Dogs, cats and new babies can all get along. There’s always a period of adjustment for everyone. When I make a home visit, I always let the pet smell me and affirm I’m a safe visitor.

During one home visit, whenever the baby cried, the dog would put her chin or paw on my knee. She was very sensitive to the baby’s crying…maybe she was trying to comfort the humans. When the baby wasn’t crying, she lay down and was calm. I remarked on this to the mother who explained that they’d adopted this dog when she was a year old. The first family had given her up when they had a new baby and realized they couldn’t take care of the dog, too.

How poignant. Being in a similar situation, it no doubt worried her. Months later I spoke with the mother and, after answering her breastfeeding questions, inquired about the dog. I’m glad to say their dog was still living happily with the family.

On another visit, I met a sweet and  very attentive dog. When the mom sat down with the baby in her arms, the dog sat next to her and leaned into her lap. This was awkward for the mother. To help distract their dog, I put my baby (teaching) doll on the couch. The dog sniffed the doll and lay down next to it, giving the mother some more space. Now that they each had a baby to take care of, it was easier to proceed.

A few minutes later, the mom and I were observing how her baby, resting on her chest, could root and latch on her own. As we were observing the newborn, I noticed the dog had found my cloth breast model on the couch and had already latched on to that!

Dogs certainly are good friends and sensitive companions.

The post Dogs and New Babies appeared first on BirthReady.

Does insurance cover for home visits? That’s usually the third question a mother asks when she calls. The first question is “Do you make home visits?” and the second is “When can you be here?”

To answer the first two questions: Yes and within a day if not sooner. To answer the third, I’ll explain the how payments are made.

For a home visit, families pay the Lactation Consultant directly and the insurance company reimburses them. Send a copy of your ‘superbill’ with your policy information. Your cancelled check or credit card receipt is proof of payment.

It’s a good idea to confirm what your insurance coverage is and review the Affordable Care Act with them. Here’s a helpful information sheet you can download from LCHomeVisits.com

The Health and Human Services Guideline for Health Insurance Coverage states women are entitled to “Comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment.” Visits with a breastfeeding specialist such as a board certified Lactation Consultant, are covered 100% with no co-pay.

Ask for your insurance company’s list of in-network providers. If they don’t have anyone in network, you have a right to see someone out of their network. It’s important to assert this.

The key word is assert. If your baby isn’t gaining weight, isn’t having bowel movements or if you’re in pain, that needs attention, especially in the first two weeks. The sooner you get help, the better you (and your baby) will feel. That also builds your confidence early on.

You have a right to this kind of lactation counseling and support. Now you know a bit more about how to assert this right and get support. Advocating for your child, and your family’s health, is a skill that you’ll continue to refine as a parent.

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Congratulations, you’ve been successfully breastfeeding your baby and you’re pregnant again. Yes, you can keep nursing. Breastfeeding more than one child (twins or an infant and an older child) at a time is called Tandem Nursing.

Healthy growing is based on healthy nutrition. As the Chinese saying goes “Treat the Mother, Treat the Child”. Be mindful of your well being. Whole grains, fresh fruits and vegetables, lean protein. Drink to your thirst. Nap, or at least rest for a few minutes. What’s good for a pregnant or nursing mother is good for the whole family.

While your body is preparing milk for your newborn, it’s normal for your supply to decrease around the second trimester. An older child is usually nursing less and eating other foods. He or she might notice the milk tastes different and wean by their own preference. Conversely, pregnancy can make your breasts sensitive and you may prefer to wean. Do that gradually to give your body and your child time to adjust.

By the time your infant is born, your milk has changed to colostrum. That provides high amounts of Secretory Immunoglobulin A (SigA), an immune factor that is especially important for newborns.

Some women nurse while in labor. The oxytocic effect of nursing promotes contractions and at the same time, helps a mom relax. Because the woman is full term and ready for labor, nursing augments the oxytocin that’s already there rather than causing labor.

You know what else causes a rise in oxytocin? Holding hands, eating chocolate, kissing, making love, laughing. Certainly we need to experience those in nine months. If you do experience contractions while nursing, see what happens when you stop. Always pay attention to signs of preterm labor and talk with your midwife or doctor.

The American Academy of Pediatrics recommends* breastfeeding “for 1 year or longer as mutually desired by mother and infant”. You’ve breastfed one child, you can breastfeed another and if you choose to, you can nurse them together.

