By Jacque Ordner BSN, RN, IBCLC, RLC 

One of the biggest concerns and struggles of parenting young children is SLEEP!  Sleep deprived parents of newborns and infants have undoubtedly been asked, “Is she sleeping through the night yet?”  Many of us have received advice from well-meaning friends and family regarding how much our babies “should” be sleeping and how to get them to do so.  But what does research tell us?  What is developmentally normal for babies?  What about the countless methods and internet-based courses focused on getting babies to sleep? Read on for some important truths about newborn and infant sleep. 

First things first, it is completely normal for your breastfed newborn to wake and eat every few hours around the clock.  Babies’ stomachs are small, and they need to feed frequently in order to consume adequate calories and nutrition.  For most breast milk fed babies, this translates to 8-12 feedings in 24 hours. It’s true that most newborns spend 15-18 hours sleeping each day, but that sleep comes in small chunks spread across 24 hours.  Frequent waking is also a protective mechanism that is designed to reduce the risk of SIDS! Check this link out for additional info https://www.ncbi.nlm.nih.gov/pubmed/9346985 .   

Scheduling or restricting feeds can be dangerous! Any sleep training method, sleep course, sleep product, or sleep coach that that advises limiting feeds, scheduling feeds, or only feeding during certain “windows” for babies is NOT BREASTFEEDING FRIENDLY despite any claims to the contrary. Babies should be breastfed on demand rather than on a schedule or within specific windows. Our IBCLCs are aware of several cases where scheduling and restricting feeds has led to poor infant weight gain and significant milk supply issues. Feeding on demand is the best way to ensure your baby is getting enough milk and to encourage your own milk production. In fact, studies show that babies can take as much as 20% of their nutrition requirements during nighttime feeds.  

It is a myth that babies regularly sleep through the night at just a few months old.  In fact, most babies do not sleep through the night until closer to age one or beyond! Sleep is a developmental skill.  Babies cannot learn to fall asleep on their own until they are developmentally ready to do so, and they aren’t all ready at the same age. It’s important to let go of unrealistic expectations regarding sleep.  Though unicorn babies, who sleep all night at 4 weeks old, do exist, they are the exception, not the norm.  

We can encourage healthy sleep behavior in our babies. Though sleep is developmental, we can still create an environment that fosters healthy habits related to sleep.  Babies are often tired, but need help falling asleep. Learning your baby’s sleep cues is a first step to helping him get off to dreamland before becoming overtired and cranky.  Common sleep cues include rubbing the eyes, yawning, drooping eyelids, redness around the eyes, smiling less, vocalizing less, exhibiting a weaker than normal suck, and turning away from toys or people. Picking up on these cues and responding in a way that helps our babies go to sleep is key!  Experts also tell us that encouraging adequate daytime naps positively contributes to more consistent night–time sleep. Breastfeeding to sleep is normal, and absolutely ok!  Your baby sees you and breastfeeding as their greatest source of comfort and safety, so it is only natural that they would desire that comfort and safety when trying to fall asleep.  Many breastfeeding mothers follow the Safe Sleep Seven to help their babies feel safe and secure all night long. Your child will eventually be developmentally ready to learn to fall asleep all on their own even if they need your help right now.  As your baby gets older, you can start to transition to more independent sleep behavior slowly.   

Will cutting out nighttime breastfeeds help my toddler sleep? It’s important to note that babies often require night–time feedings well beyond the newborn stage.  It’s also important to note that cutting out night-time breastfeeds for older babies and toddlers needs to be approached on a very individual basis with special consideration to the child’s overall intake.  It is not uncommon for older babies and toddlers to reduce night-time feedings if their daytime caloric intake simultaneously increases.  Many parents find that night-time weaning is often easier when their child is closer to 18 months of age because they are capable of communicating and understanding the negotiation surrounding the weaning process. There is evidence that reducing night-time feeds contributes to less night-time waking for toddlers.  Keep in mind that hunger is not the only reason that babies and toddlers wake at night!  When made to feel safe, secure, and comforted older babies and toddlers can learn to get themselves back to sleep without parental intervention.  

