think that ⅕ of the intake of what an infant consumes is not digestible, makes one wonder where it goes. It appears though, that this doesn’t have a role in nutrition, but instead in gut health. The bacteria of the infant gut is what thrives on these human milk sugars, not so much that an infant's growth thrives here. This could be one of the reasons why we may often see a baby gaining weight well, but not be stooling. But we might see a colicy or gassy baby, because the gut flora isn’t quite ideal. I find often getting more milk into the baby helps these symptoms. More milk = more human milk sugars = more healthy bacteria. Not to mention other little things that end up in stool. The process of digestion alone would have some sort of byproduct left, even just the epithelial cells of the digestive tract sloughing off along the way. 
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Baby not pooping? 3 days? 10 days? Is this normal?
I stated the number one reason that I hear as a reason why babies might not be stooling is that people believe breastmilk is digestible and I have provided some reasons as to why this is not true. But, I am actually more concerned about another aspect of the non-stooling situation, beyond just human milk sugars and bacteria content. I have shown my belief of *if milk is going in, stools need to be coming out”. When I come across a non-stooling infant, I want to have a look at the growth patterns of these infants. I mentioned thriving infants above because it is very important to discuss infant weight gain in all of this. Watching just pee alone is dangerous as babies can get to a pretty scary place before they start to really slow down on the peeing and may be in a state of failure-to-thrive at that point. We can possibly avoid that by watching stooling. I will say it one of the first signs of lower than required intake in many many babies I have worked with. 

This can all actually have a long term effect on breastfeeding. As babies take  in less milk & have slow or no weight gain , milk supply can be lowered, resulting in even less milk being taken in by the baby and the cycle continues. It can also be a sign of more going on and the sooner we intervene and assess the situation, the sooner we can strategize solutions to prevent things from a downward spiral. 

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What should we expect in a babies diaper then? This is what I recommend. As babies get closer to 4 months, they may slow down to 2-3 diapers a day, but in the early days and weeks fore sure with each good feed or couple feeds, there should be a bowel movement. 
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I also want to mention that these ideas and supporting information is quite new, so just like we have to be patient with babies and how they grow and change and develop, we have to be patient with the research and learning of the changes and developments coming out in breastfeeding. As much as we have been breastfeeding “forever”, it was a time before so much evidence and research existed and was desired. 

If you are concerned about your babies stooling patterns, I am always happy to help explore that with you. I welcome you to reach out for a consult, in person or virtually. 

(originally posted Feb 21...I am sure more will be added as time and linked thoughts come up)

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Is pumping being used as a new "magic fix" for breastfeeding concerns?

1/27/2020

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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, online support groups, mommy chats, 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 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? Or one of the many other solutions with have to help with the pain and healing. 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 or edema 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, or some other strategies that are much more effective. 

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. Another strategy I will mention here is block feeding. Block feeding used to be a common strategy for overactive let down but in more recent years, we have come to learn this is often detrimental to breastfeeding, as well. It appears to create a downward spiral of low intake, low weight gain and low milk supply. Always have what appears to be an overactive let down assessed by an IBCLC. 

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. If baby is not gaining weight well and is also struggling with sleep, this is a different story. 

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. I have also come to believe colic is an umbrella to other providers. I think sometimes we can seek some clarity on these babies and get past colic, rather than waiting it out. If you have what appears to be a colicky baby, perhaps booking for a breastfeeding session will give some of that clarity. 

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, proper positioning, good technique, etc. 

Mom's please seek out appropriate, knowledgeable, support when you encounter these easily managed breastfeeding concerns.
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Why a breastfeeding class could be more helpful than you know

4/26/2019

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So many families plan on breastfeeding before baby is even born. Initiation rates are 90%+ in hospitals but our stats show this drops off very quickly...less than 60% of mothers are meeting their own goals. A lot of people figure breastfeeding won't  be too difficult or that they will just try and see how it goes.  Many learn quickly that breastfeeding comes with lots of unexpected questions, confusion and lack of knowing what possible solutions are. When mothers find out they could have taken a class, they state how beneficial it would have been to receive some knowledge during pregnancy and know where to get guidance when they need it. 
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Taking a breastfeeding class with an International Board Certified Lactation Consultant (IBCLC) could help prevent many of the problems that mothers experience early on. A class will highlight common concerns and give you solutions to implement right away. You can also have the opportunity to ask questions that are individual to you. It also helps you establish a relationship with an IBCLC so you can feel more confident calling for help at the first signs of trouble. You will also learn about unique hospital policies and procedures. ​

​Taking a breastfeeding class should leave expecting parents feeling calm & confident about newborn baby behaviours and what to expect after baby is born and during their hospital stay. The topics covered in a breastfeeding class should include special circumstances, so if things with the birth do not go as expected, the parents are prepared with solutions, questions to ask their care providers and be informed about their options. They will also be informed about medical issues and an anatomical concerns that might have an impact on breastfeeding. 

If there were previous breastfeeding problems in the past, it can be useful to take a class to help identify possible problem areas and make a plan of action for the next baby in case those issues (or others) come up again.

I know so many times people say "why didn't anyone tell me". We are hear, ready to dish on it all! 
Really, are we ever prepared enough? Building your knowledge base and support team before you embark on your breastfeeding experience can make the whole thing a much different experience.

I teach the majority of these classes at The Hive Wellness Studio. 

Topics always covered in the class are: 

Importance of breastfeeding
Tips to successful breastfeeding
How breastfeeding works
Positions, breast crawl, attachment
Hunger cues
Intake, output
Challenges & solutions
and amore...

Each registration include a breastfeeding booklet and is for one expecting parent and one support person.

Register for a breastfeeding class now! 
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Foremilk! Hindmilk! Baby MUST feed for 20 minutes a side.

2/2/2019

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“You need to nurse for 20 minutes on the first side and then move baby to the other side for twenty minutes.” or "You have to empty the first breast before going to the second breast". 
Did anyone ever tell you these things? What if your baby only nursed for ten minutes? Did you ask what would happen? I suspect you may have been told that is not long enough for your baby to get the hindmilk (higher fat milk). Is 20 minutes that magic “long enough” time frame? What if baby wanted to be there for 25 minutes? What happens then? Do you have no more milk?  
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Are you breastfeeding and feeling like you have to watch the clock? How about we focus on watching the baby and take cues from them about what they need.
Have you ever expressed breastmilk? What does it look like? Have you expressed more than one time? Did your milk look the same each time? I suspect it varied from thin, watery and blue, to yellow and thick. Did you notice a difference with the time of the day you pumped? How about before a feed or after a feed?

