Milk Supply Facts

 

Milk Supply Facts

“Knowledge is gained by learning, trust by doubt, skill by practice, and love by love” Thomas S Sasz

When I read this quote, I found it particularly true for my breastfeeding parents. Something that causes a lot of the complications around breastfeeding is lack of understanding or respect for how breastmilk is produced and maintained. If this knowledge is not known or adhered to, we lose trust in our body’s’ ability to continue to feed our baby once it has been born.

How will my body know to start producing milk and will mine do it?

The transition from pregnancy to lactation is called lactogenesis. During the second half of the pregnancy, alveoli become distended by accumulating colostrum. After 16 weeks of pregnancy, lactation will occur even if the pregnancy is lost. From mid pregnancy to day 2 postpartum is called lactogenesis I. Alveoli cells change into secretory cells and prolactin stimulates mammary secretory epithelial cells to produce milk. So during pregnancy and in the first few days after baby born, milk supply is hormonally driven – endocrine control.

Despite mothers knowing the many benefits of colostrum, when they hear that it is measured in teaspoons and not tens of mls, they often think that can’t be enough for my baby, surely I must top up.

 A newborn with a stomach capacity of around 10 - 20ml translates into a feeding interval of around 1 hour. This is in line with gastric emptying of human milk and neonatal sleep cycles. Larger feeding volumes at longer intervals may therefore be stressful and the cause of spitting up, reflux and hypoglycaemia. So when you feel that all that your baby is doing is feeding, especially on day 2 of life, if you understand that this is the physiological norm, you are less likely to doubt yourself and your milk and can avoid the formula top ups that are offered.

 

Colostrum is low in fat, and high in carbohydrates, proteins and antibodies. Nature’s first vaccine. It is easily digestible, and has a laxative effect on baby helping to pass early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice. Colostrum has an important role to play in baby’s gastrointestinal tract. Newborns intestines are very permeable. Colostrum seals or paints the GI tract mostly preventing foreign objects from penetrating. Small frequent feeds are all your baby needs, and your breasts will begin to produce mature milk increasing in volume as your baby grows. It is often not that our baby is feeding too often and not getting enough in these early days, but more that our expectations of how often baby needs to be fed are misdirected.

During pregnancy the placenta is feeding your baby, at birth the delivery of the placenta results in a rapid drop in progesterone (and possibly oestrogen) in the presence of high prolactin levels. This is what causes the onset of copious amounts of milk, or the unfortunate term of the milk coming in. We are really trying to move away from that terminology as it implies that there was no milk before this, which is untrue. This is where there is switching occuring from endocrine control to autocrine control.

Day 3 to day 8 of lactation is called lactogenesis II. The breasts may become engorged. Initial engorgement or physiological engorgement usually begins around the time of increased milk production. The breasts may become swollen, painful and tender, with redness and shiny skin. The symptoms usually occur bilaterally and are generalised. A slight increase in temperature may be present. Frequent (8-12 times/day) and effective breastfeeding is important to prevent engorgement becoming problematic. (Engorgement later in breastfeeding journey can be manged differently)

After the first week, there is a move towards autocrine control and this stage is called Lactogenesis III or the maintenance phase. Milk removal is the primary control mechanism for supply. SUPPLY = DEMAND. Hormonal levels do play a role but to a lesser extent. Under normal circumstances the breasts will continue to make milk indefinitely as long as milk is being removed. Similarly if the milk is not removed then the body will slow and eventually stop the production. Every time that you give your baby milk that you have not removed from the breasts you are telling them that they do not need to produce milk and that decreases the production.

How this works is from a peptide in breastmilk called feedback inhibitor of lactation or FIL. If milk is not removed, the inhibitor collects and stops the cells from secreting any more, helping to protect the breast from the harmful effects of being too full. If breast milk is removed the inhibitor is also removed, and secretion resumes. If the baby cannot suckle, then milk must be removed by expression.

FIL enables the amount of milk produced to be determined by how much the baby takes, and therefore by how much the baby needs. This mechanism is particularly important for ongoing close regulation after lactation is established. At this stage, prolactin is needed to enable milk secretion to take place, but it does not control the amount of milk produced.