References:

Breastfeeding: A guide for the Medical Professional. Lawrence and Lawrence,  Elsevier Books  c. 2011.

*“Breastfeeding and The Use of Human Milk”  Pediatrics,  March 2012

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How the tongue moves is important for comfortable nursing. It has to stretch out, pull the nipple into the mouth and make a wave like motion to draw milk along.

When the tongue can’t make these motions, nursing is difficult. That is called a “tongue tie”. The membranes (called frenum) that attach the tongue to the floor of the mouth are too short. The tongue is restricted in it’s movement.

The mother’s nipples may look pinched, become sore and cracked. A baby may sleep more than feed at the breast, or nurse for an hour and still be hungry. A baby may have poor weight gain, even if the feedings are long. After a few weeks, feedings are still problematic.

Call an IBCLC for help. Meanwhile, express or pump to maintain your supply while the problem is resolved.

When an IBCLC suspects tongue tie, she’ll recommend meeting with an experienced pediatrician, Ear, Nose and Throat specialist or pediatric dentist who specializes in diagnosing and releasing tongue ties.

Midwives and doctors used to check for tongue tie as soon as a baby was born. (Some practitioners still do this). Releasing the frenulum is a fairly straightforward procedure.

Releasing a tight frenulum is called a frenotomy. The procedure takes place in an office or clinic. The practitioner will discuss it with you and get your consent. This procedure doesn’t require general anesthesia or a hospital stay.

An assistant will hold your baby’s head steady while the doctor/dentist releases the frenulum. It takes about one minute. Your baby will cry (sort of necessary as that means the mouth is open). There are no nerves in the membrane so it doesn’t cause pain. Usually, your baby will nurse right away afterwards.

There are different degrees of tie. It’s most obvious when the tongue tip can’t reach the upper gums. You can see a ‘string’ pulling under the tongue. That’s an anterior tongue tie: in the front. (The illustration is exaggerated, you get the idea). A tight frenulum further back is not as easy to see. It still limits the tongue’s wave motion. That’s called a posterior tongue tie.

Tongue motion affects latching and swallowing. How the tongue moves and rests in the mouth affects palate development. That effects teeth spacing, snoring, speech and general health as your child grows. A difficult latch is not always due to tongue tie, though it’s something important to consider.

Here are some more resources for information and one mother’s tale.

www.unicef.org.uk/BabyFriendly/Parents/Problems/Tongue-Tie/

www.kiddsteeth.com/

References:

Academy of Breast Feeding Medicine: Clinical Protocol #11: Guidelines for the Evaluation & management of Neonatal Ankyloglossia

Alison Hazelbaker, PhD   (2010) Tongue-Tie: Morphogenesis, Impact, Assesment and Treatment.
Aidan and Eva Press

Catherine Watson Genna, IBCLC (2013)  Supporting Sucking Skills in Breastfeeding Infants
Jones and Bartlett Learning LLC

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There’s an abundance of breastfeeding advice on the Internet. Unfortunately it’s mingled with Myth-information. Your most effective guidance will come from experienced, real people: a lactation consultant, a content breastfeeding mom or even better, a group of nursing mothers! You’ll soon spot the ‘myth-information’ and it’s discouraging affects.
Check out this video from the Surgeon General of the United States. It addresses some common myths.

Myths are usually based on one molecule of real information, and then expanded to, frankly, market a product. Here’s a ridiculous example: A test that claims it can determine your supply. That’s a myth.  ( I just learned it’s been pulled off the market. Phew!)
There’s nothing in breast milk itself that will define your supply. The fact is milk is milk, exquisitely balanced for your baby’s needs. The more you feed (express or pump), the more you will make. Growing babies need to feed often and that’s normal.
When a mom worries she can’t make enough, she may supplement with formula. Her baby fills up on that, then nurses less and her supply will definitely dwindle. It’s a self-fulfilling prophecy that benefits the company selling the products. See how that works? (Or doesn’t work as the case may be).
Here are a few more to clarify.
Myth: You have to tough it out for the first few weeks.

Fact: A slight tugging (not pinching) for a few seconds is normal. A tingly sensation as the milk lets down is normal. Especially if you’ve had a baby already, cramping in your uterus is normal.Those are all good signs your body is working. Pain that makes you wince, tighten your shoulders and dread nursing means something needs to be corrected.

