Fighting the Good Fight

I find myself increasingly sad over the current state of affairs in our county.  Fiscally, I am a Conservative.  Socially, I am a Liberal. I am aware that this makes no sense and have four teenage sons that like to remind me of that every chance they get.   I am a huge fan of the Affordable Care Act.  The Essential Health Benefits have made it possible for women to have insurance pay for our services and have provided an access to healthcare that I have been fighting for in Rhode Island for over a decade.  The possibility that this, maternity, and mental health care could be taken away is abhorrent to me. Public health in America, now a preventative health care system instead of a sick care system, is on the verge of being dismantled.

So every day, I am looking for little glimmers of progress, kindness and random people fighting the good fight.  And I do see it.  Everywhere I go, people are being kind, smiling, talking to each other, opening doors, being patient and respectful. I go out of my way to connect with people I come across. I am sure I don’t always do a stellar job, but when it isn’t reciprocated, I am crushed.  My husband, who travels all over the country and to Europe, sees the opposite.  People who are short tempered, rude, cold and impatient are the norm for him.   Europeans are amazed at what is happening in our country, trying not to laugh in his presence at the freak show they are witnessing abroad. Our home has become a refuge for some peace. That is, until we turn on the TV.

Here in our tiny state, I have met a local hero who gives me hope that good things are happening all over our country.  His name is Keith Cooper and he is the Executive Director of Beautiful Day, a non-profit located in Providence. Beautiful Day seeks to build on ramps to employment for recently arrived refugees. They own a social enterprise - an artisan granola company - and nourish the health of their community by providing first jobs and on the job training for highly vulnerable populations.  Beautiful Day produces delicious locally-made food products and are making plans for their own granola kitchen that can double as an incubator to help refugees start their own businesses.  Their ultimate goal is to develop a transferable model that could serve vulnerable populations facing daunting job-entry barriers. They seek to empower people, whose lives have been shattered, to move forward, one day at time.

Keith has reminded me what is great about our country. We help people in need.  We have a right to free speech and to advocate for those vulnerable populations who can’t advocate for themselves. He has inspired me to do what I can to make a difference. There are opportunities all around us and I am going to take advantage of them. I will support local refugees by buying Keith’s granola. I will finally start the non-profit I have always planned on, to provide lactation support for those who can’t afford it or whose insurance doesn’t cover it. It will be my back up plan if the Essential Health Benefits of ACA are repealed, so that access to this type of care is not interrupted.  And I will stay open to other ways to take part in the many things that make this country great, rather than focusing on the negative I am bombarded with daily. Will you join me?

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Breastfeeding Twins

Breastfeeding has many benefits for both mom and baby, and naturally the benefits double when nursing twins. As you know, breast milk is uniquely designed to meet the specific developmental needs of your baby, and the breastfeeding experience fosters a very special bond between the two of you. Nursing twins can be a challenge in the beginning, but it can also be a wonderful experience when moms are given the support and encouragement they need. Also, breastfeeding twins is more economical, more convenient, and less time-consuming than preparing bottles.
 
For moms of twins, it will be most important to establish an adequate milk supply early on and to maintain the supply to meet the growing demands of the babies. This can be facilitated by early and frequent breastfeedings – at least 8 times in 24 hours for each baby. As is the case with all newborn babies, do not let more than 3 hours go between the start of one feeding and the start of the next feeding. If the twins are born prematurely and have an immature suck, mom will need to pump frequently until they are able to nurse at the breast. This frequent stimulation is necessary to ensure that mothers will be able to produce enough milk.
 
There are a number of options for breastfeeding twins and it may take some experimenting to find what works best for you. The babies may breastfeed separately or simultaneously and this can be accomplished with various positions. When babies are fed separately, mom can breastfeed one infant and then the other, or one can be breastfed and the other bottle fed. You may have to wake the second baby to feed, but this will keep them on a consistent schedule. It will be important to nurse each of the babies on both breasts, especially in the early weeks, so that they are both evenly stimulated, particularly if one twin has a more vigorous suck than the other.
 