The other factor that can effect milk production is storage capacity. This is the amount of milk that the breast can store between feeds. Storage capacity is not determined by breast size. Storage capacity can also be different between breasts. A mother with a small storage capacity will need to feed the baby more frequently to satisfy the baby appetite and maintain milk supply, as the breasts will become fuller quicker slowing the production.

If you feel that you have a low supply or oversupply, please contact your lactation consultant.

 

Breastfeeding isn’t easy, it takes practice and dedication. BUT nothing that is good for us is easy unfortunately. It would be easier to lie on the couch watching Netflix and ordering Ubereats, BUT we know that it is better to go to the gym, cook a healthy meal and probably read a book. When it comes to breastfeeding, it can be difficult to trust that our bodies are good enough to meet the feeding demands of our baby, especially when we are bombarded with messages that we need formula, schedules, gadgets and apps to bring up our babies. You need to question everything except your instincts. You and your baby are the experts. Spend time with your baby cuddling and feeding on demand, and block out all the outside noise. If you are unsure when your baby needs to nurse, offer your breast. If baby is hungry he will eat. Allow your baby to guide you and all their needs will be met. Ask yourself if your baby is having wet and pooh nappies, chat to your health care provider about how many baby should have in 24hrs, if meeting that then you are golden.

 

Most babies go through several growth spurts or frequency days in the first year of life. During a growth spurt the baby may feed more frequently, often hourly, and behave fussier than usual. The reason for this that there is physical growth as well has developmental milestones. There is an increase in energy output, therefore need for increase in energy input. Growth spurts commonly occur during the first few days at home and around 7-10 days, 2-3 weeks, 4-6 weeks, 3 months, 4 months, 6 months and 9 months (more or less). Babies are individuals and these may vary. Growth spurts usually last 2-3 days, but sometimes last a week or so. Remember that a normal baby can feed between 6 – 18 times in 24hrs.

The best way to cope with the growth spurt is to follow your baby’s lead. Baby will automatically get more milk by nursing more frequently, and your milk supply will increase due to the increased feeding. It is not necessary (or advised) to supplement your baby with formula or expressed milk during a growth spurt. Supplementing (and/or scheduling feeds) interferes with the natural supply and demand of milk production and will prevent your body from getting the message to make more milk during the growth spurt.

 

ü  Contact a certified lactation consultant in your area, if you require assistance then you have a resource.

ü  Understand how milk production works, this goes a long way to trusting that your body can feed your baby.

ü  Pain is not breastfeeding, don’t power through.

ü  Set your breastfeeding goals and surround yourself with cheerleaders that will support you.

ü  Your instincts are there and will guide you, trust them.

 

You Got This!

Healthy Birthing, Your Special Journey

Healthy Birthing, Your Special Journey

Spending time with parents at many stages of their journey, as well as still being on the journey myself, you just gain so much insight into the experience. Often at my baby support group the moms share their birth stories, which I really do encourage as there is so much value in telling your story. I try use these experiences in order to constantly update my pregnancy education courses.

Some of the things that come through are extremely positive, some sad, some very funny and some traumatic.

“That moment of relief, joy, and completeness as I delivered my son will stay with me forever”.

“I felt violated and abused when nurse, then the Dr did internal. No one warned me how painful that would be and how uncomfortable would feel, then the disappointment of no progress”.

“The relief when Dr said I had to have a C-section because the responsibility of choice was removed”.

“The feeling of helplessness in the NICU when I was told that I couldn’t hold my baby”.

“My plan to have my makeup perfect for the birth photos went out the window and this is what we got, LOL”

“There is still that 1 MRI that was a bit abnormal that I keep going back to and keeps me awake at night”.

The goal is to have a birth that is fulfilling, positive, and satisfying. In order to do this parents need to be empowered. Empowerment doesn’t always look and sound the same as we are all unique. Empowerment is where parents make choices without coercion and with supportive caregivers. Education and true informed consent and decision making will make any birth, treatment plan and situation empowering.