Infant sleep problems are a common concern among parents, but knowing what is normal can help put your mind at ease! 

Our team of International Board Certified Lactation Consultants is happy to discuss newborn, infant, and toddler sleep as it relates to breastfeeding and pumping.  Click here to schedule a consultation.  

Sources: 

Burnham, M., Goodlin-Jones, B., Gaylor, E., & Anders, T. (2002, September). Nighttime sleep-wake patterns and self-soothing from birth to one year of age: A longitudinal intervention study. Retrieved May 18, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1201415/ 

 McKenna, J., & McDade, T. (2005, June). Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Retrieved May 18, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/15911459 

 Kent, J., Mitoulas, L., Cregan, M., Ramsay, D., Doherty, D., & Hartmann, P. (2006, March). Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Retrieved May 18, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/16510619 

 Middlemiss, W., Granger, D., Goldberg, W., & Nathans, L. (2012, April). Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Retrieved May 18, 2020, from https://www.ncbi.nlm.nih.gov/pubmed/21945361 

By Melissa Portunato MPH, IBCLC, RLC

Finding time for self care as a new mom can be hard enough. Throw in a global pandemic and life can get pretty intense. While the majority of the country continues to remain with stay at home orders, stress levels are at an all time high for everyone. Maybe the end of your maternity leave now means transitioning to working virtually or maybe you have found yourself home with older siblings and your new baby since most daycares have closed their doors. Self care doesn’t need to be fancy or always involve a spa or nail salon but we know those things can definitely be a sweet treat! Stress from the pandemic and everything else that comes along with being a new mom can start to get taxing mentally, physically and spiritually. If you’re not feeling well, truth is no one at home will. Let’s start with being mindful and kind to our perfectly created bodies. You just birthed a baby and with that a new mother was born too. Let’s nurture her and treat her right. 

Read on for 3 tips to practice Self Care while Social Distancing:

Get More Zzzzzzz

Sleep? Yes please! The lack of sleep that comes along with having a newborn can be the biggest life transition. No matter if you’re a first time mom or if it’s your 5th baby, you’re never really prepared for the lack of sleep you’re going to experience. Frankly, you will never sleep the same again. Good news is eventually it will get better, but how can you get more sleep during the newborn phase? Here’s how! Research shows moms who bring baby to their beds to nurse get more sleep. Co sleeping can be safe when proper guidelines are followed. And if you are exclusively pumping it’s still important to keep your baby close! The AAP recommends keeping your baby in the same room with you at least until 1 year. You’re able to respond faster to your baby, allowing you both to peacefully nod back into dreamland.

Get Moving 

With most public parks remaining closed, more moms are finding a neighborhood walk soothing and relaxing. A breath of fresh air can do wonders for your mood and boost your immune system. Vitamin D, which we mainly get from the sun, is critical in keeping your immune system up and running to help fight off viruses. How much Vitamin D should you be intaking? For nursing moms, the recommendation is to intake 6400 IUs per day in order to have adequate supplementation for both mommy and baby.  Is it impossible to get outside? Try a quick 7 minute workout like these with the 7 minute workouts (app). Quick easy to follow workouts and even some yoga poses you can incorporate. Namaste! 

Kick The Sugar 

We’ve piled our pandemic emergency stash with all the essential items cookies, cakes, and chips! But why does everything non perishable seem to always have to be unhealthy? Not true! Some easy non perishables to add to your daily diet that help with sugar cravings are nut butters like almond and cashew, dried fruit or trail mix, coconut flakes or cocoa bits can curb hunger and keep you fuller longer. Add in healthy fats like olive oil and avocados too! Breastfeeding moms gotta eat! You’re burning between 300-500 calories just by making milk. Limit sugar to have more energy to keep up with all the new normals going on. Make sure that you are compensating for those extra calories with real food. 