Some moms prefer to nurse their babies at the same time which saves time and ensures that both babies are eating on a similar schedule. Remember to alternate breasts with each baby for even stimulation and drainage. You should comfortably latch the less vigorous nurser first and then the other baby. In the beginning, you may need help getting comfortable with extra pillows, and of course good back support.  
 
There are 3 nursing positions you can try:

1- Both babies in the football hold or the double football: This position allows for better head control with smaller babies and moms can support their breasts better when latching and during the feeding. Mom also has good visualization of both babies in this position, and it is easier on a mom who has had a C-section.

2- Both babies in the cradle or cuddle hold with their legs crossed over or next to each other. This position may be more difficult in the beginning since mom can not support the babies’ heads as well.  However, as the babies gain more head and neck control, mom’s hands will be freer and she will have better eye contact with her babies in this position.

3- One baby in the cradle hold and one baby in the football hold.

As your babies mature and need less support, nursing will get easier and more comfortable. Hang in there!
 
Frequent feedings that drain the breasts will keep your supply up and will decrease the likelihood of developing sore nipples, plugged ducts, and breast infections. A breastfeeding log will help you to keep track of breastfeeding sessions in these first few hectic weeks. You can also keep track of the number of wet and soiled diapers in your log which is the best measure of breastfeeding success. You will also want to share this information with your Pediatrician and/or lactation professional.
 
I do not have personal experience nursing twins, but I have two very close friends (who happen to be twins themselves) who nursed their twin sons happily and successfully. They wanted to share some personal advice with you.

Dee – Mom of twin boys that nursed for 12 months:
 
“I remember going to La Leche League and buying a ‘twin pillow’ so I could nurse them both at the same time. It was the best investment because you are nursing so much. It gave me a little break in between. Nurse them on demand for the first couple of weeks to bring your milk supply in and remember, what seems like non-stop nursing will end. New moms have to hang in there for the first 4-6 weeks! Nursing gets so much easier after that (babies go longer and learn to nurse more efficiently so they are not on your breast as long), and it becomes so much more convenient than bottle feeding. Have someone leave snacks out for you to munch on during the day, such as graham crackers with peanut butter, because new moms forget to eat and drink…you’re so busy nursing, but you need the nutrition to build your milk supply! I had a doula for the first couple of months which helped me immensely, and she had twins so she knew what it was like.”
 
Deirdre – Mom of twin boys that nursed for 14 months:
 
“I agree with everything my twin sister said, but I would like to add a few things. In the first couple of weeks my nipples were a little sore when the babies first latched, but I hung in there and it passed and I’m so glad I did! I nursed each baby separately with soft music playing in the background. My husband would sometimes hold the second baby while I nursed the first one who was a more active, vigorous baby. In the middle of the night I would just roll over and nurse them. There was no need to get up and warm a bottle. It was so easy. Sometimes at night when the babies slept a little longer, I felt fuller, so I would pump a little milk off to keep my supply up and save it for when I had a chance to go out. I kept a breastfeeding ‘clip board’ to keep track of which baby was on which breast so I could alternate them. I sometimes wore two breast pads in my bra to help absorb leakage.  I would tell new moms to accept help from family and friends, eat well, and get rest when you can.  If I had an hour off, I wanted to be by myself, so I would take a bath with a glass of wine, or I would go out for an hour of shopping! Breastfeeding was the most rewarding experience of my life.  It is an incredible bond. Don’t quit!” 
 
The first year of life for parents of a new baby is an adjustment, and for the parents of twins it can be very hectic, and at times it may seem overwhelming. Accepting the help of family, friends, and professionals if needed, will be essential in the first several weeks to ensure adequate rest and nutrition for mom. It is also a wonderful idea to contact other moms who have nursed twins for their support and suggestions. We are happy to be offering our own support group for mom of multiples beginning on January 30th. Below is a list of some additional resources to turn to for support.
 