The first thing that I teach is that you are the leader of your care. You can ask your health care provider as many questions as it takes to make you feel comfortable, as many times as it is needed. You are not questioning their education, training or experience, you are just making sure that you understand all the variables in order to decide what you need to do and be comfortable that you are making best choice for you and your family. There is no Dr, nurse, or any health care professional that if they are confident in their treatment plan that worries about you asking questions and different options.

This can be scary. I had a mom phone me because her paediatrician said that she should stop breastfeeding for 2 weeks and use formula, then resume breastfeeding. She said that she didn’t believe that was the right thing for her baby, but paediatrician said she must do this. After chatting through the issue, I suggested that she go back to the paediatrician and ask some questions to make her feel more comfortable, as she is also a health care professional e.g. what is the research that this method has proven an effective treatment, what is the mechanism that will make it work, will it affect my milk supply, will baby go back to the breast after the 2 weeks and other questions along this line. She messaged me from the waiting room saying that she had so much anxiety about asking these questions to the Dr, but she did it. Together the mom and paed then came to a treatment plan together that they were both comfortable with. Paed phoned her and thanked her for opportunity to hear all her fears and adjust treatment according. The mom phoned me and said that was one of the most empowering experiences she has had and that she will fight for her kid always.

Start fighting for yourself and your baby from the start by empowering yourself:

·         Start your childbirth education early.

·         Get access to the correct information from qualified professionals that keep up to date.

·         Do your own research.

·         Write down your idea of a positive birth.

·         Write down your fears.

·         Find a childbirth educator that you feel confident with and is high quality.

·         Write down all your questions and make sure that at your prenatal visit they are all answered, don’t get distracted.

·         Before any procedure, intervention or change of plan ask for pro’s, con’s, benefits doing it now vs waiting, and what can expect.

You Got This!

Towel Time Meditation

Towel Time Meditation

I just spent a 10 days on holiday with my kids, sister and a few girlfriends getting some much needed Vitamin Sea. When you are on holiday with friends and family you really get to know them. I was quite shocked how hard it is for some people to switch off and relax. My niece and I were chatting about towel time the one evening. Towel time (sure there are better names) is when you get out of a hot shower or bath, wrap yourself in a towel, then lie on your bed. The exact amount of time spent in towel time is difficult to determine as it is a place where you lose all track of time. It is mindless time of just being, meditating, looking at your phone or watching brainless TV. When the discussion expanded to others in the group, some acknowledged that they also do this, even suggested climbing under the blankets during towel time, while others became distressed with comments like “what if there is a fire and you are not dressed” or “how can you lie there knowing that dishwasher hasn’t been unpacked and lunches for the following day still need to be made”. This is when I realised just how difficult it can be for many people to switch off their brains and just be.

Now probably wondering what this has to do with breastfeeding! During my holiday my baby support group continued their banter over Whatsapp, but being in a different space and thinking about how tricky some find it to chill, I was reminded that so many new parents are so stressed.

Back to work after a glorious 10 days in the sunshine, I decided to try an exercise with my support group, just to see what happened and hopefully help a few.

I asked the moms to write down a quick diary of the past 24hrs. No rules, a piece of paper with no name, and using crayons to write so neatness can’t deter them. Then we sat and did a 7 min relaxation exercise. It is so interesting to observe a group doing an exercise like this. Some completely embrace the experience, a few appear to feel observed and can’t quite completely give into the experience, some have a time limit in that 7 min was just too long, and 1 or 2 just couldn’t even attempt it. I implored them to look at their day and see where they had 10 min and try any form of meditation as it could really make a difference.

Another observation I stumbled across while tidying up the papers was the diaries, majority of the moms wrote down what the baby’s did the previous 24hrs and not what they had done. The only reference to their days was how they had fed baby, played and put baby to sleep. This seems to speak so loudly to the notion that new moms put very little value in what they are doing and feeling.

How can meditation help new parents?

Meditation is a practice that helps to calm and quiet the mind. There are many types, but the purpose of each is to train you to become aware of your thoughts and feelings and let go of mental clutter. Many articles actually say that meditation was designed for parents. The benefits of meditation can touch many areas of your life, helping you decrease stress and anxiety, better manage your emotions, let go of mental distractions, and be more present and attentive with your kids.