The life of a new mom revolves around breastfeeding, diaper changes, rinsing and repeating. It’s pretty easy to forget about yourself. But it’s especially important now, more than ever to practice healthy self care habits. Social distancing doesn’t mean social isolation mamas. Be sure to connect with your family and friends during this time. Schedule a virtual happy hour with friends, have family drive by to see the baby through the window, or even host a celebration parade to welcome your new bundle of joy. Always remember your doctor is only a call away. Don’t isolate yourself and confide in a trusted professional. Schedule a virtual consultation with one of our IBCLCs and we can help talk it over. We’re for you mamas and we support you!

By Jacquelyn Ordner BSN, RN, IBCLC, RLC

I had met my breastfeeding goals with three out of my four children, with the fourth still nursing once or twice a day.  Number four was about 2.5 years old and had decided he only needed “milkies” at naptime and bedtime.  I was comfortable with this, and we were moving through this transition happily.  But, when my husband and I decided we were going to adopt, my thoughts around weaning began to change. What if my next child needs my milk too?

As we completed the international adoption application process and began the home study process, we really began to think about the little person who would be joining our family.  We had told the agency that we’re open to parenting a child with significant medical needs. Our child could need a myriad of medical interventions, and I immediately began thinking that I needed to store breastmilk to help support him or her.  I’m an RN and IBCLC, so that’s just how my mind works. I KNOW that just 15 ounces of breastmilk can provide up to:

29% of a toddler’s energy requirements

43% of their protein requirements

36% of their calcium requirements

76% of their folate requirements

75% of their vitamin A requirements

94% of their vitamin B12 requirements

And 60% of their vitamin C requirements (Dewey 2001).

Breastmilk does not suddenly become non-nutritious or suddenly lose its bioactive and immune boosting components at a certain age! So, in the waiting and through the mountains and mountains of paperwork, I could be working toward making more milk to save for our fifth child! 

I began with the basics…..pumping! In an effort to store every ounce, I gently encouraged our current youngest to cut back to nursing just once a day.  This was easy at first, and he didn’t even seem to mind me pumping. I was double pumping with the Spectra S2 just 3-4 times a day to start. Let me tell you, this wasn’t very encouraging!  I was only yielding a total of 1-1.5 oz per DAY! That’s when I hit the first major setback….my toddler became jealous of my pump! He cried when he saw me pumping and asked for “milkies” multiple times per day.  I felt so conflicted at this point because my natural instinct was to scoop him up and provide that loving comfort as we had done thousands of times before. However, I also knew my goal was to collect and store as much milk as possible before we brought kiddo #5 home.  Knowing that an effectively nursing baby (or toddler in my case) was far more efficient at stimulating milk production than my pump, I allowed him to nurse up to three times per day while I continued to pump 3-4 times per day. 

We were hitting our stride, and my pumping output was SLOWLY increasing, when we had another setback.  My work schedule changed, and this put stress on the whole family. My little guy had to start a new daycare during at this time as well.  So, I took a break from pumping for a couple of weeks. I could kick myself for this now, but I can’t go back to change it. That two week break set me all the way back to the beginning. Still, once we found our new rhythm, I was determined to get my production up.  I began faithfully pumping 5-6 times per day and VERY SLOWLY started to see an increase! Over the course of 4 weeks, my pumping output went from 1-1.5 oz per day to 3 oz per day in addition to the milk I was providing to my nursing toddler. Though my output is small, I’m confident that I can continue to increase my supply with dedicated pumping. Re-lactation takes time!   If you are considering starting the re-lactation process, there are a few things to keep in mind:

•  Milk supply is easier to influence in the first 4-6 weeks postpartum.
• The amount of time and pumping needed to re-lactate depends on many factors such as how long you were nursing or pumping before stopping, how long it has been since you stopped nursing or pumping, and how much milk you were producing at the time you stopped.
• Pumping alone can be an effective way to stimulate re-lactation.  The use of galactagogues should only be done so with the help of a knowledgeable practitioner.
• An effectively nursing baby is the MOST efficient way to stimulate milk production.  If your baby will latch, this is very helpful to the re-lactation process. The use of an at-breast-supplementer can be significantly helpful as well.
• The knowledge and expertise of an International Board Certified Lactation Consultant, who has experience with re-lactation, can be extremely beneficial for a mother who is pursuing this goal!

