Breastfeeding in public can come with a variety of concerns for mothers. Some include:
Do I have the right to nurse in public?
How do I ( Do I have to ) keep myself covered?
What will people say or think?
All nursing mothers should know that it is perfectly normal to feed her baby wherever they may be. Many states are now developing laws to ensure that mother and baby are protected from any harrassment as a result of public nursing.
There are many things you can do as a nursing mother to manage public breastfeeding. However, before you tackle these suggestions, you must first be comfortable with the idea of nursing in public. Breastfeeding will not go smoothly in private or public if mom and / or baby is not comfortable and relaxed.
Tips for Nursing in Public
1. Purchase a Nursing Cover – There are a variety of nursing covers designed to help mothers nurse discretely in public. They can be used in the park, on the subway, in restaurants, etc.
2. Nurse at ‘Baby Friendly’ Stores – While your out running errands or shopping, inquire about stores that offer ‘baby care stations’. These stores have nice, private locations where you can nurse and change your baby.
3. Use Dressing Rooms – Many stores allow mothers to use dressing rooms to nurse their babies. This allows you to be more comfortable and relaxed for breastfeeding.
4. Purchase Nursing Tops – Nursing tops make it easier for a mother to put baby to the breast with ease and with less chance of exposing their breasts.
5. Try a sling! – Nursing your baby in a sling is a great way to nurse without anyone knowing what’s going on. You can also breastfeed and do others things at the same time!
Using Galactogues to Increase Milk Production
Galactogues are substances that are used to stimulate the milk supply in nursing mothers. Galactogues can help mothers that need to increase their milk supply. They include both pharmaceutical and herbal preparations that have been more widely used for many years in different cultures.
Pharmaceutical Preparations:
If you are having difficulty with milk supply, your health care provider can prescribe one of the following medications that are safe to the new born child:
Metoclopramide (Reglan)
The suggested dose for metoclopramide is 10mg to be taken three times a day for 5 days and then tapered off. Metoclopramide has a quick onset of action but has the potential for exacerbating depression. It should therefore be avoided in mothers who suffer from postpartum depression.
Domperidone
While domperidone has a slower onset of action, it maintains a better milk supply than metoclopramide and is safe to use while nursing preterm infants. Domperidone is not FDA approved in the US but can be formulated by a compounding pharmacist.
Herbal Galactogues:
Mother’s Milk Tea
Mother’s milk tea is a blend of fenugreek, fennel, nettle and blessed thistle in different combinations, depending upon where you purchase it.
Fenugreek tea is an extremely effective galactogue and is widely used in many cultures. It can however and cause uterine contractions and nursing mothers that are expecting another baby should not use fenugreek tea due to the risk of miscarriage. It should also be used with caution in diabetics since it can cause hypoglycemia. Mothers should not take more than 2-4 capsules up to three times per day.
Fennel Seed increases milk production, stimulates the let down reflex and also eases colic in the nursing infant. Fennel seeds can be prepared into a tea that is taken up to three times per day.
Blessed thistle is useful in keeping the digestive tract clean and improving milk supply. Like fenugreek seeds it should not be used by nursing mothers that are expecting another baby.
Other herbal galactogues include:
Brewer’s yeast – It comes in the form of tablets that are best taken in juice. The recommended dose is 3-5 tablets up to 3 times per day.
Anise – It also increases milk production while relieving gas in the newborn child like fennel seeds.
While herbal products are natural and relatively safe, it is important to check with your health care provider before using such remedies since they could have side effects for you and / or your baby. Lactation consultants are well trained in this field and can provide a lot of assistance in helping to increase your milk supply.
For More information, see The Academy of Breastfeeding Medicine.
At some point in time, mothers may become separated from their nursing babies. When this happens mothers must express their milk to continue to offer the best nutrition for their infant, maintain their milk supply, and to prevent and/or relieve engorgement. Other times, mothers may need to express and dispose of their milk when prescribed certain medications.