 

Research shows us that even 5-10 min a day can make a huge difference in your life. Some even say that 5 deep meaningful breaths can help. Three types of meditation include guided meditation (lead by a series of vocal prompts); mantra meditation (mental or verbal repetition of a phrase or affirmation); and relaxation (imagining each area of your body relaxing).

Where can I find something?

There are a number of places that you can go to find ways to help you start meditating, from articles, videos, websites, and apps to retreats and seminars on the topic. The Calm app has recently won a number of awards in this area. The team at www.easybaby.co.za  has put together a mindful section in our free course that you can download and use to get you started on this journey.

Taking 10 min in your busy day to heal your mind, try some towel time, could be life changing.

You Got This

References

1.       https://www.todaysparent.com/family/family-health/meditation-for-moms/

2.       www.headspace.com 10 reasons parents should meditate. Andy Puddicombe

 

Oral Restriction – What is it, Does my baby have it?

Oral Restriction – What is it?, Does my baby have it?

What are Oral restrictions?

A frenulum is a small fold of tissue that secures or restricts the motion of a mobile organ in the body. They are present in the oral cavity (mouth), digestive tract and male and female genitalia. There are 3 common types of oral restrictions that we see, tongue ties (ankyloglossia), lip tie and buccal ties.

Tongue tie by definition is the embryological remnant of tissue in the midline between the under surface of the tongue and the floor of the mouth that restricts movement of the tongue. (IATP). If there is a tongue tie, the frenulum can be made up largely of collagen which stretches very little max 3%, compared to normal frenulum which is normally made up from mucous membrane. Lip tie which is less common is attachment of the upper lip to the gum tissue. Buccal ties are the least well known and most uncommon.  These are tethers extending from the cheeks to the gums.

What should the tongue be able to do?

When the baby’s mouth is open it should be able to elevate the tongue and maintain this elevation, move the tongue side to side (lateralise the tongue), cup and spread the tongue.

How does the baby suck the milk?

Baby opens mouth wide, the lips create a seal to help create a vacuum. The tongue then curls around and cups the breast creating a seal. The baby then lifts and drops the tongue to create a vacuum to remove the milk from the breast. The tongue also grooves to help control the bolus of milk. Cheeks, jaw and facial muscles help stabilise the breast and facilitate the tongue to  drop and draw out the milk. The palate plays an important role creating the vacuum, also closing off the nasopharynx for swallowing.  Can see that if there are restrictions or problems with any of these areas, it can affect how effectively the baby is able to remove the milk from the breast and effect breastfeeding relationship.

Symptoms of the baby

The baby symptoms can be varied amongst babies but can be irritability or colic, coughing, choking and gulping during feeds, tired and falling asleep at the breast most feeds, difficulty latching, gassy or having excessive wind, sliding off breast and continuing to have to relatch, gumming, chewing and clamping down on the breast, clicking noises or poor suction noses, poor weight gain or weight loss, and reflux. These symptoms can be masked at times if the mother has an oversupply of breastmilk or if the baby is being topped up with expressed breast milk or artificial milk.

Mothers symptoms

The mothers symptoms are as important as the baby symptoms and must be assessed. These can be cracked, blister, bleeding and painful nipples. Nipples look pinched, creased, bruised, or abrasions on the nipples after the feed. White stripe on the end of the nipple. Discomfort or pain while breastfeeding. Low milk supply. Plugged ducts or mastitis. Thrush. General frustration with feeding and dreading the baby waking up and not wanting to breastfeed. Many of these symptoms have a variety of causes which is why important that they are thoroughly assessed by a certified lactation consultant.

How are oral restrictions treated?

A simple surgical procedure called a frenotomy can be done with or without anesthesia in the hospital nursery or doctor's office. The doctor examines the lingual frenulum and then uses sterile scissors or, if trained can use a laser, to snip the frenulum free. The procedure is quick and discomfort is minimal since there are few nerve endings or blood vessels in the lingual frenulum. Babies generally don’t like being held down or restrained which can cause some agitation. If any bleeding occurs, it's likely to be only a drop or two of blood. After the procedure, a baby can breast-feed immediately. Complications of frenotomy are rare — but could include bleeding or infection, or damage to the tongue or salivary glands, usually when done by untrained practitioner. It's also possible for the frenulum to reattach to the base of the tongue.