Resources for Breastfeeding Support with Twins:

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INSPIRED TO THINK GLOBALLY – Half the Sky by Nicholas Kristof and Sheryl WuDunn

Every once in a while I come across a book that makes a real impression on me and I want to share it with all women I know. Two of my favorites that come to mind are Mountains Beyond Mountains, by Tracy Kidder, and Three Cups of Tea by Greg Mortenson and David Oliver Relin. I consider both books must reads for everyone! The last book that had that effect on me was given to me by one of my sons. He was starting his freshman year of college and his required summer reading was Half the Sky by Nicholas Kristof and Sheryl WuDunn. He read it and passed it along to me, knowing that its topic of women’s health would be of interest to me. I was immediately engrossed and couldn’t put it down until I finished.

The title is based on the Chinese Proverb that “Women hold up half the sky.” While at times a very sad book, I found the women in it absolutely amazing and inspirational.  I was struck by the dire straits that most women of the world live in. So much that we American women take for granted~ plumbing and sanitation, basic maternity care, the ability to earn a living~ is not an option for a vast majority of women in other countries. It was heartbreaking to read about Ethiopian women with incontinence caused by poor or lack of quality obstetrical care. Something that is easily fixed here in the United States can cause a woman to be homeless and shunned in Africa. Equally disturbing was the story of a young Cambodian girl sold into the sex slavery trade. It is incomprehensible to me that anyone could exploit a child in that way, and yet it happens all the time. Both women survived their ordeals. One became a surgeon and the other supports her family with a retail business. Reading their stories made me think I could do anything I set my mind to!

I was equally amazed by the women who set out to solve all these problems. One African woman, Edna Adan, who was the victim of genital cutting, grew up to work for the World Health Organization and then started her own maternity hospital in Somaliland with her retirement savings. At the Addis Abada Fistula Hospital, a saintly gynecologist, Catherine Hamlin, solves the incontinence problems of inferior maternity care, allowing close to 90% of these women to return to fully functioning lives. Many other amazing people are hard at work in family planning, the education of young women, and microcredit. The authors show us that “the key to economicprogress lies in unleashing women’s potential. Throughout much of the word, the greatest unexploited economic resource is the female half of the population. Countries such as China have prosperedprecisely because they emancipated women and brought them into the formal economy. Unleashing that process globally is not only the right thing to do; it is also the best strategy for fighting poverty.” (Kristof and WuDunn)

Amazingly, I know someone here in Rhode Island who is making a difference daily in the maternity care provided to women throughout the world. Meg Wirth, a Providence mother of two, set out to find a way to change the grim statistic that in the 21st century developing world, pregnancy remains a leading cause of deathamong women of childbearing age. She founded Maternova, the first global marketplace for ideas and technologies that save mothers and newborns during childbirth. Maternova’s mission is to become the online media hub connecting millions of people who work on maternal/newborn health around the world and accelerate progress. They make it easy for doctors, nurses and midwives to track innovation and to buy technologies and kits to use overseas. And they are successful! Their obstetrical kits are used all over the world and help to safely deliver babies while protecting the health of their mothers.

One of my friends was jokingly lamenting the other day that she had not accomplished much, as she had stayed home to raise her sons, rather than putting her Boston College Masters degree to good use. Her mother reminded her that when you educate a mother, you educate a whole family. What a profound statement! That sentiment is reiterated in Three Cups of Tea. I see that daily in my work. We are all doing what we can, when we can. When we are home with our children, I truly believe there is nothing more important. But someday, when that phase is over, who knows what other amazing things we will accomplish…..

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"The Gift of An Ordinary Day" - A Mother's Memoir by Katrina Kenison

Last month, I commented to my youngest sister that I would give anything to go back to the days of teaching a preschool boy to drown Cheerios in the toilet. She was lamenting a stubborn three year old completely uninterested in potty training. I was dealing with an obstinate, ungrateful 18 year old man/child. Two days later she brought over a book that she declared a must read for me, given where I am in my life right now. After sailing through it, I want to suggest that it is a must read for all mothers. Whether we are at home raising tiny little people, or getting ready to launch young adults off to college, the message is relevant.