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

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

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

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Let's not get our emotions confused

1/3/2019

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When a woman plans to breastfeed her baby and that plan doesn't go accordingly, it can be a time of many emotions. This emotion is often referred to as "guilt". There is a common saying, "we shouldn't make women feel guilty for not being able to breastfeed." Of course, we shouldn't. There are so many factors, however it is not a black and white, can or can't, choose to or not, it works for some, not for others, etc. 

"Don't make her feel guilty"

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

We need to explore the feelings women experience when it comes to feeding their infant. Everything we see now is "Breast is Best". We have  become a society that is "great" at encouraging breastfeeding but we are not a society that is even "good" at supporting and sustaining breastfeeding. This means many women are not meeting their breastfeeding goals. With that comes many feelings. 

Mothers who intended to breastfeed but struggle to meet that goal, feel a sense of loss. We know there is a connection to loss of breastfeeding and postpartum depression. We need to recognize that many mothers experience grief, and not guilt, in the postpartum period.
I feel like grief is confused for guilt or a feeling of failure and it is not interchangeable. Mothers need to be given the opportunity to grieve what they had planned, what they believed postpartum would be like, the support they would receive but did not. Hearing “now, now dear, it’s ok, formula feeding is ok” doesn’t really help. It doesn’t help because it is not about breastmilk over formula. It’s about an expectation mothers had. It’s about a decision they thought they had control over, only to find out breastfeeding is difficult, but more so motherhood is difficult!  It is all more difficult than society lets people believe. Breastfeeding is not well supported. It is not understood well. So many myths and wise tales still exist and are perpetuated daily, holding women back. 
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​Women are finding themselves alone, feeling isolated & without reliable resources
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Women who choose formula from the start don’t feel this way because they got to make that choice consciously. Women who planned to breastfeed but missed out on proper supports don’t feel like they had any other options but to give up their plans to breastfeed. That’s not a choice. That’s survival. We need to guide mothers to the appropriate, breastfeeding educated resources in a timely manner. Mothers deserve to have choices, someone who can offer solutions that are acceptable to them & who can provide support and counsel when breastfeeding isn't the best option for them. 
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What's in a baby's weight?

12/10/2018

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Many mothers will be able to relate to this experience. The experience looks the same; a routine infant check up appointment, baby gets a weight check, the parents are asked some questions about development, etc.  Upon looking at the weight, it is determined the infant is not gaining weight as expected. What does this mean? What is the cause? What should be done? 
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It often is quite shocking to parents, especially mothers, to hear this news. They are perplexed because they thought feeding, usually breastfeeding, was going ok. How is it possible that baby isn’t gaining weight? How is it possible she didn’t know that baby wasn’t growing as expected? Can anything be done? 
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Common reasons provided for this phenomena is that mom has low milk supply, baby isn’t getting enough hind milk or baby is too sleepy and isn’t feeding often enough. I don’t think it is quite that simple. 

What I find in these scenarios, because I get calls often after an experience like this, is that what is not communicated to the parents is why we do these checks, why they matter, what they mean and what should be done with the information.

The simple answer is that we expect babes to maintain their own curve that they plotted on at birth (or more ideally 24 hours). When babies start to drop off that curve, this gives us a sign to look and assess what might be happening. This is a clue to ask some more questions and see if there are other pieces that can help tell us what might be happening. We want to know more about feeding behaviour, mood, output. 


Often what I hear is that there is no way baby needs to eat more. They are happy, content, sleep well, don’t really fuss. The opinion is that there is no way it is possible the baby isn't eating enough. People expect a hungry baby to cry, be irritable, to unsettled. I am going to say this is simply not true. I am sometimes more concerned about that “good baby” that sleeps well and always content. A very misunderstood piece of infant wellbeing is that weight gain influences appetite. What I mean by that, is that if a baby is gaining well, they demand to fed and show signs of being hungry regularly with easily identified feeding cues. What we think is a content baby because they have a calm mood, could be a baby who is content but not getting quite enough intake. A baby that is lower weight than expected, will have a lower appetite and will in fact cue less to be feed, will have subtle cues, likely won’t have a late hunger cueing & overall may make little fuss about it. If mother offers they will feed, but commonly have short feeding sessions. When they are being feed, their appetite is low so they do not do an efficient job, leading to milk being left in the breast and the body slowing down production. I give the example that if they are getting 70% of their intake requirement, they will eat at 70% efficiency (this will very baby to baby).  This over time can cause a low supply, which influences their feeding because babies like flow...so low flow, means less interest in feeding and the cycle continues. 

If none of that concern is explained to a family, they leave these routine visits confused and bewildered as to why some one had a concern or what they could/should do about it and have no idea why it happened in the first place. There are lots of factors to consider to understand why this is happening & what the appropriate action for each case should be. 

If you are experiencing a difficult feeding situation where weight gain is a concern, booking a consult with an IBCLC is advisable. With a good assessment by an IBCLC, the root cause can often be determined and a solid plan can be put into place to get the baby fed, get weight gain concerns addressed, increase milk supply, maintain breastfeeding, etc. 

Other things to note in cases of lower than expected weight gain could be: 
  • baby sucking fingers after feeds 
  • ongoing jaundice 
  • green stools 
  • edema
  • dry skin, cradle cap, eczema 
  • less active baby
  • longer napping sessions 
  • baby only sleeps when being held 
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6 Weeks to Successful Breastfeeding

10/6/2018

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The first 6 weeks of breastfeeding really set the stage for how breastfeeding will be beyond 6 weeks. This is why it is so important for new mothers to seek help as soon as trouble arises, but even more so, knowing what trouble looks like. If someone has never breastfeed before, they may not to be well equipped to know what is normal & what is a sign of struggle.  And even when everything goes "right" in that 6 weeks, breastfeeding is still challenging. Not only are mothers learning to breastfeed, along with their baby, they are also recovering from birth, coupled with lack of sleep and changes in hormones. 
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This is why I am now offering a 6 Weeks to Success Breastfeeding support package. This will take the guess work out of breastfeeding for new mothers. This package means new mothers are getting early, regular check in's with an International Board Certified Lactation Consultant. This package is designed to prevent breastfeeding stress and anxiety and rather build confidence and empowerment. Instead of waiting for problems to arise and then second guessing what to do and who to call for help, possible difficulties will be detected and strategies can be implemented  early. If trouble starts to arise, new mothers will know someone is scheduled to come without having to decide they need help  & begin to seek it. 