Dewey KG. Nutrition, Growth, and Complementary Feeding of the Breastfed Infant. Pediatric Clinics of North American. February 2001;48(1).

By: Mirine Richey, MPH, IBCLC

The Flu and Coronavirus:

Can your milk or pump be at risk?

You can’t avoid the stories and worries of influenza (flu) and now COVID-19 (coronavirus). If you are pregnant or providing milk for a baby, the worry can be even worse! Let’s take a brief look at both of these respiratory viruses since there is so much media attention and look at what you can do to protect yourself, your baby and your milk, especially while traveling or exposed to crowds of people.

Flu: the flu is a respiratory virus that is spread through coughing, sneezing, and droplets of saliva. Flu can live on surfaces, including plastic, but not for more than about a day or two.  Flu can be killed on surfaces by using common household disinfectant wipes and cleaners, and by wiping surfaces thoroughly including breast pumps. 

Hand washing, avoiding crowds and getting a flu shot are recommended. For pregnant women, if you get a flu shot in your last trimester, it can protect your baby for the first several months after baby is born. Breastfeeding can help your baby develop a strong immune system. 

Coronavirus or COVID-19:   This is a novel virus meaning it is new to humans and we do not have any immune-memory to fight it. There is also no treatment or vaccine. We have immune-memory to fight things such as the common cold and that is why we get over that in a few days with little complication.  Person-to-person spread is thought to occur mainly by respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (flu) and other respiratory illnesses spread. In limited studies on women with COVID-19 and another coronavirus infection, Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk and is not thought to transmit to the baby this way.

What can parents do to avoid spreading these viruses to the infant?

Precautions, including washing hands before touching the infant and wearing a face mask, if mom has symptoms. Mom wears the mask, not the baby.

If expressing breast milk with a pump, the mother should wash her hands before touching any pump or bottle parts and follow strict guidelines for keeping the pump clean after each use. This includes wiping the outside of the pump with a disinfectant wipe as both of these viruses can live on plastic for a day or two. This is especially important for a mom who travels with her pump or uses her pump in a public place. Although most cases of flu and coronavirus are not spread by touching surfaces, taking these extra precautions can lower your risk of having a virus on the outside of your pump, then touching it and touching your eyes, nose, mouth or baby’s eyes, nose or mouth. 

If you have fever or respiratory symptoms and do not have a face mask,  consider having someone who’ll feed the expressed breast milk to the infant.

Preparation tips, for community illnesses and other disasters:

• Find out what the sitter or center’s policy is on illness, fever, disinfecting.
• Make a plan for care if your center has a temporary closing.
• Make a plan with your employer to find out if you can work from home, and what that would look like. 
• If you do not have a job that has remote flexibility, find out what the policy is at your work in the event that public health authorities recommend staying home. 
• Always keep a supply on hand for baby extras, and if you are pumping keep extra pump parts on hand.

For more information and the latest updates visit:

https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidance-breastfeeding.html

Video tip on sterilizing breast pump parts

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By Jacquelyn Ordner BSN, RN, IBCLC, RLC

The fact is that most moms over 35 have healthy babies and normal pregnancies.  There are increased risks for mothers experiencing pregnancy after age 35, but the risks are still relatively low.  The increased risk of pregnancy complications correlates to potential increased difficulty in breastfeeding as well.  So, what should you know before considering pregnancy after 35? We’ve got the details!