Myth: You’ll be stuck at home.

Fact: Once breastfeeding is a comfortable habit, you can nurse anywhere, anytime. In fact, there are laws that provide protection and support for you to nurse in public places and at work.

Positive, practical guidance from people who understand breastfeeding will help you learn better.
When myth-information causes doubt and confusion, remember this. Nature plans for success and you, as a healthy mother, are an important part of that success.  That’s a fact.

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Giving your child only human breast milk is exclusive breastfeeding, even for mothers who pump and feed breast milk another way. Exclusively means wholly, completely, entirely, fully. These are good words to describe the value of human breast milk.

Exclusively also means high class, restricted in use, appearing in one place, excluding other things. None of that describes breastfeeding very well. High class? Women of any social status, education or religion can breastfeed. What’s important is your health. We’re all human mothers designed to provide for our human babies.

Are there restrictions to breastfeeding’s use? All babies benefit from human breast milk. In fact, some Neonatal Intensive Care Units use only human breast milk for premature and sick babies. Breast milk is important for eye development, brain growth and is especially protective against necrotizing enterocolitis (NEC). As your baby grows into toddlerhood, nursing continues to confer health benefits for you and your child.

Breastfeeding eventually becomes a normal habit for you and that doesn’t exclude other things. You can work, travel, play sports, go out and vote, continue with school. You can breastfeed anywhere. In Massachusetts, it’s legal to breastfeed in public places. (You can wear nursing clothes that are stylish so you can breastfeed discreetly) and there are guidelines to help your employer provide a lactation place.

Breastfeeding is a normal function of our role as mothers. It’s as normal as holding hands, kissing, putting on a band-aid, and changing diapers. Deciding to breastfeed, and for how long, has enduring ramifications for your baby, your body, your family and your planet. Consider how breastfeeding can be a wholly, completely, entirely good habit for your family.

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Breastfeeding in France, the United States or anywhere in the world, is the same subtly nuanced biological balance between mothers and babies. Nature has planned for breastfeeding success. Some laws and policies have, too.

I’ll be meeting with my French IBCLC colleagues at a conference in Paris next week. We’ve started a discussion about breastfeeding support in our respective countries.

Here in Massachusetts, there is a law that supports a woman’s right to nurse in public. I’ve read that nursing in public (a park, a café) is not uncommon for Parisian mothers. I will find out more.

Here in the U.S, federal law requires that employers provide a clean, private place for pumping. Women can not be penalized for taking time to pump (it’s not paid time). There are many resources, through the US Breastfeeding Coalition and the Department of Labor, for employers who aim to support breastfeeding women in the workplace.

All over the world, there’s the Baby Friendly Hospital Initiative. The Ten Steps are simple ways to promote and support breastfeeding in hospitals. (Simple in that they don’t require expensive equipment or construction.)

These are laws and policies that help normalize what is a normal function of Life. I’ve found that focusing on feeding, rather than breast feeding helps the discussion move forward.

• Selma Hayek, while visiting a refugee camp in Africa, nursed a hungry young baby because he was hungry and she had breastmilk. That makes sense.

• A Chinese policewoman, after an earthquake, came upon a distressed, crying infant and nursed the little baby. That makes sense.

Even if you’re not a parent, you’re not breastfeeding, you can understand that.

Policies and attitudes about breastfeeding change from country to country, yet the basic needs of  women and  families are same the world over.  I’m glad to widen my network with those who support those fundamentals.

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Sleep is a primitive need we must fulfill. Parents know that. Why don’t babies and children yield to that need and go to sleep?

One reason, especially for newborns, is that they need to feed often. Feeding includes being picked up, held, cared for by an protective adult. That’s the other reason why babies and children wake up often. They sleep better when your body is protecting them.

Just as our brains are hard wired for sleep, we instinctively know we’re vulnerable during sleep.We stay partly alert to the chance that something will grab us. That’s our brains preoccupation with “Predation Risk”. This is not something you can talk or train yourself (or your baby) out of feeling.

In fact, an adult sleeping in a different environment gets less R.E.M. deep sleep than at home. Being in an unfamiliar setting, you are instinctively more vigilant. Many animals sleep with one eye open. Half their brain rests while the other half is alert. Then they switch sides and the other half rests. Animals can’t afford to be completely unaware of their surroundings.