The upper lip tie is a little different, as the upper lip frenulum has extensive blood supply and many pain receptors. This procedure needs to be done under anesthesia. It is suggested that the tongue tie be addressed first, once tongue position and function is corrected, the upper lip frenulum can be reassessed and treated only if upper lip is being prevented from being everted. A wait and see approach is valid for upper lip frenulums.

While deciding on treatment

It is important that while deciding on treatment you feed the baby.

·         Work with your lactation consultant to find ways to get that baby to latch and drink as effectively as possible using various techniques such as nipple flipple and laid back positions.

·          Protect your milk supply. If baby is not adequately removing the milk, discuss with your lactation consultant ways to increase and maintain your supply through expression or other methods to keep the milk flowing adequately.

·         Treat other issues in the meantime. If the mother has developed cracked painful nipples, or thrush, make sure work with lactation consultant and health care provider to treat these issues so when you have made your decision you are starting from the best possible place.

·         Educate yourself on the short and long term consequences of treating or not treating the oral restriction. This is the best way to make an informed, evidence based decision. Ultimately it is the parent’s decision whether or not to treat or wait and see.

Aftercare

If you have decided to do the frenotomy, it is important that you

·         Breastfeed immediately. After feed the practitioner will check that bleeding has stopped.

·         Functional exercises to improve mobility and suck strength must be taught and done. This baby may have been sucking incorrectly from birth so important that teach baby how to suck correctly.

·         Pain relief is rarely needed but paracetamol can be given if necessary.

·         Contact your health care provider if bleeding reoccurs.

Take Home

If you are having feeding concerns and suspect that might be oral restriction. Contact a qualified lactation consultant in your area. Important that full feeding assessment done, including maternal  and infant history, examination and feeding observation. Importantly Protect your Supply.

Samantha Crompton RN RM Psych & Comm. SACLC lactation consultant

Developing Your and Baby's Routine

Developing your and baby's Routine

“I feel that one of the most important discoveries in the field of paediatrics is that the newborn baby is a human being.” John Lind 1979

On arriving to do a consult with clients, usually the first words that are said even before a greeting is an apology around the state of their house, which usually is 100% better than what I left behind on any given day. I start chatting to the mom, taking a history. She then will take out her phone and show me her baby’s exact movements how often it has fed, how many nappies and what is due next. When I ask what baby does to show signs of these events, the answer is not in the app or does not magically appear in the notebook. These devices and aids are what have replaced our village. The structure of our society is that we no longer have support. A parent is tasked with so much to do, and with the expectation of needing to do all these tasks with perfection. In the past, you breastfeed a baby on demand, slept with said baby, likely carried baby around with you for a while, had older children play with younger (or family) as they aged, they took on responsibilities and learned by watching, you had help from other women to get what needs to get done. Now we are isolated from this and it feels like we are thrown into it alone.

We know that a baby has basic needs that aren’t too complicated, food, sleep, play and love. The challenge comes in of knowing what your baby requires and when. As adults, we cope with our busy lives by creating a routine of when and how things are done. This helps us cope with the more challenging parts of the day because we don’t need to think about the routine things. So, this sounds like a great way to deal with the baby. There are countless books, articles, apps and podcasts that recommend various ways to get your baby into the perfect routine. The problem is that I see so many parents battling with sleep schedules, feeding schedules, stimulation schedules and so on, all with conflicting messages, that they get so overwhelmed and anxious that it brings them to breaking point.

So now we are at a place that we wanting a routine, but can’t seem to get baby to actually comply. Back to our mother that has all the information well documented but no solution. Lets journey back to the first hour that baby arrived. Starting the ground work for our routine here.