Sounds good right? So what are the details of the program? 
  • We will start with a phone call while the expecting mother is getting closer to her estimated due date. This is so I can learn about the mother-to-be. I will want to hear about their experience with breastfeeding until now, their goals and hopes. It gives us a chance to start building their breastfeeding experience. This call will be about 30 minutes long. 

  • Once the baby arrives, then the in-person sessions begin. I will be there for the very first or one of the first breastfeeding sessions or within the first 24 hours. (To be determined during the initial phone call.) The focus will be on optimal positioning and latching the baby to the breast. If there are concerns with latching strategies will be employed to lead to successful breastfeeding such as hand expression, handling a sleepy baby and navigating all the options and choices available in this time. (Yes, this all means I will come to the hospital for this visit). 
 
  • The next time we see each other will be within 24-48 hours. (Day 2-3).  This visit will be to assess how baby is breastfeeding, how the new parents are doing, how the latch is feeling (nipple pain & preventing damage is a priority.) I will review position & latch, getting the new mother more confident in her skills and  her baby's ability. Gaining confidence in breastfeeding is the goal of this session. 
 
  • The third meeting is on day 3-5. This should be when the new mothers feel the phenomena often referred to as “milk coming in”. (Hint: Milk is always there…there is just a sensation that occurs after a few days post birth). I will teach the mother how to deal with the new feelings and sensations and changes in breastfeeding when this happens. I know it seems weird to think breastfeeding can change that soon after birth, but it changes daily for the first few days and weeks.  
 
  • The fourth appointment  will be scheduled for the first week, day 7-10. This is typically when the early feeding challenges may arise. The new mother will be well supported in this time to ensure they get any issues and concerns remedied as soon as possible. If I think there are any specific products or feeding adjustments I think could be useful at this stage, these will be suggested at this appointment. The goal of this appointment is to keep the new mother & support people motivated & encouraged to push through any difficulties. 
 
  • After the 4th appointment, there will be two more appointments to be used over the next few weeks, up until the baby is 6 weeks old. This time will be used to assess any strategies used to overcome difficulties, learn more breastfeeding lifestyle strategies & answer questions parents have. These appointments will help new mothers & babes master the art & skill of breastfeeding. 
 
  • I will provide a copy of the Your Breastfeeding Experience Manual and any relevant handouts needed throughout your experience. 
 
  • Continuous support for the first six weeks of your breastfeeding experience between visits is provided via phone calls and text messages. 
Space is limited for this package offering. 
The estimated value of this package is over $900. From now until Dec 31, 2018 I am providing this package for an introductory cost of $500. This means 6 visits with an individual value of $75-150, for one price of $500.
If you are expecting a baby after Dec 31, you can still take advantage of this price. You can book your spot now. 
Secure your spot now
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Milk Supply Concerns; Foremik & Hindmilk

8/20/2018

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Has someone suggested to you that your baby isn't gaining weight as expected and the solution is to get baby to ingest more hindmilk? It has become common knowledge that fat content of milk changes throughout breastfeeding. This is true. Milk doesn't change in each feeding session in the same way...it changes over the course of the day and feeding patterns. The anxiety about whether or not baby is feeding "long enough" to get to the hind milk is not necessary. 
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Something else that is true is that the longer a baby feeds, the more letdowns occur and more fat is released into the milk from the milk making glands, however...there are some things that need to be pointed out and kept in mind. 

Foremilk and hindmilk are not two different kinds of milk. Women do not produce a low fat milk and a high fat milk. It is simply that the first milk a baby receives at the start of a feed is *fore*milk and the milk after that is *hind*milk; in a way meaning initial milk and subsequent milk.  The change is gradual It is not based on a percertange of fat content, like skim, 1%, 2% or whole milk that we are used to thinking of. There is no magic time in a feed that changes the fat content or we can see a switch of kind of milk. There is no percentage of fat a baby needs to be able to gain wright. On this note, all the foremilk is not always lower fat than all the hindmilk. Foremilk from one feed might have a higher fat content than hindmilk from the next feed, previous feed or other feeds in the day.      

With this all in mind, when there is a weight gain concern, the focus needs to be on increasing intake of milk and looking at the factors that might be impacting intake & not trying to avoid foremilk. Strategies to avoid formula and increase hindmilk consumption are ideas like pumping  foremilk before a nursing session, so baby can only access hindmilk or keeping baby on one breast for 15 or 20 or 40 minutes, depending on who is giving the instructions. In fact, sometimes these strategies means the baby is getting even less milk than before. It is the total daily milk intake that determines successful weight gain. We cannot look at one feed as the way it is for all feeds. We need to look at each day and all the breastfeeding sessions combined and then address ways to increase milk intake overall. 

I wrote about this again in another post; you can read that here. 

If you find yourself in the situation of having an infant that is not gaining as expected, not gaining at all, slowly gaining or losing weight, I suggest a full evaluation with an IBCLC. 

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Breastfeeding pain...what is normal?

6/29/2018

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Let's talk about breastfeeding pain. 

I have a theory. Some others might share this theory. Some might think I am crazy.

Pain in the body tells us to pay attention. Pain isn't always bad, but its a way the body signals to the brain to pay attention. It can be *pay attention* because something is wrong, or *pay attention* because this needs your focus. Pain is not always a bad thing, per say. 

Like birth, for example. Birth can hurt (it doesn't always, believe it or not). Birth is a great thing, not like illness or injury that make you feel pain, but that first contraction will kick you in the @ss as a way to say "Something BIG is about it happen. Pay attention. Cancel all unnecessary things. Put down your phone. Tune into your body. Get your people here."Birth pain doesn't necessarily need attention or anything done to stop it once we are paying attention to the process. Sometimes, it does. 

I think breastfeeding pain is similar. Either something is needing attention, like baby isn't latching well, position is off, baby isn't getting enough milk, baby is losing weight or maybe it is a message we just need to connect with baby, release some emotions, get hormones flowing, get on the same page, figure some things out, get a groove going.
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But breastfeeding pain shouldn't be ignored, or accepted as the way it is, in my opinion.
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Breastfeeding pain
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STOP! Don't rush into fixing that tongue tie.