“The Gift of an Ordinary Day” ~ A Mother’s Memoir by Katrina Kenison, starts with a family’s move from suburban Boston to rural New Hampshire. The author’s mid life crisis was the impetus for the move. Her desire to live in a slower-paced environment and have her family more grounded, starts the family on a house building adventure that doesn’t end until the oldest is off to college. Her family consists of her husband and two sons, one of whom is getting ready to start high school, the other just on the cusp of puberty. During this transition, she reflects on all the moments long passed that caused her so much anxiety, as she worried about whether her boys would turn out alright. She notices her parents’ calm demeanor and relaxed attitude toward her sons and their increasingly independent behavior. She remembers all the moments with her boys when they were little that were priceless and mostly unappreciated at the time. Mostly, she tries to live in the present,
and be truly aware of those ordinary moments with her family, cognizant of the fact that in 4 short years, these moments will be increasingly few and far between.

For me, the struggle that she writes of – the fine mingling of letting go and holding on – hits very close to home. I cannot make it through a single chapter without shedding a tear, all while trying to hide it from my husband. Each chapter offers up multiple quotes that resonate so strongly with my life, I feel like I could have written this book, although not nearly as eloquently. The description of the entire college application process, the pressure this age group is under and the reality that no kid can just be ordinary anymore, is something I am living daily. The uncertainty of how this will all end, and the desire to slow down the whole process, so I can have this delightful boy with me just a little longer, is ever present.

I also found it reassuring that another mother, and famous author at that, feels the way I do about so many things. The anxiety she experiences is something that I struggled with since I became a mother, but it did dissipate with time. My confidence in my ability to parent these boys to adulthood and in their ability to make good choices grew tremendously. Now, I am overwhelmed at times by all the struggles people in my age group are dealing with: divorce, illness, financial crisis, wayward teenagers and aging parents. My best friend’s mother always says “Little people, little problems; big people, big problems.” And she is so right! But this is the stage of life that I am in, and it will pass. And in so many ways, it is easier. I have time to myself. I get a good night’s sleep. I can go for a run when I want to. I can talk and reason with my kids. My husband and I can sneak out for a drink if we want to! I am lucky to have a job that I am as passionate about as I was about staying home and raising my boys. Really, even when it’s hard, it’s good. And this book reminded me of that on every
page!

So for the next six months, I am going to cherish every moment with my oldest, even the difficult ones. I am going to revel in the times the six of us are all together, no matter what we are doing. I will create opportunities for them to have good memories of this phase in their life. And I am going to try hard to let go with grace, and trust that they will all wind up where they are supposed to be, with faith that I have done the best I can with the most rewarding, but hardest job in the world.

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The Perfect Mother

Thanks to Brooke Shields (and unfortunately Tom Cruise), there has been much discussion in the last few years about Postpartum Depression. I’m glad the issue has attracted a lot of attention! Not only are people talking about it, more and more mothers are becoming aware of the symptoms, addressing it promptly and seeking help. It isn’t such a taboo subject anymore. Brooke’s book, Down Came the Rain, is a terrific book for mothers experiencing postpartum depression, those who want to prevent it, and people who are supporting a loved one suffering from it. I highly recommend it as a resource that gives hope and shows the light at the end of the tunnel!

Fortunately, I don’t see too many patients with postpartum depression in my practice. What I am seeing with increasing frequency, is mothers who are completely overcome by anxiety. These are women from all walks of life, who are crippled by their fears and doubt their ability to care for their baby. They are exhausted and spend the majority of their time questioning every aspect when it comes to the care of their baby. They read anything they can get their hands on regarding childcare and inevitably find something that reinforces their insecurity that they are doing everything wrong. They are tormented by all the different opinions out there and feel completely incapable of deciding what is best for their family. Their minds are racing with all the things they should be doing and how they can do them better. The expectation that they be perfect mothers is an all-consuming goal that none of them will ever achieve.

My experience in this regard has also been that the more educated and successful a woman is before she has her baby, the more significant the anxiety after the baby is born. It is almost as if these women have life under control and are confident before the baby. But once the baby comes, they are no longer in control of their situation (who is with a new baby?). In an attempt to regain some semblance of control, they go overboard, hoping to do an even better job at motherhood than they did in their career. They throw themselves into the new job, but make themselves anxious in their pursuit of doing it right.