As your baby is born place your baby skin to skin on mothers chest, allow baby to follow the 9 instinctive stages. A baby in the right place on mother’s chest will need no help to find the breast and start drinking. From there allow mom and baby to have first sleep, while dad quietly observes his new family. This is the very beginning of learning your baby’s routine. For the following 6 – 12 weeks, keep your baby on a parent’s chest for as much time as possible. This can be done skin to skin, or in a wrap that allows you to be hands free. This is not spoiling a baby, but it is keeping this baby in a place that it feels safe, warm and has easy access to source of food whenever it is required. By doing this you are removing the baby need to be in survival mode. When a baby is away from a caregiver ie in a cot or in a separate room, they are not aware that they are safely being guarded by the latest monitor on the market, they feel vulnerable, they go into survival mode, keeping themselves safe from predators and other lurking dangers. This can give a false sense of what their needs really are.

Baby in Kangaroo Mother Care is having all basic needs met, this allows us constant observation of our baby in the perfect environment. We can start to take notice how they look, sound and move when they are hungry, windy, overstimulated and sleepy. This way we can respond to these needs quickly and efficiently. We then start to notice that as the baby gets older, patterns start to emerge around when these needs occur. This means that we can start predicting when baby will want to eat, and sleep etc. Slowly we can start creating our own routines around these events, tweaking them as we go. This also allows for the human factor, on certain days baby may be hungrier than others, maybe has a bit headache wanting some extra fluids through the night so battling to sleep, or growing and teething, and maybe starting with a little flu. We can also start to see our baby’s personality shining through, early signs of their love language.

If we think about trying to get this baby into a preset routine, that we think would work, based on what would work really well with our current routine. I use a business change management strategy that is applied successfully in many businesses. As a manager implementing a new protocol, if you arrive in the office Monday morning, announce the new way of working and shut you’re your office door and tell everyone to get on with it, the chances of your new protocol working is very slim. If your staff have had input and participated in developing the new protocol with your guidance, the level of buy in and potential for success is much greater.

So what if we apply this principal to our babies. If we base our routine on observed input from the baby, with a little compromise here and there from both of us, surely there will be better buy in and less frustration from both parties? I know you are frustrated by this article as a check box step by step approach is what you feel would be easier, remember that a newborn baby is just a little human being. If you don’t know what to do, think, I am a human being, what would I like in this situation.

Samantha Crompton RN RM SACLC

The Baby Lady

Hyperemesis Gravidarum – The pregnancy Voms

Hyperemesis Gravidarum – The pregnancy Voms

“Aah Phoebes, you have that wonderful pregnancy glow. Glow … that is sweat! You throw all morning and see how you glow” – F.R.I.E.N.D.S

That unmistakable wave of nausea is commonly one of the earliest signs of pregnancy. It can be bitter sweet, as no one really likes to feel nauseous, but when pregnancy is your goal, it is really exciting. 70 -90% of women experience nausea and some vomiting in the first trimester. The cause of nausea in pregnancy is not completely understood, but does appear to be linked to the production of Human Chorionic Gonadotropin (HCG) hormone. Nausea usually starts at around 4-8 weeks and subsides around 12-14 weeks.

For around 5% and up to 20% of these women, this will continue throughout the pregnancy. Hyperemesis Gravidarum (HG) is the most severe form of nausea and vomiting in pregnancy, associated with ketosis, weightloss, dehydration, electrolyte and acid imbalances, and nutritional deficiencies. Severe cases may need hospitalisation. Women that are more likely to develop HG: developed symptoms in previous pregnancies; have menstrual migraines; develop similar symptoms taking oestrogen (birth control); experience motion sickness; and have GI problems such as ulcers or reflux.

Your obstetrician or midwife will usually start by trying natural nausea prevention methods such as Vitamin B6 and Ginger, eating smaller frequent meals, and dry food such as crackers. Drinking plenty of fluids to stay hydrated. Now, pregnant moms that I have given this advice to move from sarcastic, to nuclear, and then often to defeated. I asked some of my mom’s to tell me about their experience:

I have been pregnant twice and in both my pregnancies I have suffered terribly from nausea and vomiting. It started around 8 weeks and continued throughout the pregnancy. With my first I lost 10kg, and with the second it was 7kg. I felt nauseous all the time and certain smells and foods would set me running to the toilet. Nothing worked, I tried everything. My doctor even put me on medication but to no avail. I was open to all advice, I would have tried anything to stop it. Donna Matthews

Severe cases may require hospitalization. Pregnant women who are unable to keep fluids or food down due to constant nausea or vomiting will need to get them intravenously. Medication is necessary when vomiting is a threat to the mother or child. Majority of mothers try avoid medications at all costs during pregnancy, so usually if a pregnant mom is asking for medication, she really is desperate.