4/29/2018

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I love talking breastfeeding and I really like talking the history of breastfeeding. When people find out I am an International Board Certified Lactation Consultant, they often respond with, “you’re a what?”. As I continue to explain what I do they say “seriously? People have trouble with breastfeeding? How is it that the human race has made it this far if it weren’t for breastfeeding?” Oh, goodness, what era do you want to talk about? I mean there is so much history about how breastfeeding can fail and what resolutions people had for that, depending on the era and the region.
​

We are part of another era and in the middle of history. I call the time before where we are  right now “Before Tongue Tie”. Really, as an IBCLC of just shy of a decade, I had MINIMAL education on tongue ties and their impact on breastfeeding. Like a dismel amount. Then several years ago, I attended a few conferences, online, in person, different geographical locations. Everyone was talking about tongue ties. I said to myself and to others:
“Can we not talk about anything else?”
“There is no way there are this many tongue ties”
“Did we even know anything about breastfeeding until now then, if tongue ties are to blame for everything?”
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Tongue ties can cause a lot of issues but what should we address first; the tongue tie or the mess it makes? I have a few thoughts on the subject.
Really, I was thinking to myself, these people are INSANE. As a fellow insane person, I opened my mind and listened to what people had to say. I heard them out. I decided to change some things in my practice and assessments. I grew myself. I pushed myself to really learn more. Truth was, people were making history at that time. We were in it. It was a time of ah-ha moments all over the place. No one had all the answers about tongue tie and their related issues, but many had theories. 
They had different potential solutions. I come into all of this ready to learn and see if we can address some of the challenges that faced breastfeeding families that didn’t seem to have resolve. Much of what I was learning was that there was hope for these ongoing struggles that my previous education and training didn’t teach about.
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I dove in. I recruited other professionals as supports. We networked. We shared experiences. We re-evaluated. We want the best for families.

My job as an IBCLC is not the same as those other supports and professionals but I want to share some of my learnings and reflections. I know tongue ties cause a lot of issues. I will not deny that, but I will say that just “getting it snipped” or getting into a dentist for a laser revision isn’t a guarantee things are going to be resolved.  

A really key piece I have acknowledged is how much better babies that are at an appropriate weight recover and catch on to breastfeeding post-revision compared to babies that are underweight or slow gaining, maybe gaining weight a little faster than what is called a slow gainer and who maybe is not getting much concern from anyone but still not growing on “their curve”. Doing a revision on these babies is something I really hesitate to do now and I won’t make a recommendation for revision until resolution has occurred in the weight department. This to me a really good reason to be working with an IBCLC before hand.  

Another really important part to working with an IBCLC is to assessing milk supply. Babies respond to flow and without that flow, they just won’t want to try and improve anything. Add in a tongue tie and they just don’t care to breastfeed nicely or at all. If supply is low, again even with a revision, they just are not happy breastfeeders. Both this scenario and the above one make people say “the tongue tie wasn’t the issue” and sometimes add in that “they did the procedure for nothing”. Being able to get moms working on supply, which in turn can help the weight gain issue, if it exists, helps ensure that once they get those two factors sorted out, they are ready for revision and have a good foundation to make the revision successful. The pieces fall into place nicely and almost predictably. It also helps me be able to tell a mom a timeline for “when will this all be better”. I can help them set up a plan so they can see a means to an end, rather than “just keep trying, it will click soon”.

There is also maternal pain that is often a concern and should be addressed INDEPENDENTLY of a revision. Sometimes tongue ties cause pain, damage & trauma to mothers breasts and can be resolved with a revision, but ideally more should be done to address this instead of just waiting for things to get better. When we deal with the breast/nipple independently, it makes the revision seem significantly more effective.
Babies can have other factors/stresses affecting and influencing breastfeeding that are often identified by IBCLC’s or professionals who assess physical factors, like Chiropractors or Osteopaths. I also find when we resolve these issues first, or at least start working on them, that things get back on track faster post-revision.       

Sometimes I am not consulted until after a procedure for a tongue tie has been performed. When I get called after, I can most certainly still help and we can get past these remaining pieces, it just is in reverse. What I find though, is it is all a lot more stressful for moms and families because they also have a cranky baby and after care exercises to get in, as well as possible pumping & supplementing, and perhaps appointments with the other professionals we work with. I personally think It is better when I can set up a plan in steps with one focus at a time. Once supply and weight is up, it is one less stress, so the family  can handle the stress of the aftercare and extra needs of the baby.

I am also aware that some parents would rather not go through a revision at all and this is where my “Before Tongue Tie” experience and knowledge comes in. I say to the parents and myself, “what would we have done BTT?” Are there strategies that would be useful and address the concerns? Sometimes there are solutions that the parents are 100% ok with and will get the baby fed and minimize concerns. Sometimes all of those are tried and the revision conversation might have to happen again. This is where knowing the risks to the situation and knowing what else to watch for is important.  

Tongue ties are a topic that people get really excited about from many different perspectives and I don't see that changing for awhile, but I wanted to raise the thought that we are in a place of breastfeeding right now that in the years to come will be a historical recollection. It might be known as something more eloquent than BTT but until then we can recall what it was like BTT. ​
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Canadian Pediatric Society no longer recommends this practice from the late 1800's (it is now 2017)

9/6/2017

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What is that eye ointment babies get after birth and why do they get it? It is erythromycin and it is for prevention of severe eye infections in newborn babies. This routine practice has become outdated and no longer recommended. This might be a topic you would like to have a conversation with your care provider about. 
​

Neonatal ophthalmia (NO) is a relatively common infant illness & is defined as conjunctivitis occurring within the first four weeks of life. This term originated from cases caused by N gonorrhoea, but the term now currently refers to any conjunctivitis in this age group. 

In most instances, neonatal ophthalmia is a mild illness and can easily be treated case by case once i
nfectious conjunctivitis is determined & distinguished from eye discharge secondary to blocked tear ducts and from conjunctivitis due to exposure to some kind of irritants or chemicals. The exception to this is ophthalmia due to infection with N gonorrhoea. Those cases are quite dangerous for infants. 
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Historically, the purpose of prophylaxis treatment with Silver Nitrate at birth was for neonatal ophthalmia eye infections due to N gonorrhoea. But when I say historically, I mean the late 1800's! 