I realize that I am making a lot of generalizations with nothing but my experience to support it. But I do find this to be the most heartbreaking aspect of my job: trying to help an obviously smart, capable, loving and devoted mother see that she is doing a wonderful job! No matter how hard I try to point out all the things they are doing right, they can find me a contrary opinion that says they are doing it wrong-breast or bottle, family bed or Ferber, to vaccinate or not, Gerber baby food or homemade, cloth diapers or Pampers? It is nearly impossible for me to provide the reassurance they need and I frequently find myself at a loss when trying to make them feel better.

The other difficulty is that these women are usually able to function rather well, compared to a woman who is truly depressed. It is usually several months after giving birth that anyone notices these mothers struggling, as they are relentless in their pursuit of the appearance of perfection. Because they are running on overdrive, only the people who are closest to them realize they are having difficulty and often don’t know what to do to help them. And I am not sure what the best answer is.

I do know though that there are people far more qualified than I am to deal with these sort of mental health issues, and that should be the first place to start. Counseling and medication do help, and it is not forever. We have to remember that many phases of motherhood are just that, a phase that will pass. Sleep also makes a big difference, and that should be a priority of every new mother and those who can help her. And I am not talking about an 8 hour night. But a good nap each afternoon or in the early evening works wonders to help your body and mind rejuvenate. In addition, socialization with other mothers is strongly encouraged. Isolation makes anxiety much more intense. Having other mothers to share your experiences with and who can offer insight into how they have handled similar challenges can make all the difference!

When visiting the lactation offices at Women and Infants Hospital one day, I saw quotes on their wall that I wish every mother could remember:

You’re the only mother your baby has, and she thinks you’re wonderful!

The good news is that you don’t have to be perfect!

How I wish every new mother knew that and took it to heart!

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Trust Yourself

This New Year, make a resolution to trust yourself in all things related to your baby.   Trust myself, you are thinking?  I have no idea what I am doing.  I am winging this motherhood thing.  I just want someone to tell me what to do with this kid, and I will do it!  

Often, I am the someone you want the guidance from, and I am happy to give it. It usually involves seeing you and your baby in person, and spending quite a bit of time asking a lot of questions about what is happening.   I frequently apologize for the interrogation. But I am trying to get a handle on the situation, and you are the person with all the clues about what is going on.  I am just here to help you sort through it all.

Many times, I am confident I have it all figured out and start to tell you what I think is taking place. At that point, you might tell me all the things you have read and heard that contradict what I am telling you. You have read every book on the subject, consulted every girlfriend, your mother and mother in law, sisters, and of course, every website that popped up in your Google search. You also tell me how you tried each and every suggestion, and nothing worked.

I have addressed this topic multiple times- once about handling conflicting information and in another article about the “perfect” mother.  What I have come to realize is that in these situations, women don’t trust themselves.  They let the comments of passing strangers cause them to doubt themselves and their ability to care for their baby. They have somehow decided that a stranger that has never met their family, and is giving general advice online, knows more about their baby than they do. Nothing could be further from the truth.

And I know what I am talking about, because I have been that mommy. I have two vivid memories of my life with little boys.  One is of me freaking out because one of them (I believe boy #2 at about 7 months) fell down the stairs. (Very Bad Mommy-can’t remember how or why that happened!)  I called my husband at work, hysterically crying and asking him what I should do.  His calm response to me was, “I don’t know Kath, you are the neonatal ICU RN, what do you think you should do?”  Stunned, I examined him as any RN would.  He was fine.

The other memory is of a baby that wouldn’t sleep, unless he was on his stomach.  The AAP had just come out with the Back to Sleep recommendations.  So obviously, I couldn’t let him sleep on his stomach.  Exhausted, I stood over his crib crying, while he struggled, unable to be comfortable and sleep on his back.  I watched amazed as my husband got out of bed, rolled the baby over on his tummy, patted his bum and climbed back into our bed, both of them sleeping comfortably in a matter of minutes. That was the end of the Back to Sleep Campaign in our house.  I slept great from that moment on.

Please believe me when I say you really do know your baby best. You are the one living with him 24/7.  Sometimes, you are just too tired to clearly see what is happening.   That is where I hope to help.   I am usually telling you something you already know, you just didn’t trust yourself enough to believe it and act on it.