I was very excited when I found out I was pregnant with my first daughter, sadly that excitement was very soon replaced with nausea and vomiting which lasted all day. It started at about the same time that I began to suspect that I was pregnant and worsened as my pregnancy advanced.  I told my Gynae at time that I was suffering from severe morning sickness and could barely keep any food down. I was given Asic tablets and told to eat small meals regularly, this did not help one bit. The gynae would not give me anything stronger as she was unsure of what effect it may have on the baby. I was unable to go into any shop which stocked meat of any form as the smell made me vomit and I regularly had to leave a trolley full of groceries and run. My husband and I turned vegetarian for almost 6 months because I could not cook any meat.  My work was compromised, some days I only managed to get to work around midmorning and many days I had to call in sick. I vomited for a full 39 weeks and was totally exhausted and despondent by the time my C-section date arrived.  I suffered from exhaustion and postpartum depression for a long time after my daughter was born and I think a lot of it could be linked back to the hyperemesis. It took us 6 years to work up the courage to go through all of that again despite people telling me that the next time might be different. When I found out I was pregnant with my second daughter I made the Dr redo the blood test 3 times just to be sure as I was slightly nauseous, but not vomiting, however by week 7 the vomiting had set in again. When I was 10 weeks pregnant I was hospitalised for 4 days because I could not keep anything down and was becoming dehydrated. When I was discharged my Gynae prescribed Zofur which reduced the vomiting to mornings only, however the nausea remained. We finally got the vomiting under control around the 20^th week of my pregnancy, even though the nausea was never controlled and I struggled to eat many things. I felt a lot better and had far more energy going into the birth the second time around and am coping much better in the weeks following the birth. I had many people giving me advice about what worked to reduce their morning sickness, including ginger suckers, teas and small meals. None of this advice was helpful as none of it worked and I got progressively more frustrated and despondent. Hyperemesis is debilitating and frustrating and I don’t think that women who truly suffer from it are taken seriously, I mostly felt like a hypochondriac when I told people how terrible I was feeling. I will definitely not be having any more children as I cannot go through those months of vomiting again. Meagan Mansell

Medications that are commonly used:

Antihistamines such as Diphenhydramine or Meclizine, these commonly cause drowsiness.

Other anti-nausea medications such as promethazine and metoclopramide are available for use. Zofran (Ondansetron) is commonly used to help with HG. Zofran blocks the actions of chemicals in the body that can trigger nausea and vomiting.

The way that medications are used can improve efficacy.

-          Changing medications abruptly and frequently is counterproductive

-          Scheduled dosing improves response, rather than taking when needed.

-          Wean slowly after a few weeks of stability and adequate nutritional intake

-          Medication may be needed until delivery

Complementary treatments can be used such as acupuncture, acupressure, and hypnosis. These have been helpful for certain women.

Many of the moms worry how the HG will affect the baby. Although the pregnancy may be long and tedious, nausea and vomiting of pregnancy is typically not associated with adverse pregnancy outcomes in the absence of severe malnutrition or weight gain <7kg. There is strong evidence that women with nausea and vomiting in early pregnancy have a lower rate of miscarriage than women without these symptoms. Larger follow-up studies are needed to determine whether HG has long-term effects on offspring.

There are others that have HG and they are usually your best resource, even if it is just to know that you will survive it.

 

www.HelpHER.org

info@HelpHER.org

facebook.com/HERFoundation

twitter.com/HGmoms

I Don't Have Enough Milk

“I Don’t Have Enough Milk”

By Samantha Crompton BNURS SACLC

New mothers are often overwhelmed with the insecurity that they will not be a good mother, that they will not do everything right. Over the years our confidence in the ability of our bodies to grow, birth and nourish our babies has been stripped from us. I often hear mothers say that they don’t have enough milk, and I always try and find out why they are saying this.