For the first time in history, the birthrate of babies born to mothers in their 30’s has eclipsed the birthrate of babies born to mothers in their 20’s.  For this reason, it is important to know the risks associated with what is technically called a “geriatric pregnancy”. Another medical term, used to identify mothers over age 35, is “advanced maternal age”.  Ouch! Though these terms may not feel very flattering, it is important to understand what they mean. 

Why 35?  There is no magic transition that happens the day a woman turns 35, but many risks begin to increase rapidly by a woman’s mid-thirties. 

Fertility – By age 30, a woman’s ability to get pregnant begins to decline and does so   more rapidly as she approaches her mid-thirties and beyond.  In fact, the odds of getting pregnant naturally at age 45 are less than 4%. Why does a woman’s fertility decrease as she gets older? This happens because women are born with a certain number of eggs.   The amount of eggs she has decreases, and eggs remaining into the mid-thirties and    beyond are more likely to have abnormal chromosomes. As a woman ages, her risk of fertility affecting disorders, like uterine fibroids and endometriosis, also increases.

Complications – The risks of preeclampsia, gestational diabetes, and placenta previa all increase for older mothers as well.  The increased incidence of these complications largely contributes to the increased risk of cesarean delivery. It is important to know  that the risks of stillbirth and miscarriage are also increased for pregnant women over   35. The risk of miscarriage is about 15% at age 35, 20% at age 40, and 40% at age 45. Miscarriage occurs in every 1 out 1,000 births in women under 30 and increases to 1.4 out of every 1,000 births for mothers ages 25-39. The rate increases to 2 out of every 1,000 births at age 40. *It is especially important to understand that maternal pre- pregnancy health is a huge factor in the development of pregnancy complications. Mothers are encouraged to ensure any existing health conditions are well controlled, that they are at a healthy weight, and that they are eating a healthy diet BEFORE trying to become pregnant.

Chromosomal Abnormalities/Birth Defects – A chromosomal abnormality occurs when there is any missing, damaged, or extra chromosome. Down Syndrome is the most   commonly occurring chromosomal abnormality for babies born to older mothers. The risk of a mother having a baby with Down Syndrome increases from 1 in every 1,480     births at age 20 to 1 in every 353 births at age 35. Prenatal screening tests are available to assess the risk of baby being born with certain specific disorders or conditions.

What about breastfeeding? Does being over 35 mean moms will have more difficulty nursing or pumping breastmilk for their babies? The available evidence leads us to believe that any increase in breastfeeding difficulty is likely related to the increase in complications experienced by mothers over 35 years of age. Complications such as preeclampsia, gestational diabetes, and the need for cesarean section can delay mom’s milk from coming in by a few hours to as much as a few days. This can set the stage for future breastfeeding difficulties.  Additionally, babies born with certain chromosomal abnormalities or birth defects can have a harder time nursing. This can lead to a delay in mom’s milk coming in, low milk supply, and even mastitis. 

Can I still have an, uncomplicated pregnancy, a healthy baby, and a successful breastfeeding experience after age 35? YES!!!  You absolutely can!  When reviewing the risks associated with advanced maternal age, it’s important to notice that the percentage of increase is small in many categories.  Gaining knowledge and insight before becoming pregnant can be immensely helpful. Also, working with a healthcare team, who is experienced in caring for older mothers, is key! It is essential to contact an International Board Certified Lactation Consultant (IBCLC) for support with any breastfeeding challenges that are not easily managed.  Having the right support can make all the difference!

Sources:

Colombo, L., Crippa, B. L., Consonni, D., Bettinelli, M. E., Agosti, V., Mangino, G., … Mosca, F. (2018). Breastfeeding Determinants in Healthy Term Newborns. Nutrients, 10(48). doi: 10.3390/nu10010048

Women’s Health Care Physicians. (n.d.). Retrieved December 16, 2019, from http://www.acog.org/.