Because of this predator risk instinct, babies need to feel, smell and hear you close by. “If you are protected and safe, you can afford to …konk out completely.” *. That’s why, as soon as your blissfully sleeping baby is a few inches from your chest, he wakes right up. Skin-to-skin means they’re safe and warm.

It will help to respect this ‘predator risk’. Co-sleeping may work well for some families. A good deal of study has been done on safe sleeping. James McKenna, PhD offers specific guidelines for safe co-sleeping based on his research at the Mother Baby Sleep lab. With this information, you can create a more comfortable sleep situation for your family. The actual predator risk may be minor, though the hard-wired instincts are major.

*From an RadioLab program program on sleep, with Dr. Charles Amlaner, Professor, Department of Ecology and Organismal Biology, at Indiana State.

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You may be able to boost your milk supply with a galactagogue. Galacta comes from the Greek word which means milk. Gogue means to bring forth. A galactagogue is an herb, food or medicine that brings forth your milk.

Some galactagogues work by nourishing the mother’s body, helping her to recover and rebalance in the postpartum period. Some work by promoting hormonal increases that stimulate milk production.

Traditional postpartum foods for promoting milk supply are oats, brown rice (mochi in Japan) and Malungaay (or Moringa) leaves in the Phillipines. These are safe to eat and are sometimes adapted as teas.

Popular galactagogue teas are oatstraw, fenugreek, marshmallow, goat’s rue and red clover. Across the globe, as far back as the 14th century, the affects of herbs and foods have been observed and documented. A good herbalist will be familiar with the specific qualities and medicinal uses for plants. Diane West and Lisa Marasco (authors of Making More Milk ) recommend The PDR for Herbal Medicines. 

The two main pharmaceuticals for milk production are Reglan and Domperidone. A good resource for information about medications is Thomas Hale, PhD’s  Infant Risk Center.

Whenever you consult with an herbalist, IBCLC or medical doctor, let them know of any medicinal substances you are taking. Herbs and medicines have an effect on the body and sometimes do not combine well, even with certain foods. For example, if you are taking Domperidone, you should not consume grapefruit.  There is some caution about taking fenugreek and coumarin (a blood thinning medication).

A low milk supply could be due to many reasons, either with the mother or the baby. There are health conditions that can affect a mother’s ability to make milk. If your baby is not nursing very much, that will affect your supply. Then again, feeling you have less milk may be a normal adaptation in your body. You can review what’s a normal and healthy weight gain for your baby.

It’s best to review the whole picture. Rather than worry about your milk supply, talk with an IBCLC for help with this puzzle.

* The PDR for Herbal Medicine,edited by Joerg Gruenwald, Thomas Brendler and Christof Jaenicke. Thomson Healthcare.

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Before your newborn arrives, before you return to work, look around and see where you can get breastfeeding support. Then you’ll know where it is when you need it. There are phone lines for breastfeeding advice, weekly or monthly group meetings and classes. What’s the most helpful method of support?

A review published in May 2012 examined the ways moms learn and get support for breastfeeding. They found that person-to-person support, face to face, is the most helpful method. That makes sense. You can ask a question directly, see a subtle change in position or posture.

The review further examined what makes breastfeeding support most effective. Again, it’s common sense. Breastfeeding support is most effective when:

• a mother already knows where she can get help

• it’s easy to get to (better yet, she doesn’t have to travel)

• she can meet the same person(s) more than once.

This study showed that with convenient, consistent support, mothers will exclusively breastfeed and for longer duration. That will yield the most benefits for mothers, babies and the family’s overall well being. This is exactly the purpose of home visits. I’m glad this review confirms that.

Money spent on a home visit is a long-term investment. It’s less expensive than a several months of formula, there’s less trash (an added cost) and it enhances both the mother and the baby’s health. Your insurance company may reimburse you for these visits.

Home visits with an IBCLC would be a great employee benefit. For the price of one employee, the whole family is helped. Their stress is reduced and important issues are addressed early. Babies are healthier, so parents have fewer sick days and doctor visits.

Common sense and this recent review confirm home visits with an IBCLC offer helpful and effective breastfeeding support.

Thank you to Michelle Stolow (www.frombirth.com) for the photo of her during a home visit.

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