If one is only separated from their infant for a short while or is engorged manual expression by massaging and gently squeezing your breast in a downward motion may be all you need. While manual expression may be the most cost-effective method of milk expression, it is not always the easiest to master. A manual pump may be your next best option.
For mothers who will be separated from their baby often,or need to pump more frequently may benefit from other breastpumps. For frequent or long-term pumping –such as returning to work– a good quality double electric breast pump is a must-have. It is very important that mothers follow the manufacturer’s instructions very carefully before beginning their first pumping session. Although most pumping kits do not have to be pre-washed before use, you should wash all parts after each use according to manufacturer’s instructions.
Breast milk can be pumped directly into sterile milk storage bags, glass or plastic bottles for storing. Avoid waste by collecting milk in small amounts (2-4 oz per container) and be sure to label each bag or bottle with the baby’s name and date the milk was expressed. When preparing to offer your baby stored milk, be sure to use the oldest milk first. See the chart below for recommended storage guidelines.
|
|
Room Temp |
Refrigerated |
Freezer |
Deep Freezer |
|
Freshly Pumped |
Up to 8 hours (covered) |
Up to 7 days |
Up to 3 mos |
6-12 mos |
|
Previously Frozen |
Use immediately |
Use within 24 hours |
Do not refreeze |
Do not refreeze |
When stored, breast milk naturally separates (the fat rises to the top) and can have a blue or yellowish hue. To thaw, place in a bowl of warm water, hold under a faucet of warm running water, or let the milk defrost in the refrigerator. Microwaving breast milk is not recommended because high temperatures mitigate the anti-infective properties, kills some of the nutrients and can heat unevenly. Also, once your baby has eaten from a bottle, discard the remaining milk. Similarly, if breast milk is stored beyond the suggested guidelines it should be thrown away.
By Emily Lovely
Unfortunately for some moms returning to work is necessary and many new mommies go back after only a short maternity leave, often just six weeks. Returning to work can present challenges for breastfeeding, but with the right planning, equipment and support any mother can successfully work and breastfeed.
If at all possible, delay your return to work until breastfeeding is fully established, typically after 4-6 weeks. By 6 weeks your milk supply should be established. A well established milk supply will increase your chances of successfully continuing to breastfeed.
Purchase or rent a breast pump and start using it to store breast milk at least three weeks before your scheduled return. There is a wide selection of breast pumps but for frequent, long-term pumping the best option is a good quality double electric breast pump. You may also want to stock up on extra storage bottles or sterile bags, a proper storage container for transporting breast milk and breast pads to prevent embarrassing leaks. Start your pumping sessions immediately following early morning feedings and try to pump at least three times per day.
You want to introduce your baby to the bottle before returning to work. This should be done at an earliest of 4 weeks of life and at the latest of 2 weeks before returning to work. You want to wait until your milk supply is established; keeping in mind the longer you wait the more likely your baby may refuse the bottle nipple.
Select a bottle and nipple designed to mimic the breast for easy alternating between bottle and breastfeeding,then have another caregiver, such as daddy, offer the bottle when your baby is ready to feed. Replicating the experience of breastfeeding –such as paced bottle feeding will also ease the transition of breast to bottle. Express milk any time your baby receives a bottle to keep your milk supply and prevent engorgement.
Select a daycare or caregiver for your baby that is supportive of breastfeeding. Notify them of your dedication to nursing and make certain they are familiar with proper storage and handling techniques for breast milk, such as using breast milk with 24 hours if left at room temperature.
Also, during your pregnancy alert your employer that you will be breastfeeding and request a location to pump and solution for storing your breast milk when you return to work. Some companies provide a lactation room for mothers to pump in private. If a refrigerator is not available, breast milk can be stored on ice for up to 10 hours.
Once you have returned to work, try to express milk every 3-4 hours. Try to pump at least 10-15 minutes per session, pumping both breasts at once. Some mothers find looking at photographs of their baby stimulates their milk, passes the time and makes them feel connected with their child.
If pumping at work is not feasible, partial breastfeeding is an option, meaning you supplement with formula. Any formula your baby eats may reduce your milk supply but working mothers may find a combination of breastfeeding and formula feeding is best for them.