A lot has changed in Canada since then and the Canadian Pediatric Society is no longer recommending routine prophylaxis for neonatal ophthalmia. The primary reason is that N. gonorrhoea strains isolated in Canada are showing considerable resistance to the treatments routinely used and there are no recent studies of the efficacy of ophthalmia prophylaxis with these treatments. 

​You can see the position statement, complete 
recommendations from the CPS and the history of NO, risk factors & legal considerations depending on where in Canada you live on the Canadian Paediatric Society website. 
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The Guise of Breastfeeding Support

8/25/2017

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What is really happening when the sponsorship of events is by pump companies or formula companies/pharmaceutical companies. 

I want to be *explicitly clear* that this is NOT about individuals. This is not about the idea or execution of such events. This is not about women supporting or not supporting women. This is not about businesses who chose to plan events. This is not about businesses who participate in events. This is fully about the sponsorship by the companies covered by the WHO Code. (and I promise you they all know about the WHO Code and how that impacts their relationships). 

So, what is the WHO Code? 

The WHO Code is the common wording used to refer to the International Code of Marketing of Breastmilk Substitutes. The Code was adopted by World Health Assembly and UNICEF in 1981. Since that time, a number changes have been made with the Code. 

The purpose of the Code is to protect breastfeeding, to protect all mothers and babies, regardless of their desired feeding methods, and to prevent aggressive marketing practices that often interfere with mothers meeting their own breastfeeding goals. Infant formula, feeding bottles, and artificial nipples are the main products that fall within the scope of the Code. Breast pumps are not under the scope of the Code BUT some pump companies violate the code because they market bottles and artificial nipples. Again,  the Code only applies to the marketing of these items–it does not affect whether they are sold or used. Confusing, right? 

Confused? Of course you are! 

The Code itself can be confusing, but then try to figure of which companies are WHO code Compliant and which are not is a whole other task. Companies come in and out of compliance all the time. Something that commonly happens is large companies merge, or enter into marketing relationships with each other and they also acquire departments from other companies with buying, selling and trading. 

Then we have to consider who are the "kid" companies and who are the "parents"? Companies who are owned by Code violators are considered the same as their parent company. You really have to dig deep to find out a lot of this info, but if you start goggling different brands of formula, medications, infant supplies, etc you start to see that there are a lot of kid companies and just a few parents. The parent companies, of course, want to keep their smaller companies WHO Code violating record clean so that health care workers who have to adhere to the WHO Code can still have relationships with these companies, while the parent company gains benefits. They can also give items and samples not covered by the WHO Code and maintain compliance. But in the end, they are still violators. 

As an IBCLC, I need to educate people about the WHO Code and marketing. What I am encouraging people to do, all across Canada, is to just keep their eyes open a little bit to who is hosting events, who is sponsoring events, what is that relationship like, who is providing the educational piece & decide if the information being given is evidence based and helping mothers meet their breastfeeding goals or if the information might be slanted. You will see a large variety of how these events take place and some will be absolutely ok and some are going to have questionable practices. 

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This is not about you and it is not about me. 

Again, none of this is personal. It is not an individual issue. This is a nation wide issue. If one baby store is approached to host an event, any baby store could be being asked. If any doula is asked to be at an event, it  could've been any doula they approached. If any nurse is involved, it could be any nurse approached, It happens to doctors, chiropractors, pharmacists, or even IBCLC's. It is anybody who is nice and kind and is buying into the idea of hosting an events for moms to offer support and companionship and education. That in itself is a fabulous idea and needs to happen! I will say people are ALLOWED to do this. As an IBCLC, I choose to adhere to the Code so I will not participate  I do let people know that if that is breastfeeding matters to someone else in their profession, they can choose to adopt to follow the WHO Code.  I am not here to tell anybody how to run their own business. They CAN participate and have relationships like this if they chose to. But I will always protect breastfeeding in my community. True breastfeeding support does not come from WHO Code Violators. 

I want this to be heard by everyone because if the doula/nurse/doctor/pharmacist or IBCLC, asked to participate this time walked away, the companies will just go to find another one. This also applies to educational events for professionals so not only do we look down, we have to look up. I want parents to hear this so if they go to an event they can also see who is providing the funding for the event and the information. 

Eyes open! ​
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Keep that Fenugreek on the shelf

8/12/2017

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Do you remember that time I told you to throw away the Lanolin? (You’re welcome) 

I am here again suggesting you keep again breastfeeding old faithful on the shelf! At bare minimum before taking fenugreek to help an unsteady to low supply, keep that bottle of fenugreek sealed until some further investigation as to why you might need something to boost supply is started. 
Should I use fenugreek to post my breastmilk supply?
Should I use fenugreek to post my breastmilk supply?
We are starting to learn that fenugreek may not actually even help a supply but it can actually be quite harmful for many mothers who are struggling with a low supply, depending on why the supply is low. The very reason supply one mothers supply is low can be a contraindication for use of fenugreek on its own. For your own safety, you need to know the reason for the low supply, before taking fenugreek. Of particular awareness would be mothers with thyroid concerns, PCOS, IGT, diabetes, insulin resistant type health concerns. Women who have just had babies may not aware of or have an official diagnosis because until that time they have been mostly healthy. Sometimes it is not until the stress of a pregnancy and birth and early postpartum has an impact on the body that women start to feel unwell. And they might not even feel unwell, but just not be making a full supply. Producing milk is not a necessary part of living, so if the body has stressors then often production is suppressed. Breastfeeding is a time in life where a mother needs to take care of herself in order to be able to take care of the baby. 

I think “breastfeeding issues” are sometimes breastfeeding issues but I also think that often time struggling with breastfeeding is just a symptom of something else. Paying attention to your supply as an indiction of something else, might actually help you understand more about your body and its personal needs.

​This is not to say there are not good herbal options for supply, because there are. It is matter of knowing what is happening with your supply and your body, your own unique challenges and having a health history taken or worked up, so that the right herbal for each individual can be chosen/suggested. It might just be fenugreek for you. But, there is a good chance there is something better.

​I will also add that many mothers experience upset stomach, gassiness, loose stools, diarrhea, dehydration, low blood 
sugar & unpleasant body odour when taking fenugreek. Baby may also show similar symptoms.  