One of my MD friends posted a picture on Facebook of a coffee mug that said. “Don’t confuse your Google search with my medical degree.”  It gave me a good laugh, but I think I we all need to remember not to confuse our Google searches with our maternal instincts. Those instincts are pretty strong, and if we listen to them, instead of everyone else, our anxiety levels will dissipate, and our babies will be just fine. So please, make a New Year’s resolution to trust yourself and act on those instincts. Your baby, and probably the rest of your family, will thank you!

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The Right Pump for the Right Reasons

The Affordable Care Act provided a benefit most new mothers were thrilled about - it mandated that insurance companies provide women with a breast pump with the birth of each child. This benefit that has been fought hard for, both nationally and in Rhode Island, so many of us were so happy to see it finally happen.  Imagine our surprise when the biggest insurer in Rhode Island decided to only provide a manual pump.  We have fielded many calls from women who have said no thanks to that option, and we don’t blame them.  For many, the manual pump isn’t going to help them while working full time and traveling away from their baby.   It isn’t the right pump for their situation, and we see situations like this all the time.

Some local hospitals are able to provide each postpartum room with a double hospital-grade electric breastpump. In doing this, every mother who needed a breastpump in that hospital has access to one in their own private room. Terrific, right? Initially, everyone thought so. But often, we see a few problems that we believe sabotaged the success of breastfeeding for many mothers.

The first issue is that since there is a pump in the room, many mothers assume they need to pump. Whether they need to or not, many mothers begin pumping as soon as they can, and feel if they are doing that, they don’t need to nurse their baby. Mothers who pump frequently, and nurse only occasionally, have babies that soon prefer the bottle. Other mothers believe that if nursing the baby was good, nursing and pumping is better. These moms start doing both right from the start and quickly became exhausted and gave up on both altogether.

Another issue is that mothers don't produce much milk in the first few postpartum days of pumping. A mother's milk typically comes in around day 3 or 4 postpartum and coincidently, occurs after most mothers have been discharged. While in the hospital, they only produced colostrum. This colostrum has everything a newborn needs, but is not produced in the same quantity as mature milk. For this reason, many mothers assume that they aren't making enough milk for their babies. We see many of these mothers in their home after discharge. They tell us, with great disappointment, that they are certain they don't have enough milk for their baby, because they barely got anything when they pumped in the hospital. They weren't supposed to get much, but they didn't know that. Mentally, that is disheartening for many women.

Anybody reading this newsletter knows HBHM Inc. is in the pump business. But really, we prefer to be in the business of getting people off to a great start nursing. The vast majority of mothers do not need a pump to do that. We wish that all moms knew that the most important aspect of nursing is getting your milk supply established and maintaining it. It is a challenging but easily accomplished task, provided you are doing the right thing from the start. The best way to achieve this, of course, is by nursing your baby. A baby with a correct latch is far better at establishing and maintaining a woman's milk supply than any pump.

In a situation where the baby is not nursing, whatever the reason, a hospital-grade double electric breastpump is essential to getting the milk supply established. It is also important that the mother pump frequently, as it is the frequency of pumping that will get more milk, not the duration of time spent pumping. Once the milk supply is established and maintained, most babies will eventually nurse successfully.

When a mom is pumping and not nursing, she must remember never to judge her milk supply based on what she gets from a pump. A baby that is nursing well will always get more milk from its mother than a pump will. Moms do not get the same hormonal charge from a piece of machinery that they do from their baby. These hormones are responsible for milk production as the baby is nursing. The body quickly replaces what the baby takes out. When a woman pumps, she is going to get what is in her breast. When a baby nurses, he is going to get what he needs because the body will keep producing milk.

So what is a mom to do when she finds herself in a challenging situation and has just spent $300 on a Pump In Style? Or her insurance only provides a manual?  Or her sister has an old pump she can use? She should rent a hospital-grade pump for a week or two, and once she is off to a good start, she can use the pump that she purchased. We always try to make it clear to each mom who purchases a pump from HBHM Inc., that these pumps are intended for women who are nursing without difficulty and whose supply is well established. They are not for women with preemies in the NICU. They are not for women with supply issues. They are not for women whose babies won't latch.