What to Expect During the First Trimester of Pregnancy
Your first trimester of pregnancy is the time of your last menstrual period (LMP) to 13 weeks. Following a missed menstrual period, expectant mothers may experience nausea / vomiting, fatigue, breast and nipple tenderness, mood changes, frequent urination, bloating and constipation.
Nausea / Vomiting (‘Morning Sickness)
Morning sickness is one of the first symptoms of pregnancy. It can begin before a woman even knows she is pregnant! It can occur any time of the day and some women experience even in the second and third trimesters.
Management of morning sickness include: eating small, frequent meals and avoiding foods and smells that trigger nausea. Your healthcare practitioner can prescribe certain medications if the morning sickness is unbearable. Preggie Pops or Pop Drops are commercially available products commonly used to manage nausea. Some women also find relief by drinking ginger tea.
Constipation
Constipation is very common in pregnancy. However, it can be prevented with proper hydration, adding fiber to your diet, and daily exercise. Sometimes, your healthcare professional may need to prescribe medication to help you with this problem. It is not recommended that you take something over the counter until you speak with your provider first!
As soon as you suspect that you might be pregnant, visit your health care provider who can advise you further and will perform any necessary tests to ensure the start of a healthy pregnancy. At this point, your health care provider can confirm your pregnancy using blood tests and determine your estimated due date. Typically a range of blood and urine tests are performed as well as a pap smear if you haven’t had one recently. You will be prescribed prenatal vitamins and possibly other vitamin supplements (i.e. iron, folic acid) to ensure the healthy development of the fetus.
During the first trimester, expect to make monthly prenatal visits to ensure the well being of your unborn baby.
This is also a good time to start finding out about prenatal classes in your area. Your health care provider should have more information on this.
During your first trimester it is healthy to gain between 6 to 11 pounds of weight, depending upon the size of your baby. Speak to your health care provider about any changes you might need to make to your diet to ensure healthy weight gain.
Mild to moderate exercise is considered acceptable in a normal healthy pregnancy. It is strongly recommended to speak with your healthcare professional before starting any new exercise regimens. Through a google search you may be able to find exercise classes specifically targeted to expectant mothers (i.e. prenatal yoga).
Most women will experience a normal healthy pregnancy. However, there are warning signs all expectant mothers should be aware of and notify their healthcare professional if they are experiencing any of these signs. The most common complication of the first trimester is miscarriage.
Signs of a miscarriage are as follows: vaginal bleeding, back pain, cramping.
The fetus is rapidly developing at every point of the first trimester. Do not hesitate to ask questions if there is anything you are unsure about. It is important to give you baby the best start!
Engorgement
Definition
Engorgement is the swelling of breasts caused by increased blood flow and milk supply to the breasts. It occurs when the milk isn’t being emptied from the breast efficiently. For example, engorgement can also occur if you miss several feeding sessions and the milk is not expressed.
Signs and symptoms
Engorged breasts are typically full and become heavy. They are hard and tender to touch and the skin may appear shiny. The areola is also hardened and the nipples may become flattened making latching on difficult.
If engorgement is not correctly managed, the milk ducts can become blocked causing redness and warmth in that area of the breast. This can further lead to a breast infection and the mother may experience flu like symptoms. Inefficient emptying of the breast can also cause a reduction in milk supply.
Remedies to treat Engorgement
Since the nipples are usually flattened and the areola area very tight, the infant is not usually able to latch onto engorged breasts. This can be frustrating for both the mother and a hungry child. If the engorgement is preventing the baby from latching on or you are unable to nurse your child for any reason, you can express the milk in the breasts to relieve engorgement. You can express the milk by hand or with a breast pump. You want to express the milk for a few minutes until your breasts feel comfortable and the baby can latch. Any expressed milk can be stored and used for future feedings.
Ensure that you are using a good quality pump when expressing your milk. Cheaper pumps can cause bruising to engorged breasts and restrict further nursing.