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4 Reasons to Become a Surrogate Mother

4/24/2017

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For some people, pregnancy is easy, and they enjoy it, but pregnancy can be tough. Morning sickness, hormonal ups and downs, weight gain, constipation, swollen ankles, heartburn and a plethora of other discomforts, and that's before the pain of childbirth! Why would someone go through all of that for a complete stranger?

If you have never considered becoming a Surrogate Mother, and are not in a position to need the help of surrogacy to become a parent, you may be wondering why anyone would want to become a surrogate. 
We find there are four main reasons the people we work with want to give the amazing gift of parenthood to others!
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People become Surrogate Mothers because they want to “Pay It Forward”.

“It” can be anything. Most of the Surrogate Mothers I have talked to over my years of involvement in surrogacy choose to become Surrogate Mothers because they want to spread the good and love in the world. These amazing women just want to be a source of light in the lives of others. I cannot think of a more beautiful way to perpetuate positivity.


Women choose to become Surrogate Mothers because they believe everyone deserves a chance to be a parent.

I have found many people who are called to surrogacy are warriors for social justice. They see how difficult it is for those seeking the assistance of a Surrogate Mother to become parents. Their hearts break for the single Intended Parents, gay couples that are desperate to become fathers, older couples who have yet to experience the joy of parenthood, cancer survivors, and others who have been struggling to adopt or have children on their own. Egg Donors and Surrogate Mothers are the balance that can tip the scales of inequality for Intended Parents.

Having experienced and overcome infertility, people become Surrogate Mothers to give the gift they have been given.

Some of the Surrogate Mothers I have worked with or spoken to have decided to pursue surrogacy because they required the assistance of an Egg Donor or Sperm Donor to become a parent but were able to carry their baby. Others fought long, and hard battles with Infertility and by chance became pregnant. Their empathy and compassion for others is strong, having experienced infertility themselves.

A woman may choose to become a Surrogate because she loves motherhood and being pregnant.

Some people abhor being pregnant and view it as a necessary means to an end. Others have never felt more beautiful than when they are with child. Combine that with the joys of being a parent, even when it's the most thankless, draining job in the world, being a parent is incredibly rewarding. For some, choosing to become a surrogate is as simple as wanting to enjoy pregnancy but being finished having children of their own and wanting to help others experience parenthood, too!
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Surrogacy in Canada is altruistic. This means that everyone who chooses to be a Surrogate Mother in Canada does so out of the goodness of their heart. One cannot be compensated for their surrogacy journey (although all related expenses will be reimbursed). Surrogate Mothers are truly giving a gift that cannot be repaid. I am constantly in awe of the Egg Donors and Surrogate Mothers I meet. Their selflessness becomes a miracle for others. They truly give the gift of life.

A surrogacy consultant with Proud Fertility, our guest blogger Nathan Chan has made it his life work to help people fulfill their family dreams. 

Watch the video below to hear Candice's story with surrogacy.

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If being a good doula was based on what is in our doula bag, Mary Poppins would be the greatest doula. 

4/3/2017

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Mary Poppins has quite the bag and all things considered it could make a fairly decent doula bag! There are a few items I would leave out of my doula bag, if I was Mary Poppins. The first one  would be her coat rack. I am quite certain I can find a place for my coat at the hospital or a clients home. I can probably do without a plant, but hey, if you want a plant in your hospital room to make it a little more homelike, you can bring one…I won’t complain. Although, keep in mind, you might get some flowers gifted to you after you deliver your baby. 

Mary Poppins even brought her own lights. Lights are important, but again, I am not worried about the lighting at the hospital or your home. Even if you want dim lights, the doctors and midwives have flashlights - yes, they do! Speaking of lights, some people like to have some flameless candles to create a nice ambience. I do have some in my doula bag, but as an FYI, they are a few dollars at the $1 Store. ​
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I, just like Mary Poppins, have in my doula bag. A nice pair of dedicated runners for the hospital are in my bag. 

Mary Poppins has a mirror in her bag and I sure could use a mirror in my bag. It would be perfect for that moment the baby is crowning and a mother wants to look. Hold on, wait, that hasn’t happened. I have yet to have a mother giving birth who wants to see….

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Now, of course, I know some moms would want to but in my experience it is not super common. Again, if that is something you think you might want to try in your birth, lets chat about it and make a plan about who should bring the mirror, just like the plant. 

That tape measure Mary Poppins has in her bag is amazing and I would love one! I mean imagine being able to measure up people I am going to work intimately with and be told all about their personality. Wow, what a benefit that would be to me and to my clients. Wait, hold on. I do often have a tape measure in my doula bag…with my knitting. Yes, I pack knitting into my doula bag. What? Why on earth would I have knitting? We can talk about that later in another blog post. 

Back to this tape measure idea. I don't have a tape measure that will tell me easily what your personality is, but I do however have a tool that will help me discover more about your personality and help me connect with you to make our work together easier and a little more flawless. The “Your Birth Experience” (YBE) program allows me to connect with you, identify your needs and then equip you with the resources necessary to achieve your goals. This leave mothers and their families empowered to envision their ideal birth, prepare for that birth and ultimately achieve the birth experience they desire. That’s pretty close to the magical tape measure, right? It is close enough for me. 

So far you now know my doula bag has a few tea lights, running shoes, knitting  and a tape measure. That tape measure isn't the good personality one - that comes from our prenatal meetings.  That is all I have in my doula bag? Don't I have a rebozo, massage balls, TENS machines, birth balls? Nope. I do have some gum, some cash for parking, some hair ties and some snacks. Why some simple? Largely, infection control. For real, I don't want to disinfect birth balls and I surely don't want to clients sharing “dirty” ones. I don't want to have to wash beautiful fabrics in harsh chemicals made for industrial disinfection standards. I sure can do some neat stuff with a hospital sheet that I can get at the hospital and then leave at the hospital to have cleaned properly, just like the birth balls. Massage balls and TENS machines…what can be bad there? Nothing is really bad, but I prefer to not place an object between my clients and I. I find a better connection with direct contact and that increases endorphins which are great for labour. Again, if clients know they want to try a TENS machine or like the porcupine balls, I can help them use ones that they likely already own. 