Have we seen a mother with a baby born 3 months early, pump for 6 months with an Avent hand pump and never need to give her thriving baby formula? Miraculously, yes! Have we visited with a mother of preemie twins who pumped with a Pump In Style Advanced and had an abundant supply for both babies? Definitely! Do we know a mother who was the third user of an Original Pump In Style while she worked full time and never had to supplement with formula? Yes, we have seen all those things.

But please remember that these are very rare exceptions, and not the rule. More often than not, we see women who are using the wrong pump for their situation, and have had their milk supply and nursing relationship compromised as a result. For most women, if you do not get your supply well established from the start, it is very hard to turn the situation around.

We at HBHM Inc. are in the business of getting families off to a great start nursing. We are not in the business of selling or renting pumps that aren't appropriate for a given mothers' situation. If you are at all in doubt about what is appropriate for you, please call us. Ask questions and make sure you get the help you need. We are happy to provide just that!

 

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Handling Conflicting Information

There is one complaint I hear from almost all my patients that makes their entire birth experience and newborn period much more stressful than it needs to be.   It is that every health care provider they come across tells them something different.  The L&D RN tells them to breastfeed one way, then the postpartum RN suggests something else.   A day later, right before discharge, the lactation consultant tells them to change what they are doing, and sends them out the door.  Then they see the pediatrician the next day, who tells them something new, and insists they see me.  I see them 24 hours later, and change the plan again.   They look at me exasperated, and tell me I have contradicted everything they’ve been told so far!  And I feel terrible for them...

What I wish all new parents knew is that every health care provider they have spoken to was probably right, and had the best intentions for their new family. At the heart of the issue is that baby’s change, and they change rapidly, especially in the first month.  Each of these providers is looking for different developmental milestones, and making recommendations based on what they are seeing at that moment in time. So on day one, its lots of skin to skin, we are happy to get a few good feedings in, and not stressed about lack of pooping. That’s not so good on day seven.  Initially, we love long feedings and lots of time at the breast.   But as your milk comes in, those feedings get more efficient and many baby’s might want to skip skin to skin when they are really hungry.  The cross cradle hold with the My Brest Friend Pillow works great in the beginning.  But do you still want to be nursing that way 3 months in and carry that pillow with you wherever you go?

While it is frustrating in the beginning, it’s also a blessing.  Because just when you think you can’t take another feeding frenzy or bad night of sleep, things change.  And they almost always change for the better!  Feedings get more efficient, sleep gets longer and deeper, and you start to feel like you can do it. When things don’t get better, it is usually because your baby is ready for something different, but you are still doing what worked last week. Dr. T. Berry Brazelton calls these moments “touchpoints”- a period of family upheaval that occurs right before a developmental milestone is achieved.   His book, Touchpoints-Birth to Three, is one that I recommend to all our families.  It lets you know what all these milestones are, and what your baby is trying to tell you, and how to get through it.

So rather than get frustrated with all of us in healthcare, please try to trust that we all have your best interests at heart.  Ask for an explanation when you get contradictory advice.  Make an appointment with us or someone else your trust to help you work through what is going on, rather than suffer through it. One of my favorite quotes is that the only constant in life is change. Nothing is truer with children!  Just when you think you have them figured out, they change it up.

Roll with it.  I promise that phase won’t last forever!

 

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Tongue and Lip Ties

Years ago, reflux was the diagnosis that I was seeing on a daily basis in our office.  I am not sure if it was the advent of Zantac or Prilosec, but the vast majority of the babies we saw were on those medications and had been diagnosed with reflux. These days the new diagnosis is a lip and tongue tie.  We are seeing it all the time, and our own Doris Howie, RN IBCLC has become our resident expert!  Here is some information regarding both issues, with all credit to a lecture I attended by Marty Kaplan DDS and to the website of Dr. Fawn Rosenberg.  Both are doctors that we refer to for fix these issues.  Dr. Rosenberg’s website has great pictures that illustrate what I am describing below.  It can be accessed at:

http://www.lexingtoncosmeticdentistry.com/tongue-tied

Many people suffer from tongue-ties, or lip-ties, and they often occur together. It is a genetic abnormality that can range from very minimal in some cases to severe in others. The lingual frenum is a cord that stretches from under the tongue to the floor of the mouth. A tongue tie, or ankyloglossia, are terms used for a lingual frenum is short and restricts the movement of the tongue.  Sometimes it is long and thin and goes from the base to the tip of the tongue, and can cause the tongue to be heart shaped. Other times it is short and thick and anchors the tongue to the base of the mouth.