To soften the breast, gently massage the breast starting from the chest wall towards the nipple area gently. Applying moist heat to the breasts, by taking a hot shower or bath before breast feeding also helps soften the breast tissue and allows better milk flow.
Use cold compresses in between feeding to prevent swelling. Mothers can also use Tylenol to relieve pain as well as Motrin to relieve swelling.
Cabbage leaf compresses have been used for hundreds of years by mothers to relieve engorgement. While their effectiveness is not backed by scientific research, some women might find these useful in reducing the swelling and cooling the breasts. Try not to use cabbage leaves too frequently, they may inadvertently cause a reduction in milk supply.
Another home remedy used by many women is fenugreek seed. These are steeped in a cup of water and then crushed. The mashed seeds are placed in a warm cloth and used as a plaster on engorged breasts.
How to Prevent Engorgement
Engorgement during lactation can be prevented by nursing no more than 3 hours apart. If you baby does not wake up for night feeds, you may still have to wake up after 3 hours and nurse or pump. Similarly, if you child is unable to latch on, make sure you express the milk that is in the breasts to prevent engorgement.
Learn the proper latching techniques and various feeding positions. With time you will find suitable positions that are comfortable for you and your baby. Always allow the baby to finish on one breast before offering the other side. You might find it useful to remove the baby and re-latch in between feeding.
While nursing, always wear supportive well-fitting nursing bras that are not too tight around the breasts.
If you are continuing to have problems relieving engorgement contact your healthcare provider and seek the help of a lactation consultant.
Diet and Pregnancy
As an expectant mother, you will need to make some changes to your regular diet to ensure that your baby is getting all the nutrients he/ she requires as well and the correct amount of calories for his/her normal growth.
While the general notion during pregnancy is that you are “eating for two”, you realistically only need to increase your caloric intake by about 100 calories in the first trimester and 300 calories in the second and third trimesters.
Eat plenty of starches especially whole grain breads, pasta and brown rice. Ensure that you are getting as much fiber as possible in your diet as this will help to avoid constipation during pregnancy. Aim for 5 servings of fruits and vegetables throughout the day. These will provide essential vitamins and minerals as well as fiber.
Proteins are an essential part of the pregnancy diet and you should opt for protein sources that also contain high amounts of iron such as lean meats. While fish and seafood are high in proteins, you should limit your intake to no more that 12oz per week. Fish such as swordfish, mackerel and tilefish contain mercury that can cause birth defects in the unborn child. All meats should be thoroughly cooked before consumption to ensure that all bacteria have been killed. Avoid pates and liver that contains high amounts of Vitamin A.
While you should include dairy foods that are a good source of calcium, there are some dairy products that may be harmful for the baby. These include some cheeses such as Blue cheese, Camembert, Brie as well as unpasteurized milk.
Alcohol consumption during pregnancy can cause learning disabilities and physical deformities in the child. Alcohol and smoking is not recommended during pregnancy.
Java junkies are advised to avoid coffee and other caffeine containing products. Caffeine can cause miscarriage, low birth weight and even stillbirth. Tea and coffee also make it harder for our bodies to absorb iron, an essential mineral required during pregnancy. Substitute your coffee with herbal teas that are safe in pregnancy including citrus peel, ginger, lemon balm, orange peel and rose hip teas. Avoid chamomile tea.
Prenatal Vitamins are specially formulated to provide the necessary vitamins during pregnancy and are an important part of your prenatal care. Ensure that you are getting at least 400mcg of folic acid daily in your supplement at least during the first trimester of pregnancy. Ideally you should begin folic acid supplementation about 3 months before conception. Folic acid is found in green leafy vegetables. However, due to the importance of folic acid in preventing neural tube defects especially during the first trimester, it is essential to take a folic acid supplement daily.
Expectant mothers typically require 30mg of iron during the second and third trimester; iron is found in red meat, pulses, bread, green vegetables and fortified breakfast cereals. Since the unborn baby obtains all his/her calcium form the mothers stores, you will also need to ensure that your are getting between 1000-1300 mg of calcium and 200 IU of Vitamin D in your diet or through a dietary supplement.