What I do have that cannot be packed into a bag is my years of experience and my confidence. Relief comes to my clients simply by my being present, much of the time. Clients know they can count on me to be present for them. I am a familiar face they know already and our relationship is solely focused on me helping them have a positive experience. They are presented with a bendy straw in a cup of water to juice, before they even knew they were thirsty. I am leading them to the washroom to pee and get that bladder out of the way of babies path because they didn’t realize they needed to pee. I am lightly touching and stroking their feet to remind them to relax their WHOLE body. I am that voice in their ear telling them that they can and are “doing it” when they feel like you are not being strong. 

The thing is, people don't give birth every day, (truth be told, I don't attend birth everyday), but I do support women giving birth more often than the average person will give birth. I have been alongside many others before. Each experience is different and no path looks the same, but they are similar enough that I can follow the flow and go alongside and help women through it. They can say things like “Is this normal?” or “what else can I do?” or “what did that nurse/doctor/midwife mean?”. I will reassure them things are normal and they are doing great, I will make suggestions about what else they might want to do, or reassure them what they are doing is perfect & I will help them understand what the care providers are doing or saying. I can help the partner and encourage them just as much (maybe more, maybe less) as I do a labouring woman. 

My doula bag started out full of items, and honestly, I could have taken a small suitcase on wheels to births when I first started because I felt like I needed to bring it all. I how know that to "bring it all", we need to do more work in the time before labour, and when I “bring it all” now, I am bringing our conversations, unique goals, unique desires, unique choices and my confidence, my experience and can be “tricky” just like Mary Poppins. I am confident I can pull stuff out of thin air that will help me meet your needs without carrying a lot of baggage. 

​If you would like to explore the idea of having a doula support you during your birth, I would love to hear from you. 
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HOLD THE BATH! 15 things you might not know about vernix. 

2/18/2017

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Newborn babies are dirty business and believe it or not that white substance on newborn babies is good for them and shouldn’t be washed away!

Here are 15 things you might not already know about vernix: 
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  1. The formal name is Vernix Caseous. Vernix means varnish and caseous means cheese-like.
  2. It is a naturally occurring biofilm made in the last trimester of pregnancy. 
  3. The first mention of vernix was in the Dunglison dictionary of Medical Sciences in 1846. 1846. Can you believe that? And here we think we are on to something new these days.  
  4. Vernix is unique to humans. 
  5. At the time of birth, vernix might cover the entire body of an infant or it might only be found in the body folds of the baby.
  6. Vernix might take on a more yellow, green or brown colour instead of the typical white colour. These colours might reflect intrauterine problems or fetal distress. 
  7. Vernix is 80% water and 20% lipids and proteins. 
  8. Vernix, combined with amniotic fluid, is swallowed by the fetus in utero & has a positive impact on gut development. 
  9. Vernix acts like lubricate of the infant during delivery. 
  10. Vernix is antimicrobial. It is an antimicrobial agent that protects against the bacteria filled environment of the mothers vaginal area. It provides an acidic environment on the skin which is believed to inhibit the growth of problematic bacteria. 
  11. Vernix acts an insulator post delivery as the baby transitions into the outside world and helps babies regulate temperature. (This can continue for up to 5 days if left on the infant.)
  12. Vernix is a great moisturizer and has amazing wound healing properties (studies are being done on burn injuries).   
  13. Vernix is believed to have antioxidant properties, which helps aids against the stressors of birth. 
  14. Vernix blocks out meconium contamination of amniotic fluid. 
  15. The National Association of Neonatal Nursing (NANN) and the Association of Women's Health Obstetrical and Neonatal Nursing (AWHONN) released a consensus statement that states “removal of all vernix is not necessary for hygienic reasons” and “vernix may provide antibacterial promotion and wound healing”. The World Health Organization (WHO) also recommends leaving vernix intact on the skin surface after birth.​

I think we can agree vernix is pretty amazing. 
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What to look for when looking for a "Lactation Consultant"? 

2/1/2017

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What is a Lactation Consultant, LC, IBCLC?

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

Origin of the term “Lactation Consultant

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

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

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


Breastfeeding alphabet soup
 
I’d like to explain some of the breastfeeding alphabet soup by using the birthing support alphabet soup, as people seem to relate to that.
 

All the roles are important, but they provide their own distinct scope, responsibilities, and abilities. They can all work together to provide comprehensive support. 

Primary roles of the individual bodies

As you can see, I’ve broken this down into three primary roles.
1.      Education
2.      Support
3.      Clinical management

Education

Educators teach you about the normal and expected processes of childbirth and breastfeeding. They typically call themselves childbirth educators and lactation educators. 
They teach the normal process of birth and what you can expect when having a baby, as well as encourage and promote breastfeeding. 

This information helps you make decisions, helps you know if you are on track, gives you references for getting the birth and breastfeeding relationships you want, and helps answer your questions. 

Educators typically teach community classes in group settings. 

Support

Support people are typically those who have additional training in supporting mother, baby, and family during crucial times: birth and breastfeeding. 

They’re typically doulas and La Leche League (LLL) leaders. Doulas are usually paid professionals, and LLL is a mother-to-mother peer support group. These roles offer the encouragement and motivation you need to get through the processes of birth and breastfeeding. 

They are well versed in normal and expected outcomes. They know to watch for red flags to ensure they can guide you further if you have come outside the normal, expected process. Their job is to provide physical and emotional support, encouraging you to ask questions of your caregivers to make sure you’re well informed about what occurs. They have resources and guidelines to reassure you that you’re indeed in the realm of normal, and if things deviate from normal, they can point you in the direction of more resources.

Clinical management

Lastly, we have the clinical management professionals. 
These are the folks responsible for the clinical and medical bits of the scenario. They look at the facts and figures, big picture, and red flags to rule in or out the things that are not in the normal and expected category and then make management plans from there. They have the clinical experience of things that fall outside normal and how to manage them.

Working together

All of these people have a place in the realm of support and caregiving; what’s important is they know their role and responsibility and respect the others’. Where it becomes problematic is when the client receives something different from what she expected to receive. Sometimes, this occurs because the roles of each provider isn’t clear to her, and she might conclude that one person isn’t performing a role properly. Let’s look at how this might apply to IBCLCs specifically. 

In our example, a mother assumes that a breastfeeding educator* is an IBCLC. She notices that despite consulting with the helper, her breastfeeding issue remains unresolved. She decides to seek more help through a La Leche League leader, who determines that the issue is outside her scope and recommends an IBCLC. The mother insists that she already saw an IBCLC, but received no help. 
*this person could also be staff at a breastfeeding clinic or nurse who comes to her home

This example is typical, and it hurts all support people. The educator gets a bad rep because she didn’t help. The LLL leader is helpless because the needs were outside her scope. The IBCLC profession gets a bad rep because the client misunderstood the different roles and expectations. 