“The first milk is not enough, I need to top up until my milk comes in”, the milk coming in is an unfortunate term as it implies that there was no milk to begin with which is untrue. Despite mothers knowing the many benefits of colostrum, when they hear that it is measured in teaspoons and not tens of mls, they often think that can’t be enough for my baby, surely I must top up.

 A newborn with a stomach capacity of around 20ml translates into a feeding interval of around 1 hour. This is in line with gastric emptying of human milk and neonatal sleep cycles. Larger feeding volumes at longer intervals may therefore be stressful and the cause of spitting up, reflux and hypoglycaemia. (Bergman 2013)

 

Colostrum is low in fat, and high in carbohydrates, proteins and antibodies. Natures first vaccine. It is easily digestable, and has a laxative effect on baby helping to pass early stools, which aids in the excretion of excess bilirubin and helps prevent jaundice. Colostrum has an important role to play in babies gastrointestinal tract. A newborns intestines are very permeable. Colostrum seals or paints the GI tract mostly preventing foreign objects from penetrating. Small frequent feeds are all your baby needs, and your breasts will begin to produce mature milk increasing in volume as your baby grows. It is often not that our baby is feeding too often and not getting enough in these early days, but more that our expectations of how often baby needs to be fed are misdirected.

“My baby feeds all the time, my milk must be low or not strong enough”

Firstly it is good to know that frequent nursing is normal and expected in the early months. Most newborns need to nurse 8-12 times a day. It is needed to reduce engorgement in early days, nourish growing baby with a small stomach capacity but needs to double weight by 5-6 months, and to establish a good milk supply.

 SUPPLY = DEMAND. (Every formula bottle decreases demand therefore supply leads to vicious cycle).

Nursing is not only about nutrition, safety & security are basic needs. They just need mom, lots of kangaroo care in the first 6 weeks.

Managing expectations, it helps when the parents understand growth spurts or frequency days. I usually get the crying phone call at 2 weeks old. This is good baby suddenly turned on you and the lack of sleep caught up. Nature designed these frequency days to increase our milk supply to keep up with the growing demands of our baby. Your baby can feed every hour for 2-3 days and then usually returns to normal feeding patterns. They are difficult but if you are prepared for it mentally and physically. Adjusting expectations is the best way to cope. Once you consider frequent nursing in this time to be the norm and not a problem it will make life easier. Prioritise your to do list – List things that have to be done in the week and list things that can wait.

“When I pump, I am only getting ..ml’s”

Pumping is a good way to see how much milk you can pump. A baby that breastfeeds well can get much more milk out than you could ever pump. How much milk you can pump out depends on many factors. It is not unusual to have to pump 2-3 sessions to get enough milk for 1 feed. Pumped milk while breastfeeding full time is extra milk. It is normal for output to vary from session to session and day to day. Other things to consider:

-          Are you using the appropriate pump for the stage of nursing and the amount of pumping that you are doing. It is extremely difficult to pump colostrum with an electric pump. In early days hand expression is much better than any pump on the market. If you are pumping for a full day away, you may need a double electric pump to keep up.

-          Is the flange on the pump the correct size. Sometimes switching to a larger flange or getting the correct sizing makes all the difference.

-          How old is your pump?

There is also the lost art of Hand Expression. It is extremely important to  learn how to hand express. No need for electricity or batteries, hands are always with you. A number of my mom’s that battle to express using pumps get much better results when using hand expression or manual pumps.

How do I know that I really have a low supply?

As moms we tend to stress ourselves more than we need to. We obsess about knowing how much milk baby is getting. Let baby tell you how much milk he is getting.

-          The number of wet nappies your baby produces.

-          Weight gain problems such as a flat or dipping growth trajectory.

-          Consult with qualified SACLC or IBCLC lactation consultant

There are many factors that can cause a low supply, but it is not all doom and gloom, and the answer is not always come in a tin or a pill / supplement. We need to find the cause of your low supply and address the problem. Discuss these technicalities with a skilled lactation consultant and together you can find the right solution for you.

Samantha Crompton

BNURS RN RM community psych

South African Certified Lactation Consultant

Certified Preggi Bellies Instructor