Some common signs of a tongue-tie are:

  • Difficulty moving tongue side to side or up and down

  • Inability to touch the roof of the mouth with tongue

  • Inability to stick out tongue

  • Presence of a notch at the tip of the tongue

The labial frenum is a piece of skin that connects a person’s upper lip to their gums. A lip-tie is when the labial frenum is too short or wide and restricts upper lip movement.

Some common signs of a lip-tie are:

  • Inability to flair upper lip

  • Slurred speech

  • Gap between upper teeth

Sometimes, we will see a baby who we notice immediately has either or both of these conditions, and yet, they are doing just fine.  The frenulum is a membrane that can stretched and often does, with no consequences for the mother or the baby. If the baby is gaining weight appropriately, is happy and not causing the mother any pain, I often won’t even mention it.

However, some babies with these conditions really struggle with breastfeeding, which is frustrating for both the mother and infant. Often, they do fine in the beginning, when the mother is engorged and the breast is full of milk.  But as the breast returns to a relatively normal state, these babies may be unable to latch properly, and slide off or chew on the nipple. They never seem satisfied, yet feeding times are prolonged and they are constantly falling asleep at the breast.  They babies exhibit poor weight gain, are often gassy or fussy, and eventually labeled colicky or “Failure To Thrive.”

The poor mom often suffers from excruciating pain when nursing. Many times she is told everything looks great from the outside, and that pain is normal and will go away eventually. This is particularly frustrating for women who deal with the pain 8-12 times per day, and have their heart set on nursing their baby.  One of my patients found this fantastic video online, that perfectly illustrated how she felt while nursing:

These women will often experience creased or flattened nipples after feeding, with bruises or blisters noted.  Breast drainage is often incomplete and plugged ducts are common. A decreased milk supply, mastitis, and thrush are often the result.

Tongue and lip-ties can be easily corrected. The procedure is called a frenectomy. It is also commonly known as a frenontomy or frenulectomy. Some doctors we refer to treat tongue-ties and lip-ties with FDA approved laser that is safe, effective, and minimally invasive. Using a laser for this procedure eliminates the need for needles, general anesthesia, stitches, or a costly hospital visit. When the procedure is done with a laser beam, there will be minimal bleeding, if any at all. Other doctors, usually ENTs, use a scissors to snip the frenulum.   Either way, it only takes a few minutes and the baby can nurse immediately afterwards.

If you are concerned that this might be an issue for you and your baby, talk to your pediatrician and ask for a referral to see a pediatric dentist, ENT, or one of us.  I would start with us, because often, we can help you nurse comfortably and nothing further needs to be done. My advice is to ask for Doris!   Rhode Island also has a pediatric dentist at Children’s Dentistry of Westerly and Wakefield who has recently been trained in these procedures.  Her name Dr. Anna Capalbo, and we have been very pleased with her honest assessment and repair for babies that need it. Whatever you do, just know that nursing with pain is not normal and it can be fixed. We are happy to help, or guide you to someone who can!

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Rhode Island New Moms Connection offers a multitude of pregnancy & new mom groups for women in Rhode Island and surrounding areas. Kristen Kardos and Kathy McGuigan are on a mission to provide women with a non-judgmental space to share their motherhood experience with support, information, useful resources to help women expand their community of new mom friends.   Kristen is a fabulous DONA trained post partum doula who has been working with moms & families since 2009. She is co-chair for the Women & Infants Ob Patient Advisory Council; Kathy is a social worker who has been working with women and children for 20 years.Facilitating New Mom and Pregnancy Support Groups combines her passion for motherhood with her professional skills and experience. She is a member of the Board of Directors for Brown Play School.  Both women are members of the RI Birth Network; and contributing writers for kidoinfo.  There are new groups starting all the time, so check out their website and join them!
 

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