Clients need to know clearly what their expectations are and who can best meet those expectations based on role, scope, and experience. I want to be asked and welcome being asked these questions! I want you to go and look at the IBLCE website to see what IBCLC's are all about and verify I am indeed and IBCLC and see what scope and standards are laid in place for my profession. I welcome the same questions about being a doula! I would love to see a blog about midwives and how they are different from doulas and childbirth educators (wink, wink, nudge, nudge midwives). 

All breastfeeding and lactation professionals have a responsibility to work together to ensure mothers have accurate information, so they can receive the support and encouragement they need as efficiently and as quickly as possible. 

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Are you looking for ways to calm your crying infant & desire to have a more peaceful sleep, especially at night?

1/30/2017

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The names Sarah Ockwell-Smith, Darcia Narvaez, Wendy Middlemiss, Helen Stevens, James Mckenna, Kathleen Kendall-Tackett & Tracy Tassels might not be familiar to you, but I will tell you they are some of my favourite people and they just came out with a brilliant new resource. I am keen to share it all with you.

It is a based on one of those HOT parenting topics; SLEEP!  
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Do you want answers to questions like how many times a night it is normal for my baby to wake up or why does my baby only sleep when I am holding her? Do you want to know how you can create a calming sleep environment for you baby? Do you wonder if your baby should sleep in the same room as you? Or how about in the same bed as you? Do you desire to learn about ways to calm your baby, keep yourself calm and help your baby learn to calm herself? 

​This is the perfect handout  for you! Hope you find this resource helpful and reassuring. 


Simple Ways to Calm a Crying Baby
... and Have a More Peaceful Night’s Sleep 

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Breastfeeding pressure, postpartum depression & supports for new families. What is happening with todays mothers?  

1/18/2017

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This week husband of Florence Leung released an emotional statement about postpartum anxiety & depression after losing his wife two months ago. He also commented about the pressure to breastfeed in the same comments. I commend him for speaking up, being brave, being seen, wanting to improve other peoples situations & for encouraging all new moms experiencing low mood or anxiety or depression to seek help. He added that these mothers are not alone and that they are not bad mothers. I agree and know he is correct. I don't believe there are bad mothers. I know mothers feel alone and isolated. Too many mothers feel this way. They are alone but not alone at the same time. When we pull in the breastfeeding component it gets super confusing and conflicting and very, very emotional. There are so many versions of how breastfeeding plays into postpartum anxiety and depression. Part of it is emotional and the feeling part of our brains and body and some of it is biological and chemically controlled in our brains and bodies (hormones are so complex). Some of this is controllable, in the sense that we can just change our outlook and start to feel better, and much of it less controllable and sort it feels like it is happening TO the mother. It really feels like a loss of control. ​
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​It is true that all over the place, in so many places new and expecting parents are visiting, there are posters and flyers and brochures and people encouraging breastfeeding and exclusive breast-feeding. This recommendation is world wide and comes from the World Health Organization. While I agree with all the benefits of breastfeeding, as most people would, it is NOT enough to just give benefits. In fact, it is dangerous to encourage and promote breastfeeding & yet not be able to follow through with the support needed. Breastfeeding is significantly more complex than the two-dimensional vision posters make it out to be. Most women are certainly not relating to the mothers on the photos of the breastfeeding books. You know, the mothers who have perfect skin, no bags under their eyes, pristine hair and makeup looking like they have zero cares in the world…beyond oxytocin highs.There needs to be support for the mothers that can breastfeed "easily" so they succeed. We also must meet the needs of and support the mothers in which breastfeeding is not going to work "easily" or perhaps not at all….and all the unique, complex cases in between this.  Blanket statements are harmful, on all sides. 

Supports for new families are getting less and less available and the resources we do have are not always adequately trained and skilled to handle the cases they have presented to them. For every mother who feels judged because she could breastfeed, but doesn't want to, there is another mother who is feeling judged because she wanted to breastfeed, but did not meet her goal. There are mothers who celebrate being told their babies need to be supplemented and welcome supplementation. There are mothers who are devastated when they are given the same news. We need to learn how to support all kinds of mothers and all kinds of scenarios. We have to be prepared for that to take more than 5 minutes in the doctors office.  

Let's look at one way this all gets blurry. There are the mothers with babies who are not sleeping well but the mother has been reassured that this is just how breastfeed babies are. I don't believe that to always be the case…sometimes babies are not sleeping because they are hungry…breastfeeding is not working in that case, not for anyone. Mothers and babies need to sleep. Feeding endlessly for days and weeks is not healthy for anyone. The issue then becomes "exhaustion due to breast-feeding" weeks later, when breast-feeding issues could have been addressed, resulting in more sleep. Beyond that, families need support people to come in and do practical stuff, like care for a baby so mothers can nap, feed themselves, go for a walk. That doesn't mean breast-feeding needs to be discontinued, it just has to be understood and managed. Other examples would be a woman in so much pain from breastfeeding. Who wants to torture themselves 10 times a day. That is a breakdown waiting to happen. Again, lets get to the source as soon as we can. Get to the resolution so the mother can be pain free. There are so many options for that. 

​We know about postpartum blues and depression and how common it is. We also know that for many women it is so bad they are taking their own lives. It is horribly, horribly sad and devastating. I don't believe it is about mothers breastfeeding or not. I believe it is about support, or lack there of, about misunderstanding babies and mothers, about isolation and healthcare systems that seem to be set up for failure and not success, it is about misunderstanding what the Baby Friendly Initiative is and what it was intended to do and how it is supposed to work. 

We can do better. We need to do better. Lives matter and are being lost.

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    Kim Smith
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Lactation Consultant (IBCLC)
Serving Regina Sask & Area

306-550-6143
​[email protected]

​
Quick facts: 
International Board Certified Lactation Consultant (2010), Re-certified (2015, 2020)
TummyTime Method Instructor

Retired Doula, CAPPA trained, Pre-Certified ProDoula (2009)
Your Birth Experience (YBE) Certified (2015)
​Wife & mother of 4
Retired Medical Laboratory Technologist 
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