Remember that too much of a good thing can be bad. While you need a good prenatal vitamin, mega doses of supplements such as Vitamin A can be harmful to your child. Speak to your healthcare provider about the correct supplement for you.
Make sure you are getting plenty of fluids throughout the pregnancy. It is important to stay well hydrated.
Most of all, savor what you eat and enjoy your pregnancy!
Emily Lovely
The American Academy of Pediatrics recommends breastfeeding for at least a year, and The World Health Organization advocates two years. The facts are clear: breastfeeding is best for both you and your baby. Breast milk evolves with your baby to provide perfect nutrition and has numerous benefits, including reducing the risk of SIDS (Sudden Infant Death Syndrome), boosting baby’s immune system and possibly raising IQ, intimate bonding, faster return to your pre-baby weight and lowering your risk for cancer. Not to mention the money and time saved!
While breastfeeding may seem like a no-brainer, it can take dedication to master. Most hospitals offer breastfeeding classes and have lactation consultants (a.k.a. breastfeeding gurus) on staff to help novice nursers. You may also want to stock up on items that boost your breastfeeding efforts, such as a nursing bra, nursing support pillow, breastfeeding cover, nursing tops, breast pads and a good quality breast pump. To get the best start, try breastfeeding within an hour of delivery (or if you have a c-section, as soon as you’re united with your baby). If circumstances prevent you from meeting your bundle of joy for longer, start expressing milk using a breast pump to stimulate your milk production. The first few weeks are key to establishing your milk supply so it’s important to nurse and nurse as often as baby desires (typically every 1-3 hours).
During the initial days of breastfeeding the first milk your body makes is called colostrum – a thick yellowish substance packed with nutrients and antibodies ideal for your newborn’s first meals. Within 3-5days your body will begin producing mature milk that increases in volume and is thinner and white.
The key to effective breastfeeding is making sure your baby is latched correctly to the breast. If she isn’t latched on properly you will end up with sore nipples and a frustrated baby. There are four main positions for nursing: cradle, cross-cradle, clutch (football hold), and lying down. In the begininning it may be easier for you to use cross cradle or clutch, but it’s best to experiment until you discover the most comfortable position for you.
Signs of a good latch include: hearing rhythmic swallowing, baby’s lips are flanged (like a fish), baby’s nose and chin are touching your breast. Also, your nipple should be nice and round once baby is no longer latched. If your nipple appears pinched, baby was not on correctly. Let your infant eat as long as he wants on one breast (typically about 15 minutes for a newborn) and then offer the other side if you desire. If your baby is satiated don’t push him to eat more, just alternate which breast you start with.
Many new moms worry their babies aren’t getting enough to eat, but if your infant is eating every 1-3 hours, is satisfied after feedings, and voiding and stooling adequately, you’re doing just fine! If any of these isn’t happening, speak to your pediatrician and/or local lactation consultant.
You don’t need to follow a strict diet while breastfeeding, but it’s helpful to stay well hydrated and limit caffeine and alcohol, which may be inadvertently shared through your milk or hinder your milk supply. And if your baby is gassy, you may want to pass on the gas-causing foods (such as pizza, cabbage, broccoli or beans) to see if that helps.
While some mothers experience sore nipples and engorgement in the first weeks, breastfeeding should not be painful or distressing. Although there are many products on the market that help alleviate nipple / breast pain, expressing colostrum and rubbing it on your cracked nipples is much more effective. If you have difficulty or suffer discomfort seek advice from your doctor or a lactation consultant. There are many organizations dedicated to breastfeeding that can help you find local resources for assistance and support. La Leche League, The International Lactation Consultant Association, Ameda and Medela are good places to start. And whether you breastfeed for three months or three years, you are doing what’s best for your baby… and you!
© 2009 Your Pregnancy and Beyond. P.O. Box 8925, Elkridge, MD 21075. 443-445-2029. info@yourpregnancyandbeyond.com
